Diabetes Essay, Research Paper

HISTORY

Man has long recognized diabetes mellitus, and this disorder ? or a syndrome resembling it ? was well known to the ancients. The original clinical description must now be lost in antiquity, but Lazarus and Volk in their excellent historical review attributed the earliest writings on this subject to the papyrus Ebers (circa 1500 B.C.). The term ?diabetes? that we use today was introduced in more recent times by Aretaeus of Capdocia shortly after the birth of Christ. From this date onwards, the classical literature abounds with references to diabetes mellitus. However, the basic hormonal abnormalities remained unknown until the pioneering labors of Banting and Best resulted in the purification of insulin in 1921 (Robert M. Galbraith 1). The consequent realization that diabetes involves an absolute or relative deficiency of insulin can be considered to clarify the question of ?what is the basic hormonal abnormality??. However, the questions of ?how?? and ?why?? remain to be resolved

DEFINITION

Diabetes mellitus, a chronic disease of unknown etiology, is characterized by a primary disturbance in the metabolism of carbohydrate and by the impaired utilization of protein and fats. Either an insufficiency or abnormality of insulin reaction apparently mediates the basic metabolic disturbance that occurs. The sugar, which cannot be properly utilized by the body, collects in the blood and may be subsequently excreted in the urine. In addition, a functional alteration of the vascular system, including both the large and small blood vessels, inevitably occurs (U.S. News and World Report 74) .

DEFINITION OF TYPE 1 DIABETES

Diabetes is usually classified as either growth onset diabetes (type 1 or juvenile) or adult diabetes (type2). Type 1 diabetes almost always appears explosively in persons under 20 years of age and is recognized because the patient becomes acutely ill. The juvenile diabetic?s condition is labile, and both acidosis and hypoglycemia are likely to occur. This is sometimes called ?brittle? diabetes. Insulin is required, but even with this, the disease may not be stable (Public Health Service Publication 1). Insulin-dependent diabetes (Type I), also called juvenile-onset diabetes, is the more serious form of the disease; about 10% of diabetics have this form. It is caused by destruction of pancreatic cells that make insulin and usually develops before age 30. Type I diabetics have a genetic predisposition to the disease. There is some evidence that it is triggered by a virus that changes the pancreatic cells in a way that prompts the immune system to attack them. The symptoms are the same as in the non-insulin-dependent variant, but they develop more rapidly and with more severity. Treatment includes a diet limited in carbohydrates and saturated fat, exercise to burn glucose, and regular insulin injections, sometimes administered via a portable insulin pump (Public Health Service Publication 2).

SCOPE OF PROBLEM

Diabetes is a worldwide disease and one of the most common endocrine disorders in the United States. Estimates vary, but there are more than 16 million diabetes in this country and nearly one million have type 1 diabetes (U.S. News and World Report 74). The number of diabetics seems to be increasing, and there are a number of reasons for this. First, people, in general, are living longer. Also, the life expectancy of diabetics is increasing; consequently, the total number of diabetics is on the increase. Young diabetics now remain alive and are able to bear children, thus increasing the number of people with inherited tendency toward the Type 1 diabetes. Type 1 Diabetes is most likely to be found among those who are: 1) at a young age, 2) obese, 3) blood relatives of diabetics, 4) mothers who have given birth to babies that weighed 9 pounds or more at birth, and 5) women who have shown carbohydrate intolerance during pregnancy. Also the National Health Interview Survey data indicate that rates of diagnosed diabetes are higher in low-income groups and among persons with fewer years of education (Public Health Service Publication 5). There is also a connection between blacks and diabetes but in Type 1 the results aren?t positive yet.

DETECTION

Diabetes screening refers to the application of blood and/or urine tests preferably after a glucose challenge to large numbers of persons in the general population, or better yet, to selected high-risk groups. Blood tests are more sensitive and specific than urine tests and are more likely to identify the diabetics in the population studied. Formerly, a urine test for sugar was accepted as an adequate screening procedure. Today, it is recognized that sugar is not always present in the urine of a person who has diabetes, and that a person without diabetes may have sugar in the urine. Also, by the time sugar shows up in the urine, the disease may be far advanced (Public Health Service Publication 7).

DIAGNOSIS

Once diabetes is detected in the family history, a detailed diabetic history is in order. This detailed diabetic history has to include the following information: 1. Duration 2. Previous or current medical treatment including diet and/or medication 3. Results of previous laboratory tests 4. Changes in weight and appetite 5. History of any complications 6. Pregnancy history 7. Dietary habits 8. Socioeconomic factors 9. Review of previous medical records. This information is very helpful in current assessment of and future management planning for the diabetic patient.

