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  the facts
 

Diabetes a recap: What is Diabetes?

Diabetes Mellitus is a group of metabolic conditions characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both (Gavin et al 2002). Insulin is the hormone which regulates blood glucose level and is secreted by the -cells in the pancreas when higher than normal levels of glucose are detected in the blood. Insulin then acts to store the glucose either in the liver or muscle tissue as glycogen or converts it in to fat (Basset and Makin 2000 p109). When insulin is absent or there is a resistance to its action, levels of glucose can build up in the blood and become detrimental to the patient. There are four main types of diabetes

  1. Type 1 (Insulin dependent diabetes mellitus) This type is usually due to the immune mediated destruction of -cells leading to absolute insulin deficiency. The cause can also be idiopathic although this is less common. 
  2. Type 2 (Non-insulin dependent diabetes mellitus) May be caused by insulin resistance, relative insulin deficiency or a combination. 
  3. Type 3 other specific types of which there are eight. They range from genetic conditions and defects, to disease related causes or drug induced diabetes. For a full list please see the expert committees report on the diagnosis and classification of Diabetes mellitus (Gavin et al 2002). 
  4. Type 4 Gestational diabetes mellitus. Glucose intolerance related to pregnancy, often returning to normal following the birth.

How is Diabetes managed?

Type 1 and type 2 diabetes will be discussed as these are the most common forms of the condition and therefore will be given the most attention

Type 1 diabetes occurs in around 10 to20% of the diabetic population (Quinn 1998, Jerreat 1999) and is usually diagnosed in children and young adults, depending on the rate of b-cell destruction. This condition requires that the individual injects insulin. Type 1 is also managed by dietary intake. It often presents in this age group as ketoacidosis, -this condition will be discussed on the complications page- as there body tries to compensate for this hyperglycaemia until it can no longer do so (Gavin et al. 2002, Basset and Makin 2000).

Type 2 Diabetes Mellitus occurs in 70 to 80% of the diabetic population and is usually found in an older population. However as it is also associated with obesity also it is being found in a younger population (Jeffery et al. 2002, Rosenbloom et al. 1999).The causes of type 2 Diabetes are usually a combination of resistance to insulin action and a secretory defect. Resistance usually increases with age and obesity meaning that this is a progressive condition (Expert Committees report 2002, Porte 2001). Initially the condition may be treated by diet alone. However, as it progresses the use of oral hypoglycaemic drugs is common. These may stimulate insulin secretion (sulfonylureas and repaglinide), they may sensitize the patient to the action of insulin (Metformin) and complex carbohydrate absorption alpha-glucosidase inhibitors (Porte 2001). All have different actions and treatment is based on patient characteristics.

Type2 sufferers may well progress to insulin therapy as the management of their condition deteriorates. Good management of these conditions is essential for avoiding both hypo and hyperglycaemia and the acute and chronic problems that they entail.

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