free essay on diabetes

Essay on Diabetes for Students and Children

500+ words essay on diabetes.

Diabetes is a very common disease in the world. But people may never realize, how did they get diabetes and what will happen to them and what will they go through. It may not be your problem but you have to show respect and care for the one who has diabetes. It can help them and also benefited you to know more about it and have a better understanding of it. Diabetes is a metabolic disorder which is identified by the high blood sugar level. Increased blood glucose level damages the vital organs as well as other organs of the human’s body causing other potential health ailments.

Types of Diabetes

Diabetes Mellitus can be described in two types:

Description of two types of Diabetes Mellitus are as follows

1) Type 1 Diabetes Mellitus is classified by a deficiency of insulin in the blood. The deficiency is caused by the loss of insulin-producing beta cells in the pancreas. This type of diabetes is found more commonly in children. An abnormally high or low blood sugar level is a characteristic of this type of Diabetes.

Most patients of type 1 diabetes require regular administration of insulin. Type 1 diabetes is also hereditary from your parents. You are most likely to have type 1 diabetes if any of your parents had it. Frequent urination, thirst, weight loss, and constant hunger are common symptoms of this.

2) Type 2 Diabetes Mellitus is characterized by the inefficiency of body tissues to effectively respond to insulin because of this it may be combined by insulin deficiency. Type 2 diabetes mellitus is the most common type of diabetes in people.

People with type 2 diabetes mellitus take medicines to improve the body’s responsiveness to insulin or to reduce the glucose produced by the liver. This type of diabetes mellitus is generally attributed to lifestyle factors like – obesity, low physical activity, irregular and unhealthy diet, excess consumption of sugar in the form of sweets, drinks, etc.

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Causes of Diabetes

By the process of digestion, food that we eat is broken down into useful compounds. One of these compounds is glucose, usually referred to as blood sugar. The blood performs the job of carrying glucose to the cells of the body. But mere carrying the glucose to the cells by blood isn’t enough for the cells to absorb glucose.

This is the job of the Insulin hormone. Pancreas supply insulin in the human body. Insulin acts as a bridge for glucose to transit from blood to the body cells. The problem arises when the pancreas fails to produce enough insulin or the body cells for some reason do not receive the glucose. Both the cases result in the excess of glucose in the blood, which is referred to as Diabetes or Diabetes Mellitus.

Symptoms of Diabetes

Most common symptoms of diabetes are fatigue, irritation, stress, tiredness, frequent urination and headache including loss of strength and stamina, weight loss, increase in appetite, etc.

Levels of Diabetes

There are two types of blood sugar levels – fasting blood sugar level and postprandial blood sugar level. The fasting sugar level is the sugar level that we measure after fasting for at least eight hours generally after an overnight fast. Blood sugar level below 100 mg/dL before eating food is considered normal. Postprandial glucose level or PP level is the sugar level which we measure after two hours of eating.

The PP blood sugar level should be below 140 mg/dL, two hours after the meals. Though the maximum limit in both the cases is defined, the permissible levels may vary among individuals. The range of the sugar level varies with people. Different people have different sugar level such as some people may have normal fasting sugar level of 60 mg/dL while some may have a normal value of 90 mg/dL.

Effects of Diabetes

Diabetes causes severe health consequences and it also affects vital body organs. Excessive glucose in blood damages kidneys, blood vessels, skin resulting in various cardiovascular and skin diseases and other ailments. Diabetes damages the kidneys, resulting in the accumulation of impurities in the body.

It also damages the heart’s blood vessels increasing the possibility of a heart attack. Apart from damaging vital organs, diabetes may also cause various skin infections and the infection in other parts of the body. The prime cause of all type of infections is the decreased immunity of body cells due to their inability to absorb glucose.

Diabetes is a serious life-threatening disease and must be constantly monitored and effectively subdued with proper medication and by adapting to a healthy lifestyle. By following a healthy lifestyle, regular checkups, and proper medication we can observe a healthy and long life.

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Essays on Diabetes

As you work on a diabetes essay or obesity essay, you get a chance to educate yourself about this dangerous disorder. Diabetes is a metabolic disorder characterized by high blood sugar (glucose) levels due to certain defects in insulin secretion. Most essays on diabetes mention only two types of diabetes: 1 and 2. Type 1 diabetes is insulin-dependent diabetes or juvenile diabetes. Type 2 diabetes is non-insulin-dependent. In essays, people refer to it as an adult form of diabetes. Explore more types of diabetes in samples of diabetes essays. Among the consequences of diabetes are heart diseases; stroke; amputation; loss of vision; hearing impairment; bladder and kidney infections; erectile dysfunction and impotence. Check diabetes essay samples below for extra info on the issue.

Type 2 diabetes is a critical characteristic prolonged ailment caused by a complicated inheritance-environment interaction alongside other risk factors including obesity, and inactive lifestyles. This kind of diabetes together with its complications constitutes a fundamental worldwide problem facing public health. It affects nearly all population in both developing and developed...

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Discussion Board Prompt: In the readings, students will learn about the causes of obesity and know how to differentiate between obesity and being overweight. It is expected that everyone will be aware of BMI calculation where the square of their height divides a person's weight, and the result is expressed...

Special thanks to Jonas Gray of Cambridge University for his contribution to the development of the content of this paper. Thus, it meets the requirement of the current assignment. Type 2 Diabetes and the Cardiovascular System Etiology As a polygenic disease, type 2 diabetes is associated with blood sugars which are seemingly too...

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Type 2 diabetes is a metabolic health disorder caused by the limited production of insulin by the pancreas. The disorder is characterized by high levels of glucose in the bloodstream caused by the failure of the body to maintain normal blood sugar levels. The body requires insulin to regulate the...

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Type 2 Diabetes and its Complications Type 2 diabetes is a medical condition that occurs when the process of sugar metabolism is altered. The body’s main source of energy is sugar, and once the way the body metabolizes it is affected, almost all body processes are altered as well. Insulin is...

Health literacy is an extent to which one has the ability to acquire, to process and acknowledges information regarding health and the required services in order to make decisions appropriately. However, diabetes is one of the issues that the people need to beware and know how to control or manage....

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Diabetes as an overall term of diseases that affect the body's ability to produce or respond positively to the insulin hormone results in high levels of blood glucose as the agency cannot conduct efficient carbohydrate metabolism. There are two main kinds of diabetes, i.e., Type 1 and Type 2, and...

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Introduction Some of the modern lifestyle medical problems include diabetes, high blood pressure, and obesity. The fact that three generations of my family have the condition has piqued my curiosity in the topic. The three illnesses are present in my mother, grandmother, and great grandma. When I was a young kid,...

Diabetes Mellitus and its Potential for Health Improvements Diabetes Mellitus has been identified as an area with promising potential for health improvements due to its rapidly rising prevalence, distinctive contribution to disease burden both globally and within Australia, and increasing importance in public health policy streams. The Importance of Integrated Strategy for...

Diabetes is a metabolic disorder defined by excessive glucose levels caused by a lack of cellular resistance or insulin production (Arcangelo & Peterson 116). According to the Centers for Disease Control and Prevention (CDC), the number of diabetics in the United States increased from 26 million to 29 million in...

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Knee bilateral amputation causes major alterations in the patient's overall body structure as well as bodily functioning. It obviously results in the loss of a body component, but it also has an impact on the underlying disease, in this case diabetes. As a result, it has an impact on comorbidities...

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Rural Ohio Appalachia and Type 2 Diabetes Rural Ohio Appalachia has one of the highest rates of type 2 diabetes in the country. The main health discrepancy is that the illness primarily afflicted adults in the region as opposed to youngsters (WHO, 2017). Adults in Rural Ohio Appalachia have a higher...

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Diabetes mellitus: The epidemic of the century

Correspondence to: Akram T Kharroubi, PhD, Associate Professor of Biochemistry and Endocrinology, Dean of Faculty of Health Professions, Department of Medical Laboratory Sciences, Faculty of Health Professions, Al-Quds University, P.O. Box 51000, Abed Elhamaid Shoman Street, Beit Hanina-Jerusalem, Jerusalem 91000, Palestine. [email protected]

Telephone: +972-2-2791243 Fax: +972-2-2791243

The epidemic nature of diabetes mellitus in different regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in adults (10.9%) whereas, the Western Pacific region has the highest number of adults diagnosed with diabetes and has countries with the highest prevalence of diabetes (37.5%). Different classes of diabetes mellitus, type 1, type 2, gestational diabetes and other types of diabetes mellitus are compared in terms of diagnostic criteria, etiology and genetics. The molecular genetics of diabetes received extensive attention in recent years by many prominent investigators and research groups in the biomedical field. A large array of mutations and single nucleotide polymorphisms in genes that play a role in the various steps and pathways involved in glucose metabolism and the development, control and function of pancreatic cells at various levels are reviewed. The major advances in the molecular understanding of diabetes in relation to the different types of diabetes in comparison to the previous understanding in this field are briefly reviewed here. Despite the accumulation of extensive data at the molecular and cellular levels, the mechanism of diabetes development and complications are still not fully understood. Definitely, more extensive research is needed in this field that will eventually reflect on the ultimate objective to improve diagnoses, therapy and minimize the chance of chronic complications development.

Core tip: Diabetes mellitus is rising to an alarming epidemic level. Early diagnosis of diabetes and prediabetes is essential using recommended hemoglobin A1c criteria for different types except for gestational diabetes. Screening for diabetes especially in underdeveloped countries is essential to reduce late diagnosis. Diabetes development involves the interaction between genetic and non-genetic factors. Biomedical research continues to provide new insights in our understanding of the mechanism of diabetes development that is reviewed here. Recent studies may provide tools for the use of several genes as targets for risk assessment, therapeutic strategies and prediction of complications.

DEFINITION OF DIABETES MELLITUS

Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Metabolic abnormalities in carbohydrates, lipids, and proteins result from the importance of insulin as an anabolic hormone. Low levels of insulin to achieve adequate response and/or insulin resistance of target tissues, mainly skeletal muscles, adipose tissue, and to a lesser extent, liver, at the level of insulin receptors, signal transduction system, and/or effector enzymes or genes are responsible for these metabolic abnormalities. The severity of symptoms is due to the type and duration of diabetes. Some of the diabetes patients are asymptomatic especially those with type 2 diabetes during the early years of the disease, others with marked hyperglycemia and especially in children with absolute insulin deficiency may suffer from polyuria, polydipsia, polyphagia, weight loss, and blurred vision. Uncontrolled diabetes may lead to stupor, coma and if not treated death, due to ketoacidosis or rare from nonketotic hyperosmolar syndrome[ 1 - 3 ].

CLASSIFICATION OF DIABETES MELLITUS

Although classification of diabetes is important and has implications for the treatment strategies, this is not an easy task and many patients do not easily fit into a single class especially younger adults[ 1 , 4 - 6 ] and 10% of those initially classified may require revision[ 7 ]. The classical classification of diabetes as proposed by the American Diabetes Association (ADA) in 1997 as type 1, type 2, other types, and gestational diabetes mellitus (GDM) is still the most accepted classification and adopted by ADA[ 1 ]. Wilkin[ 8 ] proposed the accelerator hypothesis that argues “type 1 and type 2 diabetes are the same disorder of insulin resistance set against different genetic backgrounds”[ 9 ]. The difference between the two types relies on the tempo, the faster tempo reflecting the more susceptible genotype and earlier presentation in which obesity, and therefore, insulin resistance, is the center of the hypothesis. Other predictors of type 1 diabetes include increased height growth velocity[ 10 , 11 ] and impaired glucose sensitivity of β cells[ 12 ]. The implications of increased free radicals, oxidative stress, and many metabolic stressors in the development, pathogenesis and complications of diabetes mellitus[ 13 - 18 ] are very strong and well documented despite the inconsistency of the clinical trials using antioxidants in the treatment regimens of diabetes[ 19 - 21 ]. The female hormone 17-β estradiol acting through the estrogen receptor-α (ER-α) is essential for the development and preservation of pancreatic β cell function since it was clearly demonstrated that induced oxidative stress leads to β-cell destruction in ER-α knockout mouse. The ER-α receptor activity protects pancreatic islets against glucolipotoxicity and therefore prevents β-cell dysfunction[ 22 ].

