Diabetes: Definition, Symptoms, and Treatment

Diabetes Mellitus

Definition | Symptoms | Treatment | Clinic Information

Definition
Diabetes mellitus is a chronic disease involving abnormalities in the body's ability to use sugar. Diabetes is characterized by:

Elevated blood sugars for months to years.
Both hereditary and environmental factors leading to its development and progression.
A relative or absolute deficiency of effective circulating insulin. Insulin is a substance made by the pancreas which lowers blood sugar in conjunction with meals. Diabetes is characterized by either: (1) an inability of the pancreas to produce insulin (type 1 or insulin-dependent diabetes mellitus) or an inability of insulin to exert its normal physiological actions (type 2 or non-insulin dependent diabetes).
Often recognized in patients and their families by excessive urination, thirst, weight loss and/or a lack of energy. But diabetes is often silent and may exist for many years without the individual's noticing it.
Effects certain "target tissues," that is, tissues which are vulnerable to the damaging effects of chronically high blood sugar levels. These target tissues are the eye, the kidney, the nerves and the large blood vessels, such as in the heart.

Diabetes in the U.S.

The Bad News About Diabetes
Currently 2.6% of the U.S. population, or 5.5 million Americans, are known to have diabetes mellitus; however, the disease remains undiagnosed in about the same number, i.e., another 5.5 million Americans have the disease but are unaware of it or will develop the disease during their lifetime. Over 600,000 new cases of diabetes are diagnosed each year.

Officially, 34,000 deaths each year are attributed to diabetes, placing diabetes as the sixth leading cause of death in the U.S. But, in actuality, approximately 320,000 individuals with diabetes die each year, and diabetes is a significant contributing factor in a large number of these deaths. Seventy-six percent of individuals with diabetes die from vascular disease (cardiovascular disease, stroke).

Diabetes is the leading cause of new cases of adult blindness in the U.S. Approximately 5000 individuals with diabetes become blind each year.

Diabetes is the leading cause of kidney failure requiring dialysis in the U.S.

Other than accidents, diabetes is the leading cause of amputations of legs or feet in the U.S. Fifty percent of all amputations in the U.S. are performed on individuals with diabetes.

Heart attacks are 2.5 times more likely in individuals with diabetes. Strokes are 5 times more common.

Diabetes complicates pregnancy: congenital anomalies are twice as prevalent in babies born to diabetic mothers.

The Good News About Diabetes
There is now tremendous hope for people with diabetes.

The Diabetes Control and Complications Trial (DCCT) has proved conclusively that "Diabetic Control Matters." That is, long-term treatment of diabetes during which the blood sugar is kept at near-normal levels can have a major impact in preventing or delaying the eye, kidney and nerve problems associated with long-standing diabetes mellitus.

There is now a whole array of different new methods and medicines involved treating diabetes (both insulin-dependent and non-insulin dependent) which are aimed at maximizing control.

Symptoms

Excessive urination
Thirst
Weight loss
Lack of energy

Note that diabetes is often silent and may exist for many years without the individual's noticing it. If diabetes runs in your family or you otherwise suspect you may have diabetes, be sure to get regular blood tests for diabetes.

Treatment
Type 1 (Insulin-Dependent Diabetes Mellitus)
Type 1 diabetes is treated with intensive insulin therapy. This type of treatment is designed to achieve near-normal blood sugars safely - while keeping the episodes of low blood sugars ("insulin reactions") to a minimum. Insulin therapy includes:

Multiple Daily Injections of Insulin (Flexibility is important!).
Use of Insulin Pens or Pumps.
Use of new type of insulin: Lispro or Humalog (extremely fast-acting) - replaces regular insulin.

Type 2 (Non-Insulin-Dependent Diabetes Mellitus)
The treatment used in treating type 2 diabetes will be based on the physiological defects experienced by the patient. The three most common problem areas are: the pancreas, the liver and the muscle.

Pancreas: Abnormal response to meals.
Liver: Abnormal sugar production.
Muscle: Abnormal lack of sensitivity to insulin.

Frequent monitoring of blood sugars is critical to the proper treatment of diabetes.

Blood glucose monitoring: for type 1 diabetes or type 2 diabetes on insulin, at least 2-3 times daily: for type 2 diabetes on pills, 4-7 times weekly.

Hemoglobin A1C or Glycosylated Hemoglobin: measurements of long-term control (3 months' worth). For type 1, every 3-4 months; for type 2 every 6 months.

Diabetes patients should avoid hypoglycemia.

Worrying about hypoglycemia is normal. Hypoglycemia does NOT, however, have to be an insurmountable obstacle to achieving tight control.

Most of the time, nobody (especially the patient!) is to blame. The sensing of lower blood sugars changes with intensive control.

For Successful Treatment, The Emphasis Is On You!

Remember that diabetes control doesn't mean being controlled by diabetes. Current insulin schedules are designed to increase flexibility and allow patients to live busy, productive lives with diabetes.

Diabetes Medications
Sulfonylureas: Glyburide (Micronase, Diabeta) and Glipizide (Glucotrol). Traditional medicines - cheap, easy to take, work well with many people. Stimulates insulin secretion from the pancreas. Problems: Doesn't always achieve normal blood sugars and may cause low blood sugars. Metformin (Glucophage): Used in Europe for many years. Decreases sugar production by the liver, which contributes to elevated blood sugar levels. Works well with insulin. Problems: Causes gastro-intestinal upset in some, and cannot be used if you have serious heart or kidney problems.

Troglitazone (Rezulin)*: New agent, an "insulin sensitizer." Increases the body's sensitivity to insulin. Works well with insulin. Problems: Very expensive, can cause liver enzyme abnormalities which necessitates frequent blood tests. *Note that the FDA recalled Rezulin in March 2000. Anyone still taking this medication should contact their prescribing physican as soon as possible.

Acarbose (Precose): New agent which works in a unique manner by blocking the breakdown and absorption of carbohydrates by the gut. Works OK with insulin. Problems: Causes gastro-intestinal upset and gas.

For more information about patient services at the U-M Kellogg Eye Center call (734) 763-1415.