History of Type 1 and 2 Diabetes - Case Study Example

? Type 2 diabetes Type 2 Diabetes History of Present Illness The body acquires energy by utilizing glucose, manufactured from various kinds of foods. In order to function normally, the body needs to regulate the amount of glucose in the blood by influencing the pancreas to secrete the hormone insulin. Type 2 diabetes develops when the body is unable to produce adequate insulin, or unable to utilize the insulin produced. Type 2 diabetes is the most common form of diabetes and has affected people for ages (Colvin, & Lane, 2011). Two millenniums ago ancient Indians noticed an illness where the patient would pass off “sweet urine” that attracted ants. In 1910, physicians were able to make progress on determining the cause of diabetes. Edward Sharpey Shafer stated that a patient showed signs of diabetes when the pancreas failed to produce a chemical, named “insulin”, which was responsible for breaking down sugar. He explained that that was why the urine contained excess sugar. In an effort to fight the disorder, doctors encouraged a fasting diet and urged patients to exercise regularly. This was in vain, as patients continued to die prematurely (Porter, 2013). In 1921, Charles Herbert and Frederick Grant made an important discovery when experimenting with dogs. They noticed that the conditioned improvement when they injected diabetic dogs with insulin extracted from healthy dogs. This also worked with diabetic people. However, doctors noticed that some people did not respond to this treatment. In 1936, Harold Himsworth classified the two types of diabetes as “insulin-sensitive” and “insulin-insensitive” with the latter being Type 2 diabetes (Porter, 2013). The 1950s brought in oral medication for patients with Type 2 diabetes, which would help stimulate the pancreas to secrete insulin. Urine strips and glucose meters that made detection of diabetes easier, came in the 1960s as well as single-use syringe, which allowed for easier administration of insulin. Insulin pumps, which imitate the normal release of insulin by the body, came into production in 1970. Type 2 diabetes’ patients were able to lead normal lives with the help of this invention. Doctors thought Type 2 diabetes only occurred in adults but in the 1990s, they discovered it in children. They previously referred to it as adult onset diabetes but as children and teenagers cases increased, they changed it to Type 2 diabetes (Porter, 2013). Differential Diagnoses It is important for a physician to determine correctly whether a patient has Type 1 diabetes or Type 2 diabetes. This is because these two types of diabetes need different treatments. Results obtained from physical examination, laboratory tests and the patient’s history can be used to make the right diagnosis that will help clinicians differentiate Type 1 diabetes from Type 2 diabetes (Colvin, & Lane, 2011). Through physical examinations, a clinician can identify Type 2 diabetes’ patients, as they may be obese; body may show manifestation of acanthosis nigricans, have chubby cheeks, and thick necks. The patients’ history can indicate whether they have Type 1 or Type 2 diabetes, for example, patients controlling their diabetes with oral antidiabetic agent or diet for long periods can be diagnosed with type 2 diabetes. Thin patients, who have had diabetic ketoacidosis for a long period and have always depended on insulin since childhood, can be diagnosed with Type 1 diabetes (Laine, 2007). Patients who show no signs of diabetes need two abnormal test results for a clinician to make a diagnosis of Type 2 diabetes. The abnormal tests can be done on different days, or different tests can be done on the same day. If the two results are abnormal, the patient is diagnosed with Type 2 diabetes but if only one result turns out to be abnormal, the test is repeated on a different day. If it turns out to be abnormal the second time, the patient is diagnosed with Type 2 diabetes. Diagnosis of patients showing polyuria, weight loss or polydipsia, which are all symptoms of hyperglycemia, can be established once without the need of a repeat measurement. Diagnosis is made when a single random plasma glucose result exceeds or comes back at 200 mg/dL (Group Health, 2012) An abnormal test result is one where the random plasma glucose level exceeds or is equal to 200 mg/dL. Fasting plasma glucose levels exceeding or equal to 126 mg/dL are also considered as abnormal results. Prediabetes occasionally comes before Type 2 diabetes. The laboratory results indicate plasma glucose levels exceeding normal, but cannot be diagnosed as Type 2 diabetes, for they are not high enough. This means that the random plasma glucose level ranges from 140 to 199 mg/dL while fasting plasma glucose levels range from 100 to 125 mg/dL. Many people diagnosed with prediabetes develop Type 2 diabetes. Type 2 diabetes is associated with some complications such as cardiovascular diseases and they may commence during prediabetes (Group Health, 2012). Review of Type 2 diabetes Disorder According to the National Diabetics Facts sheet released in 2011, over twenty five million Americans have diabetes. Ninety percent have been diagnosed with Type 2 diabetes translating to over twenty two million Americans. Globally, over one hundred and fifty million people have Type 2 diabetes. Seventy nine million Americans have prediabetes a condition that develops into Type 2 diabetes if not monitored. Every year, over one million patients are diagnosed with type 2 diabetes. Some theorists forecast that by 2050, the number of people with Type 2 diabetes will almost double. This means that at least a third of the American population will have Type 2 diabetes. There are hopes of reducing the prevalence of the disease with researchers making new discoveries into the genetic basis of the disease and its pathophysiology, but other complications develop