Diabetes Mellitus is a group of chronic disorders that are caused by a minor or total insulin deficiency.
Although there are genetic factors to it, developing the disease also depends greatly on environmental factors.
It affects over 130 million people worldwide. In America, 1 in every 20 people has diabetes.
The disease itself must be managed through monitoring and maintaining proper blood sugar levels through a healthy diet and regular exercise.
It is a disease that weakens the vascular system and causes many complications, such as loss of eye sight or kidney damage.

Diabetes is divided into two major groups. The first group, known as Primary Diabetes Mellitus, covers the most commonly known types of diabetes:
• Type 1 - this is an insulin dependent type of diabetes
• Type 2- this is a non-insulin dependent type of diabetes
• Type 3- this is a malnutrition related type of diabetes, not commonly discussed
• Gestational Diabetes- this a type of diabetes that develops in women during pregnancy

The second group of diabetes is known as Secondary Diabetes Mellitus.
These types of diabetes are caused by outside factors other than genetics and environmental factors.
When things like acute or chronic pancreatitis or pancreatic cancer destroys the pancreas- which is the insulin producing organ in the body- secondary diabetes will occur.
Chronic liver disease like in Hemochromatosis, endocrine abnormalities like in Hyperthyroid and Cushing syndrome are very common.
The use of medications to treat other conditions can all bring about a diagnosis of secondary diabetes.

Genetic disorders, like Down syndrome is involved in diabetes.
The main abnormality with diabetes is the difficulty of having to control blood sugar. Insulin is produced in the pancreas and its function is to control your blood sugar in a narrow range. In type I diabetes we find that there is not enough insulin production. In type II diabetes, most of the time we find enough insulin but it is not available to control the sugar levels.

Diabetes mellitus is a disease that causes higher than normal blood sugars in its sufferers. It is of two types:
(1) Type I diabetes, which normally affects young people. It occurs when the body doesn’t make enough insulin to rid the body of excess sugar. The only way to treat that disease is to provide insulin to make up for the lost insulin from the pancreas.
(2) Type II diabetes generally affects older people and is a condition where the body makes insulin but the cells of the body don’t respond to the insulin in the body.

The disease of diabetes mellitus affects 20.8 million people in the US or 7% of the total population. Both genetics and environment and heredity play a role in who gets diabetes and who doesn’t. Poor dietary habits and obesity play a large role in the development of type II diabetes.

There are many people who don’t have diabetes mellitus but who are suffering from prediabetes, also sometimes called insulin resistance. Their body doesn’t respond well to the insulin made by the pancreas but the situation isn’t bad enough to raise the blood sugar levels yet. The body has higher than normal amounts of insulin in the system but it is enough to compensate for the blood sugar. Eventually, however, many prediabetics go on to develop diabetes in a few years.

There are several tests for diabetes mellitus. The first is a fasting blood sugar. This is normally less than 100 mg per deciliter. In prediabetes, the number is often between 100 and 120 mg per deciliter. The other test for diabetes mellitus is called the “three hour glucose tolerance test” or “3 hr GTT”. This involves getting a fasting blood sugar and then giving the individual a small bottle of highly sugared liquid to drink. Then the blood sugar is tested at one hour, two hours and three hours after drinking the sugared liquid. If any number is above 200, then diabetes is diagnosed.

Another test for diabetes mellitus is to check the glycosylated hemoglobin level. This is a measure of the amount of “sugar coated” blood cells in the body. The normal level is 6.0 and numbers above that is felt to be diabetes.

The treatment for diabetes mellitus is different depending on the type of diabetes the person has. Type I diabetes is almost always treated by insulin shots. This is because there is no insulin being put out by the pancreas and so insulin must be replaced. Type II diabetes is often treated with diet and medications. The medications are those that make the cells of the body respond better to the insulin being provided by the pancreas. There are also medications that act to lower the blood sugar directly.

Those with diabetes mellitus must check their blood sugars frequently with a glucometer or blood glucose meter. Insulin shots are given before each meal and sometimes at bedtime. Type II diabetics don’t often need to check their blood sugars that often.

"Life is not over because you have diabetes. Make the most of what you have, be grateful." Dale Evans Rogers (American Singer known as the "Queen of the West", )

Glucose, a form of sugar, is the body's main source of fuel. Glucose needs insulin to enter the cells to be used as energy. Insulin is produced by a large gland situated behind the stomach - the pancreas. In diabetes, either the pancreas does not produce enough insulin or the cells in the muscles, liver, and fat do not use insulin properly, or both. This allows sugar to accumulate in the blood while the cells are starved. These metabolic abnormalities lead to vascular inflammation. People with diabetes are at a much higher risk of developing cardiovascular diseases like heart attack, stroke, peripheral artery disease and heart failure.

