Diabetes (or Diabetes mellitus) is a complex group of diseases caused by a number of reasons. Individuals suffering from diabetes have hyperglycemia (high blood sugar) either because there is low production of insulin or body cells do not use the produced insulin. About 350 million people suffer from diabetes globally (Danaei et al., 2011). The World Health Organization (1999) has predicted that diabetes will rise to the top seventh cause of death worldwide by 2030. There are three common forms of diabetes: type 1 diabetes, type 2 diabetes and gestational diabetes. This paper mainly discusses these major forms of diabetes considering their causes and consequences.
Type 1 Diabetes
In type 1 diabetes mellitus, body cells fail to produce insulin due to a compromised immune system causing damage to the cells where production of insulin takes place. The cause and prevention of type 1 diabetes are not particularly known; however, it is suspected to be a consequence of certain genetic factors.
Type 2 Diabetes
In type 2 diabetes mellitus, there is low production of insulin by the body cells or the body does not effectively make use of the produced insulin. Type 2 diabetes is known to be the commonest type of diabetes; in fact, 90% of diabetes sufferers have type 2 diabetes (World Health Organization, 1999). The cause and cure of type 2 diabetes remains unknown; however, genetic factors and manner of living take part in its causes, and watching blood sugar level can control the disease.
Gestational diabetes happens when there is a development of high blood sugar level in pregnant women not previously diagnosed of diabetes. For mothers who had gestational diabetes during their first pregnancy, the probability that it will occur in subsequent pregnancies is approximately two-thirds. Furthermore, some patients may subsequently develop type 2 diabetes. After pregnancy, diabetes type 1 or 2 may occur and will require obligatory treatment.
Genetic Factors and Markers
The role of genetic factors as a cause of diabetes has been proven definitively. This is the main etiological factor for diabetes.
IDDM is considered to be a polygenic disease which is based on at least two of the mutant genes in diabetic chromosome 6. They are associated with the HLA system (D-locus), which determines the individual, genetically determined response of the body and B cells to various antigens.
The hypothesis of polygenic inheritance of IDDM suggests that diabetes is caused from two mutant genes (or two groups of genes) that have a recessive inherited predisposition to autoimmune lesions of the insular apparatus or increased sensitivity of B cells to viral antigens or attenuated antiviral immunity.
Genetic susceptibility is linked with particular genes of HLA systems, which are considered markers of such a predisposition.
Patients with a genetic predisposition to IDDM have an altered response to environmental factors. They have weakened antiviral immunity, and they are extremely susceptible to cytotoxic damage to the B cells by viruses and chemical agents.
Viral infection may be a factor that provokes the development of IDDM. The most common occurrence of IDDM clinically is preceded by the following viral infections: measles (rubella virus has a tropism to the islets of the pancreas, accumulates, and can be replicated in them), Coxsackievirus and hepatitis B virus (can be replicated in the insular apparatus), mumps (1-2 years after the epidemic of mumps, the incidence of IDDM in children dramatically increases), infectious mononucleosis, cytomegalovirus, influenza virus, etc. The role of viral infection is confirmed by seasonality in the incidence of IDDM development (often, the first diagnosed cases of IDDM among children occur in autumn and winter months, with a peak incidence in October and January), the detection of high titers of antibodies to the virus in the blood of patients with IDDM, and the detection by immunofluorescent methods for studying viral particles in the islets of Langerhans in people who have died of IDDM. The role of viral infections in the development of IDDM is confirmed in experimental studies. Viral infections among individuals with a genetic predisposition to IDDM are involved in the development of the disease as follows:
- the cause of acute injury to B cells (Coxsackievirus);
- leads to viral persistence (congenital cytomegalovirus infection, rubella) with the development of autoimmune reactions in the islet tissue.
In modern diabetology, the next staging of IDDM is expected.
First stage – a genetic predisposition, due to the presence of certain antigens in the HLA system, as well as genes of chromosomes 11 and 10.
Second stage – the initiation of the autoimmune process in islands of B cells influenced with viruses, cytotoxic agents and any other unknown factors. A crucial point in this step is the expression of B cells HLA-DR-antigen and glutamic acid, and therefore, they become autoantigens that cause the development of autoimmune response reactions.
