Diabetes: History, Types, Complications and Treatment

Abstract

Diabetes paper

Diabetes is a health and financial problem. “The size of the diabetic population worldwide, according to the International Diabetes Federation (IDF), is expected to consist of 380 millions people by 2025.” As of today it effects six percent of the population. The cost of globally of this disease was 232 billion in 2007. It is a metabolic disorder which chronic hyperglycemia effecting carbohydrates, protein, and fat metabolism. This is all a result insufficient of insulin emission from the pancreas.

History of Diabetes

The history of diabetes is very long and extensive, symptoms similar to diabetes have been described for thousands of years. The name diabetes comes from the Greek word “syphon” and mellitus being “honeyed” was added in the eighteenth century. Insulin was discovered in 1921 and first used for treatment in 1922. “Diabetes” was first described as type one and type two in the 1930s. Medicinal treatments for were first introduced in the 1950s. This led to a cluster of different research and treatments being developed. The most common of these today being Metformin was introduced in 1960. Low dose treatment related to diabetic ketoacidosis was accessible in the 1970s. These treatments have created landmarks and lead the way in the care of all diabetic patients, and especially those in pregnant women.

Types of Diabetes

There are two main types, type one and type two. Ten percent of patients are made up of type one, gestational, drug- induced, and maturity onset diabetes in youth (MODY) which is caused by genetic defects. Type one affects mainly children. There are also multiple pathological systems that can lead to this ailment. These are referred to as pre-diabetes and metabolic syndrome.

Pre- diabetes is related to higher than usual glucose levels, but the levels are not high enough to be classified as diabetes. This means pre-diabetes are prone to developing diabetes. Metabolic syndrome, which contains factors related to cardiovascular disease (CVD) as well as diabetes. Metabolic syndrome is a predictor of type two being that insulin resistance is one of the major issues related to it. Those with this illness have five times increase in developing type two, and two times the risk of developing cardiovascular disease over the next 5-10 years.

What are the risk factors related to DM? The most prevalent risk is lifestyle. Risks include people over forty-five years of age, family history, and ethnicity. Modifiable risks include better diet and increasing physical activity. Other risks include pre-diabetes, hypertension, obesity, and metabolic syndrome.

Symptoms and Complications

• Polyuria- which is excessive urinary volume. Which is considered excess if it is over 2.5 liters a day.
• Polydipsia- is an excessive thirst or excessive drinking, which can cause problems related to consuming a surplus quantity of water.
• Polyphagia- increased appetite, causing increase food intake. This is very common in diabetic patients
• Weight loss
• Blurred vision

Diagnosis

Typically, a raised glucose level is the assessment most used in the clinical diagnosis of diabetes. Th oral glucose tolerance test was developed in the nineteenth century and involves the patient being introduced to certain amounts of glucose and monitored over a certain amount of time intervals. There are issues with these tests being the “fasting” glucose levels. Some medications can affect these levels and the patient’s willingness to truly fast before the test. There is also the problem being that if the blood levels are not measured immediately the glucose levels continuously drop over time.

Diabetic Nephropathy

Diabetes Mellitus can affect virtually every organ and system. Especially the vascular system. Diabetic chronic complications include increased risk of infections, cardiomyopathy, and erectile dysfunction. Diabetic nephropathy (DN) utmost common source of end stage renal failure. Renal ultrasound shows an increase in kidney size at initial stages, later states show decreased thickness of parenchyma. Which is the solid part of the kidney where excretion takes places.

Diabetic Retinopathy

Diabetic Retinopathy is one of the main cause of blindness in people at working ages. It is classified into two stages, non- proliferative and proliferative. Non- proliferative is normally seen in the later end of the first decade of the ailment. Diagnosed with initial dilation and comprehensive eye disease within 5 years of onset (type one) type two evaluate shortly after diagnosis.

Diabetic neuropathy

Neuropathy common disorder in diabetic patients. Risk factors can include high body mass index (BMI), hypertension, smoking, and raised cholesterol. The most common form is symmetric polyneuropathy, which affects up to fifty percent of diabetic patients. Its often asymptomatic but can cause symptoms of burning pain and deep aching pain. Pain is often associated with feet and lower limbs, normally worse at night. These patients are high at risk for ulceration and amputation. Charcot neuroarthropathy (CN) nearly always in the foot, and is categorized by bone damage. Symptoms include a warm, pain and swollen foot. More advanced causes fractures leading to a severe deformity of the foot, often accompanied with severe disability. This can often be seen on plain x-ray. Magnetic resonance imaging (MRI) can help distinguish between osteomyelitis and CN.