TYPE 1 DIABETES MELLITUS

Autoimmune type 1 diabetes.

This type of diabetes constitutes 5%-10% of subjects diagnosed with diabetes[ 23 ] and is due to destruction of β cells of the pancreas[ 24 , 25 ]. Type 1 diabetes accounts for 80%-90% of diabetes in children and adolescents[ 2 , 26 ]. According to International Diabetes Federation (IDF), the number of youth (0-14 years) diagnosed with type 1 diabetes worldwide in 2013 was 497100 (Table (Table1) 1 ) and the number of newly diagnosed cases per year was 78900[ 27 ]. These figures do not represent the total number of type 1 diabetes patients because of the high prevalence of type 1 diabetes in adolescence and adults above 14 years of age. One reported estimate of type 1 diabetes in the United States in 2010 was 3 million[ 28 , 29 ]. The number of youth in the United States younger than 20 years with type 1 diabetes was estimated to be 166984 in the year 2009[ 30 ]. The prevalence of type 1 diabetes in the world is not known but in the United States in youth younger than 20 years was 1.93 per 1000 in 2009 (0.35-2.55 in different ethnic groups) with 2.6%-2.7% relative annual increase[ 26 , 31 ]. Type 1 diabetes is mainly due to an autoimmune destruction of the pancreatic β cells through T-cell mediated inflammatory response (insulitis) as well as a humoral (B cell) response[ 25 ]. The presence of autoantibodies against the pancreatic islet cells is the hallmark of type 1 diabetes, even though the role of these antibodies in the pathogenesis of the disease is not clear. These autoantibodies include islet cell autoantibodies, and autoantibodies to insulin (IAA), glutamic acid decarboxylase (GAD, GAD65), protein tyrosine phosphatase (IA2 and IA2β) and zinc transporter protein (ZnT8A)[ 32 ]. These pancreatic autoantibodies are characteristics of type 1 diabetes and could be detected in the serum of these patients months or years before the onset of the disease[ 33 ]. Autoimmune type 1 diabetes has strong HLA associations, with linkage to DR and DQ genes. HLA-DR/DQ alleles can be either predisposing or protective[ 1 ]. This autoimmune type 1 diabetes is characterized by the absence of insulin secretion and is more dominant in children and adolescents.

Number of subjects with type 1 diabetes in children (0-14 years), with diabetes in adults (20-79 years) and with hyperglycemia (type 2 or gestational diabetes) in pregnancy (20-49 years)

Data extracted from International Diabetes Federation Diabetes Atlas, 6th ed, 2013.

In addition to the importance of genetic predisposition in type 1 diabetes, several environmental factors have been implicated in the etiology of the disease[ 9 , 33 ]. Viral factors include congenital rubella[ 34 , 35 ], viral infection with enterovirus, rotavirus, herpes virus, cytomegalovirus, endogenous retrovirus[ 36 , 37 ] and Ljungan virus. Other factors include low vitamin D levels[ 38 ], prenatal exposure to pollutants, improved hygiene and living conditions decreased childhood infections in countries with high socioeconomic status leading to increased autoimmune diseases (hygiene hypothesis), early infant nutrition such as using cow’s milk formula instead of breast feeding[ 39 ] in addition to insulin resistance in early childhood due to obesity or increased height growth velocity. The role of environmental factors remains controversial[ 40 ]. Recent evidence supported the causative effect of viral infections in diabetes[ 41 - 43 ].

Type 1 diabetes often develops suddenly and can produce symptoms such as polydipsia, polyuria, enuresis, lack of energy, extreme tiredness, polyphagia, sudden weight loss, slow-healing wounds, recurrent infections and blurred vision[ 27 ] with severe dehydration and diabetic ketoacidosis in children and adolescents. The symptoms are more severe in children compared to adults. These autoimmune type 1 diabetes patients are also prone to other autoimmune disorders such as Graves’ disease, Hashimoto’s thyroiditis, Addison’s disease, vitiligo, celiac sprue, autoimmune hepatitis, myasthenia gravis, and pernicious anemia[ 1 ]. The complete dependence on insulin of type 1 diabetes patients may be interrupted by a honeymoon phase which lasts weeks to months or in some cases 2-3 years. In some children, the requirement for insulin therapy may drop to a point where insulin therapy could be withdrawn temporarily without detectable hyperglycemia[ 44 ].

Idiopathic type 1 diabetes

A rare form of type 1 diabetes of unknown origin (idiopathic), less severe than autoimmune type 1 diabetes and is not due to autoimmunity has been reported. Most patients with this type are of African or Asian descent and suffer from varying degrees of insulin deficiency and episodic ketoacidosis[ 45 ].

Fulminant type 1 diabetes

This is a distinct form of type 1 diabetes, first described in the year 2000, and has some common features with idiopathic type 1 diabetes being non-immune mediated[ 46 , 47 ]. It is characterized by ketoacidosis soon after the onset of hyperglycemia, high glucose levels (≥ 288 mg/dL) with undetectable levels of serum C-peptide, an indicator of endogenous insulin secretion[ 48 ]. It has been described mainly in East Asian countries and accounted for approximately 20% of acute-onset type 1 diabetes patients in Japan (5000-7000 cases) with an extremely rapid and almost complete beta-cell destruction resulting in nearly no residual insulin secretion[ 48 , 49 ]. Both genetic and environmental factors, especially viral infection, have been implicated in the disease. Anti-viral immune response may trigger the destruction of pancreatic beta cells through the accelerated immune reaction with no detectable autoantibodies against pancreatic beta cells[ 48 , 50 ]. Association of fulminant type 1 diabetes with pregnancy has also been reported[ 51 ].

TYPE 2 DIABETES MELLITUS

The global prevalence of diabetes in adults (20-79 years old) according to a report published in 2013 by the IDF was 8.3% (382 million people), with 14 million more men than women (198 million men vs 184 million women), the majority between the ages 40 and 59 years and the number is expected to rise beyond 592 million by 2035 with a 10.1% global prevalence. With 175 million cases still undiagnosed, the number of people currently suffering from diabetes exceeds half a billion. An additional 21 million women are diagnosed with hyperglycemia during pregnancy. The Middle East and North Africa region has the highest prevalence of diabetes (10.9%), however, Western Pacific region has the highest number of adults diagnosed with diabetes (138.2 millions) and has also countries with the highest prevalence (Figure (Figure1 1 )[ 27 ]. Low- and middle-income countries encompass 80% of the cases, “where the epidemic is gathering pace at alarming rates”[ 27 ]. Despite the fact that adult diabetes patients are mainly type 2 patients, it is not clear whether the reported 382 million adults diagnosed with diabetes also include type 1 diabetes patients.

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Comparative prevalence of diabetes in adults (20-79 years) in countries with high prevalence (≥ 10%). Data extracted from International Diabetes Federation Diabetes Atlas, 6th ed, 2013.

More than 90%-95% of diabetes patients belong to this type and most of these patients are adults. The number of youth (less than 20 years) with type 2 diabetes in the United States in the year 2009 was 0.46 in 1000 and accounted for approximately 20% of type 2 diabetes in youth[ 26 ]. The increased incidence of type 2 diabetes in youth is mainly due to the change in the lifestyle of the children in terms of more sedentary life and less healthy food. Obesity is the major reason behind insulin resistance which is mainly responsible for type 2 diabetes[ 52 - 54 ]. The ADA recommends screening of overweight children and adolescence to detect type 2 diabetes[ 55 , 56 ]. The prevalence of obesity in children in on the rise[ 6 ] which is probably the main reason for the increased incidence of type 2 diabetes in the young (30.3% overall increase in type 2 diabetes in children and adolescence between 2001 and 2009)[ 26 ].

Insulin resistance in type 2 diabetes patients increases the demand for insulin in insulin-target tissues. In addition to insulin resistance, the increased demand for insulin could not be met by the pancreatic β cells due to defects in the function of these cells[ 18 ]. On the contrary, insulin secretion decreases with the increased demand for insulin by time due to the gradual destruction of β cells[ 57 ] that could transform some of type 2 diabetes patients from being independent to become dependent on insulin. Most type 2 diabetes patients are not dependent on insulin where insulin secretion continues and insulin depletion rarely occurs. Dependence on insulin is one of the major differences from type 1 diabetes. Other differences include the absence of ketoacidosis in most patients of type 2 diabetes and autoimmune destruction of β cells does not occur. Both type 1 and type 2 diabetes have genetic predisposition, however, it is stronger in type 2 but the genes are more characterized in type 1 (the TCF7L2 gene is strongly associated with type 2 diabetes)[ 58 ]. Due to the mild symptoms of type 2 diabetes in the beginning, its diagnosis is usually delayed for years especially in countries where regular checkup without symptoms is not part of the culture. This delay in diagnosis could increase the incidence of long-term complications in type 2 diabetes patients since hyperglycemia is not treated during this undiagnosed period.

In addition to diabetes, insulin resistance has many manifestations that include obesity, nephropathy, essential hypertension, dyslipidemia (hypertriglyceridemia, low HDL, decreased LDL particle diameter, enhanced postprandial lipemia and remnant lipoprotein accumulation), ovarian hyperandrogenism and premature adrenarche, non-alcoholic fatty liver disease and systemic inflammation[ 6 , 54 ]. The presence of type 2 diabetes in children and adolescence who are not obese[ 59 - 61 ], the occasional severe dehydration and the presence of ketoacidosis in some pediatric patients with type 2 diabetes[ 55 ] had led to the misclassification of type 2 to type 1 diabetes.

Some patients with many features of type 2 diabetes have some type 1 characteristics including the presence of islet cell autoantibodies or autoantibodies to GAD65 are classified as a distinct type of diabetes called latent autoimmune diabetes in adults (LADA)[ 62 ]. People diagnosed with LADA do not require insulin treatment. In a recent study, Hawa et al[ 63 ] reported 7.1% of European patients with type 2 diabetes with a mean age of 62 years, tested positive for GAD autoantibodies and the prevalence of LADA was higher in patients diagnosed with diabetes at a younger age. This classification of LADA as a distinct type of diabetes is still controversial[ 6 , 64 - 66 ].

