A diabetes mellitus is an abnormality of the regulation of glucose (blood sugar) in the bloodstream.
There are two types of diabetes mellitus, type 1 and type 2. Type 1 affects young people and is due to the body not producing enough insulin. You need insulin to put the glucose into cells where it is used as an energy source. Without insulin, the blood glucose keeps rising, and the cells starve as they cannot get the glucose in them to feed them. Type 2 diabetes is found in older people, where they still have insulin, but not quite enough for their requirements.
The aim of the diabetic clinic is to make sure that all patients with diabetes mellitus have appropriate and adequate treatment. Type 1 diabetics all need insulin replacement injections every day. Type 2 diabetics require a variety of treatments starting with diet only, and then leading on to oral medication and may finally require insulin injections as well.
The complications of diabetes mellitus are all related to poor diabetic control. Therefore if patients with diabetes mellitus can be assisted to keep good control of their blood glucose levels, they will get fewer complications in later life. As complications include coma, amputation of toes or legs, leg ulcers, infections and blindness, it is essential that every effort is made to try to ensure good diabetic control.
When a patient turns up to clinic, a measurement of the blood glucose only says what the diabetic control has been over the last couple of hours. However, it is possible to measure the amount of glucose that has bound itself to the haemoglobin molecule in blood. This is called the HbA1c level. The worse the diabetic control, the longer high glucose levels have been in contact with haemoglobin and so the higher the Hb1C level.
Therefore, by measuring this at a blood test, the diabetic control can be assessed over the last few weeks.
Diabetes mellitus, as a chronic disease, can be very depressing. Therefore a lot of the role of the diabetic clinic is not just the science, but also the emotional and psychological support for the patient, particularly during times when this may be feeling low or having a flare-up of complications.