Diabetes Type II: The Chronic Disease Affecting Glucose Metabolism - Research Paper

Introduction

Diabetes Type II is a chronic disease that affects the body's sugar metabolism. The sugar, in this case, being glucose which is an essential source of energy to the body. The disease is characterized by high blood sugar, body cells' resistance to insulin, and lack of insulin. The condition is also referred to as noninsulin-dependent diabetes mellitus. Insulin is a hormone produced by the pancreas in a special cell known as beta cells. It is required to aid the uptake of glucose by cells where it is stored and then metabolized to produce energy. The liver is the primary organ involved in glucose metabolism, which includes uptake and storage as glycogen or for protein synthesis. In an individual with type II diabetes, the fat, liver, and muscle cells do not respond to insulin, and therefore, glucose is not taken up for metabolism as appropriate. Consequently, it leads to hyperglycemia (build-up of sugar in the blood) and manifests as type II diabetes.

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The hallmark features of diabetes type II are based on the fact that there is too much glucose in the blood, and the body's cells cannot take or utilize glucose. The symptoms that manifest are frequent urination and increased thirst. It is because as more glucose is in the blood, the blood becomes hypertonic and extract more water from tissues that leads to the thirst reflex. Consequently, as one drinks more water, diuresis increases and leads to more urination. Secondly, there is increased hunger because the cells cannot utilize glucose for energy which increases the feeling of hunger. The disease is also manifested as weight loss because of fat breakdown due to low levels of insulin in the body. One may experience fatigue as cells lack glucose, leading to low energy. Blurred vision is also a feature of diabetes type two, which comes about because fluid is drawn up from the lenses of the eyes, which results in swelling of the lens. Lastly, the disease hinders blood circulation and causes nutritional deficits which makes wounds and sores to take longer to heal (Baynes, 2015).

Significance of the Disease

The incidence of diabetes in the United States of America is thirty million people. Ninety to ninety-five per cent of them have diabetes type II. The disease mostly affects the adults over the age of forty- five but has been recently found to affect children, teens and young adults. In 2015, the prevalence of diabetes was in about 9.4% of the Americans (about 30.3 million individuals). The undiagnosed individuals were about 7.2 million and the diagnosed ones about 23.1 million. The majority had Type II diabetes (29.05 million), and 1.25 million had type I diabetes. There are about 1.5 million new cases of diabetes each year. In 2015, about eighty-four million Americans were prediabetic. Diabetes is the seventh leading cause of death in the USA. In 2015, diabetes was listed as a cause of death for approximately eighty thousand deaths. Besides, it contributed to about two hundred and fifty-two thousand deaths.

Trends

Diabetes is more prevalent among the old people who are aged above sixty-five years. Statistically, about twenty-five per cent of the Americans aged above 65 has diabetes. It means that approximately twelve million senior citizens have diagnosed and undiagnosed type II diabetes. In the youths, aged below twenty years, diabetes affects about 0.24% of their population (Zimmet, Alberti, Magliano & Bennett, 2016). It means that about one hundred and ninety-three thousand American youths have diabetes.in 2011-2013, about 5,300 youths were diagnosed with type II diabetes and majority, 17,900 had diabetes type I.

The statistical rates of diagnosed diabetes in adults by race and ethnic background showed that American Indians and Alaskan natives are the most affected with 15.1%. They are followed by Mexican Americans 13.8%, non-Hispanic Blacks 12.7%, Hispanics 12.1%, Puerto Ricans 12.0%, Cubans 9%, Central and South Americans 8.5%, Asian Americans 8.0%, and the least affected being non-Hispanic whites 7.4% (Zimmet, Alberti, Magliano & Bennett, 2016).

Pathophysiology of Diabetes Type II

The real cause of diabetes type II remains unknown although obesity, lack of exercise, and being overweight have been shown to contribute significantly to the development of the disease. In diabetes type II, the patient produces insulin, unlike in diabetes type I. However, the insulin produced is either not enough, or when provided, the body does not respond to it appropriately. Therefore, the body becomes resistant to insulin and glucose metabolism is impaired. The resistance of body cells to respond to insulin leads to the production of more insulin and decline of the beta cells of the pancreas in their function. Finally, the beta cells fail, and there is a complete failure in the production of insulin. Type II diabetes can, therefore, be said to be caused by beta-cell dysfunction due to the resistance of cells to the effects of insulin.

Type II diabetes affects many organs and systems in the body even though initially it seems asymptomatic. It affects the heart, blood vessels, nerves, eyes, and kidneys. Thus, it is essential to control diabetes and blood sugar levels to avoid complications. The acute changes caused by the disease are diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, and hypoglycemia. Diabetic ketoacidosis refers to a complication where the body produces excess ketones in response to glucose deficiency in cells due to lack of enough insulin. The complication is characterized by mouth dryness, thirst, fatigue and breath, which is fruit-scented. The hyperosmolar hyperglycemic nonketotic state is a condition that arises from a very high concentration of glucose in the blood. The state is characterized by dryness of the mouth, hallucinations, one sided-body weakness, confusion and coma. Seizures, coma, and even death may result from dehydration that accompanies diabetes when one does not take enough fluids. Diabetic hypoglycemia is low blood sugar which is below 3.9 millimoles per litre. Hypoglycemia may arise from too much insulin being produced (Flower, Henderson, Rang, & Ritter, 2016).

