As a statement made to the patient, “You’ve got diabetes,” it is in itself not very informative. Everyone knows diabetes comes from eating too much sugar, and as is almost always the case, what “everyone knows” is not correct.
To give an official definition of diabetes, it is described as, “A group of disorders associated with abnormalities in the metabolism of carbohydrate, protein and fat and characterized by distinct eye, kidney, and nerve complications and an increased risk of cardiovascular disease.”
Diabetes when the word was first used was an explanation for having to pass urine too often, like a siphon. Then it became known the urine was sweet tasting, and mellitus was added. We’ve come quite a long way since then, we know a lot more about diabetes, but as always, “the more you know, the less you know” and we are conscious of the gaps in our understanding of what is not one but many different conditions.
There’s the diabetes that affects younger persons, it used to be called “Juvenile Diabetes” but that name didn’t seem altogether to fit the bill so it’s been dropped and we now have a more mathematical name to use instead – Type One Diabetes Mellitus – commonly abbreviated to T1DM.
Then there’s what used to be known as Adult Onset Diabetes Mellitus; the more we knew, the more that didn’t quite fit with the circumstances, so it too has been renamed and is called Type Two Diabetes or T2DM.
The mellitus is often dropped in common speech, but did and does have a purpose. There is another condition that was also known as diabetes because of excessive urination. This one, however, does not have sweet tasting urine, the reason why mellitus was ever added, and so in contrast it’s known as ínspidus. Not many doctors have ever seen a case of this rare kidney or pituitary gland misadventure, but every doctor has seen many patients with diabetes mellitus.
There seem to be more distinctions than shared features between T1DM and T2DM, but what they have in common is a sweet tasting urine (if you want to try it, that is), due to too much sugar in the blood stream, a condition known to doctors as hyperglycemia (hyper meaning more than the usual, gly indicating sugar, and emia the blood stream). Both instances of hyperglycemia are related to the hormone insulin, but there the close similarity ends.
The function of insulin, a hormone made in the pancreas, is to facilitate the passage of the sugar called glucose into the cells of liver, muscle and so on, so they may provide the energy the body needs. If insulin doesn’t do its job, then the sugar that’s been absorbed in the intestine will stay in the blood, and when in excess will be passed out in the urine. Put in extremely simplified terms, T1DM, about 10% of the diabetic population, is due to an absence of insulin, and T2DM is due to a failure of insulin to work – expressed in yet another way: in the juvenile form there isn’t any insulin, in the adult form, insulin is there, but it doesn’t do the job.
The positive aspect of what the two types have in common is the potential for the patient to control them by diet and by medication, and the potential to live a full and complication-free life. The negative aspect is we do not at present have a cure, only suppressive treatment, and this requires careful attention to intake of foodstuffs for both types, and insulin for T1DM and possibly insulin or other medication for T2DM. Failing proper treatment, the outcome for both types is rather dismal. To reinforce the positive aspect, insulin has been available for 90 years and there are persons of that age alive and well and looking towards their centennial birthday!
Other variations on the T1DM and T2DM are the patients who don’t quite fit either category, or who did at first but don’t now. There are persons of young age who seem to have the older age group variety of diabetes, and there are older persons who seem to have the juvenile variety.
Then the issue of pregnancy comes up. Is it safe to have a baby? And the good news is, “Yes. It can be perfectly safe,” with the caution, “provided your blood sugar is under strict control before you get pregnant (the pre-gestation group) and it stays under strict control during your pregnancy, delivery and breast feeding.”
There are women who did not know they had diabetes until they were examined in an ante-natal clinic (the gestation group) who pose a bigger problem to bring their diabetes under control while they are pregnant and help to bring a healthy new citizen into the world.