Category: Diabetes

Rising Diabetes: Insulin, Glucose, and Global Concerns

Diabetes is a severe illness where there is an insufficient amount of insulin. The body can find it difficult to utilize insulin adequately. The pancreas is the body structure that produces insulin. Islets of Langerhans are cells found in the pancreas, whereas beta cells are cells that are found in islets, which make insulin present. Food that is high in starch and carbohydrates, amongst other nutrients, is later broken down into glucose. This process happens in the stomach, which then glucose is transmitted into the bloodstream. In order for the cells to function well, they need energy. This is exhibited by glucose. The role of insulin is to prompt liver and muscle cells (among other cells) to absorb glucose to be transferred to energy. If the body has a considerable amount of energy, insulin prompts the liver to store glucose as glycogen.

Diabetes is a serious condition if not treated well. According to the World Health Organisation, in April 2016, diabetes was going to be the seventh most consequential cause of death around the world. Nowadays, diabetes is becoming more common. Worldwide, around 347 million of the population are known cases of diabetes. A rise in deaths in the coming future is not surprising. This is because 1.5 million cases were noted in 2012, and according to research, the probability of increasing by 50% is existing. (World Health Organisation, 2016).

There are three types of diabetes:

Type 1 (also known as insulin-dependent diabetes): This is often found in adolescents and youth. When food is absorbed and reached in the stomach, glucose is present and liberated in the bloodstream. Type 1 diabetes experiences a problem. They lack insulin production, and as a result of this, glucose can not get into the cells, and they experience an increment in blood glucose levels (Diabetes UK, 2017).

Type 2: This tends to be developed during the 40’s or older. Similarly, for type 1 diabetes mellitus, the same scenario is repeated where insulin somehow lacks and cannot penetrate the cells. Despite the fact that they are similar, there are cases which differentiate. Fatty deposits cling to the cells, forbidding the glucose from getting in. This is caused by the fact that fat disallows the process to exhibit in its normal manner and not because of a shortage of insulin in the body. Type 2 diabetes is experienced in 85% of the known cases worldwide. Some factors that make this condition more severe are smoking and being obese. This is because, as previously specified, the fat disallows insulin from functioning well.

Type 2 diabetes can be found in anyone who has a good Body Mass Index. If diabetes is mistreated, chronic health issues will be faced, such as blindness- retinopathy, and neuropathy, which can end up with amputations and kidney failure (Diabetes UK,2017). Folks who experience diabetes are more exposed to Cardiovascular diseases such as CVA. The nervous system may also be damaged due to diabetes, and neuropathy can arise. Numbness and lack of feeling in the extremities of our body are the result of diabetes, and ulceration may take place. One should give importance to any cuts that may appear during daily activities, such as nail cutting or walking on bare feet. Cuts and ulcers in diabetics may take longer to heel, which might result in wounds, and if not treated well, amputations may take place.

Gestational diabetes resembles that of type one and type 2, but it is often found during pregnancy. If diabetes is shown at the initial stage of the pregnancy, it might indicate that the mother suffered from diabetes before. This can be medicated with the use of insulin, amongst other treatments. In this type of diabetes, if treatment is given with immediate effect, the condition can be eliminated. Promoting a healthy lifestyle and a good Body Mass Index before, during, and after pregnancy is of utmost importance to eliminate as much as possible diabetes (Nice.org.uk,2016).

Nursing’s Vital Role in Diabetes Care and Education

Health care staff shows compassion and care towards the patients regardless of gender, ethnic race, and religion. The nursing role consists of looking after ill patients, dying patients, and patients with special needs and advocating health advice. (“WHO|Nursing”). The role of a nurse is essential when taking care of diabetes. When the nurse faces people who lack knowledge about healthy lifestyles, the nurse must emphasize the good practices. This has to be linked with the relatives, to work hand in hand with the nurse and cooperate by not giving sugar-based food or junk food, which may not help with his/her condition.

The professionals must not use as many as possible so that the patient can absorb all the said information. If this is not abided by, goals set by the multidisciplinary team will not be achieved (Nursingworld.org.org,2017). The nurse has to undertake BGM. Following this, the nurse has to observe any differences noticed in the patient and document them in order to administer the adequate dose of medication. Prevention of sores is prudent; therefore, information is provided to the patient and relatives. Cushions and adequate padding under the legs is a good prevention.

A particular nursing role is the Tissue Viability Nurse, who has a crucial role in monitoring wounds for fast-paced healing. Foot ulcers are very trivial in patients who are experiencing diabetes. 6% out of the 15% who developed a foot ulcer ended up in the hospital to treat infection and other complications (Apma, 2016). Patients who have stage I ulcers should be treated immediately to eliminate escalating tissue damage and promote healing. Stage I foot ulcer is classified as a superficial ulcer, where wadding and cushioning are used to ease pressure and off-load the leg (Doupis & Veves, 2008).

Poor circulation, irritation, diabetic neuropathy, trauma, and pressure on the foot for long hours cause diabetic foot ulcers to form. A podiatrist’s advice is vital to recommend footwear. Footsteps are monitored by the podiatrist during follow-ups to see the patient’s process and not developing new ulcers (Nice.org.uk, 2015).

Collaborative Care: Diet, Exercise, and Physiotherapy in Diabetes Management

Promoting a healthy and accustomed diet for the patient is the role of the dietitian. The reason behind this is to keep blood glucose levels in the blood under control, together with cholesterol levels and blood pressure. A dietician is a paramount source because he aids patients with customized diet plans to minimize the risk of stroke and heart disease. The recommended food has reduced fats, salts, and sugars (Diabetes: Healthy Eating with Diabetes, 2009).

As much as possible, the nurse collaborates with the dietician to support the patient to keep his intake of biscuits and sweets as low as possible. These can be altered with fat-free and sugar-free biscuits. This way, the patient is balanced; he is pleased with biscuits, but at least fats and sugar are minimized. Sugary drinks such as soft drinks should be eliminated as blood glucose levels would increase. Two liters of water are recommended to eliminate dehydration (Bda.uk.com, 2013).

PhysiotherapyPhysiotherapy is part and parcel of the multidisciplinary team as they have to work hand in hand to achieve the goals set. Physios aid patients in enhancing their conditions by suggesting and recommending different exercises according to the condition of the patient. They analyze the improvements and appraise every little advancement to encourage independence and give hope. Physiotherapists and Pedologists are to work hand in hand for recommendations of best care, especially when mentioning foot care. A case in point is when analyzing the mobility of an individual to prevent any bed sores from forming and assessing the patient for the right posture of walking (Nhs. uk, 2017).

Nurturing Patient Awareness: Education and Challenges in Diabetes Care

Having a look at the journey of care, one can see a variety of cases. People who are not residing in long-term facility care and are diagnosed with diabetes may not be aware that they are not eating the right food with adequate amounts, which may include fat, sugar, and salt intake. They may also miss the treatment as they forget or see it as a cost, and they don’t even dare to buy it or take it when they feel up to it. Part of the role of the multidisciplinary team is to educate the patient and enhance his knowledge for better self-care. The main focus in all these scenarios is always the patient; therefore, promoting a healthy lifestyle is necessary for the good of the patient.

Education is the key to patient awareness; therefore, without it, the patient lacks self-care, healthy nutrition intake, and treatment and may mislead the planned goal. With knowledge, the patient can also be more independent, excluding that Dementia or similar conditions are not present in this case. With all of this, the nurse can promote a better way of living, and the patient looks at life in a more interesting manner. An obstacle that a nurse may face is when patients are not willing to cooperate and neglect instructions that are made clear.

