Diabetes mellitus

Not to be confused with Diabetes insipidus.

Diabetes mellitus
Classification and external resources
Insulin is made in beta cells in the pancreas. Problems with insulin causes diabetes.
ICD-10	E10.–E14.
ICD-9	250
MedlinePlus	001214
eMedicine	med/546 emerg/134
MeSH	C18.452.394.750

Diabetes is a medical condition that results when there is not enough of the insulin hormone in a person's blood, or when the person's body cannot properly use the insulin it produces (insulin resistance). People with diabetes mellitus are called diabetics.

There is another disease with a similar name called diabetes insipidus. However, they are not related. When people say "diabetes", they usually mean diabetes mellitus.

Diabetes entered the top 10 causes of death in 2019, following a significant percentage increase of 70% since 2000. Diabetes is also responsible for the largest rise in male deaths among the top 10, with an 80% increase since 2000.

Background

Diabetes involves problems with insulin, a hormone made by the pancreas. Hormones are chemicals in the body that send messages between cells. Insulin is one of several hormones that control the glucose level in a person's blood.

When you eat, the pancreas makes insulin to send a message to other cells in the body. This insulin tells the cells to take up glucose from the blood. The glucose is used by cells for energy. Extra glucose that is not needed right away is stored in some cells as glycogen. When you are not eating, cells break down the stored glycogen into glucose to use as energy.

Glucose is not the regular "table sugar" that is available in stores and supermarkets. Table sugar is sucrose, and it is very different from glucose. Glucose is a natural carbohydrate that our bodies use as a source of energy. Soft drinks and fruits have high concentrations of glucose.

Types of diabetes

3D medical animation still of type 1 diabetes showing the lower amount of insulin production in a diabetic patient.

Type 1 diabetes mellitus

Type 1 diabetes mellitus happens when a person's own immune system destroys the part of the pancreas that makes insulin. When the pancreas does not make insulin, glucose (sugar) in the blood cannot get into the parts of the body that need sugar to live. In order to live, a person with type 1 diabetes must take insulin for the rest of their life, usually through injections or a pump. They need to check their blood sugar level often, many times each day.

Type 1 diabetes happens most of the time in younger people. It can occur in adults, although this is much less common. About 1 out of every 10 people with diabetes have type 1 diabetes.

Type 2 diabetes mellitus

Type 2 diabetes mellitus is very different from type 1 diabetes. In type 2 diabetes, the person makes insulin. However, either they do not make enough, or the insulin they make does not work properly. When insulin does not work as it should, glucose (sugar) in the blood cannot get into the parts of the body that need sugar.

Gestational diabetes

Gestational diabetes mellitus is like type 2 diabetes. It happens to some women when they are pregnant.

Other types of diabetes

Other types of diabetes include but are not limited to:

• Latent autoimmune diabetes of adults (LADA)
• Maturity onset diabetes of the young (MODY)

Type 2 diabetes happens most often in older people who are overweight.

Symptoms of type 1 diabetes usually appear suddenly. In type 2 diabetes, there may be mild symptoms or no symptoms at all. This makes it much harder to detect.

About 2 % of people have other types of diabetes. These types include monogenic diabetes, cystic fibrosis-related diabetes and diabetes caused by rare syndromes.

Some medications (steroids, antipsychotics) as well as hormonal imbalance can also lead to some types of diabetes.

Symptoms of diabetes

People with diabetes usually experience the following symptoms:

• Frequent urination
• Excessive thirst
• Increased hunger
• Weight loss
• Acetone breath odor (fruity, nail polish remover-like)
• Tiredness
• Lack of interest and concentration
• Vomiting and stomach pain (often mistaken as the flu)
• A tingling sensation or numbness in the hands or feet
• Blurred vision
• Frequent infections
• Slow-healing wounds
• Bedwetting (in children and adults)

Complications of diabetes

Diabetic retinopathy, is the most common eye disease caused by diabetes, it damages the retinas in both eyes, causing vision problems which may lead to blindness

Foot ulcers are a common complication of diabetes and can lead to amputation. This ulcer is further complicated by both wet and dry gangrene.

Complications are problems that happen because of a disease. In the case of diabetes, there are two kinds of complications. The first kind happens quickly and can be dealt with quickly. This kind is called an acute complication. The other kind is caused by the blood glucose being too high for many years, and is called a chronic complication or long-term complication.

Hyperglycemia

Excess blood glucose is called 'hyperglycemia'. If a person's blood sugar is very high, it can cause acute complications. In type 1 diabetics, one of these complications is diabetic ketoacidosis which is a medical emergency and can often be detected by a fruity smell on the breath. Another very dangerous acute complication, more common in type 2 diabetics, is non-ketotic hyperosmolar coma.

Hypoglycemia

Low blood glucose is called hypoglycemia. It can also cause acute complications. If it is severe enough, it can be fatal.

If their blood sugar is too low, diabetics can have many symptoms, like sweating, trembling, anger (or feeling passive), and possibly even fainting. Diabetics with hypoglycemia may be confused or lose consciousness. They may appear to have drunk too much alcohol. Severe hypoglycemia is very dangerous and can come on quite suddenly.

