DIABETES
Diabetes is a very common and important condition. Actually its full name is DIABETES MELLITUS. This distiguishes it from DIABETES INSIPIDUS which is a very rare condition of the pituitary gland. What both conditions have in common is that untreated they cause the person to pass large quantities of urine (which is what the word "diabetes" means). In diabetes insipidus this is due to the shortage of a hormone which makes the kidneys concentrate the urine. In diabetes mellitus ("mellitus" means "sweet") this is because the sugar level in the blood gets very high if untreated and the sugar (which is, in fact, glucose) escapes into the urine sucking a lot of water out with it. For the sake of brevity in the rest of this article DIABETES will be used as being synonymous with diabetes mellitus.
Diabetes usually presents with the symptoms caused by the high blood sugar - i.e. the passage of large amounts of urine and the consequent thirst that this causes, weight loss because of the loss of calories in the form of glucose in the urine, and general ill-health because of the disturbance caused to the body chemistry by the body's inability to metabolise glucose properly. Often undiagnosed or poorly controlled diabetics are prone to frequent infections such as "thrush" (=candida) and this may alert the doctor to investigate further.
The image of diabetes in many people's minds is of the diabetic with an almost life-long dependence upon injections of insulin. However many people nowadays perhaps know or know of an older person who is also diabetic but who controls their diabetes with a simple diet or perhaps takes tablets as well. Is this all the same condition? The answer is both yes and no. Both types of patient have diabetes mellitus and without treatment would have very high blood sugars and suffer the consequences of that but there are also very major differences. The first patient has Insulin dependent diabetes (also known as IDDM, Type 1 or Juvenile-onset diabetes) whereas the latter are known as Non-insulin dependent (NIDDM, Type 2 or Maturity-onset) diabetics. The names are quite helpful in expressing the way in which these two types of diabetic differ:
The Insulin-dependant type of diabetic usually, though not always, gets ill for the first time either in childhood, teens, or early adult life. This type of diabetes is due to a failure of the pancreas to produce insulin probably as a result of a genetic predisposition and a viral infection combining to destroy the beta cells which make insulin. This type of diabetes usually comes on rapidly in a previously well patient with quite severe symptoms. The only treatment is insulin because the body is producing none if its own.
In maturity-onset or non-insulin dependent diabetes (which is more common) the patient is usually middle-aged or older, often overweight, and may have been vaguely ill for some time. The diabetes may even be a chance finding during a medical or other routine check. The essential difference is that this type of diabetic is still producing their own insulin but the sugar still rises too high after a meal - and may not come down to normal levels. The reasons for this are quite complicated but it seems that this type of diabetic is less sensitive to the sugar lowering effects of insulin.
Dr. Upshall
May 1998
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