Diabetes mellitus (or simply diabetes) is a common disorder, and the main cause of it is a partial or complete lack of insulin that is produced in the pancreas. The result is a small absorption of glucose – both in cells that need glucose for energy, and in the liver in which glucose is disposed of – so the level of glucose in blood increases. (Diabetes mellitus should not be confused with the much rarer disease called diabetes insipidus). There are two main types of diabetes: adult diabetes (diabetes mellitus in adults; insulin-independent) and juvenile diabetes (diabetes mellitus in children; insulin-dependent).
Adult diabetes (insulin-independent)
This form of diabetes usually affects people in their forties and is characterized in that the insulin producing cells in the pancreas still work, but the amount of insulin is insufficient in view of the needs of the body. The patients are usually obese, and the pancreas does not produce enough insulin due to excess glucose in the blood and increased body size, which is a consequence of obesity. An important factor is heredity, because in almost 30% of cases of adult diabetes is hereditary. Like many other body organs, the pancreas becomes more and more inefficient with age.
Juvenile diabetes (insulin-dependent)
This form of diabetes usually occurs in young people. The pancreas produces a very small amount of insulin, or practically nothing, so the patient depends on insulin injections. It is not known why there is such a disorder, although it is considered that it is associated with a failure of the autoimmune system due to which there is a permanent damage to (or destruction of) cells that secrete insulin. Due to the deficiency or lack of insulin, the body can not use glucose and is forced to use fat as a source of energy. Both forms of diabetes can be due to another disease – for example acromegaly, hyperthyroidism or Cushing’s syndrome. In this case, the disease is called secondary diabetes. Some people with secondary diabetes remain diabetics even after successful treatment of the underlying disease.
The main symptoms are the same in both forms of diabetes. The patient has to urinate often, sometimes even every hour, during the day and night, because excess of glucose passes into the urine, causing necessary increase of the volume of urine. Some patients may notice white “sugar spots” – i.e. stains from dried urine that is full of glucose – on underwear or shoes. Microbes proliferate in the “sweet” urine and can cause a variety of diseases of the urinary tract: cystitis, balanitis and pruritus vulvae. Due to excessive fluid loss, the patient is constantly thirsty, and sweetened drinks can increase urination and thirst even more.
Since the body cells are deprived of glucose, the patient feels an extraordinary fatigue, nausea and is apathetic – to the extent that sometimes he can not get up in the morning. Some diabetics (especially juvenile) showed substantial weight loss, as the body “burns” fat and muscles in order to come to power. Other possible symptoms we should mention are tingling in the hands and feet, leg cramps, reduced resistance to infection (sometimes the first signs of diabetes are blain and urinary tract infections), blurred vision due to an excess of glucose in the aqueous humor, as well as impotence in men and amenorrhea (absence of menstruation) in women.
Symptoms of juvenile diabetes usually develop quickly, over a few weeks or months, while the symptoms of adult diabetes often occur many years after the actual onset of the disease (which is sometimes detected only by chance during a routine medical check-ups).
From diabetes suffers approximately 1 person out of 70, although up to 25% of diabetics suffer from a form of the disease that does not cause any noticeable symptoms. The incidence increases with age; while the percentage in children is 0.5%, among elderly it increases to 3%. Juvenile diabetes usually affects boys and young men, while adult diabetes is the most common with obese people, especially middle-aged and older women. Diabetes is hereditary. However, even when both parents are diabetics, the possibility that their children will get this disease is about 5%.
Thanks to effective modern methods of treatment, a disease that was once often been fatal early in life, today represents a burden with which this outcome is very rare. However, even today, diabetes mellitus can be dangerous. In juvenile diabetics it may cause diabetic hyperglycemic coma, i.e. sleepiness accompanied by constant urination and intense thirst, or even fainting. Coma occurs because the body uses fat (instead of glucose) for the energy, and the by-products created in this process are toxic acids – ketones. Coma can occur before the beginning of treatment, after infection such as influenza (flu), or neglected disease treatment. Fortunately, with the rapid intervention of the hospital, people who are in coma usually achieve complete recovery.
In both types of diabetes other complications are possible, although they occur in a minority of cases, and usually 15 to 20 years after onset of the disease. Such complications are diabetic retinopathy, peripheral neuropathy, and chronic renal failure (chronic kidney disease).
People with diabetes are also at higher risk for atherosclerosis, arterial disease which is in turn accompanied by a risk of stroke, myocardial infarction and high blood pressure. The blood vessels leading to the legs are narrowing, causing cramps, chills in the feet, pain when walking (intermittent claudication), and even ulcers or dry gangrene. To avoid cuts or wounds that might cause gangrene, you must ensure that your nails are not cut too short, wear comfortable shoes and go regularly to a pedicure treatment of corns or ingrown toenails. If the cuts does not heal in 10 days, be sure to consult your doctor.
What to do?
If you suspect that you have diabetes, consult your doctor who will ask you a urine sample for analysis of the presence of glucose and ketones. If both glucose and ketones are present in large quantities, your suspicion will, unfortunately, be justified. If only glucose is found in the urine, your doctor will take a blood sample to measure the level of glucose in the bloodstream; in fact, some people have glucose in the urine, even though they are not diabetic. If those tests do not give definite results, you will need to go to the glucose tolerance test, i.e. a test in which your blood is taken before you drink a beverage containing glucose and thereafter. If the level of glucose in the later samples is abnormally high, your body does not produce enough insulin and you have diabetes. After a definitive diagnosis, the doctor will thoroughly examine you and then start treatment.