The best treatment of hypoglycemia is avoiding it. If it happens, eating food containing glucose (for example, table sugar) usually improves the condition quickly. Sometimes it is treated by giving an injection of a medicine called 'glucagon'. Glucagon is a hormone made by the pancreas which has the opposite effect of insulin. Administering glucagon will cause the blood glucose level to rise by forcing stored glucose into the blood. Hypoglycemia is usually caused by too much diabetic medication, insufficient food, too much exercise, or a combination of these.

Chronic complications are mostly caused by hyperglycemia in cases where the blood sugar is usually high, but not high enough to cause acute complications. Over time, the chronic high blood sugar damages blood vessels and nerves. Damage to blood vessels can eventually cause strokes, heart attacks, kidney failure, blindness, slow healing of skin breaks - with the added possibility of infection - and even amputations from poor circulation (decreased blood flow, usually to the feet and toes). Damage to nerves can make diabetics not feel pain (this usually happens in their feet). This causes them to have more injuries and not realize they have hurt themselves. Damage to nerves can also cause pain even when there's no real injury. It's a type of phantom pain or ghost pain. The pain can be so intense that strong pain medication may be required. They may also suffer severe constipation and frequent urination.

Monitoring of diabetes

An electronic blood glucose meter measures the amount of glucose in the blood. Regular blood glucose monitoring is very important in diabetes care.

Because high blood glucose can cause so much damage, it is important to treat diabetes mellitus. The goal is to maintain a normal blood glucose level: 80-120 mg/dL (milligrams of glucose per deciliter of blood) or 3.5-7 mmol/l (millimole per liter of blood). These are different ways of saying the same thing, much like yards and meters are different units of distance measurement.

Diabetics should check their blood glucose frequently to make sure they do not get hypoglycemia or hyperglycemia. A glucometer is a battery-powered measuring device that checks the blood glucose level. Diabetics often carry a glucometer with them and check their blood sugar level several times a day.

Doctors may also use a blood test called a hemoglobin A1C. This is sometimes written Hgb-A1C or other ways; there's no standard name. This tells the doctor what the average blood glucose has been for about the past 90 days. If the level has been too high, it may indicate new medication, different medication dosages, or a better diet may be needed. Genetic tests may also be used to diagnose most forms of diabetes which are caused by a gene mutation.

Diabetics must be monitored for signs of complications due to diabetes. They should see an eye doctor regularly to be checked for damage to the blood vessels in the eyes. If this is not found and treated early, it can cause blindness. They should have their urine or blood checked regularly for signs of kidney damage. They must check their feet for cuts, bruises, blisters, and so on at least every day. And they should have their feet checked regularly for nerve damage, circulation problems, and infections.

Treatment of diabetes

Diabetes increases the risk of developing peripheral artery disease. A person who manages their diabetes properly can reduce that risk.

The most important goal in diabetes is to keep the blood glucose level as close to normal as possible. This requires effort and awareness. Because blood glucose rises after eating and decreases after exercise, managing blood sugar can be complex.

Treatment differs between type 1 and type 2 diabetes. People with type 1 diabetes are treated with insulin. People with type 2 usually begin with diet, exercise, and weight loss, perhaps moving to medication (and, though not as common, insulin).

Education is important for both types of diabetes. Diabetics must learn about diet. They learn how to estimate and keep track of how much carbohydrate, protein, and fat are in different foods. They plan their meals to have the right amount of each. Patients with type 1 may decide how much insulin to take before a meal based on how much they will eat.

Diabetics must also be careful about exercise. Exercise is important to stay healthy, but intense or extended periods of exercise can cause hypoglycemia. As a result, diabetics must plan exercise carefully.

In addition to controlling blood glucose levels, other treatments may be needed. Diabetics often have blood vessel diseases, so it is important to pay attention to other diseases that may affect blood vessels. In people with diabetes, treating high blood pressure (hypertension) and high cholesterol is more important than usual. Both of these diseases damage blood vessels.

The treatment goals can change for diabetics. For instance, in people without diabetes, blood pressure should be 140/90 or less. In diabetics, it should be 130/80 or less.

Health Disparities

South Asian American Population

A health disparity refers to unfair burden of disease on one population compared to another. In the United States, there is a health disparity faced by South Asian Americans (SAA) when it comes to diabetes. Overall, diabetes is linked to obesity or high body mass index (BMI). However, SAA face this condition at lower BMIs due to their food, lifestyle, and biological factors. Traditional diets consist of foods that are usually are imported, brought in the country from outside, without nutrition labels or in different languages. This makes it hard to follow the dietary guidelines for Americans or government recommendations on how to eat healthy.

Also, a lot of the population does not know that there are biological factors that make it likely for them to get diabetes. One big factor is insulin resistance. Insulin is a hormone or an assisting character that helps sugar get into cells. Sometimes, bodies get into the condition of ignoring insulin which means the sugar cannot easily get into cell. To solve this problem, the body ends up making even more insulin which just leads to high blood sugar levels in bloodstream. Because diabetes costs the government and people a healthy life and a lot of money, more people, specifically SAAs, should be aware of their risks to minimize chance of diabetes.

Other websites

• World Health Organization - Diabetes Programme
• International Diabetes Federation