Abstract
Blood sugar medical conditions have plagued the world over centuries and mankind has developed several measures to the cope with this metabolic dysfunction occurring in their bodies. Even when medical science had no answers reports were that people used various herbs to cure the disease which doctors have subsequently determined is incurable. In the following pages of this presentation an account of one such blood sugar disorder would be presented I terms of assessing where science has reached in its definition or description; etiology; pathophysiology; prognosis and management.
Medicine: Type 1 Diabetes Mellitus
Introduction
The words diabetes owes their origin to a Greek Physician by the name of Areteus who named the condition sometime between 30-50 BC. This was after the disorder was discovered by Egyptians in 1550 BC and they could not identify the cause. All they knew it was characterized by perpetual thirst (polydispia) and excessive urination (polyuria) associated with progressive loss of weight. Essentially, these words were meant to describe “flowing through” (The global diabetes community, 2011).
Further reports were that since they could not have resolved the cause doctors did not know where to begin a system of treatment. Consequently, many people died due to mismanagement or no management. Some doctors referred to it as a kidney condition while others just admitted that they did not know the cause as many diseases which affect the human race in the twenty first century (The global diabetes community, 2011).
It was not until in 1920 that an American scientist by the name of Moses Barron linked the disorder to the islets of langerhans. This was a few years after an Arabian physician, Avicenna, during routine uroscopy discovered that the urine was sweet and added the word ‘mellitus’ meaning ‘honey’ in Latin (The global diabetes community, 2011).
Ever since immense research have been continuing to the extent that scientists have discovered three types of diabetes affecting humans in the twenty-first century. They are classified as Type 1, 2 and 3. From World Health Organization figures as of 2000, 171 million people internationally, suffer from diabetes. According to the present trend this number is expected to double by 2030 (World Health Organization, 2011).
Definition/ Description
Type I diabetes is defined as insulin dependent diabetes mellitus. It is so described since patients cannot survive without insulin injection therapy. Scientists have often referred to this condition as juvenile diabetes since it is associated with autoimmune destruction of insulin produced by the islets of Langerhans found in the pancreas of the person’s body. It is not a metabolic disorder as type 11 because it cannot be controlled on diet and people affected are not usually obese (Bluestone et.al, 2005).
Potential barriers to Therapy
Studies are still being conducted into discovering exactly what substances; genetic or environmental conditions are responsible for this disorder. So far anything definite is still obscure. Speculations include that it is an autoimmune disorder affecting the production of insulin in one’s body and perhaps can be initiated through infections in the pancreas by viruses or bacteria (Knip et al, 2005).In not knowing a cause it is very difficult to identify a cure. As such, this in itself is a barrier to therapeutic intervention.
Genetically, it is believed to be a polygenetic dysfunction whereby variations in the IDDM1 genetic combination can begin the autoimmune destruction. The genetic risk of a child inheriting it from the father is 10 % from a mother 1%. However; there have been cases of children developing the condition without either parent having the genetic factor (Fairweather, 2002).
Regarding environmental and viral implications epidemiologists arrived at the conclusion that children and young adults residing in certain neighborhoods which have a predisposition to Coxsackie virus; a member of the Rubella can develop type 1 diabetes. They have reported that in the immune system attack to destroy this virus beta cells I the islets of langerhans responsible for producing insulin are destroyed in the process. More research is to be conducted to validate this assumption (Fairweather, 2002). These and other factors such as insulin resistance and infection to insulin sites contribute to barriers related to therapeutic intervention.
Pathophysiology (Course of the disease)
In diabetes mellitus Type I, cells of the islet langerhans refuse to function. They are responsible for producing insulin that stores glucose after being metabolized from digestion in the intestines. When there is no insulin to store glucose these end products of digestion simply begin circulating in the blood stream in very high concentrations.
High concentrations of glucose in the blood affect blood vessels causing erosion subsequently forming plaques. These plaques can occlude vessels creating blockages. Blockages mean that blood supply to those areas of the body is either closed or minimized. Any organ or organ system can be affected by this occlusion, but often they are the heart, kidneys, brain, eyes, and the periphery.