Insulin resistance and signaling

Defects in the insulin-dependent substrate proteins IRS-1 and IRS-2 mediated signaling pathway are implicated in the development of metabolic disorders, mainly diabetes. This pathway mediates the cellular response to insulin and involves a large array of insulin-stimulated protein kinases including the serine/threonine kinase AKT and protein kinase C (PKC) that phosphorylate a large number of Ser/Thr residues in the insulin receptor substrate (IRS) proteins involved in the metabolic response to insulin[ 67 ]. In addition, other non-insulin dependent kinases including the AMP-activated protein kinase, c-Jun N-terminal protein kinase and G protein-coupled receptor kinase 2 that are activated under various conditions can phosphorylate the two insulin responsive substrates[ 67 - 71 ]. Disruption in the AKT and PKC kinases is central to the development of diabetes[ 72 ] and is associated with all major features of the disease including hyperinsulinemia, dyslipidemia and insulin resistance[ 73 ]. Replacing the wild type IRS-1 with a mutant version of the protein having alanine instead of tyrosine in three locations using genetic knock-in approach provided evidence to the central role of IRS-1 phosphorylation in the development of insulin resistance[ 74 ]. Using a similar approach to generate IRS-1 mutant with a single mutation involving a specific tyrosine residue, confirmed the role of IRS-1 phosphorylation in the development of insulin resistance pathogenesis[ 75 ]. The large cumulative evidence indicates a complex array of factors including environmental factors[ 76 ] and a wide range of cellular disturbances in glucose and lipid metabolism in various tissues[ 77 ] contribute to the development of insulin resistance. This condition generates complex cellular metabolic changes in a variety of tissues, mainly liver and muscles, that include the inability of the liver to transport and dispose glucose, control glucose production via gluconeogenesis, impaired storage of glucose as glycogen, de novo lipogenesis and hypertriglyceridemia[ 77 ]. Among the factors implicated in the development of insulin resistance, obesity is the most predominant risk factor leading to insulin insensitivity and diabetes which involves several mechanisms that participate in the pathogenesis of the disease[ 78 ]. Obesity-induced insulin resistance is directly linked to increased nutrient flux and energy accumulation in tissues that directly affect cell responsiveness to insulin[ 77 ]. However, it seems that other insulin-independent mechanisms are involved in the overall metabolic disturbances of glucose homeostasis and diabetes including activities in extra-hepatic tissues in addition to the central role of liver.

OTHER TYPES OF DIABETES MELLITUS

Monogenic diabetes.

Characterization of the genetic etiology of diabetes enables more appropriate treatment, better prognosis, and counseling[ 79 ]. Monogenic diabetes is due to a genetic defect in single genes in pancreatic β cells which results in disruption of β cell function or a reduction in the number of β cells. Conventionally, monogenic diabetes is classified according to the age of onset as neonatal diabetes before the age of six months or Maturity Onset Diabetes of the Young (MODY) before the age of 25 years. However, certain familial defects are manifested in neonatal diabetes, MODY or adult onset diabetes[ 2 , 9 , 80 ]. Others believe that classification of diabetes as MODY and neonatal diabetes is obsolete and monogenic diabetes is currently used relating specific genetic etiologies with their specific treatment implications[ 79 ]. Beta cell differentiation depends on the expression of the homeodomain transcription factor PDX1 where mutation in the gene results in early onset diabetes (MODY) and its expression decreases before the onset of diabetes[ 81 ]. The angiopoietin-like protein 8 (ANGPTL8) may represent a potential “betatrophin” that acts to promote the proliferation of beta cells, however, studies using mice lacking the ANGPTL8 active gene or overexpressed protein indicated that it did not seem to play a role in beta cells proliferation[ 82 ].

Mitochondrial diabetes is due to a point mutation in the mitochondrial DNA associated with deafness and maternal transmission of the mutant DNA can result in maternally-inherited diabetes[ 1 , 83 ].

Mutations that result in mutant insulin or the inability to convert proinsulin to insulin result in glucose intolerance in some of these cases. Genetic defects in the insulin receptor or in the signal transduction pathway of insulin have been demonstrated to result in hyperinsulinemia and modest hyperglycemia to severe diabetes[ 1 ].

Disease of the exocrine pancreas

Damage of the β cells of the pancreas due to diffused injury of the pancreas can cause diabetes. This damage could be due to pancreatic carcinoma, pancreatitis, infection, pancreatectomy, and trauma[ 1 ]. Atrophy of the exocrine pancreas leads to progressive loss of the β cells[ 84 ]. Accumulation of fat in the pancreas or pancreatic steatosis could lead to diabetes due to decreased insulin secretion but may require a long time before the damage to β cells occurs[ 85 ]. In most cases, extensive damage of the pancreas is required before diabetes occurs and the exocrine function of the pancreas is decreased in these patients[ 86 ]. Cirrhosis in cystic fibrosis may contribute to insulin resistance and diabetes[ 2 ].

Hormones and drugs

Diabetes has been found in patients with endocrine diseases that secrete excess hormones like growth hormone, glucocorticoids, glucagon and epinephrine in certain endocrinopathies like acromegaly, Cushing’s syndrome, glucagonoma, and pheochromocytoma, respectively[ 1 ]. Some of these hormones are used as drugs such as glucocorticoids to suppress the immune system and in chemotherapy and growth hormone to treat children with stunted growth.

Genetic syndromes

Diabetes has been detected in patients with various genetic syndromes such as Down syndrome, Klinefelter syndrome, Turner syndrome and Wolfram syndrome[ 1 ].

PREDIABETES

Individuals with prediabetes do not meet the criteria of having diabetes but are at high risk to develop type 2 diabetes in the future. According to the ADA Expert Committee, individuals are defined to have prediabetes if they have either impaired fasting plasma glucose (IFG) levels between 100-125 mg/dL (5.6-6.9 mmol/L) or impaired glucose tolerance test (IGT) with 2-h plasma glucose levels in the oral glucose tolerance test (OGTT) of 140-199 mg/dL (7.8-11.0 mmol/L). The World Health Organization (WHO) still adopts the range for IFG from 110-125 mg/dL (6.1-6.9 mmol/L). Prediabetes has been shown to correlate with increased cardiovascular mortality[ 87 , 88 ] and cancer[ 89 ]. The definition of prediabetes with the indicated cut off values is misleading since lower levels of glucose in the normal range are still correlated with cardiovascular disease in a continuous glycemic risk perspective[ 90 ]. In accordance with the recommendation of the ADA in 2009 to use hemoglobin A1c (HbA1c) to diagnose diabetes, ADA also recommended the use of an HbA1c (5.7%-6.4%) to diagnose prediabetes[ 91 ]. The number of people with IGT according to IDF was 316 million in 2013 (global prevalence 6.9% in adults) and is expected to rise to 471 million in 2030[ 27 ]. According to a report in 2014 by the Center for Disease Control and Prevention, 86 million Americans (1 out of 3) have prediabetes[ 92 ]. Four of the top ten countries with the highest prevalence of prediabetes are in the Middle East Arab States of the Gulf (Kuwait, Qatar, UAE and Bahrin with prevalence of 17.9%, 17.1%, 16.6% and 16.3%, respectively)[ 27 ]. The number of people diagnosed with prediabetes is different according to the method and criteria used to diagnose prediabetes. The number of people with prediabetes defined by IFG 100-125 mg/dL is 4-5 folds higher than those diagnosed using the WHO criteria of 110-125 mg/dL[ 93 ]. Diabetes and prediabetes diagnosed using an HbA1c criteria give different estimates compared to methods using FPG or OGTT. Higher percentages of prediabetes were diagnosed using HbA1c compared to FPG[ 94 - 96 ]. Prediabetes is associated with metabolic syndrome and obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension[ 97 ]. Not all individuals with prediabetes develop diabetes in the future, exercise with a reduction of weight 5%-10% reduces the risk of developing diabetes considerably (40%-70%)[ 98 ]. Individuals with an HbA1c of 6.0%-6.5% have twice the risk of developing diabetes (25%-50%) in five years compared to those with an HbA1c of 5.5%-6.0%[ 99 ].

DIAGNOSTIC CRITERIA FOR DIABETES MELLITUS

Diabetes mellitus is diagnosed using either the estimation of plasma glucose (FPG or OGTT) or HbA1c. Estimation of the cut off values for glucose and HbA1c is based on the association of FPG or HbA1c with retinopathy. Fasting plasma glucose of ≥ 126 mg/dL (7.0 mmol/L), plasma glucose after 2-h OGTT ≥ 200 mg/dL (11.1 mmol/L), HbA1c ≥ 6.5% (48 mmol/mol) or a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) along with symptoms of hyperglycemia is diagnostic of diabetes mellitus. In addition to monitor the treatment of diabetes, HbA1c has been recommended to diagnose diabetes by the International Expert Committee in 2009[ 100 ] and endorsed by ADA[ 101 ], the Endocrine Society, the WHO[ 102 ] and many scientists and related organizations all over the world. The advantages and disadvantages of the different tests used to diagnose diabetes have been reviewed by Sacks et al[ 103 ]. The advantages of using HbA1c over FPG to diagnose diabetes include greater convenience and preanalytical stability, lower CV (3.6%) compared to FPG (5.7%) and 2h OGTT (16.6%), stronger correlation with microvascular complications especially retinopathy, and a marker for glycemic control and glycation of proteins which is the direct link between diagnosis of diabetes and its complications[ 104 - 109 ]. It is recommended to repeat the HbA1c test in asymptomatic patients within two weeks to reaffirm a single apparently diagnostic result[ 110 ].

A cut off value for HbA1c of ≥ 6.5% (48 mmol/mol) has been endorsed by many countries and different ethnic groups, yet ethnicity seems to affect the cut off values to diagnose diabetes[ 111 , 112 ]. Cut-off values of 5.5% (37 mmol/mol)[ 113 ] and 6.5% (48 mmol/mol)[ 114 ] have been reported in a Japanese study, 6.0% (42 mmol/mol) in the National Health and Nutrition Examination Survey (NHANES III), 6.2% (44 mmol/mol) in a Pima Indian study, 6.3% (45 mmol/mol) in an Egyptian study as reported by Davidson[ 105 ]; and three cut-off values for Chinese[ 112 ]. The Australians recommended the use of two cut-off values: ≤ 5.5% to “rule-out” and ≥ 7.0% to “rule-in” diabetes[ 115 ]. Variations in the prevalence of diabetes[ 94 , 116 - 119 ] and prediabetes[ 120 ] due to ethnicity have been documented. Most studies diagnosed less subjects with diabetes using HbA1c compared to FPG or OGTT[ 121 - 123 ]. Yet, other studies reported more subjects diagnosed with diabetes using HbA1c[ 96 , 124 - 126 ].

GESTATIONAL DIABETES

Hyperglycemia in pregnancy whether in the form of type 2 diabetes diagnosed before or during pregnancy or in the form gestational diabetes has an increased risk of adverse maternal, fetal and neonatal outcome. Mothers with gestational diabetes and babies born to such mothers have increased risk of developing diabetes later in life. Hyperglycemia in pregnancy is responsible for the increased risk for macrosomia (birth weight ≥ 4.5 kg), large for gestational age births, preeclampsia, preterm birth and cesarean delivery due to large babies[ 127 ]. Risk factors for gestational diabetes include obesity, personal history of gestational diabetes, family history of diabetes, maternal age, polycystic ovary syndrome, sedentary life, and exposure to toxic factors[ 3 ].

