Essay on Pathophysiology: Type 2 Diabetes
Type 2 diabetes is metabolic disorder characterized by the high level of hyperglycemia in the context of insulin resistance and relative lack of insulin. This is a serious health problems that undermines the quality of life of patients, may trigger serious complications and eventually result in the death of patients. Therefore, the accurate diagnosis and effective treatment of type 2 diabetes is crucial for the survival of patients and maintenance of high standards of living, but patients should be collaborative and responsible to make their treatment effective.
Type 2 diabetes is traditionally viewed as the diseases that is triggered by heredity of patients. Genetics is one of the major factors that increases the risk of the development of type 2 diabetes in patients. Patients inherit the health problem from their parents and ancestors but it does not necessarily mean that patients will develop type 2 diabetes. Instead, the impact of genetics implies that patients are inclined to the development of type 2 diabetes but the higher vulnerability of the disease can trigger the development of the disease in patients.
At the same time, environmental factors are also important for the development of type 2 diabetes to the extent that they may trigger the genetically predisposed disease in patients. In fact, insulin resistance may be caused by an insulin signaling defect, glucose transporter defect, or lipotoxicity, and β-cell dysfunction is postulated to be caused by amyloid deposition in the islets, oxidative stress, excess fatty acid, or lack of incretin effect (Bostock-Cox, 2014). The impact of environmental factors leads to the development of type 2 diabetes. In fact, environmental factors are very important factors that cause the disease. The insulin resistance becomes a serious threat to the health of patients.
The impact of type 2 diabetes on the health of patients and their quality of life can hardly be underestimated. The morbidity related to the type 2 diabetes is high. To put it more precisely, the morbidity level is high since over 25 million of Americans had diabetes in 2010 and over 29 million in 2012. At the same time, the risk of the development of the disease differs depending on the racial background of individuals. To put it more precisely, the highest level of morbidity is marked among Native Americans and comprises 15,9%; the African American community has 13,2% of patients with diabetes; Hispanics have 12,8% of cases of diabetes; Asian Americans have 9,0%; and whites have 7,6% of diabetic population (Casey, 2011). Therefore, the high morbidity rate proves the negative impact of type 2 diabetes on patients.
Moreover, the mortality rate 7-7.9% per year is the high rate of death among patients with type 2 diabetes. At the same time, many researchers (Kahn, et al., 2014) insist that cases of type 2 diabetes often remain under-reported. This is why the mortality rate 7-7,9% may be inaccurate and underestimated. On the other hand, even this level of mortality is very high because patients with type 2 diabetes have the high risk of the consistent deterioration of their health condition and serious complications may lead to death.
In such a context, the understanding of the major risk factors can help to prevent the development of type 2 diabetes in patients. In this regard, genetics is one of the main factors that cause the development of type 2 diabetes. At this point, it is worth mentioning the fact that genetics is important but not determinant factor that causes the development of type 2 diabetes. In fact, genetics is a serious risk factor that increases the risk of the development of type 2 diabetes but what causes the development of the diseases are environmental factors mainly, including the lifestyle of people, their medical conditions, and other factors. For example, being exposed to the same environmental risk factors, individuals, who are genetically predisposed to the development of diabetes, are more likely to develop the disease compared to individuals, who are not genetically predisposed to the development of the disease.
Another risk factor is the lifestyle of patients. In fact, the lifestyle is a very important factor that contributes to the development of type 2 diabetes. The problem of the lifestyle causes the development of type 2 diabetes, if individuals have the genetic predisposition to the development of the disease. The diabetes results from the sedative lifestyle, irregular nutrition, poor food culture, the excessive use of alcohol, drugs, tobacco and other negative environmental factors. In the course of time, the negative environmental impact can trigger the development of type 2 diabetes in patients.
Furthermore, the medical condition of patients is another important factor that contributes to the development of type 2 diabetes. In this regard, many researchers (O’Shea, 2010) place emphasis on the high risk of the development of type 2 diabetes as the complication of diabetes and some other health problems. In this regard, hypertension, unstable insulin level, and other factors can be indicators of the development of type 2 diabetes. At the same time, the treatment of serious health conditions may trigger the development of type 2 diabetes as the result of the complication or side-effects of the medication and treatment of other serious health conditions.
The development of the disease evokes considerable changes in patients. Type 2 diabetes is characterized by a combination of peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells (Spollett, 2014). The insulin resistance becomes a serious challenge for the normal functioning of human body to the extent that it may lead to the lethal outcome, unless the level of insulin is balanced.
