Diabetes :: Nationwide Children's Hospital

Diabetes

Definition:

Diabetes is a disease that is characterized by a high blood glucose (“sugar”) level.

Diagnosis:

There are several different ways to diagnose diabetes:

  • A blood glucose of over 200 mg/dl with symptoms of elevated blood glucose (increased thirst, increased urination, increased appetite, unintentional weight loss)
  • Two fasting blood glucose values of 126 mg/dl or higher
  • An oral glucose tolerance test with a two hour blood glucose of 200 mg/dl or higher
  • A hemoglobin A1c measurement of 6.5% or above

Causes:

Insulin moves glucose out of the blood and into the cells of the body.  If there is too little insulin produced to keep the blood glucose at a normal level, then the blood glucose rises and diabetes results.

There are two different types of insulin deficiency.  In type 1 diabetes (also formerly known as Juvenile Diabetes), the body looses the ability to produce enough insulin through destruction of the insulin-producing islet cells in the pancreas.  In type 2 diabetes (also formerly known as Adult Onset Diabetes) the body can still produce a normal amount of insulin but the body becomes insensitive to insulin and so needs much more insulin to move the glucose out of the blood.  If the body cannot manage to produce this abnormally high level of insulin, then the blood glucose rises and results in diabetes.  

Symptoms:

High blood glucose levels cause glucose to appear in urine, and this gives many of the initial symptoms.  Glucose in the urine pulls extra fluid into the urine and so there is an increased urine production.  As a result the patient feels thirsty.  And the glucose lost in the urine carries calories out of the body leading to weight loss and increased thirst.  If the high blood glucose is not treated adequately, then glucose starts attaching to proteins in the body and causes organ dysfunction.  This particularly affects the eyes, kidneys, heart, blood vessels and nerves.  The best way to completely prevent these problems is by keeping the blood glucose at normal values.  In addition, inadequate insulin can cause ketone production.  Ketones bring acid into the blood and can cause life threatening illness that starts with symptoms of dehydration and rapid breathing and often belly pain and can progress to coma. 

Treatment:

For Type 1 diabetes, replacing the missing insulin with either an insulin pump or multiple insulin injections each day is the fundamental therapy.  Modern insulin therapy allows flexibility in size and timing of meals.  About ½ of the daily insulin is given as basal insulin, a low level of insulin that is continuously present in the blood, and about ½ of the daily insulin is divided into boluses given whenever food is eaten to move that glucose from the food out of the blood and into the cells of the body.
For Type 2 diabetes, many pediatric patients begin therapy with insulin, just like Type 1 patients.  Sometimes Type 2 diabetes can be treated with weight loss, pills, or non-insulin injections.

Outlook

Currently, diabetes has no cure.  But many researchers around the world are hard at work trying to develop a cure.  Type 1 diabetes can be managed by insulin injections and if the blood glucose is kept under good control, then the complications of diabetes do not accumulate, and in fact some can even reverse with time.

Better therapies are being developed such as insulin pumps with continuous glucose monitors that check blood glucose every few minutes automatically.  Some day the continuous monitors will adjust the pump automatically to keep just the right amount of insulin in the blood at all times.  Insulin is produced by beta cells in the pancreas and beta cell transplants are another potential approach to allow the body to once again produce just the right amount of insulin. 

Much of Type 2 diabetes can be cured by weight loss as excess fat cells cause the body to become resistant to insulin. Through weight loss, the body can get by with less insulin and the diabetes often goes away.

Resources


 

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000