Types of Diabetes Mellitus
Diabetes is a common as well as a complex disease. The condition of diabetes is marked by the excessive amount of sugar or glucose in the blood. Diabetes has been known since ancient times and the term diabetes was primarily used by Aretaeus of Cappadocia in the Second century AD. The incidence of diabetes is rising around the world. Deficiency of the hormone insulin is the fundamental abnormality of diabetes mellitus. Diabetes is a difficult disease since it causes both physical and psychological complexities in an individual’s life. It is an invisible chronic disease which can’t be completely cured. Diabetes is a kind of disease that can only be managed. The short term and long term complications associated with diabetes makes it a serious public health problem. Absolute deficiency of insulin leads to ketoacidosis and coma and the long term hyperglycemia affects the microvasculature of the eye, kidney and nerve as well as the larger arteries,leading to accelerated atherosclerosis. Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are the two main categories of diabetes. Although they have identical names both are different kind of diseases.
Type 1 diabetes mellitus (T1DM)
The insufficiency to control the excessive amount of glucose in the body owing to the deficiency of glucose is known as Type 1 diabetes mellitus (T1DM). It is all about the mechanism of insulin and sugar. Insulin is the chemical or hormone that controls the quantity of glucose in the blood. In T1DM, the immune cells and proteins react against the cells that produce insulin and destroying them. Thus Type 1 diabetes mellitus (T1DM) can be considered as an autoimmune disease. It is a lifelong chronic disease. T1DM is generally begins in childhood. The term juvenile diabetes is used to refer TIDM in the past since it occurs most frequently in children. In some cases TIDS develops in a later stage of adulthood. The name of the disease changed from juvenile diabetes to type 1 diabetes mellitus considering the lack of insulin often occurs in adults. T1DM doesn’t appear overnight. It often starts dramatically. A sample of blood is taken and its glucose level is measured for the diagnosis of TIDM. The glucose level should not exceed 125 mg/dl if the patient is fasting. The glucose level should not exceed more than 199 mg/dl without fasting. Diagnosis is confirmed only after checking inconsistencies at least at two different times. Patient’s with blood glucose of 300 to 500 mg/dl and an acetone smell on breath apparently have T1DM until proven otherwise. Urgent insulin replacement is required in patient’s with type 1 diabetes mellitus.
Symptoms of Type 1 diabetes mellitus (T1DM)
Several symptoms such as abdominal pain, blurred vision, extreme weakness and tiredness, increase thirst, increased urination irritability and mood changes, loss of menstruation, nausea, weight loss despite increased food intake and vomiting indicates the rapid development of TIDM.
The patients of Type 1 diabetes (TIDM) experience frequent urination since the kidney can’t return the entire glucose to bloodstream when blood glucose level is greater than 180 mg/dl (10 mmol/L). The large quantity of glucose urine makes it very concentrated. The body draws water out of your blood into the urine to reduce the high concentration of glucose. The bladder fills up repeatedly as a result of this water and glucose.
Increase in thirst:
The experience of frequent urination increases thirst in TIDM patients. The body begins to dehydrate in accordance with the enormous loss of water in the urine.
The patients lose weight as the body loses glucose in the urine. The body breaks down muscle and fat for energy.
Increase in hunger:
The lack of insulin prevents the glucose from entering to the cells. The cells become malnourished as a result of this. The body becomes increasingly hungry in the midst of plenty of extra glucose in the blood.
The patient feels weak because muscle cells and other tissues do not get the sufficient energy they require from glucose.
Type 2 diabetes mellitus (T2DM)
Type 2 diabetes mellitus (T2DM) is the form of diabetes that occurs most often in adults. T2DM is generally is associated with obesity and lack of exercise. Type 2 diabetes or T2DM has several alternative names such as adult onset diabetes, noninsulin dependent diabetes or insulin independent diabetes. The main problem in T2DM is not deficiency of insulin but insulin resistance. The body resists or obstructs the normal, healthy functioning of insulin.T2DM is a strongly inherited disease. The insulin resistance is caused by a genetic abnormality and it is worsen by weight gain and deficiency of exercise. Type 2 diabetes frequently appears in people over the age of 40. There are cases of undetected diabetes for several years and may not feel particularly unwell. Symptoms of Type 2 diabetes are minimal and it is usually ignored by the patients. The diagnosis of T2DM depends on finding abnormal blood glucose either in the fasting state or after the food intake. A blood glucose of 126 mg/dl or greater in the fasting state and 200 mg/dl or greater after food consumption are considered as the diagnostic of type 2 diabetes. T2DM is much more complex than a lifestyle and environmental disease. Lifestyle change doesn’t bring productive changes or normalization of blood glucose in patients with T2DM. Doctors usually prescribe several oral agents and an intramuscular drug named Byetta for the effective treatment of TIDM prior to the use of insulin.
