Diabetes mellitus

Of the 15 million Americans who have Type II diabetes, more than a third are unaware of it. Another 21 million Americans have a greater than 50/50 chance of developing the disease because they have impaired blood-sugar metabolism. This year alone more than 187,000 people will die of Type II diabetes, also called non-insulin-dependent diabetes mellitus (NIDDM), making it the sixth leading cause of death by disease. Each day, over 2,200 people are diagnosed with this chronic life debilitating, expansive, and pro-aging disease.

Before the isolation of insulin in the 1920s, most patients died within a short time after onset. Untreated diabetes leads to ketoacidosis, the accumulation of ketones (products of fat breakdown) and acid in the blood. Continued buildup of these products of disordered carbohydrate and fat metabolism result in nausea and vomiting, and eventually the patient goes into a diabetic coma.

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, which result from defects in insulin secretion, or action, or both. Insulin is a hormone secreted by beta cells, which are located within clusters of cells in the pancreas called the islets of Langerhans. Insulin’s role in the body is to trigger cells to take up the carbohydrate glucose so that the cells can use this energy-yielding sugar. The cells of persons with diabetes have decreased ability to take up and metabolize glucose, and as a result the levels of glucose in the blood increase (a condition called high blood sugar). As glucose accumulates in the blood, excess levels of this sugar are excreted in the urine. Because of greater amounts of glucose in the urine, more water is excreted with it, causing an increase in urinary volume and frequency of urination as well as thirst. (The name diabetes mellitus refers to these symptoms: diabetes, from the Greek diabainein, meaning “to pass through,” describes the copious urination, and mellitus, from the Latin meaning “sweetened with honey,” refers to sugar in the urine.) Other symptoms of diabetes include itching, hunger, weight loss, and weakness.

 Types of Diabetes Mellitus

  • Type I diabetes, formerly referred to as insulin-dependent diabetes mellitus (IDDM) and juvenile-onset diabetes, usually arises in childhood. It is an autoimmune disorder in which the diabetic person’s immune system produces antibodies that destroy the insulin-producing beta cells. Because the body is no longer able to produce insulin, daily injections of the hormone are required.
  • Type II diabetes, formerly called non-insulin-dependent diabetes mellitus (NIDDM) and adult-onset diabetes, usually occurs after 40 years of age and becomes more common with increasing age. It arises from either sluggish pancreatic secretion of insulin or reduced responsiveness in target cells of the body to secreted insulin. It is linked to genetics and obesity, notably upper-body obesity. People with type II diabetes can control blood glucose levels through diet and exercise and, if necessary, by taking insulin injections or oral medications. Despite their former classifications as juvenile or adult, either type of diabetes can occur at any age. Type II diabetes is by far the most common type of diabetes, accounting for about 90 percent of all cases.
  • Gestational diabetes develops during pregnancy. It occurs more often in African Americans, Native Americans, Latinos and people with a family history of diabetes. Typically, it disappears after delivery, although the condition is associated with an increased risk of developing diabetes later in life.

Diabetes mellitus also may develop as a secondary condition linked to another disease, such as pancreatic disease; a genetic syndrome, such as myotonic dystrophy.

Some over-the-counter remedies that are safe for people who don't have diabetes contain ingredients that can cause problems for those who do. For example, aspirin taken in large amounts can affect blood sugar levels. If you have diabetes, you must be careful when using phenylephrine, epinephrine or ephedrine, all of which can raise blood sugar levels. Type 2 diabetics tempted to use appetite suppressants to control their weight need to know that these drugs usually contain caffeine, which boosts blood sugar. Fish oil and niacin, both commonly taken as a way to improve cholesterol levels, also raise blood sugar. To learn about potential hazards lurking in nonprescription medications, talk to Doctor Tapp and your pharmacist, and read labels carefully.

Uncontrolled diabetes causes damage to many tissues of the body including the kidneys. Kidney damage caused by diabetes most often involves thickening and hardening of the internal kidney structures. Strict blood glucose control may delay the progression of kidney disease in type 1 and type 2 diabetics.

