Type 1 and type 2 diabetes

Type 1 and type 2 diabetes

Diabetes affects the way the body handles digested carbohydrates. If neglected, diabetes can cause serious health complications ranging from blindness to kidney failure.

Approximately 8% of the population in the United States suffers from diabetes. This means approximately 16 million people have been diagnosed with the disease, based on national statistics only. The American Diabetes Association estimates that diabetes causes 178,000 deaths, 54,000 amputees and 12,000 to 24,000 cases of blindness annually. Blindness is 25 times more common in diabetics than in non-diabetics. It is proposed that by 2010, diabetes will surpass both heart disease and cancer as the leading cause of death due to its numerous complications.

Diabetics have high blood sugar levels. Blood sugar levels are regulated by insulin, a hormone produced by the pancreas that it releases in response to eating food. Insulin causes the body's cells to absorb glucose from the blood. The glucose is used as fuel for cellular functions.

Diagnostic standards for diabetes have twice included fasting plasma glucose levels greater than 140 mg/dL and plasma glucose levels greater than 200 mg/dL after a glucose load of 75 grams. More recently, the American Diabetes Association lowered the criteria for a diagnosis of diabetes to fasting plasma glucose levels of 126 mg/dL or greater. Fasting plasma levels outside the normal limit require additional testing, usually by repeating the fasting plasma glucose test and (if indicated) by the patient's oral glucose tolerance test.

The symptoms of diabetes include excessive urination, excessive thirst and hunger, sudden weight loss, blurred vision, delay in wound healing, dry and itchy skin, repeated infections, fatigue and headaches. Although these symptoms indicate diabetes, they can also be due to other reasons.

There are two different types of diabetes.

Type I diabetes (juvenile diabetes or insulin-dependent diabetes): The cause of type I diabetes is caused by the inability of the pancreas to produce insulin. It is responsible for 5-10% of diabetes cases. The pancreatic islet of Langerhans cells that secrete the hormone are destroyed by the body's immune system, probably because it mistakes them for a virus. Viral infections are believed to be the trigger that triggers this autoimmune disease. It is more common in Caucasians and runs in families.

If left untreated, death occurs within a few months of the onset of juvenile diabetes as the body's cells starve because they no longer receive the hormonal demand to absorb glucose. While most Type I diabetics are young (hence the term juvenile diabetes), the disease can develop at any age. Autoimmune diabetes can be definitively diagnosed through a blood test that shows the presence of anti-insulin/anti-islet cell antibodies.

Type II diabetes (non-insulin-dependent diabetes or adult-onset diabetes): This diabetes is a result of insulin resistance in the body's tissues. It accounts for 90-95% of cases. The pancreas often produces more than average amounts of insulin, but the body's cells no longer respond to its effects due to the chronically high hormone levels. Eventually, the pancreas may exhaust its overactive hormone secretion and insulin levels fall below normal.

A tendency to type II diabetes is hereditary, but it is unlikely to develop in people of normal weight who eat a low- or low-carbohydrate diet. Obese, sedentary individuals who consume a low-quality diet based on refined starches, which constantly activate insulin secretion from the pancreas, tend to develop insulin resistance. Native peoples such as North American Indians, whose traditional diets did not include refined starches until their recent introduction by Europeans, have extremely high rates of diabetes, up to five times those of Caucasians. Blacks and Hispanics are also at higher risk. Although type II diabetes is not fatal within a few months, it can cause health complications over several years, causing severe disability and premature death. As with type I diabetes, the condition occurs primarily in one age group, in this case people over 40 (which is why it is often called adult onset). However, with the increase in childhood and adolescent obesity, it is also occurring in children.

If neglected, diabetes can lead to life-threatening complications such as kidney damage (nephropathy), heart disease, nerve damage (neuropathy), retinal damage and blindness (retinopathy), and hypoglycemia (drastic reduction in glucose levels). Diabetes damages blood vessels, especially smaller end arteries, leading to severe and premature atherosclerosis. Diabetics are prone to foot problems because neuropathy, which affects about 10% of patients, causes their feet to lose feeling. Foot injuries, which are common in daily life, go unnoticed, and these injuries do not heal because blood flow to the small arteries in the foot is poor. Gangrene and subsequent amputation of toes or feet result in many older patients with poorly controlled diabetes. Typically, these consequences occur earlier in type I than in type II diabetes because type II patients have some of their own insulin production left over to buffer changes in blood sugar levels.

Type I diabetes is a serious disease and there is no permanent cure for it. However, symptoms can be controlled with strict dietary monitoring and insulin injections. Implanted pumps that immediately release insulin in response to changes in blood sugar are in testing.

In theory, since type II diabetes is caused by diet, it should be preventable and manageable through dietary changes alone. However, in practice, many diabetics (and many overweight people without diabetes) find it personally impossible to lose weight or adhere to a healthy diet. Therefore, they are often treated with drugs that restore the body's response to insulin and, in some cases, insulin injections.

Please note that this article is not a substitute for medical advice. If you suspect you have diabetes or belong to a high-risk group, please contact your doctor.

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