Diabetes Mellitus: The Tale of the Torment - Essay Example

Diabetes Mellitus: The Tale of the Torment and Number and Number Diabetes Mellitus: The Tale of the Torment With the rapid advancement of medical science, covert information about chronic diseases like diabetes mellitus has been increasingly discovered. While this has generally led to a longer life expectancy and productivity among affected individuals, problems with healthcare cost surfaced along with the series of complicated diagnostic procedures and treatment regimen. Interestingly, professional organizations such as the American Diabetes Association (ADA) and the World Health Organization (WHO) now give more value in the primary and secondary prevention programs of diabetes mellitus than in the past decades. In facilitating information dissemination about these prevention programs, this paper will review pertinent information about diabetes mellitus including its causes and mechanism, diagnosis, treatment, and prevention. Specifically, the topic about diabetes mellitus was chosen for this paper to initiate awareness of the different innovative programs conducted by the WHO and ADA that would potentially prevent the onset of the disease among susceptible individuals as well as cut-down healthcare expenses. As less people are aware of these programs, majority of the population are particularly unaware that the disease can be prevented if certain lifestyle changes have been initiated before its onset. While several other diseases also present similar problems with costs, the chronic nature of diabetes drains out resources and give suffering in the most difficult ways. The Cost of Diabetes In the epidemiologic survey by the WHO (2000), an estimated 177 million individuals are affected with the disease worldwide. In the United States, diabetes affects 7% of the population and currently ranks fourth in the leading causes of death by disease among Americans particularly due to its cardiovascular complications. In the recent survey conducted by the American Diabetes Association (2013), the costs of treatment and control of diabetes in the US have abruptly soared from $174 billion in 2007 to $245 billion in 2012. Reasons that caused the sudden increase in health care cost include the general increasing price of insulin and other medications that control the progression of the disease and prevent complications. Causes Essentially, Diabetes mellitus (DM) is a cluster of metabolic diseases characterized by hyperglycemia, or an increased level of glucose in the blood. Although genetic predisposition and environmental factors play a role in the development of the condition, the main mechanisms of DM primarily involve problems with insulin secretion, insulin action, or more commonly, both (Cooper et al. 601). Mechanism of the Disease The condition is classified into two main types: Type 1 or Insulin-Dependent Diabetes Mellitus (IDDM), and Type 2 or Noninsulin-Dependent Diabetes Mellitus (NIDDM). Type 2 DM usually has a later onset, occurring usually in late 30s, than Type 1 which appears in individuals younger than 20. Other types of diabetes can occur with special situations as in during the course of pregnancy termed as Gestational Diabetes Mellitus, use of drugs that have metabolic side effects, and presence of pancreatic tumors, among others (Tortora and Derrickson 721). Specifically, Type 1 DM occurs as the persons immune system attacks the pancreatic beta cells resulting to an impaired or absolutely no secretion of insulin. With the lack of insulin, the body cells are not able to utilize glucose as an energy source necessary to sustain its cellular function. In turn, the body attempts to utilize its fat sources through biochemical degradation of stored lipids to compensate for this lack of energy. However, the utilization of lipids for energy has several unwanted effects. In fact, a potentially fatal complication called Ketoacidosis results as the blood pH drops due to the accumulation of the ketone by-products of fatty acid metabolism (Cooper et al. 601). On the other hand, Type 2 DM is characterized by insulin resistance, which means that the insulin receptors of body cells become less sensitive to insulin itself, thereby depressing its functions. In the same way, the body may shift to fatty acid metabolism, but only to a lesser degree than Type 1 DM. Even so, lipid droplets may also attach to blood vessel walls and occlude blood circulation especially in very minute arteries that supply the heart, brain, kidneys, and the eyes. Secondary effects of diabetes then occur depending on the end organ affected. For instance, ischemic heart disease can result when coronary arteries are occluded, and stroke happens when perfusion to some areas of the brain is arrested (McPhee, Lingappa and Ganong 525). Clinical Manifestations In both types of DM, a classic triad of symptoms becomes clinically evident described as an excessive thirst, hunger, and frequency in urination. Even if glucose is available in the blood, the lack of insulin, or insensitivity of insulin receptors causes its accumulation in the blood stream and starvation of body cells. This situation sends signals to