ESSAYON DIABETESINSTITUTIONNAME DIABETESIntroductionDiabetes is amulti-system disease that can affect people of all ages. A high level of plasma glucose beyond normalranges is characteristic of this syndrome. Diabetes is diagnosed when the bloodsugar is found to be continuously above 11mmol/L even during fasting. It can be caused by many thingsleading to the different classes used in describing it such as Type I and II, gestationaland juvenile diabetes.
These descriptive classes could be different in terms ofthe commonest population affected, median age at diagnoses and the symptomatology.Typesof DiabetesType I variant is commonlydue to the body’s immune system recognizing the beta cells of the pancreaswhich secrete insulin as foreign and attacks them. This leads to completedeficiency of the insulin in the blood stream. It is the insulin that isresponsible for breaking down glucose for use by other tissues and for storageinto fats.
Continuous and progressing loss of these cells happens over a longperiod of time during which the patient could be symptomless. Evidence hasshown a genetic component involving human leukocyte antigens (HLA) in itspathogenesis. Some presenting features due to the hyperglycemic state areconsidered classical like polyuria, polydipsia and polyphagia. Others includefatigue, unintentional loss of body weight, increased levels of ketones in thebody, increased risk for infections especially involving the genitourinary systemsand has a common age at diagnosis below forty years.
.In Type II diabetes onthe other hand, there is insulin production but the quantities produces are notsufficient to offset the cellular sugar imbalance. This causes glucose levelsto be higher in the blood stream but very low in the tissues that need it likethe peripheral muscles.
This variant of diabetes is believed to be caused bydecreased sensitivity of peripheral tissues to insulin. The pancreas attemptsto compensate by increasing production but this is also overwhelmed. It iscommonly diagnosed in older patients but of late, it has been diagnosed in wayyounger patients. This is because of the many risks that predispose to itsdevelopment among the younger population.
Increasing appeals of sedentary lifestylesand poor eating habits involving lots of junk and sweetened foods leading toobesity has been deemed the main culprit in this case, though there is also agenetic component involved it its pathogenesis. The presenting signs are thesame as in Type I with the exception of associated weight gain.Gestational diabetes isthe syndrome of hyperglycemia that occurs in pregnant women. In order to supportthe growth of a fetus, some of the metabolic changes that occur in a gravid womaninclude increase in resistance to insulin with concomitant decrease in thesensitivity to the same caused by the hormones secreted by the placenta. It canoccur in women who were previously diabetic or in previously normal patients. Howeversome degree of impaired glucose tolerance is usually evident from previousmedical history. The symptoms are the same as in Type II disease and some womenreturn to normal glucose levels after delivery while others continue to havediabetes post-partum.Juvenile diabetesrefers to the presentation of clinical and laboratory signs of diabetes inchildren.
It is commonly referred to as Type I since both occur in childhood andhave the same symptomatology therefore, both names could be used interchangeably.Metforminin treatment Type II DiabetesMetformin is ananti-diabetic drug of the biguanide class that functions to reduce theproduction of glucose from the liver and its absorption from thegastrointestinal tract and is excreted by the tubular system of the kidneys.It is recommend as afirst lime therapy for Type II diabetes and can be given alone or combined withother diabetes medications such as sulfonylureas and insulin. In addition, ithas been found to be more effective in achieving glucose control when used togetherwith insulin.
Metformin is administered as tablets of immediate or extendedrelease dosed at 500mg to 1000mg for adults and children. The oral solution isusually dosed at 100mg/mL. tIt is not recommended in the geriatric patientsbecause of reduced kidney functions.Dietaryconsiderations in treatment.Type II diabetes isusually considered under the spectrum of lifestyle diseases and thus nutritiontherapy forms an integral component in its prevention, management and self-education.All individuals are usually considered for individualized nutrition managementby a qualified nutritionist. The advised route is to avoid complete overhaul ofthe patient’s diet and instead focus of calorie intake restriction, consumptionof lesser quantities of foods high in saturated fats and those containing lotsof sugar.
Consumption of greens, fruits and vegetables is also advised thataids in weight reduction.Impactsof DiabetesShort Term:usually occur mainly as a direct influence of the excess glucose on bodytissues. The development of ketoacidosis due to dehydration and loss ofelectrolytes can lead to cerebral edema and cardiac problems due to potassiumdepletion which are medical emergencies. Other short term effects include Hyperglycemichyperosmolar states and hypoglycemia. Other effects are due to the presentingsigns and symptoms like respiratory distress, excessive thirst and hunger, dyslipidemias,hypertension, infections and obesity.Long Term:these long term effects of diabetes occur slowly over time and patients usuallypresent with symptoms in other systems of the body.
They are usually classifiedas micro-vascular and macro-vascular. Hyperglycemia affects the smallcapillaries of major organs such as the kidney, heart and the eyes and causestheir hardening. This can lead to blockage of these vessels causing diabeticretinopathy which can cause blindness, diabetic nephropathy which can lead torenal failure. The accompanying dyslipidemias can cause cerebrovascularaccidents and myocardial infarctions which can lead to paralysis and death. Othercomplication is diabetic neuropathy resulting in dysfunction involving theperipheral nerves. Loss of sensations in peripheral limbs is usually thecommonest presentation with occasional foot ulcers. Effectsof drug treatmentOral anti-diabeticmedications just like most other classes of drugs have unintended effects ontheir users.
Some of these include hepatotoxicity, gain of weight and risk forfractures for thiazolinediones, gastrointestinal discomfort, rashes, and kidneydysfunction among many more. These effects may vary from one patient to anotherand each is required to seek medical help if they notice any unusual effectsThe commonest sideeffect of insulin is rebound hypoglycemia especially when not takenappropriately. This calls for proper patient education on the usage of insulin. References