Diabetes mellitus

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"Diabetes" redirects here. For other uses, see Diabetes (disambiguation).

Diabetes mellitus

Universal blue circle symbol for diabetes.[1]

Classification and external resources
Specialty
Endocrinology
ICD-10
E10E14
ICD-9-CM
250
MedlinePlus
001214
eMedicine
med/546 emerg/134
Patient UK
Diabetes mellitus
MeSH
C18.452.394.750
Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic
diseases in which there are high blood sugar levels over a prolonged period.[2] Symptoms
of high blood sugar include frequent urination, increased thirst, and increased hunger. If
left untreated, diabetes can cause many complications.[3] Acute complications include
diabetic ketoacidosis and nonketotic hyperosmolar coma.[4] Serious long-term
complications include cardiovascular disease, stroke, chronic kidney failure, foot ulcers,
and damage to the eyes.[3]
Diabetes is due to either the pancreas not producing enough insulin or the cells of the
body not responding properly to the insulin produced.[5] There are three main types of
diabetes mellitus:

Type 1 DM results from the pancreas's failure to produce enough insulin. This
form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM)
or "juvenile diabetes". The cause is unknown.[3]
Type 2 DM begins with insulin resistance, a condition in which cells fail to
respond to insulin properly.[3] As the disease progresses a lack of insulin may also

develop.[6] This form was previously referred to as "non insulin-dependent

diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is
excessive body weight and not enough exercise.[3]
Gestational diabetes, is the third main form and occurs when pregnant women
without a previous history of diabetes develop a high blood-sugar level.[3]

Prevention and treatment involve a healthy diet, physical exercise, maintaining a normal
body weight, and avoiding use of tobacco. Control of blood pressure and maintaining
proper foot care are important for people with the disease. Type 1 DM must be managed
with insulin injections.[3] Type 2 DM may be treated with medications with or without
insulin.[7] Insulin and some oral medications can cause low blood sugar.[8] Weight loss
surgery in those with obesity is sometimes an effective measure in those with type 2 DM.
[9]
Gestational diabetes usually resolves after the birth of the baby.[10]
As of 2014, an estimated 387 million people have diabetes worldwide,[11] with type 2 DM
making up about 90% of the cases.[12][13] This represents 8.3% of the adult population,[13]
with equal rates in both women and men.[14] From 2012 to 2014, diabetes is estimated to
have resulted in 1.5 to 4.9 million deaths each year.[7][11] Diabetes at least doubles a
person's risk of death.[3] The number of people with diabetes is expected to rise to 592
million by 2035.[11] The global economic cost of diabetes in 2014 was estimated to be
$612 billion USD.[15] In the United States, diabetes cost $245 billion in 2012.[16]

Contents

1 Signs and symptoms

o 1.1 Diabetic emergencies
o 1.2 Complications
2 Causes
o 2.1 Type 1
o 2.2 Type 2
o 2.3 Gestational diabetes
o 2.4 Other types
3 Pathophysiology
4 Diagnosis
5 Prevention
6 Management
o 6.1 Lifestyle
o 6.2 Medications
o 6.3 Surgery
o 6.4 Support
7 Epidemiology
8 History
o 8.1 Etymology
9 Society and culture
o 9.1 Naming

10 Other animals
11 Research
12 References
13 Further reading
14 External links

Signs and symptoms

Overview of the most significant symptoms of diabetes

The classic symptoms of untreated diabetes are weight loss, polyuria (increased
urination), polydipsia (increased thirst), and polyphagia (increased hunger).[17] Symptoms
may develop rapidly (weeks or months) in type 1 DM, while they usually develop much
more slowly and may be subtle or absent in type 2 DM.
Several other signs and symptoms can mark the onset of diabetes, although they are not
specific to the disease. In addition to the known ones above, they include blurry vision,
headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can
cause glucose absorption in the lens of the eye, which leads to changes in its shape,
resulting in vision changes. A number of skin rashes that can occur in diabetes are
collectively known as diabetic dermadromes.

Diabetic emergencies
Low blood sugar is common in persons with type 1 and type 2 DM. Most cases are mild
and are not considered medical emergencies. Effects can range from feelings of unease,

sweating, trembling, and increased appetite in mild cases to more serious issues such as
confusion, changes in behavior, seizures, unconsciousness, and (rarely) permanent brain
damage or death in severe cases.[18][19] Mild cases are self-treated by eating or drinking
something high in sugar. Severe cases can lead to unconsciousness and must be treated
with intravenous glucose or injections with glucagon.
People (usually with type 1 DM) may also experience episodes of diabetic ketoacidosis, a
metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell
of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe
cases a decreased level of consciousness.[20]
A rare but equally severe possibility is hyperosmolar nonketotic state, which is more
common in type 2 DM and is mainly the result of dehydration.[20]

Complications
Main article: Complications of diabetes mellitus
All forms of diabetes increase the risk of long-term complications. These typically
develop after many years (1020), but may be the first symptom in those who have
otherwise not received a diagnosis before that time.
The major long-term complications relate to damage to blood vessels. Diabetes doubles
the risk of cardiovascular disease[21] and about 75% of deaths in diabetics are due to
coronary artery disease.[22] Other "macrovascular" diseases are stroke, and peripheral
vascular disease.
The primary complications of diabetes due to damage in small blood vessels include
damage to the eyes, kidneys, and nerves.[23] Damage to the eyes, known as diabetic
retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can
result in gradual vision loss and blindness.[23] Damage to the kidneys, known as diabetic
nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney
disease, sometimes requiring dialysis or kidney transplant.[23] Damage to the nerves of the
body, known as diabetic neuropathy, is the most common complication of diabetes.[23]
The symptoms can include numbness, tingling, pain, and altered pain sensation, which
can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot
ulcers) may occur, and can be difficult to treat, occasionally requiring amputation.
Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.
There is a link between cognitive deficit and diabetes. Compared to those without
diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive
function.[24]

Causes

Comparison of type 1 and 2 diabetes[12]

Feature
Onset
Age at onset
Body size
Ketoacidosis
Autoantibodies

Type 1 diabetes
Sudden

Gradual

Mostly in children Mostly in adults

Thin or normal[25] Often obese
Common

Rare

Usually present

Absent

Endogenous insulin Low or absent

Concordance
50%
in identical twins
Prevalence

Type 2 diabetes

~10%

Normal, decreased
or increased
90%
~90%

Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational
diabetes, and "other specific types".[5] The "other specific types" are a collection of a few
dozen individual causes.[5] The term "diabetes", without qualification, usually refers to
diabetes mellitus.