Present Discourse on Diabetes - Research Paper Example

 Diabetes Diabetes is a medical condition in which blood sugar levels are high because of improper functioning of the pancreas. The present discourse elaborates on types of diabetes, statistics and risk factors associated with this condition. Further, it explores different complications caused by diabetes on other parts of the body like the brain, heart, eyes, nervous system and limbs. Lastly, different treatment mechanisms associated with these complications have been highlighted. Introduction Diabetes is a condition characterized by elevated blood sugar levels, also known as hyperglycemia. The diagnostic symptoms of diabetes include increased frequency of urination, excessive thirst, blurred vision, tiredness etc. In a normal person, special pancreatic cells called the beta cells produce insulin. Insulin is required for glucose metabolism, which involves conversion of glucose to energy; this energy is utilized by the body for its normal functioning. In diabetic patients, the glucose metabolism gets disturbed and it leads to dysfunction of various organs. Types of Diabetes: As explained in the Diabetes Overview (2008), diabetes is categorized into three types, Type 1, Type 2 and gestational diabetes. Type-1 diabetes occurs when pancreas do not produce the hormone, insulin. The causative factors for pancreatic dysfunction could be autoimmune reactions, genetic abnormalities or even viral infection of the pancreas. Type-1 diabetes usually begins during childhood or adolescence. Type-2 diabetes is the most common type and begins at later age, usually after 40 years. This condition is caused when the pancreatic glands do not produce enough insulin for blood sugar metabolism, thereby increasing the blood sugar levels in the body. The third type is gestational diabetes that develops in women during pregnancy. This condition usually disappears after delivery, but may continue in some women as Type-2 diabetes. Worldwide incidence of diabetes: The WHO fact sheet as of 2011 reports that more than 220 million people suffer from diabetes in the world. Research and statistics indicate that the number of people developing diabetes will double in next two decades. A research conducted by Wild et al (2004) indicated India, China and the USA as the three countries with highest numbers of diabetes patients in the world; this research also predicted these countries to still remain the highest in the same order by 2030 of people suffering with diabetes. Risk factors for diabetes: The risk factors for Type-1 diabetes include hormonal imbalance, malnutrition, and viral infection of the pancreas. Risk factors for Type-2 diabetes include age, obesity, stress, lack of physical activity, and hypertension. NIH reports indicate that specific geographical regions and races are highly prone to Type-1 diabetes (Diabetic Overview, 2008). In some cases antipsychotic drugs such as Clozapine, Olanzapine, Quetiapine, Risperidone, Ziprasidone etc induce Type-2 diabetes (Mendelson, 2007). Implications of diabetes: Clinical symptoms associated with Type 1 and Type 2 diabetes include polyuria, polydipsia, weight loss, increased hunger, decreased vision; in severe cases the symptoms may progress to diabetic coma due to ketoacidosis (Diabetic Overview, 2008). Besides these symptoms, diabetes causes severe complications to other organs and their functions. Patients with prolonged diabetes suffer from decreased brain functioning in terms of memory, information-processing speed of understanding, and decreased cognitive ability. Secondly, insulin dysfunction causes hypertension, obesity, and abnormal levels of lipids in the blood; this condition is termed as metabolic syndrome. In the brain, few lacunar lesions and atrophy of the medial temporal lobes have been found in few cases. Abnormal hippocampus and/or amygdalar volume has also been found, which could be the cause for decreased cognition. Increased incidence of Alzheimer’s disease is also associated with diabetes mellitus. Diabetic patients are highly prone to stroke due to risk of atherosclerosis (Ahtiluoto et al, 2010). Diabetes can cause cataract, glaucoma and even corneal disease; all these conditions result in decreased vision (Klein R, Klein BEK & Moss 1995). In kidneys, prolonged and uncontrolled diabetes leads to diabetic nephropathy; this condition is marked by progressive decrease in glomerular filtration rate and increased microalbuminemia. Nephropathy progresses slowly and is characterized by high intraglomerular pressure caused by formation of high angiotensin-II (Burke 1997). In its advanced stage, nephropathy results in end-stage renal disease (ESRD), which is highly complicated and the cause of death in most people with Type-1 and Type-2 diabetes. Turner et al.’s (1998) study on Type-2 diabetic patients inferred that elevated blood sugar levels and abnormal lipoprotein cholesterol are high-potential risk factors for coronary artery disease. Decreased blood supply to various parts of the body results in complications like loss of sensation and numbness; it can also cause calluses, ulcers etc. The severity of foot-related complications keeps progressing in diabetics. Initially, the complication starts as superficial lesion followed by superficial ulcer; then the lesion extends deeper touching the bone, ligament, joint capsule or tendon; the next stage involves deep abscess, osteitis or osteomyelitis, which in the next stage becomes gangrenous; in the last stage, the complete foot might get infected with no signs of healing (Steinberg, Werber & Kim, 2009). Treatment of diabetes and its secondary complications: The best treatment option for diabetes is to control hyperglycemia by adopting a healthy life style. Management of Type-1 diabetes involves