Diabetes mellitus Classification and external resources
United Nations blue circle symbol for diabetes.[1]
ICD-10	E10.–E14.
ICD-9	250
MedlinePlus	001214
eMedicine	med/546  emerg/134
MeSH	C18.452.394.750

Diabetes mellitus (IPA: /ˌdaɪəˈbiːtiːz/ or /ˌdaɪəˈbiːtəs/, /məˈlaɪtəs/ or /ˈmɛlətəs/), often referred to simply as diabetes (Greek: διαβήτης), is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycaemia) resulting from insufficient levels of the hormone insulin.^[2] The characteristic symptoms are excessive urine production (polyuria) due to high blood glucose levels, excessive thirst and increased fluid intake (polydipsia) attempting to compensate for increased urination, blurred vision due to high blood glucose effects on the eye's optics, unexplained weight loss, and lethargy. These symptoms are likely to be less apparent if the blood sugar is only mildly elevated. Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced. ... Diabetes mellitus strikes 1 in 400 cats and a similar number of dogs, though recent veterinary studies[1] note that it is becoming more common lately. ... Image File history File links Blue_circle_for_diabetes. ... UN redirects here. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... Structure of the coenzyme adenosine triphosphate, a central intermediate in energy metabolism. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... For other uses, see Hormone (disambiguation). ... Not to be confused with inulin. ... Polyuria is the passage of a large volume of urine in a given period. ... Polydipsia is a medical condition in which the patient ingests abnormally large amounts of fluids by mouth. ... Fatigue is a feeling of excessive tiredness or lethargy, with a desire to rest, perhaps to sleep. ...

The World Health Organization recognizes three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy),^[3] which have different causes and population distributions. While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different.^[4] Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand. Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition. WHO redirects here. ... Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, T1DM, IDDM, juvenile diabetes) is a form of diabetes mellitus. ... Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ... Gestational diabetes is a form of diabetes found in pregnant women. ... This article is about pregnancy in female humans. ... Beta cells are a type of cell in the pancreas in areas called the islets of Langerhans. ... The pancreas is a gland organ in the digestive and endocrine systems of vertebrates. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... This article is about pregnancy in female humans. ...

Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions.^[2] All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter. Medicine In medicine, a persistent and lasting condition is said to be chronic (from Greek chronos). ... Not to be confused with inulin. ... In nutrition, the diet is the sum of food consumed by a person or other organism. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... Insulin pump attached to its user with an infusion set. ...

Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis, or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight), may improve the risk profile of most aforementioned complications. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.^[5] In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... It has been suggested that this article or section be merged with Diabetic ketoacidosis. ... Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Chronic renal failure (CRF, or chronic kidney failure, CKF, or chronic kidney disease, CKD) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ... This article is about the visual condition. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. ... Gangrene is a complication of necrosis (i. ... Partial hand amputation Amputation is the removal of a body extremity by trauma or surgery. ... A sphygmomanometer, a device used for measuring arterial pressure. ... The cigarette is the most common method of smoking tobacco. ... Weight, in the context of human body weight measurements in the medical sciences and in sports is a measurement of mass, and is thus expressed in units of mass, such as kilograms (kg), or units of force such as pounds (lb). ... Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. ... This article is about clinical dialysis; for the laboratory technique, see Dialysis (biochemistry) In medicine, dialysis is a method for removing waste such as urea from the blood when the kidneys are incapable of this, i. ...

In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

Classification

The term diabetes, without qualification, usually refers to diabetes mellitus, which is associated with excessive sweet urine (known as "glycosuria") but there are several rarer conditions also named diabetes. The most common of these is diabetes insipidus in which the urine is not sweet (insipidus meaning "without taste" in Latin); it can be caused by either kidney (nephrogenic DI) or pituitary gland (central DI) damage. Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced. ... Major function-filter blood. ... | Latin = hypophysis, glandula pituitaria | GraySubject = 275 | GrayPage = 1275 | Image = Gray1180. ...

