Diabetes Mellitus

Diabetes is a chronic, genetically determined, debilitating disease that affects every organ system. There are two major types of diabetes: Type I and Type II. Type I or insulin dependent diabetes mellitus (IDDM), is caused by the autoimmune destruction of the insulin producing cells of the pancreas and is usually, but not always diagnosed in childhood. People with type I diabetes must take insulin shots in order to survive. Type II diabetes or non-insulin dependent diabetes mellitus (NIDDM), are usually diagnosed in adulthood.

They produce insulin, but their bodies do not use it effectively or properly. While many modern diseases plague society, diabetes has been known for many centuries (Juvenile Diabetes Foundation, 1-3). Type I diabetes is usually diagnosed in children and young adults and was previously known as juvenile diabetes. In type I diabetes, the body does not produce insulin. Insulin is necessary for the body to be able to use sugar. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells.

When sugar builds up in the blood instead of going into cells, it can cause two problems: cells may be starved for energy, and over time, high blood sugar levels may hurt your eyes, kidneys, nerves, or heart. Type II diabetes is the most common form of diabetes. In type II diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use sugar. Type II diabetes accounts for 90 to 95% of diabetes.

Type II diabetes is nearing epidemic proportions, due to an increased number of older Americans, and a greater prevalence of obesity and sedentary lifestyles (Hoffman, 34-49). Diabetes is the leading cause of death. It is the leading cause of kidney failure, adult blindness, and non-traumatic amputations. People who have diabetes are two to four times more likely to have a heart attack or a stroke. Life expectancy of people who have this disease, on the average is fifteen years, less than that of people who do not have the disease.

It is also the leading cause of nerve damage (Hoffman, 34-49). IDDM can cause problems that should be prepared for. The three key problems: Hypoglycemia, or low blood sugar. This occurs when blood sugar drops too low. To correct this, all that is needed is some sugar. Hyperglycemia, or high blood sugar. Occurs when blood sugar is too high. It can be a sign that diabetes is not controlled very well. And ketoacidosis, or diabetic coma, is very serious and should be taken care of by a healthcare practitioner (Hoffman, 34-49).

Signs and symptoms of IDDM include: high levels of sugar in the blood, high levels of sugar in the urine, frequent urination, extreme hunger and thirst, extreme weight loss, weakness and tiredness, feeling edgy and having mood changes, and feeling sick to your stomach and vomiting. Signs and symptoms of type II diabetes: One is that it develops very slowly. Most people that get NIDDM have an increased thirst and an increased need to urinate. They also feel edgy, tired, and sick to their stomach. Some have an increase in appetite, but do not gain weight.

Other signs and symptoms may include: repeated or hard to heal infections of the skin, gums, vagina, or the bladder. Impotence, blurred vision, tingling or loss of feeling in the hands pr feet, and dry, itchy skin. These symptoms are very mild and are not easily connected to diabetes. Older people confuse these signs with aging and do not seek medical attention early enough. Since this disease is genetically determined, anybody can get it. Diabetics live with this disease forever. It never goes away, even when all of the treatments available.

Diet and exercise are the two most important things in a diabetics life. People who have diabetes can live a happy and healthy life. The key is to keep blood sugar levels as normal as possible all of the time. Testing their blood sugar levels regularly is very important; testing lets them know if their diabetes is under control. Diabetes mellitus is a disruption of carbohydrates, fat, and protein metabolism resulting from hyposecretion or inaction of insulin. It is the most widespread disorder of the endocrine system.

Blood and urine tests to confirm diabetes mellitus reveal hyperglycemia, glycosuria, and ketonuria (Saladin, 654-655). A little knowledge of kidney physiology is necessary to understand why glycosuria and polyuria occur. The kidneys filter blood plasma and process the filtrate to produce urine. The kidney tubules remove all glucose from the filtrate and return it to the blood. There is little or no glucose in the urine of a healthy person. By osmosis, the tubules reclaim most of the water in the filtrate (Saladin, 655). The glucose transporters of the kidney tubules have a transport maximum.

In DM, glucose enters the tubules so fast that it exceeds the transport maximum and the tubules cannot reabsorb it fast enough. The excess passes through into the urine. Glucose and ketones in the tubules raise the osmolarity of the tubular fluid and cause osmotic diuresis. Water remains in the tubules with these solutes, so large amounts of water are passed in the urine. This accounts for the polyuria, dehydration, and thirst of diabetes. Diabetics pass 10 to 15L of urine per day, compared with 1 to 2L in a healthy person (Saladin, 655).

Diabetes mellitus leads to long-term degenerative cardiovascular and neurological diseases. Chronic hyperglycemia activates a metabolic reaction cascade that leads to cellular damage in small to medium blood vessels and peripheral nerves. Nerve damage is the most common complication of diabetes mellitus, and can lead to impotence, incontinence, and loss of sensation from affected areas (Saladin, 656). The last effect makes a patient dangerously unaware of major injuries, which can fester from neglect and contribute to gangrene and the necessity of amputation. Many diabetics lose their toes, feet, or legs to the disease.

The cardiovascular effects include degeneration of the small arteries of the retina and the kidneys, leading to blindness and kidney failure as common complications. People with type I diabetes are more likely to die of kidney failure than those with type II diabetes. Diabetes also promotes atherocslerosis, the blockage of blood vessels with fatty deposits, causing poor circulation. In type II diabetes, the most common cause of death is heart failure stemming from atherosclerosis of the coronary arteries. Atherosclerosis also contributes to renal failure and gangrene.

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