Type 2 Diabetes - Research Paper Example

Type 2 Diabetes Introduction Also referred to as diabetes mellitus, diabetes refers to a condition where the humanbody fails to properly use sugar. It would therefore be characterized with high levels of glucose. Glucose is known to provide the energy needed in carrying out everyday activities, usually ingested through drinks and foods. The regulation of the sugar in the blood would be accomplished through the chemical insulin, which is what diabetes interferes with (Brill 15). Pancreas, an organ at the lower part of the stomach is responsible for the production of insulin. In a healthy person, insulin would allow for movement of glucose from the blood into the cells of the body where it would be converted into energy. Failure by the cells to absorb glucose results to collection of sugar in the bloodstream or leaving through urine. This results into various types of diabetes which could be type 1, type 2 or gestational. Brill refers to diabetes as a “growing epidemic” based on the recent World Health Organization statistics showing the rapid increase in diabetes prevalence from 30 million to 230 million, estimated to hit 366 million by 2030 (11). It has also been established that out of these people with diabetes, between 5 and 10 percent have type 1 diabetes. Of major concern is the type 2 diabetes noted to be most common with a prevalence of between 90 and 95 percent among those suffering from diabetes as documented by the National Center for Biotechnology Information. While it used to be associated with the elderly above their fifth decade, the disease now increasingly affects even children as young as 15. Literature Review It would be critical to understand the nature of type 2 diabetes prior to evaluating it in the context of literature. With this form of diabetes, the pancreas would continue producing insulin. However, the beta cells would either produce insulin in minimal quantities or the fat and muscle cells of the body would fail to recognize insulin, referred to as insulin rejection (Brill 17). As this sugar fails to enter cells, it would remain in the bloodstream. It usually taking long before type 2 diabetes would be diagnosed. In fact, Allman (19) notes that complications resulting from type 2 diabetes would be exhibited after decades of living with the disease. But unlike in the ancient days where this disease was associated with the elderly, type 2 diabetes has increasingly affected children. According to Yaturu (80), obesity affects 15% of American children and adolescents. In childhood, BMI changes with age substantially hence the importance of understanding type 2 diabetes in children and adolescents with regard to public health. In these obese children, tolerance to glucose would be impaired, a condition associated with pre-development of the type 2 diabetes. Type 2 diabetes has been attributed to excessive glucose in the blood. The amount of glucose in the blood would normally be measured in a deciliter of blood. For normal cases, Allman (16) notes that this amount would be between 60 and 100 milligrams per deciliter, connoted as 60 – 100 mg/dl. This is referred to as the normal fasting blood glucose, FBG level by Riaz (368). A milligram is such a small quantity yet this composition of glucose in this quantity plays a critical role in propagating the health of body cells and should be maintained at the right range. The delicate balance between the secretion of insulin by beta cells in the pancreas and the sensitivity of insulin of peripheral tissues – liver, adipose tissue and muscle - maintains the normal glucose homeostatis (Yaturu 81). When the composition of glucose in blood goes beyond 125 mg/dl, the person would be considered to have diabetes. Such people exhibit tendencies of their blood sugars skyrocketing. In type 2 diabetes in as much as the pancreas continues to produce insulin, such insulin does not unlock the cells because of the cells’ resistance to insulin, making it hard for glucose to enter the cells. This insulin resistance makes the cells starved or malnourished with the blood sugar levels rising. In the process, the pancreas pumps more insulin, seeking to lower the glucose levels. A burn-out of the beta cells would cause the less insulin to be made. Unlike the type 1 diabetes which would be mostly associated with underweight, Allman (15) finds an association of type 2 diabetes with overweight and physically inactive persons. This phenomenon of cells resisting insulin has been attributed to excess weight and body fat. Yaturu (80) adopts the definition of World Health Program in differentiating overweight from obesity, noting that the former describes a condition where human body mass index, BMI ranges between 25 and 30 kg/m2 while the latter describes a condition where the BMI equals 30 kg/m2 or more. The researcher notes the great association existing between obesity and this type of diabetes. Supporting the same postulation, Kaku (42) argues that obesity is one of the leading causes of type 2 diabetes, apart from other environmental factors such as smoking, alcohol consumption and insufficient energy consumption. Riaz (370) also supports this observation noting overweight and obesity as the leading causes of type 2 diabetes. Obesity, specifically the visceral fat type, because of lack of exercise would be accompanied by decreased muscle mass, increased insulin resistance and rapid increase in diabetes patients, particularly when fats gets deposited around the abdomen. Changing the sources of dietary energy, particularly increasing fat intake, decreasing starch intake, increasing consumption of simple sugars and decreasing dietary fiber intake would greatly contribute to obesity and deteriorate