These patients need watching constantly and also need a lot of support from their relatives (Nice.org.uk, 2015). When meeting the patient, it is of utmost importance that the nurse conduct eye contact with the patient. If this is not abided by, the patient may lack concentration, and the nurse will show a lack of interest. Speaking rapidly may also make the patient feel lost. When reaching a certain old age, the senses may start to deteriorate, such as poor eyesight and poor hearing; therefore, speaking adequately, calmly, and repeating when necessary is prudent to ensure that the message is conveyed.

Fostering Trust and Education: Effective Communication in Diabetes Care

Empathizing with the patient and treating him/her with dignity may make the patient acquire trust in the nurse, rather than unnecessary shouting and being hard. Explaining to the patient without using a lot of jargon makes the patient comfortable to understand his case. For example, Notifying the patient that he/she is suffering from hyperglycemia is useless if the patient does not know what the term hyperglycemia means. Rather than that, the nurse could say the patient is suffering from high blood sugar in the blood. In this way, the nurse is speaking in a way that she is assuring herself/himself that the patient is getting the message. Keeping distractions to the minimum is another advantage to help the patient get the message (Fischbach, 2010).

Informative leaflets can be given to the patients and their family members to help them gain more knowledge about the condition. When patients are in long-term care or residential homes, the nurses and healthcare team are responsible for taking blood glucose frequently. Also, giving out treatment and delivering good care will show up by stabilizing the blood glucose, for instance, by administering treatment regularly at the proper time and proper dosage and eating food to enhance the situation. This stability will show progress and minimize the risk of developing other health conditions.

Groups and organizations associated with diabetes are available. These contribute to awareness and conduct programs to help people overcome diabetes. These entities also provide a good source of education, where anyone concerned may utilize this knowledge to handle his/her condition better. The World Health Organization organizes an agenda for the scope of increasing information about minimizing the risk of diabetes and supplying people with information on how to adhere to healthy habits. Who also publish statistics about anyone experiencing diabetes. WHO also remarks a lot on healthy eating to make people more aware of how to live healthily and achieve a good Body Mass Index. This also includes exercising daily because being in a healthy state may be key to keeping chronic illnesses away, such as diabetes and being overweight (Who. int, 2009).

Collaborative groups like the Malta Diabetes Association give their helping hand by visiting patients, educating them and their family members, and clearing any uncertainties that they might have. The Pursuit helps by giving out concrete and practical advice. During educational sessions, leaflets are distributed to make it easy for the patient to remember and understand what it is all about. Newsletters and magazines are issued often in order to keep patients informed regarding diabetes. (Maltese Diabetes Association,2017) A good informative program about diabetes is X-PERT. These include changes in food intake, healthy snacks, and daily fitness sessions. The meetings are two and a half hours over a period of six weeks. (X-PERT Diabetes 2016).

Conclusion

When treating patients with diabetes, the multidisciplinary team is essential for the care of the patients to enhance their way of living. The multidisciplinary team does not focus on oneself or independently, but on the contrary, they work as a team to achieve the desired goal for the good sake of the patient. The focus of the multidisciplinary team is always on the patient; therefore, they must work hand in hand because if not, the patient is the one who will have a bad experience. The multidisciplinary team must make use of continual professional development in order to keep updated with new procedures, techniques, and new evolutions because medical health evolves rapidly, and with the education acquired, one can help the patient fruitfully.

In this assignment, the significance of including patient education as part of the care was emphasized. This can be achieved with the help of groups, which we specified earlier, and with the involvement of the multidisciplinary team. It is imperative that the education provided should be well elucidated and implicated by the family members. As data is showing, which is quoted earlier on, diabetes is getting more common nowadays, but longevity is getting longer, too. To be able to reduce the number of diabetes sufferers, one must understand and get educated, and that’s where the role of health promotion kicks in.

Leaflets, magazines, billboards, and health promotion advertisements on television are crucial. This will contribute to making society more intelligent and reduce the number of new cases of diabetes. We, as a society, have to contribute in order to reduce the risk of ill suffering and obviously cure. Diabetic patients may be more susceptible to experiencing depression. When this happens, the multidisciplinary team must target to tackle it as well, with care and empathy, and above all, with lots of support. If the mentioned measures are adhered to, people with diabetes will face an easier life, which involves support, a healthy lifestyle, exercising, reading of BGM on a regular basis, and treatment as required.

Appendix:

Mr. X’s condition was identified six years ago and resulted in type 2 diabetes. He is a 70-year-old gentleman who has been residing in the elderly residence for four years. He used to live with his child, who was unable to handle his bad tendencies of food, and despite healthy food being provided, he still entertains himself with food that is rich in fats and sugars. An episode of dehydration occurred, and his daughter brought him to casualty while she was alerted that her father was urinating often and haematuria was present. Mr.X was disoriented. A urinalysis and CBC, amongst other tests, were taken on admission, and it resulted that he was suffering from diabetes.

While he was in hospital, BGM was recorded regularly and resulted in type 2 diabetes. Gliclazide was administered at the dose of 80mg daily, Metformin was administered at 500 mg twice daily, and fixed doses of Insulatard. These were the treatments required to treat his condition, that is, diabetes type 2. Both patient and relative agreed that Mr.X should be sent to a long-term care facility for more professional care. On discharge, the patient was sent to St. Vincent De Paul because his daughter could not take care of him, where he could be provided with the necessary treatment and care daily. This was to safeguard Mr. X because he also had traces of Dementia and could risk an overdose leading to hypoglycemia or miss his treatment if left independently.

Mr.X is now living in Saint Vincent De Paul and is a semi-dependent patient. BGM tests are still being monitored daily. He is still being treated with metformin gliclazide and insulin, according to his BGM. Lately, he was diagnosed with a pressure sore stage 1 in his left heel. As advised by TVN, he is to be ambulated regularly, avoid long stays in bed, and observe the sore to heal to prevent further complications.

References:

1. World Health Organisation. (2016). Global Report on Diabetes. Retrieved from https://www.who.int/diabetes/global-report/en/
2. Diabetes UK. (2017). Diabetes – The Basics. Retrieved from https://www.diabetes.org.uk/resources-s3/2017-11/diabetes_the_basics_2017.pdf
3. Nice.org.uk. (2016). Diabetes in Pregnancy: Management from Preconception to the Postnatal Period. Retrieved from https://www.nice.org.uk/guidance/ng3
4. WHO. (n.d.). Nursing and Midwifery. Retrieved from https://www.who.int/news-room/q-a-detail/nursing-and-midwifery
5. Nursingworld.org.org. (2017). The Role of Nurses in Diabetes Care. Retrieved from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-role-of-nurses-in-diabetes-care/
6. Apma. (2016). Foot Complications. Retrieved from https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=981
7. Doupis, J., & Veves, A. (2008). Classification, Diagnosis, and Treatment of Diabetic Foot Ulcers. Wounds, 20(5), 117-126.
8. X-PERT Diabetes. (2016). About X-PERT. Retrieved from http://www.xpertdiabetes.com/about-x-pert
9. Diabetes: Healthy Eating with Diabetes. (2009). British Dietetic Association. Retrieved from https://www.bda.uk.com/resource/diabetes-healthy-eating.html
10. Bda.uk.com. (2013). Diabetes. Retrieved from https://www.bda.uk.com/resource/diabetes.html
11. Nhs. uk. (2017). Physiotherapy. Retrieved from https://www.nhs.uk/conditions/physiotherapy/
12. Fischbach, F. T. (2010). A Manual of Laboratory and Diagnostic Tests (8th ed.). Lippincott Williams & Wilkins.
13. Who.int. (2009). Promoting a Healthy Diet for the WHO European Region. Retrieved from https://www.euro.who.int/__data/assets/pdf_file/0017/146721/E93736.pdf
14. Maltese Diabetes Association. (2017). About Us. Retrieved from http://www.diabetesmalta.org/about-us/

Glucose, Insulin, and Complex Health Implications

Imagine a disease that is spread throughout one-tenth of all Americans and one-fourth of them do not even realize that they are infected; a disease that is ranked in the top ten in death causation in the United States; and a disease that places most noninfected people at risk. This disease is alive and well and goes by the name of diabetes. Diabetes is defined as a disease in which one’s blood glucose (blood sugar) levels are too high to be considered healthy. Glucose is an imperative element of everyone’s internal, organic makeup. For this reason, the term “diabetes” has been around for ages, yet the disease has been present for all of human history.