the brain to be perceived as hunger. Thus, the person frequently feels the need to take in food, termed as polyphagia, which will further increase blood sugar levels. Likewise, high serum glucose levels increases the osmolarity of the blood and directly cause an exaggerated stimulation of the thirst center in the brain, causing increased intake of water and other fluids, termed as polydipsia. Lastly, the increased intake of water and the effect of osmotic diuresis in the kidney increases urine formation, termed as polyuria (Tortora and Derrickson 721). Methods of Diagnosis Unlike many diseases, the diagnosis and monitoring of diabetes mellitus involves a series of blood glucose determination with special client preparation in an extended period of time. There are three options to establish the diagnosis. Serum glucose level determination of at least 126 mg/dL in an overnight fast, repeated at least twice, confirms the diagnosis. When fasting is not possible due to some reasons, the value of at least 200 mg/dL after a random blood glucose determination in addition to signs and symptoms of DM is also positive to the diagnosis. Using an oral glucose tolerance test (OGTT), a value of at least 200 mg/dL at 2 hours after a 75-g glucose load can also be an indicator of DM (Cooper et al. 601). Treatment Although an increased understanding of the mechanisms involved in DM has been noted in recent decades, the condition remains to be irreversible. Nevertheless, treatment options can effectively control the progression of the disease and prevent development of acute and chronic complications. Meanwhile, the treatment for DM depends on the type and degree of severity and considers other organs affected with the disease so far. The principal treatment for Type 1 DM is the administration of insulin. Currently, the types vary from short-, intermediate-, and long-acting insulin administered either via a subcutaneous injection or continuous infusion. Inhalation method of insulin has also been approved for use but requires the patient to undergo training to prevent mistakes in dosing (Cooper et al. 604). Diabetic Ketoacidosis can occur with deficient dose of insulin, while hypoglycemia can occur when there is an excessive administration. In contrast, Type 2 DM is not necessarily treated with insulin because the problem itself is not due to the lack of insulin, but on its inactivity or the insensitivity of insulin receptors in the body cells. In this case, diet, weight loss, and exercise can give a satisfactory control of blood glucose by increasing insulin sensitivity and reduces fasting and random blood glucose levels. Medications such as sulfonylureas, metformin, and thiazolidinediones may either increase the activity of insulin or enhance the sensitivity of insulin receptors in the cells (Cooper et al. 613). When blood glucose is not maintained below 200 mg/dL, a hyperosmolar nonketotic state can also occur with a marked hyperglycemia and impaired mental status (McPhee, Lingappa and Ganong 529). Prevention Unlike infectious diseases, there are no specific vaccines to prevent the development of diabetes. It has long been believed that genetic predisposition and environmental factors dictate whether a person should develop the disease or not. However, research studies suggest overwhelming promise of preventing diabetes through simple lifestyle changes. Actually, prevention programs are geared towards two groups of people. Primary prevention focuses on the disease itself and protects at risk individuals from developing DM (WHO, 2000). It includes promotion of a balanced diet, daily exercise, and a sustained weight reduction. While these methods sound monotonous in mass media, the results show an impressive two-third cut down in the progression of DM in China, Finland, and USA. Alternatively, secondary prevention aims at early detection, diagnosis, and treatment of complications of DM. Screening of blood pressure, lipid profiles, retinal integrity, foot and wound integrity, and proteinuria are the essential components in searching for early signs of complications that are potentially reversible and thus prevent severe disability that might affect the individual’s productivity (ADA, 2013). Indeed, diabetes mellitus can cause both physical ailments and psychological suffering on the part of the patients and their families. While there has not been a perfect prevention from the development of diabetes, the programs initiated by the WHO can be sufficient to prevent the torment brought by the disease. Works Cited American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2012. ADA, 6 Mar 2013. Web. 7 Apr. 2013. Cooper, DH, Krainik, AJ, Lubner, S and Reno, HEL. Washington Manual of Medical Therapeutics, 32nd ed. Washington, DC: Lippincott Williams & Wilkins, 2007. Print. McPhee, SJ, Lingappa, VR and Ganong WF. Pathophysiology of Disease: An Introduction to Clinical Medicine. San Francisco, California: McGraw-Hill, 2006. Print. Tortora, GJ and Derrickson, B. Principles of Anatomy and Physiology, 13th ed. Hoboken, NJ: John Wiley and Sons, 2012. Print. World health Organization. Diabetes: the cost of diabetes. WHO, 2000. Web. 7 Apr. 2013. Read More