Diabetes Mellitus

Of the many debilitating medical conditions that affect Black in this country, Diabetes has some of the most traumatic and crippling affects. There are several millions cases of Diabetes in the United States, of these Blacks constitute a very large percentage. It is estimated that 50% of the persons with diabetes in the United States is undiagnosed. This contributes to the findings that up to 25% of all patients with "new onset" type 11 diabetes have diabetic retinopathy at the time of diagnosis, indicating that diabetes has been present for 7 to 10 years prior to diagnosis.

There are two basic types of diabetes (1) type 1 or juvenile onset diabetes generally referred as insulin dependent diabetes. This account for 15 to 15% of all cases of DM and is clinically characterized by hyperglycemia (high blood glucose) and a propensity towards diabetic ketoacidosis. It occurs most commonly in childhood or adolescent before 30 years. (2) Type11 or adult onset diabetes generally referred to as noninsulin dependent diabetes. Although there is a tendency towards hyperglycemia, the association for diabetic ketoacidosis is much less. Type 11 diabetes occurs after the age of 30 years, but there are reported cases in children and adolescents. It is commonly associated with obesity. In both classes, there is genetic predisposition.

Diabetes can be developed from many causes 1) dysfunction of the Beta cells of the Islets of Langerhan in the Pancreas, either due to autoimmune destruction, tumors, decreased functional secretion and altered activity or resistance of insulin receptors.

Some of the common clinical signs of diabetes vary depending on the specific type. These include polyuria, polydipsia, polyphagia, weight loss.

Since diabetes is so common, it is important that patients recognize the pertinent clinical signs of the disease. The three P's (polyuria-frequent urination, polydypsia-frequent drinking of water and other fluids because of significant loss during urination and also offset the excessive blood sugar and polyphagia-frequent eating because the sugar is not getting into the blood for proper utilization) is valuable in the diagnosis. Once these are identified the physician will pursue further examination with specialized blood test. Some of these tests include oral glucose tolerance test, fasting blood glucose levels and urine glucose and ketone levels. Since there are other diseases that may present with hyperglycemia, it is crucial that further investigational studies be done to include pregnancy, systemic infections, autoimmune disease (lupus, Sarcoidosis and arthritis) and certain medications (Thiazides, phenytoin, steroid therapy and oral contraceptives).

Late signs and symptoms include diabetic retiopathy (variety of eye changes leading to blindness), diabetic nephropathy (kidney disease which is typical of end-stage renal disease), diabetic neuropathy (altered nerve function characterized by numbness, tingling, altered sensory perception, of the extremities and deep-seated pain. Some people may have diabetic foot ulcers which may ultimately lead periodic and systemic amputations starting at the toes, foot, lower extremity (below the knee) and finally amputation above the knee. This is one of the most morbid complications of diabetes. Another class of patients may experience infections of varying severity that result from ingrown toenails, vaginal (fungal infections) and dental abscesses from dental neglect.

One of the major problems in a variety of chronic ailments is that of late diagnosis either because of lack of education in recognizing the early signs or cultural taboos and influences to try other types of non-medical therapy. However once diagnosed, patients will be required to modify the diet by decreasing excessive sugar intake and oral medications (oral hypoglycemics e.g. glucotrol, diabinase) if there is no blood sugar control Insulin injections are recommended for patients whose elevated blood sugar is not controlled by the above two methods whether it is non-insulin or insulin dependent diabetics. Although there are different types of insulin, your physician will make necessary prescription based no disease severity and patient tolerance.

Word of warning to church members with diabetes is that Sabbath morning insulin should be accompanied be routine breakfast. If this is not done, then the blood glucose levels will drop four to six hours when the medication starts working. This passing-out effect generally occurs 12 noon and 2 PM.

Diabetes can be a debilitating disease when occurs in combination with other diseases like hypertension, high cholesterol, obesity and a family history of the disease. However with close medical management and scrutiny, associated mobidities will minimized and life expectancy extended.

-- Rawle F. Philbert, DDS 

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