Diabetes mellitus is probably as old as mankind. We know that the ancient Egyptians gave an accurate description of the condition. The name came from the way the Greeks described diabetes 2,500 years ago. Diabetes means a siphon or 'running through.' Mellitus refers to the sweetness of honey. People with diabetes urinated more often than normal and their urine was found to be sweet. Hence, people with these symptoms were said to have diabetes mellitus.
Today we know more about the condition but the symptoms remain the same. Diabetes mellitus describes a group of disorders that have one feature in common. There is a greater than normal amount of sugar (glucose) in the blood.
Glucose (the main sugar in the blood) is necessary for cells of the body to function properly. It is the main source of fuel for all cells and the only fuel for some. For instance, it is the only nutrient the brain can use as fuel. Glucose is supplied by the food that we eat and by the liver, which serves as a factory to manufacture it. Once in the blood, it can be carried to the tissues and used by all cells for energy.
Insulin is a hormone that is produced in the pancreas. It is needed for the glucose to enter, and be used by, certain cells of the body (especially muscle). Without insulin, glucose stays in the blood where it accumulates. When the level of glucose gets too high, the diagnosis of diabetes is made.
Ineffective insulin use can be due to either the absolute lack of insulin in the blood or no insulin activity at the cell. Lack of insulin means that none is being produced by the body. Lower insulin activity at the cell is referred to as insulin resistance. In this situation the body resists the action of insulin and requires greater amounts to do the same job.
Type 1 diabetes, formerly known as insulin-dependent diabetes, is associated with an absolute lack of insulin. Since insulin is essential for life, a person with Type 1 diabetes will not survive without its replacement.
People with Type 2 diabetes produce insulin but not enough to meet their needs. They almost certainly have insulin resistance and require even more insulin which their bodies are unable to produce.
A person does not develop diabetes from eating too much sugar! The tendency to have diabetes is inherited, meaning a person is born with the gene for the condition. We are not certain which factors cause Type 1 diabetes in someone carrying the gene. In certain circumstances, some viruses may be the cause. In a person with Type 2 diabetes, it is often a high-fat diet or simply being overweight, added to the presence of the gene, that produces the condition.
Classical symptoms that occur when blood glucose is high include tiredness, thirst, increased urination during the day and having to get up more often at night to urinate. Other possible symptoms include vaginal yeast infections, muscle cramps, and 'pins and needles' sensation in the feet. Many people who have diabetes do not have symptoms. The diagnosis is made on a blood test during a routine physical exam.
Untreated diabetes is dangerous. High blood sugars increase the risk of blindness, kidney disease (requiring dialysis or transplant), foot infections and amputations, and other disabilities. We also know diabetes is a major risk factor for heart attacks and strokes.
When diabetes is treated, these complications are much less likely and a person has a better chance at a long, healthy life. The closer to normal the glucose level is maintained, the less chance there will be of having problems.
The cornerstone of treating diabetes is a healthy diet. A low-fat diet with the proper number of calories is best. It is much easier for the body to keep the blood glucose controlled if the calories are spread evenly through the day.
Exercise helps to lower blood sugar during and for several hours after exercise. A program of regular exercise is recommended for anyone with diabetes.
Pills are available to treat Type 2 diabetes when diet and exercise are not sufficient. The sulfonylurea drugs ask the body to produce more insulin. Biguanides improve the liver’s sensitivity to insulin and the alpha-glucosidase inhibitors produce lower blood sugars by controlling delivery of glucose to the blood after eating. Two newer classes of drugs are the meglitinides and thiazolidinediones. Meglitinides stimulate insulin production and control glucose after a meal, while thiazolidiones enhance the action of insulin in muscles.
Insulin is required for a person with Type 2 diabetes who is not completely controlled on pills and for everyone with Type 1 diabetes. The only method of delivering insulin to the bloodstream at present is by injection because the stomach would digest the insulin molecule if it were swallowed.
Through research, we are entering a new era of treating diabetes. New pills are becoming available with novel mechanisms of action. New insulins are available and more are on the way. With the new insulins, better delivery devices, and more accurate glucose monitors (blood glucose testing machines), it is easier to keep the blood sugars controlled.
Complications are being found and treated earlier. Drugs are becoming available to prevent complications or stop them from progressing.Our understanding of both Type 1 and Type 2 diabetes is now to the point that several studies are underway to try to prevent these illnesses. A cure will be next.
The future looks hopeful for diabetes treatment. Meanwhile, follow the recommended diet, get regular exercise and take your medications exactly as they are prescribed. Learn as much as you can by attending diabetes education programs and public forums, joining a support group, and reading as much as you can find. You can take control and manage your disease.