Diabetes Types, stats and pathology
Introduction 2
Statistics 2
Types of Diabetes 3
Type-1Diabetes 3
Type-2 Diabetes 4
Juvenile Diabetes 4
Gestational Diabetes 4
Prediabetes 5
LADA 5
MODY (Maturity Onset Diabetes of the Young) 5
Causes, Symptoms, and Diagnosis 6
Medical diagnosis 7
Causes 8
Monitoring diabetes and Drug Therapy 10
Insulin Shots and therapeutic agents 10
Dietary Considerations and Nutrition Therapy 11
Conclusion 11
Introduction
Diabetes is a challenging disease for current health care that is causing a heavy financial burden to the society. Estimations have shown approximately 13,000 youths have become a victim of diabetes only in The United States. American Diabetes Association defines diabetes mellitus (DM) as an assortment of metabolic diseases that are distinguished by hyperglycemia. Hyperglycemia illustrates the disturbed carbohydrate metabolism that in turn impacts the insulin machinery (American Diabetes Association).
Diabetes is categorised in various types, but most common types are Type 1 and 2. Age factor, heredity, environmental causes, and treatments affect the type of Diabetes. In Type 1 Diabetes body directly affects the insulin-producing cells, and thwart the insulin formation. This type of diabetes takes a long time to develop and can grow silently for years. Children are highly impacted by type 1 thus it was also named as Juvenile Diabetes (American Diabetes Association). A sedentary lifestyle is an inducing factor for type 2 among children (National Diabetes Data Group 1040).
Statistics
Data Estimation of American Diabetes Association has revealed that 30 million people are suffering from diabetes in the United States. Out of which only 5% cases are linked to type 1 and rest of the 95% cases belong to Type 2 Diabetes. A report by National Diabetes Statistics Report, 2014, states that Diabetes is the 7th foremost cause of morbidity and mortality in 2010 (National Diabetes Data Group 1040).
8.3% population of US is affected by Diabetes that is around 25.8 million people which has exhibited a leap to 9.3%, means 29.1 million people in just a period of two years. This is a general estimation and among these 29.1 million only 21 million people could get an accurate diagnosis. The diabetes is specifically more prevalent among the older people above the age of 65s (American Diabetes Association).
The global data calculations on diabetes by WHO suggest 347 million people are impacted by diabetes. Type 2 is more prevalent with the affecting 90% of these people due to an inactive lifestyle and excessive body weight. On the mortality rate by Diabetes WHO estimated 1.5 million deaths in 2012 (WHO.int). Recently diagnosed diabetes cases show a high percentage of childhood diabetes that is 8-45%. According to the report of Diabetes.co.uk, approximately 7 million people are suffering from pre-diabetes that show a huge crowd under high risk of developing Type 2 in future (Diabetes.co.uk). Among children, diabetes has spread with an increase of 33% in the past fifteen years. Now it has become a serious issue, and many government and non-government organizations have started planning health promotion strategies to combat this epidemic (Peterson et al 658-664).
Types of Diabetes
Type-1Diabetes
Type 1 depicts an autoimmune disorder when the body mistakenly starts diminishing insulin-producing cells. Consequently, the formation of insulin hormone is aborted. It can be said an asymptomatic condition where symptoms and condition develop gradually for several years and can be diagnosed after a long phase. Type 1 affects the children mostly from the age group of eight to nineteen years (Rubin 11).
Type-2 Diabetes
Type-2 diabetic condition depicts the deficiency of insulin that may be due to the various reasons. It may be due to the resistance to insulin secretion and physiology, or it may be linked with an abnormality in carbohydrate and fat metabolism. Type-2 diabetes produces a condition of hyperglycemia (National Diabetes Data Group 1041). Type 2 is a mixed syndrome and the main pathophysiological characteristics of type 2 Diabetes is an anomaly in insulin secretion and augmented physical resistance against insulin. Environmental to genetic factors are involved in Type 2 including eating habits, sedentary lifestyle, and obesity (Peterson et al 658-664).
