What is Diabetes?
- Type 1 - Insulin Dependent Diabetes Mellitus (IDDM)
- Type II - Maturity Onset Diabetes or Non-Insulin Dependent Diabetes Mellitus (NIDDM)
Diabetes is a metabolic disorder caused by a lack of insulin in the body, or an ineffectiveness of the insulin that is present. This leads to an inability of the body tissues to use one of the body’s fuels, sugar (glucose) that is present in the bloodstream, causing a series of symptoms.
Insulin is a hormone that is produced by a gland in the abdomen called the pancreas and the specific parts of the pancreas producing insulin are known as the Islets of Langerhan. When a person eats, the food is broken down into different substances (including sugar), which are carried in the blood to be used by the body. In normal circumstances, the presence of sugar (glucose) in the blood causes the production of insulin, which allows the passage of glucose into the cells of the body to either use it as energy or to store it.
The liver is the main site of storage where it is stored in the form of glycogen and from the glycogen, glucose is released into the circulation throughout the day to meet the needs of the body (between meals).
This does not happen in the normal way in diabetes.
There are two main types of diabetes:
Type 1- Insulin Dependent Diabetes Mellitus (IDDM)
This is a result of the inability of the insulin producing cells of the pancreas to produce insulin. This is a permanent condition and many of the cells in the Islets of Langerhan are destroyed by the body's own defences (autoimmune disease). This may follow a viral infection, but studies have shown that genetic factors may also be contributory.
It is also known as Juvenile Onset Diabetes as it normally first presents in children and young people.
Patients with IDDM always require insulin for treatment.
They initially present with symptoms of a relatively sudden onset (that is days or weeks), which are directly related to increased glucose in the blood and deprivation of glucose in the cells. The excess blood glucose is excreted in the urine by the kidneys and this causes:
- Polyuria (frequency of urination)
- Excessive thirst (polydipsia), because of the loss of fluid in the urine
- Weakness
- Tiredness
- Weight loss
- With possible symptoms of bacterial infection (such as boils) and thrush infection.
Without prompt treatment, the patient can quickly become very ill because a condition called ketoacidosis is likely develop. This is a consequence of the need for the body’s cells to use an alternative form of energy (that is, burn fat in the fat cells).
As the fat cells break down they produce ketones, which can be smelled on the breath and are excreted in the urine and, which increase the symptoms of polyuria and polydipsia (with the addition of abdominal pain, nausea and vomiting).
This can progress to confusion and coma and, ultimately death if it remains untreated.
Type II - Maturity Onset Diabetes or Non - Insulin Dependent Diabetes Mellitus (NIDDM)
This usually first presents in an older age group (i.e. after the age of 40) in people who are often overweight. It occurs in all races but is commoner in African and Asian groups who are living a Western lifestyle. It is associated with hypertension (high blood pressure), raised blood lipids (fats) and an increased incidence of myocardial infarction.
With the increase in obesity and lack of exercise in the developed world, Type II diabetes is now being seen in young people as well.
In Type II diabetes, the secretion of insulin still continues but the effectiveness of insulin in the body is impaired; and this is known as insulin resistance. Generally, however, it occurs in older people and is progressively more common as people get older. These people are often obese and do not exercise.
Because obesity causes insulin resistance, there is a link between obesity and Type II diabetes. One of the regimens of treatment for this condition is weight reduction associated with increase in exercise.
Type II diabetes may be undiagnosed for several years as the symptoms may be minor. By the time persons with Type II diabetes are diagnosed, they may already have complications. Persons suffering from Type II Diabetes, because they excrete some insulin, do not usually suffer from ketoacidosis but the blood sugar may become very high indeed, which in itself can lead to dehydration, drowsiness, confusion and coma. This is known as non-ketotic hyperglycaemic hyperosmolar coma.
Type II diabetes may only show up on a routine check.
