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What is Diabetes:
Diabetes mellitus is an endocrine disorder characterized by high blood sugar levels, often times associated with other metabolic derangements. Diabetes arises either because the body does not produce enough insulin (Type 1), or because the body’s cells do not respond adequately to insulin (Type 2), or both. Insulin is a hormone secreted by the beta cells of the Pancreas. Its main function is to cause certain cells (muscle, fat, and liver cells) in the body to absorb sugar (glucose) from the blood to either store or use in creating energy. In the absence of insulin, glucose circulates in the bloodstream causing high levels of sugar in the blood (4). This imbalance of insulin leads to impairment of a person’s ability to maintain appropriate blood glucose levels.
Type 1 Diabetes:
Type 1 Diabetes (formerly called insulin-dependent diabetes) evolves when the body stops producing insulin (absolute insulin deficiency), due to destruction of the beta cells in the pancreas. This is most commonly caused by an autoimmune process, with other reasons such as other illnesses, medications, genetic causes, and malnutrition being more rare. The classic symptoms that show when type 1 diabetes first develops are due to the high blood sugar levels as the body tries to get rid of the circulating sugar by wasting it in the urine (hence the name “mellitus” which means “sweet”). As a result, patients have increased urination (polyuria), increased thirst (polydipsia), increased hunger (polyphagia) and weight loss. Most children also experience tiredness and weakness. Many eventually develop a characteristically “fruity” breath. If the process is not halted by giving insulin, further symptoms ensue, including headaches, abdominal pain, unremitting vomiting, and ultimately coma anddeath. The only treatment for this type of diabetes is insulin given by injection. Diabetes pills (oral medication) do not work for type 1 diabetes. Patients must inject themselves with at least two, but optimally up to 4 doses of insulin for the rest of their lives (6). In the United States, many patients are now treated with insulin pumps that continuously deliver insulin at a rate that can be adjusted by the patient or parent.
In children, type 1 diabetes is by far the most common type, representing about 90% of all pediatric diabetes.
Type 2 Diabetes:
Type 2 diabetes, the most common type in adults, occurs when the amount of insulin produced by the pancreas is insufficient to sustain the proper functioning of the body, or when the cells in the body do not react well to insulin (relative insulin deficiency)(5). Many adults have no symptoms when diabetes first develops, which makes it hard to diagnose the disease early. In the United States and other industrialized countries, patients who are at risk (such as overweight or obese persons, or those with a strong family history of diabetes) are routinely screened for the development of diabetes. This practice is not in place in many countries like Haiti. As a consequence, many adults go undiagnosed for a long time and first get picked up when they already have long term complications, such as those affecting their eyes, kidneys, heart, blood pressure, or limbs. Adults often eventually develop the “classic” symptoms of increased thirst and urination, although frequently in a milder form.The diabetic coma typical of type 1 diabetes is more rare to develop. Type 2 diabetes can usually be managed with a healthy, balanced diet and exercise at the beginning, although most patients ultimately require oral medications or insulin to keep blood sugar levels under normal parameters.
In countries with high obesity rates, type 2 diabetes in adolescents is on the rise. However, type 2 diabetes rarely affects children in Haiti.
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