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Diabetes

Diabetes mellitus is a chronic condition in which the pancreas, a gland near the stomach, fails to make insulin or does not make enough insulin, or in which the body becomes insensitive to insulin. Insulin is a hormone that works to convert what we eat to glucose or sugar. Insulin supplies muscles and other tissues with glucose for growth and energy. Without insulin, the body's blood sugar cannot be regulated, leading to a buildup of sugar in the blood (hyperglycemia) and loss of fuel for the body. Symptoms of diabetes include excessive thirst, frequent urination, unexplained weight loss, extreme hunger, vision changes, tingling in the hands or feet, dry skin, and sores that are slow to heal.

Diabetes is a major public health problem. In 2005, approximately 1.1 million people worldwide died from diabetes. Diabetes is the sixth leading cause of death in the United States. The consequences of diabetes are severe. Diabetes is associated with heart disease, stroke, kidney failure, blindness, nontraumatic amputations, and nerve damage.

History

The earliest written record of diabetes dates back to 1552 BCE in Egypt when a physician, Hesy-Ra, described one of the symptoms of diabetes as frequent urination. It was not until the late 19th century that scientists began to understand the disease. In 1869, a German medical student, Paul Langerhans, described islands of cells in the pancreas. Later, these cells were discovered to be the source of insulin and were named ‘Islets of Langerhans.’ In 1889, two European scientists, Oskar Minkowski and Joseph von Mering, discovered that removing the pancreas from dogs resulted in diabetes and therefore recognized that diabetes is a disease of the pancreas. In 1921, Canadian scientists Frederick Banting and Charles Best extended the work of Minkowski and von Mering by giving dogs without a pancreas extracts from the Islets of Langerhans from healthy dogs. Consequently, Banting and Best were able to isolate insulin and to inject insulin from bovine pancreases into humans. Their first patient was an 11-year-old boy, Leonard Thompson, who was suffering from diabetes, at that time an invariably fatal disease. After Banting and Best injected the boy with insulin, his blood sugar levels decreased, and he thrived.

Types of Diabetes

There are three main types of diabetes: type 1, type 2, and gestational diabetes.

Type 1 Diabetes

Type 1 diabetes occurs when the pancreas produces little or no insulin and it is necessary to take insulin daily by injection. Type 1 diabetes is thought to be an autoimmune disease in which the immune system attacks the insulin-producing cells of the pancreas. Approximately 10% of persons with diabetes are type 1 and most new cases occur in children; in fact, diabetes is one of the more common chronic diseases among children. Around 40% of type 1 cases are found in persons less than 20 years of age at the onset, and the incidence peaks at ages 2, 2 to 6, and 10 to 14.

It is unclear what causes type 1 diabetes, because the exact mechanism for developing the disease is unknown. However, many scientists believe that development of type 1 diabetes follows exposure to an ‘environmental trigger’ that results in an attack against the beta cells of the pancreas in some genetically predisposed people. Risk factors for type 1 diabetes are not well understood, but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes. There has been some implication of a viral connection but that has yet to be proven. Relatives of type 1 diabetics have a 10% to 15% greater risk of developing the disease than those without any family history of the disease. Males and females are at similar risk for type 1 diabetes.

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