DIABETES MELLITUS

It pays to know about diabetes. Did you know that over twenty-four million Americans are diabetic, and that over five million have not been diagnosed yet Diabetes is a major cause of medical disability and retirement, of people having premature strokes and heart attacks, of amputations, and of winding up on kidney dialysis machines. It can significantly complicate pregnancy for both the mother and her unborn child. It is not yet curable. However, its symptoms and insidious damage can certainly be reduced with proper treatment.

Diabetes has been basically streamlined in its terminology, that is, there is Type 1 diabetes and Type 2 diabetes. Type 1 occurs because the specialized cells, called beta cells, in the pancreas produce too little insulin. Insulin has to be injected into the skin or blood stream to make up for this lack. Otherwise the person has a generalized wasting disease, gaunt appearance, weight loss in spite of a voracious appetite, unquenchable thirst, sugar in the urine, and high levels of sugar in the blood. Type 2 diabetes occurs when insulin receptor cells, especially in fat cells, are desensitized and dont utilize the insulin as they are supposed to do. There is often enough insulin present; it just doesnt have its normal effect. Some experts refer to Type 2 diabetes as a disorder of lifestyle. The affected person may have it gradually develop along with, and as a result of, central obesity, hypertension, lack of exercise, improper diet and other similar aspects of a dysfunctional lifestyle.

Type 1 diabetes includes the subset of patients previously classified as juvenile onset diabetics. At various times between birth and adolescence the insulin-producing beta cells of the pancreas simply stop working. We know sometimes the predisposition for this to occur may be hereditary, or it may be due to infection by a specific virus, or it may occur for such reasons as cystic fibrosis damaging the pancreas. This type of diabetes tends to be the most brittle and hard to control. The person so afflicted may go from one crisis to another: one with the blood glucose too high to one where the glucose is too low. Both cases are life-threatening, and these patients tend to develop the earliest occurrences of cardiovascular disease with alteration in brain function, stroke, heart attacks, kidney failure, and peripheral artery disease. Type 1 diabetes is usually managed by an endocrinologist with specialized training and experience in beta cell function. In addition to diet and exercise, novel approaches such as insulin pumps for continuous insulin administration may be tried.

Type 2 diabetes is the one which affects the majority of diabetics. Medicines are prescribed which tend to reinstate insulin sensitivity and others that actually lower blood glucose. Sometimes it is necessary to add varying quantities of insulin. Metformin, which increases insulin sensitivity, is usually the first one prescribed in Type 2 diabetes. Other medicines, like sulfonylureas and thiazolidinediones, can be given in tablet form to lower blood sugar either directly or by causing the pancreas to produce more insulin.

The issue for the Type 2 diabetics is whether to be passive or proactive in the treatment of their condition. By passive I mean (a) you dont follow a diabetic diet; (b) you dont try to lose down to your ideal body weight; (c) you simply wait for one more pills to take care of your problem. Certainly pills are an important part of the treatment plan, but they dont make up for all of it. You should talk to your doctor about an exercise program; you should work with a dietician about a diabetic diet. You should read every reliable thing you can about Type 2 diabetes. Knowledge is a key component in the quest for normal blood glucose with all its benefits. Work with your doctor on your goals of treatment, be honest and straight-forward with him concerning your efforts and problems, and make up your mind to be proactive.

John Drew Laurusonis M.D.

Doctors Medical Center