Furthermore, as technology has developed and research has become more abundant, the disease has grown more complex. Various types and stages of the disease that have been established cause treatments to diversify on a patient-to-patient basis. Even with the improvement of treatment options, diabetes is still taking lives at a high rate; some would even say that it is an epidemic. As previously stated, one in ten people (Americans) are diagnosed with diabetes; however, many more are affected by the disease in some way or fashion.

Glucose, derived from the Greek word for “to pass through,” is the most familiar type of sugar to humans, attributed to the fact that it originates from the food that humans eat. This sugar, once in the bloodstream, is used for energy throughout the day. In terms, glucose is positive in every way for human function, yet not having the right amount of glucose in the bloodstream can be detrimental. If one’s glucose levels are too low, he/she will be lethargic and will lack the energy needed to perform daily tasks, but if his/her glucose levels are too high, potentially fatal, internal issues will begin to occur. When one has high glucose levels, nerve, kidney, and even eye damage are all possibilities.

High glucose levels (over time) can also lead to other serious bodily malfunctions such as heart disease and stroke. Those who have not been diagnosed with diabetes should worry not because of a natural hormone called insulin. Insulin is a natural mode of transportation that moves glucose from the bloodstream into cells. There, glucose will either be used for energy (ATP) or sent into cell storage. This is precisely where those with diabetes are lacking. Diabetes is an indicator that someone is lacking an appropriate amount of insulin to transport the amount of glucose that he/she is taking, or he/she could have insulin that does not respond as it should when in the bloodstream. This is an issue that has been around as long as glucose itself.

Historical Origins, Evolving Treatments, and Personal Struggles

The full name for diabetes is diabetes mellitus. The term originates from a combination of the Greek word “diabetes” (to pass through) and the Latin word “mellitus” (which means honey). This is important because it was first used by Apollonius of Memphis around 2269 years ago (250 BC) – it was not used in English text until 1425. This disease has been speculated to have been around since humans had originated. However, it was not fully discovered until the findings of Liverpoolian physician Matthew Dobson. In 1776, Dobson confirmed that the urine of people with diabetes had a sweet taste because of remnants of excess sugar. He learned of this phenomenon when he noticed a brown sugar-like substance in their urine. Dobson’s discoveries led to the ability to diagnose and treat diabetes.

Treating diabetes is a very difficult task. If the diagnostics show that the disease is not very serious, some can treat diabetes by making healthier life decisions. This points to lighter and more nutritious food options and being more physically active than previously before. For many, that is a tough transition to make. When one makes the same constant decisions to eat unproductively or has a job that does not require physical activity by an individual (including unemployment), it can be tough to change his/her ways if there is no positive reinforcement backing his/her decisions.

However, those people are lucky because if the disease worsens, treatment becomes a little more difficult. Most people need better dieting and exercise, but they also need medication along with it. These medicines may come in the form of pills to control the disease itself or can come in the form of injection needles (which are used to inject insulin into a diabetic bloodstream. Even if a patient does not need the insulin shots regularly, they are still necessary during occasional checkups.

Living with type 1 diabetes is very difficult for the family of the patient, and especially the one with the disease him/herself. The routine is rigorous: check one’s blood sugar and diet, take medication, have a plethora of doctor checkups and appointments, and do it all over again. I’ve learned this by watching the struggle of my grandfather. He is the most stubborn but prideful man I know on this planet. He is sixty-six years old and has been diabetic for over 20 years. In July 2013, because of damage done to his nervous system, he had a stroke (nearly paralyzing him on his entire left side).

Coping with the Consequences of Diabetes

My family was distraught, seeing that he was the matriarch of my family. Consequently, he has never been the same since before his stroke. He used to be a hard-working man (physically). He was active in every way: whenever things needed to be fixed, he was there, and whenever his grandkids (including myself) wanted to play, he was available. Now, he can no longer participate in those activities, and as a matter of fact, he cannot complete much simpler activities. His driving, eating, and even walking were all heavily impaired by the event of 2013. He often explains that the constant pain in his body due to his stroke is enough to make him shed tears every single day.

Also, he rarely has the pleasure of enjoying the time that he is relaxed because of the half dozen pills he takes three times throughout the day, the burden of having to check his blood sugar four times a day, and the (what I would call) God-awful sugar-free diet that he has been placed on. Furthermore, due to my grandfather’s stubbornness, my mother, aunt, uncle, and grandmother all feel as though they must act as caregivers. They always make sure that he is eating right and taking his medicine. They police his activity and are constantly declining his everyday wants and want-to-dos. None of my family truly enjoys having to be so authoritative towards him, and he especially does not take fondly to it. Nevertheless, he is just one person, out of millions, with the disease. He even has the most common type of the disease. Many Americans are in a much smaller boat than himself.

There are three main types of diabetes, along with another minor form. The first type of diabetes is type 1 diabetes. Type 1 diabetes, formally known as juvenile-onset diabetes, is usually the result of the human body’s defense system attacking and breaking down cells that produce insulin. Doctors are not yet clear as to why this attack occurs. Unfortunately, this disease usually occurs in infants and young children because it is more of a defect than an acquired disease. Those with type 1 diabetes need insulin injections every day, or the disease becomes fatal. The next type of diabetes is type 2. Type 2 diabetes sounds a bit more pleasant, but that is simply an illusion.

Type 2 diabetes, formally known as adult-onset diabetes, is the most common type of diabetes (accounting for at least ninety percent of all cases of the disease). The disease often has to do with a body’s resistance to insulin. Oftentimes, obesity is the cause of this disease, thus unpredictable, and can be diagnosed at any point in someone’s lifetime. This type of diabetes can often be managed by a change of diet and exercise. The third type of this disease is often referred to as Gestational diabetes. Many would think that not a large sum of individuals acquire this type of diabetes because it is specific to women in pregnancy; however, one in every four pregnant women worldwide contract the disease.

Confronting Diabetes through Personal Experiences

Complications to both the mother and the child will most likely occur. The positive in this form of diabetes is that it disappears after pregnancy ends, but both the mother and the child are more likely to attain type 2 diabetes over their lifetimes. There also exists an early stage of diabetes called prediabetes. Prediabetes is not a disease, yet it is an indication that you are on the path. To have prediabetes, your blood glucose level must be much higher than what it should be but not yet in the diabetes range. With all of these types of diabetes in mind, the average person should consider getting their blood tested more often than usual. It cannot hurt, but it would be nice to know where you are on the diabetes spectrum.

Seeing my story about my grandfather should be enough to deter anyone from an unhealthy lifestyle; however, maybe it would be more effective to see the stories of other real people. The first story highlights the battle of sixty-five-year-old Florence “Flori” Schikker. She had ten grandchildren and, for that reason, denied that she might have had diabetes for over twenty-seven years. She did not take the disease seriously until her toe was amputated. Here is a real quote along with further explanation of the situation as a whole: “Doctors told me the only way to survive this fight was to amputate my leg,” Schikker says.

She acknowledges that she has lived an unhealthy lifestyle for many years. Working in a bank, she did very little exercise, ate fast food, and drank Coke on a regular basis.