The principal two idiopathic forms of diabetes mellitus are known as types 1 and 2. The term "type 1 diabetes" has universally replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and non-insulin-dependent diabetes (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3 diabetes" as, among others, gestational diabetes,^[6] insulin-resistant type 1 diabetes (or "double diabetes"), type 2 diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of adults (or LADA or "type 1.5" diabetes.^[7]) There is also maturity onset diabetes of the young (MODY) which is a group of several single gene disorders with strong family histories that present as type 2 diabetes before 30 years of age. Gestational diabetes is a form of diabetes found in pregnant women. ... Latent autoimmune diabetes in adults (LADA) is a genetically-linked, hereditary autoimmune disorder that results in the body mistaking the pancreas as foreign and responding by attacking and destroying the insulin-producing beta islet cells of the pancreas. ... Type 1. ... Maturity onset diabetes of the young (MODY) refers to any of several rare hereditary forms of diabetes mellitus due to dominantly inherited defects of insulin secretion. ...

Type 1 diabetes mellitus

Main article: Diabetes mellitus type 1

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to a deficiency of insulin. The main cause of this beta cell loss is a T-cell mediated autoimmune attack.^[4] There is no known preventive measure which can be taken against type 1 diabetes; it is about 10% of diabetes mellitus cases in North America and Europe (though this varies by geographical location), and is a higher percentage in some other areas. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults but was traditionally termed "juvenile diabetes" because it represents a majority of the diabetes cases in children. Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, T1DM, IDDM, juvenile diabetes) is a form of diabetes mellitus. ... See diabetes mellitus for further general information on diabetes. ... Beta cells are a type of cell in the pancreas in areas called the islets of Langerhans. ... A porcine islet of Langerhans. ... T cells belong to a group of white blood cells known as lymphocytes and play a central role in cell-mediated immunity. ... Autoimmunity is the failure of an organism to recognize its own constituent parts (down to the sub-molecular levels) as self, which results in an immune response against its own cells and tissues. ...

The principal treatment of type 1 diabetes, even from its earliest stages, is replacement of insulin combined with careful monitoring of blood glucose levels using blood testing monitors. Without insulin, diabetic ketoacidosis often develops which may result in coma or death. Treatment emphasis is now also placed on lifestyle adjustments (diet and exercise) though these cannot reverse the progress of the disease. Apart from the common subcutaneous injections, it is also possible to deliver insulin by a pump, which allows continuous infusion of insulin 24 hours a day at preset levels, and the ability to program doses (a bolus) of insulin as needed at meal times. An inhaled form of insulin, Exubera, was approved by the FDA in January 2006, although Pfizer discontinued the product for business reasons in October 2007. ^[8] Diabetic ketoacidosis(DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... The subcutis is the layer of tissue directly underlying the cutis. ... Insulin pump attached to its user with an infusion set. ... In medicine, a bolus (from Latin bolus, ball) is the administration of a medication, drug or other compound that is given to raise blood concentration to an effective level. ... Exubera is the first inhalable insulin to receive US FDA approval. ...

Type 1 treatment must be continued indefinitely in essentially all cases. Treatment need not significantly impair normal activities, if sufficient patient training, awareness, appropriate care, discipline in testing and dosing of insulin is taken. However, treatment is burdensome for patients, insulin is replaced in a non-physiological manner, and this approach is therefore far from ideal. The average glucose level for the type 1 patient should be as close to normal (80–120 mg/dl, 4–6 mmol/l) as is safely possible. Some physicians suggest up to 140–150 mg/dl (7-7.5 mmol/l) for those having trouble with lower values, such as frequent hypoglycemic events. Values above 200 mg/dl (10 mmol/l) is sometimes accompanied by discomfort and frequent urination leading to dehydration. Values above 300 mg/dl (15 mmol/l) usually require medical treatment and may lead to ketoacidosis, although they are not immediately life-threatening. However, low levels of blood glucose, called hypoglycemia, may lead to seizures or episodes of unconsciousness and absolutely must be treated immediately. Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... It has been suggested that this article or section be merged with Diabetic ketoacidosis. ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ...

Type 2 diabetes mellitus

Main article: Diabetes mellitus type 2

Type 2 diabetes mellitus is characterized differently due to insulin resistance or reduced insulin sensitivity, combined with reduced insulin secretion. The defective responsiveness of body tissues to insulin almost certainly involves the insulin receptor in cell membranes. In the early stage the predominant abnormality is reduced insulin sensitivity, characterized by elevated levels of insulin in the blood. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses the impairment of insulin secretion worsens, and therapeutic replacement of insulin often becomes necessary. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ... In molecular biology, the insulin receptor is a transmembrane receptor that is activated by insulin. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... The liver is the largest internal organ in the human body, and is an organ present in vertebrates and some other animals. ...

