This essay discusses the factors affecting the blood glucose levels to fluctuate, the natural mechanism of the body to control it, the inability of the body to control it and the disease it causes.
The Human body is perfection in its own way. The controlled balance of factors keeping the internal environment of the body constant is a vital process that keeps one healthy. Any slight changes in these factors disrupt the internal environment causing disequilibrium. This maintenance of internal environment of the body between limits is called homeostasis and the parameters being controlled include: body temperature, blood pH, carbon dioxide concentration, blood glucose concentration and water balance.
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When the control of the blood glucose level does not work effectively the concentration can fall or rise beyond normal limits. This condition is called diabetes mellitus or simply diabetes. Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or action, or both. Diabetes mellitus was first identified as a disease associated with “sweet urine,” and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.
Blood glucose level is controlled by a hormone (insulin) produced by the beta cells of the Islets of Langerhans in the endocrine gland pancreas. After a heavy carbohydrate enriched meal the blood rise exponentially and thus have to be brought down within the normal limits. The high concentration is detected by receptors which then activate the beta cells in the pancreas to produce insulin which converts glucose into a polysaccharide form glucagon and store it in the liver thus removing glucose from the blood.
The history of diabetes indicates that it was present as early as the First Century B.C. when it received its name from a Greek physician, Aretaeus of Cappadocia, after the word dia-bainein which means “to siphon”. This was related to the patients passing excessive amounts of urine. Several centuries after that in 1921 Frederick Banting and Charles Best discovered insulin as a diabetes medication and won a Nobel Prize for their discovery. Insulin is the hormone that controls that lowers the blood glucose concentration and its deficiency or insensitivity by target cells causes diabetes. Later after a few years of discovering insulin in 1936 Sir Harold Percival Himsworth distinguished diabetes type 1 and 2.
There are three main types of diabetes:
Type 1 Diabetes: also known as juvenile diabetes or insulin-dependent diabetes mellitus is caused by the destruction of insulin beta cells. The onset of this type is usually during childhood (hence the name juvenile diabetes) and as the beta cells produce insufficient insulin, insulin injections are used to control the glucose levels (hence the name insulin-dependent diabetes mellitus). Diet cannot control this type of diabetes as it does not increase or decrease the amount of insulin produced by the beta cells. The classical symptoms of type 1 diabetics are frequent urination, increased thirst, increased hunger, nausea, vomiting, and fatigue and weight loss in spite of increased appetite. These symptoms may be explained by the fact that due to the uncontrolled high levels of glucose the osmotic pressure of the blood changes owing to the increased solute concentration (glucose) in the blood and the body gets rid of all the extra glucose from the body through the urine as it cannot store it efficiently.
Eventually this leads to the other symptoms. High amounts of glucose in the urine can cause increased urine output and lead to dehydration. Dehydration thus causes increased thirst and water consumption. Apart from these acute effects of high blood glucose level other chronic effects of diabetes include eye complications, kidney damage and nerve damage. Moreover Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease (angina or heart attack), strokes, and pain in the lower extremities because of lack of blood supply (claudication).
So far the researchers have concluded that a combination of genetic susceptibility, diabetogenic trigger and exposure to a driving antigen are the leading causes of inducing the Type 1 diabetes however other risk factors have also been identified. These include: environmental factors, triggering beta cells damage due to a virus, diet and other chemicals and drugs.
Type 2 Diabetes: also known as adult-onset diabetes or non-insulin-dependent diabetes mellitus and is far more common than type 1 as it is the most common and frequent type of diabetes. It usually occurs in late stages of life, but younger youth are being diagnosed with this disease more frequently. The pancreas organ produces less insulin to keep blood sugar levels in the normal range, often because the target cells are no more sensitive to the insulin. Similar to the symptoms of type 1 diabetes, type 2 symptoms are frequent urination, increased thirst, increased hunger, fatigue, increased appetite and in some cases, blurred vision.
Insulin injections are not usually needed to control this type of diabetes (hence the name non-insulin-dependent diabetes mellitus) and more stress is laid on controlling the patients diet by limiting it to low carbohydrate foods, exercising and if the condition worsens medication is often prescribed.
Similar to type 1, genetics (family history) is thought to be a leading cause in inducing Type 2 diabetes in combination with a few other risk factors such as lifestyle, eating habits, age over 45 years, gestational diabetes giving birth to a baby who weighs more than 9 pounds, heart disease, high blood cholesterol level, obesity, not getting enough exercise, polycystic ovary disease (in women), previous impaired glucose tolerance and some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans).
Gestational diabetes: is when high blood sugar levels develop at any time during pregnancy in a woman who does not have any form of diabetes. Women who have gestational diabetes are at a much higher risk of type 2 diabetes and cardiovascular disease in the future. The risk factors of this kind of diabetes are similar to the risk factors of type 2 diabetes as gestational diabetes lead to type 2 diabetes.
In general, no cure has been found for diabetes. Treatment for diabetes can involve various medicines, a balanced diet, and frequent exercise to control blood glucose levels and minimize symptoms with a long term aim to prevent the chronic complications of diabetes and to prolong patient’s life and reduce symptoms. Apart from achieving this through the use of insulin injections, diet control and exercise, blood pressure and cholesterol levels control, careful control of blood glucose levels and an educational background and awareness about diabetes play a vital role in treating and diagnosing diabetes.
Testing for diabetes is easy and very handy nowadays. Testing of the urine may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose one with diabetes. This is because the presence of glucose in not necessarily due to the patient being a diabetic and could have been caused by the damage of the basement membrane in the kidney or the malfunction of the kidney.
For diabetes diagnosis the following blood tests may be
Fasting blood glucose level – diabetes is diagnosed if higher than 126 mg/dL on two occasions
Hemoglobin A1c test
Normal: Less than 5.7%
Pre-diabetes: Between 5.7% – 6.4%
Diabetes: 6.5% or higher
Oral sugar tolerance test – diabetes is diagnosed if sugar level is higher than 200 mg/dL after 2 hours. This test is also used more for type 2 diabetes.
Random (non-fasting) blood glucose level – diabetes is suspected if higher than 200 mg/dL
Diabetes is a leading disease in many parts of the world causing innumerable deaths each year. Statistics show that diabetes affects 25.8 million people of all ages 8.3 percent of the U.S. population out of which only 18.8 million people are diagnosed while the rest remain oblivious to their medical condition. The severity of this disease goes unnoticed or unacknowledged by several people who label this disease as “sugar” and confine it to being related and associated with the intake of sweet things only.
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Very few know that diabetes is a major cause of heart disease and stroke and the seventh leading cause of death in the United States. However, over the years diabetes has emerged as one the leading health threats in third world countries and so a lot of research is being concentrated on curing, managing and preventing this disease. Curing the diseases has positively motivated several scientists to further their stem cell research and using the stem cells of the diabetic patient create a healthy fully developed and functioning pancreas or even healthy Islets of Langerhans that produce insulin. This will not only cure type I diabetes but also eliminate post operation complications like tissue rejection and immune suppressant drug dependence etc. Similarly, gene therapy is also being used to switch on certain genes on the chromosomes that would trigger insulin production.
Medicines have been introduced and drugs to increase target cell sensitivity are continuously being invented but they mainly revolve around monitoring the disease not curing it. Portable blood glucose meter, insulin pumps etc are all new inventions aimed at helping diabetics control and follow their blood glucose level thus making their life a lot easier. Lastly as mentioned before, as yet there is no cure for diabetes but as the saying goes “prevention before cure”, educating the population about the risk factors and dangers of diabetics is at the moment the nest way to prevent the number of people suffering from diabetes and so awareness should be spread.
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