ABC of Vascular Disease

Diabetes Mellitus

1. What is diabetes mellitus?
Diabetes literally means "too much urine" and the condition gets this name because of of the symptoms of diabetes is passing an increased amount of urine. The real problem is actually to do with a fault in the way the body handles sugar. The sugar in question is called glucose (or dextrose) which the body uses as "fuel". In diabetes the level of glucose in the blood is too high. The high blood sugar escapes through the kidneys into the urine and causes an increased amount of urine to be produced. The word "mellitus" means sweet, and before the days of sophisticated tests, tasting the urine of a patient was used to help make the diagnosis. Doctors don't need to do this anymore!

2. What causes diabetes mellitus?
The body normally control the level of glucose in the blood using a chemical hormone called insulin. If the body does not produce enough insulin or the insulin dies not work correctly then the sugar in the blood tends to be too high. One of the treatments for diabetes is to take regular injections of insulin (it cannot be taken as a table like many other drugs can).

3. If I have diabetes will I need to take insulin?
Not all patients with diabetes need insulin. The sugar in the blood comes from what is eaten and in some patients just reducing the amount of sugar in the diet is enough to bring the blood sugar down to normal (diet controlled). In some patients the body is able to make insulin but it doesn't make enough and these patients can be treated with drugs that stimulate the body to make more insulin (tablet controlled). Treatment with insulin is reserved for the most severe forms of diabetes.

3. What problems does diabetes cause?
There are two types of problem: the first is a sudden (acute) illness caused by failure of the blood sugar regulation process. These patients usually need urgent hospital treatment. The second type of problem is slow (chronic) damage to certain parts of the body, particularly the blood vessels. This affects the whole body and if severe enough can cause blindness, kidney failure, foot ulcers and even gangrene of the toes. Such damage takes years to develop but is irreversible and very difficult to treat. This is why treatment to control the level of sugar in the blood is very important in diabetics.

4. How common is diabetes?
About 2% of the population have diabetes. The severe form that requires insulin is more likely in younger patients, and older patients often have the milder form which can be controlled with diet or tablets.

5. Is there a cure for diabetes?
In a small number of patients the diabetes is caused by something else and treating the primary problem effectively cures the diabetes. However, in the majority of patients there is no treatment that cures the underlying problem. A lot of research is being done to find a cure because diabetes is such a common and potentially serious condition.

6. What is the link between diabetes and arterial disease?
Long-term diabetics are at risk of developing occlusive arterial disease with its characteristic symptoms of leg pain on walking (intermittent claudication) and severe lack of blood flow to the feet (critical ischaemia). Often the severity of disease is advanced when the symptoms start and surgical treatment may not be possible. Diabetes is an important risk factor that should be looked for and treated in patients with suspected arterial disease.

7. What is the link between diabetes and arterial disease?
The combination of diabetes and smoking is VERY bad for arteries and all diabetics should refrain from smoking.

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