There are numerous theories as to the exact cause and mechanism in type 2 diabetes. Central obesity (fat concentrated around the waist in relation to abdominal organs, but not subcutaneous fat) is known to predispose individuals for insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. Obesity is found in approximately 55% of patients diagnosed with type 2 diabetes.^[9] Other factors include aging (about 20% of elderly patients in North America have diabetes) and family history (type 2 is much more common in those with close relatives who have had it). In the last decade, type 2 diabetes has increasingly begun to affect children and adolescents, likely in connection with the increased prevalence of childhood obesity seen in recent decades in some places.^[10] Central obesity (or apple-shaped or masculine obesity) occurs when the main deposits of body fat are localised around the abdomen and the upper body. ... The adipokines or adipocytokines are a group of cytokines (cell-to-cell signalling proteins) secreted by adipose tissue. ...

Type 2 diabetes may go unnoticed for years because visible symptoms are typically mild, non-existent or sporadic, and usually there are no ketoacidotic episodes. However, severe long-term complications can result from unnoticed type 2 diabetes, including renal failure due to diabetic nephropathy, vascular disease (including coronary artery disease), vision damage due to diabetic retinopathy, loss of sensation or pain due to diabetic neuropathy, and liver damage from non-alcoholic steatohepatitis. Diabetic ketoacidosis(DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. ... Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... As its name signifies, Non-alcoholic steatohepatitis (NASH) or Nonalcoholic Fatty Liver Disease (NAFLD) is fatty inflammation of the liver when this is not due to excessive alcohol use. ...

Type 2 diabetes is usually first treated by increasing physical activity, decreasing carbohydrate intake, and losing weight. These can restore insulin sensitivity even when the weight loss is modest, for example around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. It is sometimes possible to achieve long-term, satisfactory glucose control with these measures alone. However, the underlying tendency to insulin resistance is not lost, and so attention to diet, exercise, and weight loss must continue. The usual next step, if necessary, is treatment with oral antidiabetic drugs. Insulin production is initially only moderately impaired in type 2 diabetes, so oral medication (often used in various combinations) can be used to improve insulin production (e.g., sulfonylureas), to regulate inappropriate release of glucose by the liver and attenuate insulin resistance to some extent (e.g., metformin), and to substantially attenuate insulin resistance (e.g., thiazolidinediones). According to one study, overweight patients treated with metformin compared with diet alone, had relative risk reductions of 32% for any diabetes endpoint, 42% for diabetes related death and 36% for all cause mortality and stroke.^[11] Oral medication may eventually fail due to further impairment of beta cell insulin secretion. At this point, insulin therapy is necessary to maintain normal or near normal glucose levels. Lactose is a disaccharide found in milk. ... Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ... An anti-diabetic drug is used to treat diabetes mellitus. ... Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ... Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ... The medication class of thiazolidinedione was introduced in the late 1990s as an adjunctive therapy for diabetes mellitus (type II) and related diseases. ... The relative risk reduction is a measure used in epidemiology. ...

Gestational diabetes

Main article: Gestational diabetes

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life. Gestational diabetes is a form of diabetes found in pregnant women. ... This article is about pregnancy in female humans. ...

Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental profusion due to vascular impairment. Induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia. Macrosomia, sometimes also called big baby syndrome, is a potential complication during childbirth and the latter stages of pregnancy. ... Surfactants, also known as tensides, are wetting agents that lower the surface tension of a liquid, allowing easier spreading, and lower the interfacial tension between two liquids. ... Infant respiratory distress syndrome (RDS, also called Respiratory distress syndrome of newborn, previously called hyaline membrane disease), is a syndrome caused by developmental lack of surfactant and structural immaturity in the lungs of premature infants. ... Jaundice, technically known as icterus, is yellowing of the skin, sclera (eyes) and mucous membranes caused by increased levels of bilirubin in the system. ... Induction is a way of artificially bringing on labour in a woman. ... A caesarean section (AE cesarean section), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ... Dystocia (antonym eutocia) is an abnormal or difficult childbirth or labour. ...

A 2008 study completed in the U.S. found that more American women are entering pregnancy with preexisting diabetes. In fact the rate of diabetes in expectant mothers has more than doubled in the past 6 years. ^[12] This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future.

Other types

There are several rare causes of diabetes mellitus that do not fit into type 1, type 2, or gestational diabetes; attempts to classify them remain controversial. Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.^[3] It has been suggested that this article or section be merged into Dominance relationship. ... ... Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... WHO redirects here. ...