Diagnosis of type 2 diabetes before or during pregnancy is based on criteria mentioned before. Fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L) or 2-h plasma glucose ≥ 200 mg/dL (11.1 mmol/L) after a 75 g oral glucose load. However, gestational diabetes has been diagnosed at 24-28 wk of gestation in women not previously diagnosed with diabetes using two approaches: the first approach is based on the “one-step” International Association of the Diabetes and Pregnancy Study Groups (IADPSG) consensus[ 128 ] and recently adopted by WHO[ 129 ]. Gestational diabetes is diagnosed using this method by FPG ≥ 92 mg/dL (5.1 mmol/L), 1-h plasma glucose after a 75 g glucose load ≥ 180 mg/dL (10.0 mmol/L) or 2-h plasma glucose after a 75 g glucose load ≥ 153 mg/dL (8.5 mmol/L). This criteria is derived from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study[ 127 ] even though the HAPO study showed a continuous relationship between hyperglycemia and adverse short-term pregnancy outcome with no threshold reported[ 130 ]. The second approach is used in the United States and is based on the “two-step” NIH consensus[ 131 ]. In the first step 1-h plasma glucose after a 50 g glucose load under nonfasting state ≥ 140 mg/dL (7.8 mmol/L) is followed by a second step under fasting conditions after a 100 g glucose load for those who screened abnormal in the first step. The diagnosis of gestational diabetes is made when at least two of the four plasma glucose levels are met. The four plasma glucose levels according to Carpenter/Coustan criteria are: FPG ≥ 95 mg/dL (5.3 mmol/L); 1-h ≥ 180 mg/dL (10.0 mmol/L); 2-h ≥ 155 mg/dL (8.6 mmol/L); and 3-h ≥ 140 mg/dL (7.8 mmol/L)[ 1 ].

The use IADPSC criteria in comparison with the Carpenter/Coustan criteria was associated with a 3.5-fold increase in GDM prevalence as well as significant improvements in pregnancy outcomes, and was cost-effective[ 132 ]. In another retrospective cohort study of women diagnosed with gestational diabetes, Ethridge et al[ 133 ] have shown that newborns of women diagnosed with gestational diabetes by IADPSG approach have greater measures of fetal overgrowth compared with Carpenter-Coustan “two-step” approach neonates. A strategy of using fasting plasma glucose as a screening test and to determine the need for OGTT is valid[ 134 , 135 ]. According to Sacks[ 136 ], correlation of glucose concentrations and the risk of subsequent complications will eventually lead to universal guidelines.

The use of ADA/WHO cut off value of HbA1c ≥ 6.5% (48 mmol/mol) to diagnose gestational diabetes is not recommended by the “one step” IADPSC criteria or the “two-step” NIH criteria. Further investigation is required in light of recent reports on HbA1c in combination with OGTT and its usefulness to predict adverse effect of gestational diabetes or obviate the use OGTT in all women with gestational diabetes[ 137 - 141 ].

DIABETES AND GENETICS

Diabetes is a complex disease that involves a wide range of genetic and environmental factors. Over the past several years, many studies have focused on the elucidation of the wide spectrum of genes that played a role in the molecular mechanism of diabetes development[ 142 - 144 ]. However, despite the vast flow of genetic information including the identification of many gene mutations and a large array of single nucleotide polymorphisms (SNPs) in many genes involved in the metabolic pathways that affect blood glucose levels, the exact genetic mechanism of diabetes remains elusive[ 145 , 146 ]. Evidently, a major complication is the fact that a single gene mutation or polymorphism will not impose the same effect among different individuals within a population or different populations. This variation is directly or indirectly affected by the overall genetic background at the individual, family or population levels that are potentially further complicated by interaction with highly variable environmental modifier factors[ 147 , 148 ].

Molecular genetics and type 2 diabetes

One of the major focuses of biomedical research is to delineate the collective and broad genetic variants in the human genome that are involved in the development of diabetes. This major effort will potentially provide the necessary information to understand the molecular genetics of the different forms of diabetes including type 1, type 2 and monogenic neonatal diabetes among individuals of all populations and ethnic groups. Despite the fact that linkage and association studies allowed the identification and characterization of many candidate genes that are associated with type 2 diabetes[ 144 , 149 , 150 ], however, not all of these genes showed consistent and reproducible association with the disease[ 151 ]. Genome wide association studies (GWAS) in various populations identified 70 loci associated with type 2 diabetes and revealed positive linkage of many mutations and SNPs that influence the expression and physiological impact of the related proteins and risk to develop type 2 diabetes. One study involved several thousand type 2 diabetes patients and control subjects from the United Kingdom allowed the identification of several diabetes putative loci positioned in and around the CDKAL1 , CDKN2A/B , HHEX/IDE and SLC30A8 genes in addition to the contribution of a large number of other genetic variants that are involved in the development of the disease[ 152 ]. Two similar studies from the Finns and Swedish populations and the United States resulted in the identification of similar single nucleotide variants[ 153 ] that are linked to the risk of acquiring type 2 diabetes[ 154 , 155 ]. The study in the United States population included in addition to type 2 diabetes, the association of the identified SNPs with the level of triglycerides in the tested subjects[ 155 ]. These SNPs are located near several candidate genes including IGFBP2 and CDKAL1 and other genes in addition to several other variants that are located near or in genes firmly associated with the risk of acquiring type 2 diabetes. Other GWAS analysis studies were performed in the Chinese, Malays, and Asian-Indian populations which are distinct from the European and United States populations in addition to meta-analysis of data from other populations in the region revealed relevant findings among patients with European ancestry[ 156 ]. The results of the combined analysis showed significant association of SNPs in the CDKAL1 , CDKN2A/B , HHEX , KCNQ1 and SLC30A8 genes after adjustment with gender and body mass index. More recently, meta-analysis of GWAS data involving African American type 2 diabetes patients identified similar loci to the previous studies with the addition of two novel loci, HLA-B and INS-IGF[ 157 ]. These results provide strong evidence of common genetic determinants including common specific genes that are linked to diabetes. A small list of specific genetic markers seem strongly associated with the risk of developing type 2 diabetes including the TCF7L2 [ 158 ] and CAPN10 [ 159 , 160 ] genes which also play a significant role in the risk and pathogenesis of the disease[ 158 , 159 ]. The association of TCF7L2 gene variants with type 2 diabetes and its mechanism of action received special attention by several investigators[ 161 , 162 ]. Over expression of the protein was shown to decrease the sensitivity of beta islet cells to secrete insulin[ 163 , 164 ] and was more precisely involved in the regulation of secretary granule fusion that constitute a late event in insulin secretion pathway[ 165 ]. The role of TCF7L2 in insulin secretion was partially clarified[ 166 ] that involves modifying the effect of incretins on insulin secretion by lowering the sensitivity of beta cells to incretins. Several other genes have been found to be significantly associated with the risk of developing type 2 diabetes including a specific SNP in a hematopoietically-expressed homeobox ( HHEX ) gene[ 167 ]. The islet zinc transporter protein (SLC30A8)[ 168 ] showed positive correlation with the risk of developing type 2 diabetes where variant mutations in this gene seem protective against the disease which provides a potential tool for therapy[ 169 ]. More recently, a low frequency variant of the HNF1A identified by whole exome sequencing was associated with the risk of developing type 2 diabetes among the Latino population and potentially may serve as a screening tool[ 170 ]. Genetic variants and specific combined polymorphisms in the interleukin and related genes including interlukin-6 ( IL-6 ), tumor necrosis factor-α and IL-10 genes were found to be associated with greater risk of developing type 2 diabetes[ 171 ], in addition to genetic variants in the genes for IL12B , IL23R and IL23A genes[ 172 ]. In a study involving the hormone sensitive lipase responsible for lipolysis in adipose tissues, a deletion null mutation, which resulted in the absence of the protein from adipocytes, was reported to be associated with diabetes[ 173 ]. Nine specific rare variants in the peroxisome proliferator-activated receptor gamma ( PPARG ) gene that resulted in loss of the function of the protein in adipocytes differentiation, were significantly associated with the risk of developing type 2 diabetes[ 174 ]. In addition, certain SNPs in the alpha 2A adrenergic receptor ( ADRA2A ) gene, involved in the sympathetic nervous system control of insulin secretion and lipolysis, were found to be associated with obesity and type 2 diabetes[ 175 ]. Link analysis between the melatonin MT2 receptor ( MTNR1B ) gene, a G-protein coupled receptor, identified 14 mutant variants from 40 known variants revealed by exome sequencing, to be positively linked with type 2 diabetes[ 176 ]. The authors suggested that mutations in the MT2 gene could provide a tool with other related genes in modifying therapy for type 2 diabetes patients based on their specific genetic background to formulate personalized therapies which potentially may ensures the optimum response. Interestingly, mutations in the clock[ 177 , 178 ] and Bmal1 [ 179 ] transcription factor genes which are involved in beta cells biological clock affecting growth, survival and synaptic vesicle assembly in these cells, resulted in reduced insulin secretion and diabetes. Evidently, prominent metabolic functions involve the production of specific reactive metabolites, leading to oxidative stress, which affect lipids, proteins and other biological compounds leading to serious damage in various tissues and organs. Mutations and SNPs in the antioxidant genes, including superoxide dismutase, catalase and glutathione peroxidase, that decrease their activity are implicated in the risk and pathogenesis of type 2 diabetes[ 180 ]. The metabolic syndrome was shown to be associated with the development of type 2 diabetes in a population that is described as highly endogenous especially in individuals over 45 years of age[ 181 ]. Since consanguinity marriages is high in this population, screening for this syndrome among families could provide an informative marker on the risk of developing type 2 diabetes[ 181 ].

Molecular genetics of type 1 diabetes

Even though type 1 diabetes is basically described as an autoimmune disease that results in the destruction of pancreatic beta cells, however, single gene mutations and SNPs have been found to be associated with the susceptibility to this type of diabetes. Initially, two gene mutations were linked to the development of type 1 diabetes including the autoimmune regulator ( AIRE ) gene which affect the immune tolerance to self antigens leading to autoimmunity[ 182 ] and the FOXP3 gene which results in defective regulatory T cells[ 183 ]. In addition, a mutation in the histone deacetylase SIRTI gene predominantly expressed in beta cells involved in the regulation of insulin secretion[ 184 ] and played a role in modulating the sensitivity of peripheral tissues to insulin[ 185 ] was detected in type 1 diabetes patients[ 186 ]. Recently, additional mutations and SNPs in the CTLA-4 +49A/G and HLA-DQB1 and INS gene VNTR alleles were found to be associated with type 1 diabetes, which have the advantage of differentiating between Latent autoimmune type 1 diabetes and type 2 diabetes[ 187 ]. The HLA-DQB1, in combination with HLA-DR alleles and a polymorphism in PTPN22 gene seem to be associated with the age onset of late type 1 diabetes[ 188 , 189 ]. Two specific polymorphisms in the promoter region of a transmembrane protein (DC-SIGN) gene expressed in macrophages and played an important role of T- cell activation and inflammation were found to be protective against type 1 diabetes[ 190 ]. An innovative non-parametric SNP enrichment tool using summary GWAS DATA allowed the identification of association between several transcription factors and type 1 diabetes and are located in a type 1 diabetes susceptibility region[ 191 ]. Nine SNP variants in several genes associated with type 1 diabetes, not including the major histocompatibility gene region, were identified using extensive GWAS analysis[ 192 ]. Furthermore, several novel SNPs in a region in chromosome 16 located in the CLEC16A gene were shown to be associated with type 1 diabetes and seem to function through the reduced expression of DEX1 in B lymphoblastoid cells[ 193 ]. Since more than 40 regions in the human genome were identified to be associated with the susceptibility to type 1 diabetes[ 194 - 196 ], a weighted risk model was developed utilizing selected genes SNPs could be used for testing infants for these genetic markers that could provide insights in the susceptibility to type 1 diabetes development or safe prevention of the disease among young children[ 197 ].

