By Dr . Abay Taddesse
Diabetes mellitus (DM) is a chronic illness that results from absolute or relative deficiency of insulin ( hormone which controls blood glucose) that leads to excessive amounts of glucose in the blood which leads to acute ( short term ) and chronic ( long term ) complications which cause most of the morbidity ( disease burden) and mortality ( death ) from the disease.
So far there are no cures for diabetes and all types of treatments ( pills, insulin injections ) are aimed at controlling blood glucose at a reasonable target so as to prevent short term and long term complications.
Classification of DM
* Type 1 DM
– Results from destruction of pancreatic cells which produce insulin leading to absolute insulin deficiency
– Caused by genetic predisposition to the disease and autoimmune destruction of the insulin producing cells
– Needs treatment with insulin from the time of diagnosis
– Insulin can be given in different forms- insulin vials with syringe and needle, prefilled insulin pens and continuous insulin delivery through insulin pumps
– Blood glucose runs in very wide ranges – at times very low
( hypoglycemia ) and most of the time running very high ( hyperglycemia)
– High risk for low blood glucose
( hypoglycemia) on treatment with insulin
*Type 2 DM
– Results from progressive insulin secretion defect from the pancreas and inability of the body to use insulin which is called insulin resistance
– Family history of DM in immediate family members commonly found
– Can be treated with diet and weight loss ( which improves ability of the body to use insulin ) and / or pills or insulin alone or in combination
– Life style change with diet and weight loss is the preferred first step of treatment
* Gestational DM
– Diabetes diagnosed during pregnancy
* Other less common types of DM
Complications of DM
* Acute ( short term complications )
– Dangerously low blood glucose
( hypoglycemia ) which can lead to coma and death
– Diabetic coma due to excess acid production from fat
( Diabetic ketoacidosis)
– Diabetic coma due to very high glucose in the blood which leads to dehydration
*Chronic ( long term complications)
– Blockage of coronary arteries
( blood supply to heart)
– Blockage of major arteries to organs and legs
– Damage to eyes leading to loss of vision
– Damage to kidneys leading to kidney failure
– Damage to sensory nerves of feet leading to diabetic feet ulcers and amputations.
Reference: American Diabetes Association Clinical Practice Recommendations published on Diabetes Care Jan 2013, vol 36 , supplement 1.
I will write more on prevention and treatment of common long term complications on future posts.
Dr . Abay Taddesse is a graduate of Jimma university, trained on Endocrinology , Diabetes and Metabolism at Wayne State University in Detroit and currently is practicing Endocrinology and Diabetes care in Southern Ohio, USA.