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Diabetes Mellitus : Type 1 and Type 2

Diabetes Mellitus : Type 1 and Type 2

Diabetes can manifest itself in two different forms and severities. When there is an occurence of diabetes due to an inadequate production of insulin by the pancreas, it is a condition of Diabetes mellitus. Insulin is a hormone which regulates the level of glucose (sugar) in the blood stream. Glucose serves as a vital source of energy for all organs in the body and is the only source of energy that can be utilized by the brain. But insulin is needed to control the glucose levels in the blood so that the body can effectively use it for regulation of metabolism. Insulin is critical in the transport of glucose to the cells for energy metabolism.

The two forms of diabetes are discussed below:

TYPE 1 Diabetes: Diabetes of this kind usually manifests in childhood or adolescence. Patients suffering from this type of diabetes are dependent on insulin injections to maintain normal body chemistry. This type of diabetes can be inherited. If this is not tackled with insulin, diabetic ketoacidosis and death can result. Type 1 Diabetes is referred to as insulin dependent diabetes.

TYPE 2 Diabetes: Usually, middle aged and overweight people suffer from this type of diabetes when their blood sugar is higher than normal. This manifestation of diabetes is also known as adult onset diabetes. Insulin injections are not needed to conrol this form of diabetes but a suitable diabetes diet and weight reduction can help. But this form of diabetes can lead to long term diabetic complications.

Complications arising out of long-term diabetes
1. Diabetic Retinopathy: There is damage to the retina (perceptive structural tissue of the eye). This condition results in decreased vision and sometimes leads to blindness.
2. Kidney Disease: Impaired kidney function can be a resultant of long term diabetes. It can even lead to overt kidney failure.
3. Stroke: Diabetics have an increased risk of stroke.
4. Heart Disease: Increased risk of myocardial infarction (heart attack).
5. Peripheral Vascular Disease
6. Poor Wound Healing: Ulcers and foot problems are common
7. Decreased immunity to infection
8. Peripheral Neuropathy: Patients suffering from Diabetes face damage to the peripheral nerves and altered sensation. It is also accompanied by numbness, tingling and/or burning pain to the extremeties.
9. Females who are diabetic need to be carefully monitored during pregnancy

Type I Diabetes manifests itself in symptoms such as increased frequency of urination, increased thirst and hunger. Type I Diabetic patients also experience weight loss and increased fatigue. Read up the symptoms of diabetic ketoacidosis

Type II Diabetes is characterized by increased hunger and thirst and increased fatigue. Persons suffering from this form of diabetes face numbness or tingling in the hands and feet as well as frequent infections along with slow healing of cuts, ulcers and sores. Impotence is yet another resultant condition.

Random and fasting blood sugar testing can help in revealing any indications of diabetes. Examining the medical history combined with a physical examination is also done by a physician. To confirm the diagnosis, a Glucose tolerance testing is also done. Blood tests for kidney profile and blood counts are also done. Urinalysis will show the excess presence of glucose.

Treating Diabetes
1. Controlling the symptoms of diabetes.
2. Achieving and maintaining a desirable weight.
3. Achieving and maintaining a healthy level of physical activity.
4. Achieving and maintaining a nearly-normal blood glucose level (between 70 mg/dl and 140 mg/dl).

Treatment of type 1 diabetes requires adherence to a strict diabetes diet and regular doses of insulin. Failure to take care of the diabetic condition can lead to potentially serious outcomes. Blood glucose levels must be monitored so that complications are avoided. Diabetics must be trained to check their own blood and urine glucose levels. They can use the newer forms of ambulatory glucose monitors that can give you automatic readings and help in diabetes management. Avoiding sweets is an elementary precaution that needs to be followed. Many a time, oral hypoglycaemic agents (Orinase, Glucatrol) may be used for regulating blood sugar levels. Find out more on a diabetes diet (in total calories). You can seek help from an Internist or Endocrinologist

Use of Steroid medications (i.e. Prednisone and Medrone) can increase blood sugar levels. They can affect the control and treatment of diabetes. Beta-blocker antihypertensive medications are yet another set of medicines that can cause serious complications for the diabetic patient and should be avoided.

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening condition when the body has practically no insulin. This insulin deficiency results in extremely high blood sugar levels. Consequently, the muscle, fat and liver cells cannot use glucose for fuel. These cells are converted into glucose by hormones such as glucagon and adrenalin and turned into ketones through oxidation. As a result, the body uses fat for fuel. The increased levels of blood sugar are not flushed through urination. DKA is usually noticed in patients suffering from Insulin-dependent diabetes. A person can suffer from diabetic ketoacidosis if there has been severe dehydration and consequently the blood chemistry has been affected. There is accumulation of organic acids and ketones in the blood. Elevated ketone levels in the body upset its blood pH and make the blood acidic thereby triggering a toxic condition for the body's cells. Diabetic ketoacidosis is noticed when hyperglycemia exceeds over 300 mg/dL. If diabetes ketoacidosis is not attended in time, it can lead to coma and death. Surgery, infection, trauma, stroke or heart attack can also trigger diabetes ketoacidosis. Insufficient fluid intake, pancreatitis and alcohol abuse can trigger diabetes ketoacidosis.

Symptoms of diabetes ketoacidosis include excessive thirst and general weakness. There is frequent urination, loss of appetite and vomiting. Other symptoms of diabetes ketoacidosis are weight loss and abdominal pain. A person suffering from DKA tends to experience low blood pressure and increased heart rate. High ketone levels can give rise to a fruity-scent on the breath and vomiting. The patient will be restless and agitated. The skin will be hot and dry and appear flushed. Patients suffering from diabetes must check their blood glucose levels if they notice any symptoms of diabetes ketoacidosis. Poor diabetes management can lead to DKA.

Acidosis can be checked by testing the pH of the blood. Normal blood pH ranges from 7.35 to 7.45. If it is observed to be below 7.35, acidosis may have set in. Ketosis, acidosis and hyperglycemia can be diagnosed through blood tests. The patient will need fluid replacement till the body is sufficienty rehydrated. Electrolytes must also be suitably replaced as they are essential to the working of major organs and nerve cells. Electrolyte imbalance can lead to severe health hazards. Intravenous insulin aids in using up glucose for energy. Thus the breakdown of fat is stopped. Consequently acidosis and ketosis processes will be reversed.

Diabetic Neuropathy

When there is loss of normal function of the nervous system as a result of long standing diabetes, it is a condition of Diabetic neuropathy. This may manifest as a dysfunction in the autonomic nervous system, which regulates bodily functions such as the maintenance of blood pressure and heart rate. Peripheral nerves that supply sensation to the extremeties may also get affected by Diabetic neuropathy. This condition is known as peripheral neuropathy.

Patients suffering from Diabetic Neuropathy complain of loss of feeling in the feet and legs along with associated burning pain in the lower extremeties. The loss of feeling can give rise to injuries to the patient without his being aware of it. It has been noticed that wounds and ulcers heal poorly on diabetic's legs.

Another manifestation of diabetic neuropathy is impotency since it has been noticed that 50% of men with diabetes develop impotence within 6 years of the onset of diabetes.

There are medications to control the symptoms though there is no cure for the complications that arise from a diabetic condition. An Internist or Endocrinologist can assist you in the regulation of your diabetes by closely monitoring and regulating the blood sugar levels.