Molecular genetics of monogenic diabetes

A large array of genes were identified to be involved in the development of monogenic diabetes[ 80 ] which represent about 2%-5% of diabetes patients. Monogenic diabetes results primarily from gene defects that lead to a decrease in beta cell number or function. Monogenic diabetes genes were identified using linkage studies or code for proteins that directly affected glucose homeostasis. The majority of genes responsible for monogenetic diabetes code for either transcription factors that participate in the control of nuclear gene expression or proteins that are located on the cell membrane, cytoplasm and endoplasmic reticulum, proteins involved in insulin synthesis and secretion, exocrine pancreatic proteins and autoimmune diabetes proteins[ 80 ]. The collective function of these proteins is their participation in glucose metabolism at different levels. Evidently, the hierarchy of a specific gene in the overall glucose metabolism pathway determines the onset of diabetes in the patient and whether it is neonataly expressed or have late onset expression (adulthood). Consequently, molecular defects in the structure and function of these genes lead to the disturbance of plasma glucose level, the primary pathological sign of diabetes. The molecular mechanism of permanent neonatal diabetes mellitus (PNDP) in addition to MODY explains the observed phenotype of monogenetic diabetes that involves loss of function of the expressed mutant protein. The first gene implicated in monogenic diabetes was the glucokinase ( GCK ) gene[ 198 ] which functions as a pancreatic sensor for blood glucose where more than 70 mutations in the gene were identified that affected its activity[ 199 ]. A recent study on GCK gene mutations causing neonatal and childhood diabetes showed that the majority of mutations resulted in the loss of the enzyme function primarily due to protein instability[ 148 , 150 ]. Two hepatocytes nuclear factor genes that code for the HNF4A and HNF1A transcription factors were closely associated with MODY1 and MODY2[ 148 , 149 ]. Definitely, a whole list of other genes involved in monogenic diabetes are either overlooked or included in the genetic determinants of type 1 and type 2 diabetes which will be identified and clarified through more careful future studies.

MOLECULAR GENETICS OF DIABETES COMPLICATIONS

In addition to the genetic determinants of diabetes, several gene mutations and polymorphisms have been associated with the clinical complications of diabetes. The cumulative data on diabetes patients with a variety of micro- and macrovascular complications support the presence of strong genetic factors involved in the development of various complications[ 200 ]. A list of genes have been reported that are associated with diabetes complications including ACE and AKR1B1 in nephropathy, VEGF and AKRB1 in retinopathy and ADIPOQ and GLUL in cardiovascular diseases[ 200 ]. A study on Chinese patients revealed a single SNP in the promoter region of the smooth muscle actin ( ACTA2 ) gene correlates with the degree of coronary artery stenosis in type 2 diabetes patients[ 201 ]. Furthermore, the alpha kinase 1 gene ( ALPK1 ) identified as a susceptibility gene for chronic kidney disease by GWAS[ 202 ], was demonstrated in type 2 diabetes patients[ 203 ]. Three additional genes have been strongly correlated with this risk of diabetic retinopathy (DR) including the vascular endothelial growth receptor, aldose reductase and the receptor for advanced glycation products genes[ 204 ] where specific polymorphisms in these genes seem to increase the risk of DR development in diabetes patients[ 204 ]. A significant differential proteome (involving 56 out of 252 proteins) is evident that characterizes vitreous samples obtained from diabetes patients with the complication in comparison to diabetes patients without the complication and control individuals[ 205 ]. Interestingly, a large portion of these proteins (30 proteins) belong to the kallikrein-kinin, coagulation and complement systems including complement C3, complement factor 1, prothrombin, alpha-1-antitrypsin and antithrombin III that are elevated in diabetic patients with retinopathy[ 205 ]. In addition, 2 single nucleotides polymorphisms in the human related B7-I gene seem to mediate podocyte injury in diabetic nephropathy[ 206 ]. Furthermore, increased concentration of the ligand of B7-1 correlates with the progression of end-stage renal disease (ESRD) in diabetes patients[ 206 ]. These results indicate that B7-I inhibition may serve as a potential target for diabetes nephropathy prevention and/or treatment. Recently, it was shown that direct correlation is evident between circulating levels of tumor necrosis factors 1 and 2 and increased risk of ESRD in American Indian patients[ 207 ]. The link between diabetes and proper bone development and health is evident. Studies using animal models with major significant reduction in insulin receptor (IR) in osteoprogenitor cells resulted in thin and rod-like weak bones with high risk of fractures[ 208 ]. Similar findings were observed in animal models with bone-specific IR knockdown animals which points to the central role of IR in the proper development of bones[ 208 ]. Type 2 diabetes is also associated with mitochondrial dysfunction in adipose tissues. Using knockout animal models of specific mitochondrial genes led to significant reduction in key electron transport complexes expression and eventually adipocytes death[ 209 ]. These animals exhibited Insulin resistance in addition to other complications that can potentially lead to cardiovascular disease[ 209 ].

Diabetes mellitus is the epidemic of the century and without effective diagnostic methods at an early stage, diabetes will continue to rise. This review focuses on the types of diabetes and the effective diagnostic methods and criteria to be used for diagnosis of diabetes and prediabetes. Evidently, diabetes is a complex disease with a large pool of genes that are involved in its development. The precise identification of the genetic bases of diabetes potentially provides an essential tool to improve diagnoses, therapy (more towards individualized patient targeted therapy) and better effective genetic counseling. Furthermore, our advanced knowledge of the association between medical genetics and the chronic complications of diabetes, will provide an additional advantage to delay or eradicate these complications that impose an immense pressure on patient’s quality of life and the significantly rising cost of health-care services.

Conflict-of-interest: The authors declare that there is no conflict of interest associated with this manuscript.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Peer-review started: November 23, 2014

First decision: February 7, 2015

Article in press: April 14, 2015

P- Reviewer: Hegardt FG, Surani S, Traub M S- Editor: Gong XM L- Editor: A E- Editor: Wang CH

Essays on Diabetes

Faq about diabetes.

Essay on Diabetes Mellitus

Diabetes is a metabolic disease that has affected a population of up to 18.2 million people in the US. Diabetes manifestation in the human body happens when the blood sugar levels are beyond optimal for a long period in order To control the disease manifestation in the human body, blood sugar levels can be controlled and managed in various ways, including diet, exercise, insulin injection and medication. Diabetes exists in its three main types based on the factor of age and gender, from which type 1 diabetes primarily affects children and people of young age. There is type II diabetes which is common in a population of 40 years and beyond. The third category is gestational diabetes which affects the female gender during pregnancy.

Diabetes is a group of complex metabolic disorders which result in hyperglycemia. These metabolic disorders vary from person to person based on various factors, including; Overweight issues, hereditary factors, and the pancreas, where the beta cell are located (Jadhav, 2016). Hyperglycemia can cause blurred vision, nerve problems, dry skin effects, kidney issues, and retinopathy. Diet is the major and primary option to control and prevent blood levels from accumulating in our bodies. As diabetes disease depends on blood sugar levels, there is the need to understand the amount and the concentration of sugars in the type’s food intake in terms of fats, carbohydrates and proteins. The major reflection of diet concerns is to regulate the sugars in the bloodstream so the Insulin can manage the sugar levels in your bloodstream. There is no known cure for Diabetes; however, exercise and medication control hyperglycemia conditions.

Introduction

Diabetes Mellitus is a chronic disease characterized by high blood sugars in the blood. There is possibly two cause of the disease; the can be a situation where the body may fail to use the Insulin optimally, or there might be a case where the body may fail to produce the Insulin. Both cases result in the hyperglycemia condition, therefore the manifestation of Diabetes Mellitus when the condition is prolonged in either of the cases, which at times may occur at the same time, i.e. the body may fail to properly use the Insulin and fail to produce Insulin all at the same time. Extreme effects of the disease may cause blindness, leg amputation, kidney failure and death. Diabetes Mellitus is number three on the list of the leading causes of the rising mortality rates in the United States (Magee, 2014).

Normal anatomy of the body system is affected

Energy is primarily the basic unit of life itself, and the human body manufactures its energy from the absorbed sugars through digestion. The digestion process starts from the moment food gets into the mouth. The food is broken into tiny, permeable sugars that are absorbed into the bloodstream through digestion. The insulin factor controls the admission of these sugars into the bloodstream, which then the cells admit these sugars and break them down to produce energy. When our bodies may fail to use Insulin or produce Insulin into the bloodstream properly, the condition contributes to hyperglycemia; unregulated sugar admission into the cells and sugar concentration in the blood accumulating within a prolonged period results in Diabetes Mellitus disease. A membrane encloses the body cells; the Insulin regulates the membrane in the insulin receptors regarding when to allow the sugars into the cells. When the insulin attachment is successful on the receptor keys, the sugars are absorbed through the cell membrane into the cell, where they are burned to produce energy (Beaser, 2008).

Normal physiological body system affected

A membrane encloses the body cells with insulin receptors. The insulin receptors control and regulate the levels of sugar admission into the bloodstream when the Insulin in the bloodstream successfully attaches to the receptors. In the pancreas, Insulin is produced by the Beta Cells located at the tail of the pancreas. Beta Cells produce and store the Insulin until when the body needs it. Glycogen, a hormone produced in the pancreas, is used to raise the sugar levels and combined with Insulin, they balance the body’s sugars. The pancreas is also home to other various enzymes that help in the process of breaking down the food into smaller absorbable substances during the digestion process. When the body fails to manage the insulin within the pancreas, this results in more absorption of the sugars into the bloodstream and, with time, results in diabetes disease.

The hyperglycemia conditions cause blurred vision from leakage(s) of the fluid into the lens, and the lens adjusts to the changes in vision. When you start the diabetes treatment, the distorted images and blurred vision get better within a few weeks. The disease’s extreme damage to the eye is retinopathy, bleeding of the small vessels of the eye in the retina; this may damage the retina resulting in blindness.

Prolonged high blood sugar levels have various advanced effects on the nerve system characterized by a painful experience known as neuropathy. The pain is like pins piercing through the skin and feeling like you are on a pair of gloves, and in extreme cases, you cannot feel the hands, legs, or both. Diabetic people may often feel dizziness when sitting or standing up from a lying position.

The kidney is a very special organ where blood purification is done as waste products and from the bloodstream, and other substances are filtered through the kidney. High blood sugar levels can damage the small kidney filters resulting in kidney failure (Beaser, 2008).

High sugar levels in the bloodstream may cause dehydration, especially when the blood sugars are beyond optimal and there is no proper control. It results in inadequate fluid in the tissues and dry skin. Diabetes may result in a skin condition called Necrobiosis lipoidica diabeticorum, it is a harmless condition where the affected areas of the skin seem to be shiny, and the danger involved is that the skin can burst open in rare cases.

Foot problems are the most common and significant effects of diabetes. When a person with diabetes is overweight, all the load is on the feet and bending can be exhausting for a person with diabetes, as well as having a clear sight on the feet to extend some carefully considered blurred vision characterized by diabetes. Diabetic people are at high risk of getting foot infections which in extreme cases results in amputation (Beaser, 2008).

Mechanism of Diabetes Mellitus

The disease manifestations occur in three types:

Type 1 Diabetes.

Type 1 diabetes results from inadequate or production failure of the Insulin in the body. It is most common in children and younger adults as the primary cause of insufficient Insulin in the body may be attributed to the failure of the immune system. The immune system produces antibodies that are harmful or destroy the beta cells affecting the production of Insulin and therefore causing an accumulation of sugars in the blood. Type 1 diabetes is manifested when the condition is not controlled for a prolonged period.