“If the doctor tells you you’re a diabetic, don’t ignore it. Don’t get to where I am. The sooner you accept things, the better it is for your health.”

Only after her toe was amputated did she realize the seriousness of diabetes and how her lifestyle was a major contributing factor to her situation. She knew very well that both her mother and brother had type 2 diabetes. And four years earlier, Peralta’s doctor had already told her that she had prediabetes. That meant that her blood sugar levels were higher than they should have been but not yet high enough to constitute diabetes.

Overcoming Diabetes Challenges through Determination

Another story highlights a woman by the name of Elizabeth Peralta from the Bronx. She was diagnosed with type 2 diabetes in July 2014 at the age of 53. She was knowledgeable that diabetes ran in her family, including her mother and brother (not to mention that four years before her incident, she was diagnosed with prediabetes).

At her annual checkups, Peralta’s doctor warned her about her growing risk given her family history of diabetes — a significant risk factor for developing the condition, according — and the fact that she gained considerable weight over the years. Peralta’s weight kept rising, which peaked at 240 pounds. Then, one day in July 2014, she lost sensation in her feet. She went on to say, “My legs were killing me, and I was feeling funny, so I went to see my doctor,” she says. Her doctor did a test to see her three-month blood sugar average and was alarmed when it was over ten.

“My doctor told me it was a miracle I was walking around because my sugar was so high,” Peralta recalls.

Soon afterward, Peralta made a vow to change her ways and become healthy once again. She worked with Maria E. Rodriguez, who is a program manager at The Diabetes Alliance at Mount Sinai. With Rodriguez’s aid, Peralta was able to make a complete one-eighty in her life. She dieted for years, along with an exponential growth in workout routines. Because she stayed disciplined, Peralta is no longer in need of medication to keep her blood sugar within a normal range.

Diabetes is a disease that everyone has heard of, yet nobody truly knows the significance of what it actually is or its effects on those diagnosed and family members.

A Hypothetical Journey into the Reality of Diabetes

For that reason, here is something that will make it a bit more relatable: a hypothetical. Imagine if you were living the life of an average American. You worked a nine-to-five, had children and a wife, and ate as you pleased. You feel as though you are having internal bodily issues; however, you think nothing of it. On an annual checkup at the doctor’s office, you learn that your blood sugar level is far too high and you have been diagnosed with diabetes. You think very little of it until your life completely changes. Every morning, when you wake up, your routine is altered. Before showering, brushing your teeth, and eating breakfast, you must take your blood sugar and take three to four pills.

Then, when you finally do sit down for breakfast, you must eat very specific meals that do not involve an excess of sugar. As you go about your day, you will have to repeat the routine of blood sugar checks and medication twice more. Also, snacks are no longer an option. At some point in your day (tired from the mental stress of work), you must find time to exercise. When your kids ask to play, the activity must be limited due to your body’s inability to produce ATP at a high rate. One day after following this diabetic routine, you feel an ache in your chest. You fall to the floor, unknowledgeable about the near future. You are rushed to the hospital and have been informed that you had a heart attack; luckily, you pull through. Nevertheless, your routine is now altered once again.

Along with the pills you have been taking, you now need to incorporate insulin shots into your day. You need to visit your doctor on a weekly basis and have been limited to little or no physical activity during the day. This means that you will never be able to be taken off of medication and can no longer do fun activities with your family. To top it all off, a couple of mistakes in your diet can now prove fatal. This is a life that no one wants to live, but it is a harsh reality for many. This should show those who are healthy how important a healthy lifestyle is. And if one is diagnosed with diabetes, it should be taken seriously immediately.

Recognizing Signs, Seeking Testing, and Preventing Loss

Diabetes is a disease in which one’s blood glucose (blood sugar) levels are too high to be considered healthy. Millions of Americans and others worldwide are affected. I myself have witnessed it, and it is certainly life-altering. Although there is no cure, living an exemplary physical lifestyle can reverse some effects. If one knows that he/she has been underperforming in the category, then searching for the signs is imperative. The symptoms are mild yet still noticeable. Hunger and fatigue is the number one indicator that one has diabetes. If constant tiredness and an unhealthy urge of hunger is always present, the disease could be present.

Urinating too frequently and a sudden sense of thirst are also noticeable differences those with diabetes can pose. Dry mouth, itchy skin, and blurred vision are also strong indicators of diabetes. If one experiences these symptoms, he/she should get tested immediately. The test either consists of Hemoglobin A1c testing or Oral Glucose Tolerance testing. The Hemoglobin A1c test is simple: one gets his/her blood drawn, and professionals check for the average level of blood sugar over an extended amount of time by looking at the hemoglobin (the protein found in red blood cells).

The Oral Glucose Tolerance test is less common, but it involves getting blood drawn once (then the patient will drink a mixture of glucose dissolved in water) and getting blood drawn again two hours later. The doctors try to analyze how effectively insulin works within a patient’s bloodstream throughout the test. These tests are very simple and take very little time. Advocation for these tests should sharply rise as more information is released about the disease itself; it also should be stated how important it is for those who receive positive results to consult with his/her doctor on what changes can and should be made. This way, fewer people, year in and year out are taken from their families and loved ones.

References:

1. Centers for Disease Control and Prevention (CDC). (2021). Diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/index.html
2. American Diabetes Association. (2021). Types of Diabetes. Retrieved from https://www.diabetes.org/diabetes/type-1
3. American Diabetes Association. (2021). Type 2 Diabetes. Retrieved from https://www.diabetes.org/diabetes/type-2
4. American Diabetes Association. (2021). Gestational Diabetes. Retrieved from https://www.diabetes.org/diabetes/gestational-diabetes
5. American Diabetes Association. (2021). Complications. Retrieved from https://www.diabetes.org/diabetes/complications
6. Bailey, E. (2015). After toe amputation, a wake-up call about diabetes. CNN. Retrieved from https://www.cnn.com/2015/05/06/health/diabetes-toe-amputation/index.html
7. Landau, E. (2015). How one woman’s diabetes turned into a message of hope. CNN. Retrieved from https://www.cnn.com/2015/04/16/health/diabetes-weight-loss-es/index.html
8. Mayo Clinic. (2021). Diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451

Unraveling the Glucose Absorption Puzzle

How much is a diabetes diagnosis subject to genetics, and how much is it on account of lifestyle? In order to figure this out, it has to be established how much of it truly is genetic. This is also efficient because people’s lifestyles are difficult to monitor in comparison to their genetics. Diabetes is a genetically passed down condition that becomes apparent in different stages of a carrier’s life depending on the variation or type. It is a very serious condition, and without knowing its genetic properties, it may be harder for an individual to assess their probability of having it. Diabetes, when studied as a genetic condition, therefore, is much more informative than an alternative.

Diabetes is a hereditary condition, which can be implied by its strong dependence on varying genetics. Diabetes is essentially a condition that turns the human body’s blood into a built-up central for sugars that have entered the body. See, how a normal body takes in energy is fairly straightforward. When someone consumes a food source with glucose in it, which is just about everything, it is dissolved and digested. During the digestion process, the pancreas sends the glucose and insulin outward into the body through the bloodstream. Cells in the body are signaled to open their membrane and allow glucose to be absorbed by the insulin in the blood. The insulin flows into receptors on a cell’s membrane that will open up paths for the glucose.

The variations of diabetes, type one or type two, are based on the irregularities in this process. Type one diabetes is when the insulin being produced is either very minute in quantity or not functioning, meaning when it falls into receptor sites, the cell does not recognize it and does not open up its wall. Type two diabetes is when there are no receptors for the insulin being made in particular. Both types essentially result in a lack of absorption of glucose in the body and a build-up in their bloodstream. This is because carbohydrates rely on insulin and have no other way of being processed out of the bloodstream. The result is not only an unhealthy bloodstream but also a malnourished body that will take it out on itself if not treated correctly (Gerstein, 2013).

