Introduction

The two major forms of diabetes are type 1, previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, and type 2, previously called noninsulin-dependent diabetes mellitus (NIDDM) or maturity-onset diabetes. Insulin Both type 1 and type 2 diabetes share one central feature: elevated blood sugar (glucose) levels due to absolute or relative insufficiencies of insulin, a hormone produced by the pancreas. Insulin is a key regulator of the body's metabolism. It works in the following way:

During and immediately after a meal the process of digestion breaks carbohydrates down into sugar molecules (of which glucose is one) and proteins intoamino acids. Right after the meal, glucose and amino acids are absorbed directly into the bloodstream, and blood glucose levels rise sharply. (Glucose levels after a meal are called postprandial levels.) The rise in blood glucose levels signals important cells in the pancreas, called beta cells, to secrete insulin, which pours into the bloodstream. Within 20 minutes after a meal insulin rises to its peak level. Insulin enables glucose and amino acids to enter cells in the body, particularly muscle and liver cells. Here, insulin and other hormones direct whether these nutrients will be burned for energy or stored for future use. (It should be noted that the brain and nervous system are not dependent on insulin; they regulate their glucose needs through other mechanisms.) When insulin levels are high, the liver stops producing glucose and stores it in other forms until the body needs it again. As blood glucose levels reach their peak, the pancreas reduces the production of insulin. About 2 to 4 hours after a meal both blood glucose and insulin are at low levels, with insulin being slightly higher. The blood glucose levels are then referred to as fasting blood glucose concentrations.

The pancreas is located behind the liver and stomach. In addition to secreting digestive enzymes, the pancreas secretes the hormones insulin and glucagon into the bloodstream. The release of insulin into the blood lowers the level of blood glucose (simple sugars from food) by enhancing glucose to enter the body cells, where it is metabolized. If blood glucose levels get too low, the pancreas secretes glucagon to stimulate the release of glucose from the liver.

Type 1 Diabetes In type 1 diabetes, the disease process is more severe than with type 2, and onset is usually in childhood:

Beta cells in the pancreas that produce insulin are gradually destroyed. Eventually insulin deficiency is absolute. Without insulin to move glucose into cells, blood glucose levels become excessively high, a condition known as hyperglycemia. Because the body cannot utilize the sugar, it spills over into the urine and is lost. Weakness, weight loss, and excessive hunger and thirst are among the consequences of this "starvation in the midst of plenty." Patients become dependent on administered insulin for survival.

Type 2 Diabetes Type 2 diabetes is the most common form of diabetes, accounting for 90% of cases. An estimated 19 million Americans have type 2 diabetes and half are unaware they have it. The disease mechanisms in type 2 diabetes are not wholly known, but some experts suggest that it may involve the following three stages in most patients:

The first stage in type 2 diabetes is the condition calledinsulin resistance. Although insulin can attach normally to receptors on liver and muscle cells, certain mechanisms prevent insulin from moving glucose (blood sugar) into these cells where it can be used. Most patients with type 2 diabetes produce variable, even normal or high, amounts of insulin, and in the beginning this amount is usually sufficient to overcome such resistance. Over time, the pancreas becomes unable to produce enough insulin to overcome resistance. In type 2 diabetes, the initial effect of this stage is usually an abnormal rise in blood sugar right after a meal (called postprandial hyperglycemia). This effect is now believed to be particularly damaging to the body. Eventually, the cycle of elevated glucose further impairs and possibly destroys beta cells, thereby stopping insulin production completely and causing full-blown diabetes. This is made evident by fasting hyperglycemia, in which elevated glucose levels are present most of the time. Maturity-Onset Diabetes in Youth. Maturity-onset diabetes in youth (MODY) is a rare genetic form of type 2 diabetes that develops only in Caucasian teenagers. It accounts for 2 - 5% of type 2 cases. Gestational Diabetes. An estimated 5% of pregnant women develop a form of type 2 diabetes in their third trimester called gestational diabetes. Gestational diabetes is usually temporary.

Diabetes Secondary to Other Conditions Conditions that damage or destroy the pancreas, such as pancreatitis, pancreatic surgery, or certain industrial chemicals can cause diabetes. Certain drugs can also cause temporary diabetes, including corticosteroids, beta-blockers, and phenytoin. Rare genetic disorders (Klinefelter's syndrome, Huntington's chorea, Wolfram's syndrome, leprechaunism, Rabson-Mendenhall syndrome, lipoatrophic diabetes, and others) and hormonal disorders (acromegaly, Cushing's syndrome, pheochromocytoma, hyperthyroidism, somatostatinoma, aldosteronoma) also increase the risk for diabetes.

