Nov 13, 2018 in Informative

Diabetes

People all over the world suffer from many chronic diseases. Some of them are inborn, some are caused by the state of the environment, lifestyle or other health conditions. Diabetes mellitus is one of many different chronic disorders that affect lives of an impressively large amount of people. Unlike many other chronic conditions, diabetes can occur because of many different reasons: lifestyle, other diseases, genes, and others. Since diabetes occurs rather often, it needs to be evaluated from a closer perspective. Therefore, the paper discusses statistics related to the disease, its symptoms, types, peculiarities, diagnosis, treatment, and prevention. 

Statistics and Overview

Many different resources provide astonishing statistics on diabetes mellitus. According to National Center for Chronic Disease Prevention and Health Promotion, more than 8% of people living in the United States (more than 25 million) have diabetes. Out of 25 million people with diabetes, only 18.8 million are diagnosed with the disorder, whereas 7 million live without knowing that they have this condition (National Center for Chronic Disease Prevention and Health Promotion. Some ethnic minorities often are  not diagnosed with the condition because of limited access to the healthcare. The greatest amount of sick people are citizens that are older than 65, however patients under 20 constitute a big part too. Diabetes is reported to cause kidney failure, blindness, heart disease, stroke, and feet amputations that are not caused by traumas. Death because of this disease occurs rather often. National Center for Chronic Disease Prevention and Health Promotion states that it is the seventh cause of death in the USA. Most children having diabetes are usually diagnosed with type 1 that occurs because of their physical characteristics. 

Symptoms

Each disease has its manifestation. Diabetes has some peculiar signs by which the condition can be defined. The blood glucose level is high and it makes a person experience some specific changes in the organism. Among main symptoms of the disease, healthcare providers single out frequent urination, especially at night, thirst or/and hunger, weight loss without clear reasons , tiredness, blurred vision, genital itching, balanitis, slow healing of wounds, and others. 

People having type 1 diabetes experience quick development of symptoms, which are usually rather noticeable. The symptoms pass as fast as they appear if the condition is diagnosed and treated properly. For patients with type 2 diabetes, the symptoms can be not that obvious as the condition develops for a longer period of time (years, not weeks as type 1). The disease is usually discovered during medical check and if treated, the symptoms disappear quickly. 

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Type 1 Peculiarities

Type 1 diabetes is a pathological condition characterized by the pancreatic β-cell destruction that results merely in insulin deficiency. The scientists distinguish between two subtypes of Type 1 diabetes, namely, type 1A, which is caused by a cell-mediated autoimmune attack on pancreatic β-cells, and type 1B, with no specific causes being identified, which is believed to be less frequent and occurs among African and Asian individuals. According to Eisenbarth, there is always a certain degree of susceptibility to developing type 1 diabetes. Considering the issue of susceptibility to diabetes mellitus (type 1), Eisenbarth concluded that it was “largely inherited” in a sense that predisposition to develop Type 1 diabetes is individual and genetically predetermined. Around 50-60% of patients are diagnosed with type 1 diabetes when they are under 18 years of age. Many countries provide astonishing statistics on the epidemiology of this type of the condition, mostly among children around 15-18  years old. Regarding the issue of type 1 diabetes management, the scientists admit the paramount importance of glycaemic control. Complications and comorbid conditions, in this case, are merely long-term diabetes-related complications. The scientists distinguish between microvascular and macrovascular subgroups of diabetes-related complications and comorbid conditions. Diabetic nephropathy, microalbuminuria, diabetic retinopathy, which are regarded as one of the main causes of the acquired blindness among the patients diagnosed with type 1 diabetes, and diabetic neuropathy are typical microvascular complications of type 1 diabetes. Cardivascular disease and clinical autoimmune thyroid disease are viewed as typical type 1 diabetes-related macrivascular condition and comorbid condition respectively. With type 1 diabetes, the organism, or more precisely, pancreas produces a very little amount of insulin or cannot produce it at all. As a rule, it is an autoimmune disorder. Watkins states that the condition is connected with genetic characteristics or some environmental triggers that are hard to determine. 

Type 2 Peculiarities

Type 2 diabetes mellitus is regarded as a complex heterogeneous condition. The latest studies, according to Watkins, found out that type 2 diabetes has many sub-types. The condition is considered to be partially curable since after some interventions, lifestyle changes and dietary control, a person might stop feeling symptoms and receiving insulin shots. During the last decade, more children were diagnosed with type 2 diabetes. They are usually overweight and belong to the ethnic minorities that are in the risk group. 

The pathophysiology of type 2 diabetes is a bit different from that of type 1 since the pancreas can produce insulin. The problem is that either there is not enough insulin produced, or the body cannot use it in a proper way. In this case, glucose resistance develops. Diabetes of this type can have very serious consequences if it is not treated: organ damage, dehydration, and even diabetic coma. No one is protected from type 2 diabetes acquisition since the condition is not inborn, but acquired. However, there are people considered to be at risk of developing the disease. The most susceptible category includes people older than 45, overweight, with history of gestational diabetes (women only) or type 2 diabetes, those diagnosed with prediabetes, those who have limited physical activity, high triglycerides and low HDL cholesterol, or belong to certain ethnic group that is regarded as having many incidents of diabetes. 

