Chapter 1

Diabetes mellitus
diabetes is a disease in which the body does not make enough insulin to control blood
sugar levels. During digestion, food is broken down into basic components. Carbohydrates
are broken down into simple sugars, primarily glucose. Glucose is a critically important
source of energy for the body's cells. To provide energy to the cells, glucose needs to leave
the blood and get inside the cells.
Insulin traveling in the blood signals the cells to take up glucose. Insulin is a hormone
produced by the pancreas. When levels of glucose in the blood rise, like following a meal, the
pancreas normally produces more insulin.
diabetes occurs when some or all of the insulin-producing cells in the pancreas are
destroyed. This leaves the patient with little or no insulin. Without insulin, sugar accumulates
in the bloodstream rather than entering the cells. As a result, the body cannot use this glucose
for energy.
diabetes is an autoimmune disease. This means it begins when the body's immune
system attacks cells in the body. In diabetes, the immune system destroys insulin-producing
cells (beta cells) in the pancreas.
Why the immune system attacks the beta cells remains a mystery. Experts suspect that
some people are genetically predisposed to the disease. And an environmental factor may act
as a trigger. Viral infections and diet are two possible triggers.
diabetes is not caused by the amount of sugar in a person's diet before the disease
develops.
diabetes is a chronic disease. It is diagnosed most commonly between ages 10 and 16.
diabetes equally affects males and females.

Chapter 2
Symptoms
Initial Symptoms
Symptoms usually come on suddenly and strongly. Typically the most prominent
symptoms are excessive urination and extreme thirst. This is because the increased glucose in
the blood causes the kidneys to create more urine than usual. Losing more fluid in the urine
makes a person dehydrated. And dehydration leads to great thirst. Children may start to wet
the bed again.
Weight loss, with no loss of appetite, also is common. The weight loss is due in part to
dehydration. Water has weight. Imagine holding a gallon jug of water: it weighs about eight
pounds. People with new, uncontrolled diabetes can lose a gallon of water from dehydration.
Other common symptoms are weakness, fatigue, confusion, nausea and vomiting.
Dehydration can cause weakness, fatigue and confusion. Another cause of these symptoms,
along with nausea and vomiting, is a condition called ketoacidosis.
Ketoacidosis occurs because cells can't the glucose they need for energy. So the cells
have to use something else. As an alternative fuel, the liver produces substances called
ketones. Ketones are a kind of acid. When they build up in the blood, it's called ketoacidosis.
Ketoacidosis can cause heart problems and affect the nervous system. Within hours, it may
put a person at risk of coma or death.
Chronic Symptoms
Even after it is diagnosed and treatment is begun, diabetes can affect all body systems.
It is less likely to damage the body, and cause symptoms, if the blood sugar levels are well
controlled by treatment.
The serious and potentially life-threatening complications that can occur with diabetes
include:
Eye damage (retinopathy) Tiny blood vessels at the back of the eye are damaged
by high blood sugar. Caught early, retinopathy can be stopped by tightly controlling blood
sugar and laser therapy. If blood sugar remains high, retinopathy eventually causes blindness.
Nerve damage (neuropathy) High blood sugar can damage nerves, leading to pain
or numbness of the affected body part. Damage to nerves in the feet, legs and hands
(peripheral neuropathy) is most common. Nerves that control body functions, such as
digestion and urination, also can be damaged.
Foot problems Sores and blisters commonly occur on the feet of people with
diabetes. If peripheral neuropathy causes numbness, a sore may not be noticed. It can become
infected. Blood circulation can be poor, leading to slow healing. Left untreated, a simple sore
can lead to gangrene. Amputation may be necessary.

 Kidney disease (nephropathy) High blood sugar can damage the kidneys. If blood
sugar remains high, it can lead to kidney failure.
Heart and artery disease People with diabetes are more likely to have heart disease,
strokes and problems related to poor circulation.
Diabetic ketoacidosis This occurs when ketones are made by the body as a
substitute for glucose. Symptoms include:Nausea and vomitingAbdominal
painFatigueLethargyComa and death (if ketoacidosis is left untreated)
Hypoglycemia Low blood sugar (hypoglycemia) can result from insulin treatment
(see Treatment section, below). Hypoglycemia may occur if too much insulin is taken or
meals are skipped. Symptoms include:WeaknessDizzinessTremblingSudden
sweatingHeadacheConfusionIrritabilityBlurry or double visionHypoglycemia can lead to
coma if it is not corrected by eating or drinking carbohydrates. Glucagon is a substance that
makes the liver release glucose into the bloodstream. An injection of glucagon can also
correct hypoglycemia.

