The lack of insulin results in an inability to metabolize glucose, and the capacity to store glycogen (a form of glucose) in the liver and the active transport of glucose across cell membranes are impaired. The symptoms are elevated sugar levels in the urine and blood, increased urination, thirst, hunger, weakness, weight loss, and itching. Prolonged hyperglycemia (excess blood glucose) leads to increased protein and fat catabolism, a condition that can cause premature vascular degeneration and atherosclerosis (see arteriosclerosis). Uncontrolled diabetes leads to diabetic acidosis, in which ketones build up in the blood. Patients have sweet-smelling breath, and may suffer confusion, unconsciousness, and death. There are two distinct types of diabetes mellitus: insulin-dependent and noninsulin-dependent.Insulin-dependent Diabetes
Insulin-dependent diabetes (Type I), also called juvenile-onset diabetes, is the more serious form of the disease; about 10% of diabetics have this form. It is caused by destruction of pancreatic cells that make insulin and usually develops before age 30. Type I diabetics have a genetic predisposition to the disease. There is some evidence that it is triggered by a virus that changes the pancreatic cells in a way that prompts the immune system to attack them. The symptoms are the same as in the non-insulin-dependent variant, but they develop more rapidly and with more severity. Treatment includes a diet limited in carbohydrates and saturated fat, exercise to burn glucose, and regular insulin injections, sometimes administered via a portable insulin pump. Transplantation of islet cells has also proved somewhat successful since 1999, after new transplant procedures were developed, but the number of pancreases available for extraction of the islet cells is far smaller than the number of Type I diabetics. Patients receiving a transplant must take immunosuppressive drugs to prevent rejection of the cells, and many ultimately need to resume insulin injections, but despite that transplants provide real benefits for some whose diabetes has become difficult to control.Noninsulin-dependent diabetes
Noninsulin-dependent diabetes (Type 2), also called adult-onset diabetes, results from the inability of the cells in the body to respond to insulin. About 90% of diabetics have this form, which is more prevalent in minorities and usually occurs after age 40. Although the cause is not completely understood, there is a genetic factor and 90% of those affected are obese. As in Type I diabetes, treatment includes exercise and weight loss and a diet low in total carbohydrates and saturated fat. Some individuals require insulin injections; many rely on oral drugs, such as sulphonylureas, metformin, acarbose or another alpha-glucosidase inhibitor, thiazolidinediones, or dipeptidyl peptidase-4 (DPP-4) inhibitors.
Diabetes affects the way the body handles fats, leading to fat accumulation in the arteries and potential damage to the kidneys, eyes, heart, and brain, and statins (cholesterol-lowering drugs) may be prescribed to prevent heart disease. It is the leading cause of kidney disease. Many patients require dialysis or kidney transplants (see transplantation, medical). Most cases of acquired blindness in the United States are caused by diabetes. Diabetes can also affect the nerves, causing numbness or pain in the face and extremities. A complication of insulin therapy is insulin shock, a hypoglycemic condition that results from an oversupply of insulin in relation to the glucose level in the blood (see hyperinsulinism).
See A. Bloom, Diabetes Explained (1973); Portland Area Diabetes Program, Diabetes and Insulin (1988); M. Davidson, Diabetes Mellitus: Diagnosis and Treatment (1991).
Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia). Excess sugar is excreted in the urine (glycosuria). Symptoms include increased urine output, thirst, weight loss, and weakness. Type 1, or insulin-dependent diabetes mellitus (IDDM), an autoimmune disease in which no insulin is produced, must be treated by insulin injections. Type 2, or non-insulin-dependent diabetes mellitus (NIDDM), in which tissues do not respond to insulin, is linked to heredity and obesity and may be controlled by diet; it accounts for 90percnt of all cases, many of which go undiagnosed for years. Untreated diabetes leads to accumulation of ketones in the blood, followed by acidosis (high blood acid content) with nausea and vomiting and then coma. Careful attention to content and timing of meals, with periodic checking of blood sugar, may manage diabetes. If not, injected or oral insulin is necessary. Complications, including heart disease, diabetic retinopathy (a leading cause of blindness), kidney disease, and nerve disorders, especially in the legs and feet, account for most deaths. Degree of blood-sugar control does not always correlate with progression of complications. Gestational diabetes may occur as a complication of pregnancy.
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Endocrine disorder causing extreme thirst and excessive production of very dilute urine, apparently due to lack of antidiuretic hormone (vasopressin, which regulates the kidney's water conservation and urine production) or failure of the kidney tubules to respond to it. Injections of synthetic vasopressin are effective if the hormone is lacking but not if the response is absent. Disorders of the hypothalamus are one cause of diabetes insipidus.
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A NHS training course is available for type 1 diabetics called DAFNE (Dose Adjustment for Normal Eating).
The DESMOND programme is facilitated by two health care professionals who have been formally trained.