Type 2 diabetes.

Type 2 diabetes, like type 1, results from insufficient insulin in the body, mainly from the secondary factors that affect metabolism. These factors include damaged or inadequate beta cells, overweight, or hereditary factors. It is the most common of the three types of the disease, with almost up to 90% of the diabetic population.

Gestational Diabetes.

Pregnant women experience this type of diabetes. It is common during the third pregnancy as the body may fail to produce the amounts of insulin required by the body during pregnancy. Insulin injection should be administered to help with the condition, which can worsen after birth when the condition is persistent for a prolonged period.

Approximately three per cent of the US population has diabetes, with 13 million officially testing positive for the disease among the 18.2 million potentially at risk of hyperglycemia. Diabetes is a chronic condition which most likely catches up with age. Currently, a population of 18.3% among those 60 years and beyond are positive with diabetes mellitus (Jadhav, 2016).

Prevention and Control

The pancreas does not automatically have diabetes and adapts to the type of food you feed. Therefore there is a need for diabetic people to understand the content of the food they should eat according to how they are breakdown and what amounts of sugars they break. Diabetic people under insulin injection prescriptions should observe a manual change in their diet to maintain the normal range of blood sugars.

Carbohydrates contain more sugars than proteins and fats, and therefore, diabetic patients should opt to feed on cereals, lentils and peas as their sources of starch. Cereals provide optimal starch required and regulate the fats absorbed into the blood, thus controlling blood sugar levels. Diabetic people should avoid junk food with loads of sugar (Magee, 2016)r.

Proteins also help in the control of blood sugars. Diabetic people should feed on less fat proteins like lean meat. They contain enzymes that help break down the starch in the bloodstream into sugars. Fats are responsible for transporting these proteins, which break down into calories that help reduce body weight. Fats can be sourced from protein fats like cheese and peanuts (Magee, 2016).

There are only two types of medication with a common objective of boosting insulin levels when the glucose concentration in the bloodstream is at its highest. Some use pills to boost the natural production of Insulin from the beta cells, and some use insulin injections. Patients using Insulin injections should be administered with the cautiousness of time factor. There are different types of Insulin, with particular types having an instant effect and others having a delayed effect. The injection should be in a way that considers the other activities of exercising and feeding (Beaser, 2008).

Exercises help maintain the sugar levels as cells get to use the available insulin in the body during exercise. Exercise also helps cut body weight, so the level of insulin demand on the body may optimize with the current needed levels, which come with reduced weight.

There is no particular cure for the disease. The only remedy for diabetic people is to observe their dietary behaviours to maintain their blood sugars within the normal range and exercise so the body can use Insulin to avoid sugar accumulation in the bloodstream. Medication is for patients who need to manually control their blood sugars through injection or pills to increase their insulin content when the blood sugar shoots (Beaser, 2008).

Diabetes Mellitus is a chronic disease that no one would wish to have. It is characterized by a hyperglycemia condition that diabetic people can control through medication, diet and exercise. Self-education on blood sugar management and control is the only remedy for its prevention (Jadhav, 2016).

Beaser, R. S. (2008). The Joslin Guide to Diabetes: A program for managing your treatment . Simon and Schuster.

Jadhav, S. (2016). HOW TO HANDLE DIABETES (JUVENILE) IN CLASSROOM?. International Journal of Research in Informative Science Application & Techniques (IJRISAT) , 1 (2).

Magee, E. (2014). Tell me what to eat if I have diabetes: Nutrition you can live with . Red Wheel/Weiser.

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Essay on Diabetes

Introduction

Diabetes is a healthcare condition that has continued to affect so many people, both young and old. Understanding more about Diabetes will help people live a healthy lifestyle by avoiding all the possible things that might cause it. In this assignment, I will assess why Diabetes is a significant health issue to individuals and the world. I will discuss the background of Diabetes, its definitions, and the types of Diabetes. Besides, I will discuss what is needed to promote individual and group health for people who have Diabetes. By the end of the assignment, one will have better knowledge about Diabetes since I will also discuss the causes and preventive measures that can be undertaken to prevent the disease. Towards the end of the assignment, I will describe three achievable health promotion goals, hence helping fight against Diabetes. I will also describe some of the interventions and roles that different people, groups, and organizations play to reduce the high cases of Diabetes in the world.

During the medieval ages, being diagnosed with Diabetes was like a death sentence. The pioneers of diabetes treatment were Thomas Willis, Sushruta, and Arataeus (Mandal, 2021). The three were Greek physicians who encouraged people to exercise on horsebacks to prevent excess urination. They also described other therapies like overfeeding and taking wine to reduce starvation and excessive loss of fluids (Mandal, 2021). On the other hand, the ancient Indians would test for Diabetes by taking ants near a person’s urine. If the human urine attracted the ants, then the person would be diagnosed with urine (Mandal, 2021). Diabetes is a disease that is the leading cause of high blood sugar levels. People who have Diabetes have bodies that cannot make enough insulin, or their bodies cannot use the insulin they have effectively (Healthline, 2021). Insulin is the hormone that moves sugars from the blood to the body cells. There are several types of Diabetes, including type 1 diabetes, type 2 diabetes, gestational diabetes, prediabetes, and Diabetes insipidus (Healthine, 2021). All these types affect our bodies differently, and they all have different effects, hence different coping strategies.

The rationale for Choosing Diabetes

Diabetes is among the most severe health issues in the world. This is the reason why I chose to discuss it to create awareness about it. The bad thing with Diabetes is that one can get it and not know that they have it. By the time they realize that they have Diabetes, the condition is worse, and the person is highly affected. According to Genesis Medical Associates (2015), one out of three adults have higher blood sugar levels; a condition referred to as prediabetes. If the persons do not change their lifestyles, the sugar levels increase, leading to other types of Diabetes (Genesis Medical Associates, 2015). Learning about Diabetes will allow people to support each other in the fight against Diabetes. This includes eating healthy meals and maintaining a healthy lifestyle through exercising (Dowshen, 2021). Another reason why I chose to discuss Diabetes is to learn more about the causes and how to manage the disease. Since most people do not know about the condition, it is crucial to educate them so that in case they feel any symptoms, and they can get the treatment as early as possible (Dowshen, 2021). It is easy to deal with Diabetes as long as the signs are detected early enough and the patient follows the given guidelines on healthy living.

Epidemiology

Diabetes is a significant health concern since it affects so many people in the world. Diabetes can affect any person. However, some ethnic groups are affected more than others. The Alaska Natives and the American Indians are more affected by Diabetes as compared to all other ethnic groups. In terms of age, more than sixty-five years are more prone to getting diabetes than young people. According to Shaikh (2021), % of the people who are more than 65 years have diabetes. However, the young people are also affected but at a meager percentage compared to the older people.

The risk factors for Type 1 diabetes are hereditary, hence easily transferred from parents to children. Type 1 diabetes primarily affects young children and teenagers. Also, white Americans are at a higher risk of getting the disease than African Americans and Latino Americans (Shaikh, 2021). Type 2 diabetes affects middle and old age persons. Also, other risk factors for type 2 diabetes include genes, being overweight, a history of gestational pregnancy, and giving birth to a baby that is more than 9lbs (Shaikh, 2021).

It is important to note that diabetes is more prone in rural areas where people do not have access to health services and education. In the United Kingdom, 28% of the people with diabetes have issues obtaining medication due to a lack of health services and knowledge on how to go about diabetes treatment (Whicher et al., 2019 p.243). Besides, most of the people who are in the rural do not go for annual health checkups; hence their conditions get worse daily.

Assessment and assessment tools for Diabetes

Different tools are used during the assessment of diabetes. Assessing diabetes is very important as it helps differentiate between different types of diabetes and the extent of the condition. The Diabetes Prevention Screening Tool helps identify the persons at risk of getting diabetes (Diabetes Education Services, 2021). Such people are encouraged to join the CDC prevention program. There is also the Risk Test for Pre Diabetes patients to understand the risks they face as pre-diabetics (Diabetes Education Services, 2021).

The Diabetes Risk calculator is a tool that is used to detect undiagnosed diabetes and prediabetes. The social Support Assessment Tool helps diabetic patients to have a support system (Diabetes Initiative, 2020). Patients who have Diabetes need a lot of support from family and friends. The support shown will help them adhere to the doctor’s instructions, hence improving the chances of being better. Another assessment is the Mental Health Progress Report. The report is filled up during the patient’s follow-up visits. The assessment involves questions determining if the patient is affected by the condition mentally (Diabetes Initiative, 2020). It helps the doctors to guide the patient on how they can cope mentally with Diabetes.

Health Promotion Goals that you will like to Achieve

One of the goals that I would like to achieve is to reduce the high number of people diagnosed with Diabetes. I will encourage people to ensure they exercise at least thirty minutes a day to become physically fit. To make this goal achievable, I will create small groups that will act as support systems. This will help push people towards healthy living, preventing them from being diagnosed with the condition (Cecelia Health, 2021). My goal is realistic since it is easy to adopt a good eating habit and exercise at least thirty minutes daily. Still, it becomes easier when these activities are done in groups so that members feel motivated. To ensure that the goal is achieved, I will set a time frame of three months. Each member must have dropped at least 10 pounds within three months and managed to exercise at least 30 minutes daily, consistently.

The second goal is to enhance a better diabetes management program. Most people who have diabetes do not know what they should avoid, while others ignore the advice given to them by the doctors. In this case, I will form a group of people of different ages who are diabetic. The group formed will be a support system that will help each other cope with Diabetes. I will encourage the group members to remain healthy by eating the right food and exercising daily (McDermott, 2020). For those that are older, they can do simple exercises like jogging and walking a few kilometers daily. After five months, I will assess each patient’s changes in sugar levels and the general healthcare status (McDermott, 2020). I expect the sugar levels to be expected or close to normal for most patients within this period. Besides, the patients will have adapted to the new lifestyle since they got used to it.

Interventions for your health promotion goals

As indicated above, the first goal is to reduce the high numbers of people diagnosed with diabetes. The first health intervention is by ensuring that people are engaging in vigorous activities and exercises. Before one retires to bed, they must ensure that they have done a bit of practice to increase the metabolic activities of their bodies (Harvard T.H CHAN, 2021). Exercising helps maintain a moderate weight; hence, the high obesity and overweight people will reduce significantly. Besides, exercise helps increase insulin sensitivity in the body. As a result, the body cells can consume the sugars that are in the bloodstream.

For this intervention to work, both individuals and groups work together. A person must know that they have a personal responsibility to ensure that they maintain healthy body weight. Besides, organizations can play a significant role by ensuring that they create team-building activities (Harvard T.H CHAN, 2021). Organizations can set a day or two per month whereby all the employees and employers are involved in various team-building activities. This will help to ensure that at least all members keep fit, even if some of the members might not be keeping fit at a personal level. Since young people are also at a very high risk of getting diabetes, schools should develop a schedule to see all the students engage in exercise activities (John Muir Health, 2021). For example, the school can decide to have a physical exercise lesson after every two days.