insulin shots and Type-2 involves insulin medicines. However, treatment of the secondary complications is very complex and specific. ‘Treatment of eye-related problems in diabetic patients requires laser treatment or vitrectomy,’ (Tan & Donnelly, 2009; p.32). Control of blood glucose and blood pressure can prevent eye-related problems in diabetic patients. Prevention and treatment of kidney-related complications involve bringing the blood glucose level to normal. Secondly, angiotensin converting enzyme (ACE) inhibitors in combination with non-hydropyridine calcium channel blockers are recommended. In advanced stages of nephropathy, i.e. in ESRD, usually dialysis and kidney transplantation are recommended. Dialysis is highly complicated and very expensive; it is also very cumbersome for the patients and their families (Burke, 1997). Prevention and control of cardiovascular disease in diabetic patients involves regulation of blood sugar and blood pressure levels. Diabetic foot requires prophylactic care in order to avoid exacerbation of the issue that may eventually require amputation. Treatment for diabetic foot involves debridement of the infected fibrotic tissue. Various debridement methods are employed depending upon the extent of the complication. At early stages of foot complications topical treatment with paste, ointment etc is employed. In advanced cases, the wound is offloaded and weight bearing on the feet is reduced by using foot devices such as total contact cast, removable cast walkers, wedge shoes, extra depth shoes etc. Amputation is suggested in most advanced stages of diabetic foot (Steinberg et al, 2009). Conclusions In conclusion, diabetes is a serious health complication with a potential to cause long-lasting morbidity and mortality. In this condition blood sugar level is elevated because of improper functioning of the pancreas, as in Type-1, and insufficient insulin, as in Type 2. Both Type 1 and Type 2 diabetes are very common owing to genetic factors, unhealthy life style, improper eating and inadequate physical activity. Both types of diabetes can cause severe complications by affecting other vital organs of the body. From literature and research, it is evident that diabetes can affect the central and peripheral nervous system, cardiovascular system, the kidneys, and even the limbs. Treatment and management of complications caused by diabetes is complex and expensive; in extreme cases these complications can even cause death of the patient. Hence, it is crucial to maintain a healthy life style, which can be done by performing adequate physical activity, regular exercise, maintaining appropriate weight, and taking a healthy diet. References Ahtiluoto, S et al. (2010). Diabetes, Alzheimer disease, and vascular dementia: A population- based neuropathologic study. Neurology. 75(13), 1195-1202. Retrieved March 12 2011 from,http://www.natap.org/2010/HIV/diabetsAD.pdf Burke, J.M. (1997). Approach to the Treatment of Diabetic Nephropathy. In Wilson, A (Ed.) Managing the patient with type II diabetes. (pp: 25-32). Maryland: Aspen Publishers Inc. Retrieved March 8 2011 from, http://books.google.co.in/books?id=NiKUGHtQrvsC&pg=PA25&dq=treatment+for+diabetic+nephropathy&hl=en&ei=0CZ3TaqLLsnsrQfI-oW_Cg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CEIQ6AEwAA#v=onepage&q=treatment%20for%20diabetic%20nephropathy&f=false Diabetes Overview. (2008). National Diabetes Information Clearinghouse. NIDDK, NIH. NIH Publication No.09-3873. Retrieved March 13 2011 from, http://diabetes.niddk.nih.gov/dm/pubs/overview/ Klein, R, Klein, BEK and Moss, MA. (1995). Age-Related Eye Disease and Survival: The Beaver Dam Eye Study. Archives of Ophthalmology. 113:333-339. Retrieved March 13 2011 from http://archopht.ama-assn.org/cgi/reprint/113/3/333 Mendelson, S. (2007). Metabolic syndrome and psychiatric illness: interactions, pathophysiology, assessment and treatment. Massachusetts: Academic Press Publishers. Retrieved March 8, 2011 from, http://books.google.co.in/books?id=yhyhUZ448f0C&pg=PA81&dq=Clozapine+olanzapine+risperidone+quetiapine+and+ziprasidone+induce+diabetes&hl=en&ei=x353TczhE4fnrAfujbG_Cg&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFEQ6AEwBg#v=onepage&q&f=false Steinberg, J.S, Werberg, B and Kim, P.J. (2009). Bioengineered Alternative Tissues for the S urgical Management of Diabetic Foot Ulceration. In Zgonis, T (Ed.) Surgical Reconstruction of the Diabetic Foot and Ankle. (pp: 100-118). Philadelphia: Lippincott Williams & Wilkins Publication. Retrieved March 9, 2011 from http://books.google.co.in/books?id=LJIgAh0DESEC&pg=PA100&dq=treatment+of+diabetic+foot&hl=en&ei=lcF4TbfqNYXYrQeS14G7BQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CFAQ6AEwAg#v=onepage&q=treatment%20of%20diabetic%20foot&f=false Tan, G and Donnelly, R. (2009). Diabetes and Vascular disease. In Donnelly, R and London, N.J.M (eds.) ABC of Arterial and Venous Disease. (2nd ed., pp: 31-36). West Sussex, UK: John Wiley and Sons Ltd. Retrieved March 9, 2011 from, http://books.google.co.in/books?id=qXSmB8wv4oQC&pg=PA32&dq=diabetes+causes+nephropathy&hl=en&ei=cSB3TfuCBMrlrAfH5P2-Cg&sa=X&oi=book_result&ct=result&resnum=9&ved=0CHUQ6AEwCA#v=onepage&q=diabetes%20causes%20nephropathy&f=false Turner, R.C et al. (1998). Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study. British Medical Journal. 316: 823-828. Retrieved March 13 2011 from, http://www.bmj.com/content/316/7134/823.full.pdf WHO. (January, 2011). Diabetes. Media centre. World Health Organization. Retrieved March 8, 2011 from, http://www.who.int/mediacentre/factsheets/fs312/en/ Wild, S et al. (2004). Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. DIABETES CARE. Vol: 27, No. 5, pp:1047-1033. Retrieved March 8, 2011 from, http://www.who.int/diabetes/facts/en/diabcare0504.pdf Read More