What is Diabetes Mellitus?
Diabetes mellitus is a chronic disease of absolute or relative insulin deficiency or resistance. It's characterized by disturbances in carbohydrate, protein, and fat metabolism. Insulin transports glucose into the cells for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage in the adipose tissues. Insulin deficiency compromises the body tissues' access to essential nutrients for fuel and storage.
Diabetes mellitus occurs in two primary forms: type 1, characterized by absolute insufficiency, and the more prevalent type II, characterized by insulin resistance with varying degrees of insulin secretory defects.
Onset of type I usually occurs before age 30, although it may occur at any age; the patient usually is thin and requires exogenous insulin and dietary management to achieve control. Type II usually occurs in obese adults after age 40, although it's commonly seen in North American youths. It's often treated with diet and exercise, in combination with antidiabetic drugs; treatment may include insulin therapy.
Diabetes mellitus is thought to affect about 8% of the population of the United States (16 million people); about half are undiagnosed. Incidence is higher in males than in females and increases with age.
Causes of Diabetes Mellitus
The effects of diabetes mellitus result from insulin deficiency. Insulin transports glucose into the cell for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage. Insulin deficiency compromises the body tissues' access to essential nutrients for fuel and storage.
The etiology of both type I and type II diabetes remains unknown. Genetic factors may play a part in the development of all types. Autoimmune disease and viral infections may be risk factors in type I.
Other risk factors include:
Signs & Symptoms of Diabetes Mellitus
The Signs and symptoms of type 1 diabetes.
However, a person with type 2 diabetes may experience symptoms listed below, which tend to appear slowly over time:
In nonpregnant adults, diabetes mellitus is diagnosed when they present with:
Two of the above tests are required for diagnosis; they can be the same two tests or any combination and may be separated by more than 24 hours.
An ophthalmologic examination may show diabetic retinopathy.
Other diagnostic and monitoring tests include urinalysis for acetone and blood testing for glycosylated hemoglobin, which reflects glucose control over the past 2 to 3 months.
For patients with type I diabetes, treatment includes insulin replacement, diet, and exercise. Current forms of insulin-replacement include single-dose, mixeddose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may include use of an insulin pump.
Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultralente), or a combination of rapid-acting and intermediate-acting (70/30 or 5O/50 of NPH and Regular) mixed together.
Insulin Lispro may be used in place of Regular insulin. It's rapid in onset (15 minutes) and waiting to eat after injection isn't necessary. It has a short duration of action (4 hours), which decreases between-meal and nocturnal hypoglycemia.
Pancreas transplantation is available and requires chronic immunosuppression.
Patients with type 2 diabetes may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates.
A patient with either type of diabetes requires a diet that is planned to meet nutritional needs, control blood glucose levels, and reach and maintain appropriate body weight.
For the obese patient with type II diabetes, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently, with meals eaten at regular times.
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