According to the charity Diabetes UK, about million people in the UK have Diabetes Mellitus and 75 per cent of them have type 2 (12). Type 2 Diabetes Mellitus (known as non-insulin-dependant), which results from the body's inability to respond properly to the action of insulin produced by the pancreas. Type 2 Diabetes Mellitus is much more common and occurs most frequently in adults, but being noted increasingly in adolescents as well. In type 2 Diabetes Mellitus people have high levels of insulin circulating in the blood because the ability of the Islet cells to produce the hormone is well preserved. This is quite different to type 1, in which the destruction of beta cells and hence falling insulin production occurs early on is the cause of the condition. However, the effects that insulin has on its target tissues (such as muscle and liver cells) is markedly impaired in type 2 Diabetes Mellitus. The beta cells (i.e. insulin-producing cells) of the pancreas gland in people with type 2 Diabetes Mellitus do not seem to undergo the attack from the immune system that is seen in Type 1. Beta cells are unable to cope. In people who don't have Diabetes Mellitus insulin surge stimulates the body to store excess glucose coming in through the digestive system and so keeps the blood glucose level fairly constant. In type 2 Diabetes Mellitus the inadequate response from the beta cells causes blood glucose to climb even further after meals.Therefore there are two processes going on in type 2 Diabetes Mellitus:
1. Inadequate release of insulin in response to raised blood glucose (beta cells failure)
2. Inadequate effects of insulin upon the tissues of the body (insulin resistance) (11).
Type 2 Diabetes Mellitus is quite different to type 1. In the former there is an excess of insulin production but in the latter there is a deficiency. Type 2 Diabetes Mellitus is a famine in the midst of a feast - there is (initially) plenty of insulin but it becomes increasingly ineffective as tome goes on (6).
When someone develops type 1 Diabetes Mellitus they have it forever. We don't have the power to make betta cells work again to produce insulin, so a diabetic who needs insulin injections due to type 1 Diabetes Mellitus will always need them. In type 2 Diabetes Mellitus, however, the beta cells remain able to produce insulin for many years, although they do so inefficiently. Some of the treatments for type 2 Diabetes Mellitus take advantage of this by stimulating the beta cells to work better but as time goes by there comes a stage in some people with type 2 Diabetes Mellitus when their beta cells become exhausted. Then, no matter how much treatment is given, it becomes impossible to coax enough insulin out of the pancreas to overcome person's insulin resistance. Blood glucose begins to climb higher and in effect the person's Diabetes Mellitus has changed into "insulin-requiring type 2 disease" (10).
There are several symptoms that are common to two main types of Diabetes Mellitus:
* Thirst
* Frequent passage of urine
* Fatigue or non-specific ill health
* Blurring of vission (due to changes in the lenses of the eyes)
* Tendency to infections (particularly yeat infections like trush)
These symptoms relate to the inefficiency or absence of action of insulin within the body. Insulin is essential for most cells to utilise glucose for energy and without it people easily become fatigued. They also start to burn up reserves of alternative energy such as fat and muscle tissue. Particularly in the type of Diabetes Mellitus that is common in younger people (type 1), this can lead to rapid weight loss. Despite the weight loss, appetite is often increased. This is contrast with the type of Diabetes Mellitus commoner in older people (type 2), which tends to come on more gradually and is usually associated with the person being overweight (3).
You don't need to have all of these symptoms to be a diabetic and there are many conditions other than Diabetes Mellitus that can cause the same symptoms. The presence of any of them is good enough reason to see doctor and have a check up.
Several of the symptoms result directly from the physical effects of raised blood glucose levels and are fue to "osmosis". Osmosis is the tendency for water to equalise its concentration when two solutions of different strenght are seperated by a "semi-permeable membrane". A semi-permeable membrane is a barier whose microscopic structure contains holes large enough to allow through molecules of water, but little or none of the material that's dissolved in water. That's why a diabetic person can become thirsty and pass lots of urine. If the blood sugar is high enough to exceed the kidney threhold for glucose then this causes glucose to appear in the urine. That urine glucose has an osmotic effect, and draws extra water from the tissues surrounding the millions of tiny tubes that make up the kidney's filter. The person passes excess amounts of urine, which leads to thirst. Blurring of vision can be a symptom of diabetes and is also an osmotic effect due to high blood glucose levels acting for month on the lens of each eye. The lens absorbs the extra glucose and then draws in more water from the surrounding tissues. It therefore swellup, which of course changes its optical properties and puts the eye out of focus (7).
These symptoms relate to the inefficiency or absence of action of insulin within the body, that is part of diabetes.
