How Diabetes Works and Diabetes Statistics Alarming - Essay Example

Diabetes Diabetes, a disease which alters the body’s capability to utilize glucose effectively, plays asignificant role in the deaths of millions of people worldwide and the number is growing exponentially. According to the International Diabetes Federation (cited in Dorfman, 2007), the number of people diagnosed with diabetes has risen from 30 million people to more than 246 million people in only the past twenty years. This illness is well documented in the United States, revealing that the total annual economic cost of diabetes in 2002 was estimated to be $132 billion, or one out of every 10 health care dollars spent in the United States. However, the International Diabetes Federation indicates that seven of the ten countries with the highest number of diabetics are in the developing world rather than where the medicines and treatments might be readily available. Increased risks of stroke and heart disease are associated with diabetes no matter where it strikes. “These life-threatening consequences strike people with diabetes more than twice as often as they do others” (American Diabetes Association, 2006). Further complications associated with diabetes include kidney disease, blindness, and the threat of amputations. “In some countries in the Caribbean and the Middle East, the percentage of the diabetic population ranges from 12 to 20 percent” (Dorfman, 2007). These numbers increase every year along with the rising costs associated with health care provisions. This discussion examines what diabetes is, the lifestyle and genetic risk factors of the disease and its potential health consequences. It will also discuss preventative measures as well as proper diet and care for those afflicted with the disease. A primary factor in diabetes is the level of insulin present in the body. Insulin is a chemical the body produces naturally to mange the induction of glucose into the system. When the body produces too little amounts of insulin, greater amounts of glucose are allowed to enter the bloodstream thereby causing the symptoms of the disease called diabetes. Glucose, a simple sugar, enters the body by way of ingested food and into every red blood cell via the bloodstream; the cells then break down the glucose which acts to supply energy throughout the body. Brain cells, as well as other organs, are fueled by glucose alone. In diabetics, the body does not keep a stable amount of glucose in the cells. This means the body has more than the necessary glucose levels immediately after a meal but too little otherwise. To maintain a constant blood-glucose level, the healthy body produces glucagon and insulin, two hormones originating from the pancreas. Typically, there is balance of these hormones in the bloodstream with the insulin acting to prevent the concentration of blood-glucose from increasing disproportionately. There are generally two types of diabetes that have been identified, differing primarily in the onset and cause and referred to as Type One and Type Two diabetes. Type One diabetes, or juvenile diabetes, is caused by the body’s inability to produce insulin. Occurring primarily in children, this type afflicts less than 10 percent of all diabetics. Type Two refers to ‘non-insulin-dependent’ or ‘adult-onset diabetes’ and describes the condition in which the body manufactures insulin but cannot process it. More than 90 percent of diabetics suffer this type which normally afflicts those over 40 years of age. “Type Two diabetics have an abnormal glucose-tolerance test and higher than normal levels of insulin in their blood” (Freudenrich, 2002). The immune system, the environment and genetics are factors that influence Type One diabetes but the risk factors are more clearly defined for Type Two diabetes. These include obesity, physical inactivity, elderly people, family history of diabetes, a past history of gestational diabetes and those with a weakened tolerance for glucose. Ethnicity is another risk factor. “African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for Type Two diabetes” (American Diabetes Association, 2006). Although about 33 percent of people with the illness are unaware of their condition, nearly three million or almost 12 percent of the African American population over 20 years of age suffer with symptoms of diabetes.  Because of this, African Americans have been identified as being at greater risk than those of Anglo descent to suffer macro-vascular problems such as strokes and heart disease. “African Americans are 1.6 times more likely to have diabetes than non-Latino whites. 