After digestion glucose passes into the bloodstream where it is used by cells for growth and energy. For glucose to enter the cells insulin must be present. Insulin's main role is to help move certain nutrients -- especially sugar -- into the cells of the body's tissues. Cells use sugars and other nutrients from meals as a source of energy to function. The amount of sugar in the blood decreases once it enters the cells. Normally that signals the beta cells in the pancreas to lower the amount of insulin secreted so that you don't develop low blood sugar levels hypoglycemia. But the destruction of the beta cells that occurs with type 1 diabetes throws the entire process into disarray. In people with type 1 diabetes, sugar isn't moved into the cells because insulin is not available. When sugar builds up in the blood instead of going into cells, the body's cells starve for nutrients and other systems in the body must provide energy for many important bodily functions.
There are many types of diabetes mellitus, the most common of which are:
• Type 1 Diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy.
Type 1 diabetes appears to occur when something in the environment, such as a toxin or a virus, triggers the immune system to mistakenly destroy the beta cells of the pancreas to the point where they can no longer produce sufficient insulin.
• In Type 2 Diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Millions of Americans have been diagnosed with type 2 diabetes, and many more are unaware they are at high risk. Type 2 diabetes has strong genetic links, meaning that type 2 diabetes tends to run in families. Several genes have been identified and more are under study which may relate to the causes of type 2 diabetes. Some groups with a higher risk for developing type 2 diabetes are African Americans, Latinos, Native Americans, Asian Americans, Native Hawaiians and other Pacific Islanders.
• Gestational Diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy.
Gestational diabetes generally has few symptoms and it is most commonly diagnosed byscreening during pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied. No specific cause has been identified, but it is believed that the hormones produced during pregnancy increase a woman's resistance to, resulting in impaired glucose tolerance.
Babies born to mothers with gestational diabetes are at increased risk of problems typically such as being large for gestastional age (which may lead to delivery complications), low blood sugar, and jaundice. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks.
The classical symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes symptoms usually develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible mental fatigue. All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled, although unexplained weight loss may be experienced at the onset of the disease. Final diagnosis is made by measuring the blood glucose concentration.
Management concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible without presenting undue patient danger. This can usually be with close dietary management, exercise, and use of appropriate medications (insulin only in the case of type 1 diabetes mellitus. Oral medications may be used in the case of type 2 diabetes, as well as insulin).
There are also roles for patient education, dietetic support and sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, lifestyle modifications are recommended to control blood pressure in patients with hypertension and cholesterol in those with dyslipidmia.
The major goal in treating diabetes is to minimize any elevation of blood sugar glucose without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes is treated first with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, treatment with insulin is considered.
Adherence to a diabetic diet is an important aspect of controlling elevated blood sugar in patients with diabetes. The American Diabetes Association (ADA) has provided guidelines for a diabetic diet. The ADA diet is a balanced, nutritious diet that is low in fat, cholesterol, and simple sugars. The total daily calories are evenly divided into three meals. In the past few years, the ADA has lifted the absolute ban on simple sugars. Small amounts of simple sugars are allowed when consumed with a complex meal.
Weight reduction and exercise are important treatments for diabetes. Weight reduction and exercise increase the body's sensitivity to insulin, thus helping to control blood sugar elevations.
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