Diabetes is a medical disorder characterised by chronic elevation of blood sugar due to an absolute or relative deficiency of insulin. Insulin is the only hormone responsible for the regulation of blood sugar in the body and is produced by the islet of Langerhans located in the pancreas.

Diabetes affects approximately ten percent of the American population and is a leading factor in the development of cardio-vascular diseases which result in significant morbidity and mortatility, for example it is the leading cuse of blindness worldwide and the diabetic patient has three to four times the risk (compared to the aveage population) for developing life threatening complications such as heart attacks and strokes.

Complex carbohydrates or starch is converted into simple sugars and the action of insulin is to ensure that these simple sugars are absorbed from the blood stream into the cells and tissues of the body. In the case of an absolute deficiency of insulin there is minimal production of insulin which is not sufficient to ensure the normal metabolic reactions of the body. When there is relative deficiency of insulin the hormone is produced in sufficient quantities but the body has developed what is referred to as insulin resistance. For example in patients who are obese.

Whatever is the underlying cause, the manifestations or symptoms and signs of diabetes are the same. Diabetes affects the small and micro-blood vessels of the body and for this reasons all tissues and organs of the body from the brain to the toes are affected.

It is important to note the risk factors for the development of diabetes which include a strong family history, obesity, and a sedentary lifestyle and women who had gestational diabetes or delivered big babies (those which weighed more than four kilograms at birth)

The symptoms and signs of diabetes are due to the effects of the chronic elevation of blood sugar (hyperglycemia) which can result in a wide range of symtoms and signs including, constant thirst causing excessive consumtion of fluids (polyuria) and this in turn causes frequent passage of urine (polyuria) which in many cases lead to dehaydration, weakness and dizziness. Severe dehydration can lead to electrolyte imbalances resulting in diabetic hyperosmolar coma and even death.

Many persons affected by diabetes also complain of blurred vision, easy fatigability,(this is due to the fact that the body tissues is not able to utilise the glucose present in the body), tingling and numbness in the limbs, fingers and toes due to the effect on the nerve endings (peripheral) neuropathy, slow healing of cuts and scratches which are due to poor circulation, and itching of skin or the eruption of fungal infections on the skin and in women the typical itching of the external genitals.

Diabetes is confirmed by testing blood glucose levels. Standard testing is the blood glucose profile. The blood glucose levels are tested at the fating level or the absence of food intake for at least six hours. Food is then ingested and another sample taken two hours after the meal is consumed. If the fasting glucose level is ore than 6 mmol/l and the two hour post prandial is more than 8 mmol/l or a random sample is more than 10 mmol/l especially with the symptoms and signs present these will confirm diagnosis.

The main goals of treatment are to normalise and maintain blood sugar levels, prevent complications of the disease, through lifestyle changes, dieting and exercising and compliance with the prescribed treatment. There are patients whose blood sugar levels will be contolled by dieting and regular exercises but the vast majority in addittion to these will be prescribed tablets which are known as oral hypoglycaemic agents or insulin, which comes in different forms. The type of tablets or insulin used, the frequency and dosages are individually tailored to suit the specific needs and circumstances of each patient. Sometimes these are also used in various combinations.

Diabetes mellitus when diagnosed early and managed properly ensure normal productive lives of millions of patients who achieve their full life expectancy and beyond.