Diabetes is a general term that describes two different forms and severities of this disease.
 
Diabetes mellitus occurs secondarily to an inadequate production of insulin by the pancreas, or from an ineffective utilization of the insulin in the body. Insulin is a hormone which regulates the level of glucose (sugar) in the blood stream. Glucose is a critical source of energy utilized by every organ in the body and is the ONLY energy source utilized by the brain. Without insulin, the glucose level rises in the bloodstream, but the body is unable to effectively use it for the regulation of metabolism. Insulin is the necessary link that enables the body to transport glucose into the cells for energy metabolism.
 
Type 1 Diabetes
This refers to the form of diabetes that has its onset in childhood or adolescence. This can be an inherited disease. These patients are dependent on insulin injections to maintain normal body chemistry. Without insulin, they can be subject to diabetic ketoacidosis and death. Patients with type 1 diabetes are also commonly referred to as insulin dependent diabetics, because without it, death can result.
 
Type 2 Diabetes
This form of diabetes most commonly occurs in middle aged, overweight people whose blood sugar is higher than normal. Type 2 diabetes is also referred to as adult onset diabetes. In most cases, these patients do not require insulin injections to control their diabetes, but can control the condition with a diabetes diet and weight reduction. These patients are usually not subject to the same severe chemical imbalances as the type 1 diabetics, but they can contract the same long term diabetic complications.
 
Complications of Long Term Diabetes

•	Diabetic Retinopathy — Damage to the retina (perceptive structural tissue of the eye) resulting in decreased vision and, possibly blindness.
•	Kidney Disease — The long term effects of diabetes can result in a steady decline in kidney function, or kidney failure.
•	Stroke — Diabetics have an increased risk of stroke.
•	Heart Disease — Increased risk of myocardial infarction (heart attack).
•	Peripheral Vascular Disease
•	Decreased Immunity to Infection
•	Peripheral Neuropathy — Damage to the peripheral nerves and altered sensation. Patients may complain of numbness, tingling, and/or burning pain to the extremities, hands, and feet.
•	High Risk Pregnancy (in the female diabetic)

 
Symptoms, Type 1 Diabetes

•	Increased frequency of urination
•	Increased thirst
•	Increased hunger
•	Weight loss and increased fatigue may also be seen in the type 1 diabetic

 
Symptoms, Type 2 Diabetes

•	Increased hunger
•	Increased thirst
•	Increased urination
•	Blurred eyesight
•	Increased fatigue
•	Numbness or tingling in the hands or feet
•	Frequent infections
•	Slow healing of cuts or sores
•	Impotence

 
Diagnosis
Evaluation will include patient medical history and physical examination. The physical examination may reveal clues that indicate long standing diabetes is present. Random and fasting blood sugar testing is also be required. Glucose tolerance testing can help confirm this diagnosis. Blood tests for kidney profile and blood counts are also done. Urinalysis will show the excess presence of glucose.
 
Treatment Goals

•	Control of the symptoms of diabetes
•	Achieve and maintain a desirable weight
•	Achieve and maintain a healthy level of physical activity
•	Achieve and maintain a near-normal blood glucose level (between 70 mg/dl and140 mg/dl)
•	Achieve a feeling of well-being and control over diabetes.

 
Treatment of type 1 diabetes requires adherence to a strict diabetes diet and regular doses of insulin.
 
Deviation from either will result in an imbalance that may lead to a potentially serious outcome.
 
Patient education is now the cornerstone of good diabetes management. Tight control of blood glucose can DECREASE the progression of diabetic complications.
 
Treatment must start in childhood, moreover, the patient must learn how to check their own blood and urine glucose. Close medical follow-up is important in order to monitor any ensuing complications. New technology is now available in the form of ambulatory glucose monitors that will automatically give you the appropriate dose of insulin required, based on your blood sugar level at the time of the reading.
 
Your physician will discuss all the options of diabetes management with you. Type 2 diabetes often can be controlled with weight reduction and regulation of the diet. Avoidance of heavily sugared foods (sweets) is often all that is necessary for adequate blood sugar control. In some cases, oral hypoglycaemic agents may be used to regulate blood sugar. These medications are taken on a fixed daily schedule in tandem with a consistent diabetes diet (in total calories).
 
An Internist or Endocrinologist are the experts in the management of this problem. There are several medications that can interfere with the regulation of diabetes. Steroid medications (i.e. Prednisone and Medrone) can increase blood sugar levels, making it very difficult to control blood sugar in the diabetic patient. Those patients who are “borderline” diabetics have great difficulty taking these medications. Beta-blocker antihypertensive medications can also cause serious complications for the diabetic patient and should be avoided.

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