Introduction to Diabetes Mellitus

Edward Hsiao, MD, PhD

In this article, Dr. Hsiao provides a generally overview of diabetes. Please remember that your best source of medical information is your personal physician or heath-care provider.

 

The initial diagnosis of diabetes mellitus (often abbreviated as diabetes) can be a stressful event. Patients are often scared of the associated health problems, the need for insulin injections, and the potential social stigma of a disease that affects body weight and dietary choices. However, most patients with diabetes are able to maintain an active lifestyle and eat a wide variety of foods. In addition, many of the health complications from diabetes can be reduced if the diabetes is managed appropriately.

 

What is Diabetes Mellitus?

The term diabetes mellitus refers to a group of diseases characterized by abnormally high blood glucose levels (hyperglycemia). The diagnosis is based on having one of three laboratory test abnormalities: an elevated fasting blood glucose above 126 mg/dl, a random blood glucose above 200 mg/dl with symptoms of diabetes mellitus, or an abnormal oral glucose tolerance test. Some patients may have a moderate elevation of their blood glucoses (between 100 and 125 mg/dl), referred to as impaired fasting glucose or pre-diabetes. Patients with pre-diabetes are at an increased risk of developing full-blown diabetes.

 

What is the difference between Type 1 and Type 2 Diabetes Mellitus?

There are several major types of diabetes, the most common being type 1 (insulin dependent) and type 2 (non-insulin dependent). In most cases, a physician is usually able to distinguish which type is present; however, in situations where it is not clear, a physician may treat the patient as a type 1 diabetic until a clearer diagnosis can be made.

 

Patients with type 1 diabetes tend to be younger at the time of diagnosis, and may present with unintended weight loss. These patients are also at higher risk for developing diabetic ketoacidosis (DKA) and may have ketones in the urine. Type 1 diabetes is often associated with antibodies in the blood that destroy the insulin-producing cells in the pancreas.

 

Type 2 diabetes is usually associated with older patients. Obesity, a sedentary lifestyle, and family history of diabetes are significant risk factors. Certain ethnic groups including people of African, Hispanic, or Asian heritage, are at higher risk of developing type 2 diabetes. More recently, type 2 diabetes has become more common in younger patients because of the increase in childhood obesity. In addition, some patients with certain medical conditions or are pregnant can develop type 2 diabetes.

 

What are the Presenting Symptoms of Diabetes Mellitus?

Most patients with diabetes mellitus develop symptoms of high blood glucose (hyperglycemia) before a formal diagnosis is made. The most common symptoms include excessive thirst, frequent urination, fatigue, and blurred vision. In some cases, patients will develop diabetic ketoacidosis (DKA) which includes the symptoms of hyperglycemia, as well as rapid breathing, decreased mental alertness, abdominal pain, and nausea or vomiting. Patients with DKA require emergency medical care.

 

Why Treat Diabetes Mellitus?

Patients with diabetes are at significantly increased risk of developing heart disease, including high blood pressure, increased blood cholesterol (hyperlipidemia), heart attacks (myocardial infarction), chest pain (angina), and strokes. In addition, diabetes patients often develop eye problems (retinopathy), kidney failure (nephropathy), and nerve damage (neuropathy) over the long term as a result of their disease. Diabetes patients, particularly if their blood glucose is poorly controlled, may also be at increased risk for infections, skin ulcers, and dental cavities.

 

Many studies have shown that these complications from diabetes can be reduced if patients check their blood glucose levels frequently and maintain a near-normal glucose level through exercise and medication.

 

How is Diabetes Mellitus Treated?

Diabetes is best treated through a multi-disciplinary approach involving the patient and their family, the medical team (physicians, nurses, and nutritionist), and a diabetes educator. Other physicians may be involved, including a diabetes specialist (endocrinologist or diabetologist), cardiologist, ophthalmologist, and podiatrist.

 

The mainstay for diabetes treatment is insulin. Patients with type 1 diabetes require regular doses of insulin (usually 2-5 injections per day) to control the blood glucose levels. Many patients with type 2 diabetes can be treated with oral medications, but some patients may also require insulin particularly if they have longstanding diabetes. A small group of patients may do well with an insulin pump which continuously delivers insulin under the skin.

 

In addition to insulin, medications to treat high blood pressure, high cholesterol, or complications from the diabetes may be necessary.

 

In all diabetes patients, regular exercise, avoiding smoking, and balanced nutrition can make glucose control easier and prevent health complications from diabetes. Patients with type 2 diabetes can benefit significantly from weight loss even if it is only a few pounds.

 

Where to Get More Information

Every patient is unique, and recommendations may vary from one patient to another. The information provided in this article is not intended as specific medical advice, but rather as a guide to introduce you to diabetes mellitus.

 

Your healthcare provider is the best source of information if you have questions or concerns about diabetes. In addition, information provided by the National Institutes of Health, the American Diabetes Association, and other well-known organizations are often reliable sources of information.

 

Helpful resources

General medical information:

National Library of Medicine (www.nlm.nih.gov/medlineplus/healthtopics.html)

 

Endocrine-oriented information:

The Endocrine Society (www.endo-society.org)

The Hormone Foundation (www.hormone.org/public/diabetes.cfm)

 

Diabetes oriented information:

National Inst. of Diabetes, Digestive, and Kidney Diseases (www.niddk.nih.gov)

American Diabetes Association (www.diabetes.org)

Up-to-Date Patient Information (patients.uptodate.com)

 

Dr. Ed Hsiao is a board-certified endrocrinologist.