The term diabetes can mean one of two quite different diseases:

Type 2 is by far the most common form, especially in developed countries, and is characterized by a decrease in the ability to respond to insulin, though often in the presence of normal insulin amounts. Its causes are obscure in detail but are connected with heredity and with lifestyle (eg, Western diet and obesity).

Type 1 diabetes almost always requires insulin injections, and is generally fatal without proper treatment. Type 2 diabetes can sometimes be managed by weight reduction and exercise alone. Often oral medication and/or insulin are initially required. Most cases of type 2 diabetes are eventually treated with medication.

Type 1 diabetes is an autoimmune disorder, in which the body makes antibodies that attack the insulin-producing cells in the pancreas. The cause is complex and unclear, but may involve genetics, viruses, diet and environmental factors such as chemicals. Type 1 diabetes was once called juvenile diabetes because it is often diagnosed in childhood or early adulthood. People with type 1 diabetes must take insulin by injection, pump or other methods. Possible treatments, which are cures when successful, include transplant of a segment of pancreas or with islet (beta) cells.

While under- or over-treated diabetes can be extremely dangerous and until June, 1921 (when insulin was first discovered and made available), a clinical diagnosis of what is now called type 1 diabetes was an invariable more or less quick death sentence, for most treated patients today the main risks are from its characteristic long-term complications. These include cardiovascular disease (doubled risk), chronic renal failure (it is the main cause for dialysis in developed world adults), retinal damage which can lead to blindness and is the most significant cause of adult blindness in the non-elderly in the developed world, nerve damage which can lead to erectile dysfunction (impotence), to gangrene with risk of amputation of toes, feet, and even legs.

The complications are less common and less severe in people who control their blood sugars well. In fact,the better the control, the lower the risk of complications (down to that of non-diabetics). Hence patient understanding and participation is vital, as blood glucose levels change continuously throughout each day. Other health problems that accelerate the damaging effects of diabetes should also be addressed. These include smoking (abstain), elevated cholesterol levels (control with diet, exercise or medication), obesity (even small losses can be very helpful), high blood pressure, and lack of regular exercise.




Etymology

The word diabetes was coined by Aretaeus (81 133 CE) of Cappadocia. The word is from the Greek diabaŪnein, and literally means "passing through", or "siphon", a reference to one of diabetes' major symptoms -- excessive urine discharge. The word became "diabetes" from the English adoption of the medieval Latin diabetes. In 1675 Thomas Willis added mellitus from the Greek word for honey (mel in the sense of "honey sweet") when he noted that a person with diabetes's urine and blood has a sweet taste. This had been noticed long before in ancient times by the Greeks, Chinese, Egyptians, and Indians. In 1776 it was confirmed the sweet taste was because of an excess of a kind of sugar in the urine and blood of people with diabetes.

The ancient Chinese tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment "sweet urine disease" (|÷\?uš); medieval European doctors tested for it by tasting the urine themselves, a scene which was occasionally depicted in Gothic reliefs.

Passing abnormal amounts of urine is a symptom common to several disorders (most commonly of the kidneys), and the single word diabetes has been given to many of them. The most common of them are diabetes insipidus and the subject of this article, diabetes mellitus.




History

Although diabetes has been recognized since antiquity, and treatments of various efficacy have been known since the Middle Ages, the elucidation of the pathogenesis of diabetes occurred mainly in the 20th century.

The discovery of the role of the pancreas in diabetes is generally ascribed to Joseph von Mering and Oskar Minkowski, European researchers who in 1889 found that when they completely removed the pancreas of dogs, the dogs developed all the signs and symptoms of diabetes and died shortly afterward.

In 1910, Sir Edward Albert Sharpey-Schafer of Edinburgh in Scotland suggested that people with diabetes were deficient in a single chemical that was normally produced by the pancreas - he proposed calling this substance insulin. The term is derived from the Latin insula, meaning island, in reference to the islets of Langerhans in the pancreas that produce insulin.

The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not fully clarified until 1921, when Sir Frederick Grant Banting and Charles Herbert Best repeated the work of Von Mering and Minkowski, but went a step further and demonstrated that they could reverse induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs.

They and their colleagues went on to isolate the hormone insulin from bovine pancreases at the University of Toronto in Canada.This led to the availability of an effective treatment - insulin injections - and the first clinical patient was treated in 1922. For this, Banting et al received the Nobel Prize in Physiology or Medicine in 1923. The two researchers made the patent available and did not attempt to control commercial production. Insulin production and therapy rapidly spread around the world, largely as a result of their decision.

Despite the availability of treatment, diabetes was still a major cause of deaths in its early ages. Statistics reveal that the cause-specific mortality rate during 1927 amounted to about 47.7 per 100,000 population in Malta.

The distinction between what is now known as type 1 diabetes and type 2 diabetes was made by Sir Harold Percival (Harry) Himsworth in 1935 and the findings were published in January 1936.

Diabetes - Wikipedia




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