Exploring Diabetes Inheritance and CTLA-4 Relevance

There are many effects of the condition. The sugary bloodstream will eventually begin to slowly kill proteins in the body, which several organs and even tissues need to function correctly. Other parts of the body, like the cornea of a person’s eye, kidney, heart, or nerves, can be threatened by the body’s complications (Gerstein, 2013).

Type 1 diabetes is the most commonly associated with hereditary passage. Speculations of this stem from the fact that most type one diagnoses begin in children or a young age population group when type two, in comparison, usually shows up after the age of thirty, suggesting more of a lifestyle factor being at hand (Gerstein, 2013).

It is believed that diabetes is largely passed on by an autosomal chromosome 2q33 with a deficient strain of CTLA-4. CTLA-4 is a type of protein receptor that is usually associated with conditions that have dominant autosomal characteristics, but diabetes, on the other hand, is not necessarily dominant or recessive (Nistico, 1996). Type one diabetes is considered almost mysterious because its association with CTLA-4, or 2q33, isn’t quite a consistent phenomenon because type one is polygenic.

This essentially means that there are a variety of genes that can contribute to the conclusive overall condition of diabetes. Having so many genes involved means that it can be recessive, dominant, or a combination (Nistico, 1996) (Nieuwenhuijze, Liston, 2015). CTLA-4 was initially thought to be associated with a type of diabetes because it is one encoder for t-cell receptors, and being that diabetes is an autoimmune disease, t-cells are essential to its effects (Nistico, 1996).

Genetic Factors, Transmission Patterns, and Diversity in Diabetes Diagnosis

Definitive research does not exist to show certain likelihoods as to whether a father or a mother is more genetically responsible. This is difficult to prove, of course, because of the variating recessive and dominant genes that make up a diabetes diagnosis. However, there are more cases of diabetes in young children whose fathers are carriers of the condition, but the exact reasoning is not proven (Osborn, 2013). Transmission may not be realized in the case of type two, being that it is normally dormant until brought to fruition from lifestyle (Gerstein, 2013).

Linkage is one of the concepts developed after Mendel developed his initial basis of genetics. Given that diabetes is an example of linkage, this would make it post-mendelian. Approximately 73% percent of type one diabetes is shown to be subject to allele transferring or sharing of ASP pairs shown in a study with siblings (Risch, 2000).

It is often misunderstood among the populace that someone necessarily must be overweight to be diagnosed with diabetes. Diabetes can be an apparent condition in anyone with a hereditary pool. According to the American Diabetes Association, as of 2015, over 9.4% of the population in the U.S. alone was diagnosed with diabetes of one form or another, and 1.5 million every year. They say that the top four ethnicities that make up the diagnosed population are currently Asian Americans (8%), Hispanics (12.1%), African Americans (12.7%), and the combined group of American Indians as well as Alaskan natives (15.1%). Since diabetes is polygenic, it’s difficult to say exactly what the cause of these concentrations is.

Adaptive Nature of Diabetes Types and Management Challenges

The more adaptive type of diabetes is type two diabetes because it tends to stay dormant until someone develops obesity or a generally unhealthy lifestyle. This means that it tends to arise or be more likely to arise if the body is taking in and storing an overwhelming amount of carbohydrates or glucose, to begin with. Both types can prove the body somewhat adaptive because the side effects are just the body trying to accommodate it. For example, when the body isn’t getting enough from its intake, it begins to feed off of what’s stored in the body, resulting in weight loss (Gerstein, 2013).

Unfortunately, the condition’s unpredictability caused by its polygenetic causes and multi-effect results make it not only difficult to diagnose but incurable as well. However, an individual can combat many of the symptoms by self-injecting insulin shots on a daily basis (Gerstein, 2013).For these reasons, it can be concluded that, yes, diabetes is largely on account of genetics, but in a lot of cases, mainly type two, lifestyle has to be taken into account.

References:

1. Gerstein, H. C. (2013). Diabetes: Chronic Complications (3rd ed.). John Wiley & Sons.
2. Nistico, L. (1996). CTLA-4 in autoimmune diseases. Annals of the New York Academy of Sciences, 778, 325-332.
3. Nieuwenhuijze, A., & Liston, A. (2015). The multifaceted role of the thymus in tolerance. Immunology and Cell Biology, 93(9), 787-793.
4. Osborn, C. Y. (2013). Inherited diabetes: Betrayal of the pancreas. Journal of Diabetes & Metabolism, 4(6), 279.
5. Risch, N. (2000). Linkage strategies for genetically complex traits: I. Multilocus models. American Journal of Human Genetics, 66(6), 1773-1784.
6. American Diabetes Association. (2015). National Diabetes Statistics Report, 2014. Diabetes Care, 38(Supplement 1), S1-S93.

Diverse Risks: Diabetes and its Complications

People with diabetes are more prone to develop a wide variety of serious health problems. Consistently high blood pressure levels lead to serious diseases that mainly affect the heart and blood vessels, eyes, kidneys, nerves, and teeth. In addition, people with diabetes may also have a higher chance of developing infections.

Nowadays, diabetes is a leading cause of cardiovascular diseases, blindness, kidney failure, and lower limb computation. So, by maintaining blood glucose levels, blood pressure, and cholesterol, diabetes complications can be prevented or delayed. Therefore, people with diabetes need regular monitoring.

Major complications of diabetes are as follows:

I. Cardiovascular diseases- They affect both the heart and blood vessels and usually cause fatal complications such as coronary artery disease and heart stroke. Cardiovascular is the most common disease that leads to death in people with diabetes. High blood pressure, high blood glucose levels, high cholesterol, and other risk factors lead to an increase in cardiovascular complications.

II. Kidney disease- It occurs by damaging the blood vessels in the kidneys, which leads to kidney failure. Kidney disease is very common in people with diabetes. So, maintaining normal levels of blood glucose and blood pressure can reduce the risk of kidney disease.

III. Nerve disease- When blood pressure and blood glucose levels are too high, diabetes causes damage to the nerves throughout the body. This leads to indigestion, erectile dysfunction, and other problems. The most commonly affected areas are the extremities, especially in the feet. Nerve damage in these areas is known as peripheral neuropathy, which causes pain, tingling, and loss of feeling. So, people with diabetes should regularly examine their feet.

IV. Eye disease- People with diabetes mostly develop eye diseases like a reduction in vision and blindness. It develops because of high blood pressure, high blood glucose levels, and high cholesterol. It can be managed by regularly checking the eyes and by not taking high levels of glucose and lipids.

V. Pregnancy complication- Women who develop diabetes during pregnancy have a high risk of complications if they don’t carefully monitor and manage their conditions. Women with type 1 and type 2 diabetes should achieve targeted glucose levels before conceiving to prevent possible organ damage to the fetus.

High blood glucose during pregnancy can lead to excess weight put on the fetus. This causes problems during delivery, trauma to the child and mother, and a sudden decrease in blood glucose for the infant after birth. Children who are exposed for a longer time to high blood glucose in the womb may develop diabetes in the future.

VI. Oral complication- If blood glucose is not properly managed by people having diabetes, then they may cause inflammation of the gums (periodontitis). Periodontitis is a major cause of tooth loss, and it also has a high risk of cardiovascular disease. Regular oral check-ups should be done to ensure early diagnosis.

