Prevention of Diabetes Complications

The constellation of abnormalities caused by insulin deficiency is called diabetes mellitus. The cause of clinical diabetes is always a deficiency of the effect of insulin at the tissue level. Type I diabetes or insulindependent diabetes mellitus (IDDM), is due to insulin deficiency caused by autoimmune destruction of the B cell in the pancreatic islets, and it accounts for 35 % of cases and usually presents in children. Type 2 diabetes, or non-insulin-dependent diabetes mellitus (NIDDM), is characterized by the dysregulation of insulin release from the B cells, along with insulin resistance in peripheral tissues such as skeletal muscle, brain, and liver. Type 2 diabetes usually presents in overweight or obese adults. The incidence of diabetes in the human population has reached epidemic proportions worldwide and it is increasing at the rapid rate.150 million people in 2000, which is predicted to rise to 220 million in 2010. In animals, it can be produced by pancreatectomy; by administration of alloxan, streptozocin, or other toxins that in appropriate doses cause selective destruction of the beta cells of the pancreatic islets; by administration of drugs that inhibit insulin secretion; and by administration of anti-insulin anti-bodies. Strains of mice, rats, hamsters, guinea pigs, miniature swine, and monkeys that have a high incidence of spontaneous diabetes mellitus have also been described. Diabetes is characterized by polyuria, polydipisa, weight loss in spite of polyphagia, hyperglycemia, glycosuria, ketosis, acidosis, and coma. Widespread biochemical abnormalities are present, but the fundamental defects to which most of the abnormalities can be traced are 1) reduced entry of glucose into various peripheral tissues and 2) increased liberation of glucose into the circulation from the liver. Therefore there is an extracellular glucose excess and, in many cells, an intracellular glucose deficiency a situation that has been called starvation in the midst of plenty. Also, the entry of amino acids into muscle is decreased and lipolysis is increased.