Third stage – the stage of the active immunological process with formation of antibodies to B cells, insulin and autoimmune insulitis development.
Fourth stage – the progressive reduction of insulin secretion stimulated by glucose (1-phase secretion of insulin).
Fifth stage – clinical diabetes (the manifestation of diabetes). This step develops during the occurrence of the degradation and death of 85-90% of the B cells.
Many patients after the insulin treatment fall into remission of the disease (the “diabetic honeymoon”). Its length depends on the severity and degree of B cell damage, their ability to regenerate, and the level of residual insulin secretion, as well as the severity and frequency of related viral infections.
Sixth stage – the complete destruction of b-cells, and a complete lack of insulin secretion and C-peptide. Clinical signs of diabetes form and insulin treatment becomes necessary again.
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In America, the fact that fast food restaurants are located at every corner many people becomes obesity leading to huge risk factors. The various issues of unhealthy living lead to multiple life threatening diseases, such as diabetes. When people hear the news that they have been diagnosed with diabetes, it makes them feel frightened. In 2011, statistics show that in United States 25.8 million of children and adults has diabetes (American Diabetes Association, 2012). American Indians and Alaska natives have a higher percentage of adults with diabetes than other ethnicities (Collazo-Clavell et all. 2009).
Diabetes is a serious life-long illness caused by high level of glucose in the blood. This condition is when the body cannot produce insulin that is located in the pancreas. Insulin is a hormone that moderates the blood level. Diabetes affects the process of how the body uses blood sugar (Collazo-Clavell et all. 2009). Glucose is significant since it is "the main source of fuel" (Collazo-Clavell et all. 2009). There is no cure for diabetes but there are ways to lower the risks. Although diabetes is a disorder, it can also lead to other factors such as heart attack, kidney failure, or death. A person with diabetes has to maintain a healthy lifestyle including eating the right food, exercising, controlling their blood sugar level, and be optimistic. Diabetes occurs in several forms but the major ones are Type I and II diabetes and gestational diabetes.
Type I diabetes is also known as "Juvenile Diabetes" because it typically occurs in children and young adults. The symptoms for Type I diabetes are frequent urination, extreme thirst and hunger, unusual weight loss, and exhaustion (American Diabetes Association, 2012). Young adolescents are able to continue a fit lifestyle with the treatment of insulin therapy (American Diabetes Association, 2012). Metzger (2012) explained how insulin is injected under the skin instead of through the mouth because digestive enzymes will destroy insulin. Diabetes is a serious issue and put a person's life at risk if they don't manage a positive lifestyle. However if people don't prevent themselves from being at risk, then it'll lead to difficulties. American Diabetes Association (2012) listed the possibilities of the problems including the eye, heart disease, high blood pressure, hearing loss, and ketoacidosis. Statistics show that diabetes is the main cause of kidney failure (American Diabetes Association, 2012). Living with type I diabetes can be fairly easy by handling the recommended components such as exercise, healthy diet, controlling the levels of sugar, daily insulin injections, and supportive people (American Diabetes Association, 2012). Although living with this type of illness is challenging, a person has the capability to do normal things that anyone can do. Moreover several things such as environment, genetics, or eating unhealthy can cause diabetes. American Diabetes Association (2012) explained how cold weather could affect people to develop type I diabetes. As for genetics, the child could be at risk. For men, the risk of type 1 diabetes occurring in the child is 1 in 17 (American Diabetes Association, 2012). For women, if she had the child before 25 the risk is 1 in 25. If she had the child after 25, the risk is 1 in 100 (American Diabetes Association, 2012). Children who are white have a higher risk than other ethnic groups.
