Challenges of Type 2 Diabetes - Literature review Example

Diabetes mellitus is a cluster of endocrine diseases characterized by the bodys complete or partial inability to absorb glucose, the principal sourceof energy, from digested foods into cells (Harris, cited by DeCoster, 2001). The glucose, which remains unabsorbed, accumulates in the blood stream and damages the blood vessels and capillaries. Type I diabetes is also known as ‘juvenile diabetes’ or ‘insulin-dependent diabetes mellitus’. This develops when the body’s immune system destroys the pancreatic beta cells, which is responsible to make the hormone insulin to regulate the blood glucose. Insulin has to injected in to the body. In type II diabetes, the insulin secretion is less effective compared to the non-diabetics. It is characterized by hyperglycemia. Such patients also have altered metabolism of lipids, carbohydrates, and proteins, and it is associated with an increased risk of vascular disease (Jachak cited by Kelble, 2005). This is initially treated through diet, exercise and oral medication, although insulin may be required if this does not help to control the disease. Diabetes has been ranked as the sixth leading cause of death and the costliest chronic disease in the US (Rizvi, 2005). As per the statistics provided by the American Diabetic Society (2005), more than 20 million Americans have diabetes while one in three have not been diagnosed. A survey by the National Health and Nutrition Examination revealed that almost 21% of the people above the age of 60 have diabetes while only 9.6% above the age of 20 years suffer from this disease. Type 1 diabetes was prevalent in approximately 1 in every 500 children and adults that were diagnosed. With age, the risk of diabetes also increases. African Americans fall under the high risk category compared to the white Americans for type 2 diabetes. The ratio of white Americans to African Americans for type 2 diabetes is 1:1.6. The diabetic complications too affect the African Americans much more than the white Americans with diabetes (BHC, 2000). A study by Jenkins (2003) revealed that about one in four African American women over the age of 55 years have diabetes, which is almost double the rate of white women (Jenkins, 2003). Reduced physical activity and increased calorie intake are the main causes for such high proportion of this disease affecting the people in US. Risk for diabetes increases as one gets older, gains too much or has a sedentary lifestyle. The ethnic population, which includes African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders are highly susceptible to type 2 diabetes. The common symptoms of diabetes which people often ignore are frequent urination, thirst, and weight loss without intending to do so. People with blood pressure above 130/80 or with a family history of diabetes are more prone to it than normal people. Even a woman having a baby weighing more than nine pounds at birth falls into the high-risk category of diabetes. Gestational diabetes may occur during pregnancy as it is a temporary condition of glucose intolerance, but a large study found that more than half the women who had gestational diabetes ultimately ended up with type 2 diabetes (Lewis, 2002). The risk for diabetes increases as the body mass index (BMI) increases. There are three ways to diagnose diabetes - fasting plasma glucose, casual plasma glucose, and the oral glucose tolerance test. The pre-prandial glucose range should be between 90-130 mg/dl. If the postprandial plasma glucose exceeds 180 mg/dl, it calls for Glycemic control. Diabetes leads to various diseases like retinopathy, neuropathy, kidney problems, high cholesterol, and cardiac diseases. A new fixed-dose medication, Avandaryl (TM), is expected to improve blood sugar control in type 2 diabetes (Nazor, 2006). An insulin pump has also been devised which delivers insulin at a preprogrammed basal rate. It improves glycemic control while reducing the risk of serious hypoglycemia (Rizvi). Scientists and doctors alike agree on the side effects that medications cause. The non-pharmacological medical therapy for type 2 diabetes should include regular monitoring of blood glucose to adjust therapy, space between meals, physical activity, and adjustment of diet. The calorie intake would depend upon age, weight and the level of activity. Control of the blood glucose level is the most effective approach to treatment as medication has side effects. Home monitoring of glucose levels several times a day is advised. Apart from the dietary guidelines, the diabetics should be informed of the symptoms of hypo/hyperglycemic and the reactions. They should also be educated on the cause of the fall and rise of the blood sugar levels. Stress management has been found effective in keeping the blood glucose level within limits. Gestational diabetes increases the risk of the baby growing larger than he would have been and a large baby could mean complicated delivery (Lewis). This requires prompt treatment. According to Clark et al., (2004), obese people are more likely to be affected with type 2 diabetes than normal-weight people are. Obesity causes