Diabetes Mellitus
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Quick Facts
Over 37 million people in the U.S. have diabetes, and around 1 in 5 don’t know they have it (CDC, 2022).
Diabetes Mellitus is a chronic condition that affects how the body processes blood sugar (glucose). There are three main types:
- Type 1: The body doesn’t produce insulin (autoimmune).
- Type 2: The body becomes resistant to insulin or doesn’t use it effectively.
- Gestational: Occurs during pregnancy and usually resolves after birth.
DIABETES MELLITUS (HYPERGLYCEMIA) FAILURE TO DIAGNOSE AND TREAT
There is little doubt that Diabetes Mellitus has reached epidemic proportions around the world, including the United States. The hallmark of Diabetes Mellitus is elevated blood glucose levels, which is known medically as Hyperglycemia.
The Centers for Disease Control and Prevention and the American Diabetes Association confirm approximately 38 million Americans have been diagnosed with Diabetes and an approximate additional 97 million Americans have been diagnosed with pre-Diabetes, a condition that often will progress to Type II Diabetes Mellitus if not timely diagnosed and properly treated. In total, these combined diagnoses impact upwards of 40 percent of the United States population, a figure which has increased dramatically over the past 2 decades due to increased obesity, decreased activity levels and an aging population.
Given the magnitude of the problem, elevated blood glucose is something many physicians, especially, primary care physicians encounter regularly in their practice.
A patient’s blood glucose level can be diagnosed by means of simple blood testing. It can be determined by a fasting blood glucose assessment that is obtained during a patient’s Comprehensive Metabolic Panel Blood Testing. A fasting blood glucose of 126 or more is consistent with the diagnosis of Diabetes Mellitus and a fasting blood glucose of 100-125 is consistent with the diagnosis of pre-Diabetes. Alternately, a patient’s A1C (glycated hemoglobin), which is likewise obtained by a simple blood test can be performed on a non-fasting basis and a result of 6.5 or higher is consistent with a diagnosis of Diabetes Mellitus while a result of 5.7-6.4 is consistent with a diagnosis of pre-Diabetes.
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DIABETES MELLITUS PATHOPHYSIOLOGY
Diabetes Mellitus represents a group of metabolic conditions, each of which is characterized by elevated blood sugar levels.
Glucose is the body’s main source of energy and comes from carbohydrates that a person ingests and represent the body’s main source of energy. The way glucose enters the body’s cells to provide the body with fuel is through insulin, a hormone that is produced in the pancreas.
Those patients with Diabetes Mellitus either do not produce insulin (Type I) or are unable to use insulin properly (Type II). When this happens, glucose remains in the blood and does not reach the body’s cells, thereby causing a spike in the person’s blood glucose level. A person with consistently high blood glucose levels can develop serious health issues, including heart, eye and nervous system damage.
DIFFERENT TYPES OF DIABETES MELLITUS
Type I Diabetes Mellitus
This occurs when the pancreas does not make insulin. It is an autoimmune disease, most often diagnosed in children and young adults, that is caused by the body’s immune system attacking and destroying the islet cells in the pancreas that are responsible for insulin production. Because the body does not produce insulin, patients with Type I Diabetes Mellitus must take insulin so as to permit glucose to enter the body’s cells from its blood. Type I Diabetes Mellitus accounts for less than 10 percent of those patients diagnosed with Diabetes Mellitus.
Type II Diabetes Mellitus
Unlike Type I Diabetes Mellitus, Type II Diabetes Mellitus is due to insulin resistance where the body fails to properly use the insulin produced in the pancreas. This is the most common type of Diabetes Mellitus and often arises during adulthood and is associated with obesity and decreased activity levels. However, recent trends have shown worrisome increases in Type II Diabetes Mellitus in children. This recent trend, which shows no evidence of stopping, reveal increased cases of Type II Diabetes Mellitus in Americans, children included, being diagnosed each year.
Gestational Diabetes
This form of Diabetes Mellitus develops during pregnancy. It is estimated to occur in approximately 9 percent of pregnancies in the United States annually. This form of Diabetes Mellitus typically resolves after the patient gives birth.
LADA (Latent Autoimmune Diabetes in Adults)
While akin to Type I Diabetes Mellitus, LADA often develops more slowly and is usually diagnosed in patients who are over 30. While a rare form of Diabetes Mellitus, it too is diagnosed by elevated blood glucose levels on fasting blood glucose and/or A1C testing. Eventually, patients with LADA often require insulin. However, LADA is a hybrid of Type I and Type II Diabetes Mellitus as it has characteristics of both conditions.
COMMON RISK FACTORS FOR DIABETES MELLITUS
Type I Diabetes Mellitus is an autoimmune condition, which has less than a one percent of diagnosed cases occurring without a pre-existing family history. This percentage increases slightly when either parent has been diagnosed with Type I Diabetes Mellitus.
