Diabetes Type 1 Treatment - Essay Example

Diabetes Type Diabetes mellitus type type DM) was first documented following recognizable reports in the second half of 19th century. More common in children and young adults, it results from the autoimmune annihilation of the beta cells that produce insulin in the pancreas. Consequently, glucose and blood in the urine increase due to the absence of, or reduced amount, of insulin. Symptoms include increased hunger, frequent urination, weight loss and increased thirst. Presently, the cause remains unknown, but explanatory theories offered include being exposed to antigens and genetic susceptibility. Diagnosis is done by checking for abnormalities in blood, such as high sugar levels, and also glucose in urine. Administering insulin injections and providing care are critical for patients’ survival. Other ways of managing type 1 DM include maintaining the level of blood sugar at the targeted range through planning means and exercise. When uncontrolled, type 1 DM can result in retinopathy, kidney damage and nerve damage. Diabetes Type 1 Occurring as a multisystem disease of the metabolism of proteins, fats and carbohydrates due to the lack of insulin, type 1 diabetes (type 1 DM) has both anatomic and biochemical consequences. The prevalence of type 1 DM is across all ages but usually seen more in children and young adults around puberty. Out of the total population of persons with diabetes, only five percent suffer this form. The body fails to produce insulin, which is a hormone required to convert food, specifically sugar and starches, into the energy the body needs. Occurrence results when a person’s own immune system attacks the beta cells of the pancreas that produce insulin (Zhao, Lin & Hwang, 2010). Under normal circumstances, the immune system attacks bacteria and viruses but, in the case of type 1 DM and for unknown reasons, it attacks the cells of the body. This condition is managed through the help of insulin treatment, exercise and healthy meals through which patients can lead long and healthy lives. This paper will discuss the history, causes, diagnosis and disease epidemiology of type 1 DM. In the 1970s, scientists described type 1 DM as an auto immune disease (Polonsky, 2012). This means that the body’s own immune system attacks its body cells rather than foreign invaders. The description was founded on observations that discovered auto-antibodies against islets of Langerhans in persons with diabetes and other deficiencies of autoimmunity. Later in the 1980s, it was also established that the progression of disease could be hindered through immunosuppressive therapies, which further supported the notion of type 1 DM being an autoimmune disorder (Fineberg, Kawabata & Krasner, 2007). Although the causes of type 1 DM are not exactly known, it culminates from the destruction of beta cells as well as lymphocytic infiltrations. Genetics may also have a role in the body’s own immune system destroying the beta cells. Further, exposure to various environmental factors, for example, viruses, can set off the development of type 1 DM. With the continued decline of the mass of, the secretion of insulin also decreases to a level that the insulin can no longer maintain the levels of blood sugar at the recommended normal. When the beta cells are destroyed by up to 90%, it will lead to the development of hyperglycemia, at which point diabetes can now be diagnosed (Fineberg, Kawabata & Krasner, 2007). In order to prevent ketosis, reverse the catabolic condition, normalize protein and lipid metabolism and reduce hyperglucagonemia, exogenous insulin is essential for patients. In patients who are susceptible genetically, the body may start producing antibodies against viral proteins, triggered by a viral infection. In response, an autoimmune response will also be triggered against beta cell molecules that are similar to the viral proteins. Typically, many genes are involved in type 1 DM. Basing on locus or a combination of them, the genes can be either recessive or dominant, even with a possibility of falling in between the two states. IDDMI is the gene that is the strongest and its location is an area on chromosome 6 known as MHC Class II (Zhao, Lin & Hwang, 2010). Specific variants of the gene, such as DQB1, DQB1 0302 and DRB1 0402, are known to escalate the risk of type 1 DM’s decreased histocompatibility (Fineberg, Kawabata & Krasner, 2007). This trait is more prevalent among Europeans as well as North Americans who have a European ancestry (Ludwig, Sanbonmatsu & Gennetian, 2011). In cases where a father has type 1 DM, his child bears a 10% risk of developing it as well. On the other hand, a child only has a risk of four percent of developing the disease if the mother has it and was younger than 25 when giving birth, which reduces to one percent if she was over 25. When a sibling has it, a child still has a 10% risk. Scientists have also shown that the expression of type 1DM can also be influenced by environmental factors. The example of identical twins is used to support this idea. When a twin was diagnosed with the disease, the other turned out to have had it no more than 50% of the duration in spite of the fact that they share an exactly similar genome. The fact that one had type 1 DM and the other was not diagnosed with it is a suggestion of environmental roles as seen in Caucasians who inhabit different European regions. Diagnosis of type 1 DM is through measuring blood glucose, a certain protein or sugar levels by blood tests. The measuring of the specific protein determines the type of diabetes involved. The American Diabetes Association uses various diagnostic criteria for type 1 DM. They include the fasting plasma glucose (or FPG), oral glucose tolerance test (or OGTT) and random plasma glucose test (Chiang, Kirkman & Peters, 2014). Through FPG, blood glucose is measures after the patient goes through fasting for at least hours. It is the preferred diagnostic test mainly due to its convenience, ease of conducting and low cost. However, its reliability is still in question because of certain observations such as the one indicating that it turns out more accurate when conducted in the morning. Yet, when people record normal results in the afternoon, they have been proven to actually have levels of blood glucose above the recommended normal that would have been seen had the test been done in the morning (Chiang, Kirkman & Peters, 2014). As a two-step process, OGTT first starts with the standard blood test of FPG after a patient has fasted for at least eight hours. In the second step, the patient is allowed to take a solution of water and 75 grams of glucose then made to rest for two hours. Blood samples are then taken and tested in half-hour intervals for two hours. Essentially, the