Signs and symptoms

The classical triad of diabetes symptoms is polyuria, polydipsia and polyphagia, which are, respectively, frequent urination; increased thirst and consequent increased fluid intake; and increased appetite. Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes the symptoms develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible fatigue. All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled. Polyuria is the passage of a large volume of urine in a given period. ... Polydipsia is a medical condition in which the patient ingests abnormally large amounts of fluids by mouth. ... Phagy or phagia is an ecological term that is used to identify particular nutritional systems. ...

When the glucose concentration in the blood is raised beyond the renal threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits the reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells, causing dehydration and increased thirst. In physiology, the renal threshold is that concentration of a blood substance above which the kidneys begin to pass it through into the urine. ... In physiology, reabsorption or tubular reabsorption is the flow of glomerular filtrate from the proximal tubule of the nephron into the peritubular capillaries. ... In the biology of the kidney, the proximal convoluted tubule is the segment of the renal tubule that drains Bowmans capsule. ... This article is about the urine of animals generally. ... This article or section does not adequately cite its references or sources. ... Polyuria is the passage of a large volume of urine in a given period. ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ...

Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change whereas type 2 is generally more gradual, but should still be suspected.

Patients (usually with type 1 diabetes) may also present with diabetic ketoacidosis (DKA), an extreme state of metabolic dysregulation characterized by the smell of acetone on the patient's breath; a rapid, deep breathing known as Kussmaul breathing; polyuria; nausea; vomiting and abdominal pain; and any of many altered states of consciousness or arousal (such as hostility and mania or, equally, confusion and lethargy). In severe DKA, coma may follow, progressing to death. Diabetic ketoacidosis is a medical emergency and requires hospital admission. For other uses, see Acetone (disambiguation). ... Kussmaul breathing is the rapid, deep, and labored breathing of people who have acidosis. ... Polyuria is the passage of a large volume of urine in a given period. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... For other uses, see Coma (disambiguation). ...

A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration due to loss of body water. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss. Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ... Positive feedback is a mechanism by which an output is enhanced. ...

Genetics

Both type 1 and type 2 diabetes are at least partly inherited. Type 1 diabetes appears to be triggered by some (mainly viral) infections, or in a less common group, by stress or environmental exposure (such as exposure to certain chemicals or drugs). There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i.e., the genetic "self" identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger. A small proportion of people with type 1 diabetes carry a mutated gene that causes maturity onset diabetes of the young (MODY). HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ... This article does not cite any references or sources. ... For linguistic mutation, see Apophony. ... Maturity onset diabetes of the young (MODY) refers to any of several rare hereditary forms of diabetes mellitus due to dominantly inherited defects of insulin secretion. ...

There is a stronger inheritance pattern for type 2 diabetes. Those with first-degree relatives with type 2 have a much higher risk of developing type 2, increasing with the number of those relatives. Concordance among monozygotic twins is close to 100%, and about 25% of those with the disease have a family history of diabetes. Candidate genes include KCNJ11 (potassium inwardly rectifying channel, subfamily J, member 11), which encodes the islet ATP-sensitive potassium channel Kir6.2, and TCF7L2 (transcription factor 7–like 2), which regulates proglucagon gene expression and thus the production of glucagon-like peptide-1.^[4] Moreover, obesity (which is an independent risk factor for type 2 diabetes) is strongly inherited.^[13] Concordance as used in genetics means the presence of the same trait in both members of a pair of twins, or in sets of individuals. ... For other uses, see Twin (disambiguation). ... Inwardly rectifing potassium channels (Kir or IRK) are potassium selective ion channels. ... Proglucagon is a precursor of glucagon, and several other components. ... GLP-1 and DPP-4 inhibitors Glucagon-like peptide-1 (GLP-1) is derived from the transcription product of the proglucagon gene. ...

Various hereditary conditions may feature diabetes, for example myotonic dystrophy and Friedreich's ataxia. Wolfram's syndrome is an autosomal recessive neurodegenerative disorder that first becomes evident in childhood. It consists of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, hence the acronym DIDMOAD.^[14] Myotonic dystrophy (DM) is a chronic, slowly progressing, highly variable inherited multisystemic disease that can manifest at any age from birth to old age. ... Friedreichs ataxia is a rare autosomal recessive disorder caused by a mutation in Gene X25 that codes for frataxin, located on chromosome 9. ... Wolfram syndrome, also called DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness), is a rare genetic disorder, causing diabetes mellitus, optic atrophy, and deafness. ... In genetics, the term recessive gene refers to an allele that causes a phenotype (visible or detectable characteristic) that is only seen in a homozygous genotype (an organism that has two copies of the same allele). ... Neurodegenerative disease is a condition which affects the brain function. ...

