Diabetes Type 1 & 2

Definition

Blood glucose levels persistently above the normal range in the population is defined as diabetes mellitus (DM)

Diabetes mellitus is classically divided into type 1 & type 2 Diabetes mellitus. Insulin is the hormone that moves glucose from bloodstream into fat and muscle tissue.
 

Type 1 Diabetes Mellitus

Type 1 diabetes mellitus occurs predominantly in young people often under 20 years of age. It is due to the autoimmune inflammation and destruction of insulin producing cells in the clusters of cells called islet cells in the human pancreas.

The dramatic fall in insulin production results in markedly elevated glucose levels and symptoms of profound weight loss, thirst, passing a lot of urine, tiredness, blurred vision and fungal infection of vagina or penis. Symptoms may occur suddenly before diagnosis.

In adults 20-60 years old slower onset of symptoms can can occur producing adult type 1 diabetes mellitus called latent onset autoimmune diabetes of adults (LADA)
 

Type 2 Diabetes Mellitus

This common form of diabetes occurring in adults due to a combination of insulin resistance (insulin no longer works effectively to transfer glucose into cells) or pancreatic insulin production fails or combination of both.
The result is elevated glucose levels and symptoms often occurring progressively over prolonged period of time. Mild elevations in glucose may not produce symptoms and patients may not be aware that the diabetes has been present for a long period of time prior to diagnosis.  Patients are often overweight contributing to insulin resistance.

 

Tests

Diagnosis is via blood tests

 

Complications

Diabetes mellitus can damage eyes causing visual impairment and blindness via leaking vessels and haemorrhage or glaucoma or cataract. The kidneys can be damaged leading to leaking of protein into urine. Eventually kidney failure can occur requiring dialysis to support the patient.

Nerve damage particularly of lower limbs can cause numbness and pain. Nerve damage to eye movement muscles, thigh muscles can also occur. Bladder and blood pressure nerve control can also be damaged resulting in bladder urine retention and low blood pressure.

Diabetes mellitus can cause vascular damage contributing to occlusion of coronary arteries or blood vessels in the legs or neck. Erectile dysfunction manifests as inability to have erection of penis and also be due the diabetes mellitus. Good control of diabetes mellitus minimise the risk of developing many of the above complications

 

Treatment

For type 1 Diabetes Mellitus

Insulin is the only therapy via multiple injections a day of human insulin or via an automated ‘beeper’ size pump supplying hourly insulin under their skin.

Insulin pump therapy improves diabetic control, can lower the risk of hypoglycaemia and improves quality of life.

 

Type 2 Diabetes Mellius

Diet and lifestyle modification are important management tools and many patient control the glucose levels only with these non pharmaceutical methods.

However often diet and lifestyle changes are insufficient to normalise glucose levels so treatment with medications is required. The drugs available include:

1. Metformin is a common tablet that controls liver production of glucose and reduces appetite to promote weight loss
2. Sulfonylurea class of drugs eg Diamicron tablets stimulate insulin production to control glucose levels
3. Pioglitazone reduces insulin resistance to improve glucose levels
4. DPP4 enzyme blocker (gliptins) tablets
5. Weight loss – both medical and surgical options

Dr Zeimer has vast experience in treating both type 1 & 2 type diabetes mellitus patients and has widely prescribed and initiated the use of insulin and insulin pumps. Dr Zeimer has been prescribing the latest new type 2 diabetes mellius drug therapies alone or in various combinations especially newer agents that may delay the need for insulin injection therapy and promote weight loss.