Introduction, Background and Various Types

Abstract

Diabetic individuals have chronic hyperglycemia, characterized as fasting blood glucose levels of 126 mg/dL (-6.9 mmol/L) and above.4 Acute complications include severe elevations in blood sugar levels that, if occurring in a dehydrated patient, can lead to an increase in blood osmolality and coma.5 Ketoacidosis, the accumulation of high levels of ketones in the blood, can also occur and be life threatening for diabetic individuals.6 Chronic effects of uncontrolled blood glucose in diabetic patients include increased risk of complications involving the eyes, heart, kidneys, peripheral nerves and blood vessels.7 History of Diabetes Mellitus Treatment While the history of diabetes mellitus spans several centuries, the use of insulin in the treatment of diabetes mellitus was not introduced until the 1920s. Pathogenesis of type 1 diabetes beyond ß cell destruction includes the presence of autoantibodies such as glutamic acid decarboxylase, insulin, islet cell and tyrosine phosphatase IA-2 and IA-2B autoantibodies.16 Type 1 diabetes often leads to the formation of ketone bodies, known as diabetic ketoacidosis (DKA).16 DKA is more common in type 1 diabetes mellitus; however, it can also occur with type 2 diabetes mellitus.17 Roughly 30% of children with type 1 diabetes mellitus present with acute DKA.18 Patients with DKA display acidosis, electrolyte imbalances, and are often dehydrated. If infections are left untreated for prolonged periods of time, they may spread to areas such as the bone and require amputation of the extremity.26 Complications of type 2 diabetes mellitus involving vision, such as retinopathy and blindness, also are increased.27 According to the Center for Disease Control and Prevention "a person with diabetes has a shorter life expectancy and about twice the risk of dying on any given day as a person of similar age without diabetes" with medical bills doubling that of their nondiabetes counterparts.28 Complications may be prevented or reduced through adequate monitoring of blood glucose levels.29 The incidence of type 2 diabetes mellitus continues to increase in the young population of America. In all individuals, it is important to take note of common symptoms of diabetes mellitus, including increased thirst, frequent urination, blurry vision or an unusual amount of fatigue.31 Gestational Diabetes Gestational diabetes occurs in pregnant women who do not exhibit hyperglycemia prior to pregnancy, but develop high blood glucose levels during pregnancy.32 Gestational diabetes affects an estimated 1-14% of pregnancies in the United States.33 During pregnancy, the placenta produces numerous hormones that diminish the effects of insulin on cells, resulting in increased blood sugar levels during pregnancy.