Pathophysiology

Mechanism of insulin release in normal pancreatic beta cells. Insulin production is more or less constant within the beta cells, irrespective of blood glucose levels. It is stored within vacuoles pending release, via exocytosis, which is primarily triggered by food, chiefly food containing absorbable glucose. The chief trigger is a rise in blood glucose levels after eating

Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells (primarily muscle and fat cells, but not central nervous system cells). Therefore deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus. Image File history File links Size of this preview: 800 × 517 pixel Image in higher resolution (903 × 584 pixel, file size: 87 KB, MIME type: image/png) Mechanism of glucose dependent insulin release CORRECTION: I think that the potassium channel allows potassium out of rather than into the cell as... Image File history File links Size of this preview: 800 × 517 pixel Image in higher resolution (903 × 584 pixel, file size: 87 KB, MIME type: image/png) Mechanism of glucose dependent insulin release CORRECTION: I think that the potassium channel allows potassium out of rather than into the cell as... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... In biochemistry, a receptor is a protein on the cell membrane or within the cytoplasm or cell nucleus that binds to a specific molecule (a ligand), such as a neurotransmitter, hormone, or other substance, and initiates the cellular response to the ligand. ...

Much of the carbohydrate in food is converted within a few hours to the monosaccharide glucose, the principal carbohydrate found in blood and used by the body as fuel. Insulin is released into the blood by beta cells (β-cells), found in the Islets of Langerhans in the pancreas, in response to rising levels of blood glucose after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon which acts in an opposite manner to insulin. Glucose thus recovered by the liver re-enters the bloodstream; muscle cells lack the necessary export mechanism. Monosaccharides are the simplest form of carbohydrates. ... Glycogen Structure Segment Glycogen is a polysaccharide of glucose (Glc) which functions as the primary short term energy storage in animal cells. ... Glucagon ball and stick model A microscopic image stained for glucagon. ...

Higher insulin levels increase some anabolic ("building up") processes such as cell growth and duplication, protein synthesis, and fat storage. Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa. In particular, a low insulin level is the trigger for entering or leaving ketosis (the fat burning metabolic phase). Anabolism is the metabolic process that builds larger molecules from smaller ones. ... Protein biosynthesis (synthesis) is the process in which cells build proteins. ... Some common lipids. ... Anabolism is the aspect of metabolism that contributes to growth. ...

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by those body cells that require it nor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis. Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... For acidosis referring to acidity of the urine, see renal tubular acidosis. ...

Diagnosis

The diagnosis of type 1 diabetes, and many cases of type 2, is usually prompted by recent-onset symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. These symptoms typically worsen over days to weeks; about a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways. These include ordinary health screening; detection of hyperglycemia during other medical investigations; and secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia. Polyuria is the passage of a large volume of urine in a given period. ... Heart attack redirects here. ... For other uses, see Stroke (disambiguation). ... Neuropathy is usually short for peripheral neuropathy. ... toes infection brown with white markings ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ...

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:^[3]

• fasting plasma glucose level at or above 126 mg/dL (7.0 mmol/l).
• plasma glucose at or above 200 mg/dL (11.1 mmol/l) two hours after a 75 g oral glucose load as in a glucose tolerance test.
• random plasma glucose at or above 200 mg/dL (11.1 mmol/l).

A positive result, in the absence of clinical symptoms of diabetes, should be confirmed by another of the above-listed methods on a different day. Most physicians prefer to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete. According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/l) is considered diagnostic for diabetes mellitus. A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ...

Patients with fasting glucose levels between 110 and 125 mg/dL (6.1 and 7.0 mmol/l) are considered to have impaired fasting glycemia. Patients with plasma glucose at or above 140 mg/dL or 7.8 mmol/l two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease. Impaired fasting glycaemia (IFG) is a pre-diabetic state of dysglycemia, associated with insulin resistance and increased risk cardiovascular pathology, although of lesser risk than Impaired glucose tolerance (IGT). ... Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. ...

