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Juvenile Onset Diabetes Mellitus- JODM, Type I Diabetes Adult Onset Diabetes Mellitus- AODM, Type II Diabetes Gestational (pregnancy) Diabetes Mellitus Steroid Induced Diabetes Mellitus Juvenile Onset Diabetes Mellitus (Type I Diabetes) Type I diabetes is a relatively uncommon form of diabetes. It is best known as the diabetes that children acquire. However, it actually occurs as commonly in adults as children. For every one person with Type I diabetes there are 99 people with Type II diabetes. People with Type I diabetes make no insulin in their bodies anymore. The organ known as the "pancreas" has been damaged. The cells known as beta-cells have been destroyed by antibodies. These cells make insulin. The exact cause for the formation of the antibodies against the beta-cells is not absolutely certain, but is likely related to viral infection somewhere along the way. People who don't make insulin must take insulin injections in some form. If they don't take insulin they will rapidly become ill and will die eventually. If you have Type I diabetes and get an infection with either viruses or bacteria you may become ill with a condition called Diabetic Keto-Acidosis. This is a very serious complication resulting from a lack of insulin that is needed to help process fat that is being broken down in the body. Without enough insulin around, the ketone bodies that form as fat is broken down cannot be processed. As a result, the blood becomes quite acidic in character. This is not well tolerated. It can result in rapid breathing, coma and death. Keto-acidosis is uncommon in Type II diabetes, and if it occurred would cause us to wonder whether such a person might have Type I diabetes. Since many people with Type I diabetes acquire it at a young age they will experience the risks of complications for many years. Long term complications will develop after many years of diabetes, especially when diabetic control has been poor. With modern insulin therapy it is possible to minimize the risks of complications. However, sometimes even with good diabetic control complications will occur. Recent studies have shown that intensive control of blood sugars with four injections of insulin a day are especially good at preventing the long term complications of diabetes. Use of insulin pumps can be quite effective also. People with Type I diabetes are typically thin. At the time of diagnosis, they sometimes present with keto-acidosis as their first symptom of the disease. However, they are more likely to have had the classic symptoms of diabetes, called the "3 polys": polyphagia (desire to eat a lot or sugar craving), polydipsia (desire to drink water all the time), and polyuria (having to urinate frequently). These symptoms will often be associated with weight loss. If you have these symptoms you should be checked for diabetes. Type I diabetes does occur more often in relatives, but it is not nearly so family related as Type II diabetes is. Adult Onset Type II Diabetes (AODM, Type II Diabetes) Type II diabetes is common. It typically occurs in adults. As our population becomes increasingly overweight, we are seeing this type of diabetes more frequently in over weight children. We are in the midst of an epidemic of AODM. AODM typically occurs in overweight adults. Some people will have it with normal body weights. It is said that 80% of adults who are overweight with AODM could actually make the diabetes go away if they could successfully loose weight down to an ideal body weight. The loss of weight down to an ideal body weight is a primary treatment goal for people with AODM. There are at least three biochemical problems underlying AODM. The first is called "insulin resistance". Being overweight causes the problem we call insulin resistance. At the cellular level in the body, the insulin doesn't seem to work quite right. For instance, suppose it takes '10 units' of insulin to get a certain amount of sugar to go into the cells normally. In a state of "insulin resistance", it might take '40 units' of insulin to accomplish movement of the same amount of sugar into the cells. It appears the cells are resistant to the effect of insulin, since more insulin is needed to get the same amount of sugar into the cells. Insulin resistance is one of the main problems in AODM. The second problem is the liver producing to much sugar (glucose) at night. This is a good reason not to eat late night snacks. The third problem is when pancreas cells, that release insulin into the blood in response to eating, do not put out as much insulin as is needed at the proper time. We typically use medications to treat all three of these problems. Of course, insulin will work for them, too. But, the best thing is to loose weight, eat sensibly, and exercise routinely. People with AODM may have severe complications of diabetes at the time of diagnosis of the disease. You might wonder why ? It is suspected that many people with AODM have had a low level of diabetes that has gone undetected for many years. As a result, they have had time to develop a lot of damage from the diabetes before the diagnosis has been made. Since it is possible to have severe complications of diabetes "at the time of" or shortly after diagnosis, it is very important to have a thorough assessment for conditions such as eye disease as soon as practical after the diagnosis is made. This would generally involve seeing an optometrist or ophthalmologist. It is important to have your eyes dilated and let them take a good look with special equipment. Your primary care doctor can look in your eyes, but they will not be able to see as much as an eye doctor can see with their special tools. You should tell your eye doctor about your new diagnosis of diabetes so they will do the appropriate checks. The tendency to have AODM will often run in a family, but not always. When one of your parents has the disease, your chance of getting it is about 50%. If both your parents had AODM your chance is very high of coming down with it. You cannot do much to alter your genetic background, but you can work on keeping your weight down and maintaining active physical exercise to prevent this condition. This is diabetes that occurs during pregnancy. It is generally temporary and will go away after delivery. Women who have had gestational diabetes are at some increased risk of developing adult onset diabetes later in life. These women will typically be treated with insulin therapy, sometimes now with an insulin pump. Recent data has suggested that some medicines may work also. Diabetes during pregnancy is an especially risky condition for the developing baby. Diabetes can cause the baby to grow excessively large which may result in having to perform a C-section. With good diabetes control the baby will generally do well, but there can be serious complications. This is a fairly uncommon form of diabetes. It generally results from an injury to the pancreas which effects the insulin producing cells called "Beta Cells". The result is that a person cannot make insulin. These patients have often had a disease such as pancreatitis, where the pancreas has been inflamed, resulting in damage to the pancreas. They may develop the complications of diabetes over time. They are typically easily controlled with insulin. Pills will not work well for them. They would be best served by keeping their weight down to prevent insulin resistance. One form of secondary diabetes which is fairly common is "steroid induced" adult onset diabetes. This form of diabetes develops in response to being on "corticosteroid drugs" such as prednisone, methylprednisolone, or decadron. It will generally go away when the drug is stopped, but not always. In my opinion, anyone who develops this form of diabetes, in response to a steroid, is likely close to having diabetes without the steroid. Generally, this diabetes is like adult onset diabetes (AODM) as discussed above. It may require insulin therapy. |
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