Non Insulin-Dependent Diabetes Mellitus

Non insulin-dependent diabetes mellitus (NIDDM) used to be called maturity onset diabetes, because it is a condition where there is elevated blood glucose occurring in the older age group, rather than the insulin-dependent diabetes mellitus (IDDM), described in the section on auto-immune disease and also in that on the pancreas, which usually comes on in childhood or adolescence. NIDDM, unlike IDDM, is not due to an absence of insulin but more to insensitivity of the cells to the effects of insulin (called insulin resistance). This is a disorder with a strong genetic influence, which is worsened by obesity. The level of blood sugar needs to be controlled to prevent the development of complications which affect many different parts of the body, usually as a result of impairment of the blood supply. Reduction of blood supply to the back of the eye can cause disease of the retina (called diabetic retinopathy, described in the section on the eye), increased deposition of fat in the walls of arteries (called atheroma, described in the section on blood and circulation) increases the risk of heart disease and stroke, as well as problems with the blood supply to the feet. Impairment of the blood supply to nerves cause a reduction in sensitivity, numbness and tingling in the hands and feet. The combination of poor blood supply and numbness puts the feet at risk of injury and infection, which may be difficult to treat. NIDDM, when poorly controlled, is responsible for many cases of blindness and amputation. NIDDM is rapidly increasing in incidence, in parallel with the increase in obesity. Attention to diet and weight reduction may bring the blood sugar levels down within the normal range, but treatment with medicines that either increase the sensitivity of the cells or increase the production of insulin by the pancreas may be necessary. If effective control cannot be achieved by diet and taking tablets by mouth, insulin may be required. The management of NIDDM involves a team of people, including dieticians, opticians, chiropodists, and specialist nurses as well as physicians. The most important member of the team is, however, the patient, who would be well advised to take charge from the start.
 

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