Juvenile Diabetes
Type 1 Diabetes or as Juvenile Diabetes has a high prevalence among young children. In juvenile diabetes, the immune system of the body stops the insulin forming mechanism resulting in the blockage of insulin secretion. It is categorised as a life-threatening disease for children and requires accurate treatment (National Diabetes Data Group 1044).
Gestational Diabetes
Gestational diabetes develops among pregnant women during the 24th week of pregnancy disappears with the childbirth. The incidence of gestational diabetes during pregnancy does not indicate the onset of diabetes in women or child though it needs proper prevention to protect baby from further complexities. If diabetes starts prior to the pregnancy, it does not affect the child’s health but during pregnancy onset can affect the baby’s weight (National Diabetes Data Group 1044).
Prediabetes
It is an early stage of type 2 diabetes which can be distinguished by high blood glucose levels but not as much high to be categorised as diabetes. It is also referred as “gray area” that lies between the normal blood sugar levels and diabetic sugar levels.
LADA
LADA defines Latent Autoimmune Diabetes of Adulthood that progresses very slowly among adults. LADA patients do not carry all the symptoms of type 2 including obesity, age factor and inability to attain normal glycaemic control despite using oral hypoglycaemic agents.
MODY (Maturity Onset Diabetes of the Young)
MODY is caused by genetic mutations and mostly inherited. MODY shares some symptoms of type 2 but not linked to obesity and age (Diabetes.co.uk).
Figure 1: Explanation of the flowchart:
C-peptide: C-peptide test is performed to calculate the insulin production by pancreas.
Autoantibodies: Autoantibodies denotes the immune cells that destroy the insulin producing cells for which a GAD test is conducted to identify such autoantibodies.
Type 2: Type 2 diabetes is prevalent among adults.
IM Type 1: Common type 1 diabetes that is Immune mediated.
Idiopathic Type 1: Rare type 1 diabetes with unknown causes.
MODY: Maturity onset diabetes of the young caused by specific genetic mutations
Causes, Symptoms, and Diagnosis
The symptoms of Diabetes are:
1. Abdominal pain
2. Increase in thirst and frequency of passing Urine
3. Weakness and fatigue
4. Blurring of the vision
5. Weight loss, mood swings and nausea
6. Low blood pressure, rapid breathing and palpitation
In children, it is difficult to classify Type 1 and Type 2 diabetes. Type 1 Diabetes in Adolescents shows a presence of insulin autoantibodies and antibodies against islet cell antigens. Type 2 diabetes in children exhibits weight gain and insulin resistance (Rubin 19)(Peterson et al. 658-664).
For diabetes type 2 manifestations are made on the basis of after effects of the imbalanced glucose tolerance, such symptoms may include changes in psychological behaviours, haemostasis and metal ion metabolism, polyuria, polydipsia, polyphagia, fall in reproductive health, increased thirst and hunger, weight loss and fatigue, difficulty in vision etc (Pickup & Crook, 1241-1248).
Medical diagnosis
The Diabetes diagnosis needs cautious recognition of symptoms. For an asymptomatic disease like diabetes, a single blood glucose test is not sufficient. The family history, obesity and age can trigger the risk factors for diabetes type 2 major risk factors for Diabetes type 2 including hypertension and cholesterol. ADA advises fasting plasma glucose test (FPG) mandatory for diabetes screening (Arcangelo & Peterson 681). FPG 100 or below and PG near or below than 140 is categorised as IGT (Impaired Glucose Tolerance) (Arcangelo & Peterson 681). Physicians also refer glucose tolerance test (OGTT). Several other factors are also considered regarding the adiposity and associated disorders before prescribing any therapeutic agent (Arcangelo & Peterson, 681).
Causes
Heredity plays an important role developing diabetes; everyone is not prone to this disease. Type 1 linked to HLA or human leukocyte antigen complex that is positioned on the chromosome 6. In the presence of HLA complex, only a slight viral infection can act as a trigger for developing the disease. During the response of immune system against these viruses, the beta cells are destroyed mistakenly (Rubin 45)
Excessive body fat and a high BMI or body mass index also are capable of causing type 2. Environmental as well as genetic factors are caught up in influencing the mechanism of beta-cells and tissue in liver and pancreas, and developing the insulin sensitivity (Scheen 335-341).