Type 2 Diabetes Overview Type 2 diabetes, often called non-insulin dependent diabetes, is the most common form of diabetes, affecting 90% - 95% of the 21 million people with diabetes. In this article, you'll learn the basics about type 2 diabetes, including symptoms and causes, as well as type 2 diabetes in children. What Is Type 2 Diabetes? Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, either their pancreas does not produce enough insulin or the body cannot use the insulin adequately. This is called insulin resistance. When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells. When glucose builds up in the blood instead of going into cells, the body's cells are not able to function properly. Other problems associated with the buildup of glucose in the blood include:

Dehydration. The buildup of sugar in the blood can cause an increase in urination. When the kidneys lose the glucose through the urine, a large amount of water is also lost, causing dehydration. Diabetic Coma (Hyperosmolar nonketotic diabetic coma) . When a person with type 2 diabetes becomes severely dehydrated and is not able to drink enough fluids to make up for the fluid losses, they may develop this life-threatening complication. Damage to the body. Over time, the high glucose levels in the blood may damage the nerves and small blood vessels of the eyes, kidneys, and heart and predispose a person to atherosclerosis (hardening) of the large arteries that can cause heart attack and stroke. Although it is more common than type 1 diabetes, the causes of type 2 diabetes are less well understood. It is likely caused by multiple factors and not a single problem. Type 2 diabetes can run in families, but the exact nature of how it's inherited or the identity of a single genetic factor is not known. For more detail, see WebMD's article Causes of Type 2 Diabetes.

What Are the Symptoms of Type 2 Diabetes? The symptoms of type 2 diabetes vary from person to person but may include:

Increased thirst. Increased hunger (especially after eating). Dry mouth. Nausea and occasionally vomiting. Frequent urination. Fatigue (weak, tired feeling). Blurred vision. Numbness or tingling of the hands or feet. Frequent infections of the skin, urinary tract or vagina. Rarely, a person may be diagnosed with type 2 diabetes after presenting to the hospital in a diabetic coma. For more detail, see WebMD's article Type 2 Diabetes Symptoms. How Is Type 2 Diabetes Diagnosed? To diagnose type 2 diabetes, your health care provider will first check for abnormalities in your blood (high blood glucose level) during a random fasting blood test or through a screening test known as the 2 hour glucose tolerance test. In addition, he or she may look for glucose or ketone bodies in your urine. Type 2 diabetes testing includes a fasting plasma glucose test or a casual plasma glucose test. You will also need to check your blood sugar levels regularly. For more detail, see WebMD's article Diagnosis of Diabetes. Complications Associated With Type 2 Diabetes If your type 2 diabetes isn't well controlled, there are a number of serious or lifethreatening problems you may experience, including:

Retinopathy . People with type 2 diabetes may already have abnormalities in the eyes related to the development of diabetes. Over time more and more people who initially do not have eye problems related to the disease will develop some form of eye problem. It is important to control not only sugars but blood pressure and cholesterol to prevent progression of eye disease. Fortunately, the vision loss isn't significant in most. Kidney damage . The risk of kidney disease increases over time, meaning the longer you have diabetes the greater your risk. This complication carries significant risk of serious illness -- such as kidney failure and heart disease. Poor blood circulation and nerve damage. Damage to nerves and hardening of the arteries leads to decreased sensation and poor blood circulation in the feet. This can lead to increased infections and an increased risk of ulcers which heal poorly and can in

turn significantly raises the risk of amputation. Damage to nerves may also lead to digestive problems, such as nausea, vomiting, and diarrhea. Type 2 Diabetes in Children More and more children are being diagnosed with type 2 diabetes. Find out about type 2 diabetes symptoms in children, the diagnosis, and the treatment in WebMD's article on type 2 diabetes in childhood. If your child is at risk for childhood diabetes, its important to learn specific self-care tips to help prevent diabetes.

Who Gets Type 2 Diabetes? Anyone can get type 2 diabetes. However, those at highest risk for the disease are those who are obese or overweight, women who have had gestational diabetes, people with family members who have type 2 diabetes and people who havemetabolic syndrome (a cluster of problems that include high cholesterol, high triglycerides, low good 'HDL' cholesterol and a high bad 'LDL' cholesterol, and high blood pressure). In addition, older people are more susceptible to developing the disease since aging makes the body less tolerant of sugars. In addition, people who smoke, have inactive lifestyles, or have certain dietary patterns have an increased risk of developing type 2 diabetes.

Coping With Diabetes and Stress When you have diabetes, stress can significantly affect your ability to control the disease. If you are under stress, you may skip meals or forget to take your medicines, which will affect your blood sugar level. Learning to deal with this stress is especially important if you have diabetes. Although you can't completely remove stress from your life, there are several ways you can reduce it. And by learning to better cope with stress, you can help keep your diabetes under control. Here are some tips Fight Stress With a Positive Attitude When things seem to be going wrong, it's always easier to see the bad instead of the good. Find something good in each important area of your life: work, family, friends, and health. Thinking about the good can help you get through the bad times and the stress. Be Nice to Yourself What are your talents, abilities, and goals? Are you expecting too much from yourself? Don't expect more of yourself than you have or are able to give.

Accept What You Cannot Change For those stressful situations or problems that cannot be changed, develop a simple plan of action. Ask yourself the following questions:

"Will this be important two years from now?" "Do I have control over this situation?" "Can I change my situation?"

Talk to Someone About Your Stress Don't keep stress bottled up inside. If you don't want to talk with a family member or close friend, there are counselors and clergy trained to provide support and insight. Ask your doctor for recommendations if you would like to see a psychologist or counselor. Exercise to Fight Stress The benefits of exercise in reducing stress are well known, particularly for someone with diabetes. Exercise gives you a feeling of well-being and may relieve symptoms of stress. Take Time to Relax Practice muscle relaxation, deep breathing, meditation, or visualization. Ask your health care provider for information and available programs.