name “diabetes mellitus means sweet
It stems from ancient times when
physicians would taste a patients urine as a
part of a diagnosis.
Diabetes is the growing health problem in the United
States and has risen about six fold since 1950.
Its now affecting about 17 million Americans and one
third of those Americans (5.9 million) don’t even now
they have the disease.
Today, not only are adults being diagnosed with this
disease, but its also affecting today’s youth.
Diabetes mellitus (DM) is a group of diseases characterized by high
levels of blood glucose resulting from defects in insulin production,
insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of
multiple aetiology characterized by chronic hyperglycaemia with
disturbances of carbohydrate, fat and protein metabolism resulting
from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage,
dysfunction and failure of various organs.
The development of diabetes is projected to reach pandemic
proportions over the next10-20 years.
International Diabetes Federation (IDF) data indicate that by the
year 2025, the number of people affected will reach 333 million –
90% of these people will have Type 2 diabetes.
In most Western societies, the overall prevalence has reached 46%, and is as high as 10-12% among 60-70-year-old people.
Was previously called non-insulin-dependent diabetes mellitus
(NIDDM) or adult-onset diabetes.
Type 2 diabetes may account for about 90% to 95% of all diagnosed
cases of diabetes.
It usually begins as insulin resistance, a disorder in which the cells do
not use insulin properly. As the need for insulin rises, the pancreas
gradually loses its ability to produce insulin.
Type 2 diabetes is associated with older age, obesity, family history of
diabetes, history of gestational diabetes, impaired glucose
metabolism, physical inactivity, and race/ethnicity.
Type 2 diabetes is increasingly being diagnosed in children and
Glucose is a simple sugar that provides energy to all
cells in the body
The cells take in glucose from the blood and break down
it for energy most of this is used for fuel.
Glucose come from the food we eat
Glucose gets absorbed from the intestines and
distributed by the bloodstream to all cells.
The body tries to maintain a constant glucose
concentration in the blood.
So, when we over supply on glucose, our body stores the
excess in the liver and muscles by making glycogen
When glucose is in short supply, the body makes glucose
from stored glycogen or from the food that’s been eaten.
To maintain a constant blood
glucose level, the body relies on
two hormones produced in the
pancreas that have opposite
actions: insulin and glucagon.
2 diabetes is a disease that generally
develops over a period of years.
People who will eventually develop this disease
are insulin resistant several years before their
blood sugars become abnormal.
bodies try to make up for the higher
insulin needs created by insulin resistance by
producing more insulin.
But in Type 2 diabetes, the body ends up
producing abnormally high levels of insulin
over the years eventually begins to have a
The pancreas gradually begins to lose its
ability to produce the extra insulin needed
to overcome insulin resistance. As body
insulin levels fall, blood sugars begin to
Type 2 diabetes and the insulin resistance that causes it
have a strong genetic basis and are made worse by
environmental factors, including inactivity, weight gain,
Most people are overweight at the time their Type 2
diabetes is discovered. Being more active or losing
weight may help prevent or delay the development of
Type 2 diabetes was once called "Adult-onset Diabetes"
but this term is no longer used because it is inaccurate.
Type 2 diabetes is on the increase in all age groups,
even among children of high school and grade school
Who gets Type 2 Diabetes
who are overweight
Have a parent or sibling with diabetes
Are 40 years of age
Have high blood pressure
Had diabetes during pregnancy
Have the stress of an illness or injury
Had a baby that weighed more than 9
pounds at birth.
Type 2 diabetes is often without symptoms in its early
stages. That’s the reason there are 40% of people with
Type 2 diabetes are unaware of their disease. When
there are symptoms, they may occur gradually. If
present, they usually are:
feeling tired and weak
passing large volumes of urine, especially during the
having frequent infections
having blurred eyesight
Excessive hunger and thirst
If left untreated this, Diabetes can cause many life
Chronic Renal Failure= kidney failure
Atherosclerosis= heart attacks and stroke
Diabetic Neuropathy= numbness and pain to hands and feet
Autonomic Neuropathy= diarrhea, rapid heart beat, and low
Coma or death may occur as a result in Diabetic
Ketoacidosis (caused by infection)
People who smoke are a much higher risk at heart
attacks, stroke, infections, and problems with poor
Simple office tests or more complicated quantitative laboratory tests may be used
to determine the quantity of glucose lost in the urine. In general, a normal person
loses undetectable amounts of glucose, whereas a person with diabetes loses
glucose in small to large amounts, in proportion to the severity of disease and the
intake of carbohydrates.
The fasting blood glucose level in the early morning is normally
80 to 90 mg/100 ml, and 110 mg/100 ml is considered to be the
upper limit of normal. A fasting blood glucose level above this
value often indicates diabetes mellitus or a least marked insulin
In type I diabetes, plasma insulin levels are very low or
undetectable during fasting and even after a meal.
In type II diabetes, plasma insulin concentration may be Several
fold higher than normal and usually increases to a greater
extent after ingestion of a standard glucose load during a
glucose tolerance test.
,” when a normal, fasting person ingests 1 gram of glucose per kilogram of body
weight, the blood glucose level rises from about 90 mg/100 ml to 120 to 140
mg/100 ml and falls back to below normal in about 2 hours.
In a person with diabetes, the fasting blood glucose concentration is almost always
above 110 mg/100 ml and often above 140 mg/100 ml. Also, the glucose tolerance
test is almost always abnormal. On ingestion of glucose, these people exhibit a
much greater than normal rise in blood glucose level, as demonstrated by the curve
in Figure 78–12, and the glucose level falls back to the control value only after 4 to
6 hours; furthermore, it fails to fall below the control level. The slow fall of this curve
and its failure to fall below the control level demonstrate that either
the normal increase in insulin secretion after glucose ingestion does not occur
there is decreased sensitivity to insulin.
Small quantities of acetoacetic acid in the blood,
which increase greatly in severe diabetes, are
converted to acetone. This is volatile and
vaporized into the expired air.
Consequently, one can frequently make a
diagnosis of type I diabetes mellitus simply by
smelling acetone on the breath of a patient.
Also, keto acids can be detected by chemical
means in the urine, and their quantitation aids in
determining the severity of the diabetes.
The theory of treatment of type I diabetes mellitus
is to administer enough insulin so that the patient
will have carbohydrate, fat, and protein
metabolism that is as normal as possible. Insulin
is available in several forms.
“Regular” insulin has a duration of action that lasts
from 3 to 8 hours, whereas other forms of insulin
(precipitated with zinc or with various protein
derivatives) are absorbed slowly from the injection
site and therefore have effects that last as long as
10 to 48 hours.
Because there are several defects in the body's
chemistry that develop as Type 2 diabetes
changes over time, there are many tools used to
treat it. In its earliest stages, Type 2 diabetes can
often be controlled effectively by becoming more
active and by managing food to reduce the body's
need for insulin. This may involve promoting a
modest amount of weight loss, controlling and
distributing carbohydrate intake through the day,
When the disease has progressed to the point
where blood sugars are not controlled by activity
and food management alone, several types of oral
medications (pills) and/or insulin may be used
singly or in combination to regain blood glucose
control. Their effectiveness is judged by testing
the blood sugar periodically throughout the day.
The major components of the treatment of
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