Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia). Excess sugar is excreted in the urine (glycosuria). Symptoms include increased urine output, thirst, weight loss, and weakness. Type 1, or insulin-dependent diabetes mellitus (IDDM), an autoimmune disease in which no insulin is produced, must be treated by insulin injections. Type 2, or non-insulin-dependent diabetes mellitus (NIDDM), in which tissues do not respond to insulin, is linked to heredity and obesity and may be controlled by diet; it accounts for 90% of all cases, many of which go undiagnosed for years. Untreated diabetes leads to accumulation of ketones in the blood, followed by acidosis (high blood acid content) with nausea and vomiting and then coma. Careful attention to content and timing of meals, with periodic checking of blood sugar, may manage diabetes. If not, injected or oral insulin is necessary. Complications, including heart disease, diabetic retinopathy (a leading cause of blindness), kidney disease, and nerve disorders, especially in the legs and feet, account for most deaths. Degree of blood-sugar control does not always correlate with progression of complications. Gestational diabetes may occur as a complication of pregnancy.