25 percent of African Americans between the ages of 65 and 74 have diabetes. One in four African American women over 55 years of age has diabetes” (American Diabetes Association, 2006). The disproportionate gap that exists between the African American population and others regarding diabetes continues to widen. “National health surveys during the past 35 years show that the percentage of the African American population that has been diagnosed with diabetes is increasing dramatically” (Tull & Roseman, 1995). In a thorough investigative study conducted from 1976 to 1980, the total prevalence of diabetes was less than nine percent in African Americans aged 40 to 75. Another similar study conducted between 1988 and 1994 showed that this number had increased two-fold to more than 18 percent while in the white community the rate rose only slightly to just over ten percent. African Americans, Hispanic/Latino Americans, American Indians and those with a family history of diabetes also experience a greater chance of contracting gestational diabetes than do those of other life classifications. In addition, the women who have contracted this form of diabetes find themselves at a higher risk for developing Type Two diabetes later in life. Gestational diabetes is similar to Type Two diabetes and can arise in all categories of women who are pregnant. Studies have confirmed that nearly all women with a history of gestational diabetes have about a 40 percent chance of developing diabetes in the future. “Other specific types of diabetes, which may account for one to two percent of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses” (National Center for Chronic Disease Prevention and Health Promotion, 2005). Women with gestational diabetes experience an abnormal tolerance to glucose and have somewhat elevated insulin levels. While pregnant, the effects of insulin are blocked by various hormones which act to desensitize the patient to the insulin her body produces. This form of diabetes can be effectively treated by supplemental insulin injections and by submitting to specialized diets. Normally, the symptoms of gestational diabetes do not continue in the woman following the birth of the baby. Diabetics display numerous symptoms including “excessive thirst (polydipsia), frequent urination (polyuria), extreme hunger or constant eating (polyphagia), unexplained weight loss, presence of glucose in the urine (glycosuria), tiredness or fatigue, changes in vision, numbness or tingling in the extremities (hands, feet), slow-healing wounds or sores and abnormally high frequency of infection” (Freudenrich, 2002). These various symptoms are common to both forms of diabetes. However, patients are not necessarily subject to all of the signs mentioned. A Type One diabetes patient’s diet should include about 16 calories per pound of their individual body weight per day or about 35 calories per kg of body weight. Type Two diabetes patients are commonly regimented to a 1500 to1800 calorie diet per day. This is to control obesity issues and to maintain an ideal body mass. These numbers, of course, vary somewhat depending on the patient’s gender and age along with their current weight and body type and their level of physical activity. Those diabetics who are overweight when they begin the nutritional program may require more initial calories until their weight drops to a more normal level. The reasoning is that too rapid of a weight loss can be very unhealthy and it takes additional calorie intake to sustain a larger body frame. Gender also plays a role in a proper program as males generally possess a greater muscle mass than females and consequently may require a higher intake of calories. Because muscle uses up more calories per hour than does fat, people who are not physically active will have less need for calorie intake, a good reason for everyone, and especially those with diabetes, to exercise regularly and build-up muscle mass. In other words, if you like to eat, supplement it with proportional amounts of exercise. There are different theories regarding the most effective diet but the fact that diet is very important in controlling the symptoms of diabetes is indisputable (American Diabetes Association, 2006). A diabetic’s daily calorie intake, generally speaking, should consist of 40 to 60 percent carbohydrates because the lower the carbohydrate intake, the lower levels of sugar enters the bloodstream. The advantages associated with carbohydrate intake are negated by the patient’s intake of foods that are high in fat. This dilemma can be improved upon by the substitution of polyunsaturated and monounsaturated fats for saturated fats. “Most people with diabetes find that it is quite helpful to sit down with a dietician or nutritionist for a consultation about what is the best diet for them and how many daily calories they need. It is quite important for diabetics to understand the principles of carbohydrate counting and how to help control blood sugar levels through proper diet” (Norman & Politz, 2006). An A1C test measures the level of glucose in blood cells. The diabetic who has not received treatment may show levels as high as 10 percent while a person not afflicted with the disease tests at close to five percent. As previously discussed, the lack of insulin production allows higher levels of glucose in cells. High levels of blood glucose (or sugar) in the bloodstream leads to various diabetic related health complications if allowed to go unchecked (Becton & Dickinson, 2006). According to the Florida Department of Health, the proper management of glucose in the bloodstream benefits people with both type of diabetes. “For every one point reduction in A1C, the risk for developing micro-vascular complications (eye, kidney and nerve disease) decreases by up to 40 percent. Blood pressure control can reduce cardiovascular disease (heart disease and stroke) by 33 to 50 percent and can reduce micro-vascular disease (eye, kidney and nerve disease) by approximately 33 percent. Improved control of cholesterol and lipids (e.g. HDL, LDL, and triglycerides) can reduce cardiovascular complications by 20 to 50 percent. Detection and treatment of diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent. Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.” (“Prevention of Diabetes”, 2003). Proper weight control, increased activity and not smoking should also coincide with regular visits to the doctor in order to better regulate blood pressure, glucose and cholesterol levels. The patient would be best served if they form a team-like relationship with their health care professionals. “Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease” (American Diabetes Association, 2006). In “Metallothionein-Mediated Antioxidant Defense System and Its Response to Exercise Training Are Impaired in Human Type 2 Diabetes” (Scheede-Bergdahl 2005), the authors discuss the importance of metallothioneins I and II (MT 1&2) as part of the antioxidant defense system and its relationship to exercise in the diabetic patient. Previous studies regarding these antioxidants have indicated that exercise has only beneficial effects on the production of MT 1&2, but the research team noticed that none of the studies had actually been conducted on people with Type 2 Diabetes. Further evidence had suggested the possibility that these important chemicals are reduced with exercise in persons with Type II Diabetes. During the study, it was confirmed that levels of MT 1&2 are increased in the skeletal muscle tissue and plasma of healthy individuals who have participated in a regular exercise program. Participants who had Type 2 Diabetes showed no corresponding increases though. While the study was careful to note that there were no increases or decreases in MT 1&2 levels in the skeletal musculature in these patients, it was also noted that levels were decreased somewhat in the plasma levels. Decreased MT 1&2 can lead to oxidative stress, which “contributes to the development and acceleration of related conditions such as nephropathy, neuropathy, retinopathy and macro- and microvascular damage” (Scheede-Bergdahl 2005). At the same time, tissue samples taken from patients with Type 2 Diabetes indicated increased oxidative stress from the control group with tissue appearing more susceptible to damage. As further research is conducted as to just how important the decreased levels of MT 1&2 are in the overall health and well-being of the diabetic patient, some changes may occur in the types of physical therapy recommended for these patients. Before this occurs, however, it must be determined the exact role these compounds play in the antioxidant defense as well as whether pharmacological or therapeutic treatment options will work best to provide the patient with the greatest possible benefit. However, exercise will continue to play a large role in the treatment of diabetic patients thanks to the many other benefits it offers. According to Kennedy et al (1999), exercise also helps to distribute GLUT4 throughout the body, a process that doesn’t occur as readily in the person with diabetes as it does in those without the illness. GLUT4 is the glucose transporter that brings glucose into the cell through the plasma membrane. For various reasons, GLUT4 is considered to be “the major mechanism responsible for the increased rate of glucose transport after insulin or exercise stimulation” (Kennedy et al 1999). However, this is a process that takes place primarily in the skeletal muscle, which, in the diabetic patient, has proven to have decreased insulin-stimulated uptake. This study showed that the muscle is not similarly resistant to the effects of exercise by demonstrating that the GLUT4 transporter enters the plasma membrane in response to exercise where it doesn’t respond to insulin. “In contrast to insulin stimulation, acute exercise promotes normal glucose uptake and GLUT4 translocation” (Kennedy et al 1999). In addition, the study showed that exercise can increase the GLUT4 content in the plasma membrane to be nearly identical with people who don’t have diabetes, are leaner and younger. This study begins to outline the various ways in which exercise and physical therapy in diabetic patients can assist them in their disease maintenance. Exercising the muscle helps to increase the levels of GLUT4 in the plasma membrane making it more possible for the patient’s body to absorb the glucose within the bloodstream. Even more specifically, exercise targets an area of dysfunction that insulin has little to no effect upon as skeletal muscle has been shown through this and other studies to have little to no reaction to insulin. This study is backed up by a subsequent study conducted by Musi et al (2001) in which it was determined that AMP-Activated Protein Kinase (AMPK) activity was normal in response to exercise, as it should be if the previous study regarding the effect of exercise on the GLUT4 transporter held true. “AMP-activated protein kinase (AMPK) has recently emerged as a potentially key signaling intermediary in the regulation of exercise-induced changes in glucose and lipid metabolism in skeletal muscle” (Musi et al 