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What is Diabetes?

Diabetes Mellitus is a syndrome characterized by hyperglycemia (high blood sugar), glycosuria (sweet urine) and is caused by an impairment in insulin secretion/and or insulin action. Insulin is a hormone produced by the beta cells of the Islet of Langerhans in the pancreas and is responsible for glucose metabolism. When these beta cells are destroyed (by an auto immune process or by virus), the insulin production is diminished or halted, leading to the body's inability to metabolize glucose, thereby causing hyperglycemia (high blood sugar), the condition we call Diabetes Mellitus.

Where did the name Diabetes Mellitus come from?

Diabetes is a Greek word that means "excessive urine" and Mellitus is a Latin name for "honey." Put together, they describe the medical condition where the patient has blood "as sweet as honey" and excessive urine.

How prevalent is Diabetes?

There are more than 300,000 Filipinos who suffer from Diabetes Mellitus. In the United States, there are about 16 million diabetics and about 1800 new cases are diagnosed each year. Type I Diabetes, used to be called Juvenile Diabetes, is insulin-dependent (the person's pancreas does not produce insulin), meaning insulin injection is needed to treat the condition. It is medically known as IDDM (Insulin Dependent Diabetes Mellitus, most commonly among persons younger than 30 years old associated obesity is not common. It accounts for 5 to 10% of all diabetics. Type II Diabetes is NIDDM (Non-Insulin Dependent Diabetes Melllitus), which can be treated by pills (sulfonyl ureas, antihyperglycemic drugs) rather than insulin, most commonly found among those who are older than 30, and associated obesity is frequent. It accounts for majority (90 to 95%) of diabetics. The third type is Gestational Diabetes.

Is Diabetes hereditary?

Yes, as suggested by a strong association that exists between type I Diabetes diagnosed among patients younger than 30 years old and specific HLA-D phenotypes. One or more genes that convey susceptibility to type I Diabetes are believed to be located in chromosome 6. A baby born to a mother, age 25 or older, with type I Diabetes has about one percent risk of developing Diabetes, which is the same risk as one born to a parents who are not a diabetics. But if the diabetic mother is younger than 25, the risk increases to 4 percent. If the father has type I Diabetes, the risk is about 6%. The risk is about 12% if both parents developed diabetes before age 11.

Are there environmental factors that cause Diabetes?

Yes. Viruses (German Measles, Mumps, Coxsackie B) may incite the development of autoimmune destruction of the beta cells in the pancreas. The viruses contain proteins that look very similar to the proteins found in the insulin-producing beta cells in the pancreas. The body's immune system mistakes the beta cells for virus particles and destroy them along with the viruses, causing insufficient insulin production. Exposure to cow's milk RATHER THAN maternal milk during infancy (where the albumin from cow's milk may cross react with islet protein) have been postulated to be a factor in the causation of Diabetes. Geographic location appears to play a role, as the incidence of type I Diabetes is alarmingly high in Sardinia and Finland, compared to the rest of the world.

Can pregnancy cause Diabetes?

Yes, but fortunately (and obviously) not every pregnancy leads to Diabetes Mellitus. When it occurs, it is called Gestational Diabetes and develops more than halfway through pregnancy. At about the 24th week, the placenta starts to produce hormones that increase insulin resistance for the duration of the pregnancy. If the insulin resistance becomes severe enough, the woman develop Gestational Diabetes. As in type II Diabetes, obesity and age over 30 are key factors for Gestational Diabetes.

So, when should pregnant women be tested for Diabetes?

Prenatal care is very essential. All women, starting from the 24th week of pregnancy, should be tested for insulin resistance and Gestational Diabetes. Those who are at a higher risk of this condition should be tested earlier, even at 16 weeks, and, if negative, should be retested in 24 to 28 weeks. In the United States, Diabetes complicates about 4% of pregnancies, with Gestational Diabetes accounting for 88%, or an estimated 135,000 pregnancies a year. Diet is the cornerstone in the treatment of Gestational Diabetes. An estimated 75 to 90 percent can be managed successfully with diet and exercise. If untreated or not properly treated, this could lead to birth defects. This is the reason why it is prudent for all pregnant women to have a regular prenatal check-up, which will include the above mentioned tests.

Do oral contraceptives cause Type II Diabetes?

Recent evidence has shown that women who developed Gestational Diabetes while pregnant, and shortly after birth of the child used oral contraceptives for six months or more significantly increases their risk of developing type II Diabetes. The pill with greatest risk was the "progestin-only" variety. The ones reported causing the least risk were combination pills with low doses of progestin. This reinforces the danger of taking oral contraceptives without physician supervision.

Does Diabetes cause impotence?

Male erectile dysfunction, the inability of men to have adequate erection and maintain it for a successful sexual intercourse, is common among diabetics. Today, with the aid of Sildenafil Citrate (Viagra), this complication of diabetes is effectively managed, allowing diabetic males to have normal sexual activities. Other possible complications of diabetes are blindness, kidney failure, heart attack, stroke and damage to the nerves of the feet, etc.

Is type II Diabetes also genetic in origin?

Genetics also play a role in the etiology of type II Diabetes Mellitus, but lifestyle is a bigger factor. This type of Diabetes tends to run in families and genetics can increase the tendency. However, type II Diabetes is largely a disease of obesity and lack of exercise. In spite of the genetic predisposition, type II Diabetes can be prevented by an effective diet, weight loss and exercise program under a physician's supervision.

Is eating sweets bad for diabetics?

Yes, but only IF these food items are eaten over and above what has been prescribed as the total daily calorie intake. If the amount of calories from certain sweets (desserts, etc.) have already been computed into the prescribed diabetic diet, then these items are acceptable. The idea is to stay within the total calories allowed per day.

How do I know if I have Diabetes?

If your blood sugar is persistently elevated to greater than 140 mg/DL or 7.77 mmol/L, then you have Diabetes Mellitus. But the prudent way to find out is by visiting your physician who will evaluate your symptoms and detailed history, etc. and make a definitive diagnosis, and prescribe a management strategy for you according to the type of Diabetes you have.

What is an Insulin Pump?

The state-of-the-art method of administering insulin to insulin dependent diabetic patients is by the use of an implantable insulin pump. The small device is implanted under the skin and the catheter connected to it is inserted into a vein. The computerized pump contains insulin in its chamber and delivers a precise dose of insulin at a preset time schedule. The insulin chamber is refillable. This pump replaces the needle injection as a method of giving insulin.

When a diabetic passes out, does it mean high blood sugar?

Not always. If the patient is non-compliant and the blood sugar shoots up very high, the patient could go into diabetic coma. If the diabetic patient is on treatment, and his sugar goes down too low (hypoglycemia), could feel faint and pass out also. As the patient gains personal experience in the care of his/her diabetes, most patients will eventually be able to tell if hypoglycemia is about to occur. For this, drinking orange juice loaded with sugar, or eating candies, is the most common practice among diabetics. Diabetics must have self-discipline to stick to their prescribed diet, take their medications properly, monitor their blood sugar as directed by their doctor, exercise daily, visit their physician regularly for checkup, including blood sugar test and eye exam. As always, the physician's role in the management of any medical condition, especially Diabetes Mellitus, is essential in preventing the complications of Diabetes and the general well-being of the patient.

©2003Raoul R. Diez, M.A.O.D.