Type 2 Diabetes Mellitus - Essay Example

Type 2 Diabetes Mellitus Name: University: Tutor: Course: Date: Introduction “Type 2 Diabetes Mellitus is one of the most common diseases affecting human beings all over the world” (WHO Expert Committee on Diabetes Mellitus, 1998). Type 2 Diabetes Mellitus is a common disease that is characterized by hyperglycemia. Hyperglycemia is the increased blood sugar level in the blood. In a normal human being, the blood sugar levels are controlled by insulin, a hormone produced in the body. The Diabetes comes about when the body does not produce insulin as it is required of it or the insulin is produced but the body just does not respond to it as it should. The physical symptoms that can be observed are: frequent passing of urine (which is a condition known as polyuria), increased intake of water due to increased thirst (a condition also known as polydipsia) and a general increase in hunger and thus an increase in the food intake of the patient (polyphagia) (Hoet et al, 2010). Diabetes in humans is brought about by various factors. These are: Genetic factors (in most cases, Diabetes runs in the family), and the life style of the patient. This includes the diet and frequency of valid exercise. A good diet should consist of sufficient quantities of fruits and vegetables. Incorporation of fruits and vegetables in the diet can significantly reduce the risk of type 2 Diabetes Mellitus and can also go a long way in the management of the disease in the case of a person who already has the disease (Campbell et al, 2010). Generally, studies have shown that the risk of getting diabetes increases with age and is more prominent in women than in men. Figure 1: Graph showing the increase of diabetes cases with age increase (Bar-on H et al, 2010) Type 2 Diabetes Mellitus- Description Type 2 Diabetes Mellitus is one of the various types of Diabetes that affects humans present today. “This type of Diabetes is brought about either by lack of enough insulin being produced for the body’s needs or by the resistance of the insulin produced by the body cells thus rendering it useless in the body” (Campbell et al, 1993). The cells that are most identified with resistance to insulin are fat cells and muscle cells. Type 2 Diabetes Mellitus is characterized by various symptoms. The most common give away of this kind of Diabetes is the increased blood sugar levels in the patient’s body. The excess blood sugar that is not able to be reabsorbed back into the body is disposed off in the urine of the patient thus the patient’s urine is sweet. This condition is referred to as glycosuria. Other symptoms that may signal the presence of type 2 Diabetes are increased thirst, fatigue, increased need to pass urine and unexplained weight loss. The weight loss comes about due to the cell’s resistance to the effect of insulin. Insulin aids in the transport and absorption of glucose by the bodies cells from the intestines during digestion. The presence of Diabetes in the body could also make the body susceptible to infections such as sick infections and so on. Type 2 Diabetes Mellitus has also be observed to significantly increase the risk of the patient succumbing to cardiovascular disease. Generally, type 2 Diabetes Mellitus is caused by genetic factors and/or poor lifestyle (Hoet et al, 2006). Type 2 Diabetes Mellitus was known to affect adults who were well over 40years of age. This statistic has changed drastically overtime. These days, there are reported cases of diabetes in younger children, adolescents and young adults. This has been linked to the change in diet and lifestyle over the years. There has been an increase in obesity in the general population especially the younger people (Himsworth, 1963). The most common cause of Diabetes is genetics. A person with a family history of diabetes is at a higher risk of getting diabetes. Some races and tribes are also more susceptible to the disease than others. Women are at higher risk than men are of getting T2DM. The main contributory factor is that most women suffer from gestational diabetes and this increases their risk of getting diabetes after a few years. This can be shown graphically as below: Group No. Follow-up (yrs) % Type 2 Navajo Indians 111 11 53 %* Copenhagen 345 5.9 13 % Sweden 145 3-4 3.4 % Australia 881 17 40 %* US Latinos 671 6 55 % Trinidad 60 3.5-6.5 62 % Zuni Indians 94 6 36 %* Table 1: Percentages of women who had their diabetes recur after they have had gestational diabetes (De Vegt F et al, 1997). The table shows the approximate number of women who end up getting diabetes after gestational diabetes. The table also shows different races and tribes. We can see from this table that the indigenous people (Trinidad, Latinos, and Navajo Indians) have the highest risk of getting diabetes. They had over 50% chance of getting diabetes. This is different with the population from urban areas like Copenhagen where the percentage was just a mere 13%. Type 2 Diabetes