Gestational Diabetes

Gestational diabetes is not always regarded as a separate type of the disease. The condition of this kind affects only pregnant women. If a woman is determined to have high glucose level only during the pregnancy, she has gestational diabetes. Almost 4% of all women are diagnosed with this condition. Because of hormonal changes that the woman experiences during the pregnancy, the blood sugar level can raise above the average norm. Usually, the pancreas develops more insulin during the pregnancy than in ordinary state in order to lower the sugar level. When it fails, the woman is diagnosed with gestational diabetes. If the level is too high, especially during the third trimester of the pregnancy, there is a serious risk for both the mother and the child. 

Gestational diabetes might have serious complications for both the mother and the child. The risk of miscarriage during the first trimester is rather high. It is a real problem especially for women that try to get pregnant for a long time. Another issue is possible birth defects. Gaither states that mother’s high glucose level in the first trimester can result in brain, heart or any other organ damage. The high glucose and insulin levels are dangerous during the second and third trimesters of pregnancy as well. Since the mother has high blood sugar level, her body produces more insulin than usually. Thus, the baby receives too much insulin (acquires hyperinsulinemia). Right after birth, the situation may change cardinally as the baby will not have as much sugar as in the uterus, so his/her sugar level can drop very low and the newborn can die or have some serious complications. If a mother cannot control diabetes during the second and the third trimesters of pregnancy, the disease will foster baby’s over-nutrition and excessive growth. Under such conditions, the delivery will be rather risky. If the emergency caesarean delivery is not used and the woman has to give birth on her own, there are all chances that the newborn as well as woman will receive birth trauma . Although gestational diabetes is very risky, professionals claim that there is a high possibility that the child will be healthy if the mother controls her condition. 

A number of characteristics can add to woman’s possible development of gestational diabetes. These characteristics should be considered  before getting pregnant, if the woman belongs to an ethnic group that has larger chances of developing diabetes (Asian, African, Hispanic and Native Americans), having sugar in urine. Other risks are the family history of diabetes, high blood sugar (not as high as to be considered diabetes), experience of giving birth to a stillborn or a very large baby (over 9 pounds), gestational diabetes during previous pregnancies, having polyhydramnios (much more amniotic fluid than needed), and some others. However, many women that develop gestational diabetes do not have any risk characteristics, but still can acquire the condition. The most important thing is that women should take care of their health: visit the healthcare professionals regularly, eat healthy food, and have a good rest. In this case, the risk of diabetes development is lower. 

Diagnosis

Although diabetes can be easily suggested as a diagnosis, the healthcare providers need to be very careful in determining the disease and its type since, in most situations it is a life-long condition, which, in case of improper diagnosis, can lead to serious complications and death. If people have evident symptoms, the healthcare providers use only glucose measurement in order to prove the diagnosis. If a person does not report any unusual symptoms, for example, experience mild hyperglycaemia only that would indicate the disease in short terms, professionals need to obtain two abnormal test results at least. In order to diagnose diabetes, the healthcare givers use different tests. They might include glucose tolerance test, ketones measurement and many others.  

Gestational diabetes is easier to manage, when it is diagnosed as early as possible. For this reason, women belonging to risk groups are tested when they find out they are pregnant, whereas women without predisposition are checked during their 24-28th weeks of pregnancy. Pregnant women have an ordinary blood test and the healthcare providers define whether the level of sugar indicates the developing or existing gestational diabetes.

Complications

Diabetes is reported to cause some serious health complications that can be irreversible or even deadly. Among main complications, healthcare providers mention stroke or other heart-related disease, hypertension, blindness (sight problems), kidney failure, amputations, diseases of nervous system, pregnancy complications, dental problems, and others. Most complications can be avoided if the patient diagnosed with diabetes, controls his or her level of glucose in blood, takes medications, and leads healthy lifestyle. 

Heart problems caused by diabetes occur rather often. According to the National Center for Chronic Disease Prevention and Health Promotion, adults that suffer from diabetes experience stroke or heart problems two to four times often than adults without diabetes. In most cases, the condition affects either heart itself or the vessels, causing coronary artery disease leading to heart attack. High blood pressure, high glucose and cholesterol levels, obesity and other factors that are associated with diabetes mellitus cause most diabetes-related heart and vessel problems. 

Blindness and sight problems often result from diabetes. At first, a person with type 1 or 2 diabetes develops eye disease (retinopathy) and only after that risks of  becoming completely or partially blind. The causes of retinopathy are the same as of heart problems: hypertension, and high glucose and cholesterol levels. The regular sight checking and controlling the level of sugar in blood can prevent blindness and reduced vision. 

Patients with diabetes suffer from kidney problems rather often. Many diabetic patients develop diabetic nephropathy as a result of their chronic condition. Diabetes affects blood vessels, including those in kidneys. Since the vessels are damaged, the kidneys cannot work in a proper way and finally stop working at all. The state of kidneys of the patients with diabetes mellitus should be regularly checked and the basic chronic disease should be controlled in order to prevent compromising and fatal outcomes. 

