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The symptoms of IDDM can be sudden and severe. They may
include frequent urination, extreme thirst, constant hunger,
blurred vision, and extreme fatigue. Because people with IDDM
lack insulin, glucose builds up in the blood. The kidneys,
trying to remove the excess sugar, excrete large amounts of
water and essential body elements, causing frequent urination
and thirst.
Because the body cannot use glucose, its first source of
energy, it turns to stored fat and protein for fuel. As the
body uses fat and protein, weight is lost. Breakdown products
of fat collect in blood and raise its acid content. If levels
of these products are high enough, a critical condition called
ketoacidosis can develop, requiring prompt treatment.
How Is Diabetes Treated?
A person with IDDM must have insulin injections to
survive. Without insulin, symptoms worsen until the patient
loses consciousness and slips into a coma. With daily insulin
shots and a careful diet, however, most people with IDDM can
lead active lives with the same ambitions and challenges as
those without diabetes.
[Graphic Omitted]
A person with IDDM needs to time meals with insulin doses to
keep blood glucose from getting too high or low.
[Graphic Omitted]
Treatment for IDDM includes a daily routine of insulin
shots or use of an insulin pump. Following a doctor's
instructions, a person with IDDM buys insulin and syringes and
injects himself or herself daily. (The parent of a young child
with IDDM can do this for the child.) More and more people are
also using home blood glucose monitoring devices to measure
their blood glucose during the day. In this way, they can
tailor the insulin dose more closely to changes in their
hour-to-hour blood glucose. Blood glucose monitoring is a more
accurate way to monitor diabetes treatment than urine testing.
Eating the right foods at the right time is an important
part of treatment. A person with IDDM needs to time meals with
insulin doses to keep blood glucose from getting too high or
low. The foods you choose can play a role in controlling blood
glucose levels, too. Increasing the proportion of fiber and
complex carbohydrates in your diet and avoiding refined sugar
may aid in reducing drastic changes in blood glucose and may,
in some people, permit lowering of insulin dose. Foods
containing fiber include beans, whole grains, and some fruits,
while complex carbohydrates, or starches, include potatoes,
rice, and pasta.
Reducing fats and cholesterol can help reduce the risk of
heart disease, which affects people with diabetes more often
than those with normal glucose metabolism.
Exercise, like diet, can help reduce the risk of heart
disease. Being fit can also bring a sense of well-being and
strength that has special meaning for someone with a chronic
illness like diabetes.
Exercise carefully, though. Strenuous exercise increases
the muscles' use of glucose, so it can lower glucose in the
blood. At the same time, exercise also stimulates the body to
release glucose and fats for use as energy. This stimulus can
have the effect of raising blood glucose. In order to exercise
safely, you should balance insulin dose, meals, and the timing
of exercise to keep blood glucose levels from getting too high
or too low.
[Graphic Omitted]
What Causes Diabetes?
No one knows exactly what causes IDDM. What is clear is
that the body's own immune or disease-fighting system for some
reason turns against the body's own tissues. Certain substances
formed by the immune system attack the beta cells of the
pancreas, destroying their ability to make insulin.
Research shows that most, if not all, people with IDDM may
inherit traits that put them at risk for IDDM. However, not
everyone who inherits these traits develops IDDM. One or more
factors in the environment are believed to trigger the immune
system to destroy the insulin-producing cells. In some cases,
the trigger may be a viral infection. Scientists have, in a few
cases, been able to link the onset of diabetes with a virus. In
most cases, however, the trigger for diabetes is unknown.
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The discovery of insulin in 1921 lengthened the lives of
people with IDDM from weeks or months to decades. In spite of
insulin's life-preserving effects, diabetes remains a deadly
disease. This fact is largely due to the complications of
diabetes that develop over many years of insulin treatment. The
complications affect the heart, eyes, kidneys, and nerves. Much
of the damage done to these organs involves changes in small
blood vessels throughout the body. Research is under way to
determine whether very careful control of blood glucose can
prevent or delay diabetic complications. Studies are also under
way to determine why some people with IDDM have trouble with
complications while others live long, relatively healthy lives.
Until the answers to these questions are known, it is wise
for people with IDDM to follow their doctor's advice in
controlling blood glucose and to be aware of the signs and risk
factors for complications of diabetes.
Acute Complications
The acute complications of diabetes are the rapid effects
that can occur when blood glucose levels climb too high or fall
too low. If an insulin injection is missed, for example, blood
glucose rises, and the person affected may start to feel weak
and hungry, and may urinate frequently. Since the body can't
use glucose for energy, it shifts to using fats and protein.
The products of fat and protein metabolism, substances called
ketones, are toxic when they reach high enough levels. This
condition is called ketoacidosis, and it can cause coma and
death if untreated. Ketoacidosis can develop slowly over
several days. The warning symptoms may include abdominal pain,
nausea and vomiting, rapid breathing and a fruity odor on the
person's breath, and drowsiness.
Common symptoms of hypoglycemia include trembling, nervousness,
sweating, hunger, headache, nausea, drowsiness, or a feeling
similar to drunkenness.