Mellitus in Australia Globally, Type 2 Diabetes Mellitus has been placed in the list of the most important health problems. It affects populations all over the world irrespective of their tribes and races though there has been research that shows some tribes and races are more prone to Diabetes than others. It causes many deaths each year mainly due to cardio-vascular related complications, kidney failure and amputations (legs). Diabetes also affects the eyesight in its advances stages (Health Insite, 2002). In Australia, Type 2 Diabetes is considered one of the six most prominent diseases affecting Australians. A survey carried out by the World Health Organization and the International Diabetes Institute showed that the number of people with diabetes is gradually growing every year. The survey gave figures of approximately 1.23 million Australians with Diabetes in the year 2010. This is quite a number considering the population of Australia which is approximately 20 million. This is about 6% of the population with diabetes in Australia only. In the year 2000, ten years ago, the number of Australians with Diabetes was documented to be approximately 940,000. These figures show an increase in the cases of Diabetes reported. This drastic rise in the number of people with diabetes is shown graphically below (Diabetes Mellitus-Australian Institute of Health and Welfare, 2010). Figure 2: Graph showing the increase in the number of Australians with Diabetes over the years (Amos et al, 2002). These results are alarming and measures should be taken to reduce the number of people getting diabetes. The health policies of Australia are dedicated to improving the health of the citizens. There is a range of service providers, both public and private that have joined together to make a good health care system called Medicare. Some of the policies that Medicare looks in to are provision of hospital programs and care, taking care of the groups classified as special needs groups or those who are considered high risk groups, reduction of exposure to health endangering activities and situations among the citizens and education of the public to enable them to make informed decisions when dealing with issues regarding their health (Oliviera et.al, 2005). This increase in the occurrence of Diabetes in the Australian population is directly linked to the changing trends in lifestyles of the modern Australians. This includes the types of foods they are eating and the frequency of exercise. In today’s modern Australia, many children are exposed to fast foods with a lot of unhealthy saturated fats thus leading to obesity at a very young age. Many young people in Australia do not incorporate the required amounts of fruits and vegetables in their diets and have hardly any time to exercise. Most Australians work in offices where they sit all day and use vehicles to travel to and from work. This is a very unhealthy lifestyle. The lack of a well balanced diet and regular exercise accelerates the occurrence of Diabetes in humans. This is what is happening in Australia today (Australian Diabetes Society, 2000). This situation is soon going to get out of hand as diabetes is one of the diseases considered to raise the mortality rate in Australia. In one year alone, diabetes can cause up to 2,500 deaths in Australia alone. These statistics are saddening putting into consideration that diabetes is a manageable disease and it is not a death sentence. Figure 3: Graph showing the number of deaths that occur annually due to diabetes in Australia (Amos et al, 2002). The graph above shows the number of deaths that are brought about by Diabetes every year in Australia. It can be observed that the mortality rate is increasing year by year especially if the death was from complications of diabetes (Diabetes as a multiple cause of death) (Oliviera et al, 2005). Type 2 Diabetes Mellitus among Aboriginal Australians When talking about Diabetes in Australia, one cannot leave out the Aboriginals in Australia. “Diabetes is one of the factors that separate the Aboriginal Australians from the non-aboriginal Australians” (Campbell et al, 1993). Studies have shown that Aboriginal Australians have a higher tendency of getting Diabetes than non-Aboriginal Australians. Aboriginal women have a higher risk of getting Diabetes over Aboriginal men. The Aboriginal population is more affected by diabetes than the regular Australian mainly because of their genes. It has been found that various races and tribes are at higher risks of getting Diabetes than others (My Doctor.com- Diabetes, 2003). This is the case with the Aboriginal Australians. Other than their genetic makeup, there are still other factors that expose the Aboriginal Australians to Diabetes. These are their eating habits and diet, low standards of living, lack of accessible medical care and low weight of infants at birth (Better Health Channel, 2009). Originally, the “Aboriginal Australians were hunters and gatherers” (Amos