Definition : Diabetes mellitus, often simply referred to as diabetes is a group of metabolic diseases in which a person has high blood

sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). There are three main types of diabetes:

Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.) Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.) Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.

Both type 1 and 2 are chronic conditions that usually cannot be cured. Causes : The cause of diabetes depends on the type. Type 1 diabetes is partly inherited and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i.e., the genetic "self" identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger.Type 2 diabetes is due primarily to lifestyle factors and genetics.[16]Following is a comprehensive list of other causes of diabetes:[17]

Genetic defects of -cell Function o Maturity onset diabetes of the young (MODY) o Mitochondrial DNA mutations Genetic defects in insulin processing or insulin action o Defects in proinsulin conversion o Insulin gene mutations o Insulin receptor mutations Exocrine Pancreatic Defects o Chronic pancreatitis o Pancreatectomy o Pancreatic neoplasia o Cystic fibrosis

Endocrinopathies o Growth hormone excess (acromegaly) o Cushing syndrome o Hyperthyroidism o Pheochromocytoma o Glucagonoma Infections o Cytomegalovirus infection o Coxsackievirus B Drugs o Glucocorticoids o Thyroid hormone

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Management : Diabetes mellitus is a chronic disease which cannot be cured except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible, without causing hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes, oral medications as well as possibly insulin in type 2 diabetes). Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels.[22][23] The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher.[24] Attention is also paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.[24] Lifestyle There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.[25] Medications Metformin is generally recommended as a first line treatment for type 2 diabetes as there is good evidence that it decreases mortality.[26] Routine use of aspirin however has not been found to improve outcomes in uncomplicated diabetes.[27] Insulin Type 1 diabetes is typically treated with a combinations of regular and NPH insulin, or synthetic insulin analogs. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications.[26] Doses of insulin are than increased to effect.[26] Support In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care of a patient in a team approach. Optometrists, podiatrists/chiropodists, dietitians, physiotherapists, nursing specialists (e.g., DSNs (Diabetic Specialist Nurse)), nurse practitioners, or certified diabetes educators, may jointly provide multidisciplinary expertise.