Diabetes

Diabetes: Diabetes is a chronic, lifelong disease that is marked by high levels of glucose (sugar) in the blood. (American Diabetes Association, www.ADA.org) Insulin is a hormone that is produced by the pancreas in order to control blood sugar. Diabetes is caused by having too little insulin in the blood, a resistance to insulin, or both. The purpose of sugar in the body is to give people the energy they need to perform regular daily exercise, sports, and even just normal everyday housework. Sugar is transferred into the body by the food that a person eats and digests. When the body is unable to regulate the levels of sugar in the blood then the body loses its energy. In the course of the digestion process the pancreas plays a significant role in the way that food is digested. In order for sugar to be able to get into the blood cells insulin has to be available. Insulin is produced in the pancreas; this is a large gland that is found behind the stomach. The pancreas’ main function is to automatically produce the correct amount of insulin needed to move the glucose received from the food into the cells of the body. After the digestion of the food the sugar is known to pass into the bloodstream. Blood cells store and use the glucose for energy. Those people who suffer from diabetes produce very little or no insulin at all. Their cells do not respond correctly to the amounts of insulin that is needed to process the sugar in the food. Glucose often builds up in the blood and can be disposed of in the urine which results in the body losing its main fuel source so that very little or no energy is left. There are three types of diabetes, Type one, type two, and gestational. Type one diabetes is most often diagnosed during childhood although some people are diagnosed in their early twenties. Daily injections for this type of diabetes are needed. It is thought that genetics, viruses, and autoimmune issues might play a role in the development of this disease. Type two diabetes is much more common than type one, it makes up most of the cases of diabetes and usually occurs in adults but research is now showing that many young people are being diagnosed at an increasing rate. (Center for Disease Control, www.CDC.gov) In type two diabetes the pancreas does not make enough insulin to keep the blood glucose levels normal, this is mainly due to the fact that the body does not respond well to insulin. Often people who have type two diabetes are not even aware that they have the disease even though it is a very serious condition. Gestational diabetes happens when high blood sugar develops at any time during pregnancy in a woman who does not have diabetes. Women who get gestational diabetes can have a higher risk for contracting type two diabetes or heart disease later in life. Risk Factors: There are many risk factors that a person can control but there are also some risk factors that a person has such as genetics that cannot be controlled. In type one diabetes, which generally starts in early childhood, the main risk factor is a family history of the disease. The American Diabetes Association recommends that “anyone with a first-degree family history of diabetes such as a mother, father, sister, or brother should be screened.” A simple blood test can determine this type of diabetes. Injury or disease related to the pancreas can prevent the ability to produce insulin which can lead to type one diabetes. Certain infections or illnesses can cause damage to the pancreas which can also cause type one diabetes. Risk factors for type two diabetes are most commonly obesity or being overweight. Diabetes has been shown to link to these factors and be the number one cause of type two diabetes. Impaired glucose tolerance is a form of pre-diabetes and has also been found to be a major risk factor for type two diabetes. Insulin resistance is a condition where the pancreas has to work twice as hard as normal to make enough insulin so that the cells can get the energy that is needed. This can eventually lead to type two diabetes. Ethnic background is also a risk factor. Diabetes has been shown to occur more often in Hispanics, African Americans, Native Americans, Asian Americans, Pacific Islanders, and Alaska natives. (WebMD, www.webmd.com) Hypertension, otherwise known as high blood pressure, is a major risk factor but low levels of HDL, or good cholesterol, can also put a person at risk. Sedentary lifestyle, being inactive, can make a person more likely to develop type two diabetes as well as age. Some doctors will recommend that anyone over the age of forty-five be screened for diabetes. This is due to the fact that increasing age can put a person at higher risk of developing diabetes. Risk factors for gestational diabetes are; being obese or overweight, a history of previous glucose intolerance or previous gestational diabetes in other pregnancies can increase the risk of gestational diabetes in the current pregnancy. Family history such as a parent or sibling who has been diagnosed with diabetes can also increase the risk of getting gestational diabetes. The older a woman is when she becomes pregnant puts her at higher risk for gestational diabetes. Symptoms: Symptoms for type one diabetes include; blurry vision, fatigue, weight loss, excessive thirst or hunger, and frequent urination. Symptoms of type two diabetes; because this type of diabetes develops slowly some people may not experience any symptoms at all but some symptoms can include; fatigue, increased urination, increase in thirst, nausea, vomiting, and weight loss in spite of increased appetite. Evolution of Treatment: Early Treatments: Into the seventeenth century diabetes treatment was mostly guesswork. Doctors often prescribed natural treatments such as jelly of viper flesh, almonds, and red coral according to Diabetes Health (www.diabeteshealth.com) Doctor Fredrick Allen began treating diabetes with a low calorie diet in the twentieth century. In spite of keeping patients alive, the treatment only allowed 450 calories a day which caused near starvation for most of his patients. In 1921, Canadian doctors Banting and Best kept a diabetic dog alive for seventy days using a crude form of insulin which then led to the use of insulin to treat diabetes. Coupled with Roger Hinsworth’s discovery of the two types of diabetes in 1935 insulin treatment became used throughout the world. (Diabetes Health, diabeteshealth.com) During the 1970’s, the insulin pump was developed, refining insulin treatment by releasing insulin into