Diabetes mellitus

Diabetes mellitus
A hollow circle with a thick blue border and a clear centre
Universal blue circle symbol for diabetes.[1]
Pronunciation
SpecialtyEndocrinology
SymptomsFrequent urination, increased thirst, increased hunger[2]
ComplicationsDiabetic ketoacidosis, nonketotic hyperosmolar coma, heart disease, stroke, chronic kidney failure, foot ulcers[2][3]
Risk factorsType 1: Family history[4]
Type 2: Obesity, lack of exercise, genetics[2][5]
Diagnostic methodHigh blood sugar[2]
TreatmentHealthy diet, physical exercise[2]
MedicationInsulin, anti-diabetic medication like metformin[2][6][7]
Frequency415 million (8.5%)[2][8]
Deaths1.5–5.0 million per year[8][9]

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.[10] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.[2] If left untreated, diabetes can cause many complications.[2] Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.[3] Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.[2]

Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced.[11] There are three main types of diabetes mellitus:[2]

  • Type 1 DM results from the pancreas' failure to produce enough insulin due to loss of beta cells.[2] This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".[2] The cause is unknown.[2]
  • Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[2] As the disease progresses, a lack of insulin may also develop.[12] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes".[2] The most common cause is a combination of excessive body weight and insufficient exercise.[2]
  • Gestational diabetes is the third main form, and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.[2]

Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with the disease.[2] Type 1 DM must be managed with insulin injections.[2] Type 2 DM may be treated with medications with or without insulin.[9] Insulin and some oral medications can cause low blood sugar.[13] Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM.[14] Gestational diabetes usually resolves after the birth of the baby.[15]

As of 2015, an estimated 415 million people had diabetes worldwide,[8] with type 2 DM making up about 90% of the cases.[16][17] This represents 8.3% of the adult population,[17] with equal rates in both women and men.[18] As of 2014, trends suggested the rate would continue to rise.[19] Diabetes at least doubles a person's risk of early death.[2] From 2012 to 2015, approximately 1.5 to 5.0 million deaths each year resulted from diabetes.[8][9] The global economic cost of diabetes in 2014 was estimated to be US$612 billion.[20] In the United States, diabetes cost $245 billion in 2012.[21]

Signs and symptoms

Overview of the most significant symptoms of diabetes

The classic symptoms of untreated diabetes are unintended weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger).[22] 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 blurred 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. Long-term vision loss can also be caused by diabetic retinopathy. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.[23]

Diabetic emergencies

Low blood sugar (hypoglycemia), is common in people 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 effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases.[24][25] Moderately low blood sugar may easily be mistaken for drunkenness;[26] rapid breathing and sweating, cold, pale skin are characteristic of low blood sugar but not definitive.[27] Mild to moderate 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.[28]

People (usually with type 1 DM) may also experience episodes of diabetic ketoacidosis (DKA), 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.[29]

A rare but equally severe possibility is hyperosmolar hyperglycemic state (HHS), which is more common in type 2 DM and is mainly the result of dehydration.[29]

Complications

Retinopathy, nephropathy, and neuropathy are potential complications of diabetes

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20) 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[30] and about 75% of deaths in diabetics are due to coronary artery disease.[31] Other macrovascular diseases include stroke, and peripheral artery disease.

The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves.[32] 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 eventual blindness.[32] Diabetes also increases the risk of having glaucoma, cataracts, and other eye problems. It is recommended that diabetics visit an eye doctor once a year.[33] 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 transplantation.[32] Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes.[32] 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 atrophy 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.[34] Being diabetic, especially when on insulin, increases the risk of falls in older people.[35]

Other Languages
Afrikaans: Suikersiekte
Alemannisch: Diabetes mellitus
አማርኛ: ስኳር በሽታ
العربية: السكري
অসমীয়া: বহুমূত্ৰ ৰোগ
Avañe'ẽ: Tuguyasuka
azərbaycanca: Şəkərli diabet
تۆرکجه: دیابت
Bân-lâm-gú: Thn̂g-jiō-pēⁿ
башҡортса: Шәкәр диабеты
беларуская: Цукровы дыябет
беларуская (тарашкевіца)‎: Цукровы дыябэт
български: Захарен диабет
brezhoneg: Diabet
Cymraeg: Diabetes
dansk: Sukkersyge
davvisámegiella: Diabetes
ދިވެހިބަސް: ހަކުރު ބަލި
Esperanto: Diabeto
euskara: Diabetes
فارسی: دیابت
føroyskt: Sukursjúka
français: Diabète sucré
Gaeilge: Diaibéiteas
ગુજરાતી: મધુપ્રમેહ
한국어: 당뇨병
हिन्दी: मधुमेह
Ido: Diabeto
বিষ্ণুপ্রিয়া মণিপুরী: ডায়াবেটিস
Bahasa Indonesia: Diabetes melitus
interlingua: Diabete
íslenska: Sykursýki
italiano: Diabete mellito
עברית: סוכרת
Basa Jawa: Kencing Manis
ಕನ್ನಡ: ಮಧುಮೇಹ
Kapampangan: Diabetes mellitus
қазақша: Қант диабеті
Kiswahili: Kisukari
Кыргызча: Кант диабети
latviešu: Cukura diabēts
Lëtzebuergesch: Diabetes mellitus
македонски: Шеќерна болест
മലയാളം: പ്രമേഹം
मराठी: मधुमेह
Bahasa Melayu: Penyakit kencing manis
မြန်မာဘာသာ: ဆီးချိုရောဂါ
Nederlands: Diabetes mellitus
नेपाली: मधुमेह
नेपाल भाषा: मधुमेह
日本語: 糖尿病
norsk: Diabetes
norsk nynorsk: Diabetes mellitus
ଓଡ଼ିଆ: ମଧୁମେହ
Oromoo: Diabetes
oʻzbekcha/ўзбекча: Qandli diabet
ਪੰਜਾਬੀ: ਸ਼ੱਕਰ ਰੋਗ
پنجابی: شوگر
Papiamentu: Diabétis Mellitus
Patois: Dayabiitis
polski: Cukrzyca
português: Diabetes mellitus
română: Diabet zaharat
Runa Simi: Misk'i unquy
русиньскый: Цукрёвый діабет
саха тыла: Диабет
संस्कृतम्: मधुमेहः
Simple English: Diabetes mellitus
سنڌي: ڊيابطس
slovenčina: Diabetes mellitus
slovenščina: Sladkorna bolezen
Soomaaliga: Sokorow
کوردی: شەکرە
српски / srpski: Шећерна болест
srpskohrvatski / српскохрватски: Dijabetes
Basa Sunda: Diabétes mélitus
suomi: Diabetes
svenska: Diabetes
татарча/tatarça: Шикәр авыруы
తెలుగు: మధుమేహం
Türkçe: Diyabet
Türkmençe: Süýjülik (kesel)
українська: Цукровий діабет
اردو: ذیابیطس
Tiếng Việt: Tiểu đường
吴语: 糖尿病
ייִדיש: צוקערקרענק
粵語: 糖尿
žemaitėška: Sokraus diabets
中文: 糖尿病