Diabetes
Introduction.
Diabetes mellitus is an endocrine, metabolic disorder characterized by the body’s inability to control its blood glucose levels. As a result, the condition mainly presents with hypoglycemia. Diabetes is a widespread condition reporting high prevalence rates of up to 382 million people in 2013, with the rates projected at 592million by 2035 (Forouhi and Warahem 602). Broadly, diabetes is classified into type 1 and type 2. Type 2 diabetes is the most prevalent among the worlds’ population, with research establishing that over 85 percent of all diagnosed cases are type 2 (Forouhi and Warahem 602). According to Baynes H (541), 50% of individuals with diabetes are still currently undiagnosed. Diabetes is a complicated health condition that requires a multidisciplinary approach among all health care stakeholders. The recent increase in diabetes and occurrence among the younger population is attributed to the rise in prevalence of obesity, inactivity, and poor diet practices (Singh and Clare, 7).
Etiology of the disease.
The cause of diabetes mellitus is broadly stated as partial insulin resistance and the inability to secrete adequate required insulin by the pancreatic beta cells. Presence of plasma pro-inflammatory cytokines and increased quantities of plasmas free fatty acids is argued to reduce glucose transport into muscle cells, increase the breakdown of fat, and generally increase the liver’s glucose (Baynes H. 541). Also, both insulin and glucagon’s regulatory roles are lost, leading to the promotion of glucagon role even when glucose levels are elevated. Ideally, glucagon is secreted from the alpha cells and serves as an antagonistic to insulin. The glucagon’s primary role includes a breakdown of fats, reduction in muscle uptake of glucose, and breakdown of other complex sugars into glucose. In essence, glucagon promotes gluconeogenesis leading to an elevation of blood glucose levels in diabetic patients. Diabetic patients, therefore, present with hyperglycemia due to beta-cell dysfunction and increased glucagon activity.
Types of diabetes associated with hypoglycemia
The various types of diabetes associated with hypoglycemia include; type 1 diabetes, type 2 diabetes, and gestational diabetes. The distribution of these types of diabetes varies worldwide. However, research indicates the most common type of diabetes is type 2 diabetes mellitus, with reports mentioning up to 90% of cases being type 2 (Baynes, 542).
First, type 1 diabetes mellitus is a chronic metabolic disorder resulting from beta cells’ continued inability to produce insulin. Though mostly associated with the juvenile population, this type of disease can occur at any age. The main cause of paleadingases ‘defect is the autoimmune destruction of beta cells responsible for insulin production (Baynes, H 542). Primary symptoms of this condition include polyphagia, polydipsia, unexplained weight loss, and polyuria. According to the American Diabetic Association (2), the diagnosis of this condition is confirmed if a person presents with; a fasting plasma glucose equal or greater than 7.0 mmol/L, a random blood sugar of 11.1mmol/L, and a two-hour plasma glucose level of 11.1mmols/L during a 75-g oral glucose tolerance test. Patients who have type 1 diabetes depend on insulin injection to maintain normal glycemia.
Second type 2 diabetes consists of several dysfunctions, in which the body cells develop insulin resistance. Other individuals experience inadequate insulin secretion and or incongruences in glucagon production. This type of diabetes is often associated with several cardiovascular conditions and neuropathies. According to several studies, type 2 diabetes is most prevalent in the elderly between 45 and 60 years old (Baynes, H 543). Patients with type 2 diabetes require insulin treatment. However, their beta cell retains the ability to produce some endogenous insulin; therefore, they don’t require insulin for life. In addition to classic diabetic symptoms, individuals with this condition present with; blurred vision, lower extremity paresthesia, yeast infection, among other symptoms. The risk factors for developing this condition are obesity, inactivity, poor dietary practices, and genetics. This form of diabetes is diagnosed through a relatively similar approach. Fasting plasma glucose level of 7.0mmol/L, a two-hour oral glucose levels of 11.1mmol/L following oral glucose tolerance test with 75grams of glucose, and random blood sugar of 11.1 mmol/L while displaying classic symptoms of hypoglycemic crisis. Measurement beyond 6.5% for hemoglobin A1c has is also helpful in diagnosis. However, a dispute exists on whether it should be adopted as the gold standard for the type 2 diagnosis (Baynest H, 543).
