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Diabetes
What is diabetes?
When we use the term diabetes, we almost always mean diabetes mellitus. There is another, rare form of diabetes, known as diabetes insipidus, which has nothing to do with blood sugar and is a completely different disease. Diabetes insipidus is usually due to a tumor in the hypothalamic region in the brain. Blood glucose is normal in these patients. On the other hand, diabetes mellitus is due to a disease of the pancreas, which results in a high blood glucose level. Markedly elevated blood glucose levels then lead to excessive thirst and excessive urination. Diabetes mellitus is a progressive disease with horrendous complications, which include heart attack, stroke, memory loss, dementia, impotence, leg amputation, kidney failure and blindness. Unfortunately, diabetes remains undiagnosed in a large number of patients because it does not cause any symptoms for many years. By the time diabetes is diagnosed, most patients have developed complications of this disease. According to some conservative estimates, at least 17 million Americans have diabetes. Unfortunately, almost half don’t even know they have it . The number of cases of diagnosed diabetes in the U.S. has increased 33% from 1990 to 1998. The greatest increase has occurred in the young age group of 30-39 years of age . In general, people are very concerned about cancer, heart disease and cholesterol, but don’t think much about the consequences of diabetes. The advanced complications of diabetes, quite frankly, make for a miserable quality of life. Patients with advanced complications (such as kidney failure, leg amputation and blindness) often ask why no one warned them diabetes could lead to such a hellish existence.
What are the different types of diabetes?
For a practical standpoint, there are three types of diabetes: Type 1, Type 2 and gestational diabetes. Type 2 diabetes is the most common form of diabetes, accounting for about 95% of diabetic patients. If properly managed, it usually does not require insulin therapy. On the other hand, Type 1 diabetes, which requires insulin therapy, accounts for less than 5% of cases. Gestational diabetes refers to development of diabetes during pregnancy. After pregnancy ends, most of these women return to “normal” blood glucose ranges. However, within 10 years, more than 50% of women with gestational diabetes will develop Type 2 diabetes.
In Type 1 diabetes, there is complete destruction of insulin producing cells (beta cells) in the pancreas and consequently, insulin production stops. Therefore, these patients have to take insulin on a regular basis in order to sustain their life. If they stop taking insulin, these patients can rapidly lapse into a coma and die if treatment is not instituted in time. On the other hand, in Type 2 diabetes, the body is able to produce insulin, but there is resistance to the action of insulin at the cellular level. Type 2 diabetes is part of Insulin Resistance Syndrome and we will focus on this type of diabetes in the remainder of this chapter. In the past, Type 2 diabetes was also called NIDDM (non insulin dependent diabetes mellitus) or Adult Onset Diabetes. Type 1 diabetes was called IDDM (insulin dependent diabetes mellitus) or Juvenile Onset Diabetes. We have stopped using these older terms because they can be inaccurate and misleading. For example, some Type 2 diabetic patients end up on insulin and many physicians mistakenly classify these patients as IDDM (Type 1). Although Type 1 diabetes typically develops at a young age,it can develop in an adult. In the past, most young people with diabetes were classified as Type 1. However, sometimes Type 2 diabetes develops in teenagers. Actually, Type 2 diabetes in teenagers is on an alarming rise, primarily due to our "fast food culture" and a lack of physical activity in the teenage population.
What are the Symptoms of Diabetes?
Type 2 diabetes is a silent killer. It develops slowly over a period of years. Usually there are no symptoms for a long time. Patients often have vague, non-specific symptoms such as fatigue and usually blame it on getting old. Unfortunately, during this time, complications of diabetes are usually developing and the patient may ultimately have any of the following symptoms:
Excessive thirst and urination, blurry vision, drowsiness and coma are usually symptoms of severe diabetes. Type 1 diabetes usually has more dramatic symptoms such as
What is the link between diabetes and Insulin Resistance Syndrome?
Insulin Resistance Syndrome consists of obesity, low HDL cholesterol, high triglycerides, high blood pressure and impaired glucose tolerance or diabetes. Insulin resistance is present in almost all Type 2 diabetic patients. Insulin resistance means that your body becomes less sensitive to the action of your own insulin. In order to compensate for this insulin resistance, the pancreas is able to produce large quantities of insulin and therefore, blood glucose remains normal for many years. Ultimately, after several years, your body is unable to keep up with this mounting insulin resistance. Your blood glucose start rising, but only after meals. This condition is called Impaired Glucose Tolerance. This condition can be diagnosed only if you have an oral glucose tolerance test. In this test, if your blood glucose is between 140 mg/dl and 200 mg/dl at two hours after a 75 grams glucose drink, then you have Impaired Glucose Tolerance. Eventually, several years later, your blood glucose starts rising even in the fasting state. If your fasting blood glucose elevates in the range of 100 mg/dl. to 125 mg/dl, it is called Impaired Fasting Glucose. Impaired Glucose Tolerance and Impaired Fasting Glucose are early stages of diabetes (also known as Pre-diabetes), but are frequently ignored by many physicians. Ultimately, a diagnosis of diabetes is made when a fasting blood glucose is more than 125 mg/dl or when after a two hour oral glucose tolerance test, your blood glucose is more than 200 mg/dl. The capacity of the pancreas to produce insulin varies from person to person. Some people have a limited capacity to produce insulin and they develop diabetes only after a few years of mild insulin resistance. Others have a tremendous reserve for insulin production and do not develop diabetes for many years despite severe insulin resistance. On an average, 10-20 years of insulin resistance go by before a diagnosis of diabetes is made. During that time, many people experience complications of diabetes such as heart attack, stroke, dementia, neuropathy in feet and hands and gangrene of the legs. They may even die before they are diagnosed with diabetes.
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