et al, 2002). Their bodies had mutated to suit their lifestyle then and their lean eating habits. During the past years, the Aboriginal Australians have survived on a low calorie diet and involving physical activity thus their bodies were not used to high levels of glucose. As civilization is catching up with them, their diet and exercise levels have significantly changed over the years. The readily available foods are high in glucose and their bodies are not able to adapt to the sudden change in diet. This situation in most cases leads to diabetes and the lack of vigorous exercise leads to obesity which does not help the diabetes situation. Their children are the most affected as they lack adequate nutrition during childhood thus increasing their chances of getting diabetes when older. Studies have shown that “Type 2 Diabetes is high among Aboriginal women as compared to men” (Amos et al, 2002). This is because of the obesity levels among the women. It also brought about by the fact that most Aboriginal women have fat deposited around the stomach area. This is also a factor that increases the risk of diabetes. The women also are at a high risk of falling back to diabetes later in their lives if they had suffered from it during pregnancy if they do not have access to good management. The low socioeconomic status of the Aboriginal Australians does increase their exposure to practices that could bring about diabetes. Their low socioeconomic status also limits their access to good medical care and knowledge on management of diabetes once they get it. This puts them at the most disadvantaged group in Australia (Oliviera et al, 2005). Figure 4: Graph showing the prevalence of diabetes among the Aborigines in Australia as compared to regular Australians (Oliviera et al, 2005). The graph above shows that the Aborigines have a recorded higher risk of getting diabetes especially in their older ages of 55 and over. The non-Indigenous Australians have a way lower risk of getting diabetes. Type 2 Diabetes Mellitus among Aboriginal Australians in the city of Playford The Australian Bureau of statistics has rated the city of Playford one of the most socio-economically disadvantaged area. The income level of most of Playfords families is below $26,000 annually. This is a very low income compared to people in other areas in Australia. In Playford, there are several government initiatives that are dedicated to supporting the population to access food easily. This shows that there is a huge problem of food availability especially in the interior parts of Playford where the transport network is not very developed. This lack of reliable transport network can alienate the locals in these areas from not only fruits and vegetables but access to good medical care, education and good employment (Amos et al, 2002). A large portion of the population of Playford is made up of the Aboriginal Australians. These Aborigines live in the remote areas of Playford thus they are the ones who face the challenges of obtaining cheap food supplies and medical services when needed. This could be the reason why they do not have access to fruits and vegetables. They (the Aborigines) being the ones at high risk of diabetes are the most affected by this lack of fruits and vegetables. They have problems dealing with obesity and this increases the diabetes risk further (Amos et al, 2002). The city of Playford has set up programs aimed at general enlighten of the Aborigines so that the development does not alienate them. “Centres such as Marni-Waeindi, which is considered an Aboriginal and Torres Strait Islander Transition Centre” is a good example. Such centres can be used for the education of the Aborigines on why they are at higher risk of getting diabetes and the measures they should take to prevent early onset of the diabetes and also on management of diabetes for those who already have it. This education of the public can go a long way in the reduction of the number of deaths recorded from diabetes related complications such as kidney failure. Through these centres, the community can be taught the importance of changing their diet for the better by incorporating more vegetables and fruits. They can also be taught the need for regular exercise. The women can also be taught the importance of getting pre-natal care so as to avoid and manage gestational diabetes during pregnancy (Campbell et al, 1993). Importance of fruits and vegetables in the diet In relation to T2DM Type 2 Diabetes Mellitus is a disease characterized by high blood sugar levels. This sugar in the blood is glucose that is obtained from the food we eat. Carbohydrates produce most glucose. Glucose is essential in the body as it is the main energy source for the body, it fuels the body. However, the body requires glucose in regulated amounts. Thus the body produces insulin (a hormone produced in the pancreas) which is the chief blood glucose regulator. When a person has taken excess glucose, the insulin