Disease Research Report: Diabetes Mellitus

Introduction

The disease that I chose to focus on is diabetes mellitus (DM). Diabetes is a chronic disorder of carbohydrate metabolism resulting in hyperglycemia and glycosuria. Insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) are two forms of diabetes mellitus. IDDM is considered to be type one diabetes while NIDDM is considered type 2 diabetes. I chose this disease state because I am currently living with my aunt Rita who has diabetes. Living with my aunt Rita, who is partially blind due to her diabetes, has motivated me to help others like my aunt. Seeing how she has struggled to find employment and is unable to drive has made her lose the joy she once had in life. Despite her struggles, she has managed to find joy in the little things in life and continues to fulfill her passion of cooking. I believe learning more about the disease and ways to prevent chronic diseases such as this one from impairing a person's life is the best way of informing myself to help others.

Research about the Disease/Condition

According to an article written by Meyer, the U. S. Food and Drug Administration (FDA) has sought to create a personalized therapy treatment for patients with diabetes mellitus. However, Meyer states prior to creating a personalized prevention and treatment plan more scientific research needs to be done. Nonetheless, the article mentions that challenges have arisen for the prevention of type 1 diabetes due to the lack of identifying disease biomarkers prior to their development. In the near future, better prevention strategies are expected to help detect type 1 diabetes before it progresses. Whereas improving therapy instead of prevention is the primary focus for type 2 diabetes.

In order to provide precise medicine for each patient, though, more relevant information is needed such as genotype or incorporation of specific biomarkers to match individualized therapeutic strategies. Another study compared the health literacy among patients with type 2 diabetes. Although the studies results had been taken throughout several countries, the results showed that there was limited health literacy among one in three patients in the United States. Abdullah (2019) indicates how this impacts a patient’s ability to self-manage their own blood sugar because of their lack of understanding of medical terminology and struggle with patient-provider communication. The findings of the study supported current policies that have been recently established in the United States to create more health literate health organizations which would benefit patients to access these services.

In addition, another study by DiZazzo-Miller (2017) showed the positive impact healthcare providers can have on patients that have diabetes. The study recognized that many barriers were present among the patients such as what the disease was itself, refusal to recognize they had diabetes, and reflecting on the stigma of the disease. The study concluded that educating patients about the disease impacted the patient's ability to self-manage their diabetes. Additionally, using motivation strategies by setting goals showed positive results among patients with diabetes.

Definition of Disease

Diabetes Mellitus is defined as a metabolic disorder characterized by elevated blood glucose levels and disordered insulin metabolism. People that have diabetes may be unable to produce enough insulin or use insulin effectively, or they can have both types of abnormalities. Etiology of disease One of the less common types of diabetes mellitus is type 1 diabetes. According to Ralfes (2018) textbook, Understanding Normal And Clinical Nutrition, type one diabetes affects less than five to ten percent of individuals. Typically children or adolescents develop type 1 diabetes but it can really happen at any age. She presents that type 1 diabetes is usually caused by an autoimmune disease that attacks the beta cells, found in the pancreas, which produces and secretes insulin for the body. Unfortunately, her textbook states that symptoms may arise too late that the destruction of the beta cells progresses so much that exogenous insulin must be supplied. Although the reasons why this autoimmune attack occurs is unknown, it is believed that a viral infection or environmental toxins could increase an individual’s susceptibility to developing that autoimmune attack.

In like manner, individuals with this genetic disorder are also susceptible to developing other autoimmune diseases. The most common form of diabetes mellitus is type 2 diabetes which accounts for 90-95% of cases. Her textbook states that the age of onset for this disease is over 40 years of age but can be present in children and adolescents. Type two diabetes is depicted as being insulin resistant. In other words, the muscle, liver, and adipose cells are less responsive or sensitive to insulin. Moreover, there is a slight deficiency of insulin which makes it more difficult to manage glucose levels. This tends to happen when an individual constantly has a high glucose level in their blood due to their diet and lifestyle. Under those circumstances, the pancreatic beta cells begin to secrete more insulin to compensate but are unable to meet the needs of the body due to the diminished effects it has on the cells. Over time, the beta cells begin to diminish their insulin production.

Pathophysiology

Diagnosis of type one diabetes usually follows after an illness has taken place in children or adolescents. As a result, Ralfes indicates that an illness can increase insulin requirements and stress the islets of Langerhans which contain the beta cells that produce insulin. With this in mind, it is no surprise that the individual then experiences symptoms such as polyuria (excessive urine production), polydipsia (excessive thirst), weight loss, and weakness. Additionally, some may experience ketoacidosis which is a condition that is characterized as high production of ketone bodies found in the blood which is typically the first sign of the disease. Without insulin secretion, glucagon levels become more evident in the blood, more triglycerides are broken down in adipose tissue, and protein degeneration occurs in the muscle. Therefore, the free fatty acids that were a part of the triglyceride are then oxidized in the liver which creates ketones. These ketone bodies make the blood acidic and can pour over to the urinary tract. This can cause life-threatening harm to the blood and organs. Her textbook affirms that individuals who experience diabetic ketoacidosis will most likely have Disease: Diabetes Mellitus 6 ketosis, acidosis, and hyperglycemia. Patients who have ketoacidosis demonstrate symptoms of fatigue, lethargy, nausea, vomiting, and even diabetic coma.

Another condition that is common among type 1 diabetics but can also occur with type 2 diabetics is hypoglycemia. Hypoglycemia is characterized as low blood sugar which primarily occurs because of inappropriate management of diabetes. There are several reasons why this can occur from excessive insulin dosage or antidiabetic drugs to poor lifestyle choices. Symptoms of hypoglycemia include sweat, heart palpitation, shakiness, hunger, dizziness, and mental confusion. It is important to detect these symptoms early on to prevent irreversible brain damage, comas, and death.