samples are tested to determine the manner in which the patient’s body deals with the glucose that was administered through the solution. Although not as convenient as FPG, OGTT is more accurate for the diagnosis of type 1 DM. The random plasma glucose test is used to measure the levels of blood glucose without making a patient fast and is the least accurate compared to FPG and OGTT. It is more useful only when there are high levels of blood glucose and cases where patients already suffer from the early symptoms of diabetes which include unexplained loss of weight and constant and increased as well as urination. Urine tests can also be conducted by testing samples of urine to determine if glucose is present (Fineberg, Kawabata & Krasner, 2007). Since glucose is not usually contained in urine, its presence will be an indication of type 1 DM. Glucose will usually find its way into urine by overflowing from the kidneys. In urine diagnosis, the presence of ketones, which are chemicals that indicate a patient has type 1 DM, is tested. Basing on the results obtained from urine tests, it can then be decided to go on to blood tests for further confirmation. Other tests include the glycated hemoglobin test (or HbA1c), and antibody tests (Fineberg, Kawabata & Krasner, 2007). For patients already diagnosed with type 1 DM, HbA1c test serves the purpose of showing how well, or not, the disease is being controlled. The test gives the average level of glucose over the earlier two or three months and the results are indicative of whether the control measures being taken by patients are effective or not. Antibody tests are for specific antibodies capable of identifying type1 DM (Fineberg, Kawabata & Krasner, 2007). Regardless of the diagnostic type taken, follow-up tests are recommended, which is especially significant because so as to determine the presence of autoantibodies that the immune system produces to attack the body’s beta cells. In terms of epidemiology of type 1 DM, according to a report released by the CDC (US Centers for Disease Control and Prevention) in 2011, it was approximated that one million people in the US have type 1 DM (Ludwig, Sanbonmatsu & Gennetian, 2011). Among young adults, 15, 6000 Americans were newly diagnosed with type 1 DM every year from 2005 through to 2005. For children below the age of 10, the yearly rate was recorded as 19.7 out of every 100,000 children while for those just above 10, it was 18.6 new cases out of every 100,000 children. This makes the disease the most prevalent metabolic disease in childhood. Although type 1 DM affects both sexes equally during childhood, it is more common in men during early adulthood. The role played by specific factors, which includes viruses, is still controversial, the growing incidence of type 1 DM is has been cited as a suggestion of key environmental contributions by researchers (Fineberg, Kawabata & Krasner, 2007). Internationally, the disease has been known historically to be most common in populations whose origins can be traced to Europe, although its prevalence in other diverse ethnic groups is increasing. North-west Europe and Scandinavia report the highest rates of type 1 DM among children, recording and incidence that ranges from 57 cases out of every 100,000 children in Finland to four out of 100,000 in Macedonia annually (Ludwig, Sanbonmatsu & Gennetian, 2011). These statistics represent children aged below 14 years. Populations that differ genetically may show differences in incidence. For instance, it is less common for Icelanders of Norwegian descent that it is among Norwegians. Further, Finish children have a risk factor of type 1 DM that is three times higher than that of Estonian children. Japan and China report the lowest case of type 1 DM, which is represented by less than one percent of all the cases of diabetes, although these statistics may be skewed due to reporting incompleteness and definitional issues (Chiang, Kirkman & Peters, 2014). In conclusion, type 1 DM is seen to have first been documented from recognizable reports in the 1970s. This was based on the discovery of autoantibodies that attacked the islets of Langerhans. Its prevalence is also more common in children and young adults around puberty. It occurs as a multisystem disease of the metabolism arising from the absence or insufficient amounts of insulin in the body, resulting in both anatomic and biochemical complications. Currently, the exact causes of the disease are unknown, but it is largely linked with the destruction of beta cells and lymphocytic infiltrations which lead to the pancreas failing to produce insulin, or producing insufficient amounts. Certain environmental factors have also been associated with the triggering of the disease. Diagnosis is mainly done through blood and urine tests and, in order to manage the disease effective, early diagnoses as well as follow-ups are recommended. References Chiang, J., Kirkman, M., & Peters, A. (2014). Type 1 diabetes through the Life span: A position statement of the American Diabetes Association. Diabetes Care, 37(7), 2034-2054. Provides focused statistical information gathered by a reliable institution. It includes relevant evidence for the statistics provided, with further support from international organizations from which they got international data. Fineberg, S., Kawabata, T., & Krasner, A. (2007). Immunological responses to exogenous insulin. Endocrine Reviews, 28(6), 625-652. Describes laboratory processes and tested means of diagnoses. Apart from providing credible academic information, it is also useful in terms of professional information that is obtained through empirical studies. Ludwig, J., Sanbonmatsu, L., & Gennetian, L. (2011). Neighborhoods, obesity, and diabetes: A randomized social experiment. New England Journal of Medicine, 365(16), 1509-1519. Quite an informative source that was based on actual studies conducted in different societies. Provides in-depth information on the way people with different ancestries are affected or exposed to type 1 DM. Polonsky, K. (2012). The past 200 years in diabetes. New England Journal of Medicine, 367(14), 1332-1340. Using sources dating back to the 19th century, the journal provides credible information on the history of type 1 DM. It describes the development and evolution of studies conducted over time to understand causes and management of type 1 DM. Zhao, Y., Lin, B., & Hwang, D. (2010). New type of human blood stem cell: A double-edged sword for the treatment of type 1 diabetes. Journal of Laboratory and Clinical Medicine, 155(5), 211-216. Contains elaborate information on lab procedures and how the disease develops. Although the journal article does not dwell on diagnosis and management, it is a critical source of information on how the disease is triggered. Read More