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An introduction to the issue of diabetes mellitus

The Diabetes Center

Diabetes mellitus is characterized by abnormally high levels of sugar glucose in the blood. When the amount of glucose in the blood increases, e. Insulin stimulates muscle and fat cells to remove glucose from the blood and stimulates the liver to metabolize glucose, causing the blood sugar level to decrease to normal levels. In people with diabetes, blood sugar levels remain high. This may be because insulin is not being produced at all, is not made at sufficient levels, or is not as effective as it should be.

Gestational diabetes is a form of diabetes that occurs in an introduction to the issue of diabetes mellitus, and other forms of diabetes are very rare and are caused by a single gene mutation. For many years, scientists have been searching for clues in our genetic makeup that may explain why some people are more likely to get diabetes than others are.

Classification Diabetes is classified by underlying cause. An introduction to the issue of diabetes mellitus 1 compares the presentation phenotype of type 1 and type 2 diabetes.

Table 1 Comparison of Type 1 and Type 2 Diabetes. Type 2 diabetes commonly occurs in adults who are obese. There are many underlying factors that contribute to the high blood glucose levels in these individuals. An important factor is the body's resistance to insulin in the body, essentially ignoring its insulin secretions. A second factor is the falling production of insulin by the beta cells of the pancreas.

Therefore, an individual with type 2 diabetes may have a combination of deficient secretion and deficient action of insulin.

In contrast to type 2, type 1 diabetes most commonly occurs in children and is a result of the body's immune system attacking and destroying the beta cells. The trigger for this autoimmune attack is not clear, but the result is the end of insulin production. Report of the expert committee on the diagnosis and classification of diabetes mellitus. For much of this time, little was known about this fatal disease that caused wasting away of the body, extreme thirst, and frequent urination.

It wasn't until 1922 that the first patient was successfully treated with insulin. One of the effects of diabetes is the presence of glucose in the urine glucosuria. Ancient Hindu writings, many thousands of years old, document how black ants and flies were attracted to the urine of diabetics. The Indian physician Sushruta in 400 B.

Up until the mid-1800s, the treatments offered for diabetes varied tremendously. The most successful treatments were starvation diets in which calorie intake was severely restricted. Naturally, this was intolerable for the patient and at best extended life expectancy for a few years. A breakthrough in the puzzle of diabetes came in 1889. German physicians Joseph von Mering and Oskar Minkowski surgically removed the pancreas from dogs. The dogs immediately developed diabetes.

Diabetes mellitus

Now that a link was established between the pancreas gland and diabetes, research focused on isolating the pancreatic extract that could treat diabetes.

Frederick Banting took up the challenge of isolating a pancreatic extract, he was met with much skepticism. Many great physiologists had tried and failed to isolate an internal secretion from the pancreas.

Charles Best, a medical student at the time, worked as his assistant. To concentrate what we now know as insulin, Banting tied the pancreatic ducts of dogs. The pancreatic cells that released digestive enzymes and could also destroy insulin degenerated, but the cells that secreted insulin were spared. Over several weeks the pancreas degenerated into a residue from which insulin could be extracted.

In July 1921, a dog that had had its pancreas surgically removed was injected with an extract collected from a duct-tied dog.

In the two hours that followed the injection, the blood sugar level of the dog fell, and its condition improved. Another de-pancreatized diabetic-like dog was kept alive for eight days by regular injections until supplies of the extract, at that time called "isletin", were exhausted.

Further experiments on dogs showed that extracts from the pancreas caused a drop in an introduction to the issue of diabetes mellitus sugar, caused glucose in the urine to disappear, and produced a marked improvement in clinical condition. So long as the extract was being given, the dogs were kept alive. The supply of the extract was improved: This extract kept a de-pancreatized dog alive for 70 days. Collip, a biochemist, was drafted to continue improving the purity of the pancreas extract, and later, Best carried on this work.

A young boy, Leonard Thompson, was the first patient to receive insulin treatment. On January 11, 1922, aged 14 and weighing only 64 pounds, he was extremely ill. The first injections of insulin only produced a slight lowering of blood sugar level.

The extract still was not pure enough, and abscesses developed at the injection site. Collip continued to refine the extract. Several weeks later, Leonard was treated again and showed a remarkable recovery.

  1. These complications may be caused by glycosylation of ocular tissue or nervous tissue, accumulation of osmotically active glucose metabolites in these tissues, or disease of the small vessels in these tissues.
  2. However, insulin-resistant individuals would develop a compensatory hyperinsulinemia accompanied by elements of the metabolic syndrome.
  3. Another prominent area of investigation involves determining how inflammation is involved in the etiology of T2D.
  4. Diagnosis and treatment Many people are unaware that they have diabetes.