Glucose can also fall too low in diabetes. Going too long
without a meal, engaging in strenuous exercise, or taking too
large a dose of insulin can cause glucose to drop, a condition
called hypoglycemia, or insulin shock. Common symptoms of
hypoglycemia include trembling, nervousness, sweating, hunger,
headache, nausea, drowsiness, or a feeling similar to
drunkenness. Like ketoacidosis, hypoglycemia can cause coma and
death if untreated. A quick, sugar-rich snack or drink such as
orange juice or an injection of glucagon, a hormone that raises
glucose levels, can restore normal glucose levels.
Long-Term Complications
In young people, acute complications pose the greatest
threat to survival for people with IDDM. As people grow older,
the long-term complications become more important. Diabetes can
damage many organs through its effects on blood vessels. How
this occurs is not well understood, but the damage can lead to
kidney, heart, eye, and nerve disease.
Kidney Disease
Kidney disease is the greatest threat to life in adults
with IDDM. The kidneys have a complex network of small blood
vessels that filter impurities from blood for excretion in
urine. Diabetes can damage these small blood vessels so that
the kidneys cannot perform their waste-filtering work. The
kidneys are essential to life. People can live without one
kidney, but those who lose both must have their blood cleansed
by a dialysis machine or have a kidney transplant.
[Graphic Omitted]
Diabetes doubles the risk of heart disease.
High blood pressure can increase the chances that someone
will develop kidney disease, so keeping blood pressure under
control is especially important for someone with IDDM.
Heart Disease
Diabetes doubles the risk of heart disease. For reasons
not yet well understood, fat and cholesterol collect more
rapidly in the arteries of people with diabetes than in those
without diabetes. These fatty deposits reduce the supply of
blood to the heart and can lead to a heart attack.
Other risk factors for heart disease include hypertension
or high blood pressure, obesity, high amounts of fats and
cholesterol in blood, and cigarette smoking. The more these
factors can be eliminated, the more a person reduces the risk
of heart disease.
Eye Disease
The major threat to vision from diabetes is diabetic
retinopathy. Retinopathy means disease of the retina, the
light-sensing tissue at the back of the eye. Diabetes causes
changes in the tiny vessels that supply the retina with blood.
The blood vessels may swell and leak fluid. When retinopathy is
more severe, new blood vessels may grow from the back of the
eye and bleed into the clear gel, or vitreous, that fills the
eye.
A yearly eye examination enables an eye doctor to detect
changes before vision is affected and eye disease becomes
harder to treat. Scientists have found that laser treatment for
diabetic retinopathy can help prevent loss of vision and can,
in some cases, restore vision lost as a result of this disease.
A yearly eye exam by an eye doctor is the best way to make sure
that changes in eyesight are diagnosed early and that effective
treatment is carried out when it can be most helpful.
[Graphic Omitted]
A yearly eye exam by an eye doctor is the best way to make
sure that changes in eyesight are diagnosed early.
Diabetic Nerve Disease
Nerve damage from diabetes (diabetic neuropathy) can dull
sensation in the feet, legs, and fingertips. When this happens,
bruises or sores may go unnoticed until they become open or
infected. Reduced blood flow caused by diabetes' effects on the
blood vessels (peripheral vascular disease) can slow healing of
foot sores. Because of diabetic neuropathy and peripheral
vascular disease, people with diabetes are at increased risk of
needing amputation when leg and foot sores become gravely
infected.
Severe pain in the legs and feet sometimes comes with
diabetic neuropathy. Pain-killing drugs and sometimes
antidepressant drugs are used to treat painful neuropathy. In
most cases, the pain subsides on its own with time.
Diabetic neuropathy can also affect body functions such as
digestion. A doctor may prescribe drugs to relieve these
symptoms. In addition, diabetes can, over time, affect the
nerves that control erection in men. A doctor can find out
whether impotence is the result of emotional or physical
changes, such as diabetes, and then suggest treatment or
counseling.
[Graphic Omitted]
A mother's careful control of her glucose is essential to the
health and life of her baby.
Pregnancy
With insulin treatment available, IDDM no longer poses the
threat it once did to the health of the pregnant mother. The
infant of a mother with IDDM does, however, have a higher than
average risk of birth defects, stillbirth, respiratory
distress, and other problems at birth. A mother's careful
control of her glucose is essential to the health and life of
her baby. With careful diabetes control, beginning before
conception if possible, it is likely that the child will be
healthy in every way.
Does Diabetes Run in Families?
A susceptibility to diabetes can be inherited. The
brothers and sisters of a child with diabetes have a higher
than average risk of developing IDDM. However, their risk
remains small--only about 1 in 20 children with a diabetic
sibling will develop IDDM. In fact, an identical twin of a
child with IDDM has less than a 50 percent chance of developing
the disease. Scientists are still doing research to determine
how and why certain factors--both inherited and
environmental--sometimes lead to diabetes.
Illness and Surgery
Illness, such as influenza, and stress, such as personal
losses or conflicts, can affect the body's use of glucose.
During times of illness and stress, a person needs to be even
more careful about keeping glucose in control.