References:

1. American Diabetes Association. (2021). Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2021. Diabetes Care, 44(Supplement 1), S125-S150.
2. Thomas, M. C., & Cooper, M. E. (2006). Zinman B. Cardiovascular disease in diabetes: how does diabetes management change with cardiovascular disease?. Diabetes, Obesity and Metabolism, 8(3), 161-170.
3. Tuttle, K. R., Bakris, G. L., Bilous, R. W., Chiang, J. L., de Boer, I. H., Goldstein-Fuchs, J., … & Molitch, M. E. (2014). Diabetic kidney disease: a report from an ADA Consensus Conference. American Journal of Kidney Diseases, 64(4), 510-533.
4. Vinik, A. I., & Ziegler, D. (2007). Diabetic cardiovascular autonomic neuropathy. Circulation, 115(3), 387-397.
5. Scanlon, P. H. (2003). The English national screening programme for sight-threatening diabetic retinopathy. Journal of Medical Screening, 10(1), 16-18.
6. American Diabetes Association. (2020). Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement 1), S183-S192.
7. Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., … & Hamman, R. F. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA, 311(17), 1778-1786.
8. Löe, H., Theilade, E., & Jensen, S. B. (1965). Experimental Gingivitis in Man. Journal of Periodontology, 36(3), 177-187.

Diabetes is a chronic condition/disease that people can get that will change their lives forever in good and bad ways. Diabetes affects the body by the pancreas either producing the hormone insulin too much (type 2) or by it failing and requiring manual injections of it or the insulin pump to be set to do certain things and does certain amounts of insulin (type 1). Over time the treatment of diabetes has changed, specifically type 1 diabetes, starting from insulin pumps to Continues Glucose Monitor (CGM). Although problems arise with the technology and the disease itself from hyperglycemia and hypoglycemia, highs and lows.

Diabetes is a life changer for that suffer from it and those who live with people that have it. The condition targets the pancreas and eats away at the hormonal cells that produce the hormone ‘insulin’. This hormone is vital for the functioning body as it counters the sugars in food that you eat. Without it your blood glucose level (BGL) would shoot through the roof creating hyperglycemia and if high for an extended period of time, it would develop ketones. Symptoms that show that you are getting diabetes include massive weight loss, lots of drinking water, and urinating lots. If symptoms are visible it is recommended by professionals to see your doctor. If left for too long, the ketones will begin eating at vital organs such as the liver and kidneys. This will then lead to you going into a coma from the ketones. This stage is very difficult to go through and will sometimes end up in death. This is just the beginning. This condition changes the daily life of an average person into manual injections and finger pricks to extract blood into a machine. This is a daily process unless you have an insulin pump and CGM. The body will function as normal but when it comes to eating food, an injection will be required for the sugar and carbohydrates in the food. The only thing that differs from the normal body that is healthy, is that the pancreas will not dose the insulin required for the sugar. The only systems affected by this disease are the digestive system and the circulatory system. Other systems such as the nervous system are safe. This is because the pancreas is important for the digestive system by countering the food the is in the stomach. It affects the circulatory system by carrying the energy into the bloodstream to different parts of the body. The insulin acts as a guide and as a way to counter the extra energy that has no point in being in the system. Most of the time the energy will be sent to an area of the body for reasons that have been explained. The insulin prevents hyperglycemia from occurring, too much sugar, and the sugar prevents hypoglycemia from happening, too much insulin, both of which can end in extremely bad situations.

Modern treatment for diabetes includes manual injections with finger pricking, or an insulin pump with a CGM, or these methods with different ones, CGM and injections, and vice versa. The manual injections require blood glucose levels to see where the level is standing. Once the level is recorded and written down, a card showing dosage units depending on the amount insulin units per 15 grams of carb. For example, it is possible to have .75 units per 15 grams or the simple standard dosage amount of 1 unit for every 15 grams. The dosing card includes the correction factor that is dependant on the level. If the level is in between a recommended range of 4.0-7.0 there is no correction. Anything above these levels will require a correction. The CGM requires Bluetooth from phones to show the level. The pump only requires grams of carb for the dose. With a BGL, the pump will automatically correct with the correct dosing. The body systems aren’t affected by these modern treatments, but rather the body system acts as if the pancreas is still working fine. Modern technology is still advancing on better treatments. For hyperglycemia, all that is needed is corrections. For hypoglycemia, sugar is needed, fast and slow acting. Fast-acting foods include lollies, juice, carbonated drinks, and anything that has high amounts of sugar. Slow-acting foods include pizza, pasta, wheat passed foods, nut bars, and rice. The fast-acting foods are used for immediate low treatment, and the slow-acting is used after a low when the level goes back up to something above it.

The rate of people who has type 2 diabetes all over the globe is increasing rapidly. As discussed by Wallerstein (2017), an imbalance of the sugar level in the body is the leading cause of diabetes. In the case of type 2 diabetes, the human body cannot respond to insulin, which is referred to as insulin resistance. High blood sugar is one of the major causes of severe health-related issues such as heart disease, vision loss, and kidney disease. The major factors, which are leading to type 2 diabetes as a global epidemic are overweight, sedentary lifestyle, and consumption of unhealthy diets like red meat and processed meat, refined grains, and sugar-sweetened beverages. Comprehensive reports are showing that about 1 in 11 adults, across the globe, have type 2 diabetes. Asia is considered the historic center of this disease. It had been reported that in the year 2018, 34.2 million, which is 10.5% of the entire population were suffering from diabetes in the UK (Diabetes UK, 2017). Among the 34.2 million people, 26.8 million people were diagnosed, while 7.3 million were undiagnosed. There are more than 1.5 new cases of diabetes, the rate of which is increasing every year.

Older adults are suffering the most. This is the growing health burden, the rate of which is drastically increasing across the globe. Gyawali (2019) showed that consumption of unhealthy diet and alcohol and obesity are some of the major causes of the increasing rate of type 2 diabetes. People aged above 65 are highly prone to diabetes. As per the report published by WHO, the prevalence of diabetes is increasing especially in low or middle-income countries. It is reported that 1.6 million death across the globe is the direct outcome of type 2 diabetes. According to WHO, diabetes is the seventh leading cause of diabetes around the world (Who. int, 2020). It is essential to take an early intervention, lack of which can lead to severe health-related issues like blindness, kidney failure, heart attacks, stroke, and lower limb amputation. The global prevalence of diabetes was 8% in the year 2011, and it is expected that this rate will be increased to 10% by 2030 (Who. int, 2020).

Healthcare practitioners must think beyond their customer’s points of view and involve the community within their intervention program. According to Blanks (2016), the population is defined as the non-spatial dimension, which includes the people, who exist as a heterogeneous group. Community-based interaction is one of the primary ways of addressing any broader issue by implementing collaborative action. This is the mode of enabling the community to address the broader issue. Cefalu (2016) shaved light on the fact that this is the key to accomplishing community readiness and participation. As the elderly community is more prone to suffering from type 2 diabetes, the implementation of community-based interaction will help in addressing their common problem by encouraging them to share their ideas and perception.

The ladder of community-based interaction is needed to be followed by the healthcare practitioners as it offers a practical framework that comprises community readiness, participation, engagement, organization, development, capacity-building, collective action, and community empowerment. Collaboration (2015) highlighted by saying that preparedness is the initial parameter of the ladder of the community-based program, which shows the readiness of the community to engage them to implement an intervention program. Lifestyle change participation program is a significant community-based intervention program, through which readiness can be generated among the people to accept the changes from one stage to the other, by creating willingness among them.

