insulin and diabtes mellitus

Diabetes is one of the major causes of physician visits, and the fourth leading cause of death in the US. Direct and indirect costs of diabetes and its complications are estimated at $100 billion annually, amounting to approximately 12% of the total annual US health care expenditure. There are two distinct types of diabetes: insulin-dependent diabetes mellitus (IDDM), also called Type 1 or juvenile diabetes; and non-insulin-dependent diabetes mellitus (NIDDM), also called Type II or adult-onset diabetes. IDDM occurs when the immune system attacks and destroys the pancreatic insulin-producing cells, while NIDDM occurs when cells in the body lose the ability to respond efficiently to insulin, a condition termed "insulin resistance."

In both IDDM and NIDDM, the hyperglycemia results in the excretion of glucose in the urine (which causes an increase in urine production) and the increased release of fatty acids from adipose tissue, with resulting increased ketone production by the liver. The accumulation of ketone bodies can cause life-threatening ketoacidosis. NIDDM patients, particularly elderly patients with underlying illnesses, may also develop another life-threatening condition--nonketotic hyperosmolar state--characterized by extremely high blood sugar levels. While these severe hyperglycemic episodes can be life-threatening, chronic hyperglycemia is also a cause of premature death in diabetics. Hyperglycemia and associated metabolic abnormalities--the production of advanced glycation end products, intracellular accumulation of sorbitol, and dyslipidemias--lead to complications such as retinopathy, renal damage, peripheral neuropathy, hypertension, cerebral, peripheral, and coronary artery disease, and neuroischemic gangrene requiring amputation. Managing IDDM requires 1-4 daily injections of insulin, plus careful planning of diet and exercise. NIDDM is managed with diet, exercise, weight loss, oral hypoglycemics, and insulin when necessary. And patients with both types of diabetes must guard against the complications.

Rubenstein AH. JAMA.