helps in its conversion to fats for storage. This fat is used in future in an incident where the body will have low blood glucose. The stored fats are converted to glucose so as to keep the blood glucose at a balance (Franz et al, 2010). Type 2 diabetes patients lack sufficient insulin or their body cells do not respond to the insulin produced thus the only option they have is to manually control their blood glucose by monitoring what they eat. There should be a balance in the diet such that the patient does not completely remove carbohydrates form the diet but only eats them in regulated amounts. The complete lack of glucose in the body will lead the body to wasting, thus the body will be using up its reserves to maintain the required glucose levels. The incorporation of fruits and vegetables in the diet comes in here. Fruits and vegetable do not have high glucose levels as compared to carbohydrates. A diabetic patient should be advised to significantly reduce the carbohydrate intake and add on the vegetable and fruit intake as well as protein intake. Proteins are also a better option when compared to carbohydrates. The incorporation of fruits and vegetables will ensure that the patient gets enough to eat and the blood glucose levels do not go out of hand. The fruits and vegetables will also ensure that the patient does not get to obesity, no matter how much fruit one takes. Obesity should be avoided in diabetes. The patient should be of reasonable weight (Diabetic Diet Management advice, 2007). Figure 5: Relative risk of type 2 diabetes in middle age with relation to Body Mass Index (weight) (Franz MJ. Et al, 2007). The graph above shows the gradual increase in the risk of diabetes with increase in weight (BMI) especially in women. This helps to emphasize the urgent need for the whole population to exercise and eat right (Schmidt et al, 2009). Survey method The Aboriginals in Australia should be educated more on diabetes if they are to learn how to manage the disease without much supervision. Before the education of the locals, it is wise to carry out a survey to help pave the right way for the education. The choice of the survey method to be used in every different survey is a very important decision and it various factors should be considered when selecting an appropriate survey method. For this survey, invites to complete a survey of fifteen questions will be sent via mail to the homes of fifty randomly selected Aborigines a week before the actual day of the survey. 75% of them will preferably be from Playford city and the other 25% from other cities for purposes of comparison of the survey results. The questionnaire can be seen in Appendix 1. To encourage the participants to participate in the survey, a reward of $100 will be promised to any participant who will complete the survey. The survey will take place at a local community centre where many Aborigines can be found especially on weekends. When choosing the people who will receive the invite, the age bracket of 25-54 years will be targeted. This is because this is the age bracket that has the highest recorded number of diabetes patients. The ratio of men to women will also be balanced. 80% of the participants can be Aborigines from Playford and the other 20% can represent Aborigines from other neighboring cities. The best location to carry out the survey will be the local community centre where most Aborigines can be found over the weekend. This location will be indicated in the invite that will be sent out. The survey will be carried out as a face to face interview in order to avoid sidelining any Aborigines who might have problems with writing English. The face to face interview will be carried out by trained staffs who are to explain the aim of the survey and why the Aborigines are a targeted group in this survey. The face to face interview was selected over other survey methods so as to minimize the possibility of sidelining some of the people who come to complete the survey due to factors like low education and writing skills, language barrier and culture. The trained staff that will be conducting the interviews should have some knowledge on the Aborigine language. This will help in the event of language barrier. The survey is aimed at finding out the Aborigine intake of fruit and vegetables and their reasons for their intake whether low or high. The survey is also aimed at finding out just how much the local Aborigines know about Type 2 Diabetes Mellitus so that the results can be used to map a way forward in the education of the locals on diabetes. After finishing the interview, each participant will receive the promised cash reward for taking their time to participate in the survey. There are some problems that are anticipated during the survey. The main problem that is anticipated is lack of trust. The Aborigines who received the invite might not show up for the interview due to lack of trust. The invite should contain a simple explanation of what