The incidence of diabetes is reaching epidemic proportions. Worldwide, it is estimated that the prevalence of diabetes will rise from 2.8% (171 million people) in 2000 to 4.4% (366 million people) in 2030. Elevated blood glucose levels are responsible for 21% of deaths from coronary heart disease and 13% of deaths from stroke. This translates into 3.16 million deaths a year. Diabetes is also a major problem in the United States.

Many clinical trials have established that cardiovascular diseases are the most common and most serious complications in diabetics. Almost 65% patients with diabetes die of heart attack or a stroke. Dr. Garcia and his co researchers reported in Diabetes in 1974, using data from the Framingham Study, that patients with diabetes have a two-three-fold increased incidence of cardiovascular disease and those who present in the fourth and fifth decade of life have a two-fold increase in mortality. This cardiovascular risk develops even before diabetes becomes clinically apparent. Researchers from the Harvard School of Public Health in Boston found that women who eventually developed type 2 diabetes had a risk of heart attack almost 4 times higher than those who never developed the disease. This data from the Nurses Health Study, was published in the July 2002 issue of Diabetes Care.

The cause of the increased risk of macro-vascular cardiac disease is multi-factorial. Eighty percent of patients with type 2 diabetes are either obese or overweight. Diabetics also carry an abnormal lipid profile. Diabetics typically have elevated plasma triglycerides, normal or mildly elevated low-density lipoprotein cholesterol (LDL-C), and reduced plasma HDL-C concentrations. This encourages atherosclerosis. The combination of high blood sugar and high insulin levels are also toxic to the cardiovascular system. Further, more than two thirds of the adults with diabetes suffer from high blood pressure, another major risk factor for cardiovascular disease.

"What was so upsetting was I didn't really know anything about diabetes except that Ella Fitzgerald lost her legs and later died from it." Della Reese. Diabetics also causes many micro-vascular complications. These include diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. Despite good long-term sugar and blood pressure control, diabetes remains a major cause of blindness, renal failure and amputations. Two landmark studies, the Diabetes Control and Complications Trial, published in the New England Journal of Medicine in 1993 and the United Kingdom Prospective Diabetes Study Group (UKPDS) study published in the British Medical Journal in 1998, have shown that intensive control of blood glucose levels and tight blood pressure control reduce the risk of these micro vascular complications in diabetics.

An earlier report from the UKPDS Study published in the British Medical Journal in 1996, showed that increasing age, poor sugar control, increased systolic blood pressure, raised bad LDL-cholesterol, reduced good HDL-cholesterol levels and smoking were significant risk factors for coronary heart disease in diabetics. Lifestyle interventions reduce the risk of cardiovascular diseases and include eating healthier, staying active, drinking alcohol in moderation , stopping the use of tobacco products and maintaining a healthy body weight. They have been shown to prevent the development of diabetes by almost 58%. In patients who have impaired glucose tolerance, they can delay diabetes by almost 11 years. These beneficial effects of lifestyle interventions were also proven in the Diabetes Prevention Program Research Group report published in the New England Journal of Medicine in 2002.

"Diabetes is like being expected to play the piano with one hand while juggling items with another hand, all while balancing with deftness and dexterity on a tightrope" - Marlene Less, Scott's Diabetes Journal. Treating diabetes and controlling your sugar may be difficult. This is because blood sugar levels ideally should be continuously maintained within a small normal range. This may require frequent medications or injections and careful monitoring of the sugar levels. Recent data suggests that the traditionally used blood sugar lowering medications may also have a dark side. In 2002, Duke researchers presented data at the 51st Annual Scientific Sessions of the American Heart Association which showed that there was a 2.6-fold increased risk of death for patients taking injected insulin and sulfonylurea drugs, compared with insulin-sensitizing therapies, such as metformin. They also found that at 90 days into the trials, 12% of diabetic patients on insulin-providing therapy had a major adverse event, compared with 5% of diabetic patients on insulin-sensitizing therapy. Treating diabetes is therefore just not limited to reducing blood glucose levels. Several metabolic abnormalities including elevated insulin levels, inflammation and lipids have to be taken into account. Most diabetics are now also placed on a class of high blood pressure pills called ace inhibitors and angiotensin receptor blockers, cholesterol lowering statins and the household aspirin. Recent trials (especially the ASCOTT-LLA study, published in Lancet in 2003) have shown that even in the absence of a history of coronary heart disease or high cholesterol, statin therapy is beneficial in diabetes. The American Diabetic Association advocates the use of aspirin in diabetics with an additional risk factor. Diabetics share a common vascular inflammation seen in patients with cardiovascular disease and aspirin appears to be beneficial in decreasing cardiovascular mortality. Ace inhibitors or angiotensin receptor blockers appear to have a better cardiovascular protection effect in diabetics that goes beyond the benefit achieved by their reduction in blood pressure. The blood pressures goals are lower in diabetics and you are better protected if the blood pressure is reduced to 120/80 mm/Hg or less.

