الفهرس 
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Abstract
Diabetes mellitus (DM) is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or due to combination of insulin resistance and inadequate insulin secretion to compensate. It has a multisystem effects on both biochemical and functional consequences.
For Type II (DM), both defects must exist i.e. combination of peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells. For example, all overweight individuals have insulin resistance, but diabetes develops only in those who cannot increase insulin secretion sufficiently to compensate for their insulin resistance. Their insulin concentrations may be high, yet inappropriately low for the level of glycemia.
Rates of diabetes are increasing worldwide. At least 171 million people currently have diabetes, and this figure is likely to more than double to 366 million by 2030. The top 10 countries, in numbers of people with diabetes, are currently India, China, the United States, Indonesia, Japan, Pakistan, Russia, Brazil, Italy, and Bangladesh. The greatest percentage increase in rates of diabetes will occur in Africa over the next 20 years. However, at least 80% of people in Africa with diabetes are undiagnosed, and many in their 30s to 60s will die from diabetes.
Diabetes mellitus is one of the main cause of microvascular (i.e., retinal, renal), macrovascular (i.e., coronary, peripheral vascular) and neuropathic complications. Diabetes mellitus is the major cause of blindness in adults aged 20-74 years in the United States; diabetic retinopathy accounts for 12,000-24,000 newly blind persons every year. DM also leads to end-stage renal disease (ESRD), According to the Centers for Disease Control and Prevention, diabetes causes 44% of new cases of ESRD. Diabetes mellitus is the leading cause of non traumatic lower limb amputations, with a 15- to 40-fold increase in risk over that of the non diabetic population. In 2004, in US about 71,000 non traumatic lower limb amputations were performed related to neuropathy and vasculopathy. Approximately two thirds of people with diabetes die of heart disease or stroke. Men with diabetes face a 2-fold increased risk for coronary heart disease, and women have a 3-fold to 4-fold increased risk.
Diet control is a basic part of management in every case. Treatment cannot be effective unless adequate attention is given to ensuring appropriate nutrition. Together with dietary treatment, a programme of regular physical activity and exercise should be considered for each person. Such programme must be tailed to the individual health status and fitness. Oral hypoglycemic drugs (OHD) are considered only in Type II (DM). There are two major groups of OHD: sulphonyleureas (SUs) and biguanides (BGs) which act by stimulating insuline release from beta cells and also by promoting its action. Biguanides also exert its action by decreasing gluconeogenesis and increasing the peripheral utilization of glucose. Patients with Type I (DM) or patients with Type II (DM) with poor respose to oral hypoglycemic drugs have to be treated with insulin therapy. Insulin therapy is aiming to achieving good metabolic control by mimicking physiological insulin secretion as much as possible. The dose of the insulin preparations is adjusted according to frequent monitoring of blood glucose levels. Blood glucose monitoring should be intensified during intercurrent illness and other stressful conditions and the insuline dose may have to be increased.