In non-insulin dependent diabetes mellitus (NIDDM), which is also called type II, adult-onset, or stable diabetes, the body has enough insulin or even high levels of this hormone. The main problem is the body's resistance to insulin.
Insulin receptors or cells that accept insulin don't function well or are in short supply. This usually occurs in overweight people over 40. These people don't always need insulin injections but their blood sugar level can be controlled by means of diet, exercise, and oral hypoglycemic agents -medications taken by mouth that lower the concentration of sugar in the blood.
"Most persons with NIDDM are overweight or obese. Excess weight worsens the state of the diabetes, and weight reduction has a favorable effect. In some instances, insulin injections will be required to keep blood glucose concentrations within satisfactory limits but, unlike the situation in IDDM, omission of these injections will not result in complications," said Dr. David E. Larson, editor-in-chief of the Mayo Clinic Family Health Book.
"Medicines taken by mouth called oral hypoglycemic agents, often are helpful in NIDDM but are of no value for treating IDDM (insulin-dependent diabetes mellitus). As a result of a weight-loss program, insulin or an oral hypoglycemic medication often may be decreased or eliminated," he added.
The classic symptoms of diabetes are frequent urination and thirst, excessive hunger, weight loss in spite of increased appetite, fatigue, nausea and vomiting. Other signs are itching in the genital area, skin infections, slow healing of cuts and bruises, blurred vision, and occasionally, impotence in men and lack of menstruation in women.
In mild cases or in those with NIDDM, these symptoms may exist for years but the disease is discovered only during a routine examination which reveals high concentrations of sugar in the blood (hyperglycemia) or urine (glycosuria).
Before the advent of insulin, there was a very little hope for diabetics. Most of them lived for a few months only. A diagnosis of diabetes in those days was like getting a death sentence. As Dr. Isadore Rosenfeld of the New York Hospital Memorial Sloan-Kettering Cancer Center said in The Best Treatment:
"This knowledge about how insulin works the juvenile verses the adult form of diabetes, insulin receptors, and the auto immune concept - has all come to light only in the last decade or so. Leafing through a medical book published in the early 1900's, I found the symptoms of diabetes - thirst, frequent urination, weight loss, increased appetite, itching and coma - accurately described. But although high blood sugar was recognized as the cause, insulin was not destined to be discover until the 1920's.
"In the same text the author stated that most children with diabetes live only six months to four years after the diagnosis is made. Death on those days came in the form of 'exhaustion' or coma. Treatment consisted of an absolutely rigid diet without even a trace of a sugar or starch - no bread, milk, potatoes, carrots, and not a single fruit. No wonder these kids died so soon," Rosenfeld said. (Next: Complications of diabetes,)
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