Complications
Hence, organ damage can occur as a complication if blood glucose levels are no constantly monitored and kept at a healthy level. Frequently the first effects are detected in the build up of blood pressure. As such, Hypertension is a major complication of Diabetes Type 1.
Then retinal damage occurs due to blockage in the capillaries supplying blood to the eyes. Peripheral neuropathy develops in that blood supply to extremities such as tip of fingers, toes and skin usually diminishes. With diminished blood supply comes decreased nerve stimulation and sensations are either misinterpreted or not interpreted. Subsequently, there is the tendency for toes and fingers to gangrene if injury occurs.
Prognosis
This condition definitely reduces life expectancy to more than half, especially, since populations being affected are juveniles and young adults. However, with modern therapeutic interventions persons with Type 11 diabetes who respond to insulin therapy have known to live normal lives on they take the necessary precautions.
Scientists have predicted that the complications of diabetes regardless of its type cannot be removed. Insulin therapy merely postpones them and allows individuals to live a healthier life longer. Predictions are once a person lives long enough they will eventually meet complications and subsequently die from them if they do no die by accident or another disease.
Management
The first line of therapeutic management and traditional mode is through insulin replacement therapy. This is administered either through subcutaneous route or an insulin pump. Patients often respond to insulin replacement therapy. These are biosynthetic products derived from pigs, cattle, sheep and in some instances fish.
Alternatively, in extreme cases when there is acute pancreatitis a pancreas transplant is usually recommended. In such a situation, there must be a compatible donor to facilitate the process. With advancement in stem cell research scientists have now been experimenting with replacing the islet of langerhans to reintroduce the level of insulin production.
Even though diet and exercise may not be a major focus of therapeutic intervention in type 1 diabetes since its etiology and Pathophysiology is distinct from type 11 as a general rule of health doctors still advice of a well balanced diet with carbohydrate intake monitoring.
Patient teaching
Patients with Type I diabetes ought to be educated concerning their condition, especially, when it comes to keeping doctor’s appointments. This is essential in management of blood glucose levels. Teaching on how to check blood for glucose using the machine must be undertaken by all persons who happen to be caregivers or parents of juvenile.
Also, a major development could be use of sites for administering insulin. These sites ought to be rotated and the proper way of holding needles and tauting of the skin must be demonstrated. Patients must know how to recognize when they are becoming resistant to insulin and report any irregularities in reading to the primary care physician.
When the use of pumps is recommended this is another lesson to be taught. Usually these devices are not installed when children are too young to mange then. As such when they become much older they can be sensitized to its use. Each manufacturer may have their distinct pattern of maintenance of these pumps, but basically ought to be carefully used according the instruction which comes with them.
Conclusion
The foregoing pages of this document discussed type 1 diabetes from its historical perspective; gave a descriptive account of its definition; advanced assumptions related to its etiology; offered an analysis of the clinical manifestations examining signs and symptoms; thoroughly outlined the Pathophysiology; advanced deliberations concerning its prognosis and projected achievements in modes of treatment adapted in the twenty first century.
It is heartening to know that since the discovery of diabetes in 1550 BC to now with a world population of over 171, million people affected, medical science has been continually conducting studies towards developing strategies which can improve the accessibility of care to the millions of juveniles affected across the globe.
References
Bluestone, J. A.; Herold, K.; Eisenbarth, G. (2010). "Genetics, pathogenesis and clinical
interventions in type 1 diabetes". Nature 464 (7293): 1293
Fairweather Delisa, Rose Noel (2002).Type 1 Diabetes: Virus infection or autoimmune system.
Nature Immunolog.3, 12-15
Knip, M.; Veijola, R.; Virtanen, S. M.; Hyoty, H.; Vaarala, O.; Akerblom, H. K. (2005).
Environmental Triggers and Determinants of Type 1 Diabetes.
Nature Immunology.3 (54), 338-340.
The Global diabetes community (2011). “Diabetes history.” (Retrieved 11th Dec, 2011) from
http://www.diabetes.co.uk/diabetes-history.html
World Health Organization (2011). Diabetes Statistics. Geneva.
