Diabetes is a condition which results in too much sugar in the blood. This happens because the body does not produce enough insulin, the hormone that controls blood sugar levels.

It is otherwise known as Diabetes Mellitus (diabetes deriving from Greek meaning siphon, and reflecting excessive passing of urine, and mellitus coming from the Latin for honey, reflecting the sweetness that ancient physicians noted in the urine).

There are two types of diabetes:

• Type 1 Diabetes, which affects children and young adults and is also often referred to as Insulin Dependent Diabetes (IDDM).
• Type 2 Diabetes, which comes on in later life, especially in the overweight and often runs in families. This is also referred to as Non Insulin Dependent Diabetes (NIDDM).

• Drinking a lot (polydypsia) and thirst
• Passing a lot of urine (polyuria)
• Weight loss
• Tendency to get minor infections, such as boils or thrush

All of these might lead a doctor to consider the diagnosis of diabetes. If you have these symptoms, and especially if you have a family history of diabetes, you should consult your doctor. It may be helpful to take a urine specimen with you for him to test for sugar, although he may prefer to do a blood test.

If you have diabetes you can do a lot for yourself, but it is very important to seek medical advice.

There are various factors involved in causing diabetes:

• Genetic or inherited susceptibility, which is more common in Type 2 Diabetes.
• Pancreatic disorders. (The pancreas produces insulin and thus diseases affecting the pancreas may reduce production.)
• Other hormone disorders, for example of the adrenal glands, and changes seen in pregnancy in some people.
• Drug induced, for example with use of steroids and certain diuretics (water tablets).
• Obesity or remaining overweight is one contributory factor in Type 2 Diabetes.

Also there is evidence that low birth weight babies of short, overweight mothers are more likely to develop problems associated with insulin resistance.

Ring form of the D-glucose molecule (C₆H₁₂O₆).

Your doctor is most likely to want a blood sugar (glucose) test. This may just involve a finger prick which can be analysed at the surgery. A urine test is also sometimes used, but urine sugar level can be misleading.

Your doctor may wish to obtain a blood sample when you have fasted overnight or possibly a glucose tolerance test which involves a series of blood and urine tests following a fast and after administration of a glucose drink. These help in cases where the diagnosis is not clear.

You are also likely to be tested for glycosylated haemoglobin or HbA1C (haemoglobin A1C) which gives an idea of the blood sugar control over recent days/weeks. You may also have tests to check on your kidney function and blood cholesterol.

Whichever sort of diabetes you have it is most important that you come to terms with it and take responsibility for your own day to day management. The more you can understand the condition and how it effects you, the better you will be able to control it and prevent complications.

A diet which does not include sugary food or drinks is important for both types of diabetes.

Type 1 Diabetes requires the use of regular insulin injections. This will need to be taught to you, but most people are well able to manage this for themselves after a very short time. You will develop an understanding of the different doses needed when more activity takes place or in situations when you are unable to eat, for example when vomiting.

Type 2 Diabetes can often be controlled by attention to diet alone. It is also most important to get your weight down to a reasonable level. It is likely that your doctor will set a target weight with you. Your doctor may well initially monitor your blood sugar while you adopt this approach. If, however, your initial blood sugar is too high or you do not show a response to diet alone, then you will be started on medication. This usually involves one or more tablets a day.

Diabetes can adversely affect the blood vessels, the eyes, the heart, the nervous system, and the kidneys, but this usually appears to follow many years of poor blood sugar control. Thus although you may not have many symptoms from your diabetes you should try to maintain the best possible control of your blood sugar and attend your doctor regularly to monitor progress.

If you smoke, stop. As mentioned above, diabetes can adversely affect the blood vessels, so can smoking.

• India Diabetes Research Foundation
• American Diabetes Association

Books

American Diabetes Association Complete Guide to Diabetes, by American Diabetes Association

Perhaps the most complete and authoritative resource on diabetes, it covers everything from how to manage types 1 and 2 and gestational diabetes, to travelling with insulin, sick-day action plans, and recognizing hypoglycaemia.