There are many complications that are associated with Diabetes Mellitus. Many of the problems arise because high glucose levels damage the fine structure of the arteries throughout the body. Arteries deliver the blood that nourishes every tissue and in diabetes this process is impaired. Diabetes increases the risk of developing hardening of the arteries (atherosclerosis), which leads to narrowing and blockage of the circulation. The effects of that depend on the organ involved: blockage of heart arteries leads to angina and heart attacks, whereas in the brain a stroke can result. Many of the long-term complications relate to the damage to nerve and/or blood glucose. It can affect nerves in any part of the body, but it's mostly likely to cause problems with feet. Some people may be more likely to experience complications because of their genetic make-up. The fact that most people who develop non-insulin-dependant Diabetes Mellitus do so in their fifties or sixties means they may be at increased risk of circulatory problems, especially coronary heart disease. By this time of life, many people already have some degree of hardening of the arteries, which happens to all of us to some extent as we get older, and they may have also accumulated fatty deposits on the inside of the arteries. Raised blood glucose can exacerbate both these conditions, probably because it alters the balance of certain fats, such as cholesterol, in the blood. If blood glucose was high for some time before Diabetes Mellitus was diagnosed, people may notice that distance vision improves once treatment has brought down blood glucose levels. This is because raised glucose changes the shape of the lens and interferes with its ability to focus properly. People who have had Diabetes Mellitus for many years may suffer damage to the blood vessels at the back of the eyes, especially if the condition has not been well-controlled. Men who had poorly-controled diabetes for some years may become impotent as a result of damage to the nerves and blood supply to the penis. Diabetes Mellitus has the potential to accelerate hardening of the arteries which can result in poor blood supply to the feet and fingers. This increases susceptibility to such problems as infections and neuropathy, and may make more sensitive to extremes of heat and cold. Diabetes Mellitus can damage the kidneys and in a significant proportion of people severe kidney failure can eventually result. The kidneys are essential organs. They filter and eliminate the waste products of metabolism, have a central role in controlling blood pressure and fluid balance in the body and produce the key hormone that stimulates the bone marrow to manufacture red blood cells. When the blood vessels in the kidneys are injured, kidneys cannot clean body properly. Body will retain more water and salt than it should, which can result in weight gain and ankle swelling. It may have protein in urine. Also waste materials will build up in blood. Diabetes Mellitus may cause damage to nerves in body. This can cause difficulty in emptying bladder. The pressure that results from full bladder can back up and injure the kidneys. If urine stays in bladder for a long time, it may get an infection. This is because bacteria grow rapidly in urine that has a high sugar levels (10).
The Diabetes Mellitus can can be eliminated by bearing in mind a few basic principles:
* Insulin lack, directly or indirectly, is the basis of diabetes.
* Insulin moves excess glucose into storage (in the liver) and moves glucose into muscles for use in activity.
* The amount of energy the muscles need depends on the person's level of activity.
* Food intake (energy intake) needs to be balanced against activity (energy output).
* Insulin is required for both of these funcions.
* In both Type 1 and type 2 Diabetes Mellitus, therefore, the common need is for diet and exercise to be matched. The principles of healthy eating in Diabetes Mellitus are:
a) Eating regular meals. Starchy foods such as potatoes, pasta, bread, rice, cereals release their energy slowly as they need to be digested first. Therefore they do not cause high surges of glucose in the blood in the same way as sugary foods do.
b) Cutting down on high sugar foods. Foods with sugar (sucrose or glucose) require little or no digestion for the sugars to be absorbed and so they cause blood glucose to rise quickly after a meal.
c) Reducing the amount of fat in the diet. Weight for weight fat has the most calories so cutting down fat intake is an easy way to reduce the total amount of calories eaten. reducing fat intake (especially hard fats from animal origin) is an essentialpart of reducing raised cholesterol and lowering the chance of getting heart disease.
d) Eating five portions of fruit and vegetables daily. A good intake of fruit nad vegetables is proved to reduce blood pressure and protect against many other conditions including heart disease and probably some cancers as well as providing the essential vitamins and minerals.
e) Cutting down salt intake.
f) Alcohol. Consuming a small amount of alcohol daily ( up to two standart units) appear to have a beneficial effect upon cardiovascular risk. However, the effects rapidly turn from beneficial to harmful when higher levels of alcohol are consumed. In Diabetes Mellitus alcohol can lower the blood glucose level and therefore make it likely for a hypoglycaemic reaction to occur.
There are many benefits to exercise for a diabetic person:
a) Lower blood glucose levels duing and after exercise.
b) Less insulin resistance.
c) Lowering of "bad" cholesterol and elevation of "good" cholesterol.
d) Lowering of blood pressure.
e) Increased fat loss and muscle mass.
f) Reduced stress and improved well-being.
g) Improved circultion and reduced cardiovascular risk.
Diet and exercise are the basic components of "lifestyle intervention" for Diabetes Mellitus (5).
Higher than normal levels of glucose in the blood for more than very brief periods can affect many parts of the body adversely. Some of these problems may take years to develop and maintaining good control is vital. Fortunately, good treatment of Diabetes Mellitus markedly reduces the chance of serious complications developing. For treatment to be most effective it is important to detect Diabetes Mellitus in its early stages and to treat it right away.It is therefore very important that everyone is aware of the possible signs od Diabetes Mellitus and that they are acted upon early.
