The causes of Diabetes mellitus - Essay Example

 The causes of Diabetes mellitus Introduction Diabetes mellitus is a chronic disease which is caused by an increased concentration of glucose in the blood, known as hyperglycaemia. Insulin is a hormone produced by the pancreas, which regulates blood sugar. When the pancreas does not produce enough insulin, or when the body is unable to effectively use the insulin that is produced, raised blood sugar levels are the result, and this is characteristic of uncontrolled Diabetes mellitus. This chronic disease can over a period of time lead to serious damage to several body systems, especially to the nerves and blood vessels (WHO, 2008). This paper proposes to discuss the hormonal deficiency condition of Diabetes mellitus. The causes of diabetes, the complications that arise from the condition, effective treatment methods for management of the disease, and other related factors will be determined. Discussion Diabetes mellitus is classified according to the pathophysiologic mechanism leading to hyperglycemia. Type 1 diabetes, also known as insulin-dependent or childhood-onset diabetes, is characterized by an absence of insulin production. Type 1 diabetes can occur at any age, but usually it begins in childhood or young adulthood. Since there is absolute insulin insufficiency, blood glucose control has to be achieved from exogenous insulin. Type 2 diabetes which is also called non-insulin-dependent or adult-onset diabetes is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity. Type 2 diabetes is usually associated with people of older age, typically after age forty; but children and adolescents can also be diagnosed with this type of diabetes. Diet and exercise, in combination with various oral antidiabetic drugs are prescribed. Insulin therapy may also form part of the treatment. Gestational diabetes is hyperglycaemia that first appears during pregnancy. There are other types of diabetes which result from specific conditions such as genetic defects of pancreatic beta cells, also known as maturity-onset diabetes of the young or MODY, genetic discrepancies in insulin action; disorders involving the exocrine function of the pancreas; endocrine disorders; drugs; surgery; malnutrition, infections, and other illnesses (Williams & Springhouse, 2006: 3). Diabetes mellitus is of great concern to health care providers from all specialities of medicine. Both diagnostically and therapeutically in the management of diabetes the clinical chemistry laboratory plays a crucial role (Winter & Signorino, 2002: 1). The disease is becoming increasingly prevalent in the United States and worldwide. The Incidence and Prevalence of Diabetes In the United States of America, around 2200 people are diagnosed with diabetes every day. Of the nearly twenty million Americans with diabetes, several millions of Americans are undiagnosed (Winter & Signorino, 2002: 1). The World Health Organization (WHO, 2008) estimates that more than 180 million people worldwide have diabetes. By the year 2030, this number may very likely double in strength. In 2005 an estimated 1.1 million people died from diabetes. 80% of the deaths occur in low and middle income countries, 55% of deaths are of women, and nearly half of diabetes deaths occur in people under the age of seventy years. It is predicted that within the next ten years diabetic deaths can increase by more than 50%, and rise to levels of 80% in upper middle income countries if urgent preventive action is not taken. A great cause for worry in the prevalence of diabetes is the wide presence of Type 2 diabetes in children and adolescents. With the rise in childhood obesity, Type 2 diabetes which occurred mainly in adults older than 45, is becoming more common among younger people (Williams & Springhouse, 2006: 4). The Causes of Diabetes The group of diseases which comprise diabetes is characterized by high levels of blood glucose that is the outcome from defects in insulin production or insulin action. In the United States it is the sixth chief cause of death. The main reasons for the onset of diabetes are: “aging, unhealthy diet, obesity, and lack of exercise” (Williams & Springhouse, 2006: 10). The exact cause of the disease are unknown, though there are several causal factors whose presence place a person at greater risk for the development of diabetes. These include: a parent or sibling with diabetes, obesity, age older than forty-five, belonging to certain ethnic groups such as Native American, Black and Latino, history of diabetes during pregnancy: gestational diabetes, or delivering a neonate weighing more than nine pounds, and high blood pressure, high triglyeride levels, and high cholestrol levels (Williams & Springhouse, 2006; 10). Lundstrom & Rossini (2003: 19) support the view that the main causes of diabetes are: heredity and obesity. The risk for developing Type 1 diabetes is 2% to 7% through heredity. On the other hand, there is a 90% risk of developing Type 2 diabetes through the hereditary factor compounded by obesity. Some other causal factors are: Aging: with advancing age, the number of insulin producing beta cells may decline. Viruses: Some viruses may destroy beta cells or may trigger the immune system to destroy beta cells in susceptible people. Faulty immune system: Increasingly, scientists believe that there is not one cause of diabetes but multiple factors that may trigger the immune system to destroy beta cells. Physical trauma: The pancreas which produces insulin may be destroyed by an accident or an injury. Drugs: Drugs prescribed for another condition may cause insulin resistance or destroy beta cells, and reveal diabetes in the patient. Stress: Hormones that are released during periods of stress such as an acute illness or surgery may decrease the action of insulin. Similarly, hormones produced during pregnancy may decrease the action of insulin. Thus, the disease could arise due to any of the above factors. Complications in Diabetes The complications of diabetes are extensive. Diabetes can affect many organs and body systems leading to serious and sometimes life-threatening consequences. High blood glucose levels may damage blood vessels and nerves, leading to vascular disease and neuropathies. The disease can also lower the body’s ability to fight infection and various illnesses, leading to more complications. Further, acute