Homeostasis is also a significant part that is hampered by disturbances in blood glucose levels. To maintain this balance, the internal body interaction is highly crucial. All the homeostatic control mechanisms create a negative feedback loop including such mechanisms that can transform the variables to the original state or value through a loop. Controlling blood glucose by insulin sets the best example of the negative feedback loop as can be seen in figure 2. In this loop, the blood sugar increases stimulating the receptors of the body against this sensory alteration. In the response to this change the control centre, i.e., the pancreas starts secreting the insulin hormone and lowers the blood sugar levels until blood sugar levels attain homeostasis. After achieving the original state of homeostasis, pancreas terminates the insulin production (Anatomy & Physiology.com).
Figure 2: As blood sugar increases the receptors senses this change. In the response control centre, i.e., the pancreas starts insulin secretion. Insulin stimulates liver cells to absorb glucose and store it as glycogen. Body cells take more glucose hormone. Consequently, the glucose level in the blood drops. And Insulin secretion is stopped, and homeostatic sugar levels are attained (Anatomy & Physiology.com).
Monitoring diabetes and Drug Therapy
Diabetes can not be treated completely. The main target of diabetic treatment is to provide a better life.
Monitoring the glucose levels is the best habit to prevent the condition from worsening. Nowadays glucose meter is available for monitoring sugar levels on a regular basis. A habitual analysis of blood sugar levels can also help the patient and health care provider in disease management (Rubin 99-221).
Insulin Shots and therapeutic agents
In diabetes type 1 insulin shots via pump or injections are mandatory while, in type 2, insulin is not necessarily required. Type 1 often needs additional therapeutic agents along with insulin (Rubin 99-221), while type 2 changes in lifestyle sometimes become efficient. In type 2 the medication therapies can be stopped for a while if the condition is in control. Doctors recommend insulin doses according to the patient’s requirement (American Diabetes Association).
The several drug agents effective in treating diabetes and maintaining blood glucose levels are Meglitinides that triggers beta cells to release insulin, Thiazolidinediones, DPP-4 inhibitors, Alpha-glucosidase inhibitors, and Biguanides. According to the effect of the medicines and condition of disease doctors prescribe combination therapies prescribing drugs in various combinations (American Diabetes Association).
For type 2 diabetes self-management is the best medication that is tailored according to the patient stats (Peterson et al. 658-664). Self-monitoring of glucose level and exercises are the best treatment objectives in an effectual management plan.
The treatment of children requires more attention than adults. The treatment of children focuses on the reduction in insulin sensitivity without hampering their physical and sexual maturity (Rubin 293)(Peterson et al. 658-664).
Dietary Considerations and Nutrition Therapy
An active lifestyle, healthy diet and exercises are adequate to treat diabetes (Arcangelo & Peterson 681). For diabetes management nutrition therapy rejects food content high in sugar and fat and alcohol. Obese persons should be encouraged to shed excessive body weight and sedentary lifestyle (Peterson et al. 658-664).
If not treated on time it can become a severe long-term complication. The major impacts of long-term diabetes are vision loss due to retina damage, an anomaly in the renal functioning, cardiovascular problems and nerve functioning (Rubin 43-83). Short-term impacts include polyuria, hyperglycemia, hypoglycemia, and hyperglycemic hyperosmolar non-ketotic syndrome (HHNS). Further adverse effects are microvascular complications and dyslipidemia. The side effects of Diabetic treatment include GI disturbances, liver disease and diarrhea (Arcangelo & Peterson 681).
Conclusion
Diverse attempts are made by the government and non-government organisations to prevent diabetes from spreading. It is better to take precautions early so the onset of disease can be avoided. Causes, symptoms, and prone populations all are apparent through unlimited research. So the prevention and management is easy now.
A healthy and active lifestyle with a nutritious diet can lessen the risk of diabetes along with other associated outcomes.
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