Type II diabetes is similar to Type I but it puts the person at higher risk. Type II diabetes was once known as non-insulin dependent or adult-onset diabetes. People with type II diabetes could either have pancreas that does not produce the necessary amount of insulin or does not respond to insulin. This condition is called insulin resistance. Without insulin, glucose cannot go into the body's cells. Glucose will expands that will cause the body's cell function differently than its suppose to (WebMD, 2012). The symptoms for Type II diabetes are similar to Type I but also includes blurred vision, infections, and numbness in the hands or feet (American Diabetes Association, 2012). Symptoms do not usually show during the early stages (Metzger, 2006). Before developing type II diabetes, a person can be diagnosis with prediabetes. Prediabetes is defined to be when a person's blood glucose level is high but not at the target level for type II diabetes (Metzger, 2006). Metzger (2006) stated that people over the age of 45 are mostly diagnosis with type II diabetes. American Diabetes Association (2012) stated that it is most common in the African Americans, Latinos Native Americans, and Asian Americans. Metzger (2006) showed a chart that provides information on which category is more insulin sensitive to others. It showed that white males' insulin sensitivity is the highest. Before, it was rare for child to be diagnosis with type II diabetes. According to WebMD (2012), there are more than thousands of young adolescents with both types. Being overweight is the one of the main reasons why children have type II. Also type II diabetes is caused by genetics. If either one of the parents have type II diabetes, the possibility for the child is 1 in 7 (American Diabetes Association, 2012). There's a theory that the mother with type II diabetes, her child will have a higher risk.
Gestational Diabetes occurs during pregnancy. Gestational Diabetes develops when a pregnant women has high blood sugar levels. When a woman has gestational diabetes, her pancreas works harder to produce insulin. Although there is insulin, the blood glucose level does not lower down so the extra blood glucose goes through the placenta. It will cause the baby's pancreas to produce more insulin than its needs. The baby will have unnecessary energy that will than develop into fat. The fat leads to macrosomia (American Diabetes Association, 2012). The symptoms for gestational diabetes are the same as Type I diabetes. It is recommended to get treatment quickly if neither the mother nor the baby want to get affected. American Pregnancy Association (2012) informed that pregnant women diagnosis with gestational diabetes may develop having type II diabetes later in life. The risks that can happen if gestational diabetes is not treated are large birth weight, premature delivery, the need of cesarean section, or fetal and neonatal death (American Diabetes Association, 2012). The causes that puts a woman at risk are if she has high blood pressure, overweight before pregnancy, becomes pregnant after 25, a huge amount of amniotic fluid, or unexplained miscarriage or stillbirth (The New York Times Health Guide, 2012).
Diabetes is a chronic illness that will lead to highly risk factors if not treated immediately. There are several different reasons why diabetes develops.
Most common causes are obesity, family history, age, or ethnicity (Metzger, 2006). If a person has more weight in their abdomen, the fat causes the cells to be sensitive to insulin in which develops type II diabetes (Metzger, 2006). Metzger (2006) stated that people over the age of 45 commonly develops type II diabetes because their pancreas does not have enough energy to produce and become less responsive to insulin. A long family history of diabetes will significantly affects throughout the generation. Furthermore, Metzger (2006) explained the lack of a person's lifestyle is also a risk factor. According to WebMD (2012), it stated that if there is any damage to the pancreas it might lead to type I diabetes. As for type II diabetes, it has similar risk factors for developing gestational diabetes also. The risk factors for both types of diabetes are. Along with risk factors, there are complications also. Metzger (2006) stated that complications such as hypoglycemia, hyperglycemic hyperosmolar nonketotic syndrome, and diabetic ketoacidosis occur commonly for type II diabetes. Hypoglycemia is known as low blood sugar. Hypoglycemia can easily change by consuming anything that is sweet (Metzger, 2006). Hyperglycemic hyperosmolar nonketotic syndrome happens when blood sugar level is high. Diabetic Ketoacidosis causes the body to produce more insulin than it normally can. Some other complications for type II diabetes are heart disease, nerve damage, or Alzheimer's disease (Mayo Clinic, 2012). Mayo Clinic (2012) referred to American Heart Association stating that people with diabetes has a high death rate of heart disease than people without it. If blood sugar control is not better, it causes damage to the nerves and also affects the high risk of having Alzheimer's disease. Other than illnesses developing, people with diabetes sometimes enters the emotional stage and becomes depressed.