With type 2 diabetes conditions such as hyperosmolar hyperglycemic syndrome can develop in the absence of significant ketosis. Patients with this syndrome are unable to detect thirst due to age, illness, or sedation which causes dehydration. For this reason, people with this syndrome have higher concentrations of glucose and plasma in the blood which can lead to hyperglycemia and neurological malfunctions. These malfunctions can range from confusion, speech and vision impairment, muscle weakness, abnormal reflexes, seizures, and comas. As her textbook states, long exposure to hyperglycemia can lead to chronic damage cells and tissues. This occurs when high amounts of advanced glycation end-products accumulate and begin to alter the structures of proteins and stimulates damaging metabolic pathways. Additionally, glucose accumulates sorbitol which increases oxidative stress to cells which can cause injury. Hence, diabetic individuals can experience macrovascular complications, microvascular complications, and diabetic neuropathy. Other tissues that can be affected include the eyes (cataracts or glaucoma), and the skin (lesions).

Treatments for this Disease

The main goal for all diabetic patients is to regulate their glucose levels to reduce the chance of developing chronic diseases; therefore, through proper treatment, the individual can achieve just that. One form of treatment the textbook has to offer is through nutrition therapy. Nutrition therapy takes into account macronutrient distribution, glycemic index, sugars, whole grains, fibers, dietary fats, alcohol consumption, and body weight for type two diabetes. Nutrition therapy also involves meal-planning strategies to manage glycemic control. Meal-planning involves carbohydrate counting which gives the patient a daily carbohydrate allowance and is split evenly between each meal/snack. Another form of treatment is through insulin therapy. Insulin therapy is typically used for individuals with type 1 diabetes and some type 2 diabetes patients who are unable to regulate their glycemic levels using medication, diet, and exercise. The three types of insulin are short, intermediate, and long-acting which affects the time of insulin delivery into the system. A carbohydrate-to-insulin ratio must be established for people with type 1 diabetes to ensure a controlled glycemic level.

On the other hand, 30% of patients with type 2 diabetes use insulin therapy as an alternative when antidiabetic drugs fail to function. This is primarily used because the pancreas begins to worsen and does not respond to medication the same. However, there are repercussions to using insulin therapy. Patients can experience hypoglycemia if too much insulin is used. Comparatively, too little insulin can cause hyperglycemia. One new insulin that was approved by the FDA in 2015 was Gla-300. GLA-300 is an improved insulin glargine that delivers the same number of insulin units as GLA-100 but in one third the injection volume. The results of the study showed that a more constant pharmacokinetic profile with a prolonged duration of action beyond 24 hours was observed using Gla-300. Treatment can also be obtained by using antidiabetic drugs for those who have type 2 diabetes. Treatment varies according to the individual but there is monotherapy which involves using one drug and combination therapy which uses two or more drugs. Results have shown that combination therapy is more effective in managing glycemic levels. There are several drug categories that exist to treat diabetes.

A common drug category that is prescribed as biguanides. An example of a medication that falls under this category would be metformin. This type of drug inhibits liver glucose production and improves glucose utilization. However, some common side effects of using this medication include metallic taste, nausea, vomiting, abdominal cramping, diarrhea, and anemia. A new drug that was approved by the FDA in 2012 is called Bydureon. According to the U. S. Food and Drug Administration (2018), this new medication allows type 2 diabetics to inject the medication once a week with the use of other medications to regulate their glycemic levels.

Conclusion

There were several new and interesting things I learned about this disease. Something interesting that I learned about this disease is that insulin does not only help regulate glucose levels but it has other functions as well. Insulin also helps with protein decomposition and lipid synthesis. This would explain why people with diabetes get thinner and have a higher risk of developing cardiovascular disease and high blood pressure. This information is useful for me personally because I am currently living with someone who has diabetes. Knowing how this disease develops and ways to regulate the disease is useful information. I hope on becoming a nutritionist soon and by acquiring this information I know I can help those who need it more.

Works Cited

1. Abdullah, A. , Liew, S. M. , Salim, H. , Ng, C. J. , & Chinna, K. (2019). Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLoS ONE, 14(5), 1–16. https://doi-org. mantis. csuchico. edu/10. 1371/journal. pone. 0216402.
2. DiZazzo-Miller, Roseanne. (2017). Diabetes Is Devastating, and Insulin Is a Death Sentence: Provider Perspectives of Diabetes Self-Management in Arab-American Patients. Clinical Diabetes: A Publication of the American Diabetes Association. , 35(1), 43-50. https://doi. org/10. 2337/cd15-0030.
3. Leonard, P. C. (2017). Quick & easy medical terminology (8th ed. ). St. Louis, MO: Elsevier. Meyer, R. (2016). Precision Medicine, Diabetes, and the U. S. Food and Drug Administration. Diabetes Care, 39(11), 1874-1878. https://doi. org/10. 2337/dc16-1762.
4. Rolfes, S. R. , Pinna, K. , & Whitney, E. (2018). Understanding Normal And Clinical Nutrition (11th ed. ). Boston, MA: Cengage Learning. U. S. Food and Drug Administration. (2018). BYUDREON (exenatide extended-release) for injectable suspension [pdf file]. Retrieved from https://www. accessdata. fda. gov/drugsatfda_docs/label/2018/022200s026lbl. pdf
5. White, John. (2016). Advances in Insulin Therapy: A Review of New Insulin Glargine 300 Units/mL in the Management of Diabetes. Clinical Diabetes: A Publication of the American Diabetes Association, 34(2): 86-91. Retrieved from https://clinical. diabetesjournals. org/content/34/2/86