Type II Diabetes Mellitus risk factors include being overweight, lack of physical activity, a family history of Type II Diabetes Mellitus and certain ethnic groups being at increased risk (i.e., African American, Asian Americans, Hispanic/Latino and Native Americans). Again, this represents the largest percentage of diagnosed cases of Diabetes Mellitus.
DIABETES MELLITUS TREATMENT
Regardless of the type, the goal of treatment for Diabetes Mellitus is to properly manage the patient’s blood sugar levels so as to prevent complications that can arise. With pre-Diabetes, the goal is also to delay or stop its progression to Type II Diabetes Mellitus.
In Diabetic or pre-Diabetic individuals, the monitoring of blood glucose levels is essential. By careful monitoring of a patient’s blood glucose levels, a determination can be made as to whether treatment is successful and/or requires adjustment. It also permits the determination of whether the person’s Diabetes Mellitus is progressing, which again can occur with pre-Diabetes progressing to Type II Diabetes Mellitus.
Type I Diabetes Mellitus: Because these individuals do not produce insulin, Type I Diabetes Mellitus is treated with insulin. The units of insulin required can be adjusted based upon the person’s blood glucose level, which can fluctuate greatly due to a variety of factors and its strict control is a constantly evolving process for the person and his/her medical providers.
Type II Diabetes Mellitus: The initial treatment for Type II Diabetes Mellitus is initially focused on diet and increased physical activity. The objective is for the person to ideally lose 5 percent of his or her body weight over a 3-month period. If successful, repeat blood glucose or A1C testing should reveal improved blood glucose or A1C test results. If unsuccessful and also as an initial treatment for certain patients, medications, such as Metformin (Glucophage), SGLT2 inhibitors (Jardiance) or a GLP-1 receptor agonist (Ozempic), are prescribed to improve the patient’s blood glucose levels. In certain circumstances, including those individuals with LADA, insulin might be required.
DIABETES COMPLICATIONS
Without adequate control of a person’s blood glucose levels, the person can develop numerous complications.
Cardiovascular Disease: Individuals with Diabetes Mellitus are reported to be 3 times more likely to develop cardiovascular disease over their lifetime as Diabetes Mellitus significantly increases the risk of cardiovascular disease. This is because Diabetes Mellitus can damage blood vessels, including the coronary arteries. The damage to the blood vessels will promote the formation of plaque type deposits in the arteries that over time can cause a blockage, either partial or complete, in the affected blood vessel. If this occurs in one of the coronary arteries, it can cause a heart attack or a stroke.
Kidney Disease: Kidney failure is estimated to be 10 times more common in Diabetics than non-Diabetics. As with the heart’s blood vessels, increased blood glucose levels can also cause damage to the kidney’s small blood vessels. This results in reduced kidney function, causing the kidneys to experience difficulty filtering the body’s waste and excess fluid. Over time, if Diabetes Mellitus is not well controlled, the person can experience chronic kidney disease and ultimately even kidney failure, potentially requiring transplant surgery.
Eye Complications: Diabetes Mellitus can damage the retina. Again, vascular in nature, diabetic retinopathy is caused by damage to the small blood vessels in the retina from increased blood glucose levels. When this occurs, the retina, which is responsible for receiving light and converting it into images, becomes damaged. If the damage becomes extensive, it can significantly impair vision and possibly lead to blindness.
Nerve Damage: Persons with Diabetes Mellitus are at significantly increased risk for lower limb amputation as lower limb amputations due to Diabetes Mellitus are reported to occur approximately 120,000 times per year in the United States alone. Diabetes caused neuropathy can impact virtually any nerve in the body. However, peripheral neuropathy from Diabetes Mellitus most often affects the feet. Again, uncontrolled blood glucose levels can damage the small blood vessels of the feet. When this occurs in individuals with uncontrolled blood glucose levels, they can experience impaired sensation in their feet, making them highly susceptible to foot ulcers. Because of the impaired blood flow from uncontrolled diabetes to the feet, healing also becomes impaired. This is the reason why Diabetics are at such an increased risk for lower limb amputation.
Diabetic Ketoacidosis: Perhaps, the most serious of Diabetes Mellitus complications, Diabetic Ketoacidosis, can be life-threatening. Typically, it is caused by uncontrolled hyperglycemia over a prolonged time period. However, it can also be triggered by acute illness, an infection or the administration of steroid medications. When the body’s cells do not receive the adequate amount of glucose they require to provide energy to the body, fat (as opposed to glucose) becomes the body’s primary energy source. When fat breaks down, a chemical substance, Ketones, are produced by the liver to enable fat to be used by the body as its primary energy source. Ketones, when they build-up, cause the blood to become dangerously acidotic. Diabetic Ketoacidosis usually develops slowly over time and its symptoms include increased thirst, frequent urination, high blood glucose levels and increased ketones. If undiagnosed and untreated, Diabetic Ketoacidosis can be fatal. It can also make those who develop more susceptible to serious infections, such as fungal infections, which are difficult to treat and can result in life-altering consequences.