Chapter: 6.5 Diabetes Mellitus

Diabetes Mellitus - a complex disorder of carbohydrate, fat and protein metabolism that is primarily a result of a deficiency or complete lack of insulin secretion by the beta cells of the pancreas or resistance to insulin. The various forms of diabetes have been organized into categories developed by the Expert Committee on the Diagnosis and Classification of diabetes mellitus of the American Diabetes Association. Type 1 diabetes mellitus in this classification scheme includes patients with diabetes caused by an autoimmune process, dependent on insulin to prevent ketosis. This group was previously called type I, insulin dependent diabetes mellitus (IDDM), juvenile onset diabetes, adult onset diabetes, ketosis prone diabetes, patients with type 2 diabetes mellitus are those previously designated as having type II non insulindependent diabetes mellitus (NDDM), maturity onset diabetes, adult onset diabetes, ketosis resistant diabetes, or stable diabetes. The onset of type 1 diabetes mellitus is sudden in children. Type 2 diabetes often begins insidiously. Those with gestational diabetes mellitus are women in whom glucose intolerance develops during pregnancy. Other types of diabetes are associated with a pancreatic disease, hormonal changes, adverse effects of drugs, or genetic or other anomalies. A fourth subclass, the impaired glucose tolerance group, also called pre diabetes includes persons whose blood glucose levels are abnormal although not sufficiently above the normal range to be diagnosed as having diabetes. Approximately 95% of the 18 million diabetes patients in the United States are classified as type 2, and more that 70% of those patients are obese. Contributing factors to the development of diabetes are heredity, obesity, sedentary life style, high fat low- fiber diets, hypertension and aging. The goal of treatment is to maintain insulin glucose homeostasis. Type 1 diabetes is controlled by insulin, meal planning and exercise. Tight control of blood glucose level [i.e. frequent monitoring and maintenance at as close to normal as possible to the level of non diabetics] significantly reduces complications such as eye disease, kidney disease and nerve damage. Type 2 diabetes is controlled by meal planning, exercise, one or more oral agents, and insulin, stress of any kind may require medication adjustment in both type 1 and type 2 diabetes.