Surgery also places unusual stress on the body. Surgical
teams take special precautions when doing surgery on a person
with IDDM. The best way to ensure that doctors are aware of a
patient's diabetes is to tell them.
During times of illness and stress, a person needs to be even
more careful about keeping glucose in control.
Back to the Table of Contents
Diabetes research is the best hope that one day a means of
curing and possibly preventing diabetes will be found. In the
last 10 years, diabetes researchers have made great strides in
understanding this disease. Critical to this effort has been
the technology developed in genetics, microbiology, immunology,
and other disciplines that have given diabetes researchers the
tools they need to examine at the cell level what happens in
diabetes.
The National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) was established by Congress in 1950 as
an institute of the National Institutes of Health (NIH), whose
mission is to improve human health through biomedical research.
The NIH is the research arm of the Public Health Service under
the U.S. Department of Health and Human Services.
The NIDDK conducts and supports a variety of research in
diabetes and its complications. In the past several years,
scientists have identified the genetic factors that are
associated with both IDDM and NIDDM. A major goal of future
research will be to clarify how inherited factors affect the
immune or disease-fighting system to result in IDDM. Already,
scientists have identified immune factors circulating in blood
that indicate increased risk of developing IDDM. This
information may lead to early identification of IDDM cases and
will help pave the way to understanding why the immune system
goes awry in IDDM.
Scientists also have a better understanding of how insulin
works in glucose metabolism. For example, groups of researchers
at Memorial Sloan-Kettering Cancer Center, New York; the
University of California, San Francisco; Mr. Zion Hospital and
Medical Center, San Francisco; and Stanford University,
Stanford, California, recently cloned and analyzed the
structure of the insulin receptor, a molecule on cell surfaces
to which insulin must attach in order to act. Defects in
receptor function have been linked to abnormalities in glucose
metabolism.
Human insulin made by recombinant DNA techniques is
commercially available, as are externally worn pumps that can
be programmed by the wearer to deliver insulin through a
catheter in the abdomen. Research is continuing on internally
implantable pumps, and clinical trials on at least one such
pump have been undertaken.
New treatments are being developed for the complications
of diabetes. Laser photocoagulation therapy has been shown to
reduce the risk of blindness in people with diabetic
retinopathy. Preventive measures and medications are available
to help control high blood pressure, to avoid lower extremity
amputations, and to reduce the risk of tooth loss from
periodontal (gum)disease. Understanding how maternal diabetes
can affect the unborn child is increasing, and with it,
strategies to improve the chances that such a child will be
born normal and healthy.
Research on transplantation of the insulin producing cells
of the pancreas is ongoing. The aim of this research is to
provide a means of transplanting insulin-producing cells into
someone with diabetes without the need to suppress the immune
system to prevent rejection. If successful, the procedure would
eliminate the need for daily injections of insulin.
Clinical Trials
Clinical trials are one means to test new approaches to
treatment that emerge from basic research. In a clinical trial,
new and existing treatments are compared with each other or
with no treatment.
The NIDDK is supporting and planning clinical trials that
are designed to weigh the benefits and risks of various
approaches to treatment of diabetes and its complications. For
information about NIDDK-supported clinical trials, contact the
National Institute of Diabetes and Digestive and Kidney
Diseases, National Institutes of Health, Building 31, Room
9A04, Bethesda, Maryland 20892.
Back to the Table of Contents
The Diabetes Dictionary
Available from the National Diabetes Information Clearinghouse,
Box NDIC, Bethesda, Maryland 20892, telephone (301) 468-2162.
Diabetes Mellitus: Theory and Practice,
Ellenberg, M., and
Rifkin, H., Editors.
This book is an example of medical textbooks that provide an
overview of diabetes, its symptoms, epidemiology, and
treatment.
This text is revised periodically and published by Medical
Examination Publishing Company. It is written for readers with
a medical background and is available in medical libraries and
possibly university libraries or through interlibrary loan at a
public library.
Diabetes and Your Eyes
Available from the National Eye Institute,
National Institutes of Health, Building 31,
Room 6A32, Bethesda, Maryland 20892,
telephone (301) 496-5248.
The American Diabetes Association, listed on the next
page, has a variety of periodicals and publications, at both a
lay and technical level, on various aspects of diabetes.
Other Resources
American Diabetes Association
National Service Center
1660 Duke Street
Alexandria, Virginia 22314
(703) 549-1500
Juvenile Diabetes Foundation, International
432 Park Avenue, South, 16th Floor
New York, New York 10016
(212) 889-7575
National Diabetes Information Clearinghouse
Box NDIC
Bethesda, Maryland 20892
(301) 468-2162
Back to the Table of Contents
U.S Department of Health and Human Services
Public Health Service
National Institutes of Health
NIH Pub. No. 90-2098
Revised April 1990
This booklet was written by Charlotte Armstrong of
NIDDK's Office of Health Research Reports. The draft
was reviewed by Dr. Allan L. Drash of Children's Hospital of
Pittsburgh.
Single
copies may be obtained from the National Diabetes Information
Clearinghouse, Box NDIC, Bethesda, Maryland 20892, (301)
468-2162.
Note: Graphics Omitted for on-line version
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