What is Diabetes Mellitus?
Diabetes mellitus consists of a group of metabolic diseases characterized by inappropriate hyperglycemia (high blood sugar) resulting from defects in insulin secretion, insulin action, or both.
The disease processes in the development of diabetes involve cells in the pancreas (beta cells) These cells produce and release insulin under the control of feedback systems. Beta cell dysfunction leads to impaired insulin synthesis and/or release. In some types of diabetes, the body becomes resistant to the effects of insulin. When this happens, the body may actually produce MORE insulin than normal. Since the body is not responding properly to the insulin, however, the blood sugar level increase and diabetes follows.
The beta cell dysfunction may be due to immune-mediated insulitis, genetically determined beta cell dysfunction, or acquired beta cell dysfunction (including glucose toxicity).
Insulin resistance is manifested by persistent hepatic glucose production and diminished peripheral glucose disposal. The binding of insulin to its receptor does not produce the normal signalling with observed defects in glucokinase activity and glucose transporter translocation being noted.
Signs and symptoms
The “Metobolic Syndrome” consists of high blood sugar, insulin resistance (usually with elevated insulin production), and disordered lipid metabolism. The person is overweight with most of the fat accumulated around the mid-section.
Symptoms of acute hyperglycemia (high blood sugar) include polyuria (frequent urination of large amounts or urine), polydipsia (thirst with frequent drinking of fluids), polyphagia (constant or frequent hunger with frequent eating), weight loss (with the type 1 diabetic), blurred vision, fatigue, headache, occasional muscle cramps, and poor wound healing.
Signs and symptoms of chronic hyperglycemia include growth impairment and susceptibility to certain infections. Also seen are renal, retinal, peripheral vascular, connective tissue, and neuropathic syndromes.
Acute life-threatening consequences of diabetes include hyperglycemia with ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and therapy-induced hypoglycemia.
Treatment differs depending on the type of diabetes, however the goal is to provide the cells with a proper amount of glucose for normal body function without alowing the blood sugar to rise to dangerous levels. The foundation of treatment is diet control and excercise. Controlling the amount of carbohydrates eaten and choosing foods that raise the blood sugar more slowly (See Glycemic Index) help the body normolize the blood sugar. Exercise helps reduce insulin resistance and improves the utilization of glucose.
Insulin may be taken by injection or by using medications that increase insulin release from the pancreas. Diabetics may also need medication to improve their lipid metabolism and reduce the insulin resistance. There are many resources for diabetic information. The diabetic associations are a good place to start, as in the link labeled More Information. This will take you to the National Library of Medicine where you can review current research.
Keeping track of your blood sugar, medication, diet, and exercise is very important. You will review this information with your doctor from time to time. More importantly, you will use this information to decide how well you are managing your diabetes and what changes will improve your health. This record (or “Log”) should contain at least the following information:
- Date and Time of the entry
- Your first blood glucose reading in the morning (Fasting Blood Sugar)
- Your blood sugar 2 hours after eating (Post-Prandial Blood Sugar)
- Time and amount of your meals (including the amount of carbohydrate eaten is very helpful)
- Time and amount of the medication you take
- Time and duration of the exercise you do