Another intervention that will see few people being diagnosed with diabetes is maintaining a healthy eating lifestyle. Most people, especially teenagers, eat food that is full of calories. First, one should ensure they increase the fiber intake (Science Daily, 2018). Fiber is essential as it helps to slow down the digestion of carbs and sugars. Foods that contain more fibers include legumes, vegetables, and whole grains. Too many carbs place a person at a very high risk of getting diabetes. Another healthy eating habit is taking plenty of water to stay hydrated at all times (John Muir Health, 2021). When one takes a lot of water, it also helps the kidney eliminate excess sugars through the urine (Science Daily, 2018). A well-hydrated person is at a lower risk of getting diabetes. However, one should avoid sugar-sweetened drinks as they raise the level of glucose in the blood.

Both individuals and organizations have a role to play when it comes to maintaining a healthy eating lifestyle. Families should ensure that they prepare meals that are balanced diet. As an individual, one has a choice to eat whatever they want. Following this, one should avoid taking foods with high carb content instead of increasing the intake of high fiber meals. Organizations should also participate in this intervention by preparing healthy meals for their employees (Science Daily, 2018). Communities should be encouraged to grow more fibers and take the origin foods rather than rely on ready-made foods with high calories. Also, schools can be involved by ensuring that they have a reasonable timetable for all the meals, and the fiber intake for each student should be higher than the carb intake.

The second goal is enhancing better management for people who are living with diabetes. Individuals have a tremendous responsibility to ensure that they follow the given guidelines to stabilize sugar levels efficiently. As a diabetic patient, one should know the type of diabetes they are suffering from and the measures they are supposed to take to become better (NIH, 2021). The first step that a diabetic person should take is to ensure that they are not stressed. Stress triggers sugar levels, hence raising them. To reduce stress triggers, one can listen to their favorite music, take a walk, breathing in and out, or doing their favorite activities (Diabetes UK, 2021). Also, a person needs to have a support system to reach out in case they feel stressed.

The second step that one can take to deal with diabetes is ensuring that they eat well. After being assessed by the doctor, a health care team should help the sick person come up with a meal plan (Diabetes UK, 2021). The meal plan should contain fewer calories, fewer sugars and salt, and high saturated fats. Also, a diabetic person should eat foods that have high fiber, like rice and bread. Instead of drinking sweetened juices, a diabetic person should ensure that they take plenty of clean drinking water. This helps to keep the body hydrated at all times.

Both individuals and groups have a significant role in ensuring that diabetic persons are taken care of. They have the necessary things needed for them to reduce sugar levels. Health facilities should make sure that they do follow-ups so that if a patient has forgotten to go for checkups, they can go upon being reminded. Besides, other organizations like NGOs should develop fiber for needy people who might not afford such things.

Evaluation of your Health Promotion Care

Maintaining a healthy lifestyle through exercise is not hard to achieve as long as the people involved know the benefits of exercising. Exercising is an effective strategy that will help prevent diabetes and prevent other diseases like heart attack and stroke (Diabetes UK, 2021). However, people should be allowed to choose the kind of exercise that they want to do. Instead of going for a run, one can engage in other activities like playing football, netball, or swimming (Harvard T.H CHAN, 2021). Since people are not the same, one should not be forced to go for a morning jog, yet they like swimming. If this is done, the exercises will be more effective since people will be doing them willingly. I would recommend that the government makes it paramount for organizations to have different days from engaging in other activities like swimming, running, jogging, etc. Also, schools should ensure that there are various exercises for all the students to have one or two activities that they can engage in easily.

The second promotion of care was encouraging people to eat healthy meals. From the above discussion, it is evident that people need to engage in healthy lifestyles. Whether a person has diabetes or not, engaging in a healthy lifestyle is very important (Science Daily, 2018. Following this, one should ensure that they avoid high calories and have high fibers. This healthcare plan can be effective only if the government and other non-governmental organizations are willing to provide the proper meals for the people in need. Some diabetic people do not have access to medical care; hence they cannot do follow-ups about their conditions. As a result, the health care plan will become hard to achieve if the doctors and health care workers do not follow up on their patients to ensure they have taken the right medicines and that the sugar levels are not increasing (John Muir Health, 2021. For this, I would recommend that treatment of diabetes becomes free of charge in all public healthcare institutions. This will make it easy for the poor diabetic people to go for checkups since they know they will not be asked for any money to get the services they need. During the Diabetes Awareness week in the country, the government led by the health care sector should ensure that people are educated about diabetes. This will help people learn more about it and engage in activities that will help reduce diseases.

Tannahill Health Promotion Model

The Tannahill Health Promotion Model helps in the prevention of diabetes and protection of people who have diabetes. As discussed above, diabetes can be prevented through eating the right foods and ensuring that one is physically fit. The Tannahill Health promotion strategy also suggests a good communication flow between the patient and the health care providers (Queens University Belfast, 2021). In this case, the healthcare providers should do the follow up’s for their patients. The third aspect of the Tannahill Health promotion program is that the citizens should be given health protection through the legislature, social measures, and financial measures (Queens University Belfast, 2021). This includes helping needy people eat healthy meals and ensuring that organizations and companies give their employees the proper meals. Besides, Companies, organizations, and schools should set aside specific days where each person is engaged in other activities like swimming, ring, and playing their favorite games.

Diabetes is indeed one of the most severe diseases in the world. Diabetes affects both the young and the old and people of all ages. Although people at the age of 65 and older are more prone to being diagnosed with diabetes, other factors also determine if a person is prone to getting diabetes (Healthline, 2021). For example, a child can get diabetes from their parents; hence they get hereditary diabetes. Women who have experienced gestational diabetes are also at a very high risk of contracting the disease again (Shaikh, 2021). People who are not physically fit are also prone to getting diabetes. Following this, it is evident that although some people are more prone to getting diabetes, several other factors play a significant role.

Although diabetes is a severe condition worldwide, it can be controlled and the high rates reduced. This can be achieved through two maintaining it; exercising and eating suitable meals. Since some people cannot afford the healthy diet recommended for diabetic people, the government and other non-governmental organizations can provide such meals to the people (Whicher et al., 2019 p.243. Also, ensuring that the medication services are accessible at the public hospitals will encourage most people to go for follow-ups. Exercising is easy since there are so many activities that help burn calories (Shaikh, 2021). That is why it is essential to let the person choose activities they are good at and concentrate on them. Generally, although diabetes is a serious condition, it is easy to prevent and manage it if all resources are available.

Cecelia Health, 2021. How to Set and Achieve SMART Goals — in Life and Diabetes – Cecelia Health . [online] Cecelia Health. Available at: <https://www.ceceliahealth.com/how-to-set-and-achieve-smart-goals-in-life-and-diabetes/> [Accessed 1 June 2021].

Diabetes Education Services, 2021. Screening Tools for Diabetes – Diabetes Education Services . [online] Diabetes Education Services. Available at: <https://diabetesed.net/screening-tools-for-diabetes/> [Accessed 1 June 2021].

Diabetes Initiative, 2020. Tools: Assessment Instruments . [online] Diabetesinitiative.org. Available at: <http://www.diabetesinitiative.org/resources/type/assessmentInstruments.html> [Accessed 1 June 2021].

Diabetes UK, 2021. 10 Tips for Healthy Eating with Diabetes . [online] Diabetes UK. Available at: <https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/10-ways-to-eat-well-with-diabetes> [Accessed 1 June 2021].

Dowshen, S., 2021. Diabetes Control: Why It’s Important (for Teens) – Nemours KidsHealth . [online] Kidshealth.org. Available at: <https://kidshealth.org/en/teens/diabetes-control.html> [Accessed 1 June 2021].

Genesis Medical Associates, 2015. The Importance Of Understanding And Preventing Diabetes – Genesis Medical Associates, Inc . [online] Genesismedical.org. Available at: <https://www.genesismedical.org/blog/the-importance-of-understanding-and-preventing-diabetes> [Accessed 1 June 2021].

Harvard T.H CHAN, 2021. Simple Steps to Preventing Diabetes . [online] The Nutrition Source. Available at: <https://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention/preventing-diabetes-full-story/> [Accessed 1 June 2021].

Healthline, 2021. Everything You Need to Know About Diabetes . [online] Healthline. Available at: <https://www.healthline.com/health/diabetes#:~:text=Diabetes%20mellitus%2C%20commonly% 20known%20as,the%20insulin%20it%20does%20make.> [Accessed 1 June 2021].

John Muir Health, 2021. Preventing Diabetes . [online] Johnmuirhealth.com. Available at: <https://www.johnmuirhealth.com/health-education/conditions-treatments/diabetes-articles/preventing-diabetes.html> [Accessed 1 June 2021].

Mandal, A., 2021. History of Diabetes . [online] News Medical. Available at: <https://www.news-medical.net/health/History-of-Diabetes.aspx#:~:text=The%20term%20diabetes%20was%20probably,sweet%20taste%20of%20the%20urine.> [Accessed 1 June 2021].

McDermott, A., 2020. 7 Long-Term Goals for Better Diabetes Management . [online] Healthline. Available at: <https://www.healthline.com/health/type-2-diabetes/living-better-with-type-2-diabetes/long-term-goals-everyone-with-type-2-diabetes-should-make> [Accessed 1 June 2021].

NIH, 2021. 4 Steps to Manage Your Diabetes for Life | NIDDK . [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: <https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/4-steps> [Accessed 1 June 2021].

Queens University Belfast, 2021. Health Promotion. [online] Queens University Belfast. Available at https://www.qub.ac.uk/elearning/public/HealthyEating/HealthPromotion/ [Accessed 1 June 2021]

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Diabetes Mellitus: Symptoms, Types, Effects Essay

Introduction.

According to the World Health Organization in 2000, around 171 million people suffered from diabetes worldwide. Diabetes is a major disease found in every other person, resulting from an imbalance of blood sugar and insulin levels in the body.

Diabetes is the third leading cause of death in the United States after cancer, and every second person seems to be diabetic. Diabetes mellitus is a disease caused by high blood sugar levels, which result in defective releases of insulin in the body (Mathur, R. 2008). Initially this disease was associated with “sweet urine” and excessive loss of muscles (Mathur, R. 2008).

In Diabetic patients, the glucose levels in the blood are increased, a condition known as ‘hyperglycemia’, and glucose is excreted in the urine. Insulin is the hormone that controls the levels of glucose in the blood, and when the pancreas releases it, immediately the high levels are controlled, like after a meal. The pancreas is an organ present in our bodies. If insulin is not being produced sufficiently, or is not functioning properly, diabetes occurs. Although diabetes can be controlled, it is a chronic disease, lasting till the end of life (Mathur, R. 2008).

R.R. was diagnosed with mild case of diabetes 4-5 years ago. Over the years he developed some more severe kind of symptoms that were indicative of this disease. Certain risk factors and pathphysiology of the disease is discussed over here.

Physical Assessment

Age: 62-years

Height: 1.75m

Weight: 77.1 kilograms

BP: 180/105mmHg

Bilateral Engorged Jugular veins

Inspiratory moist rales

Dorsalis pedis

Posterior Tibial Pulses

Erythematous right foot

2 nd , 5 th and lateral aspects of big toe has areas of right gangrene

Sensation: Absent in right foot

Plasma glucose: 237 mg/dl

Total serum cholesterol: 266 mg/dl [Normal: <200mg/dl] High density lipoprotein (HDL) cholesterol: 29 mg/dl (Normal :>35 mg/dl)

Triglycerides: 285 (Normal: <200 mg/dl),

HbA1c 8.9% (normal <6.2%)

Among most important risk factors associated with diabetes are obesity, high blood pressure, high blood cholesterol, old age.

