Diabetes Mellitus (DM)
The term diabetes mellitus encompasses the abnormalities in carbohydrate metabolism that result in hyperglycemia. Insulin, the hormone that effects sugar entering the cells, can be absent or its production can be impaired (TYPE 1) or there can be “insulin resistance” of tissues to insulin (TYPE 2).
The prevalence of DM in the U.S. is >8%, and it consumes more healthcare resources than any other illness. Treatment requires continuous management of alterations in blood sugar by keeping the blood sugar within a desired range that extends life expectancy and reduces its complications.
The mainstay of managing diabetes is the administration of insulin. Other less invasive methods can be used prior to insulin becoming necessary which include oral hypoglycemics and diet modification.
The Types of Diabetes
Type 1 DM is an autoimmune disease in which the insulin-producing cells in the pancreas are destroyed. It makes up about 5-10% of the cases of DM. It begins in childhood in 3/4 of the cases, creating complications beginning earlier than those seen in Type 2 DM.
Type 2 DM is a decrease in sensitivity to insulin, which is called a “relative” insulin deficiency. It makes up 90% of the cases of DM. The risk of developing it rises with age and its prevalence continues to rise as more people are living longer. Because of its “relative” insulin deficiency, as opposed to the “absolute” deficiency of Type 1 DM, initial treatment can involve oral hypoglycemics that lessen this resistance.
In diabetes, co-morbidities impact each other negatively. High lipids, especially triglycerides, low HDL-cholesterol, hypertension, obesity, and other characteristics collectively called “the metabolic syndrome” combine with diabetes to cause worsening of all of them. The metabolic syndrome is an important consideration because of the increased risk it creates toward developing Type 1 DM.
In diabetes, the narrow range of acceptable blood sugars requires aggressive management to prevent complications. These include diabetic retinopathy, nephropathy, diabetic ulceration and foot pain, and cardiovascular complications.