Symptoms of Type 2 diabetes mellitus (T2DM)
The symptoms of Type 2 diabetes mellitus include fatigue, frequent urination, thirst, and vaginal infections in women.
Tiredness or fatigue is the central symptom of T2DM.The patients feel tired because the body cells fails to acquire the sufficient glucose fuel they required. Even though there is a large quantity of insulin in blood, the body of T2DM patient is resistant to its actions.
Frequent urination and thirst:
Patients with type 2 diabetes urinate more frequently than usual. This frequent urination dehydrates the body and causes thirsty.
The inconsistent rise and fall of blood glucose levels cause the swelling and shrinking of the lenses of the eyes in Type 2 diabetes patients. The vision blurs because eyes fails to adjust quickly to the\ lens changes.
Slow healing of skin, gum, and urinary infections:
Type 2 diabetes leads to the presence of high-glucose environment in the body. The high-glucose environment prevents the proper functioning of white blood cells, which help with healing and defend the body against infections. The bugs that cause infections flourish in the high-glucose environment. Thus T2DM leaves the body especially vulnerable to infections.
High-glucose environment in stimulates the yeast infections. Thus Type 2 diabetes is often accompanied by the itching and discomfort of yeast infections.
Numbness in the feet or legs:
The extreme elevations of the glucose causes occasional occurrence of numbness. The experience of numbness indicates the common long-term complication of diabetes called neuropathy. Neuropathy usually takes more than five years to develop in a diabetic environment.
Heart disease, stroke, and peripheral vascular disease:
Severe complications such as heart disease, stroke, and peripheral vascular disease or blockage of arteries in the legs occur more frequently in type 2 than in the nondiabetic population.
Similarities and Differences between Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM)
Both type 1 diabetes and type 2 diabetes share several features. The central characteristic feature shared by both diseases is the consequences of not controlling the blood glucose or sugar. Microvascular complications like eye disease, kidney disease, and nerve disease; and macrovascular complications like heart disease, stroke, and obstruction of blood vessels, especially in the legs and feet are usually associated with both type 1 diabetes and type 2 diabetes. The major differences between T1DM and T2DM can be summed up in the single word: insulin. The chemical hormone insulin is partially or completely absent in T1DM from the beginning itself. In T2DM insulin is present for long after the beginning of the disease.
Age of onset:
Patients with type 1 diabetes are generally younger than those affected with type 2 diabetes. However, the rising incidence of type 2 diabetes in overweight children is making this difference insignificant for distinguishing type 1 and type 2 diabetes.
Patients with type 1 diabetes are commonly thin or normal in weight. Obesity is a central characteristic of people with type 2 diabetes.
Level of glucose:
Patients with type 1 diabetes have higher glucose levels at the onset of the disease Patients with type 1 diabetes . type 1 diabetes generally have blood glucose levels of 300 to 400 mg/dl (16.6 to 22.2 mmol/L) whereas those affected with type 2 diabetes commonly have blood glucose levels of 200 to 250 mg/dl (11.1 to 13.9 mmol/L).
Type 2 diabetes is a hereditary disease whereas life history is usually insignificant in the cases of Type 1 diabetes.
Relation to HLA:
Type 1 diabetes is highly associated with human leukocyte antigens (HLA). Type 2 diabetes has no significant connection with HLA.
Presence of antibodies:
Presence of antibodies is usual in Type 1 diabetes whereas presence of antibodies is rare in Type 1 diabetes.
Severity of onset:
Type 1 diabetes patients are usually very sick at the condition of diagnosis itself. Type 2 diabetes gradually exhibits its symptoms and patients are mildly ill at the condition of diagnosis.
Latent autoimmune diabetes
Some patients seem to have features of both T1DM and T2DM when they’re screened for diabetes. This type of diabetes is commonly known as Latent Autoimmune Diabetes in Adults (LADA).It is a cross between type 1 diabetes T1DM and Type2 diabetes T2DM. A patient with LADA exhibits traits of both diseases. ). LADA has also been called late-onset autoimmune diabetes of adulthood and slow onset type 1 diabetes. Latent autoimmune diabetes frequently develops in adults but shares more characteristics with T1DM.