Diabetic Cardiomyopathy

Diabetic cardiomyopathy is now seen as a complication of both types of diabetes (type one and type two) It is a pulmonary disease, causing myocardial remodeling, leading to stiffened ventricle that progresses to diastolic heart failure. Diagnosis of this disorder includes echocardiography and cardiac MRI. Echocardiography is the most popular used for the measure of the ventricular left wall thickness and Doppler pulse-wave used for diastolic function. MRI is the gold standard for measuring masses. The use of gadolinium allows the imaging of myocardiac fibrosis.

Diabetic ketoacidosis

Diabetic Ketoacidosis is a quick onset, life threatening illness that normally occurs in recently diagnosed type one patients(thirty percent). It is caused by an deficiency in insulin. Clinical applications include; nausea, vomiting, pain, anorexia and weight loss drowsiness, confusion, and seizures. It is also characterized by ketosis breath, or fruity breath. A normal radiograph of the chest is performed to rule out pneumonia. CT and MRI may demonstrate decreased cerebral ventricles and reduce gray and white matter differentiation. Prognosis is 2.5-5% of patients in developing countries die. Treatment includes; Intravenous fluids and correcting hyperglycemia, and searching and correcting the underlying cause.

Diabetic myonecrosis

Is a unusual complication related to diabetes mellitus, it occurs in patients with chronic bad glycemia control. Slightly more common in females with type one diabetes, with the average age being forty years old. Clinically the signs and symptoms are; pain, swelling, tenderness in lower limbs. Most common being the quadriceps. In MRI this is seen with a mass like area of muscle necrosis. This presents itself in computed tomography as muscle enlargement with decreased attenuation. The prognosis is normally bad with most patients dying within five years.

Treatment

Treatment of diabetes typically contains taking insulin, better diet and physical activity. There are significant differences in treatment depending on the type you have. Type one is mainly treated with taking insulin, because your body no longer produces it. This also could lead to the necessity of an pump, giving you a small steady dose throughout the day.

Treatment of type two, includes making healthy food choices and being more active, many need medicine as well. This can include insulin and other medications to control your blood glucose.

Gestational Diabetes treatment, involves first trying to control blood glucose by diet and being more active. If the levels are very high you may be started on medications immediately. There are several types of insulin and they work in very different ways.

Types of Insulin and How They Work

• Insulin type How fast it starts to work (onset) When it peaks How long it lasts (duration)
• Rapid-acting About 15 minutes after injection 1 hour 2 to 4 hours
• Short-acting, also called regular Within 30 minutes after injection 2 to 3 hours 3 to 6 hours
• Intermediate-acting 2 to 4 hours after injection 4 to 12 hours 12 to 18 hours
• Long-acting Several hours after injection Does not peak 24 hours; some last longer

The chart above shows averages of insulin use. The doctor may suggest premixed insulin which is a mix of two different types. There are also different ways of taking it. These include; needle and syringe, pen, pump, inhaler, injection port, jet injector. Side effects of medicines can include hypoglycemia (low blood glucose) if the patient doesn’t balance physical activity and medication. Other side effects include; upset stomach and weight gain.

Obesity is a common cause for type two diabetes. Treating the obesity with bariatric surgery (weight loss surgery) may help the patient recover regular blood glucose levels. There is also an artificial pancreas in development that would replace manual blood glucose testing and the use of an pump.

Cost

The American Diabetes Association estimates the total cost of diabetes increased to 327 billion. Showing over a twenty five percent rise over the last five years. The components are further broken down into;

• Hospital inpatient care – 30%
• Prescription medications – 30%
• Diabetic supplies – 15%
• Physician office visits – 13%

Patients average medical costs in a year are $16,752, of this total $9,601 is attributed to diabetes. 67.3% of this cost is covered by the United States government insurance (Medicaid, medicare, and the military) the remaining is private insurance and 2% is uninsured.

Prevention

Genes we inherit can impact if you develop type two diabetes. “Data from the Nurses’ Health Study suggest that 90 percent of type 2 diabetes in women can be attributed to five such factors: excess weight, lack of exercise, a less-than-healthy diet, smoking, and abstaining from alcohol.” Being overweight can increase your chances for diabetes by seven times the normal risk. To cut the chances in half, lose 7 to 10 percent of your current weight. Changes in diet can affect your chances of developing this condition. Studies have shown that diets rich in whole grain can help in thwarting the disease. Some other foods to avoid include; red meat, and processed meat. There is evidence that has been found that links moderate alcohol consumption can increase the efficiency of insulin getting inside cells.