resistance to insulin and concentration of the blood glucose. Weight loss, on the other hand, helps improves glycemic control, improves insulin action and may result in reduced medication. It reduces other risk factors like cardiovascular disease as the blood pressure decreases. Physical activity automatically increases as weight reduces and the lifestyle undergoes a change. Exercise helps reduction of weight, improves the lipids, and lowers the blood pressure, which proves that there is a direct mechanism between exercise and blood glucose level, although type 2 diabetics should avoid exercise if the systolic BP exceeds 180-200 (Diabetes Care, 2003). They may have to progress gradually as the body stamina increases. If blood glucose can be controlled in the pre-diabetes stage, diabetes can be delayed or prevented altogether (Gavin, 2003). However, US Researchers have developed the oral glucose tolerance test to identify people at high risk of developing type 2 diabetes. The concentration of glucose in the blood samples are measured over 2 or 3 hours after making the patient drink high concentration glucose solution (Sue, 2002). Once the high-risk individuals have been identified, they are given behavioral and pharmacological interventions to prevent them from developing diabetes and the numerous complications. Lifestyle modification, especially exercise has found to be effective in prevention of type 2 diabetes. Research has also shown that progression of disease could be reduced by as much as 58 % by pre-diabetic patients who reduced their weight. Physical activity itself lowers the incidence of diabetes. Research has shown that women who drink two or more cups of coffee everyday have a lower risk of type 2 diabetes irrespective whether the coffee was caffeinated or decaffeinated (Dam, 2006). Women who drink alcohol in moderate amounts also have a reduced risk of type 2 diabetes (Beulens, 2005). As far as type 1 diabetes is concerned, blood tests for specific genes help to determine if the individual is susceptible to type 1 diabetes. Rodgers (2002) cites the results of a study that concluded that low-dose insulin injections have been found unable to prevent type 1 diabetes in people whose insulin secretion is low. Such people fall under the high risk category. Nevertheless, because of researches, predictions can be made about the risks and the immune events that lead to diabetes. Further research is going on to test whether this can prevent type 1 diabetes in those who fall under the low risk category within 5 years. Scientists believe that this may help to prevent diabetes because the immune cells that line the digestive tract learn to recognize the insulin in a different way. The immune responses develop that delay the onset or progression of diabetes or may even prevent it altogether. If diabetes is accepted as a way of life and not as a disease, it will be easier for the individual, the family and the social workers to handle this. With modifications in lifestyle, inclusion of physical activity as a daily routine, diet regulation, and regular monitoring of the blood sugar level, people have been known to lead a near normal life. Knowledge, treatment options, and technology are available but metabolic goals have to be specified and adhered to. It is essential for people with diabetes to take care of themselves. References: American Diabetes Association (2005), National Diabetes Fact Sheet, 02 April 2006 Beulens J W J (2005), ADA, Drinking Alcohol Decreases the Risk of Type 2 Diabetes Among Older Women, 02 April 2006 BHC (2000), Diabetes in African Americans? 02 April 2006 Clark et al., Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies, Diabetes Care, ADA, 02 April 2006 Dam R M (2006), ADA, Drinking Coffee Can Help Lower the Risk for Type 2 Diabetes in Women, 02 April 2006 Decoster V A (2001), CHALLENGES OF TYPE 2 DIABETES AND ROLE OF HEALTH CARE SOCIAL WORK, A Neglected Area of Practice, Journal Title: Health and Social Work. Volume: 26. Issue: 1. Publication Year: 2001. pp 26. Diabetes Care (2003), ADA, LatinoSlidesAugust05.ppt Gavin J R (2003), Diabetes: Introduction, Ebony. Volume 58 Number 5. 2003. pp 63-65 Jenkins J H (2003), African American health issues, Reference Services Review Volume 31 Number 4 2003 pp. 359-373 Kelble A (2005), Spices and type 2 diabetes, Nutrition & Food Science, Volume 35 Number 2 2005 pp. 81-87 Lewis C (2002), Diabetes: A Growing Public Health Concern, FDA Consumer. Volume 36 Number 1 2002 pp 26-27 Nazor N (2006), Avandaryl: New Combined Drug for Type 2 Diabetes, 02 April 2006 Raphael et al., (2003), The social determinants of the incidence and management of type 2 diabetes mellitus, Leadership in Health Services Volume 16 Number 3 2003 pp. 10-20 Rizvi A A (2005), Current trends in diabetes management, JAAPA, VOL.18, NO. 8 AUGUST 2005 pp 23-29 Rodgers G (2002), Type 1 Diabetes Prevention Trials, National Institute of Diabetes and Digestive and Kidney Diseases, 02 April 2006 Sue W (2002), A new technique for identifying risk for type 2 diabetes? The Lancet 359.9315 (April 20, 2002): 1411. British Council Journals Database. Thomson Gale. 01 April 2006 Read More