Diabetes Mellitus Type II - Report Example

Diabetes Mellitus Type II Diabetes Overview The carbohydrates, as well as other food groups consumed in every meal,are converted in the body into glucose. When this glucose is in the blood, it is referred to as blood sugar. This is the sugar that the cells use for metabolism and they must, therefore, absorb it from the blood that bathe them. An optimum level of blood glucose must be maintained for proper functioning of the cells and the body. This means that when the cell cannot take up glucose from the blood, a high concentration of this important substrate for metabolism exist and the cell metabolism is affected (Drouin et al., p. 65). To ensure that the sugar levels in the blood are stabilized, the pancreas produces and releases insulin into the circulation. Insulin is a hormone that enhances the uptake of glucose by the cells. Diabetes mellitus is a metabolic disorder in which the blood has higher than normal concentration of blood sugar (glucose). Physiologically, the disease is characterized by a sharp negative nitrogen balance, increased blood glucose (hyperglycemia), glycosuria, and ketoacidosis in severe cases. There are two major types of diabetes mellitus. These are diabetes type I and diabetes type II (Atkinson, Eisenbarth, and Michels, p. 76). These two types differentiated by the cause, onset of disease, manifestation as well as the treatment modalities. Diabetes type I, also called juvenile diabetes is diagnosed early in childhood and young adults. Statistics indicates that approximately 3 million Americans suffer from type 1 diabetes. The disease is caused by failure of the body to produce insulin. It, therefore, occurs when the body fights and destroys the pancreatic cells responsible for insulin production. Treatment, therefore, involves administration of synthetic insulin. The patient must remain insulin dependent for the rest of their lives. Diabetes type II, which is the main focus of this report, has an adult onset. This means that at one time, the control of blood sugar is normal but later the control is lost. Type II diabetes is a common condition among African Americans, Latinos, Asian Americans, and Native Americans (Deshpande, Harris-Hayes, and Schootman, p. 1268). Among all populations, the disease is common in the aged population. In the USA, almost 37 million people (about 38.2% of the American population) have type 2 diabetes. Pathophysiology of Diabetes Type II Type II diabetes occurs when there is adequate insulin being produced by the body, but the peripheral tissues cells become non-responsive to insulin. It can also occur when, due to age or systemic diseases, the pancreas cannot produce enough insulin. These factors cause a build-up of glucose in the blood as the cells cannot take up glucose. Sedentary lifestyle and poor diet can be contributing factors to the onset of diabetes type II. This is closely tied to the excess consumption of sugars that makes the pancreas overproduce insulin and eventually wear off and become less effective. The incidence is also related to obesity and build-up of body fats which also contributes to the reduction in the cell response to insulin (Alsahli and Gerich, p. 310). Build-up of glucose in the blood means that there is no enough glucose entering the cells for metabolism. With less than enough glucose in the cells, normal metabolic processes are adversely affected and the body has to survive on insufficient source of energy. This implies that the available energy is only used for vital processes and the patient feels weak and lethargic. This causes inability to perform normal duties. The blood sugar increases to a level that the body has to try and eliminate the excess through the kidneys in urine. This is the cause of glycosuria, a common symptom in diabetes. In addition, the excretion of sugars in urine depletes the body of the water reserves and the patient has a constant feeling of thirst coupled with polyuria (American Diabetes Association). Hyperglycemia has other adverse effects that cause the onset of fatal and life-threatening complications of diabetes. First, the insufficiency of glucose for metabolism sometimes reach a point when the vital organs such as the brain have to use alternative sources of substrates for metabolism. The most common alternative is the use of ketone bodies and fats as substrates. The effect of this is increased production of ketoacids to the brain causing brain damage. Ketoacidosis leads to a diabetic crisis which is a medical emergency. Secondly, increased glucose in the blood provides a suitable environment for the growth of bacteria and other pathogenic microorganism. This is