HYPOGLYCEMIA

For insulin dependent diabetes, controlling blood sugar is no easy task. Many factors can upset the balance, including illness, stress, medications other than insulin, and alcohol. If the balance is upset, the result is an insulin reaction from too much insulin circulating in the bloodstream. Hypoglycemia occurs more commonly with insulin therapy, but it can also happen with some oral medications. Some warning signs of low blood sugar are headache, sweating, pale, moist skin, cold and clammy, extreme/sudden hunger, weakness/dizziness, shakiness, fatigue/tiredness, rapid pulse rate, blurred/double vision, shallow breathing, confusion/inattention, and loss of coordination. Symptoms that require medical intervention are seizure and loss of consciousness. The treatment for low blood sugar is to give your body sugar and fast (www.jfd.org).

HYPERGLYCEMIA

Hyperglycemia occurs when your blood sugar is high. Ketoacidosis can occur when the body breaks down fats for energy because a lack of insulin, whether it is long-acting or short-acting (regular), prevents the metabolism of glucose. As a result, poisonous acids called ketones are formed. Hyperglycemia and Ketoacidosis are commonly seen together. A number of factors can cause high blood sugar, including eating too much, taking too little insulin, skipping your diabetes medication, other medications, or inactivity. Having an infection or being sick or under stress can also cause blood sugar to rise. Ordinarily, when blood sugar levels rise, hyperglycemic hormones are not released, but when hyperglycemia becomes excessive, the person begins to feel nauseated, which precipitates the fight-or-flight response. This results, inappropriately, in all the reactions that normally occur in the hypoglycemic (fasting) state to make glucose available. Thus, the already high blood sugar levels soar even higher, and excesses of glucose begin to be lost from the body in the urine (Elaine N. Marieb 615). When Hyperglemia occurs it has several warning signs and they are the following: extreme thirst, frequent urination, drowsiness or lethargy, sugar in urine, dry and hot skin, lack of appetite, high levels of ketones in urine, fruity and sweet or wine-like odor on breath, heavy or labored breathing, stupor or unconsciousness. Ketones are excreted in the urine, and special kits are available to test the urine for ketones. Check you urine for ketones if your blood sugar is consistently over 240 and doesn?t come down. The treatment is to call a doctor immediately and to drink fluids without sugar (www.jfd.org).

CARBOHYDRATE METABOLISM

Because all food carbohydrates are eventually transformed to glucose, the story of carbohydrate metabolism is really a tale of glucose metabolism. Glucose enters the tissue cells by facilitated diffusion, a process that is greatly enhanced by insulin. Immediately upon entry into the cell, glucose is phosphorylated to form glucose-6-phosphate by transfer of a phosphate group to its sixth carbon during a coupled reaction with ATP.

Because most body cells lack the enzymes needed to reverse this reaction, it effectively traps glucose inside the cells. Only intestinal mucosa cells, kidney tubule cells, and liver cells have the enzymes needed to reverse this phosphorylation reaction, which reflects their unique roles in glucose uptake and release (Elaine N. Marieb 926).

DIET

Physicians almost always recommend dietary adjustment of some kind to cope with the abnormal metabolism of diabetes (Robert M. Galbraith 17). All of these measures aim to achieve ideal weight and the normal metabolism of foodstuffs, with or without added insulin or oral hypoglycemic agents. Recommendations vary from diets that require the measuring or weighing of most foods, to advice only to avoid concentrated carbohydrates. Adjustments in caloric intake may be advised to produce weight gain or loss. In addition, modification in the fat or sodium content may be advised for patients with certain additional medical problems.

Because a diabetic?s carbohydrate tolerance is lowered by obesity, a weight-reduction diet is often advised for one who is overweight. Better control of blood glucose and serum lipids appear to be associated with attainment of desirable weight. In Type 1 diabetes calories are used inefficiently. Weight loss usually occurs before the diagnosis is known (Robert M. Galbraith 15)

There are several approaches to diet therapy for diabetics. Physicians vary in their philosophies and recommendations. The three main ones are:

1. Unmeasured or ?free? diets- these permit the patient to eat a normal diet, but avoid concentrated carbohydrate foods. The patient should be encouraged to distribute their food intake throughout the day and to observe fairly consistent eating patterns

2. Weighed diets- the diabetic on a weighed diet is required to weigh all his portions of food. Usually a gram scale is used. A chart designating protein, carbohydrate, and fat allowances of foods is provided for the patient, and he is given a chart to help him make proper substitutions to achieve a variety. Careful instruction is required.

3. Meal planning with exchange lists- the meal plan is based on six list of food called food exchange lists. Foods of similar composition are grouped together in the same exchange based on heir protein, fat, and carbohydrate content. Common portion sizes and household measurements are used.

