Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, which result from defects in insulin secretion. Diabetes mellitus, commonly referred to as diabetes, means "sweet urine." Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Insulin is a hormone produced by the pancreas, which normally controls blood glucose levels. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes mellitus, the absence or insufficient production of insulin causes hyperglycemia. Diabetes mellitus is a chronic medical condition, meaning it can last a lifetime.

Causes:

Insufficient production of insulin (either absolutely or relative to the body's needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin leads to hyperglycemia and diabetes mellitus. This condition affects mostly the cells of muscle and fat tissues and results in a condition known as "insulin resistance." This is the primary problem in type 2 diabetes. The absolute lack of insulin, usually secondary to a destructive process in the pancreas, is the particular disorder in type 1 diabetes.

Glucose is a simple sugar found in food. It is an essential nutrient that provides energy for the proper functioning of the body cells. After meals, food is digested in the stomach and the intestines. The glucose in digested food is absorbed by the intestinal cells into the bloodstream and is carried by blood to all the cells in the body. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, cells become starved of glucose energy despite the presence of abundant glucose in the blood. In certain types of diabetes mellitus, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine.

Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels. When the blood glucose levels are lowered, the insulin release from the pancreas is turned off. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. In patients with diabetes mellitus, the insulin is either missing (as in type 1 diabetes mellitus), or insulin is relatively insufficient for the body's needs (as in type 2 diabetes mellitus). Both cause elevated levels of blood glucose (hyperglycemia).

There are two major types of diabetes mellitus, called type 1 and type 2. Type 1 diabetes mellitus was also called insulin dependent diabetes mellitus (IDDM), or juvenile onset diabetes mellitus. In type 1 diabetes mellitus, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin. Abnormal antibodies have been found in patients with type 1 diabetes. Antibodies are proteins in the blood that are part of the body's immune system. The patient with type 1 diabetes must rely on insulin medication for survival.

Type 2 diabetes mellitus was also referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM). In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately. In many cases this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells) these larger quantities of insulin are produced as an attempt to get these cells to recognize that insulin is present. In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective, and occur late in response to increased glucose levels. Finally, the liver in these patients continues to produce glucose despite elevated glucose levels.

While it is said that type 2 diabetes mellitus occurs mostly in individuals over 30 years old and the incidence increases with age, we are seeing an alarming number patients with type 2 diabetes who are barely in their teen years. Most of these cases are a direct result of poor eating habits, higher body weight, and lack of exercise. While there is a strong genetic component to developing this form of diabetes, there are other risk factors - the most significant of which is obesity. Type 2 diabetes is often associated with a strong familial, probably genetic predisposition. This is less common in the autoimmune form of type 1 diabetes.

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