Types of Diabetes

Diabetes mellitus is classified into four categories: type 1, type 2, gestational diabetes, and other. In type 1 diabetes, specialized cells in the pancreas are destroyed, leading to a deficiency in insulin production. Type 1 diabetes frequently develops over the course of a few days or weeks. Over 95 percent of people with type 1 diabetes are diagnosed before the age of twenty-five. Estimates show 5.3 million people worldwide live with type 1 diabetes. Although the diagnosis of type 1 diabetes occurs equally among men and women, an increased prevalence exists in the white population. Type 1 diabetes in Asian children is relatively rare.

diet: the total daily food intake, or the Family history, diet, and environmental factors are risk factors for type types of foods eaten 1 diabetes. Studies have found an increased risk in children whose parents have type 1 diabetes, and this risk increases with maternal age. Environ-toxins: poison mental factors such as viral infections, toxins, and exposure to cow's milk are being contested as causing or modifying the development of type 1 diabetes.

Type 2 diabetes is characterized by insulin resistance and/or decreased insulin secretion. It is the most common form of diabetes mellitus, accounting for 90 to 95 percent of all diabetes cases worldwide. Risk factors for type 2 diabetes include family history, increasing age, obesity, physical inactivity, ethnicity, and a history of gestational diabetes. Although type 2

diabetes is frequently diagnosed in adult populations, an increasing number of children and adolescents are currently being diagnosed. Type 2 diabetes is also more common in blacks, Hispanics, Native Americans, and women, especially women with a history of gestational diabetes.

Genetics and environmental factors are the main contributors to type 2 diabetes. Physical inactivity and adoption of a Western lifestyle (particularly choosing foods with more animal protein, animal fats, and processed carbohydrates), especially in indigenous people in North American and within ethnic groups and migrants, have contributed to weight gain and obesity. In fact, obesity levels increased by 74 percent between 1991 and 2003. Increased body fat and abdominal obesity are associated with insulin resistance, a precursor to diabetes. Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are two prediabetic conditions associated with insulin resistance. In these conditions, the blood glucose concentration is above the normal range, but below levels required to diagnose diabetes. Subjects with IGT and/or IFG are at substantially higher risk of developing diabetes and cardiovascular disease than those with normal glucose tolerance. The conversion of individuals with IGT to type 2 diabetes varies with ethnicity, anthropometric measures related to obesity, fasting blood glucose (a measurement of blood glucose values after not eating for 12 to 14 hours), and the two-hour post-glucose load level (a measurement of blood glucose taken exactly two hours after eating). In addition to IGT and IFG, higher than normal levels of fasting insulin, called hyperinsulinemia, are associated with an increased risk of developing type 2 diabetes. Insulin levels are higher in African Americans than in whites, particularly African-American women, indicating their greater predisposition for developing type 2 diabetes.

The complexity of inheritance and interaction with the environment makes identification of genes involved with type 2 diabetes difficult. Only a small percentage (2-5%) of diabetes cases can be explained by single gene defects and are usually atypical cases. However, a "thrifty gene," although not yet identified, is considered predictive of weight gain and the development of type 2 diabetes. Thrifty-gene theory suggests that indigenous people who experienced alternating periods of feast and famine gradually developed a way to store fat more efficiently during periods of plenty to better survive famines. Regardless of the thrifty gene, the contribution of genetic mutations in the development of type 2 diabetes has not been established, due to the number of genes that may be involved.

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. This definition applies regardless of whether insulin or diet modification is used for treatment, and whether or not the condition persists after pregnancy. GDM affects up to 14 percent of the pregnant population—approximately 135,000 women per year in United States. GDM complicates about 4 percent of all pregnancies in the U.S. Women at greatest risk for developing GDM are obese, older than twenty-five years of age, have a previous history of abnormal glucose control, have first-degree relatives with diabetes, or are members of ethnic groups with a high prevalence of diabetes. Infants of a woman with GDM are at a higher risk of developing obesity, impaired glucose tolerance, or diabetes at an early age. After a pregnancy with GDM, the mother has an increased risk of developing type 2 diabetes.

Type 1 diabetics are more likely than other diabetics to require insulin injections to regulate blood glucose levels. Insulin pumps like the one shown here can provide an extra measure of control by administering a very accurate dose of insulin on a set schedule. [Photograph by Paul Sakuma. AP/Wide World Photos. Reproduced by permission.]

Type 1 diabetics are more likely than other diabetics to require insulin injections to regulate blood glucose levels. Insulin pumps like the one shown here can provide an extra measure of control by administering a very accurate dose of insulin on a set schedule. [Photograph by Paul Sakuma. AP/Wide World Photos. Reproduced by permission.]

genetics: inheritance through genes protein: complex molecule composed of amino acids that performs vital functions in the cell; necessary part of the diet carbohydrate: food molecule made of carbon, hydrogen, and oxygen, including sugars and starches fat: type of food molecule rich in carbon and hydrogen, with high energy content cardiovascular: related to the heart and circulatory system anthropometric: related to measurement of characteristics of the human body gene: DNA sequence that codes for proteins, and thus controls inheritance famine: extended period of food shortage genetic: inherited or related to the genes obese: above accepted standards of weight for sex, height, and age drugs: substances whose administration causes a significant change in the body's function

Other forms of diabetes are associated with genetic defects in the specialized cells of the pancreas, drug or chemical use, infections, or other diseases. The most notable of the genetically linked diabetes is maturity onset diabetes of the young (MODY). Characterized by the onset of hyperglycemia before the age of twenty-five, insulin secretion is impaired while minimal or no defects exist in insulin action. Drugs, infections, and diseases cause diabetes by damaging the pancreas and/or impairing insulin action or secretion.

plasma: the fluid portion of the blood, distinct from the cellular portion hemoglobin: the iron-containing molecule in red blood cells that carries oxygen ketoacidosis: accumulation of ketone bodies along with high acid levels in the body fluids energy: technically, the ability to perform work; the content of a substance that allows it to be useful as a fuel triglyceride: a type of fat ketones: chemicals produced by fat breakdown; molecule containing a double-bonded oxygen linked to two carbons pneumonia: lung infection electrolyte: salt dissolved in fluid

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