Overview

Diabetes mellitus is a disease that characterized by an excess of blood (glucose) sugar levels. The cell needs glucose as the source of its energy. But the glucose can not easily enter the cells because the glucose has large molecule. When the insulin is present, it will open the door on the cells through biochemical reactions and let the cell takes up the glucose. Exception for the liver, because it does not need insulin, it can take up the glucose without insulin. The conclusion is every cell in our body excluding the liver, needs insulin to take up the glucose.

Now we know that glucose can not enter the cells easily. The cells need insulin to take up the glucose. When there is impairment in insulin production and/or insulin action, the blood sugar levels will increase. Without insulin the cells are surely starving and the body will try to overcome this situation by increasing the blood sugar levels through hormonal reactions (via glucagons, etc), but that effort is futile because those glucoses still cannot enter the cells even there are so many glucoses. The cells won’t give up easily, they will use fat as alternative fuel and due to fat metabolism, keton bodies are produced and accumulated. When the blood sugar levels exceeding 180 mg/dl, the glucose will be excreted to urine so it can be detected in the urine.

The cause of diabetes is still unknown, but there are many of risk factors that plays role such as genetics and environmental factors.

Diagnosis

The World Health Organization definition of diabetes is for a single raised glucose reading with symptoms (excessive of urine secretion, excessive of thirst sensation, excessive of appetite), otherwise raised values on two occasions, of either^[11]:

• fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl)

or

• With a Glucose tolerance test, two hours after the oral dose a plasma glucose ≥ 11.1 mmol/l (200 mg/dl)

Screening test is suggested on people who have one of Diabetes Mellitus risks:

• Age > 45 years old
• Body mass index > 23 kg/m3
• Hypertension
• Diabetes Mellitus in family's history
• HDL cholesterol <> 250 mg/dl
  
• abortus history, ever gave birth newborn baby > 4000 g or handicap baby

For high risk group which screening test is negative, another screening test can be performed every year and for people above 45 years old without diabetes risk, the screening test can be performed every three years. The screening test is also useful to diagnose diabetes on people with impairment tolerance of blood glucose and impairment tolerance of fasting blood glucose.

Clinical diagnose of DM generally thought when there are characteristics symptoms of DM:

• Excessive of urine secretion
  
• Excessive of thirst sensation
  
• Excessive of appetite
• Unexplainable loss of body weight

Other symptoms include:

• Weakness
• Itching
• Blurry vision
• Pruritus Vulvae (Female)
• Erectile dysfunction (Male)

Characteristic symptoms of DM with plasma glucose > 200 mg/dl or fasting plasma glucose > 126 mg/dl are enough to diagnose Diabetes Mellitus.
For group, without characteristic symptoms of DM but plasma glucose is abnormal on once examination, is not enough to diagnose Diabetes Mellitus.