Chapter 3
Diagnosis
diabetes is diagnosed by a combination of symptoms, a person's age and blood tests.
The blood tests include tests for sugar levels and for other substances.
Fasting plasma glucose (FPG) test. Blood is taken in the morning after fasting
overnight. Normally, blood sugar levels remain between 70 and 100 milligrams per deciliter
(mg/dL). Diabetes is diagnosed if a fasting blood sugar level is 126 mg/dL or higher.
Oral glucose tolerance test (OGTT). Blood sugar is measured two hours after drinking
75 grams of glucose. Diabetes is diagnosed if the 2-hour blood sugar level is 200 mg/dL or
higher.
Random blood glucose test. A blood sugar of 200 mg/dL or greater at any time of day
combined with symptoms of diabetes is sufficient to make the diagnosis.
Hemoglobin A1C (glycohemoglobin). This test measures the average glucose level over
the prior two to three months. Diabetes is diagnosed if the hemoglobin A1C level is 6.5%
percent or higher.
Expected Duration
diabetes is a lifelong disease.
People with diabetes need regular checkups. They must carefully monitor their blood
sugar levels every day. They must receive insulin treatment throughout life.
A small number of people can become exceptions to this rule. Some people with
diabetes eventually require kidney transplants. A transplant of the pancreas, or of the insulinproducing cells from the pancreas (called "islets"), sometimes is performed at the same time.
Since the new pancreas can make insulin, this can cure the diabetes.
On unusual occasions, when someone's diabetes is very hard to control with available
treatments, pancreas or islet transplantation may be performed even when kidney
transplantation is not necessary. However, this approach is still experimental, and is not
generally recommended.
Prevention
There is no proven way to prevent diabetes. Vitamin D deficiency, which is very
common, may increase the risk of diabetes. However, correcting the deficiency has not been
yet shown to prevent diabetes. Likewise, avoiding cow's milk during infancy may possibly
prevent diabetes in genetically susceptible infants. But there is no definite proof that this
prevents the disease.
4

Chapter 4
Treatment
Treatment of diabetes requires daily insulin injections. The injected insulin makes up
for the insulin that is not produced by the body. Most people with diabetes need two to four
injections per day.
Some people use a syringe for injections. Other patients use semiautomatic injector
pens that help to measure precise amounts of insulin. An increasing number of patients use
insulin pumps. Insulin pumps deliver a regulated dose of insulin through a needle implanted
under the skin. The insulin pump is worn in a pack on the body.
People with diabetes must properly regulate insulin intake. Enough insulin must be
taken to keep blood sugar levels from getting or staying too high. But low blood sugar can
also be dangerous. Low blood sugar may occur if too much insulin is taken or if not enough
carbohydrates are ingested in to balance the insulin.
In order to properly regulate their insulin intake, people with diabetes need to monitor
their blood sugar levels several times per day. They do this by testing a sample of blood. They
must prick their finger and place a small drop of blood on a test strip. The test strip is inserted
into a device called a glucose monitor. An accurate reading of blood sugar levels is returned
within seconds.
Newer glucose monitors have test strips that take the blood directly from the spot that
was pricked. This process requires less blood. Other monitors allow blood to be taken from
the forearm, thigh or the fleshy part of the hand. This can be less painful.
People with diabetes need to watch their diets. A healthy diet for someone with diabetes
keeps the amount of glucose in the blood relatively constant. This makes blood glucose levels
easier to control with insulin. A person with diabetes typically is advised to eat, exercise and
take insulin at about the same times every day. Regular habits help to keep glucose levels
within the normal range.
Fast-acting insulin may be taken as needed, depending on the amount of carbohydrates
ingested. Your doctor or dietitian will help you determine the best insulin and diet schedule
for you or your child.
People with diabetes should get regular exercise. Exercise helps to keep the heart and
blood vessels healthy. It also helps to control blood sugar by causing muscles to use glucose
and by keeping body weight down. Ask your doctor how much and when to exercise to best
control your diabetes.

Chapter 5
When To Call a Professional
Call your health care professional if you experience a sudden increase in thirst and
urination. Unexplained weight loss always should be reported to a physician.
If you or your child has diabetes, see your doctor regularly to make sure that you are
keeping good control of your blood sugar. You should also be checked regularly for early
signs of complications such as heart disease, eye problems and skin infections.
Your doctor most likely will suggest that you also visit other specialists regularly. These
may include a podiatrist to check your feet and an ophthalmologist to check your eyes for
signs of diabetes complications.
Prognosis
People with diabetes generally adjust quickly to the time and attention that is needed to
monitor blood sugar, treat the disease and maintain a normal lifestyle.
As time goes on, the risk of complications is substantial. But it can be reduced greatly if
you strictly monitor and control your blood glucose levels.