"I lay in the bed at the hospital and said, 'let's see what I have left.' And I could see, I could speak, I could think, I could read. I simply tabulated my blessings, and that gave me a start." Dale Evans Rogers, American Singer. Many diabetics may feel this way, but recent understanding of the disease and the cardiovascular connection has made complications easier to delay or avoid. And lifestyle changes can even prevent or delay the development of diabetes. Jill Johnson said, ""Living a healthy lifestyle will only deprive you of poor health, lethargy, and fat." And I may add, diabetes and heart disease.

Dr. Shashi K. Agarwal is a Board Certified Internist and Cardiologist with a private practice in New York City and New Jersey. He is also a Diplomate of the American Board of Holistic Medicine and the American Academy of Anti-Aging Medicine.

Having diabetes can complicate your life in many ways. It can even cause problems for your feet. This disease, accurately named diabetes mellitus, is a chronic disorder that is characterized by high blood glucose levels. High sugar levels in the blood can result in tissue and organ damage. Diabetes mellitus is caused by faulty insulin, no insulin, fewer amount of insulin, or changes in the body’s reaction to this hormone. Insulin breaks down blood glucose so that it can be used by the body for energy.

The pancreas produces insulin, and diabetes mellitus can be subdivided into two principle types. Persons suffering from Type 1 diabetes have defective insulin producing cells, so that the body cannot produce the hormone, or can produce only very low levels of it. On the other hand, people suffering from Type 2 diabetes have resistant body tissues, and will often have a different, more extensive treatment and maintenance regimen. People with diabetes have to eat special diets, avoid certain foods, and take medication that can allow them to maintain good blood insulin levels.

Foot Care
People suffering from diabetes mellitus will often have a hard time maintaining their feet, because diabetes can damage the nerves leading to the feet. Diabetes can also impede blood circulation, especially to the extremities, including the feet. Because of impeded circulation, the feet can be prone to more infections, especially since the immune system will have a hard time targeting infectious agents entering through the feet. People with diabetes will often complain about having stiffer joints, wounds that heal slower, and decreased speed of blood clotting.

Because of these effects of diabetes on the feet, much more extensive damage can occur. For that matter, impeded circulation can also keep the wounds in the feet from healing properly, so that people with diabetes can also have foot ulcers. By the time they detect such ulcers, it is too late to heal the wounds by simply applying ointments, and amputation may have to be carried out.

If you are diagnosed with diabetes, then you have to have a good foot cleaning and maintenance regimen in order to avoid infections. Foot care for Diabetes Mellitus involves the following. First, take care that you wash your feet every day, using some mild soap and warm water. Lather your feet well and clean the areas between the toes and on your heel. When you are done, rinse your feet well and dry each part of your foot carefully. If you are wearing closed shoes, use talcum or foot powder to dust your foot and keep moisture out. Be sure, however, to apply only a little powder, and take care not to leave powder to cake in between your toes.

Look at each part of your foot each day, and inspect its bottom using a mirror. Look for sores, bruises, cuts, or changes in toenail color. To supplement your foot care, practice good, healthy habits: quit smoking, exercise regularly, and avoid drinking alcohol.

Care for your feet regularly and make sure that they are always well groomed. When cutting toenails, make sure that you cut across the top, and never force your nail cutter into the corners of your toes. When you encounter sharp angles on your feet, use a good emery board or nail file to smoothen your nail out. You want to avoid cutting your foot with your own toenails. Avoid walking around barefoot, and always wash your feet if you step into dirty soil or mud.

When buying shoes, shop in the afternoon when your foot is relatively larger, and buy a shoe that fits your feet exactly. You need comfortable shoes that will not hurt your feet, cut into your toes, or damage the skin of your feet or legs. As much as possible, avoid buying high heels, pointed or narrow toes, or hard shoes that can tax on your bones.

Visit a podiatrist, or foot specialist, at least once a year; and consult with your doctor regularly. Do as much research as you can on foot care for Diabetes Mellitus.