Diabetes mellitus, usually referred to simply as “diabetes”, has been known to mankind since ancient times. Diabetes means “flowing through” and mellitus means “sweet as honey”.
Diabetes used to be described as either “insulin-dependent” (IDDM) or “non-insulin dependent” (NIDDM). Nowadays, you are more likely to hear the terms “type 1 diabetes” and “type 2 diabetes”.
Egyptian hieroglyphic findings from 1550 BC illustrate the symptoms of diabetes. Some people believe that the type of diabetes depicted was type 2 and that type 1 diabetes is a relatively new disease, appearing within the last two centuries.
In the past, diabetes was diagnosed by tasting the urine. The only treatment was alcohol which lowered the blood sugar level. Before insulin was discovered, type 1 diabetes always resulted in death, usually quite quickly.
If you are going to get type 1 diabetes, you will probably know before your 35th birthday. Most people whose diabetes is diagnosed in childhood or the teenage years have this kind of diabetes.
Type 1 diabetes is insulin-dependent, meaning that treatment with insulin is necessary from the time the disease is first diagnosed. In this kind of diabetes, the insulin-producing cells of the pancreas are destroyed by a process in the body known as “autoimmunity”. This leads eventually to a total loss of insulin production. Without insulin, glucose remains in the bloodstream, so the blood glucose level increases, especially after eating meals. Glucose is then passed out of the body in the urine.
Type 2 diabetes is also called adult onset diabetes; it usually takes place after the age of 35. In this kind of diabetes, the ability to produce insulin does not disappear completely, but the body becomes increasingly resistant to insulin, so tablets are needed to balance this. The tablets do not contain insulin, but act by increasing the body’s sensitivity to insulin, or by increasing the release of insulin from the pancreas. It is rare for insulin injections to be necessary in the early stages of type 2 diabetes.
Although this type of diabetes is also called non insulin- dependent diabetes, many people need treatment with insulin at a later stage in much the same way as people with type 1 diabetes.
A new generation of medication for this kind of diabetes (glitazones) is now being used in adults. These tablets make the body more sensitive to insulin, and may also be helpful in other ways, for example by lowering the level of fats in the blood and reducing blood pressure. However, they are not yet approved for use in children.
An increasing number of reports from North America, Japan, the UK, and other parts of the industrialized world indicate that overweight teenagers are now beginning to develop this type of diabetes. This appears to be more common in girls than in boys. In North America, type 2 diabetes and heart disease among the young and middle-aged people from the members of the native American population is reaching epidemic proportions.
In certain groups, the number of cases of this second type of diabetes as a proportion of the total number of newly diagnosed diabetes among children is extremely high. This proportion is nearly 100% in Native Americans, 31% in Mexican Americans, and 70-75% in African Americans. Type 2 diabetes is often diagnosed in African Americans after they become ill with the symptoms of ketoacidosis.
Other risk factors for type 2 diabetes in children and young people are low birth weight, similar kind of diabetes in the family, ethnic origin (Canadian and American First Nation’s people, Hispanic, African American, Japanese, Pacific Islander, Asian and Middle Eastern), high fat and low in fibre, lack of exercise, and signs of insulin resistance (such as high blood pressure and dark velvety discoloration of the skin (known as acanthosis nigricans).
A possible reason for the increase in ‘type 2’ diabetes in young people may be that some people were “programmed” thousands of years ago to survive famine by conserving energy compared to periods when there was better access to food. Today, when we have easy access to food, these “survival capacities” may cause problems instead. For example, the number of young people with type 2 diabetes is much higher in African Americans than among Africans still living in their home continent, although the genetic make-up of these two groups is very similar. This suggests that lifestyle and diet may be particularly important.
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