Diabetes-Diabetes Milletes and types of Diabetes Milletes

It is generally accepted that diabetes mellitus is an inherited disease, although there has been no agreement on a single mode of transmission. Recent research sug­gests that environmental factors, such as viruses, initiate the expression of the genetic potential for insulin-depen­dent diabetes mellitus in genetically predisposed individ­uals,5 who may also have some immunological abnor­mality. On the other hand, excessive food intake resulting in hyperinsulinemia with a decrease in insulin receptors in obese people may initiate the expression of non insulin­dependent diabetes mellitus in those who are genetically predisposed.
Diabetes occurs in all age groups from young infants to the elderly. The greatest incidence occurs in middle or older aged adults. It is estimated that 80% to 85% of all patients with diabetes mellitus are 45 years of age or older. More women than men, and more women over 45 years of age who have had children have the disease. The higher incidence in women who have had children may reflect factors related to pregnancy. Today's longer life expectancy and the re­duced mortality rate for infants of diabetic mothers re­sults in the "seeding" of the diabetic potential; for this reason, the number of people who will develop the disease is expected to increase.
Types of Diabetes Milletes
Diabetes mellitus has been and will proba' tinue to be classified by some as growth or juve and maturity or adult onset. The two primary types are dependent, ketosis prone diabetes mellitus and sulin-dependent, nonketosis prone diabetes melletes.
Insulin-Dependent Diabetes Mellitus
IDDM usually, but not always, occurs in :vears of age or younger. It rarely occurs under 1 age, and there appears to be no special freq occurrence by age in the younger group. About 1 diabetic patients have IDDM.
The onset of the disease is sudden, and the pa frequently in ketoacidosis at the time of diagn majority of patients have lost weight prior to due to glucose wastage (glycosuria) and most are weight to some degree. Insulin secetion by the par::. minimal or lacking and, therefore, these pari insulin-dependent and require diet plus insulin to the disease. The course of the disease can be unstable, characterized by episodes of hypoglycemia (low blood sugar), hyperglycemia, and their sequelae.
Non-insulin-dependent diabetes mellitus (NIDDM)
NIDDM usually occurs in people over age 40 are, frequently in the older age group, 55 and over. people mayor may not be obese. In the oldest gr, age-related increase in normal fasting blood glucose must be differentiated from the elevated blood ­levels of diabetes mellitus.
The onset of the disease is gradual and may ­diagnosed until years after onset. The course of the in many instances is stable, and the patients are no~ :­to develop ketoacidosis except during a severe illneso as a myocardial infarction (heart attack) or a ce: vascular accident (stroke). Approximately 85% of vvith NIDDM are obese at the time of diagnosis. Although adequate insulin may be produced by the panc secretion of insulin may be delayed in response t cose challenge, or there may be peripheral resistance (muscle and adipose cell) to the action of insuli:­overproduction by the islet cells of the pancreas possible that, over time, the ability of the pan secrete insulin may decrease and, as a result, so
tients may require exogenous insulin to control glucose metabolism. Otherwise, NIDDM can be controlled by diet or diet plus oral agents.
Impaired glucose tolerance (IGT)
The blood glucose level is mildly elevated with levels between normal and those which are clearly diag­nostic for diabetes mellitus. Those affected mayor may not progress to IDDM or NIDDM, and in some the blood glucose returns to normal.
Other types 
Diabetes mellitus can occur secondary to other dis­ease states, such as pancreatitis, cirrhosis of the liver, cystic fibrosis of the pancreas, tumors of the pancreas Cinsulinomas), or disorders of other endocrine glands, for example, the pituitary, the adrenals, or the thyroid. It can also occur in patients receiving pharmacological doses of glucocorticoids.