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Diabetes mellitus is a disorder of sugar and starch metabolism. In diabetes sugar is not taken up and used by the cells of the body, but instead accumulates in the blood and is excreted by the kidneys; hence the large quantities of sugar in the urine of diabetics.

There are two types of diabetes mellitus. The most com­mon is non-insulin-dependent diabetes mellitus (NIDDM), sometimes called type-2 or maturity-onset diabetes. In this type, the pancreas produces some insulin but not enough to cope with the amount of glucose in the blood. This condition is often caused by obesity and excessive food intake, and can be treated by dieting alone.

In insulin-dependent diabetes mellitus (100M), also called type-1 or juvenile diabetes, there is a total or almost total failure of the pancreas to produce insulin. It usually starts before the age of twenty, and sufferers will need daily insulin injections for the rest of their lives in order to keep blood-glucose levels stable.

There are many causes of diabetes mellitus. Genetic factors are known to playa part, and diabetes can follow the removal or destruction by disease of the pancreas. Several diseases of other endocrine glands can also cause diabetes, and people taking steroid hormones or some diuretic drugs may develop diabetes as a side-effect.

Symptoms and diagnosis

Both types of diabetes mellitus cause the same main symptoms. Two of the first symptoms are excessive thirst and high urine output, the result of the accumulation of an abnormally high level of sugar in the blood which over­flows into the urine. To keep the excess sugar dissolved in the urine, the volume of water excreted has to be increased. An affected person may find that the frequent need to pass urine occurs at night as well as during the day. This excess loss of fluid in turn causes dehydration, leading to constant thirst. Sugary urine is a breeding ground for microbes, which may cause urinary-tract problems such as cystitis, or fungal infection such as Candida.

The diabetic's inability to utilize carbohydrate may lead to a breakdown of body' protein and fat to supply essential energy needs, and this gives rise to a loss of weight and strength, and a need for much more sleep than usual.

Diabetes mellitus is easily diagnosed by testing the levels of glucose in blood and urine. Other conditions apart from diabetes can also cause high glucose levels in urine, however, so that if there is no clear result a glucose-tolerance test will be needed. In this, the blood-sugar level is measured during fasting and then at intervals after taking a measured dose of glucose.


Diabetes mellitus used to be fatal, but since the discovery of insulin in the 1920s diabetics can lead a full and normal life. However, no cure has been found, and lifelong treatment is still essential for almost all diabetics. Treatment involves controlling the amount of blood-glucose by diet, insulin or drugs, the exact treatment depending on the individual.


Diet is often the only treatment needed for non-insulin dependent diabetes, but all diabetics should restrict the amount of sugar they eat. Small, regular meals high in unrefined carbohydrate and fibre, including vegetables, beans and wholemeal bread, are best, and the amount of food that can be eaten is usually determined by a dietician who plans a diet tailored to the individual. In cases of obesity, a strict weight-reducing diet will be required.


For many diabetics, treatment with insulin is the main method of controlling the disease. Insulin has to be given by injection because it is a protein and so would be broken down by digestion if taken by mouth. Most types of insulin are extracted from the pancreas of cows or pigs, but human insulin, made by genetic engineering, is also available.

There are several different types of insulin, which vary mainly in how long they act in the body. Although using a long-acting insulin reduces the frequency of injection, this type often does not control the blood-sugar level accurately. Shorter-acting insulin, given twice daily, is often the best treatment. Injections are given just under the skin, in the thighs, hips, abdomen or arms. (Insulin can also be given by a continuous infusion with a portable pump.) Insulin is usually self-injected shortly before a meal. Timing is important, since if the action of the insulin in lowering blood. glucose occurs before enough sugar has been absorbed from food into the blood, too low a blood-glucose level may occur and cause hypoglycaemia.

Many diabetics on insulin therapy are encouraged to measure their level of blood sugar on a regular basis, This can be done by a simple test, which also helps the doctor decide whether the correct dose of insulin is being taken By ensuring that blood-sugar levels remain as stable as possible, the risk of complications may be avoided.


Certain drugs can be taken by mouth to control diabetes. They are often effective for those who develop diabetes in middle age. None of the oral diabetic drugs contains in. sulin, and each acts in a different way; the sulphonylurea type drugs, for example, stimulate the pancreas to produce more insulin and are therefore only effective when some pancreatic tissue is still producing the hormone. The biguanidine drugs can help lower blood-sugar levels but have serious side-effects and are rarely used.

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