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Diabetes mellitus refers to several different diseases characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. In all types of diabetes, the basic problem is that without treatment there is too much sugar in the blood. The classification of diabetes includes four clinical classes:

1. Type 1 diabetes (the body does not produce insulin).
2. Type 2 diabetes (either the body does not produce enough insulin or the cells ignore the insulin).
3. Gestational diabetes mellitus(diagnosed during pregnancy).
4. Other specific types of diabetes due to other causes, e.g., genetic defects in beta-cell function, genetic defects in insulin action, diseases of the pancreas (such as cystic fibrosis), and drug or chemical induced (such as in the treatment of AIDS or after organ transplantation).

Your Body and Blood Glucose (Sugar)

The cells of the body run on a fuel called glucose. The body manufactures this glucose from the food you eat. Glucose travels in the bloodstream to the cells for storage. If you have diabetes, the cells will not absorb the glucose. Glucose cannot get into a cell without a key. That key is insulin, a hormone made by the pancreas to help the body use glucose. The body needs glucose in order for the heart, brain and muscles to function properly.

Classifications of Diabetes

Type 1 diabetes, previously known as juvenile diabetes, is diagnosed in children and young adults. In type 1 diabetes, your body destroys the cells in the pancreas that produce insulin, usually leading to a total failure to produce insulin.

Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose. Glucose is the basic fuel for the cells in the body, and insulin takes the glucose from the blood into the cells. When sugar builds up in the blood instead of going into cells, it can cause two problems:

1. Right away, your cells may be starved for energy.
2. Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.

While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. Due to the increased obesity rates in children, the diagnosed rate of type 2 diabetes is rapidly increasing.

Gestational diabetes occurs in pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy. Gestational diabetes affects about 4 percent of all pregnant women - about 135,000 cases of gestational diabetes in the United States each year.

Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes. Before you develop type 2 diabetes, you usually have pre-diabetes. Recent diabetes research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.

If you take action to manage your blood glucose when you have prediabetes, you can delay or prevent type 2 diabetes from ever developing

Screening for Diabetes

• Screening for prediabetes and diabetes should be considered in all individuals at age 45 years and above, particularly in those with a Body Mass Index (BMI) greater than 25. If your BMI is less than 25, you should retest at 3-year intervals.

• Screening should be considered at a younger age or be carried out more frequently in individuals who are overweight (BMI greater than 25) and have additional risk factors.

Risk Factors for Diabetes

The more risk factors you have the greater your risk of developing diabetes. If you have any of the risk factors listed below and fall within one of the two screening categories, you should talk to a health professional about how to lower your risk, and if testing is needed.

Common risk factors include:

• Obesity
• Apple-shaped figure
• Age
• Sedentary lifestyle
• Family history-first degree relative
• History of gestational diabetes during pregnancy
• History of delivering large babies (greater than 9 pounds)
• On previous testing, glucose was not in normal range
• Blood pressure greater than 140/90 mmHg
• High cholesterol or other fats in the blood
• HDL cholesterol level less than 35 mg/dl
• Triglycerides greater than 250 mg/dl
• High-risk ethnic population (African American, Latino, Native American, Asian American or Pacific Islander)
• Clinical conditions associated with insulin resistance
• History of vascular disease
• Polycystic ovary syndrome

Symptoms of Diabetes

You may experience one or more of the following symptoms:

• Frequent urination and thirst: The glucose in the urine draws more water off the blood, so more urine forms. More urine in your bladder makes you feel the need to urinate more frequently. As the amount of water in your blood declines, you feel thirsty and drink more frequently.
• Unexplained weight loss: When insulin is lacking, the body begins to break down. You lose muscle tissue. As your body breaks down and you lose glucose in the urine, you often experience weight loss.
• Unusual tiredness or drowsiness: Because glucose cannot enter the cells, you have no fuel to move your muscles or facilitate the chemical reactions that have to take place to produce energy.
• Repeated infections of skin, gums or bladder: As blood glucose rises, all the fluids in your body contain higher levels of glucose. Many bugs, such as bacteria and fungi, thrive in the high glucose environment.
• Other symptoms are:
  • Tingling or numbness of the legs, hands or feet
  • Blurred or changed vision
  • Slow healing cuts, sores, and blisters especially on your extremities
  • Increased hunger
  • Obesity
  • Heart disease

The signs and symptoms of type 2 diabetes are similar in some cases to the symptoms of type 1 diabetes, but in many ways are different. A few differences are as follows:

• Age of onset: Those with type 1 diabetes are younger at diagnosis than type 2.
• Body weight: Those with type 1 diabetes are thin or normal in weight, but obesity is a common characteristic of those with type 2 diabetes.
• Level of glucose: Those with type 1 diabetes have higher glucose levels at the onset of the disease.
• Severity of onset: Type 1 diabetes usually has a more severe onset, but type 2 diabetes gradually shows its symptoms.

Diagnosing Diabetes

In addition to any symptoms you may present, your health care provider may use one of the following tests to diagnosis diabetes.

• A fasting plasma glucose test measures your blood glucose after you have gone at least 8 hours without eating. A normal reading is 70 mg/dL to 100 mg/dL. If your fasting blood sugar is 100 mg/dL to 126 mg/dL, you may have prediabetes. Fasting blood glucose over 126 mg/dL is considered diabetes.
• An oral glucose tolerance test measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. A two- hour post-load glucose greater than 200 mg/dl is abnormal.
• A casual plasma glucose test measures your blood glucose without regard to when you ate your last meal. A glucose level greater than 200 mg/dl, along with an assessment of symptoms is used to diagnose diabetes but not pre-diabetes.

Additional Diabetes Tests

• Glycohemoglobin Test (HbA1c):The HbA1c test averages blood sugar carried by hemoglobin (component of red blood cell that carries oxygen) over 2-3 months. If you have diabetes, you should test your HbA1c every 3 to 6 months to help ensure your blood sugar is under control, below 7.0 percent. However, if you do not manage your diabetes well (glycohemoglobin or HbA1c reading above 8 or 9 percent), it is important that you see your health care team frequently.

• Urine Protein Test:Normally there is almost no protein in the urine. The urine protein test looks for the presence of protein in the urine. Protein in the urine may be a sign of kidney disease, which can be caused by diabetes. If you have diabetes, you will be tested for microabuminuria, a special type of urine test that can detect trace amounts of protein.

Complications of Diabetes

Short-term and long-term complications of diabetes will occur if you do not manage your blood sugars at the recommended levels. Diabetes can result in problems such as heart disease in the form of angina and myocardial infarction, stroke, peripheral vascular disease (disease of blood vessels located outside the heart, especially those in the legs and arms), eye damage or blindness, kidney disease, nerve damage and sexual dysfunction in both sexes.

You have a higher risk of cardiovascular disease if you have diabetes. If you have prediabetes, you have a 1.5 increased risk of cardiovascular disease compared to someone with normal blood glucose. Your cardiovascular risk increases 2-4 times when you have type 1 or type 2 diabetes. By practicing healthy lifestyle habits, you can delay or prevent the onset of type 2 diabetes.