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1. What is Diabetes
Mellitus?
Diabetes mellitus is a common disease
where there is too much sugar (glucose)
floating around in your blood. This occurs
because either the pancreas can’t
produce enough insulin or the cells in
your body have become resistant to
insulin.

2. How does your body
normally regulate
glucose?
When you eat food, the amount of glucose in your
blood skyrockets. That’s because the food you eat
is converted into glucose (usable energy for your
cells) and enters your blood to be transported to
your cells around the body. Special cells in your
pancreas sense the increase of glucose and release
insulin into your blood. Insulin has a lot of
different jobs, but one of its main tasks is to help
decrease blood glucose levels. It does this by
activating a system which transports glucose from
your blood into your cells. It also decreases blood
glucose by stimulating an enzyme called glycogen
synthase in the liver. This molecule is responsible
for making glycogen, a long string of glucose,
which is then stored in the liver and used in the
future when there is a period of low blood
glucose. As insulin works on your body, the
amount of glucose in the blood slowly returns to
the same level it was before you ate.. This glucose
level when you haven’t eaten recently (called
fasting glucose) sits around 3.5-6 mmol/L (70-110
mg/dL). Just after a meal, your blood glucose can
jump as high as 7.8mmol/L (140 mg/dL)
depending on how much and what you ate.

3. What happens in
diabetes mellitus?
There are two types of diabetes mellitus, type
1 and type 2. In both types, your body has
trouble transporting sugar from your blood
into your cells. This leads to high levels of
glucose in your blood and a deficiency of
glucose in your cells. The main difference
between type 1 and type 2 diabetes mellitus is
the underlying mechanisms that cause your
blood sugar to stray from the normal range.
Type 1 DM:
Type 1 diabetics suffer from a complete lack of
insulin in their bodies. Although the exact
cause has not been identified, it is clear that
the cells which make insulin are destroyed by
the body’s own immune system. This occurs
due to autoimmunity, a process by which the
immune system believes some of the body’s
cells are foreign and targets them for
destruction. Eventually the body destroys all of
these cells and the symptoms of diabetes
manifest.

4. What are the
symptoms of diabetes
mellitus?
Type 1: The classic initial presentation of type 1
diabetes is increased thirst, increased urination,
weight loss, hunger due to starvation of cells, and
fatigue. As blood glucose levels increase, the body
tries to remove excess glucose in the urine and
dilute the blood by increasing water intake.
However, many patients are initially diagnosed
when they come to the hospital very sick in a state
called diabetic ketoacidosis. This occurs when cells
use alternative energy producing mechanisms,
leading to high levels of byproducts called
ketoacids. Ketoacids acidify the blood, leading to
dangerous acid base disturbances. Diabetic
ketoacidosis causes abdominal pain,
nausea/vomiting, and drowsiness and is a
potentially life threatening condition.
Type 2: The symptoms of type 2 DM are similar to
type 1, but generally occur later in life and have a
more gradual onset. 40% of patients have no
symptoms. The other 60% can present with
increased thirst and urination, diabetic
ketoacidosis, or a condition called hyperosmolar
hyperglycemic state, a state of severe dehydration
requiring hospitalization.

5. Long-term
complications of
Diabetes Mellitus:
Many of the major complications of diabetes, including
coronary artery disease, cardiovascular disease, peripheral
vascular disease, and cerebrovascular disease are caused
by damage to large vessels in the body. High glucose levels
lead to chronic inflammation in the body, including the
walls of the arteries in the blood. This chronic
inflammation leads to atherosclerosis, a buildup of a
plaque with a fibrous cap on the walls of the arteries. This
narrows the arteries and leads to decreased blood flow in
the arteries. In addition, these plaques can rupture and
lead to formation of a blood clot which blocks off blood
flow. If this happens in the brain or the heart, it causes a
stroke or a heart attack.
High blood glucose levels may also damage the smallest
vessels in the body, leading to multiple long-term
microvascular complications. This damage both destroys
the cells in the blood vessels and leads to decreased blood
flow and tissue death. Poorly controlled diabetes can
cause retinopathy (damage to the retina in the eyes,
leading to blindness), nephropathy (damage to the kidneys
resulting in kidney failure), neuropathy (damage to your
nerves, which can cause numbness or tingling), and
gastroparesis (dysfunction of your digestive system causing
chronic vomiting and abdominal pain). All of these
symptoms are caused by glucose induced damage to blood
vessels.
Diabetes has a large negative effect on the body’s immune
system. High glucose levels ramp up activity of immune
cells. These cells eventually become exhausted and
desensitized, decreasing their effectiveness against
invading pathogens. Poorly controlled diabetics are more
prone to severe skin infections and have longer hospital
stays for infections like pneumonia or urinary tract
infections.

6. How likely are you to
get it?
It’s unclear who gets type 1 diabetes or how
to prevent it. Given the main cause of type 1
diabetes is autoimmunity, environmental
factors is likely the largest risk factor. Type 2
diabetes, on the other hand, is directly
related to obesity and diet. Overweight
individual become more and more resistant
to insulin and are much more likely to get
diabetes. Physical fitness and a healthy diet
are the most important aspects of type 2
diabetes prevention. Both types of diabetes
have genetic predispositions, with type 2
having a larger genetic component to
disease.

7. How do you treat it?
The only effective treatment in type 1 diabetes is
administering insulin as these patients no longer
produce it. There are many different types of
insulin and different regimens but many patients
will use a long-acting insulin at night
supplemented by a short-acting insulin before
meal times. Newer treatment regimens include
the use of an insulin pump where blood glucose
levels are entered into a machine which then uses
an algorithm to pump insulin into the body.
Type 2 diabetics have more options. Initial therapy
for type 2 diabetics with mild disease is lifestyle
modification: a healthy diet with exercise to help
lose weight. If this fails, the first medication used
is typically Metformin, a drug which stops the liver
from making glucose in a process called
gluconeogenesis. It also increases the number of
insulin receptors present on cells, so they become
more sensitive to insulin. Between Metformin and
insulin therapy are a number of drugs which help
increase the release of insulin from the pancreas.
These include sulfonylureas, a-glucosidase
inhibitors, and glinides.

8. Consider the following:
Sometimes, pregnant women can develop
diabetes while they are pregnant, a process
called gestational diabetes. This usually
reverses once they give birth, but can persist
after the pregnancy. Gestational diabetes is
similar to type 2 diabetes: the hallmark of
this disease is insulin resistance. During the
second trimester, pregnant women increase
their resistance to insulin and have higher
blood sugar levels, likely to increase delivery
of glucose to the fetus. Most women
increase the amount of insulin produced
from the pancreas, but women with
gestational diabetes cannot produce enough
and functionally become type 2 diabetics
throughout their pregnancy.