What is the cause of diabetes?

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Diabetes Mellitus (Greek diabetes, a siphon; Latin mellitus, honey), a disease in which the body is not fully capable of making use of the glucose (a form of sugar) supplied to it. The disease is characterized by the presence of glucose in the urine (glycosuria), by raised levels of glucose in the blood (hyperglycemia), and often by excessive thirst and appetite.

All of these changes can be ascribed to the inability of the cells of the body to take up glucose. Many cells need the hormone insulin to take up glucose, and the simplest form of diabetes mellitus is the result of insulin lack. Insulin is made by the pancreas, so it is probable that the inability of this organ to make the hormone is the ultimate cause of the disease.

Diabetes mellitus is treated, usually once or twice a day, by injections of insulin.

Causes of Diabetes Mellitus

Susceptibility to diabetes mellitus is inherited as a recessive autosomal (non sex-linked) trait. In order for the disorder to de­velop in a susceptible person, certain factors must usually be present. Among these are obe­sity, menopause, pregnancy, infection, trauma, severe emotional shock, and various glandular disorders. In some cases, diabetes is not related to heredity, but is due to other causes, including destruction of the pancreas by cancer.

Treatment of Diabetes Mellitus

The treatment of diabetes involves three major factors: special diet, good hygiene, and medica­tions that lower the level of blood sugar. Most mild cases of diabetes can be controlled by reducing the consumption of sugars and other carbohydrates, and all diabetics who are overweight are advised to reduce. Plenty of sleep, regular meals, controlled but ample exercise, and adequate relaxation are necessary to maintain good hygiene. Because of the diabetic's low resistance to infection, colds, sore throats, and similar ailments should be treated carefully, and small cuts, scratches, or irritations should be cared for im­mediately, particularly if they occur on the feet.

Before Frederick G. Banting and Charles H. Best demonstrated the beneficial effects of insulin therapy on diabetics in 1921, severe cases were usually fatal. Today, insulin is the most important medication used in the treatment of diabetes. There are different kinds of insulin to meet the specific needs of patients. All people with severe diabetes and nearly all children with diabetes require some kind of insulin, which must be taken for the rest of their lives. In most cases the patient injects himself with a prescribed dosage each morning. For the treatment of milder diabetes a number of medications that can be taken by mouth have been developed in recent years.

Sometimes, if too much insulin is administered, the level of sugar in the blood is drastically lowered, result­ing in a condition called insulin shock. A person suf­fering from insulin shock may appear drunk or con­fused and then become drowsy and go into a coma. While the person is conscious and can swallow, he should be given candy, sugar in water, or some other sweet food. A physician should be consulted.

Diagnosis of Diabetes Mellitus

The discovery of sugar in the urine does not automatically indicate the presence of diabetes mellitus. Sometimes, the urine sugar is lactose, fructose, or some other type of sugar, indicating a different type of disorder. Even when the urine sugar is identified as glucose, the diagnosis of diabetes is not confirmed. Some people normally excrete a certain amount of glu­cose in their urine, a harmless condition known as renal diabetes. Glucose may also appear in the urine as a result of certain glandular dis­orders, such as hyperthyroidism. To distinguish diabetes from these other conditions, the physi­cian determines the level of sugar in the patient's blood after a period of fasting. If an abnormally high blood sugar is confirmed, the diagnosis of diabetes can be made. However, even if the blood sugar is normal after fasting, diabetes can­not be ruled out, and the doctor then measures the blood sugar level after the patient has in­gested some glucose.

Prognosis

Although most diabetics, especially those with adult diabetes, can live normal, healthy lives, others, despite proper treatment, develop serious complications. Sometimes, se­vere premature atherosclerosis attacks the coro­nary arteries, leading to a heart attack. The blood vessels of the legs may also be affected, producing difficulty in walking and eventually leading to painful ulcers and infections of the feet. In such cases, gangrene sometimes devel­ops and the patient's foot may be amputated. Diabetes mellitus may also lead to a special type of nephritis and, in the eyes, it may cause cataracts, hemorrhages, spots in the retina, and paralysis of the eye muscles. A painful neuritis may occur temporarily in the legs.

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