 Symptoms of NIDDM

The early symptoms of untreated diabetes mellitus are related to elevated blood sugar levels, and excretion of it to the urine. High amounts of glucose in the urine can cause increased urine output and lead to dehydration. Dehydration causes increased thirst and water consumption. Some untreated diabetic patients also complain of fatigue, nausea, and vomiting. Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas. Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and coma (diabetic coma).

The most unrecognized symptom of NIDDM is weight gain. High insulin levels prohibit the release of serotonin, a neurotransmitter in the brain that informs the body to slow down eating. Without serotonin, there is a tendency to overeat, which then leads to a spiral of excessive sugar intake. A viscous cycle of hyper-insulinemia resulting in insulin resistance is set up. This in turn creates a "carbohydrate addict" whose craving for a higher sugar intake continues to increase. The same dietary factors that cause NIDDM lead to obesity. Eating refined carbohydrates such as sugar, or carbohydrates that easily converts into sugar such as yam, potato, or rice, creates more glucose than the body can handle. Excess glucose then gets stored as fat. As diabetes sets in, so does lethargy and inactivity, contributing further to the vicious cycle of weight gain and worsening of diabetes.

 Diagnosis and Treatment

Doctor Tapp will first ask about your medical history and perform a physical examination to check for symptoms of diabetes and high blood sugar. Diabetes usually is diagnosed with the following tests that measure the glucose levels in your blood:

  • Fasting Plasma Glucose Test: This is the standard test for diagnosing type 1 and type 2 diabetes. You must not eat or drink anything for at least eight hours prior to this simple test in which blood is drawn to check your sugar levels. A diagnosis of diabetes will be made if you have a fasting blood sugar level of 126 milligrams per deciliter or higher on two separate days.
  • Other Test: Diabetes also may be diagnosed based on a random high glucose level of ³ 200mg/dl and symptoms of the disease. Your doctor may wish to perform an oral glucose tolerance test, which is the traditional test for diabetes mellitus.

Modifying one's eating habits is typically the first step toward reducing blood sugar levels. At Tapp Medical Clinic, all patients will be encouraged to work with their doctor and/or certified dietician to develop a dietary plan to manage blood sugar levels. Patients are put on diets designed to help them reach and maintain normal body weight and to limit their intake of sugars and fats. Our materials provide patients with information on food nutrient content as well as how to eat and cook in a healthier manner.

Patients will be encouraged to exercise regularly, which enhances the movement of glucose into muscle cells and blunts the rise in blood glucose that follows carbohydrate ingestion. A good exercise routine is a walk or some other physically active motion for 30 minutes a day, 5 days a week will reduce the risk of type 2 diabetes. Remember, consult Doctor Tapp before beginning a exercise regiment, whereas you should start slowly if not accustomed to exertion. To increase your daily activity take the stairs rather elevators, park at the far end of the parking lot and spend time on a bicycle.

Diabetics who are unable to produce insulin in their bodies receive regular injections of the hormone, often customized according to their individual and variable requirements. In addition to conventional beef-pork insulin—which is the pancreatic extract of pigs and cattle—human insulin, based on recombinant deoxyribonucleic acid (DNA) technology, became available for use in the 1980s. Doctor Tapp will determine your dose and how often you need to take insulin. There is not any standard insulin dose as it depends on many factors such as your body weight, when you eat, how often you exercise and how much insulin your body produces.

Sometimes blood sugar levels remain high in people with type 2 diabetes even though they are eating in a healthy manner and exercising. When this happens, medications taken in pill form may be prescribed to help control blood sugar levels. The medications work by several different mechanisms. These include improving the effectiveness of the body's natural insulin, reducing blood sugar production, increasing insulin production and inhibiting blood sugar absorption. Oral diabetes medications are sometimes taken in combination with insulin.

The objective of all forms of treatment of diabetes is to keep the level of blood sugar within normal limits and thus reduce the complications, primarily cardiovascular, that account for most diabetes-related deaths. Other serious complications include a condition known as diabetic retinopathy (retinal changes that can lead to blindness), kidney disease, and frequent infection.

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