His blood sugar levels fell, he gained weight and lived for another 13 years. He died from pneumonia at the age of 27. During the spring of 1922, Best increased the production of insulin to enable the treatment of diabetic patients coming to the Toronto clinic.

Over the next 60 years, insulin was further refined and purified, and long-acting and intermediate types were developed to provide more flexibility. A revolution came with the production of recombinant human DNA insulin in 1978. Instead of collecting insulin from animals, new human insulin could be synthesized.

In 1923, Banting and Macloed were awarded the Nobel Prize for the discovery of insulin. Banting split his prize with Best, and Macloed split his prize with Collip. In his Nobel Lecture, Banting concluded the following about their discovery: It enables the diabetic to burn sufficient carbohydrates, so that proteins and fats may be added to the diet in sufficient quantities to provide energy for the economic burdens of life. To view this, you will need to have Flash installed on your computer.

Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. This form of diabetes can go undiagnosed for many years, but the number of cases that are being diagnosed is rising rapidly, leading to reports of a diabetes epidemic. However, the prevalence of type 2 diabetes is now at epidemic proportions. In the United States, diabetes accounts for over 130 billion dollars of health care costs and is the fifth leading cause of death 2.

The number of new cases being diagnosed continues to rise. It has been estimated that of the children born in the year 2000, 1 of 3 will suffer from diabetes at some point in their lifetime 3. Diabetes is predicted to become one of the most common diseases in the world within a couple of decades, affecting at least half a billion people 4.

But now type 2 diabetes is increasingly being diagnosed in young adults and even in children. This young generation of diabetics will have many decades in which to develop the complications of diabetes.

This increased to 7. Obesity The driving force behind the high prevalence of diabetes is the rise of obesity in the population. In today's society, it an introduction to the issue of diabetes mellitus be difficult to maintain a healthy weight.

We have the combination of ample food and a sedentary lifestyle.

  1. There are several other agents that can be highly effective in the treatment of diabetes.
  2. Eating produces a rise in blood glucose, the extent of which depends on a number of factors such as the amount and the type of carbohydrate eaten i. It is less clear whether the control of hyperglycemia has a similar effect in controlling large-vessel complications.
  3. The duration and severity of hyperglycemia can be assessed by measuring levels of advanced glycosylation end products AGEs.
  4. But now type 2 diabetes is increasingly being diagnosed in young adults and even in children. Banting split his prize with Best, and Macloed split his prize with Collip.
  5. As glucose accumulates in the blood, excess levels of this sugar are excreted in the urine. A satisfactory compromise for some patients is twice-daily administration of mixtures of intermediate-acting and short-acting insulin.

This is in stark contrast to only a couple of hundred years ago, when people were more active and food supplies were not as abundant. As a result, many of us are heavier than we should be. It is a calculation that takes your height and weight into consideration and gives you a score. A score of 18—24. If you are overweight, your score lies within the range to 25—29. By the year 2001, this had increased to an estimated 20.

Obesity is a major problem for the United states. Every year, an estimated 300,000 US adults die of causes related to obesity 7.

Thrifty Genes Epidemics of infectious diseases increase when there is increased spread of the infectious agent and decrease when the number of victims who are susceptible falls they either become immune or they die. An epidemic of a genetic disease such as type 2 diabetes is similar.

The number of cases rises when there is a rise in environmental risk abundant food supplies, lack of activity and decreases when the number of susceptible individuals falls by deaths from the complications of diabetes. The classic example of an epidemic of diabetes is found on an remote island in the Pacific Ocean, the island of Nauru. Before the turn of the 20th century, the lifestyle of Nauruans was harsh.

The soil was poor, agriculture was difficult, and frequent episodes of starvation were common. In 1922, it was discovered that Nauru contained phosphate rock, which was then mined for use in fertilizer, and for which the islanders received royalties. Over several decades, the Nauruans became extremely wealthy, and with their new-found riches came major lifestyle changes. Food was now abundant and could be bought from stores. Instead of fishing and farming, Nauruans now led sedentary lives.

By the 1950s, type 2 diabetes exploded from being non-existent in this population to affecting 2 of 3 adults over the age of 55 and becoming a common cause of death.

It has been postulated by Neel 9 that genes that are metabolically thrifty give a survival advantage in times when there is a constant threat of famine and starvation. When food is abundant, these genes aid the efficient metabolism of the food, enabling rapid build up of fat stores. This enabled people like the Nauruans to survive food shortages later on.

But when food is always abundant, a thrifty genetic makeup turns into a survival disadvantage. Thrifty genes cause obesity, which in turn predisposes to diabetes.

The epidemic that took hold of the island of Nauru is now emerging in developing countries and already has a firm hold on the developed world.