Diabetes Mellitus


Diabetes is one of the most widespread non-transmissible chronic diseases and the most common endocrine disease. It is characterized by disorders of the entire metabolism, especially of carbohydrates metabolism and by complications affecting the eyes, kidneys, nerves and blood vessels. Basically, diabetes is a disease in which the body does not produce enough insulin or does not use it effectively.

Because of its frequency, diabetes falls into the category of so-called chronic civilization diseases. As simple as the determination of blood glucose seems nowadays, it is still difficult to determine the prevalence of diabetes. This is largely due to the fact that the disease's diagnostic standards are not yet uniformly applied.

It is estimated that 2-6% of the population of Western Europe and North America suffer from this disease. Even more alarming is that nearly a third of these persons are unaware of that they suffer from it. 

Types of Diabetes

Diabetes mellitus is grouped in several forms of disease manifestations and distinct causes, namely:


The causes of diabetes are only partially elucidated. On one hand, it is known that the occurrence of both types of diabetes is related to a certain extent to hereditary factors. On the other hand, environmental factors can also play an important role.

One of the environmental factors that are believed to cause the appearance of many cases of Type 1 diabetes is a virus that infects beta cells which produce insulin in the pancreas. This hypothesis is supported by clinical and experimental evidence. Viral infection can induce diabetes either by destruction of insulin-producing cells or by triggering an immune response.

Another factor that appears to predispose to autoimmune diabetes (type 1) would be drinking cow's milk or milk products in small babies. Research suggests that the albumin from the cow's milk would lead to the emergence of antibodies that by cross-reactivity, ultimately affects pancreatic beta cells and thus contributes to the appearance of diabetes mellitus.

For the emergence of type 2 diabetes, the most important modifiable factors are excessive body weight and lack of exercise, namely sedentary lifestyle.

Another noteworthy factor may be excessive mental stress. Immediately after the 1977 earthquake, diabetologists in Bucharest have noticed a high incidence of diabetes. Thus, some authors mention as a possible diabetogenic factor, the stress, particularly stress of crowds.

Among the responsible factors, there is also food abuse, namely sugar products  excess. All these factors may explain why diabetes is more common in urban areas. Depending on the causes, diabetes is divided into primary and secondary. When there is no other associated disease, it is a case of primary diabetes.

When disorders or pathological conditions that cause or favour the development of diabetes can  be identified, in that case it is secondary diabetes. Among the causes that can lead to secondary diabetes are: diseases affecting the pancreas (for example  chronic pancreatitis in alcoholic cases), hormonal disorders (for example acromegaly, pheochromocytoma, Cushing's disease), diabetes induced by drugs and chemical substances, various genetic diseases ans so on. Depending on the mechanism of the cause of diabetes, there are type 1 and type 2 diabetes.

Type 1 diabetes occurs mainly in young children and always requires insulin treatment because the pancreas can no longer produce it. For this reason, it is also called insulin-dependent diabetes. Type 2 diabetes usually occurs in middle-aged adults (40 years) or later, especially in overweight people. In this case, the body continues to produce insulin, but this can not fulfill its normal role. This second type of diabetes usually does not require treatment with insulin, and for this reason it is called non-insulin dependent diabetes.

It is worth mentioning that the dependence of insulin does not necessarily mean that the patient will follow insulin therapy, also the term non-insulin dependent does not always mean that insulin therapy is absent. Experts believe rather that the concept of "insulin-dependent" means that in the absence of insulin, the patients present the risk of diabetic ketoacidosis. In other words, the terms "insulin" and "non-insulin dependent" actually describe physiological states (predisposition, or resistance to ketoacidosis), while the terms "type 1" and "type 2" refers to the pathogenic mechanism, autoimmune (in type 1) and that is not autoimune (in type 2).


The symptoms of diabetes vary from case to case. In general, diabetes is characterized by an above normal blood glucose (hyperglycemia) concentration increase, with or without the elimination of sugar through urine (glycosuria). Other symptoms that may occur are: excessive thirst, increased intake of water, eliminating large amounts of urine, excessive hunger eating a lot.

These three symptoms, known in medical terminology as polydipsia, polyuria and polyphagia are generally caused by hyperglycemia. In patients who are sick, but have ignored the signs for a long time and therefore are not diagnosed, it can happen that the first symptom taken into account is the diabetic coma.

Type 1 diabetes usually shows signs before the age of 40, but there are patients in whom type 1 diabetes occurs in an atypic way, later in life, at the age of 50  or even later in rare cases. Typically, patients with type 1 diabetes manifested at an older age are not obese as those who suffer from type 2 diabetes.

Type 1 diabetes can start suddenly, with thirst, excessive urination, increased appetite and weight loss. People with type 1 diabetes may be normal weight or underweight, depending on the time interval between the onset of symptoms and the beginning of the treatment. Usually, in the case of type 1 diabetes, once the symptoms have appeared, it is necessary to administer insulin.

Type 2 diabetes usually begins in midlife or later. Usually, patients with type 2 diabetes are overweight or obese. Also, in these diabetic cases, the symptoms appear and  manifest gradually. If the patient manages to control his body weight by dietary measures and by the administration of oral antidiabetic medication, it is not necessary to administer insulin. There are still many patients with type 2 diabetes who take insulin.

The most serious complications, possibly fatal, are the acute ones. These occur by  a high decrease or increase of blood sugar levels (hypoglycemia with hypoglycemic coma, diabetic ketoacidosis in insulin-dependent diabetics and hyperosmolar non-ketotic coma usually in non-insulin-dependent diabetes).

In many cases, diabetes leads to the so called late complications. While some diabetics never develop such complications, others develop them early. On average, late complications occurs after 15-20 years after the manifestation of hyperglycaemia. Some patients may present more complications simultaneously.

Diabetes affects the whole metabolism and, in the absence of adequate treatment, leads in time to serious complications due to the damage of blood vessels on the  heart, brain or kidneys level. Untreated diabetes can lead to blindness, nerve pains, leg ulcers, etc...

In case of diabetes, atherosclerosis appears to a larger extent and earlier than to the rest of the population. Cardiovascular diseases - ischemic heart disease, myocardial  asymptomatic infarction, stroke have an increased frequency.

Diabetic retinopathy occurs in approximately 85% of patients and is an important cause of blindness. Diabetic nephropathy is a disease that causes damage to the blood vessels of the kidneys and affects approximately 35% of patients with type 1 diabetes.

This complication often leads to disability and even death. Diabetic neuropathy can affect every part of the nervous system, less commonly the brain. Neuropathy can affect a nerve or more, in this case being diabetic polyneuropathy. This is manifested by numbness, paresthesia (tingling), severe hyperesthesia (increased sensitivity of the receptor nerve) pain. The pain can be intense and often gets worse during the night.A particular complication of diabetes is the leg ulcers. This is due to abnormal pressure distribution caused by diabetic neuropathy. The evolution of infections in diabetes cases is generally worse. Skin, urinary tract, respiratory and fungal infection (candidiasis) are common. Experts warn especially against four particularly serious infections characteristic to diabetes patients: malignant external otitis, rhinocerebral mucormycosis (a fungal infection), emphysematous cholecystitis and emphysematous pyelonephritis.







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