Diabetes can also result in nerve disease (diabetic neuropathy). Around 65% of diabetic patients suffer from either mild or severe damage of the nervous system. When a person has too high glucose and blood pressure, nerves damage and different complications occur. Nerve damage can lead to digestion problems, carpal tunnel syndrome, loss of sensitivity, pain and tingling, erectile dysfunction, and other problems.

Amputation is one of possible outcomes for patients suffering from diabetes. Ulcers can develop as the result of neuropathy (peripheral nerve disease) and blood vessels damage. A person might lose sensitivity in lower limbs and, therefore, not notice the ulcers. There is a possibility that a person with diabetic ulcers can lose feet since diabetic patients have worse wound healing abilities. For this reason, people with impaired leg sensitivity caused by diabetes mellitus should have daily personal feet checks and annual professional examinations. 

Pregnancy complications associated with diabetes mellitus are also possible. If a woman with this chronic condition (of any type) does not carefully control her state before and during pregnancy, she creates risky environment for a fetus. From 15% to 20% of diabetic women with uncontrolled disease have spontaneous abortions. Moreover, birth defects become more possible under the circumstances. If the state is not controlled during the second and third trimesters, the children can grow too big and, therefore, then both the mother and the newborn are threatened. If women with diabetes plan to have children, they should carefully monitor their glucose level before the conception. Glucose should be controlled during the pregnancy as well since the child risks developing the mother’s condition in the future. 

Treatment

Although diabetes mellitus is a chronic disorder, it can be controlled and cured. Type 1 can be only controlled, and type 2 and gestational diabetes are curable. The main options while dealing with diabetes and diabetes-related complications are as follows. First of all, glycemic control and insulin injections are regarded as the appropriate actions in this case. Evidently, keeping to dietary regime and exercising can be viewed as both the preventive measures and measures for treatment and care in case of diabetes mellitus and diabetes-related conditions. Doctors’ appointments, oral healthcare, specific types of treatment and care for expecting women and elderly people are considered to be the pivotal aspects of diabetes management as well. Oral healthcare is important for the patients diagnosed with diabetes merely because they are prone to gum problems and teeth loss. Specific types of treatment and care for expecting women and elderly people with diabetes are significant because the disease can potentially affect baby’s health, and bring the increased risk of coronary disorders in both groups. Doctors’ checks are the essential part of living with diabetes.

Gestational diabetes is treated in a different way. Pregnant women are not recommended to take any medications, so healthcare providers recommend them the least invasive methods. Thus, they have their sugar measured four times per day. Pregnant women with gestational diabetes have their urine tested for ketones. Ketones are elements of the acid that show whether the diabetes is controlled or not. In addition to these measures, women with this type of diabetes follow strict diet, do some exercises to lose weight if they are obese, control their weight and blood pressure, and take some medications if necessary (usually insulin shots or some hypoglycemic medications). 

Exercising is regarded as an essential part of treatment since many studies proved it to be effective concerning type 2 diabetes management. Sigal, Kenny, Wasserman, Castaneda-Sceppa, and White state that physical activity is essential for the disease prevention as it stimulates weight loss, which reduces the risk of impaired glucose tolerance development. Moreover, structured exercise interventions are helpful in glycemic control. Physical activity and aerobic fitness reduce the risks of cardiovascular disorders and, therefore, decrease the morbidity and mortality rates associated with type 2 diabetes.

Conclusions

Diabetes mellitus is a chronic condition that causes significant morbidity and mortality. Healthcare professionals determine three types (some two only) of the condition: type 1, type 2, and gestational diabetes. Many people all over the world have the disease, but are not diagnosed. It often refers to type 2 diabetes since it develops over a long time and can be acquired because of the lifestyle, diet, ethnic belonging, health problems, family history of diabetes, and other reasons. Type 1 diabetes is an autoimmune disease, which appears because the pancreas does not produce insulin. Type 1 is usually inborn, thus it cannot be developed. Pregnant women can suffer from gestational diabetes because of physical predisposition and hormonal changes. Each type has some complications if untreated properly. These can be blindness, amputation, heart disease, stroke, kidney failure, pregnancy and labor complications, and others. The manifestation of the disorder can be either evident or hardly noticeable. Usually, a sick person has frequent urination, thirst or/and hunger, genital itching, tiredness, unexplained weight loss, and some symptoms. Since the disorder is chronic and can have serious consequences, people that have been diagnosed with it need to take care of their treatment and strictly follow the recommendations of their healthcare professional. Treatment options depend on the type of the disease and can include dietary control, insulin shots, special medications, exercises and other measures. Exercises are considered to bring much benefit for the type 2 diabetes management. Since certain types of the disease can be prevented, people need to take care of their lifestyle in order to avoid the development of diabetes mellitus. Therefore, they need to eat healthy food, exercise a lot, control sugar consumption, have regular checks, and avoid weight gain. Overall, diabetes is a serious disease that takes away lives of many people, although rather often it can be controlled, cured or prevented. 

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