Diabetes is the seventh leading cause of death listed in the United States. Diabetes is the leading cause of blindness. “In 1996 diabetes contributed to more than 162,000 deaths”(Lewis 1367).
“Diabetes mellitus is not a single disease but a group of disorders with glucose intolerance in common” (McCance 674). Diabetes mellitus is a metabolic disorder characterized by hyperglycemia (increased blood sugar) and results from defective insulin production, secretion, and utilization. There are many forms of diabetes. “Diabetes increases the risk of heart and blood vessel disease, amputation, infections, kidney damage, eye problems (including blindness), and nerve malfunction” (Husain). I will briefly define the different forms of diabetes and then I will discuss diabetes mellitus in general.
1. Insulin dependent diabetes mellitus (IDDM) or type 1 is when the pancreas will produce little or no insulin, therefore requiring injections of insulin to control diabetes and prevent ketoacidosis. All patients with this type of diabetes need insulin to survive (Deakins 34). Five to ten percent of all diabetic patients have IDDM. Usual presentation is rapid with classical symptoms of polydipsia (increased thirst), polyphagia (increased hunger), polyuria (increased urination), and weight loss. IDDM is
most commonly seen in patients under thirty, but can be seen in older adults.
2. Non-insulin dependent diabetes mellitus (NIDDM) or type 2 is caused by a defect in insulin manufacture and release from the beta cell or insulin resistance in the peripheral tissues. Approximately ninety percent of diabetic patients have NIDDM. Genetics play a big role in the etiology of NIDDM and is often associated with obesity. Usually presentation is slow and often insidious with symptoms of fatigue, weight gain, poor wound healing, and recurrent infection. Primarily occurs in adults over thirty.
3. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance, which occurs during pregnancy. Occurs in approximately three percent of pregnancies, and usually disappears after pregnancy. Women with GDM are at higher risk for having diabetes in the future. GDM is associated with increased risk of morbidity. Women should be screened for GDM between the 24th and the 28th weeks of gestation.
4. Diabetic ketoacidosis is a serious condition, which occurs primarily in IDDM during times of severe insulin deficiency or illness producing severe hyperglycemia (increased sugars in the blood), ketonuria (acetone bodies in urine), dehydration, and acidosis (PH balance of less than 7.35).
According to McCance the diagnosis of diabetes is based on (1) more than one fasting plasma glucose level greater than 140mg/dl, (2) elevated plasma glucose levels in response to an oral glucose test, and random plasma glucose levels above 200mg/dl combined with classic symptoms of polydipsia, polyphagia, and polyuria (674).