Diabetes Mellitus

Diabetes is characterized by an absolute sustained elavation of blood sugar. American Diabetic Association classified diabetes as a fasting blood sugar greater than 126mg/dl on two occasions or a postprandal blood sugar elevation one and a half times normal

There are two types diabetes:

Type I- Insulin dependent Diabetes Mellitus Also Known As Juvenile onset Diabetes Mellitus

In this type diabetes, insulin plays a prominent role in treatment. Patients are usually young, onset is usually that of childhood or adolescents. It is the most common diabetes in patients less than forty years old. There's a higher incidence of hyperglycemia and DKA(elevated ketones) in this type.

Causes of Type I generally stemmed from lack of the pancreas to produce insulin, either due to a viral infection or from a genetic disease associated with a selective destruction of particular cells in the pancreas that produces insulin. These patients have limited reserve of insulin in the pancreas and generally do require insulin for glucose metabolism.

Type II - Non Insulin Dependent Diabetes Mellitus also known as Adult onset diabetes Mellitus or Maturity onset diabetes Mellitus

In this type of diabetes, onset usually commences at or over the age of 30-40 years old. These patients do suffer from hyperglycemia but are usually associated with increased osmolar state instead of DKA. They are generally treated or amenable to oral agents.

Causes of Type II diabetes are many including:

• Problems with production of enough insulin, either due to exhaustion or other factors.
• Problems associated with the function of insulin either at molecular or at target tissue level.
• Other pathological process associated eventually with increased blood sugar In these patients the pancreas still makes insulin but what happens with, an after that, becomes a problem.

Treatment
The treatment of Diabetes Mellitus has advanced significantly. Initially only insulin and Sulfonylureas were the mainstay of therapy after a patient has failed a structured diet. Recently however, other groups of drugs have emerged in the battle for diabetes. These are:

• Insulin(e.g. Humulog) - Newer and better Insulin are now being produced.
• Sulfonylureas(e.g. Starlix) - Newer generations of these drugs have become available.
• Biguanide(e.g. Glucophage) - Attacks diabetes through the liver and may be associated with weight loss.
• Alpha-Glucosidase(e.g. acarbose)- Prevents absorption of carbohydrate from the gut thereby less blood sugar.
• Thiazolidinediones(e.g. actose, avandia) - The new frontier in the battle for increased blood sugar control. It moduleates the target organ so that insulin can be more efficiently utilized.