Diabetes mellitus, or simply, diabetes, is a disease that damages the body when the blood glucose (sugar) is allowed to remain too high for too many years.
Major Types of Diabetes
There are several major types of diabetes:
- Type 1 diabetes is the form that used to be called juvenile diabetes or insulin-dependent diabetes. It starts most often in childhood. The patient has an absolute need for the hormone insulin, since his pancreas, the organ that makes insulin, can no longer do so. The insulin is usually given by injection and must be balanced by food intake in order to keep the blood glucose as normal as possible.
- Type 2 diabetes is the form that used to be called adult-onset diabetes. It is a lifestyle disease, resulting from excessive weight gain and lack of exercise. The patient does not lack insulin, but has insensitivity to his own body’s insulin. Treatment is started with diet and exercise but may ultimately require pills or insulin.
- Gestational diabetes is the form that occurs in pregnancy when the hormones of pregnancy overwhelm the body’s insulin so that the blood glucose rises. It can cause problems with the growing fetus who tends to grow large and have a difficult delivery. Gestational diabetes can also become type 2 diabetes later in life.
Diagnosis of Diabetes
The diagnosis of all types of diabetes is made when the blood glucose in the overnight fasting state is 126 milligrams per deciliter (mg/dl) or higher on more than one occasion. The diagnosis may also be made if the blood glucose after eating rises to 200 mg/dl or higher on more than one occasion. Recently the finding of a level of 6.5 percent or greater in a blood test called a hemoglobin A1c has been added to the recommended way of making a diagnosis of diabetes mellitus.
The different types of diabetes share many features once the diagnosis is made. The drugs are powerful and some may reduce the level of blood glucose to the point that the blood glucose of the patient becomes low, usually less than 65 mg/dl. This state is called hypoglycemia and results in hunger, sweating, a rapid heartbeat, confusion and even coma. It is treated by giving the patient glucose.
If the blood glucose is allowed to remain high, usually greater than 180 mg/dl over ten years or more, the patient with any form of diabetes may develop one or all of the following complications:
- Eye disease which may lead to blindness
- Kidney disease which may lead to kidney failure
- Nerve disease which may lead to loss of sensation in parts of the body, especially the feet, or to loss of movement in one or more muscles
- Hearts and blood vessel disease, which may lead to a heart attack, a stroke or loss of blood supply to the legs and feet
None of these complications need ever occur with proper management of the diabetes. The tools that will keep the blood glucose in a range that prevents complications of diabetes are available today and with the help of a diabetes team consisting of a doctor, a diabetes educator, a dietitian, an eye doctor and other specialists as needed, the person with diabetes may live a long, quality life.