Diabetic patients are advised to join a self-protection unit to combat diabetes (if such units or “club” exists in your local community), because they will get valuable support and advice. Your doctor will give you a card, which you will carry with you all the time, and which includes your full name, address, information that you are diabetic, and instructions for help if you get sick. You can also get a bracelet or a necklace with the same information. In some countries, in addition, you must inform insurance company and institution that issues driving license about your condition, because otherwise your insurance and driving license would not be valid.
A cure for diabetes has not yet been found, meaning, if you have a diabetes you will need to get treatment for the rest of your life. Treatment is largely in the hands of the patient, so its effectiveness will largely depend on the patient himself.
In one third of cases, this form of the disease can be kept under control with diet. Diet limits the amount of carbohydrates, so obese patients significantly lose the weight. Permitted number of kilocalories per day is 800 to 1500 (3349-6280 ms), depending on the body mass. Generally speaking, the amount of carbohydrates should be small, but also regular in order to avoid too high and too low blood glucose levels. Do not eat sugar, sweets, cakes, jam, etc. Make sure that there is a sufficient plant fiber in the diet, so eat the bread of bran (wholemeal) and a lot of salads, fruits and vegetables. Avoid sweet drinks (if diabetes is under control, you can drink moderate amounts of beer, dry wine and spirits).
Engage in physical activities, regularly and moderately, and do not smoke cigarettes as this can further damage blood vessels and cause atherosclerosis. In mild cases, it is sufficient to avoid concentrated sugar in cakes, candies, cookies and sweet drinks to reduce blood glucose levels to normal. This is especially true if you manage to lose the weight, because in this case the amount of insulin that your pancreas secretes may be sufficient for reduced body mass.
Blood glucose levels should be monitored (i.e. you should regularly check how much you managed to lower the level), so your doctor will thake samples of blood at regular intervals or send you to the hospital for tests. In addition, the doctor will advise you to follow your own illness with glucose assay kit. You will have to do that every day, until you (with diet) reach normal blood glucose levels. However, when the situation returns to normal, it is easy to turn on old habits – especially if your case is a mild form of the disease. That is why you need to take care of yourself and do tests once or twice a week, and see your physician regularly for control, inspections, etc.
Although they strictly follow a special diet, many diabetics sooner or later discover that mentioned and similar tests of urine or blood do not show normal results anymore. In this case, the doctor will – along with a diet – prescribe hypoglycemic pills that will lower blood glucose levels. There are several types of such tablets on the market today so your doctor will, in case you feel side effects of one type of tablets, prescribe you another. In rare cases, if a patient took an overdose, hypoglycemia may develop. If this happens to you, just eat something sweet (because you will otherwise faint), and a day or two after that see your doctor so he can adjust the dose. To thwart such an attack while you are away from home, always carry a few lumps of sugar or glucose tablets. As the very diet may be insufficient to control the disease, hypoglycemic tablets may also gradually become more and more inefficient. When that happens, it will be necessary to take injections of insulin.
This form of diabetes is treated by diet and injections – once or twice daily – of insulin (obtained from the pancreas of cattle or swine, or by a microbial synthesis after so-called genetic engineering), which compensates for a lack or deficiency of this hormone in the body. Insulin can be administered only by injection; if taken by mouth, digestive juices will destroy it before it absorbs in the bloodstream. Your doctor will show you how to use a syringe, so you can give yourself injection under the skin in the thigh, arm or abdomen. Most people master this skill after several days. In diabetic children, injections must be given by their parents until the child is about 10 years old. Recently, in Japan, they were able to produce insulin that can be taken by mouth or in the form of suppositories.
You have to strictly stick to the program of main meals (as well as light meals in the meantime) recommended to you by a doctor. With ths program, your blood will be supplied with a constant amount of glucose, so the regular doses of insulin will still have roughly the same amount of glucose for “processing”. Insulin has various types and severity; your doctor will prescribe a particular type based on a number of factors, among which are also the age and stage of disease. Whenever you purchase insulin, make sure you get the correct type and strength.
Your doctor will advise you to check the effectiveness of treatment with tests which we described in section about adult diabetics. Such a test may be required several times a day. Some urine tests are not satisfying because they give only a positive or negative result, and the amount of glucose in the urine only approximately reflects the amount of glucose in the blood. Therefore, these days, more diabetics are using specially treated plastic strips or small battery meter (reflectometer) for measuring the actual amount of glucose in the blood. Given the fact that these blood tests provide accurate data on the level of glucose in the blood, the patients can more precisely control their own state.
For successful control of diabetes, self-discipline is important. Whenever you want to do any strenuous activity, e.g. to play tennis or digging in the garden, consult a doctor. Physical activity burns glucose and can cause hypoglycemia, so you might have to eat somewhat more food prior to those activities. Any disease – from the common cold to heart attacks (infarction) – causes stress and thus increases the amount of insulin needed. If you can not eat normally, drink drinks with glucose (but do not reduce the dose of insulin) and consult a doctor as soon as possible.
Diabetes can cause additional difficulties in pregnancy and in children. Sometimes, small children can not understand why they have to be on a diet and why are they not allowed to eat cake or drink lemonade, but when it comes to diet, you must not give in. If you are a diabetic, you should mention this to doctors or dentists before any therapy or surgery, so that they can take the necessary precautions.
If you are treating diabetes reasonably, you can expect a long and healthy life. You should not have particular difficulties with employment, because today diabetics are found in all kinds of professions. However, if you are taking insulin, you should avoid shift work that disturbs the regularity of a diet and taking injections. Also avoid work at heights and do not drive public transport vehicles or heavy goods vehicles because of the risk of hypoglycemia attacks. Even complications – although they are reflected in the small number of cases – can be reduced to a minimum by regular controls and taking recommended precautions.