While not used for diagnosis, an elevated level of glucose irreversibly bound to hemoglobin (termed glycosylated hemoglobin or HbA1c) of 6.0% or higher (the 2003 revised U.S. standard) is considered abnormal by most labs; HbA1c is primarily used as a treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately). However, some physicians may order this test at the time of diagnosis to track changes over time. The current recommended goal for HbA1c in patients with diabetes is <7.0%, which is considered good glycemic control, although some guidelines are stricter (<6.5%). People with diabetes who have HbA1c levels within this range have a significantly lower incidence of complications from diabetes, including retinopathy and diabetic nephropathy.^[15][16] Structure of hemoglobin. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ... This article is about the management of diabetes mellitus. ... Retinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. ... Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. ...

Screening

Diabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. The screening test varies according to circumstances and local policy, and may be a random blood glucose test, a fasting blood glucose test, a blood glucose test two hours after 75 g of glucose, or an even more formal glucose tolerance test. Many healthcare providers recommend universal screening for adults at age 40 or 50, and often periodically thereafter. Earlier screening is typically recommended for those with risk factors such as obesity, family history of diabetes, high-risk ethnicity (Hispanic, Native American, Afro-Caribbean, Pacific Island, and South Asian ancestry).^[17][18] A risk factor is a concept in finance theory such as the CAPM, APT and other theories that use pricing kernels. ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... In medicine, a family history consists of information about disorders that a patients direct blood relatives have suffered from. ... This article or section should be merged with ethnic group Ethnicity is the cultural characteristics that connect a particular group or groups of people to each other. ... Hispanic (Spanish: ; Portuguese: ; Latin: , adjective from Hispānia, the Roman name for the Iberian Peninsula) is a term that historically denoted relation to the ancient Hispania and its peoples. ... For other uses, see Native Americans (disambiguation). ... The African diaspora was the movement of Africans and their descendants to places throughout the world - predominantly to the Americas, then later to Europe, the Middle East and other corners of the globe. ... The Pacific Ocean has an estimated 20,000 to 30,000 islands; the exact number is unknown. ... Map of South Asia (see note on Kashmir). ...

Many medical conditions are associated with diabetes and warrant screening. A partial list includes: high blood pressure, elevated cholesterol levels, coronary artery disease, past gestational diabetes, polycystic ovary syndrome, chronic pancreatitis, fatty liver, hemochromatosis, cystic fibrosis, several mitochondrial neuropathies and myopathies, myotonic dystrophy, Friedreich's ataxia, some of the inherited forms of neonatal hyperinsulinism. The risk of diabetes is higher with chronic use of several medications, including high-dose glucocorticoids, some chemotherapy agents (especially L-asparaginase), as well as some of the antipsychotics and mood stabilizers (especially phenothiazines and some atypical antipsychotics). Dyslipidemia is a disruption in the amount of lipids in the blood. ... Polycystic Ovary Syndrome (abbreviated PCOS or POS), also known clinically as Stein-Leventhal syndrome, is an endocrine disorder that affects approximately 10% of all women . ... Different stages of liver damage Fatty liver (also known as steatorrhoeic hepatosis or steatosis hepatis) is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis. ... Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ... Myotonic dystrophy (DM) is a chronic, slowly progressing, highly variable inherited multisystemic disease that can manifest at any age from birth to old age. ... Friedreichs ataxia is a rare autosomal recessive disorder caused by a mutation in Gene X25 that codes for frataxin, located on chromosome 9. ... Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ... Asparaginase (EC 3. ... Phenothiazines are the largest of the 5 main classes of antipsychotic drugs. ... The atypical antipsychotics (also known as second generation antipsychotics) are a class of prescription medications used to treat psychiatric conditions. ...

People with a confirmed diagnosis of diabetes are screened routinely for complications. This includes yearly urine testing for microalbuminuria and examination of the retina (retinal photography) for retinopathy. In the UK, screening for diabetic retinopathy has helped reduce the incidence of legal blindness since its implementation.^{[citation needed]} Microalbuminuria - the measurement of small amounts of albumin in the urine that cannot be detected by urine dipstick methods. ... Human eye cross-sectional view. ...

