Diabetes Mellitus

What is diabetes?

After a meal, food in the digestive tract of a normal person will be converted into sugars and fats that are deposited in the blood stream. In response to eating, the pancreas produces a molecule called insulin that tells the body to convert the sugar in the blood into fat for storage.

Diabetes is a disease where the body is unable to convert sugar into fat. This may occur if the body is unable to produce insulin or if the insulin produced is insufficient to drive the sugar-to-fat conversion.

How do people get diabetes?

Type 1, or insulin-dependent, diabetes occurs when the cells producing insulin in the pancreas are destroyed. People with Type 1 diabetes are therefore unable to produce insulin. This type of diabetes is congenital, meaning that it is a condition inherited through the genes, and usually reveals itself in childhood.

Type 2, or insulin-resistant, diabetes occurs when the ability of insulin to convert sugar to fat is decreased, and the body cannot make enough insulin to overcome the decrease. This can happen if a person becomes overweight or obese. Type 2 diabetes is caused by a combination of genes and an unhealthy diet.

Less commonly, diabetes can also occur during pregnancy or be caused by drugs or illnesses.

How do doctors treat diabetes?

If the body is unable to produce insulin, as in Type 1 diabetes, the disease must be treated with replacement insulin therapy, which is injected into the body.

If the body is unable to produce enough insulin, as in Type 2 diabetes, the disease may be treated with oral drugs that decrease the conversion of food into blood sugar, increase the sensitivity to insulin, and/or stimulate the pancreas to produce more insulin. In severe cases, patients may also require insulin injections to control their blood sugar.

What happens if diabetes is not controlled?

Uncontrolled diabetes has many consequences. Common side effects include:

• Increased (2-4 times) risk for heart attack

• Doubled risk for stroke

• Kidney disease leading to renal failure

• Eye disease leading to retinopathy and possible blindness

• Pain and tingling in the feet and legs leading to ulcers and eventual amputation

• Poor wound healing and frequent infections

Can people be cured of diabetes?

In Type 1 diabetes, the insulin-producing ability of the pancreas is permanently destroyed. Patients with this variant will require insulin injections for the remainder of their lives.

In less severe or early Type 2 diabetes, the decreased production of insulin and resistance to its function can be reversed by a healthy diet and regular exercise.

Severe cases of Type 2 diabetes may not be reversible by lifestyle modification; such patients will require medical therapy indefinitely.

For more information:

• Diabetes overview from the National Institutes of Health

• Diabetic diet from MedlinePlus

• Health risk calculator from the American Diabetes Association