the body continuously through a tube creating a more natural release of insulin into the body. (The History of Diabetes, www.historytreatmentdiabetes,html) The main goal in treating diabetes is to minimize any rising of blood sugar without causing abnormally low levels of blood sugar. Type one diabetes is treated with insulin, exercise, and diet. Type two diabetes is first treated by reducing weight, healthy diet, and regular exercise. If these treatments fail to control high levels in blood sugar then oral medications can be used. If oral medications do not work then treatments with inhaled or injected insulin are considered. Keeping with a diabetic diet is very important in controlling elevated blood sugar in patients with diabetes. The American Diabetes Association provides guidelines for a balanced, nutritious diet low in cholesterol and simple sugars. The total daily calories are evenly divided between three meals. In the past two years the ADA has lifted the absolute ban on simple sugars. Small amounts are allowed as long as they are eaten with a complex meal. Medications: Based on what is known medications for type two diabetes are designed to; increase the insulin output by the pancreas, decrease the amount of glucose that is released by the liver, increase the sensitivity of cells to insulin, decrease the absorption of carbohydrates from the intestine, and slow the emptying of the stomach to delay the presentation of carbohydrates for digestion and absorption in the small intestine. (WebMD, www.webmd.com) Varying combinations of medications are also used to correct abnormally elevated levels of blood glucose in diabetes. As the list of medications continues to expand, treatment options for diabetes can be better tailored to meet each individuals needs. Not every patient with type two diabetes can benefit from every drug and not every drug is suitable for every patient. Historically, increasing insulin output by the pancreas has been the major area targeted by medications used to treat diabetes. These medications belong to a class of drugs call sulfonyureas. The History of Diabetes, www.historytreatmentdiabetes.html A class of drugs known as meglitinides is fairly new. Meglitinides also work on the pancreas to promote insulin secretion. Unlike sulfonylureas which last longer in the body, meglitinides are short acting with peak effects within one hour. For this reason they are given three times a day before eating a meal. The History of Diabetes, www.historytreatmentdiabetes.html A class of drugs called biguanides has been used for many years in Europe and Canada. In 1994 the Food and Drug Administration approved the use of biguanides for the treatment of type two diabetes in the United States. The History of Diabetes, www.historytreatmentdiabetes.html This medication is unique in the ability to decrease glucose production by the liver and has a tendency to decrease appetite which can be beneficial in diabetics who tend to be overweight. In the past biguanides were used to treat a condition called lactic acidosis which is a dangerous acid buildup in the blood. The History of Diabetes, www.historytreatmentdiabetes.html Another class of drugs called thiazolidinediones lowers the blood glucose by improving target cell response to insulin. These drugs were once taken off the market due to severe toxic liver effects however, new compounds are now available that are safer. The History of Diabetes, www.historytreatmentdiabetes.html Community Programs: As of now due to the fact that I live in a very small community there are not any available awareness programs for diabetes but I do have some ideas for what I would like to see implemented to promote awareness. School Programs: There could be diabetes awareness taught in the health classes in schools since the United States is seeing a trend of more and more obesity in children. These classes could discuss the importance of a healthy diet and exercise as related to diabetes. The schools could also serve healthier foods in the cafeteria instead of foods that are high in fat such as pizza, burritos, and fried chicken. They might offer more healthy choices such as salads with skinless chicken breast, fresh fruits, and salads with low calorie dressing. There could possibly also be diabetes screening clinics held once or twice a year for the children of low-income families who do not go to the doctor very often if at all. I would like to see a diabetes awareness week in the community where there might be charity events such as a diabetes walk-a-thon or barbeque. Fliers could be put on the community board at the local grocery store and gas station and volunteers could also be used to put fliers on doors or in mailboxes throughout the community. The local community health center could also promote diabetes awareness with posters on the walls in the waiting rooms that describe the disease and its symptoms which might encourage more patients to talk to their doctors about their concerns or for more information. My idea for spreading the word would be a diabetes coloring book that is given to children of all ages in school. This would be something that would be required to be taken home and shared with the children’s parents. Children are often a good source of suggestion. For example: my children learned about the effects of cigarette smoking in school and the health problems it can cause. They were constantly reminding me of these things every time I lit a cigarette. They first got me to stop smoking in the house and car by reminding me of the dangers of second hand smoke and finally their statement of how they did not want me to get lung cancer and die because they loved and needed me around convinced me to quit. This could also work for diabetes awareness. More people need to be informed about the dangers of obesity and lack of exercise and how it can lead to this disease which has become more common, especially in young people. Without awareness people will not know how much danger they or their children or other loved ones could be in by ignoring the signs, symptoms, and risks of this potentially deadly disease. Research has come a long way in the treatment of diabetes and with proper monitoring, lifestyle changes, and medications those with diabetes now have a better chance to live long and healthy lives. References: American Diabetes Association, www.ADA.org Center for Disease Control, www.CDC.com Diabetes Health, www.diabeteshealth.com The History of Diabetes, www.historytreatmentdiabetes.html WebMD, www.webmd.com