Plasma glucose concentration is normally maintained within a narrow range despite
wide fluctuations in the supply (meal) and demand (exercise) for nutrients. In adult
humans, plasma glucose concentrations throughout a 24-hour period average 90 mg/
dl, with maximum values 60-90 minutes after meals, usually not exceeding 140 mg/
dl, and values during a moderate fast or exercise usually remaining above 50 mg/dl.
The development of type 1 (insulin-dependent) diabetes mellitus requires genetic
susceptibility (1). This disease is thought to be the result of an organ-specific autoimmune
process in which the immune system reacts abnormally against the body's own
insulin secreting 0 cells in the pancreatic islets.
Studies of the prevalence of diabetes in the population can serve several useful
purposes. They can provide information vital to the rational planning of health services
for diabetic patients, they can explore hypotheses about risk factors for the
disease and possible causal mechanisms, and finally they can provide estimates of
the impact of the disease on the health of the population.
Why does insulin-dependent diabetes mellitus occur? What are the factors that
account for the remarkable variability in the age and timing of onset of clinical disease?
There is general agreement that insulin-dependent diabetes mellitus (IDDM) is an
autoimmune disease (reviewed in 1-7). Evidence supporting this concept includes
selective lymphocytic infiltration in and around affected islets (that is, insulitis) at
the time of diagnosis (8)
Until recently, the diagnosis of type 1 (insulin-dependent) diabetes mellitus (IDDM)
was simple. Hyperglycemia has always been the gold standard for the diagnosis of
diabetes, and insulin dependency is usually easy to identify from simple clinical and
Non-insulin dependent diabetes is a cause of rising morbidity and mortality in
developed countries. In the United States, it is estimated that there are 14 million
NIDDM cases (7% of the population), approximately half of whom remain undiagnosed.
Diabetes mellitus is the most common endocrine disorder that occurs during human
gestation. In the United States, diabetes (including gestational diabetes) affects approximately
3-5% of all pregnant women (1) or about 70,000-100,000 women per
The physiological changes of pregnancy tend to reset glucose homeostasis in the
direction of diabetes. About 2-3% of all pregnant women develop abnormal glucose
tolerance in pregnancy.
The infant of the diabetic mother (IDM) is a prime example of the problems that may
exist in the neonate secondary to maternal disease (diabetes).
The Papyrus Ebers contained reference to a condition that may have been diabetes
mellitus dating back to before 1500 BC. A good clinical description was given by
Celsus (30 BC-50 AD).
Patients with insulin-dependent diabetes may suffer from major vascular disease
leading to retinopathy, glomerulonephropathy and hypertension as well as to neuropathy,
especially in the presence of poor metabolic control.
The Diabetes Control and Complications Trial (DCCT) was designed to assess
the value of intensive treatment in patients with insulin-dependent diabetes mellitus
The treatment of diabetic patients for the past 70 years has been based on drugs
(insulin or oral hypoglycemic agents), diet, and exercise.
Insulin-dependent diabetes mellitus (IDDM) remains an incurable disease. The
metabolic lesion resulting from /3 cell destruction cannot be reversed, and insulin
replacement therapy remains palliative at best.
Diabetes mellitus is characterized by derangements in the metabolism not only of
glucose and fat but also of protein (1). However, protein has always received less
attention than fat and glucose, both in terms of alterations in its metabolism and in
its nutritional implications.
Pancreatic and islet transplantation, either as an immediately vascularized organ
graft or as a free graft of dispersed tissue, is the only treatment of type 1 diabetes
that can establish an insulin-independent state (1).
Education is the process that will enable patients with diabetes to obtain the optimum
metabolic control while continuing to maintain their chosen style of life. Education
is not merely the process of informing and providing theoretical knowledge.