Despite of the different kinds of diabetes, whomever has developed it, has to manage the same nutritious lifestyle. Both at home and eating out people with diabetes need to have a healthy meal diet. Vegetables and fruits are the best healthy food choices. Non-starchy vegetables are the main food group that is has fewer calories, which is the best for a person with diabetes. There are many non-starchy vegetables but the common ones are artichoke, beans, cabbage, eggplant, mushrooms, squash, and water chestnuts (2012). Whole grain food including brown rice and dried beans should be eaten. Fish and lean meats needs to be chosen and also the skin of chicken and turkey have to be removed. Next, there are certain types of fishes that have omega-3 fatty acids, which are salmon, mackerel, and herring. It helps lower blood fats called triglycerides (Mayo Clinic, 2012). However, fried fishes are best to be avoided. Fishes such as tilefish, swordfish, and king mackerel have high intake of mercury also should be eliminated. Moreover, the best beverages are water and calorie-free diet drinks. If water is too bland, adding lemon will give it flavor. The drinks that need to avoid are soda, fruit punch, sweet tea, and energy drinks. According to American Diabetes Association (2012), sugary drinks contain many calories that can raise blood glucose. Besides water, low-fat milk and 100% juice is another alterative (American Diabetes Association, 2012). Alcohol is allowed but it should be limited. Drinking a large amount of alcohol can lead to a hypoglycemic attack (Walker and Rodgers, 2004). In addition, sweets is suggested not to be consumed daily but a small serving is allowed (American Diabetes Association, 2012). It is also best to watch out how much carbohydrates are eaten. WebMD (2012) stated that carbohydrates significantly influence blood sugar levels. Carbohydrates, fats, and proteins are part of energy source. Some fats are good and some are bad. Monounsaturated and polyunsaturated fats reduces low-density lipoprotein cholesterol (Collazo-Clavell et all. 2009). When picking the right food for meals and beverages, it is better to have it in small portions. A meal that includes variety of food decreases the risks.
Exercise reduces the risks for people with diabetes. Weight is an important factor to people with diabetes. Being physically active helps the person to have more energy to every-day activities. There are ways to be physically active both at home and work. Stress is one of the risk factors so exercise is a fun active activity to boost up the mood. A daily routine should include three types of activities, which are aerobic exercise, strength training, and flexibility exercises (American Diabetes Association, 2012). Aerobic exercise significantly affects people with diabetes because it enhances insulin sensitivity according to the health guide of The New York Times (2012). Aerobic exercise reduces the risk of type II diabetes (WebMD, 2012). Some examples of aerobic activates are walking, cross-country skiing, or jogging (Collazo-Clavell et all. 2009). In addition, examples for strengthening are squats, calf strengthening, knee extension or wall or table push-ups (Collazo-Clavell et all. 2009). The best amount of time for exercising is 30 minutes a day (American Diabetes Association, 2012). American Diabetes Association (2012) suggested that blood sugar control could be highly better if there is 150 minutes per week of physical activity. Metzger (2006) stated that the level of HDL cholesterol is improved by exercise. Walker and Rodgers (2004) demonstrated a chart that shows climbing stairs and gardening burns the most calories for every 30 minutes. Research concluded that having the right amount of sleep is much needed to help insulin use and lower the risk factors (The New York Times Health Guide, 2012). Moreover, children with diabetes also need to be fit. The time that children spent playing with electronics has to be limited. Video games involving physical movement improve children's health. To keep children interested in fitness, make it fun for them. Furthermore, it is important for both adults and children to be physically active.
Diabetes is a complicated disease that affects many lives for women, men, and children. Each age group copes with the illness in many different ways than others. The percentage of women having type II diabetes is around 90 to 95 (CDC, 2012). Women with diabetes would have to overcome tough obstacles such as heart disease, depression, eating disorders, and her sexual health. American Diabetes Association (2012) explained how women with diabetes result in death due to heart disease. According to CDC (2012), heart disease is most common in women than men. Women with diabetes deal with a lot of stress that leads to depression and having a lack of interest in sex. A women's sexual health can be affected by having diabetes. If a diabetic woman decides to have a baby, she has to get her health in control and be cautious. Furthermore, men are also affected by the similar difficulties like women. Some men with diabetes may have erectile dysfunction. Erectile dysfunction is when a man cannot maintain an erection to engage in sexual intercourse. American Diabetes Association (2012) stated the treatments that help erectile dysfunction. The treatment choices include taking prescribe medications, injecting prostaglandins into the penis, insert blood into the penis by using a vacuum tube, or surgery to fix blood vessels in the penis. Another condition that may occur to men is low testosterone. As for children, it is very important to care for them when they are diagnosed. It will take awhile for the child to adjust to living with diabetes. Supportive family and friends can help them adapt to it and live a normal life. Other people will respond differently when told that someone's child has diabetes and they have no knowledge of the term. Parents should inform teachers or caregivers what is diabetes and instructions if anything happens. Having diabetes doesn't mean that children can't live the life they want to. As long as the family plans ahead and have the right medications for the child.
