See Why Diabetes Mellitus is a Chronic, Lifelong Condition That Affects Your Body's Ability

Diabetes mellitus is a chronic, lifelong condition that affects your body's ability to use the energy found in food.

Diabetes mellitus is a common metabolic disorder resulting from defects in insulin action, insulin production, or both. Insulin, a hormone secreted by the pancreas, helps the body use and store glucose produced during the digestion of food.

 Characterized by hyperglycemia, symptoms of diabetes include frequent urination, increased thirst, dehydration, weight loss, blurred vision, fatigue, and, occasionally, coma.

Uncontrolled hyperglycemia over time damages the eyes, nerves, blood vessels, kidneys, and heart, causing organ dysfunction and failure.

A number of risk factors are attributed to the incidence of diabetes, including family history, age, ethnicity, and social group characteristics, as well as behavioral, lifestyle, psychological, and clinical factors.

The World Health Organization estimates that 150 million people had diabetes worldwide in 2002. This number is projected to double by the year 2025.

Much of this increase will occur in developing countries and will be due to population growth, aging, unhealthful diets, obesity, and sedentary lifestyles. In the United States, diabetes is the sixth leading cause of death.

While 6.2 percent of the population has diabetes, an estimated 5.9 million people are unaware they have the disease.

In addition, about 19 percent of all deaths in the United States for those age twenty-five and older are due to diabetes-related complications.

The prevalence of diabetes varies by age, gender, race, and ethnicity. In the United States, about 0.19 percent of the population less than twenty years of age (151,000 people) have diabetes, versus 8.6 percent of the population twenty years of age and older. In addition, adults sixty-five and older account for 40 percent of those with diabetes, despite composing only 12 percent of the population. Considerable variations also exist in the prevalence of diabetes among various racial and ethnic groups. For example, 7.8 percent of non-Hispanic whites, 13 percent of non-Hispanic blacks, 10.2 percent of Hispanic/Latino Americans, and 15.1 percent of American Indians and Alaskan Natives have diabetes. Among Asian Americans and PacificThe standard method of measuring blood glucose level is called a fingerstick, which is a small blood sample taken from the fingertip. Diabetics must monitor their blood glucose levels daily in order to avoid dire complications such as kidney disease, blindness, stroke, and poor blood circulation. [Photograph by Tom Stewart. Corbis.

Reproduced by permission.]Islanders, the rate of diabetes varies substantially and is estimated at 15 to 20 percent.

The prevalence of diabetes is comparable for males and females 8.3 and 8.9 percent respectively. Nevertheless, the disease is more devastating and more difficult to control among women, especially African-American and non-Hispanic white women.

In fact, the risk for death is greater among young people (3.6 times greater for people from 25 to 44 years of age) and women (2.7 times greater for women ages 45 to 64 than men of the same age).

Types of Diabetes

All types of diabetes mellitus have something in common. Normally, your body breaks down the sugars and carbohydrates you eat into a special sugar called glucose.

Glucose fuels the cells in your body. But the cells need insulin, a hormone, in your bloodstream in order to take in the glucose and use it for energy.

With diabetes mellitus, either your body doesn't make enough insulin, it can't use the insulin it does produce, or a combination of both.Diabetes mellitus is classified into four categories: type 1, type 2, gestational diabetes, and other.

In type 1 diabetes, specialized cells in the pancreas are destroyed, leading to a deficiency in insulin production.

Type 1 diabetes frequently develops over the course of a few days or weeks. Over 95 percent of people with type 1 diabetes are diagnosed before the age of twenty-five. Estimates show 5.3 million people worldwide live with type 1 diabetes.

Although the diagnosis of type 1 diabetes occurs equally among men and women, an increased prevalence exists in the white population.

Type 1 diabetes in Asian children is relatively rare.
Family history, diet, and environmental factors are risk factors for type 1 diabetes. Studies have found an increased risk in children whose parents have type 1 diabetes, and this risk increases with maternal age.

Environmental factors such as viral infections, toxins, and exposure to cow's milk are being contested as causing or modifying the development of type 1 diabetes.

Type 2 diabetes is characterized by insulin resistance and/or decreased insulin secretion. It is the most common form of diabetes mellitus, accounting for 90 to 95 percent of all diabetes cases worldwide.

Risk factors for type 2 diabetes include family history, increasing age, obesity, physical inactivity, ethnicity, and a history of gestational diabetes.

Although type 2Type 1 diabetics are more likely than other diabetics to require insulin injections to regulate blood glucose levels. Insulin pumps like the one shown here can provide an extra measure of control by administering a very accurate dose of insulin on a set schedule.

Type 2 diabetes is also more common in blacks, Hispanics, Native Americans, and women, especially women with a history of gestational diabetes.
Genetics and environmental factors are the main contributors to type 2 diabetes.

 Physical inactivity and adoption of a Western lifestyle (particularly choosing foods with more animal protein, animal fats, and processed carbohydrates), especially in indigenous people in North American and within ethnic groups and migrants, have contributed to weight gain and obesity.

In fact, obesity levels increased by 74 percent between 1991 and 2003. Increased body fat and abdominal obesity are associated with insulin resistance, a precursor to diabetes. Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are two prediabetic conditions associated with insulin resistance.

In these conditions, the blood glucose concentration is above the normal range, but below levels required to diagnose diabetes. Subjects with IGT and/or IFG are at substantially higher risk of developing diabetes and cardiovascular disease than those with normal glucose tolerance.

The conversion of individuals with IGT to type 2 diabetes varies with ethnicity, anthropometric measures related to obesity, fasting blood glucose (a measurement of blood glucose values after not eating for 12 to 14 hours), and the two-hour post-glucose load level (a measurement of blood glucose taken exactly two hours after eating).

In addition to IGT and IFG, higher than normal levels of fasting insulin, called hyperinsulinemia, are associated with an increased risk of developing type 2 diabetes. Insulin levels are higher in African Americans than in whites, particularly African-American women, indicating their greater predisposition for developing type 2 diabetes. CONTINUE READING

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