Diabetes mellitus

The contents of this page have been produced by a team of physicians and experts of the Italian Institute of Telemedicine in compliance with the recommendations of the latest medical and scientific guidelines. Institutional communication not subject to authorisation pursuant to the Ministerial Decree 23/02/2006.

What is the Diabetes mellitus?

Diabetes mellitus is a chronic condition characterized by an increase of the glucose levels in the blood (glycaemia). We can speak of Diabetes mellitus when glycaemia reaches values ≥126 mg/dL.

The hormone which enables the body to use the glucose for the energy processes in cells, by regularising the glycaemia, is the insulin, produced by the pancreas. When there is an absolute or relative failure in the production of insulin, glucose dangerously accumulates in the blood causing the development of the diabetes.

Diabetes in figures

Diabetes affects approximately 3 million Italians and 170 million people in the world and is frequently related to other cardiovascular risk factors, namely hypertension and dyslipidemia.

As a matter of fact approximately 30-40% of diabetics suffer from some cardiovascular disease, with a death rate increased 5 times if compared to a non-diabetic.

Types of diabetes

Diabetes is a disease for which the hereditary factor has a great importance. It causes serious vascular diseases, especially to the heart and to the kidneys.

Diabetes comes in two forms

Type 1 diabetes mellitus:

  • Mainly occurs during childhood and adolescence
  • Connected with genetic (hereditary), immune and environmental factors (infections).
  • Characterized by an almost absolute insulin deficiency

Type 2 diabetes mellitus:

  • It’s the most common form of diabetes
  • Generally occurs during the adulthood
  • Characterized by a partial insulin deficiency and by the inability of the circulating insulin to act in a satisfactory manner (the so-called insulin resistance)

Risk factors

  • Age over 45 years
  • Overweight (particularly if the fat is located in the abdomen)
  • Too sedentary life
  • Family relationship (especially if first-degree) with a diabetic
  • For women after giving birth to a child whose weight is over 4 kg or women who suffered from diabetes during pregnancy
  • Impaired fasting blood glucose (between 110 and 125 mg/dL)
  • Hypertension
  • Belonging to high-risk ethnic groups (e. g. Hispanics, Asians, Africans)

How to diagnose the diabetes mellitus

People with a positive family history for diabetes mellitus should regularly check their blood glucose to act promptly in case the diabetes should arise.

Scarcity or lack of insulin prevents the body from using the glucose to produce the energy needed for its functioning. The glucose, introduced with the food, is not used and is eliminated from the body in urine. Thus we have an increase of the volume of the urine (polyuria), with the resulting increase of the feeling of being thirsty (polydipsia), and a sudden weight loss due to the fact that the nutrients are not retained.

The serious consequence of a non-treated diabetes, particularly if type l, is the increase in the amount of the ketone bodies in the blood which become “acid” (the so-called ketoacidosis which can result in coma and death).

These symptoms are typical of the type 1 diabetes mellitus, while by type 2 diabetes the symptoms appear more slowly and often in a less evident manner. There might be cases of high blood glucose without any occurrence of its symptoms. For this reason the diagnosis of this form of diabetes is often not rapid, and comes when the disease is already full blown. The diagnosis of diabetes mainly bases on the measurement of the fasting blood glucose.

Diagnostic parameters for diabetes

  • Fasting blood glucose ≥126 mg/dL
  • Blood glucose ≥200 mg/dL two hours after glucose oral assumption
  • Symptoms of diabetes (polyuria, polydipsia, inexplicable weight loss) related to a random blood glucose value (regardless of the times of the day) ≥200 mg/dL

How to measure the blood glucose

Of utmost importance for the diabetes is the blood glucose self-monitoring

  • The measurement of blood glucose must be performed after at least a 12-hour fasting
  • The exam can be performed on capillary blood, pricking the finger (home or pharmacy measurement), or on venous blood (at the Hospital, at the medical center or at an analytical laboratory)
  • A person can be considered to be diabetic according to various parameters:
  1. if at least after 2 subsequent measurements successive over a week, the fasting blood glucose is equal or higher to/than 126 mg/dL
  2. if treated with oral hypoglycaemic agents or insulin
  3. if in his/her personal and medical report diabetes has been recorded
  • The home blood glucose self-monitoring is performed on a drop of blood obtained by pricking a fingertip: only one drop of blood is sufficient
  • Self-monitoring is a painless test, fast (2 minutes are sufficient) and is reliable, since the results can overlap with the ones from the laboratory

How to treat the diabetes mellitus

For the treatment of the diabetes mellitus setting up a correct lifestyle (healthy food and regular exercise) is of the utmost importance.

An insulin-based therapy is needed for diabetes type 1, in which this hormone is lacking.

For diabetes type 2, if diet and exercise are not sufficient to restore the blood glucose levels to optimum levels, the physician shall prescribe oral hypoglycaemic drugs which shall reduce the glucose levels in the blood.

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