complications which are directly related to blood glucose control can occur. Gender plays a part in determining which complications arise due to diabetes (Williams & Springhouse, 2006: 5). As compared to members of the general population, heart disease and stroke are two to four times more likely to occur in people with diabetes. Among diabetes patients, more than 75, 000 deaths per year result from heart disease. The co-morbidity of hypertension affects 20% to 60% of people with diabetes. This gives rise to microvascular complications related to the eyes, kidneys and nerves. Hypertension occurs twice as frequently in diabetics as in non-diabetics. Gestational diabetes occurs more frequently among black, Latino and native American women. After the pregnancy, approximately 5 to 10% of these women are diagnosed with Type 2 diabetes and the rest have a 20% to 50% risk of developing diabetes within the next five to ten years. In the case of pregnancies where blood glucose levels are not controlled before conception and during the first trimester, major defects can occur in up to 10% of the cases. The risk for spontaneous abortion is from 15% to 20%. Large birthweight infants and neonates with congenital malformations are higher for women who do not receive prenatal diabetic care (Williams & Springhouse, 2006: 8). Diabetes is the leading cause of nontraumatic lower limb amputations, which occurs at the rate of more than 56, 000 amputations per year. Compared to non-diabetic individuals people with diabetes are 15 to 40 times as likely to require a lower extremity amputation as non-diabetic individuals. Further, as many as 12, 000 to 24, 000 people develop blindness every year as a consequence of diabetes. Among people aged 20 to 74, the chief cause of new cases of blindness is diabetes. Also, up to 40% of new cases of end-stage renal disease are mainly caused by diabetes. From 60% to 70% of patients with diabetes suffer from neuropathy which can contribute to amputations. Diabetic foot lesions may also require foot amputation if there is severe deterioration of the condition (Winter & Signorino, 2002: 3). Treatment and Management “Prevention of acute and long-term complications of the disease is the principal focus of the treatment strategies” asserts (Aspen & Beard, 1999: 3). The long-term management of the disease is a challenging project for the health professional, the patient and the family. The main goals of treatment are: normal physical and emotional development, reduction in symptoms associated with excessive glycemic excursion, and reducing long-term complications. Undertreatment in children results in growth retardation and delays in sexual maturation. Hypoglycemia which can cause an altered level of consciousness, seizures and brain damage. Retinal, renal and nerve damage may occur as long term problems. Management of the disease is crucial. This includes education of the family and the patient, so that they can start taking independent decision on daily issues relating to diet, activities, and insulin dose adjustment to prevent hyperglycemia and hypoglycemia. To avoid metabolic abnormalities, blood glucose has to be monitored several times daily, along with urine ketone checks at intervals. Frequent health care visits are essential in order to monitor the hemoglobin levels, blood lipids and blood pressure (Aspen & Beard, 1999: 3). For delaying the onset and slowing the progression of Diabetes mellitus intensive insulin therapy is considered to be superior to conventional therapy. Intensive therapy results in significant reductions in the occurrence of microalbuminuria, albuminuria and clinical neuropathy. Simultaneously, increase in incidence of severe hypoglycemia should be avoided. Strategies other than tight glycemic control are considered to be more feasible for long term treatment and management. For this purpose, patient education programs are crucial, since the basic foundation for prevention and treatment lies in the hands of the patient. Eye diseases such as proliferative retinopathy, diabetic macular edema, cataracts and glaucoma should be diagnosed and treated at an early stage. The incidence of foot infections and ulcerations can be reduced by patient education about foot care, by advising smoking cessation and by treatment through medical and surgical management in order to prevent increase in the infected ulceration. Further, attention to the prevention and treatment of hypertension and hypercholesterolemia may reduce the incidence of cardiovascular complications. Failure to provide adequate treatment for diabetes can result in severe complications, hospitalization and death, which may be more expensive as compared to the cost of high quality care (Aspen & Beard, 1999: 4). Conclusion This paper has highlighted the various aspects of the disease Diabetes mellitus. The types of diabetes, the incidence and prevalence of the disease, the causes of diabetes, the various complications that result from not controlling the progression of the condition, and the various treatment interventions and techniques of managing the disease have been outlined. The disease condition, its possible complications along with the expensive treatment, place diabetes as a burden on the patient and his/ her family. In current times, children are increasingly developing diabetes due to lack of sufficient physical exercise and sedentary activities coupled with careless eating habits. Counseling the patient as well as his family is very essential for the patient to be able to take charge of preventing and treating the condition. References Aspen, Jo G. & Beard, Shawn. Diabetes management: clinical pathways, guidelines and patient education. Maryland: Jones & Bartlett Publishers. 1999. Lundstrom, Ruth E. & Rossini, Aldo A. The diabetes handbook. Massachusetts: Jones & Bartlett Publishers. 2003. WHO (World Health Organization). Diabetes mellitus. World Health Organization. 2008. Available at: http://www.who.int/topics/diabetes_mellitus/en/ Williams, Lippincott & Springhouse, Wilkins. Diabetes mellitus: a guide to patient care. The United States of America: Wolters Kluwer Health Publishers. 2006. Winter, William E. & Signorino, Maria R. Diabetes mellitus: pathophysiology, etiologies, complications, management and laboratory evaluation. The United States of America: The American Association for Clinical Chemistry. 2002. Read More