Several theories have been put forward to explain the pathophysiology of diabetes. These theories include; beta-cell dysfunction, genomic factors, insulin resistance, and amino acid metabolism. Most researchers have considered a broader scope in defining the cause of diabetes. The pathology of beta cells is assumed to contribute a significant role in their dysfunction. Studies have also identified the consistency between single nucleotide polymorphism variations to beta-cell dysfunction and insulin resistance (Forouhi and Warahem, 604). Also, too high levels of amino acids of up to 3 amino acids in a fasting plasma concentration are a predisposing factor to the condition’s development.
Finally, gestational diabetes is a type of hyperglycemia associated with pregnancy. To screen gestational diabetes, a two-step process is undertaken—50 grams one-hour challenge for blood glucose and a subsequent 100gram three-hour oral glucose tolerance test. Mothers with gestational diabetes should be monitored carefully to prevent the fetus from experiencing hypoglycemia. Women from the high-risk ethnic group and those with obesity should be screened often as they are more predisposed to developing the condition. Many researchers agree that frequent screening generally contributes to early diagnosis of the disease and efficient care initiation.
Several life-altering complications are associated with the development of diabetes. These complications include; peripheral neuropathy, retinopathy, cardiovascular risk, among others. Insulin resistance is generally associated with an increase in high and low-density lipoprotein as well as cholesterol. These components accompanied by inactivity and poor dieting and obesity contribute typically to cardiovascular conditions. Also, diabetes is known to cause a slow wound healing rate, which often leads to secondary wound infection and the development of diabetic wounds. Most importantly, diabetes is a leading cause of immune suppression and, therefore, contributes to the development of other diseases.
Treatment of diabetes.
The management of diabetes requires a multidisciplinary approach involving nurses, internal medicine physicians, dietitians, and psychosocial support. Prevention of diabetes is altogether cost-effective as compared to its treatment. Although prevention is not entirely possible most doctors advocate for lifestyle trimming to avoid a sedentary lifestyle. Keeping a low healthy fat and sugar diet, exercising, avoiding alcohol use, and continuous screening in susceptible individuals are the hallmarks of diabetes (Forouhi and Warahem, 701). Diabetes is a lifelong chronic illness, and those who develop it should be assisted to the easy transition of lifestyle into care oriented one.
Specifically, the treatment of diabetes requires pharmacological management, physical activity, smoking cessation, immunization, diagnosis, and treatment of vascular complications. Also, management success is optimized by conducting self-management education. Whereas the use of insulin manages type 1 diabetes, the management in type 2 incorporates both insulin and other oral hypoglycemic agents. Metformin has formed the first line of defense as an oral hypoglycemic agent. The other agents used in the world platform alongside metformin include; oral sulfonylureas, meglitinide derivatives, thiazolidinediones, alpha-glucosidase inhibitors, and others.
Conclusion
In conclusion, diabetes mellitus presents a grave medical concern for international health societies. In recent times, projections have estimated diabetes would soon be more endemic as compared to infectious diseases. Indeed, analysis of this condition justifies the need to incorporate all other health care stakeholders to achieve maximum care for diabetic patients.
References
Nita Forouhi and Nicholas Warahem (November 2010). Epidemiology of diabetes Medicine, 2010, 38(11):602–606. DOI: 10.1016/j.mpmed.2010.08.007
Singh H, Clare B. (January 2006). Quality of life in diabetes. International Journal of Diabetes in Developing Countries, 2006, Vol. 26(1). Pages: 7-10. DOI: 10.4103/0973-3930.26882
American Diabetes Association. statistics on diabetes. [Retrieved from]: https://www.diabetes.org/resources/statistics/statistics-about-diabetes [Accessed on]: 9/11/2020.
Baynest H. Classification, Pathophysiology, Diagnosis, and Management of Diabetes Mellitus. Journal of Diabetes and Metabolism; 2015, 6(5) DOI: 10.4172/2155-6156.1000541