Diabetes" redirects here. For other uses, see Diabetes (disambiguation).
| Diabetes mellitus | |
|---|---|
| Classification and external resources | |
Universal blue circle symbol for diabetes.[1] | |
| ICD-10 | E10–E14 |
| ICD-9 | 250 |
| MedlinePlus | 001214 |
| eMedicine | med/546 emerg/134 |
| MeSH | C18.452.394.750 |
There are three main types of diabetes:
- Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
- Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.)
- Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.
All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Both type 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery. Diabetes without proper treatments can cause many complications. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, retinal damage. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.
As of 2000 at least 171 million people worldwide have diabetes, or 2.8% of the population.[2] Type 2 diabetes is by far the most common, affecting 90 to 95% of the U.S. diabetes population.[3]
Contents[hide] |
Classification
Most cases of diabetes mellitus fall into three broad categories: type 1, type 2, and gestational diabetes. A few other types are described. The term diabetes, without qualification, usually refers to diabetes mellitus. The rare disease diabetes insipidus has similar symptoms as diabetes mellitus, but without disturbances in the sugar metabolism (insipidus meaning "without taste" in Latin).| Comparison of type 1 and 2 diabetes | ||
|---|---|---|
| Feature | Type 1 diabetes | Type 2 diabetes |
| Onset | Sudden[4] | Gradual[4] |
| Age at onset | Any age (mostly young)[4] |
Mostly in adults |
| Body habitus | Thin[4] or normal[5] | Often obese[4] |
| Ketoacidosis | Common[4] | Rare[4] |
| Autoantibodies | Usually present[4] | Absent[4] |
| Endogenous insulin | Low or absent[4] | Normal, decreased or increased[4] |
| Concordance in identical twins |
50%[4] | 90%[4] |
| Prevalence | Less prevalent | More prevalent - 90 to 95% of U.S. diabetics[3] |
Type 1 diabetes
Main article: Diabetes
mellitus type 1
Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of
Langerhans in the pancreas leading to insulin deficiency. This type of
diabetes can be further classified as immune-mediated or idiopathic. The
majority of type 1 diabetes is of the immune-mediated nature, where beta cell
loss is a T-cell
mediated autoimmune
attack.[8] There is no
known preventive measure against type 1 diabetes, which causes approximately 10%
of diabetes mellitus cases in North America and Europe. Most affected people are
otherwise healthy and of a healthy weight when onset occurs. Sensitivity and
responsiveness to insulin are usually normal, especially in the early stages.
Type 1 diabetes can affect children or adults but was traditionally termed
"juvenile diabetes" because it represents a majority of the diabetes cases in
children."Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.[9] There are many different reasons for type 1 diabetes to be accompanied by irregular and unpredictable hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias, including an impaired counterregulatory response to hypoglycemia, occult infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (eg, Addison's disease).[10] These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.[11]
Type 2 diabetes
Main article: Diabetes
mellitus type 2
Type 2 diabetes mellitus is characterized by insulin resistance which may be combined
with relatively reduced insulin secretion. The defective responsiveness of body
tissues to insulin is believed to involve the insulin receptor. However, the specific
defects are not known. Diabetes mellitus due to a known defect are classified
separately. Type 2 diabetes is the most common type.In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver.
Gestational diabetes
Main article: Gestational
diabetes
Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several
respects, involving a combination of relatively inadequate insulin secretion and
responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after
delivery. Gestational diabetes is fully treatable but requires careful medical
supervision throughout the pregnancy. About 20%–50% of affected women develop
type 2 diabetes later in life.Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.
A 2008 study completed in the U.S. found that the number of American women entering pregnancy with preexisting diabetes is increasing. In fact the rate of diabetes in expectant mothers has more than doubled in the past 6 years.[12] This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future.
Signs and symptoms
Hyperglycemia and osmosis
The classical symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).[15] Symptoms may develop rapidly (weeks or months) in type 1 diabetes while in type 2 diabetes they usually develop much more slowly and may be subtle or absent.Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes; sustained sensible glucose control usually returns the lens to its original shape. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected[citation needed].
Diabetic emergencies
People (usually with type 1 diabetes) may also present with diabetic ketoacidosis, a state of metabolic dysregulation characterized by the smell of acetone; a rapid, deep breathing known as Kussmaul breathing; nausea; vomiting and abdominal pain; and altered states of consciousness.A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss.
Dr Rupali Sharma
Family Physician
Asha USA Mini Medicine Citi
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