DIET PRESCRIPTION

The diet prescription ordered by the physician states the number of calories and usually the amounts of carbohydrate, protein, and fat needed to provide these calories. The patient?s age, sex, weight, body build, occupation, and amount of exercise are considered. Food should be distributed regularly throughout the day to provide nutrients at a rate the body can use them. The physician may prescribe a snack to be eaten several hours after a short acting injection. Longer acting insulin may necessitate snacks in the midafternoon and/or before bedtime.

After the prescribed calorie level has been allocated to protein, fat, and carbohydrate, appropriate selections for each meal are made from the six exchanges or food groups. Good nutrition is assured by including the foods essential to provide protein, vitamins, and minerals in the daily diet. This is particularly important since diabetes is generally a lifetime matter. Briefly, a sound diet foundation includes two or more servings of meat; two cups milk (four for teenagers); four servings of fruits and vegetables; and four servings bread and cereals. Most diabetic diets include more of these foods, plus other foods, to fulfill calorie needs (Dorothy R. Blevins 25).

INSULIN

There are different types of insulin. They vary in their onset, peak, and duration of action. The four types of insulin are: long-acting (Ultralente), intermediate-acting (NPH and Lente), short-acting (regular) and rapid-acting (lispro). Long-acting insulin has an onset period of 6 hours and a peak of 18 hours and the duration is 36-48 hours. Intermediate-acting has an onset period of 2 hours and a peak of 9 hours and a duration of 24 hours. Short-acting insulin has a onset period of 1 hour and a peak of 3-4 hours and a duration of 6-8 hours. Rapid-acting insulin has and onset period of less than and hour and a peak of 1-2 hours and a duration of 1-2 hours. Some people with diabetes use a combination of these different insulins. Your doctor may change the type of insulin you take or the frequency based on your blood glucose levels and other lab tests (www.jdf.org).

INTERVIEW

has been a Type 1 diabetic since the age of 9. He has no regular diet but has to check his blood sugar before and after ever meal. He wakes at 7am and eats breakfast taking his insulin and eats lunch at 11:30 then checks his blood. He eats dinner at around 6:30 and takes more insulin before he goes to bed. He may have to take extra insulin depending on his blood sugar during the day. Josh has two types of insulin: Humulin R which is a regular insulin that has a peak time of about 1-3 hours and Humulin N which is NPH and has a peak work time of 8-12 hours. Josh started losing his vision as an effect of having diabetes at the age of 14 and at 16 years old he went blind entirely. His bladder has not been functioning properly for 4 years and now he has to catherize himself every day. As a result of the bladder problem he often gets kidney and urinary tract infections in which he has to be instantly hospitalized for. Josh has gone to Alfred State College and received an Associate?s Degree in business. He can no longer pursue his goal of running a business because of his diabetic condition. I asked Josh what was the one thing that he has wanted to do but he can?t because of his diabetic condition and he simply answered, ? I wanted to get my driver?s license.?

SUMMARY

Type 1 Diabetes is a very hard thing to have, not only to an adult but yet to children who have not yet lived their life or even graduated from high school and never will their life be normal. It isn?t easy having diabetes. I know this from just being around Josh and not knowing what he is really going through until this paper. I don?t ever think I could be as strong as him or the millions of children all over the world who are suffering for better treatments and easier ways of maintaining their blood sugar. I can only hope that someday their wishes will be answered.

BIBLIOGRAPHY

Schultz, Stacey. U.S News and World Report, ?Living with diabetes is getting easier-and

a cure could be on the way?. 2000

Juvenile Diabetes Foundation International. The Diabetes Research Foundation,

www.jfd.com. New York, New York, Oct 99?

U.S. Department of Health, Education, and Welfare, Public Health Service.

Atlanta, Georgia 1969

Blevins, Dorothy R. The Diabetic and Nursing Care. New York: McGraw-Hill Book

Company, 1979

Galbraith, Robert M. Immunological Aspects of Diabetes Mellitus. Boca Raton, Florida:

CRC Press, 1979

Marieb, Elaine N. Human Anatomy & Physiology. Menlo Park, California:

Benjamin/Cummings Science Publishing, 1998

TYPE 1

DIABETES

Schultz, Stacey. U.S News and World Report, ?Living with diabetes is getting easier-and

a cure could be on the way?. 2000

Juvenile Diabetes Foundation International. The Diabetes Research Foundation,

www.jfd.com. New York, New York, Oct 99?

U.S. Department of Health, Education, and Welfare, Public Health Service.

Atlanta, Georgia 1969

Blevins, Dorothy R. The Diabetic and Nursing Care. New York: McGraw-Hill Book

Company, 1979

Galbraith, Robert M. Immunological Aspects of Diabetes Mellitus. Boca Raton, Florida:

CRC Press, 1979

Marieb, Elaine N. Human Anatomy & Physiology. Menlo Park, California:

Benjamin/Cummings Science Publishing, 1998