glucose tolerance. It has been indicated that even with the mild form of obesity with BMI below 25, there would be 4 to 5 times risk of development of diabetes, specifically if it would be accompanied by increased visceral fat mass. According to Yaturu (79), not all patients with type 2 diabetes suffer from obesity and not all subjects with obesity have diabetes, but a majority of those with type 2 diabetes are obese or overweight. To a minimal extent, Kaku (42) appreciates the genetic role in the developemnt of type 2 diabetes. According to this researcher, the family history would influence the prevalence of type 2 diabetes, noting that monozygotic twins exhibit higher chances of being victims than their dizygotic counterparts. This has been attributed to the abnormality affecting the molecules involved in regulation of glucose metabolism. Analyzing the candidate genes involved in glucose stimulated insulin production of pancreatic beta cells and molecules has indicated the existence of genetic abnormalities which could be autonomous causes of pathogenesis, encompassing those in mitochondrial genes, glucokinase genes and insulin receptor genes. Even though research in this field still remains loosely informed, genetic contribution to the prevalence of type 2 diabetes has been pegged at 30%. Riaz (370) also argues on sex as a type 2 diabetes risk factor. According to the researcher, in spite of men making up 49% of the American population, they make up 53% of type 2 diabetes adult cases as reported by National Institutes of Health. Discussion and Recommendations The argument for increased body weight and obesity in causing type 2 diabetes has been explained by Brill (17), who observes that being overweight or obese causes the pancreas to work even harder so as to manufacture extra insulin that would balance the sugar going into the cells. With the rise in the demand for insulin, the pancreas reaches its production threshold losing its ability to produce adequate amounts. Thus, overweight persons have high chances of having insulin resistance with their excess fat interfering with the ability of the body to use insulin. The prevalence among children could be attributed to children’s lack of engagement in physical activities such as outdoor play, recess and sports. A lot of time would be spent watching television, working on computers, messaging and playing video games. In addition, their typical diets would include chips, candy, soda pop and other high fat and sugary foodstuff, especially in school. This lifestyle of eating a lot of unhealthy food and not being involved in physical activities could lead to obesity which has been cited by the National Center for Biotechnology Information as the major cause of type 2 diabetes. With statistics from the Third National Health and Nutrition Examination Survey, NHANES III indicating that two thirds of men and women have BMIs greater than 27 kg/m2 and World Health Organization projecting 2.3 billion people globally aged 15 and above as overweight and 700 million others as obese, there is great need to adopt effective physical exercises in humans’ everyday lives (Yaturu 79). Allman (19) argues that the only way to curb type 2 diabetes among children would be in the change of their lifestyles. With Wabitsch, M., et al (308) citing 1 out of 3 children being obese and hence at risk of being victims of type 2 diabetes, appropriate measures should be undertaken to change their lifestyles from the physical inactivity. As such, physical exercises should make up part of such persons’ daily activities. According to the National Center for Biotechnology Information, moderate physical activities pegged at 30 minutes per day would be adequate to keep the disease at bay by 58%. In fact, for those aged above 60, the cut would be about 71%. This translates to weight loss of about 15 lb or 5 to 7 percent of body weight. It remains an increasingly urgent need for the respective governments to define effective programs and strategies that would be used in the treatment of obesity and encouraging physical activities. Such strategies for disease prevention and health promotion should be customized to meet the demands of specific populations and also geared towards addressing poverty and other barriers to attainment of perfect health. In addition, appreciating type 2 diabetes a global epidemic, it would be important to diagnose it at younger ages. It has been widely argued that symptoms and signs of type 2 diabetes do not show up for years, even decades. But with the progression and development of the disease with subsequent increase in blood sugar levels, people with type 2 diabetes would exhibit some symptoms. Such symptoms include decreased sensation or even numbness in the feet and hands. Their sight also becomes blurred and the skin becomes dry and itchy. Type 2 diabetes has also been associated with frequent vaginal and bladder infections and increased urination frequency. Other than increased thirst and hunger, the patients also experience tiredness and slow healing of sores and cuts. In some instances, it could cause erectile dysfunction or male impotence (Brill 18). Researchers (Kaku 44; Wabitsch et al 310) have advocated for evidence-based clinical practices that would propagate regular monitoring of glucose in the blood, cholesterol levels and blood pressure and giving appropriate feedback to the diabetes health team so as to lower the impact of serious complications and the associated risks. Complication associated with type 2 diabetes, such as diabetic retinopathy and neuropathy could be contained through control of glucose levels and following the Diabetes Control and Complications Trial plan (Riaz 373). Government investments in the management approaches to chronic diseases would offer an interdisciplinary solution to effective diabetes care. The recommended combination of the team that would guide on approaches to attainment of optimal care should include nurses, physicians, pharmacists, diabetes educators and other healthcare experts working with people living with diabetes. Treatment for type 2 diabetes is available with Kaku (44) appreciating its goal as securing the quality of life and lifespan so as to attain comparability to those of the healthy persons. Some anti-diabetic and life improvement drugs such as thiazolidine, metformin and ?