Diabetes mellitus (DM)
Diabetes mellitus is a
disorder in which the body is unable to metabolize carbohydrates (e.g.,
food starches, sugars, cellulose) properly. The disease is characterized
by excessive amounts of sugar in the blood (hyperglycemia) and urine;
inadequate production and/or utilization of insulin; and by thirst,
hunger, and loss of weight.
Diabetics who require daily insulin shots to maintain life have
insulin-dependent diabetes mellitus, or DM 1. In this type of
diabetes, the pancreas secretes little or no insulin and the blood sugar
level remains high, unless treated. DM 1 usually occurs in children and
young adults and is often called juvenile onset diabetes. Onset of the
disease is abrupt. The patient becomes very sick and requires immediate
insulin therapy. Approximately 1 million people in the United States have
DM 1.
Non-insulin-dependent diabetes, or DM 2, differs from DM 1 in
that the main problem is a peripheral resistance to the action of the
insulin. DM 2 usually occurs in adults over the age of 40 who are
overweight and have a family history of the disease. Some patients can
manage their diabetes with weight loss and changes in their diet. Others
require medication, and many with DM 2 eventually require insulin. Onset
is gradual, and patients may be sick for quite some time without knowing
it. Nearly 95% of diabetics are diagnosed with DM 2.
Signs and Symptoms
Approximately 25% to 40% of patients with DM 1 ultimately develop
diabetic nephropathy (DN), which progresses through about five predictable
stages.
Stage 1 (very early diabetes) Increased demand upon the kidneys
is indicated by an above-normal glomerular filtration rate (GFR).
Stage 2 (developing diabetes) The GFR remains elevated or has
returned to normal, but glomerular damage has progressed to significant
microalbuminuria (small but above-normal level of the protein albumin in
the urine). Patients in stage 2 excrete more than 30 mg of albumin in the
urine over a 24-hour period. Significant microalbuminuria will progress to
end-stage renal disease (ESRD). Therefore, all diabetes patients should be
screened for microalbuminuria on a routine (yearly) basis.
Stage 3 (overt, or dipstick-positive diabetes) Glomerular damage
has progressed to clinical albuminuria. The urine is "dipstick positive,"
containing more than 300 mg of albumin in a 24-hour period. Hypertension
(high blood pressure) typically develops during stage 3.
Stage 4 (late-stage diabetes) Glomerular damage continues, with
increasing amounts of protein albumin in the urine. The kidneys’ filtering
ability has begun to decline steadily, and