Insulin resistance and β-cell dysfunction are known to be the major pathophysiologic factors driving type 2 diabetes; however, these factors come into play with very different time courses. Insulin resistance in muscle is the earliest detectable abnormality of type 2 diabetes. In contrast, changes in insulin secretion determine both the onset of hyperglycemia and the progression toward insulin therapy (Casey, 2011). The combination of insulin resistance and β-cell dysfunction can cause the development of disease and deterioration of the condition of the patient’s health.
Reversal of type 2 diabetes to normal metabolic control by either bariatric surgery or hypocaloric diet allows for the time sequence of underlying pathophysiologic mechanisms to be observed. In reverse order, the same mechanisms are likely to determine the events leading to the onset of hyperglycemia and permit insight into the etiology of type 2 diabetes (O’Shea, 2010). In such a way, the development of the disease starts progressing fast and its manifestations should draw the attention of health care professionals, who should address the obvious symptoms of type 2 diabetes to start its treatment at the early stage of its development.
Within 7 days of instituting a substantial negative calorie balance by either dietary intervention or bariatric surgery, fasting plasma glucose levels can normalize. This rapid change relates to a substantial fall in liver fat content and return of normal hepatic insulin sensitivity (O’Shea, 2010). Over 8 weeks, first phase and maximal rates of insulin secretion steadily return to normal, and this change is in step with steadily decreasing pancreatic fat content (O’Shea, 2010). In such a way, 8 weeks period leads to the full phathophysiological development of type 2 diabetes. In such a way, patients face considerable health problems and need the immediate assistance of health care professionals.
The glucose metabolism occurs in the course of the development of type 2 diabetes and is the major factor leading to the development of the disease. In the progression from normal to abnormal glucose tolerance, postprandial blood glucose levels increase first. Eventually, fasting hyperglycemia develops as suppression of hepatic gluconeogenesis fails (Spollett, 2014). In such a way, patients develop type 2 diabetes in the result of the abnormal glucose metabolism.
Researchers (Spollett, 2014) distinguish the following genomic factors that determine, to a significant extent, the pathophysiology of type 2 diabetes:
Decreased beta-cell responsiveness, leading to impaired insulin processing and decreased insulin secretion (TCF7L2)
Lowered early glucose-stimulated insulin release (MTNR1B, FADS1, DGKB,GCK)
Altered metabolism of unsaturated fatty acids (FSADS1)
Dysregulation of fat metabolism (PPARG)
Inhibition of serum glucose release (KCNJ11)
Increased adiposity and insulin resistance (FTO and IGF2BP2)[
Control of the development of pancreatic structures, including beta-islet cells (HHEX)
Transport of zinc into the beta-islet cells, which influences the production and secretion of insulin (SLC30A8)
Survival and function of beta-islet cells (WFS1)
These factors are crucial for the development of type 2 diabetes, but the problem is the difficulty associated with tracing the change and impact of the aforementioned factors on the physical condition of patients.
In face of such risk factors, patients and health care professionals should be able to diagnose type 2 diabetes at the early stage of its development to minimize the negative impact of the disease on the health and life of patients. Researchers (Phillips, 2014) distinguish the following symptoms, which are distinct symptoms of the type 2 diabetes: frequent urination, increased thirst, increased hunger, weight loss, blurred vision, itchiness, peripheral neuropathy, fatigue, frequent infections of skin, urinary tract, or vagina.
To diagnose type 2 diabetes, health care professionals use either blood tests or Zinc transporter 8 autoantibody test/ Blood tests are the most widely-spread types of tests, which are applied to diagnose type 2 diabetes. These tests are accurate, fast to conduct and easy to manage. Zinc transporter 8 autoantibody test is applied in the most complicated cases of type 2 diabetes, when health care professionals face difficulties with the diagnosis of the disease with the help of blood tests. As a rule, this test is applied, when patients have already had some problems and face serious complications.
On diagnosing the disease, health care professionals starts the treatment of patients with type 2 diabetes. The injection of insulin is the traditional treatment of type 2 diabetes which focuses on stabilization of the level of insulin in patients. This treatment is accompanied by medication, which may vary depending on the patient and specific case of type 2 diabetes. Often physicians prescribe metformin lowers blood glucose mainly by decreasing the amount of sugar (glucose) (Phillips, 2014). Sulfonylurea medicines also increase the amount of insulin made by pancreas of patients (Phillips, 2014). Nateglinide and repaglinide have a similar action to sulfonylureas and they books the insulin level fast that discourage health care professionals from their frequent use (Phillips, 2014).