the survey is about to help with this problem. The prize money is also aimed at the same. Other problems could be language barriers and low literacy levels. For analysis of the survey results, the frequency of fruit and vegetable intake can be tallied and an average reached. These results can be relayed to the community programs that have been set up by the council of the city to aid in the education of the community. The survey results will clearly show what the community knows and does not know and from this, a program for the education can be laid out. Conclusion Type 2 Diabetes Mellitus is a very common disease affecting millions all over the world. It is brought about by various factors like genetics, obesity, types of food and even some races and tribes are at higher risk of getting diabetes than others. This is the case with the Aborigines of Australia. Due to their genetic make up, they are at higher risk of getting diabetes that the regular Australian. Diabetes is a chronic disease thus management of the disease is the best option a patient has (Dunstan, 2010). For people who are almost certain they will get diabetes later in life due to the family genes, management of how one lives can also delay the manifestation of the disease. The aboriginals of Australia are considered people of low income as compared to the general population of Australia. They have low education levels and they do not have access to good medical insurance covers and care. These factors increase their risk of succumbing to the complications of diabetes. Due to the developing environment in which they live in (e.g. Playford), the type of foods accessible to the locals has changed overtime and the healthy options are being replaced by the unhealthier options. This does not help the Aborigines especially those from the ages of 24 and above (Dunstan, 2010). These are the people who are at highest risk of getting diabetes. Since most Aborigines have low levels of education, other avenues should be sought to make available to them the information on what is diabetes, its symptoms and how to manage the disease. Community based programs are the best option for this kind of grass root education. Community based programs have officers who can access the locals in their very own villages and be able to interact with them first hand. Before the education of the public is carried out, a survey should be undertaken so that the officers can know exactly what the locals do know and do not know. The survey results will help the officer’s plan for their sessions with the locals. The main focus of the education process should be they dietary change. This will enable the locals manage their diabetes without falling into any diabetes related complications. The locals should be taught the importance of incorporating fruits and vegetables in to their diets (Schmidt et al, 2009). This will help in their weight management and also in their blood glucose levels (Khan et al, 2005). The importance of regular exercise should also be emphasized. This will also go a long way in diabetes management. Finally, the locals can be taught the importance of getting checked since we have established that the aborigines are at high risk of getting diabetes. This will enable one to detect the disease very early before it has progressed and management at this stage will be easier (Khan et al, 2005). Appendix 1 The aim of this survey is to identify the problem of lack of fruits and vegetables with regards to diabetes among the Aboriginal Australians. Part I: About the respondent 1- What is your age group?  25-30  31 -40  Over 40 2- What is you gender?  Female  Male 3- What is your Education level?  Undergraduate  Postgraduate  Other ----------------- 4- What is your approximate income per year?  ---  ---  unemployed Part II: About Diabetes 5- Do you have diabetes? If no, have you ever been tested for Diabetes? Yes No 6- Do you have a family history of Diabetes?  Yes  No  Do not know 7- Do you know anyone with Diabetes? Yes No 8- Do you have any other medical condition? If yes what?  Yes ----------------------  No 9- Do you have insurance to obtain medical care and relief from Diabetes and other diseases? Yes No 10- How often do you cook vegetables? Every day  2-4 days a week  Rarely 11-How often do you do exercise Every day  1-3 days a week  Never 12-How often do you eat fruits? Every day  2-4 days a week  Rarely 13- Are vegetables and fruits easily accessible where you live? Yes No 14-Compared to other foods, fruits and vegetables are? Cheap  Same price range  Expensive 15-Do you know what a Diabetes patient should eat? If yes, give examples Yes No References Amos AF, McCarty DJ, Zimmet P: The rising global burden of diabetes and its complications: And Lifestyle Study. (2002) Diabetes Care among the Australian aboriginal population-An 8 year follow up study, http://www.care.diabetesjournals.org, Date accessed, 26th August, 2010. 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