when patients catch the disease. In America’s list of leading causes of death, diabetes is ranked seven (Laine, 2007). Researchers have found a connection between genetic factors and the development of diabetes. People with a family history of diabetes are at risk of developing Type 2 diabetes. Numerous genetic abnormalities relating to Type 2 diabetes have been described. When combined, they explain at least thirty percent of all the genetic elements associated with diabetes. As research advances, insight will be brought to show the role of these genetic factors (Kaku, 2010). Other factors that increase the risk of an individual developing Type 2 diabetes include; obesity, Ethnicity, alcohol drinking, age, and smoking. People, who are overweight especially abdominal obesity, may be at risk of developing Type 2 diabetes. This is because obesity leads to decreased muscle mass and enhances insulin resistance. As people grow old so does the risk of developing Type 2 diabetes. The pancreas ages and this may lead to lack of cell regeneration, thus becoming inefficient People of African-American, Asian, Pacific Islander, Native-American, or Hispanic ethnicity may be at risk of developing Type 2 diabetes (Laine, 2007). The two conditions that contribute to the development of pathophysiological conditions of Type 2 diabetes are insulin resistance and impaired insulin secretion. Insulin resistance springs up and expands before the early stages of the disease. The condition develops when insulin fails to perform its role in the blood efficiently. This leads to the deterioration of insulin activity in some vital organs like the muscles and the liver, which is a common functional change feature associated with of Type 2 diabetes (Kaku, 2010). Deterioration in the responsiveness of glucose towards insulin secretion is observed prior to the clinical early stages of Type 2 diabetes. This is referred to as impaired insulin secretion and in its early phases induces impaired glucose tolerance. The condition advances gradually resulting to lipo-toxicity and glucose toxicity. When the condition is left untreated, the pancreatic cell mass decrease, eventually affecting the regulation of blood glucose in the long run. In the early stages, the condition shows a rise in blood glucose but progression leads to irreversible rising of blood glucose (Kaku, 2010). Treatment A patient who has been diagnosed with Type 2 diabetes should be evaluated to test for current complications and measure the risk factors for complications. For a non-drug therapy treatment, the two main components are diet and exercise for management of Type 2 diabetes. Diet and exercise therapies are used as the first phase of treatment but drug therapy is introduced if there is severe hyperglycemia (National Collaborating Centre for Chronic Conditions, 2008). For some patients pharmacology therapy may start after diagnosis. Home blood glucose testing is important for patients undergoing drug therapy as it assists them adjust their insulin dosage, oral medications and find out if symptoms are associated with hyperglycemia or hypoglycemia. Insulin treatment starts when patients are unable to achieve enough glycemic control after combining diet, exercise and oral medications. Onset of symptomatic hyperglycemia or comorbid illness may warrant the use of insulin treatment (Laine, 2007). In the management of Type 2 diabetes, diet and exercise are very important. For those patients who are obese, weight reduction is recommended and bariatric surgery can be performed to help prevent the aggravation of the disease. Physicians should emphasize the need for screening to help prevent the disease from developing into Type 2 diabetes. Since patients require numerous oral therapies plus the insulin therapies, costs should be considered when the physician is selecting the treatments. Constant follow-ups and monitoring are also emphasized as they ensure that the patient is recovering well. Elderly people seem to have a trend of rejecting their prescription drugs. This can be attributed to the fact that they are subjected to numerous pills every day. Effective pills in smaller dosage should be administered (Kaku, 2010). Conclusion The susceptibility to Type 2 diabetes is seen to be from a combination of factors, that is genetic and environmental factors. As research advances, strides are being made slowly towards reaching a significant cure that will not only help manage the effects of the symptoms associated with Type 2 diabetes but also curb it (Laine, 2007). Children seem to be affected by this disease, which was a rare thing in the past, therefore, the need to educate parents and raise awareness about the disease should be emphasized. People should be encouraged to eat healthy food and exercise to ensure that the disease’s prevalence falls. Screening services for those who are at risk should be offered to ensure that the disease is prevented. In order to achieve treatment goals, early intervention and continued treatment are the keys to achieving the treatment goals. References Colvin, R., & Lane, J. T. (2011). The type 2 diabetes handbook: Six rules for staying healthy with Type 2 diabetes. Omaha, Neb.: Addicus Books. Group Health. (2012). Type 2 diabetes: Screening and treatment guideline. Group Health Cooperative. Kaku, K. (2010). ‘Pathophysiology of type 2 diabetes and its treatment policy.’ Japan Medical Association Journal. 53(1). 41-46. Laine, C. (2007). ‘In the Clinic Type 2 diabetes.’ American College of Physicians. National Collaborating Centre for Chronic Conditions. (2008). Type 2 diabetes. National clinical guideline for management in primary and secondary care (update). London. Royal College of Physicians. Porter, E. (2013). History of type 2 diabetes: From ancient Egypt to modern medicine. Retrieved November 5, 2013, from http://www.healthline.com/health-slideshow/history-type-2-diabetes Read More