Chronic disease changes are the long-term pathophysiological effects of diabetes type II. They include microvascular and macrovascular complications. The microvascular complications damage the small vessels and cause retinopathy and cataracts in the eyes, diabetic nephropathy in the kidney, and diabetic neuropathy on the nerves. Macrovascular complications affect the heart, brain, and prominent blood vessels (Baynes, 2015).

Diabetic retinopathy is a condition that affects diabetes patients and causes blindness. The disease is caused by blood vessels in the eyes swelling up and leaking fluid or ordinary new blood vessels developing on the surface of the retina. Initially, the disease is asymptomatic, but over time, the disease leads to gradual vision loss and finally, blindness. The condition has four stages which are a mild non-proliferative stage, moderate non-proliferative stage, severe non-proliferative stage, and finally the proliferative stage. In the soft non-proliferative stage, there is an occurrence of microaneurysms on the blood vessels of the retina. It is followed by blockage of the blood vessels in the moderate stage. In the severe non-proliferative stage, most of the blood vessels are blocked, and the retina is deprived of nutrients which leads to signalling for new blood vessels to form. The final stage is the proliferative stage, where blood vessels have developed on the retina. However, these vessels are delicate and break, leading to leakage of blood which leads to blindness.

Diabetic nephropathy is a disease of the kidneys where high blood sugar leads to kidney damage. In this condition, the nephrons are damaged by high amounts of sugar, and they become leaks proteins in the urine. The disease can progress to chronic kidney disease, and finally, kidney failure. Kidney damage is mostly asymptomatic and requires urine tests to determine. The disease manifests when it has progressed over a long time with symptoms of weight loss, poor appetite, limb oedema, dry, itchy skin, malaise, dysuria, and loss of concentration. The 'leaky' effect of diabetes on the nephrons occurs from scarring of the glomerulus by the sugar in the blood, a condition known as glomerulosclerosis, and from high blood pressure characteristic of diabetic patients.

Diabetic neuropathy refers to nerve damage to diabetic patients. The high blood sugar injures nerves, mostly on the legs and feet. Thus, the significant symptoms of the disease are pain and numbness on the legs and feet. Rarely, the condition also causes problems on the digestive system, urinary tract, blood vessels, and the heart. There are four types of complication which include peripheral neuropathy, autonomic neuropathy, diabetic amyotrophic disease, and mono-neuropathy. Peripheral neuropathy affects the legs, hands, and arms and is characterized by numbness, tingling, cramps, muscle weakness, loss of reflexes, and ulceration of the limbs ((Flower, Henderson, Rang, & Ritter, 2016). Autonomic neuropathy affects the controls of the heart, bladder, gut, sex organs, and vision. It leads to gastro-paresis, urine incontinence or retention, constipation or diarrhoea, and difficulty in swallowing besides, erectile dysfunction. The diabetic amyotrophic disease affects the neurons to the hip, thighs, gluteal region, and legs. It manifests as severe pain on the hip, thighs, and gluteus: Thigh muscle hypotrophy, abdominal distension, and weight loss. Mono-neuropathy is the damage of specific nerves on the face, torso, or limbs. The symptoms mostly resolve by themselves and manifest depending on the nerve involved. Primarily, it manifests as paralysis of the affected muscles (Baynes, 2015).

Macro-vascular effects of diabetes on the body are also chronic effects of the disease and include coronary artery disease, peripheral arterial disease, and stroke. Coronary artery disease and peripheral arterial disease arise from atherosclerosis which is a result of chronic inflammation and injury to the endothelium of these blood vessels. T leads to narrowing of the blood vessels in the whole body, including the heart, brain, and peripheral organs. Low-density lipoproteins tend to accumulate on the injured vessels which may promote the production of angiotensin II to oxidize them. Leucocytes may also be attracted to the site of injury. After a series of events, there is the formation of a lipid-rich lesion which may rapture leading to vascular infarcts in the affected blood vessel.

Besides, there is an increase in the tendency of platelets to aggregate and adhere to the endothelium and an increased rate of coagulation. Diabetes is also a significant risk factor for stroke and cerebrovascular disease. It also develops from injury on cerebral blood vessels which leads to blockade and brain hypoxia. An individual suffering from diabetes is at more than two hundred percent risk of suffering from a stroke. The risk of stroke has increased the mortality rate associated with diabetes considerably.

Risk Factors

The risk factors of diabetes type II include obesity, age, family history or genetic make-up, race, high blood pressure, low levels of high-density lipoproteins, depression, and polycystic ovary syndrome. (Wheelock, Sinha, Knowler, Nelson, Fufaa & Hanson, 2016). Mostly, people who are overweight develop insulin resistance later in life due to the excess sugar in their blood which causes overproduction of insulin. Diabetes type II is mostly age-dependent and affects people above the age of forty-five years. It is because these people rarely exercise and gain a lot of weight as they age. Thirdly, studies have shown t...