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Diabetes mellitus, a term that means “the running through of sugar,” was first identified in the 1st century AD.(1) The disease was described in historical text as “the melting down of flesh into urine.” Diabetes mellitus is a chronic condition of insufficient insulin availability in relation to need. This can represent an absolute insulin deficiency, impaired insulin secretion, defective insulin receptors on target cells, or insulin that is inactivated before it is able to function. Diabetes mellitus is a disease in which the body does not produce or does not use insulin effectively. It is not simply hyperglycemia.
Insulin is a hormone produced in the pancreas by the beta cells in the Islets of Langerhans. Insulin secretion is regulated by blood glucose levels. It is responsible for transporting glucose (from carbohydrates) into the cells to fuel cellular metabolism and energy production. After a meal, when blood sugar increases, insulin levels rise. Between meals, when blood sugar is low, insulin levels remain low. Insulin is secreted from the pancreas directly into the liver where some is utilized and some is degraded. The rest is released into the general circulation. By facilitating the transport of glucose into the cells, insulin reduces blood sugar. Insulin also decreases the catabolism of fat stores and stimulates triglyceride synthesis. Insulin is involved in the active transport of amino acids into the cell, increasing protein synthesis. The growth and development of children is dependent on insulin.
Diabetes can affect people of any age. It increases the risk of chronic, debilitating conditions, including cardiovascular disease, retinopathy and blindness, peripheral neuropathies, vascular insufficiency and amputation, immune deficiencies, skin ulceration and wound healing disturbances, and kidney disease. The discovery of insulin in the early 20th century has afforded much progress in the diagnosis and treatment of the disease.
Diabetes is diagnosed when there is a fasting plasma glucose (FPG) of greater than 126mg/dL, or a two-hour plasma glucose (OGTT – oral glucose tolerance test) of greater than 200mg/dL. There are two forms of diabetes mellitus recognized today: type 1 (formerly referred to as IDDM, insulin dependent diabetes mellitus, or juvenile onset) and type 2 (previously called NIDDM, non-insulin dependent diabetes, or adult onset).
Type 1 diabetes is a condition in which the pancreatic beta cells fail to secrete insulin. This is known as an absolute insulin deficiency, characterized by hyperglycemia and the breakdown of fats and protein in order to meet the energy demands of the body. The catabolism of fats and protein predisposes insulin dependent diabetics to an accumulation of ketone bodies and subsequent ketoacidosis. Insulin dependent diabetics require a continuous supply of insulin to prevent ketoacidosis and maintain a stable blood sugar concentration.
Type 1 diabetes typically occurs in people younger than 30 years of age. It is thought that the disease is a caused by a genetic predisposition for an abnormal immune response to beta cells in the Islets of Langerhans. Islet cell antibodies have been detected in 60-95 percent of persons with type 1 diabetes.(2) Some of the potential triggers to this autoimmune response include Coxsackie virus, vaccination, other viral loads, and fungal mycotoxins.
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