In addition to medication, physicians may and normally do recommend their patients to change their lifestyle because the wrong lifestyle is one of the major causes of the development of type 2 diabetes. In this regard, diet, weight control and physical activities are key factors contributing to the overall decline of the physical shape of patients and increase of the risk of the development of type 2 diabetes.
Thus, type 2 diabetes is extremely dangerous disease but its complications are even more dangerous. Possible complications of type 2 diabetes include retinopathy, kidney damage, poor blood circulation, nerve damage, HHNKC, which involves the severely high glucose level leading to the coma of the patient and requires the immediate medical care. This is why health care professionals should diagnose the disease accurately and at possibly early stage to conduct the treatment effectively.
Just ask Jamie Oliver; here’s a guy raising his voice to our support, with a small detail forgotten – that there are two types of diabetes – and BAM! Blows up in his face, like an overly ripe foux da fa fa. Ouch.
So. let’s nail some basics here to keep it from happening to you.
The Most Common Pitfalls
When writing about diabetes and people with the disease, please mind the following:
- We do not suffer from; but live with diabetes.
- There are two main types. Do not mess’m up! We’ll have your head on a pole faster than you can scream “JAMIE ROCKS!” Srsly. This mistake is met with mobs equipped with torches and pitchforks, it gets very emotional – see below for a detailed description of the types.
- It is not a patient’s fault
–>In type 1, we have no clue why it happens.
–>In type 2, part of it can be lifestyle, but there is a massive random element to it and some genetics too!
- We do not measure our insulin, we measure our blood glucose.
- A hyper – high blood glucose – won’t kill you as fast as they do in the movies! They just wanted the script to be more exciting. Bastards…
- A hypo – low blood glucose – can land you in awkward situations, but we’re usually able to handle it. But, we may need help. Thanks.
- Speaking of insulin, it’s the LAST thing we need when “hypo.”
–>In fact a hypo calls for fast acting sugar. Surprised?
- There is no such thing as a special “diabetic diet.” We can eat the same things as everyone else, and would do well to follow a healthy, balanced diet. Just like you.
- We are not weak, we are awesome even if we have to invest ~2 hrs a day to manage this crap.
- Lacking fact checks and not caring about the quality of life for us with diabetes, just costs – ouch. Happened in NYT a while ago – was countered in an amazing and factual way by Kelly Close and diaTribe, and “one or two” other friends… big ouch.
Here are some facts, and a brief outline, to make life easier for you.
- Blood glucose rises due to things we eat; carbohydrates, protein and fat.
- Insulin lowers blood glucose.
- Diabetes means that the body in some way does not handle insulin like it should.
- Diabetes does not leave. It is chronic.
- Almost 400M people have diabetes, and there are two main types.
–>40M have type 1, where the body attacked itself – fancy name is autoimmune disease.
–>360M have type 2, where the body becomes resistant to insulin. Check out a video on this here!
So, we need to either lower resistance to insulin (type 2), or handle the blood glucose in some other way (type 1 and also later on type 2).
If things go really bad, it’s bye bye feet and such. The usual stuff you read about.
If all goes well, we’ll live longer than you guys – since we mind what we eat and stay active! HA!
One fact is certain: The therapy is annoying, whichever type you have.
Type 1 Therapy
Therapy is a major time drain, and very taxing in the long run.
We prick our fingers to find out what our blood glucose is. Based on that value we shoot insulin to lower our blood glucose or sometimes eat carbs to raise it.
For meals and snacks, we estimate the carbohydrates on the table and based on this estimation we calculate the proper dose of insulin to inject.
If we really want to be dramatic, we say we make life and death decisions 20 times a day – and it’s true. But seriously, it’s not that bad; if…
- we have decent control
- we have access to all the things we need
- we have the right basic education
- and the right mindset
We live – thanks to technology and science – the ultimate quantified lives. But in the mind, that’s where we make our decisions to USE that which we have, and that which we’ve learned.
Type 2 Therapy
Reducing insulin resistance is done using exercise, diet and meds if needed.
In early stages, it can be held off, and meds are not needed.
If the resistance does not drop due to lifestyle changes, meds are needed.
A few pills (and potentially shots) a week are enough as you start out.
At later stages, the body can no longer keep up with insulin production and simply stops. We become insulin dependant – same therapy as type 1, but add some meds.
When we speak about diabetes…
… doing it right is easy. Mind the pointers above, include us who live with diabetes, and ask before publishing. We enjoy being able to help, even if our names are not mentioned – you are most likely helping us!
Have an amazing day!