Prevention

Type 1 diabetes risk is known to depend upon a genetic predisposition based on HLA types (particularly types DR3 and DR4), an unknown environmental trigger (suspected to be an infection, although none has proven definitive in all cases), and an uncontrolled autoimmune response that attacks the insulin producing beta cells.^[19] Some research has suggested that breastfeeding decreased the risk in later life; ^[20][21] various other nutritional risk factors are being studied, but no firm evidence has been found. ^[22] Giving children 2000 IU of Vitamin D during their first year of life is associated with reduced risk of type 1 diabetes, though the causal relationship is obscure.^[23] HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Beta cells are a type of cell in the pancreas in areas called the islets of Langerhans. ... Suckling redirects here. ...

Children with antibodies to beta cell proteins (ie, at early stages of an immune reaction to them) but no overt diabetes, and treated with vitamin B-3 (niacin), had less than half the diabetes onset incidence in a 7-year time span as did the general population, and an even lower incidence relative to those with antibodies as above, but who received no vitamin B3.^[24] Niacin, also known as nicotinic acid or vitamin B3, is a water-soluble vitamin whose derivatives such as NADH, NAD, NAD+, and NADP play essential roles in energy metabolism in the living cell and DNA repair. ...

Type 2 diabetes risk can be reduced in many cases by making changes in diet and increasing physical activity.^[25][26] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2½ hours of exercise per week (several brisk sustained walks appears sufficient), having a modest fat intake, and eating a good amount of fiber and whole grains. The ADA does not recommend alcohol consumption as a preventive, but it is interesting to note that moderate alcohol intake may reduce the risk (though heavy consumption absolutely clearly increases damage to body systems significantly). There is inadequate evidence that eating foods of low glycemic index is clinically helpful despite recommendations and suggested diets in favor.^[27] The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. ... The relationship between alcohol consumption and health has been the subject of formal scientific research since at least 1926, when Dr. Raymond Pearl published his book, Alcohol and Longevity, in which he reported his finding that drinking alcohol in moderation was associated with greater longevity than either abstaining or drinking... Glycemic index (also glycaemic index, GI) is a ranking system for carbohydrates based on their effect on blood glucose levels. ...

There are numerous studies which suggest connections with some aspect of Type II diabetes with ingestion of certain foods or with some drugs. Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin,^[26] rosiglitazone,^[28] or valsartan.^[29] In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77% though causal mechanisms are unclear.^[30] Breastfeeding may also be associated with the prevention of type 2 of the disease in mothers.^[31] Rosiglitazone is an anti-diabetic drug from the thiazolidinedione class. ... Valsartan (trade name Diovan®) is an angiotensin II receptor antagonist, acting on the AT1 subtype. ... Hydroxychloroquine is an antimalarial drug, sold under the trade name Plaquenil®, also used to reduce inflammation in the treatment of Rheumatoid arthritis (see Disease-modifying antirheumatic drugs) and lupus. ... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ...

Treatment and management

Main article: Diabetes management

Diabetes mellitus is currently a chronic disease, without a cure, and medical emphasis must necessarily be on managing/avoiding possible short-term as well as long-term diabetes-related problems. There is an exceptionally important role for patient education, dietetic support, sensible exercise, self glucose monitoring, with the goal of keeping both short-term blood glucose levels, and long term levels as well, within acceptable bounds. Careful control is needed to reduce the risk of long term complications. This is theoretically achievable with combinations of diet, exercise and weight loss (type 2), various oral diabetic drugs (type 2 only), and insulin use (type 1 and increasingly for type 2 not responding to oral medications). In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications should be undertaken to control blood pressure^[32] and cholesterol by exercising more, smoking cessation, consuming an appropriate diet, wearing diabetic socks, and if necessary, taking any of several drugs to reduce pressure. Many Type 1 treatments include the combination use of regular or NPH insulin, and/or synthetic insulin analogs such as Humalog, Novolog or Apidra; the combination of Lantus/Levemir and Humalog, Novolog or Apidra. Another Type 1 treatment option is the use of the insulin pump with some of the most popular pump brands being: Cozmo, Animas, Medtronic Minimed, and Omnipod. This article is about the management of diabetes mellitus. ... Medicine In medicine, a persistent and lasting condition is said to be chronic (from Greek chronos). ... This article is about the management of diabetes mellitus. ... The diet recommended for people who suffer from diabetes mellitus is one that is high in dietary fibre, especially soluble fibre, but low in fat (especially saturated fat) and sugar. ... A diabetic sock is a sock which is specially designed for those with diabetes. ...

In co