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Diabetes Mellitus Abstract
There actually two disease entities called diabetes; these are 'Diabetes Mellitus' and 'Diabetes
Insipidus.' The end result is severe dehydration and extreme thirst secondary to urination of very large quantities of urine, sometimes exceeding 10 liters
per day.
Diabetes mellitus primarily is a
disorder of impaired regulation of glucose metabolism; secondarily, it is also associated with alterations of the biochemistry of lipids (fats) and
proteins. In other words, it is a metabolic disease which is characterized by reduced carbohydrate utilization and enhancement of the production of lipids and
proteins.
Most of us feel that it is the result of an absolute or
relative deficiency of functional insulin. As a consequence of decreased insulin, whether absolute or relative,
hyperglycemia (high glucose in the blood) and glucosuria (larger
amounts of glucose excreted in the urine); these biologic conditions result in abnormalities in water and electrolyte (sodium and potassium) loss from the
blood.
Hyperglycemia and glucosuria are felt to cause most of the
long-term complications of diabetes mellitus such as neuropathies (a generic term meaning changes in function or sensation of the peripheral nerves), visual
deterioration, impaired ability to heal, increased susceptibility to infections, renal (kidney) failure and generalized degenerative changes in the large and
small blood vessels (Many of these will be discussed later). This observation lead to the introduction of our initial classification of diabetes mellitus,
which with some refinement remains in place today.
Non-Insulin Dependent Diabetes
Mellitus (NIDDM) (Type II): This is the most common type of diabetes mellitus in the United States. We are capable of identifying certain phenotypes that might
develop diabetes mellitus, Type II. Presently, there are over 15 million diabetics in America, roughly 90 percent have Type II (non-insulin dependent) and
roughly 10 percent have Type I (insulin-dependent) disease.
For the Type II (NIDDM)
patient polydipsia, polyuria and fasting blood glucose levels of 140 mgs/dl are common presenting findings. Often, these
patients have no symptoms and are discovered by an abnormally high fasting blood glucose level. Neuropathy (usually involving nerves of the
extremities) is the most common presenting symptoms.
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