Diabetes mellitus (DM), or simply diabetes, is a common endocrine disorder expected to affect more than 500 million people worldwide according to the International Diabetes Federation (IDF). The majority of affected people come from low to middle-income countries, which makes it an even more important case to discuss, especially in Lebanon.

Diabetes is a group of metabolic diseases characterized by high blood sugar (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs and tissues, especially the eyes, kidneys, nerves, heart, and blood vessels.

Conventionally, diabetes has been classified into three types:

Type 1 DM or insulin-dependent diabetes mellitus (IDDM), also termed “juvenile diabetes”, results from a cellular-mediated autoimmune destruction of the β-cells, which are responsible for insulin production, of the pancreas. In fact, β-cell damage has a wide range of origins, like metabiological, pharmacological, environmental, and viral factors. In this form of diabetes, which accounts for only 5–10% of those with diabetes, the rate of β-cell destruction is quite variable, being rapid, mainly in infants and children, and slow in adults. Some patients, particularly children and adolescents, may present with ketoacidosis as the first manifestation of the disease. Others have modest fasting hyperglycemia that can rapidly change to severe hyperglycemia and/or ketoacidosis in the presence of infection or other stress.

Type 2 DM or non-insulin-dependent diabetes mellitus (NIDDM), previously referred to as “adult-onset diabetes”, results from insulin resistance in which cells fail to use insulin properly, with or without an absolute insulin deficiency. Most patients with this form of diabetes, which accounts for 90–95% of those with diabetes, are obese, which causes, in itself, some degree of insulin resistance. Patients who are not obese by traditional weight criteria may have an increased percentage of body fat distributed predominantly in the abdominal region.

The third main type is gestational diabetes (GDM) which begins when women without a previous history of diabetes develop a high blood glucose level during their pregnancy. It may precede the development of type 2 DM. As pregnancy advances, the increasing insulin resistance creates a demand for more insulin. In most pregnancies, the demand is readily met, and the balance between insulin resistance and supply is maintained. However, if resistance becomes dominant, the pregnant woman becomes hyperglycemic. Approximately 7% of all pregnancies are complicated by GDM.

Treatment options for hyperglycemia are varied, and its initiation depends on the underlying pathology and presentation of the patient. Currently, available pharmacotherapy for the treatment of DM includes insulin and oral hypoglycemic agents, and they act by either increasing the secretion of insulin from the pancreas or reducing plasma glucose concentrations, by increasing glucose uptake and decreasing gluconeogenesis. However, these current drugs do not restore normal glucose homeostasis for a long period of time, and they include undesired side effects such as hypoglycemia, kidney diseases, gastrointestinal problems, hepatotoxicity, heart risk problems, and insulinoma. Also, these drugs have to be taken permanently, which does not come at a cheap cost. Various herbal drugs have also been proven to be effective due to their beneficial contents in the treatment of diabetes.

The main goal of diabetes management is to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or tablets. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management include preventing or treating the many complications that can result from the disease itself and from its treatment.

Living with diabetes is no easy task. With three different types of diabetes, each has its own way of treatments and regulations to keep the blood-sugar level at a healthy level. Although the above treatments are a must, they are not enough: Diabetics have to control their diets in a way that will work in favor of the appropriate treatments given. As such, with the right treatment and diet, diabetics can still enjoy their lives and live a healthy and comfortable one too.