Participation is another significant aspect of the ladder of community-based interaction programs. This is the mode of understanding the universal need of people by encouraging them to share their ideas and experiences. Active listening is one of the major strategies, which healthcare practitioners can implement to carry out community-based intervention programs. Dunkley (2014) showed that this is the way of keeping people informed about the issue that can affect their health and wellbeing. As older people are more prone to type 2 diabetes, it is the prime responsibility of healthcare practitioners to keep them informed about how high blood sugar levels can cause severe health-related issues such as heart disease, vision loss, and kidney disease. This is the way of generating awareness among them to get effective treatment to address the item at the early stage. Henry (2017) showed that need assessment is another primary strategy of implementing a community-based intervention program. This is the way of identifying the need for people and take action accordingly. The healthcare practitioners must be committed to offering the people a sense of ownership about their own health needs. In this case, also, the healthcare practitioners should provide necessary information to the older adults and encourage them to take action on their own for the sake of resolving their health-related issues. Working together in partnerships is another vital strategy for implementing a community-based program. External agencies like NGOs need to develop an equal company and treat all people equally. As the prevalence of diabetes is high in middle or lower-income countries is relatively high, it is essential to conduct community-based programs in these countries also without discriminating against people based on their socio-economic background (Walker, 2014).

Type 2 diabetes is the leading cause of poor health quality of a wide range of people across the globe. Thus, it is essential to take effective action at the early stage, which will help in conducting this program and promote the health and wellbeing, especially of older adults. The community-based program plays a significant role in the way influencing the decision-makers to take effective action for the sake of addressing the health concern among the people. Capacity building is the key to strengthening the engagement of the community, which is the key to resolving the degree of health concern among the people (Philip, 2018). Capacity building is one of the major of developing a productive relationship between health promoters, health agencies, and community members. Capacity building plays a pivotal role in the way of strengthening the health infrastructure and the capacity to deliver a particular program that can help in addressing specific health concerns. In this program, it is imperative to accelerate the support of health governing bodies for the sake of improving the participation of the local community. Capacity building plays a significant role to encourage the local people to take effective action. To address the growing rate of diabetes among older adults, healthcare practitioners need to use the capacity building as a strategy for the sake of fostering a sense of ownership among the people to take effective action on their own to address the health-related issue among them. By using a capacity-building strategy, healthcare practitioners would be able to encourage the elderly community to have greater control over their health and wellbeing by addressing their health-related issues (Koonce, 2015).

Appropriate redistribution of power is very much needed in this context. Engagement is the third significant parameter of the ladder of the community-based program. This leads people to involve people in identifying problem-solving. This is the collaborative process, which requires external agency and the community. Capacity building is one of the significant ways of having sustainable development within the city, which is the key to engaging the older people within the decision-making process and thereby address the growing health concern of type 2 diabetes.

To address type 2 diabetes among older adults, healthcare practitioners need to implement practical approaches. It is a widely admitted fact that the prevalence of type 2 diabetes is increasing rapidly. In this situation, healthcare practitioners must take effective action to generate awareness among the people to take effective action in terms of making awareness, especially among the older adults regarding the disease. The health belief model (HBM) is one of the significant social-psychological health behavior change models, which intends to predict health-related behavior among people regarding competent health services. Diabetes can harm the quality of life of people. Self-care is one of the primary ways of controlling diabetes among people, the lack of which can lead to a severe health-related issue. Thus, people need to take effective self-care measures such as maintaining a healthy diet, regular use of medications, regular exercise, and monitoring blood glucose daily.

By following these measures, people can control their blood sugar level and thereby promote their health and wellbeing. The role of healthcare practitioners is needed to be considered in this context. In this situation, healthcare practitioners should apply the health belief model to promote self-care behavior among diabetic patients. Conduction of health education programs is the critical aspect of the health belief model. This model of health education is entirely based on the prevention of diseases by adopting active behavior. This is the way, through which illness can be prevented. It is the prime responsibility of healthcare practitioners to implement this model, to identify the illness and disease chains and mitigate the chain by analyzing the relationship between health beliefs and behaviors. According to the health belief model, it is essential for healthcare practitioners to generate awareness among the people, so that they can show effective practice. The health belief model plays a pivotal role in disseminating knowledge among people, which is the key to assessing the response of people towards their health-related issues. However, Glenn (2020) argued by saying that this model lacks the discussion of relevant factors, which can make it difficult for healthcare practitioners to build a healthy relationship with people, who are suffering from type 2 diabetes.

Model for Health Education Planning is another vital model of educating the community about type 2 diabetes. This model comprises various steps such as initiation, needs assessment, goal setting, planning/programming, implementation, and evaluation that play a significant role for the healthcare practitioners to carry out the education program in a systematic manner. The education approach is also a considerable way of educating people regarding type 2 diabetes. Community-based education program plays a pivotal role in preventing life-threatening disease and thereby improve the quality of life. By implementing the community-based education approach, the health care practitioners would be able to reach a wide range of people and generating awareness among them regarding the prevalence of type 2 diabetes. Through this way, healthcare practitioners can change the aspect among the elderly community towards type 2 diabetes and promote appropriate behavior among them. Patient-centered care is another dominant approach for addressing growing health concerns among people. This is the mode of self-care behavior among people to have self-monitored blood sugar.

With time, the prevalence of life-threatening is rapidly increasing. People are becoming much more aware of promoting health and wellbeing by preventing the occurrence of such diseases. In this situation, it is the prime responsibility of healthcare practitioners to generate awareness among the elderly to take early intervention for addressing type 2 diabetes. There lies the significance of the community-based initiative, which is the key to creating awareness among the people. By implementing a Lifestyle change participation program, the health care practitioners would be able to change the perception among the people towards type 2 diabetes and show effective health-related measures and thereby growing health-related concerns.

Obesity is normally caused by eating too much food and not working it off. If you digest a lot of fats and sugars but don’t work it off by exercise and physical activity, the energy will be kept in your body as body fat and that is how you put on weight. The lifestyles people live by causes the population to be classified as obese. It is recorded that over 20% of Australia’s population is obese. Technology is a major issue with obesity. More people are sitting on their phones and are on social media and aren’t getting enough exercise to burn off the food they are eating. A large number of Americans eat a very large amount of fats and sugars mainly because of the number of fast-food restaurants they have and their sugary drinks.

It has been proven that people with obesity eat more because they don’t feel full as quickly. They also eat a lot out of boredom and try to get rid of stress and anxiety.

Obesity comes with many serious complications. Obesity is a very serious disease that could be a massive threat to your life. Obesity makes you more likely to have high blood pressure and high cholesterol levels, which makes it a high risk for heart diseases and strokes. Obesity also increases your chance of getting many types of cancers including uterus, cervix, endometrium, ovary, breast, colon, liver, gallbladder, pancreas, kidney, and prostate, you also have a very high risk of getting type 2 diabetes which affects your blood sugar levels. People with obesity are more likely to have sleep apnea, which is a potentially serious disorder that makes your breathing repeatedly stop and start during your sleep.

There are many steps you can take to prevent having an unhealthy weight and related health problems. The steps to make sure you don’t gain an abnormal amount of weight are the same steps you take to lose weight which include: daily exercise, a healthy diet, and watching what you eat and drink. There are steps that should all be major priorities if you are wanting to live a healthy lifestyle. Sticking to a healthy weight plan as much as possible increases your chances of succeeding in your goals of being healthy.

The most effective way to treat obesity is to eat healthily and to exercise regularly. Some of the best ways that would help with this would be to not overeat and to eat the right portion sizes, you could also get a recommended diet plan for your particular body by your GP or a professional weight loss professional such as a dietitian

There are many ways to find out if you are overweight or obese which include: your clothes getting tight and you needing to buy bigger sizes in your clothing, seeing that you’ve gained an abnormal amount of weight. Symptoms aren’t just what you can see on your body they can also be what is happening in your body like not being able to breathe normally, difficulty with sleeping, not being able to cope with sudden physical activity, feeling tired every day, and your back and joints hurting. If you are experiencing all or most of these symptoms you may want to ask for professional help to make sure you are not obese.

Obesity is a very serious disease that is becoming more popular around the world. It has been found that obesity is mainly caused by unhealthy eating and not exercising but there are also causes which are less common such as developed through genetic reasons, medical reasons.