2001). AMPK plays a significant role in the signaling of the GLUT4 to release into the plasma membrane. This study proves that AMPK functions properly in the Type 2 Diabetic during exercise and suggests that it does not function properly while at rest. This was done by comparing the blood sugar levels of a test group of diabetics with the blood sugar levels of the control groups before, during and after riding an exercise bicycle for 45 minutes. While the blood sugar levels of the diabetics were significantly reduced after the exercise, the blood sugar levels of the control groups remained the same. However, like GLUT4, the mean AMPK content in diabetic patients as compared to the control group did not show a significant difference. Because of its believed role in the regulation of this process, however, this study suggests further investigation as to just how the AMPK pathway stimulates the uptake of glucose with the intent of the development of a new set of drugs designed to stimulate the exercise-induced response. With exercise comes the possibility of broken bones, making the studies of Lu et al (2003) necessary for proper physical therapy treatment and understanding following an accident. In their study, “Diabetes Interferes with the Bone Formation by Affecting the Expression of Transcription Factors that Regulate Osteoblast Differentiation,” researchers found that people with Type 1 Diabetes do experience inadequate bone formation, osteopenia and delayed fracture healing as a result of their illness. Previous studies are cited that have already established diabetics have decreased bone density and bone formation as compared to control groups which suggests they have diminished osteoblast activity. “In streptozotocin-induced diabetic rats, abnormal bone repair was shown to be insulin dependent because the deficient osseous healing was reversed by insulin treatment. This finding demonstrates a specific cause and effect relationship between inadequate insulin production and abnormal bone formation” (Lu et al 2003). The study indicated that these deficiencies could be reversed with the proper application of insulin, yet finding the mechanism that prevents the bone formation at the protein level would enable researchers to further negate the effects of diabetes on patients. While there is no known cure for the disease, diabetes can be managed effectively with proper treatment. “The key to treating diabetes is to closely monitor and manage your blood-glucose levels through exercise, diet and medications” (Freudenrich, 2006). The type of diabetes dictates the type of treatments to be followed. Type One diabetics must examine their blood-glucose levels many times per day and inject insulin accordingly, usually at mealtime so as to help manage the glucose being ingested. The supplementation of insulin assures that blood glucose levels maintain stability. Type Two diabetics have the ability to control the disease through personal lifestyle decisions such as the loss of weight, exercising more and not smoking at all. In severe instances, medication may need to be given to control glucose levels. Diabetics are able to significantly decrease the risks of complications due to the disease if they are willing to educate themselves then apply that knowledge to their daily lives. References American Diabetes Association. (2006). “Diabetes Statistics for African Americans.” All About Diabetes. American Diabetes Association. August 27, 2008 Becton & Dickinson. (2006). “Hemoglobin A1c Testing.” BD Diabetes. August 27, 2008 Dorfman, Marjorie. (March 8, 2007). “Diabetes Statistics Alarming.” Suite101. August 27, 2008 < http://heartdiseasediabetes.suite101.com/article.cfm/diabetes> Freudenrich, Craig. (2006). “How Diabetes Works.” How Stuff Works. August 27, 2008 Kennedy, J.W.; Hirshman, M.F.; Gervino, E.V.; Ocel, J.V.; Forse, R.A.; Hoenig, S.J.; Aronson, D.; Goodyear, L.J. & Horton E.S. (May 1999). “Acute Exercise Induces GLUT4 Translocation in Skeletal Muscle of Normal Human Subjects and Subjects with Type 2 Diabetes.” Diabetes. Vol. 48. Lu, H.; Kraut, D.; Gerstenfeld, L. & Graves, D. (2003). “Diabetes Interferes with the Bone Formation by Affecting the Expression of Transcription Factors that Regulate Osteoblast Differentiation.” Edocrinology. Vol. 144, N. 1, pp. 346-52. Musi, N.; Fujii, N.; Hirshman, M.; Ekberg, I.; Froberg, S.; Ljungqvist, O.; Thorell, A. & Goodyear, L. (2001). “AMP-Activated Protein Kinase (AMPK) is Activated in Muscle of Subjects with Type 2 Diabetes During Exercise.” Diabetes. Vol. 50, pp. 921-27. National Center for Chronic Disease Prevention and Health Promotion. (January 31, 2005). “Basics About Diabetes.” Diabetes Public Health Resource. Center for Disease Control. August 27, 2008 Norman, James & Politz, Douglas. (June 26, 2006). “The Diabetes Center.” EndocrineWeb. Norman Parathyroid Surgery Clinic. August 27, 2008 “Prevention of Diabetes.” (2003). Florida Department of Health. State of Florida. August 27, 2008 Scheede-Bergdahl, C.; Penkowa, M.; Hidalgo, J.; Olsen, D.; Schjerling, P.; Prats, C.; Boushel, R. & Dela, F. (2005). “Metallothionein-Mediated Antioxidant Defense System and Its Response to Exercise Training Are Impaired in Human Type 2 Diabetes.” Diabetes. Vol. 54, pp. 3089-94. Read More