the main reason for the increased incidence of teeth and gum disease as well as the slowed healing of wounds associated with diabetes mellitus. Failure to heal of peripheral and extremities wounds often lead to gangrene and eventual amputation in poorly managed diabetes (American Diabetes Association). The most common clinical manifestations of diabetes mellitus are lethargy, fatigue, increased thirst feeling, increased frequency of micturition, ketone breath, breathing difficulties, poor healing of wounds and increased incidences of infection of the gum and teeth. In addition, blurred vision, tingling and numbness and skin infections are also common. The disease often complicates to diabetic nephropathy, retinopathy and ketoacidosis crisis. Treatment for Diabetes Type II Patients suffering from diabetes mellitus type II will always require to consume a regulated diet and maintain a healthy and active lifestyle. In addition, oral medications for the pharmacological treatment of the disease are available. Drugs such as Thiazolidinediones, Alpha-glucosidase inhibitors, synthetic Insulin, Sulfonylureas, Meglitinides and GLP-agonists have been used to control blood sugar in diabetes type II. Thiazolidinediones such as Pioglitazone are drugs whose action makes the body cells more sensitive to the little insulin that the body produces. The drugs are available as a once a day dose. They cause the glucose receptors on the cell surfaces to be more responsive to endogenous and synthetic insulin administered. Alpha-glucosidase inhibitors are drugs that cause a reduction in the activity of Alpha-glucosidase, an enzyme necessary in the absorption of the carbohydrates in the alimentary canal. The drugs, therefore, slows down the absorption of carbohydrates and hence help control blood glucose. Example of these drugs commonly used are Acarbose (Precose) and Miglitol (Glyset) (Alsahli and Gerich, pp. 299-308). Biguanides are drugs that reduce the release of glucose from the liver after metabolism. Metformin, a biguanide, is recommended as a first-line drug in the treatment of the disease. It has been associated with a decrease in mortality rate related to diabetes. Synthetic insulin in type II diabetes is used as a long-acting formulation together with oral drugs. Sulphonylureas are also important drugs in the management of diabetes mellitus type II. These drugs act by stimulating the active cells in the pancreas to produce more insulin to facilitate uptake of glucose by cells. These drugs include Glimepiride, Micronized glyburide and Glyburide (Alsahli and Gerich, p. 312). In addition, patients suffering from diabetes mellitus need to exercise a strict dietary modification. This ensures that the patient’s body has a restricted intake of carbohydrates. Specifically, direct and simple sugars are restricted and all the carbohydrates consumed by the patients must be less easily absorbed in the body. This ensures that the body does not acquire high levels of blood sugars in rapidly after meals and that the body has time to absorb the glucose in the blood. Further, the patient should undergo comprehensive medical counselling and education to ensure strict adherence to the medication regime and the dietary modification. When the disease is associated with obesity and sedentary lifestyle, modification of the lifestyle is an important treatment modality. Finally, it is necessary for information to be passed on the complications of the disease and measures to avoid them (Deshpande, Harris-Hayes, and Schootman). Diabetes type II is associated with both genetic and environmental factors. Genetically predisposed persons are at a higher risk of developing the disease. This likelihood is increased when environmental factors of the sedentary lifestyle, diabetic promoting diet and pancreatic disrupting drugs. When these factors are controlled, the risk of developing diabetes is reduced. Current research is focused on reducing the dependence on synthetic insulin and helping the pancreas increase its production of insulin. Works cited Alsahli, Mazen, and John E. Gerich. “Hypoglycemia in Diabetes Mellitus.” Principles of Diabetes Mellitus. N. p., 2010. 297–312. American Diabetes Association. “Diagnosis and Classification of Diabetes Mellitus.” Diabetes care 34 Suppl 1 (2011): S62–9. Atkinson, Mark a, George S Eisenbarth, and Aaron W Michels. “Type 1 Diabetes.” Lancet 383 (2014): 69–82. Deshpande, Anjali D, Marcie Harris-Hayes, and Mario Schootman. “Epidemiology of Diabetes and Diabetes-Related Complications.” Physical therapy 88 (2008): 1254–1264. Drouin, P et al. “Diagnosis and Classification of Diabetes Mellitus.” Diabetes care 32 Suppl 1 (2009): S62–7. Read More