Treatment for diabetes requires a big commitment. It is not something that a person should be reckless about. Each type of diabetes has similarities and differences for treatments. For gestational diabetes, the mother and the baby's health has to be monitor. Some women with diabetes are not required to use medications or insulin according to the New York Times Health Guide (2012). The key factors for treatment can help the people with diabetes to live healthy. First, checking the blood sugar level several times a week. Second, eating healthy foods including fruits, vegetables, and whole-grains. Third, physical activity helps the body to be more active and consume energy. Lastly, there has to be daily insulin injections or diabetes medications. Insulin therapy is needed for people with type II diabetes. Insulin therapy is used to keep blood glucose at a normal level and prevent complications. There are different types of insulin in which are rapid-acting, short-acting, intermediate-acting, long-acting, and peakless long-acting (Walker and Rodgers, 2004). Insulin is usually injected into the thighs, buttocks, or abdomen (Walker and Rodgers, 2004). Mediations are also used for treatment. Medication is an important essential when having diabetes. According to Mayo Clinic (2012), a diabetes medication called metformin is usually given to people who developed diabetes. Metformin helps lower glucose level in the liver. Overall, insulin injections and medications helps lower the blood glucose level in which also prevents complications. Controlling blood sugar level is an essential thing to avoid complications. The ideal level for the person to be at is 70 to 100 milligrams per deciliter of blood (Collazo-Clavell et all. 2009). The two ways to check blood glucose level is to test urine or blood. Checking blood glucose level constantly is recommended. Home tests show the current blood glucose level on the given day. By using the A1C test, it gives a percentage of the blood glucose level for the past few weeks.
There are many ways to prevent from developing diabetes. The main components are normal weight, nonsmoking, physically active, healthy diet, and limited drinking (MacMillian, 2011). To prevent children from having diabetes, parents need to lessen fats and sweet in their child's meals (WebMD, 2012). Mayo Clinic (2012) explained each five guidelines to prevent diabetes. The first tip is become active. Engaging in physical activity has good outcomes such as losing weight and low level of blood sugar. Second tip is consuming good amounts of fiber. Fiber boosts the control of blood sugar and decreases the risk of heart disease. The third tip stated to eat whole grains. The results for whole grains are similar to eating fiber. Fourth tip is weight loss if the person is overweight. Studies shows that for every 2.2 pounds that overweight adult lose, they lower their risk by 16 percent (Mayo Clinic, 2012). The final tip is to eat healthy food. Mayo Clinic (2012) also advised 10 recommendations to avoid complications. The first one stated to be committed with managing diabetes. People with diabetes have to become adapt to their new lifestyle. Secondly, smoking needs to be cut off. Thirdly, blood pressure and cholesterol has to be restrained. Both of these conditions cause damage to the body and leads to life-threatening illnesses. Fourth, physical and eye exams are suggested to be taken to detect any problems. Fifth, vaccines are also important to take. Sixth, teeth should be taken care of since diabetes may cause gum infections. The seventh advice is that foot has to be well taken of also. The eighth advice stated that taking aspirin daily prevent blood to clot and also other risk factors. The ninth way explained how blood sugar is affected by alcohol so if a person with diabetes wishes to drink, it has to be controlled. The final way is to avoid stress and become more relax. Diabetes is a serious matter that needs to be taken care well unless there will be consequences. Preventing diabetes from developing also prevent other chronic complications such as heart disease, stroke, or kidney disease. The main ideal for prevention is stay healthy.
In conclusion, I've learned a lot of information about diabetes that I did not know about. Living with a chronic disease is challenging. There are several risk factors and complications that can occur but it can be prevented. The best way to deal with diabetes is to manage a healthy lifestyle with the support of family and friends.