Young diseases

Your body converts carbohydrates to glucose. Glucose is the simple sugar that is the main source of energy for the body's cells. To enter cells, glucose needs the help of insulin. Insulin is a hormone produced by the pancreas. When a person does not make enough insulin, the body can’t utilise glucose. The glucose builds up in the blood. High levels of glucose in the blood or urine lead to a finding of diabetes.

Diabetes mellitus is a disorder where the pancreas does not make enough insulin or the insulin is not effective. This insulin imbalance causes the body’s blood sugar level to rise, and eventually many unhealthy changes can occur in different body organs.

The normal and target blood glucose ranges are:
#
Ref: American Diabetes Association Guidelines & The Malaysia Clinical Practice Guidelines 2005

There are more than 1 million people in Malaysia have diabetes. Many times the disease can lead to kidney damage and even kidney failure. Diabetes is the most common cause of kidney failure in Malaysia.

Latest statistics indicated that 57% of kidney failure was due to diabetes. Most people’s diabetes does not damage the kidneys enough to cause kidney failure. Proper control of diabetes and blood pressure, together with certain medications may prevent the onset of kidney complications or reduce further kidney damage if that has already occurred.

What are the symptoms of Diabetes?
People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:

* Frequent urination
* Excessive thirst
* Unexplained weight loss
* Extreme hunger
* Sudden vision changes
* Tingling or numbness in hands or feet
* Feeling very tired much of the time
* Very dry skin
* Sores that are slow to heal
* More infections than usual

Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, namely Type1 Diabetes.

What are the types of Diabetes?
Type 1 Diabetes, also called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for 5% to 10% of all diagnosed cases of diabetes. Occurs mainly in young people below 30 years and is caused by an inability of the pancreas to produce enough insulin. These people need insulin injections.

Type 2 Diabetes, also called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes usually develops in people older than 40 years, accounts for about 90% to 95% of all diagnosed cases of diabetes. The abnormal blood sugar in these people is usually controlled with diet and / or medications.

Gestational diabetes is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over.

What are the risk factors for Diabetes?
#
Risk factors for Type 2 Diabetes include old age, obesity, a family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.

Risk factors are less well defined for Type 1 Diabetes than for Type 2 Diabetes, but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes.

Gestational diabetes occurs more frequently in people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for developing Type 2 Diabetes in the later part of their life.

Studies have shown that nearly 40% of women with a history of gestational diabetes developed diabetes later. Other specific types of diabetes, which may account for 1% to 2% of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

What is the treatment for Diabetes?
#
Healthy eating, physical activity, and insulin injections are the basic therapies for Type 1 Diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.

Healthy eating, physical activity, and blood glucose monitoring are the basic therapies for Type 2 Diabetes. Most people will require oral medications and eventually will require a combination of oral medications and insulin or a switch to insulin to control their blood glucose levels. People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high.

People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists (specialist deals with diseases that affect organs that make hormones), who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists (specialist deals with disorders of lower limbs) for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.

Is there a cure for Diabetes?
In response to the growing health burden of diabetes, the diabetes community has three choices: prevent diabetes; cure diabetes; and improve the quality of care of people with diabetes to prevent devastating complications. All three approaches are actively being pursued by the Ministry of Health Malaysia.

Several approaches to "cure" diabetes are being pursued overseas:

* Pancreas transplantation
* Islet cell transplantation (Islet cells produce insulin)
* Artificial pancreas development
* Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with Type 1 Diabetes)

Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas.

What causes Type 1 Diabetes?
The causes of Type 1 Diabetes appear to be much different than those for Type 2 Diabetes, though the exact mechanisms for developing both diseases are unknown. The appearance of Type 1 Diabetes is suspected to follow exposure to an "environmental trigger," such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically predisposed people.