-glucosidase suppress the risk of developing type 2 diabetes. Metformin, insulin and SU drugs have proved effective in the control of macrovascular and microvascular diseases with earlier intervention being critical in controlling macrovascular diseases. Pioglitazone has been attributed to suppression of recurrent cardiovascular disorders. One of the challenges associated with management of people living with diabetes has been cited as the needed greater self management level so as to make the approach effective. Individuals with diabetes would be required to have abilities and skills that would enable them reduce the emotional and physical impact of the disease without intervention from their healthcare team. As such, people with type 2 diabetes would need to be trained on goal setting, planning skills and problem solving which are significant ingredients of self management. Such persons should be able to access relevant tools including devices, supplies and medication that would enable them attain the recommended cholesterol, blood pressure and blood glucose levels. Riaz (373) also appreciates the importance of nutritional counseling in this case. The outcomes would be dependent on effective management of the disease where lack of the necessary tools and strategies would hamper the achievement of optimal results. Government intervention would be required to ensure that personal management cost do not become a barrier to effective management. Yaturu (87) hypothesizes an important aspect of adoption of prevention mechanisms of type 2 diabetes. Although prevention of type 1 diabetes has been elusive, the author appreciates that adoption of prevention methods for type 2 diabetes would result in significant health benefits which include lowering the rates of renal failure and cardiovascular disease. Between 30 and 60 percent of type 2 incidences could be prevented by adopting early medication and lifestyle interventions. Adoption of early comprehensive intervention in monitoring lipids, blood pressure and glucose levels would be critical in controlling vascular complications and even further improving prognosis (Kaku 44). According to Riaz (373), the primary focus of prevention interventions for type 2 diabetes would be on adoption of weight management practices such as engagement in regular exercises and partaking sensible diets. Schools and other institutions of learning should include physical education, PE in their curricula to encourage engagement in physical activities among the students. These practices avoid insulin resistance and prove beneficial to controlling cholesterol and blood pressure. Conclusion Diabetes refers to a group of metabolic disorders that would be characterized by chronic hyperglemic condition caused by insufficient action of the insulin, secreted by the pancreas. The major pathophysiological features of type 2 diabetes, appreciated as a major form of diabetes among people with diabetes includes increased insulin resistance and impaired insulin secretion. The recent trend shows the increase in the prevalence of type 2 diabetes, even in children. This has been attributed to the prevalence of lifestyles that do not involve physical activities and promote poor feeding habits. Obesity and overweight have been largely associated with this form of diabetes with other environmental and genetic factors minimally contributing to type 2 diabetes. Unfortunately, a significant population of people with type 2 diabetes would go undiagnosed for several years and would not be diagnosed until the doctor recognizes symptoms associated with diabetes in general. Hence, this calls for the compulsory diabetes tests for persons aged above 45, particularly for those with body mass index, BMI greater than 25. This should be repeated in an interval of three years. In as much as there are drugs that could reduce the negative effects of type 2 diabetes, prevention mechanisms have been cited as being more effective. Of particular importance would be adoption of healthy and appropriate feeding habits and daily engagement in physical activities that would keep away obesity and overweight, cited as major causes of type 2 diabetes, and increase insulin intake by beta cells. Works Cited Brill, M. T. Diabetes. Minneapolis, MN: Twenty-First Century Books, 2012. Kaku, Kohei. “Pathophysiology of Type 2 Diabetes and its Treatment Policy.” Journal of the Japan Medical Association 53.1 (2010): 41 – 46. National Center for Biotechnology Information. US National Library of Medicine. Type II Diabetes. Bethesda, MD: US National Library of Medicine, 28 June 2011. Web. 27 November 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/ Riaz, S. “Diabetes Mellitus: Review”. Scientific Research and Essay 4.5 (2009): 367 – 373. Wabitsch, M., et al. “Type II Diabetes Mellitus and Impaired Glucose Regulation in Caucasian Children and Adolescents with Obesity Living in Germany.” International Journal of Obesity 28 (2004): 307 -313. Web. 27 November 2012. http://www.nature.com/ijo/journal/v28/n2/full/0802555a.html Yaturu, S. “Obesity and Type 2 Diabetes.” Journal of Diabetes Mellitus 1.4 (2011): 79 – 95. Read More