The problems which he goes through are described as follows:

R.R. initially visited a doctor due to gangrene of the foot, and shortness of breath. Dry foot gangrene has become a part of diabetes and is a big medical problem these days. Foot gangrene is usually caused by an improper circulation of the blood – if there is insufficient oxygen-rich and nutrient-dense supply of blood due to arterial (femoral, popliteal or tibial) hindrance. The patient had a femoral- popliteal bypass too, which means that his blood supply was insufficient to keep tissues of his leg alive.

In the initial stages, a dull, aching pain is aroused, and there is immense pain in the affected area. The color of the skin slowly changes to dark purplish- blue, and later on, black. The doctors diagnosed the patient with diabetes then, and ever since he has been having skin-related and breathing problems. Diabetes causes skin infections, and wounds take longer to heal in diabetics (Smoking and Diabetes, 10 th Jan, 2008).

The patient had been a heavy smoker since the age of twenty, and this had led to myocardial infarction in him, along with the dyspnea and diabetes mellitus (Fenton, 2007). The devastating use of tobacco had injured his inner body, leading to shortness of breath. And being a diabetic, it worsened the situation. However, he quit smoking two years ago. The health issues related with smoking are well-known by everyone. There is a specific threat to the lives of diabetic patients who smoke.

The complications that may arise in smokers, who are also diabetics, may be, nephropathy, and smoking reduces retinal blood flow and affects the hypoxic environment of the diabetic retina. Prevention of tobacco use should be encouraged for all patients with diabetes. Smoking doubles the risk of diabetes in normal healthy individuals (BMJ, 2008).

Smoking and diabetes are greatly associated with one another. If smoking can cause diabetes, then it can lead a diabetic patient to a worse condition as well. Numerous studies have been conducted to associate smoking and glucose imbalance. It shows that smoking may be separately linked with glucose intolerance, abnormality in fasting glucose, and Type II diabetes ( Smoking and Diabetes, 10th Jan, 2008). The reason smoking causes diabetes is that it leads to resistance of insulin and insufficient insulin secretions. Thus, there is a 50% increase in the likelihood of increase in risk of diabetes in smoking people (Smoking and Diabetes, 10 th Jan, 2008). Smoking makes the risks of diabetes twofold.

Diabetics who are smokers are more at a risk of having worsened their health. They are more prone to diseases such as heart attack, stroke, blood glucose, blood pressure, high cholesterol (the level of cholesterol increases in smokers), skin infections, and kidney and nerve infections (Smoking and Diabetes, 10 th Jan, 2008).

Smoking affects the damage caused to the body by diabetes, by doubling it. The bodies large arteries leading to the legs and brains are affected, and this leads to more cases of stroke and amputations.

Effects of Diabetes

The following conditions may result from diabetes. Some of them have been mentioned earlier:-

Kidney failure,
Damage of nerves,
Damage to other vessels, smaller in size, causing microvascular diseases,
Atherosclerosis,
Coronary heart disease,
Macrovascular diseases.

Since the patient had had diabetes since the last few years, it may have led to the shortness of breath he experienced a year ago, since diabetes may lead to heart diseases (Mathur, R. 2008)

Types of Diabetes

There are two types of diabetes, one is the Type I and the second is the Type II diabetes. The former is also called insulin dependent diabetes, or diabetes mellitus. In this case, the pancreas ceases to produce insulin for some reason. The patients suffering from Type I diabetes also possess abnormal antibodies. Antibodies are proteins that are found in blood, which are a component of the immune system. Thus in the case described, the patient may be suffering from a number of problems due to his weak immune system. A diabetes mellitus patient is compelled to take in insulin to keep alive (Mathur, R. 2008)

Type II diabetes is non-insulin dependent. In this situation, a patient may still produce insulin, but is insufficient for the body. Type II diabetes is said to occur more frequently in people over thirty years of age, though now it is more common in childhood, than Type I diabetes.

Symptoms of Diabetes

The symptoms of diabetes include,

Dehydration in the body due to increase in urine frequency
Loss of weight
Bladder, skin and vaginal infections
Blurred vision
Coma, in extreme cases.

The case being studied initiated with skin problem, i.e. gangrene. Diabetes may have caused it, as it does give rise to such infections. Foot ulcers are also common in diabetes patients (Bentley, J. 2007).

Pathophysiology

Insulin is responsible for the processing of all the nutrients that enter our bodies. It reduces the levels of glucose in the blood by stimulating it to convert into glycogen (Lamb, W. 2007). Insulin also slows the breakdown of fat to triglycerides, fatty acids and ketones. It additionally stops the breakdown of fat in the liver and kidneys. Since the patient was diabetic, lack of insulin could not slow the fat breakdown process, and thus he had a record of high triglycerides (Lamb, W. 2007). Triglycerides are essential for body functions, but a balance is necessary (Forogos, R. 2008).

A condition known as hyperglycemia occurs when the deficiency of insulin leads to “gluconeogenesis”. The circulation of glucose is stopped, neither is it stored. The glucose is unable to be absorbed by the kidneys, due to its large quantities, and this in turn causes glycosuria, osmotic diereses, thirst, and dehydration. The weight loss experienced by a diabetic patient is due to the increase in breakdown of fats and proteins, which is resultant in creation of ketones (Lamb, W. 2007).

This does not mean that an excess of insulin in the body is beneficial. If in too much quantity in the body, the release of glucose into the bloodstream is reduced, and this results in a condition known as “hypoglycemia”.

Other Risk Factors of Diabetes

Some of the commonly prevailing diseases or conditions resulting from diabetes are risk of colorectal cancer (Larrson, S. 2005), obesity, high blood pressure, and high cholesterol levels.

Obesity and diabetes are major causes of deaths in the United States. Both are interlinked, weight gain causes an increase in risks of diabetes (Mokdad, A, 2001). The costs of health care for diabetics are on the rise, and are problem-causing. Studies have shown that the occurrence of weight gain and diabetes have increased yearly. The Body Mass Index of an individual is measured by the division of the weight in kilograms by the square of height in metres. Further studies have been carried out to see whether there is a constant increase in obesity and diabetes, or if there are any plans for the people to lose weight to remain healthy.

The outbreak of obesity and diabetes took place in the 1990s, and even the current records show that most adults in the USA are overweight, and 7.3% have diabetes (Mokdad, A. 2001). Some diabetics are not even diagnosed, but are affected. BMI and gain in weight are mutual risk factors for diabetes. For every one kilogram increase in weight, the risk of diabetes goes up by 4.5%.

Diabetes and obesity can be prevented. Changes in lifestyles can help prevent the diseases, especially in those who are prone to them. Studies show that if weight is controlled, then everything automatically falls in place, like blood pressure, triglycerides, high-density lipo-protein cholesterol levels, etc. Therefore, an improvement in the diet and adequate physical activities can reduce the chances of diabetes and obesity.

High Blood Pressure

The cardiovascular system of an individual is badly affected if hypertension or high blood pressure, and diabetes exist together. If the hypertensive patient has diabetes mellitus, the risk of him getting a stroke, or experiencing any other heart-related problem, will be normal, and much expected (Grossman, E. 2000). The patient in consideration was diabetic, had high blood pressure, and the triglyceride ratio in his body was high also. Thus, all such problems are inter- linked.

If the blood pressure is lowered, there is a substantial cut down in the risk of a cardiovascular event. Renal problems are also decreased with low blood pressure.

High Cholesterol

High cholesterol takes its toll in the body over many years, and is basically caused by atherosclerosis (Effects of High Cholesterol, 2007). Atherosclerosis is the contraction of the arteries, and the high cholesterol that is caused by this condition leads to further heart illnesses, like heart attack and stroke. The best way to avoid such an instance is to reduce the amount of cholesterol in the diet, so that the cholesterol in the blood is also reduced. If the level of cholesterol in the blood is too high, the low-density lipo-proteins will tend to leave spare cholesterol in the blood. If the high-density lipo-proteins do not take all of this cholesterol, it will start accumulating in the walls of arteries, with fat and other remains. The building up of this cholesterol in arteries is termed as ‘plaque’, and the increase in plaque is called atherosclerosis.

The effects of high cholesterol leave a profound effect on the other systems of the body, and lead to heart attack, coronary heart disease, stroke, angina, and high blood pressure (Effects of High Cholesterol, 2007). It is apparent that R.R was suffering from diabetes, high blood pressure, and high cholesterol, and these were all interlinked. The cause of his femoral-popliteal bypass may also be due to the blockage of arteries in the leg, of which high cholesterol may have been the cause.

Femoral-popliteal Bypass

R.R had also gone through a femoral-popliteal bypass surgery, the newer procedure is also called percutaneous transluminal angioplasty (PTA) of the femoral artery. The femoral- popliteal bypass is the opening of the upper leg through surgery, to directly be able to view the femoral artery. The blocked portion of this artery is replaced with another blood vessel. These vessels or pieces of veins may be extracted from the legs. The blood flow is rerouted by attaching one piece of vein above and one below the blockage. One of the reasons for the need of this surgery is “gangrene”, apart from other causes, like nonhealing wounds (which is mainly caused in diabetic patients), and ischemic rest pain (Ouriel, 2001).

It can also be concluded that the myocardial infarction the patient had a year ago was partly the cause of the femoral-popliteal bypass he had two years ago, because there is a risk of such complications after the surgery (Ouriel, 2001).

The condition of R.R was an unhealthy one, with severe irritating diseases or malfunctioning in the body. The diabetes may have been existing and the main cause of the rest of the disorders, such as the gangrene, high blood pressure, and high cholesterol. All these disorders are inter-related and if proper medical care is not aided, result in complications

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"Diabetes Mellitus: Symptoms, Types, Effects." IvyPanda , 27 Oct. 2023, ivypanda.com/essays/diabetes-mellitus-symptoms-types-effects/.

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IvyPanda . 2023. "Diabetes Mellitus: Symptoms, Types, Effects." October 27, 2023. https://ivypanda.com/essays/diabetes-mellitus-symptoms-types-effects/.

1. IvyPanda . "Diabetes Mellitus: Symptoms, Types, Effects." October 27, 2023. https://ivypanda.com/essays/diabetes-mellitus-symptoms-types-effects/.

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IvyPanda . "Diabetes Mellitus: Symptoms, Types, Effects." October 27, 2023. https://ivypanda.com/essays/diabetes-mellitus-symptoms-types-effects/.

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Types of Diabetes

Causes of Diabetes

Symptoms of Diabetes

Levels of Diabetes

Effects of Diabetes

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Diabetes mellitus: The epidemic of the century

DEFINITION OF DIABETES MELLITUS

CLASSIFICATION OF DIABETES MELLITUS

TYPE 1 DIABETES MELLITUS

Idiopathic type 1 diabetes

Fulminant type 1 diabetes

TYPE 2 DIABETES MELLITUS

Insulin resistance and signaling

OTHER TYPES OF DIABETES MELLITUS

Disease of the exocrine pancreas

Hormones and drugs

Genetic syndromes

PREDIABETES

DIAGNOSTIC CRITERIA FOR DIABETES MELLITUS

GESTATIONAL DIABETES

DIABETES AND GENETICS

Molecular genetics and type 2 diabetes

Molecular genetics of type 1 diabetes

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MOLECULAR GENETICS OF DIABETES COMPLICATIONS

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Essay on Diabetes Mellitus

Introduction

Normal anatomy of the body system is affected

Normal physiological body system affected

Mechanism of Diabetes Mellitus

Prevention and Control

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Free Diabetes Essay Examples and Topics for Students