According to the World Health Organization, approximately 177 million people worldwide have diabetes. It is on the third place among causes of death after heart disease and cancer (Peacock, 2000).
Ancient Chinese, Japanese, Arab, and Hindu writings show that even at that time people knew and tried to treat the disease during which patients “released sweet urine”. The modern name to the ailment was given by the Roman physician Areteus Cappadocia. Watching frequent urination of patients, he decided that fluid coming into the body is released unchanged. Therefore, Areteus called the disease “diabetes” (passing through, flowing). Much later the other word “mellitus” (mell – sugar, honey) was added and the disease was called “diabetes mellitus”. But the idea about causes and pathogenesis of the disease was far from modern for a long time. Because of erroneous views of Galen, who had great reputation among doctors of that time, for over a thousand of years it was thought that the disease was caused by the damage of kidneys. Only Paracelsus stated that diabetes was the disease of the whole body, during which sugar was formed in the blood. This theory was studied only in 1788, when the English scientist Thomas Cowleg isolated glucose from patient’s urine (Peacock, 2000).
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No matter how many scientists argued about causes of diabetes, patients did not get better because the disease was still incurable. In 1921 a new era in treating diabetes started and patients had hope for healing. The Canadian surgeon Frederick Banting was the first to isolate insulin, and within a year a saving injection of the hormone started to be given to patients (Peacock, 2000).
Now we know a lot about diabetes, but not all questions related to the disease are answered. Although today this disease is treated quite successfully, it is impossible to get rid of it completely.
Diabetes is a complex systemic disease caused by an absolute or relative deficiency of the hormone insulin, which results from a malfunction of carbohydrate exchange in the body. The first sign of diabetes is the elevation of glucose level in blood (hyperglycemia). The consequence of hyperglycemia is excretion of glucose into urine (glycosuria). At the same time, fluid and electrolyte balance as well as metabolic processes of fat and protein are disordered. Therefore, a loop of hormonal and metabolic changes is formed, which can eventually lead to the so-called late diabetic complications: myocardial infarction, stroke, severe vascular lesions of the retina, kidneys, and other systems. All these risks put diabetes in the top rank of acute medical and social problems that require urgent solution (Peacock, 2000).
Most of the food we eat breaks down to glucose during digestion. Glucose is the main source of energy for our body. Hormone insulin, which is secreted by pancreas, allows cells of our body to absorb glucose. During diabetes the body is unable to utilize glucose and, as a result, too much sugar accumulates in the blood. Then, first symptoms of diabetes become clear: frequent urination, excessive thirst, weight loss, fatigue, irritability, and deterioration of vision (Allman, 2008).
It is found that diabetes is an extremely heterogeneous disease. It happens that it can be a manifestation of the underlying disease. For example, so-called symptomatic diabetes results from the failure of proper functioning of endocrine glands: thyroid, pancreas, pituitary gland, and adrenal gland. This form of diabetes can be also caused by certain medicines. Wit successful treatment of the underlying disease, clinical manifestations of diabetes will disappear (Brill, 2007).
True diabetes is divided into two main types: insulin dependent (first type), formerly it was called “juvenile”, and insulin independent (second type) or adult diabetes (Allman, 2008). First type diabetes occurs around the age of 30, and 10-15% of the total number of patients suffer from this type. One of the causes of this type of diabetes is the destruction of beta cells of Langerhans islets of the pancreas that produce insulin. A number of patients can have viral infections, especially rubella and hepatitis that precede diabetes. Scientists suggest that the virus affects beta cells of those patients, who have a family history of diabetes. This type of diabetes can be an autoimmune disease, which is based on the defect of the immune system (Allman, 2008).
Majority of patients (approximately 85%) suffer from non-insulin dependent (second type) diabetes. Moreover, approximately 15% of these people have normal body weight, while the rest are obese. In other words, obesity and diabetes almost always go hand in hand (Allman, 2008).
The causes of diabetes of the first and second types are different. Type 1 diabetes results from a viral infection or autoimmune destruction of beta cells, which produce insulin. The deficiency of insulin grows with all the dramatic consequences (Allman, 2008). In type 2 diabetes beta cells produce sufficient or even high levels of insulin, but tissues lose their sensitivity to produce the specific reaction on insulin. If diabetes is accompanied with obesity, the major cause of insulin insensitivity is that adipose tissue, being sort of a screen, blocks the effect of insulin. To break through the blockade, beta cells begin to work with extra load. Eventually, their number becomes insufficient, and their relative shortage changes into absolute. However, it is very important to mention that insulin-dependent diabetes does not turn into insulin independent one (Allman, 2008).
People with type 2 diabetes and a healthy body weight can develop the disorder of perception of the signal of insulin receptors on the cell surface (Allman, 2008). The increase of sugar in blood is accompanied by its intensified excretion in urine. This can cause exsiccosis, during which patients experience extreme thirst and, instead of 1.5-2 liters of fluid per day, drink 8-10 liters. As a result, the amount of urine increases and that is a vicious circle (Brill, 2007).
Along with increased thirst, weakness of the body is growing. Patients suffer from itchy skin and dry mouth. Apart from disordered metabolism of carbohydrates, development of diabetes also causes disordered metabolism of fat and protein. As a result, patients with diabetes have a lower resistance to many infectious diseases. Other diseases are also treated with difficulty (Brill, 2007).
Main aims of treatment of any form of diabetes is to lower sugar level in the blood, normalize all types of metabolism in the body, and prevent the development of serious complications. Treatments are different, however, depending on the type of the disease. Those who suffer from insulin-dependent (first type) diabetes need insulin injections. Patients with the second type of diabetes are prescribed hypoglycemic agents. Sometimes it is also possible to normalize blood sugar by following a diet (Peacock, 2000).
Diet therapy is the cornerstone of treatment of patients with diabetes, regardless of the clinical form. Each patient, depending on the weight of his body, age, sex, and level of physical activity should strictly count calories, content of carbohydrates, proteins, fats, minerals, and vitamins. Moderate physical activity has beneficial effects on the patient. During physical exercises oxidation of glucose in muscle increases and, therefore, the level of blood sugar decreases (Peacock, 2000).
So far, the exact causes of diabetes are not known. At this point, there are several theories. One of them is heredity. It is found that if some of patient’s ancestors had diabetes, the chances of a bad "legacy" increase by 37%. According to the theory of stress, frequent sicknesses and other "jarring" lead to a breach of the pancreas. As a result, insulin production becomes disordered and diabetes develops. Due to failures of the immune system, the organism does not recognize "where the stranger is" and starts to destroy its own pancreas. Here, the inflammatory process occurs, and then - according to the above (stress) scheme. This is immune theory (Allman, 2008).
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