Diabetes is one of the leading diseases affecting 171 million people and most of the patients suffer from type II diabetes (Gershell, 2005). As type 2 diabetes mellitus is increasing day by day and accounts for 9 % of deaths, there is an urgent need to find out new potential therapeutic agents. The treatment for type 2 diabetes mellitus has been improved to some extent during the last decade, however; drug resistance is still a big concern. There is a need to maintain the blood glucose level and reduce its production in the small intestine. Carbohydrate-rich diet on consumption increases the absorption of carbohydrate from human intestine due to action of α-glucosidase enzyme which breaks disaccharides into absorbable monosaccharides. The inhibitors of α-glucosidase inhibits the digestion of disaccharides and enable an overall smooth glucose profile (Casirola and Ferraris, 2006). Thus, natural products have great diversity in their structure and are potential inhibitors. The alpha-glucosidase inhibitory effect of studied plants justifies their popular use in diabetes.

The alloxan-induced diabetic mice had a double elevation in blood glucose levels (110 mg/dl to 250 mg/dl) relative to the normal control mice. There are many studies that show that the administration of alloxan a diabetogenic agent induces Type I diabetes in experimental animals (Etuk, 2010; Viana et al. 2004). Alloxan monohydrate induces diabetes by selective necrosis of pancreatic beta-cells of Langerhans. This, therefore, results in hyperglycemia by effecting endogenous insulin synthesis (Iranloye et al. 2005). The toxic alloxan by the generation of free radicals, through inhibition of glucokinase enzyme and oxidation of essential sulphydryl group, induced its toxicities on pancreatic beta cells (Szkudelski, 2001). The underlying mechanism of action involves the selective uptake of the compound due to its similarity to glucose as well as the uptake mechanism of the pancreatic beta-cells (Lenzen, 2008). The probable mechanism for the hypoglycemic effect of the aqueous extracts of plants could be linked to potentiation of insulin release from pancreatic beta cells of islet or by elevating the peripheral glucose uptake and utilization (Bedoya et al. 1996). Literature showed that saponins and flavonoids are good antidiabetic metabolites (Sharma et al. 2010). Our studies are in line with the previous studies (Mehta et al. 2009) where P. Emblica showed antidiabetic activity in animal models. Similarly C. sativa has also shown antidiabetic activities against streptozotozocin induced diabetic rats (Levendal and Frost, 2006).

On the basis of these results it is concluded that studied plants have the potential to decrease the glucose level by inhibiting the alpha-glucosidase enzyme and potentiation of insulin release from the pancreas. This will leads to the development of alternative drugs and therapeutics strategies. However, more detailed in vivo assays are required to know the exact mechanisms involved in lowering the glucose level.

Abstract

According to global ranking, Pakistan is on 7th number. 6.6% adults in Pakistan have diabetes and it is believed that in 2030 around 14 million people will have diabetes. People with foot ulcers, no knowledge of diabetes and specifically young children diabetes are of major concern in the plan of action presented by international diabetes federation. Various shareholders and collaborators were working together at both stages globally to enhance the bad conditions of diabetes in Pakistan.

Introduction

Diabetes is a non transmissible illness that ranks number four in the world. Diabetes is more prevalent in Asian countries. On the report of various researchers and surveyors, people living in urban and rural areas contribute to 22% and 17.1% of the total population respectively. Total ratio varies in different provinces of Pakistan. In Punjab, about 16.6% and 19.3% males and females respectively have diabetes mellitus. Whereas in Sindh 16.2% and 11.7% of males and females respectively have diabetes. In Balochistan, on whole, both males and females, about 10.8% of the population have diabetes mellitus.

There are several mechanism that cause the development of diabetes. Which involves self destructions of beta cells of pancreas. This can completely alter insulin functioning. In some cases it can also lead to insulin insufficiency. Short supply of insulin can cause abnormal functioning of macronutrients. Insulin deficiency and malfunctioning of insulin can also effect normal tissue reactions. In some cases it can also effect normal hormone functioning. If a person has both insulin deficiency and insulin malfunctioning then it is a severe abnormality and it is characterised as the main cause of low blood sugar levels.

There are 3 basic types of diabetes. Type 1 which is insulin dependent; type 2 which is non-insulin dependent and gestational diabetes which occurs during pregnancy. For diagnosis of diabetes, there are several tests that can be performed. It includes oral glucose tolerance test, glycated hemoglobin test and fasting blood sugar levels are tested.

Indications for diabetes include excessive urine, excessive thirst, weight reduction and excessive hunger is also noticed in some of the cases. It can also cause damage to the eye-sight. If blood glucose levels are persistently high then it can cause chronic and severe harm to different organs of body including heart, eyes. Blood vessels and kidneys. Can also cause damage to their normal functioning.

Review of literature

Pakistan was named as the first of the countries that are still developing yet has a complete prioritisation strategy for almost all the non transmissible diseases. Various stakeholders and collaborators played their vital roles in the elimination of non transmissible diseases. Various non governmental agencies also played vital and effective role in the prevention of diabetes mellitus. National leaders alone can not completely stop the spread of diseases. Due to insufficient efforts on governmental and ministerial level, people’s engrossment in tobacco and poor agribusiness has caused unsatisfactory results in the implementation of various health laws.

Pakistan has thrice the fewer amount of medical assistants in comparison to the health professionals globally. Before 1996, there was no proper health and medical facilities for diabetes in Pakistan. Even no organisation was working for the prevention of this disease. “Baqai Institute of Diabetology and Endocrinology” was the first institute that came into being in Pakistan for the prevention and elimination of diabetes. It had proper medical assistance and initial treatments for about 7,000,000 people. This institute was believed to be evolved and enlarged.

In 1999, a one year degree in the management of diabetes was introduced in universities of Pakistan. As a result of which more than 300 doctors were trained for initial management and control of diabetes. More importance was given to diabetes and certain measure were even taken in non-government section to prevent diabetes.

Later in 2010, surgeons and physicians acknowledged diabetes as an important subject from the point of specialisation. So the “College of physicians and surgeons of Pakistan” also gave this subject importance and significance for specialisation. At political level, national leaders also recognised the importance of prevention of diabetes. So they developed a “National institute of Diabetes and Endocrinology” which gave higher degrees in the subject related to the treatment and prevention of diabetes.

In November 2009, Allama Iqbal College established a separate foundations for diabetes in Lahore. Which was named as ‘Jinnah Allama Iqbal Institute of Diabetes and Endocrinology”. This institution also worked for the prevention and primary care of diabetes. It was affiliated with college of physicians and surgeons of Pakistan.

In various cities of Pakistan, there are devoted therapeutic departments that are now operational for the prevention of diabetes. Certain endocrinology departments are in Peshawar’s hospital. There is also a proper department for the treatment and prevention of diabetes in Islamabad. These institutes not only provide medical care but also deliver knowledge and understanding about diabetes. These institutes usually arrange campaigns and schedule various seminars related to the prevention and treatment of diabetes.

Health institutes and professionals made an alliance with the university of Oslo. It was a significant collaboration. It introduced a high-level degree called as ‘Norad’s programme for master studies”. The main objective of this degree was to enhance and improve the educational activities. This program targeted the countries that are still developing and also selected general and individual groups of the societies. This program also introduced higher degrees such as MPhil and PhD. The main purpose this organisation was to investigate medical treatments and services for the problems related to diabetes and other non transmissible diseases.

In Pakistan, Baqai Institute of Diabetology and Endocrinology is the initiator to develop a group of healthcare professionals for the primary care and prevention of diabetes. This institute also provided the one year degree for the primary care of diabetes for the first time in Pakistan. It has been 15 years and about 15 groups of students have been graduated with the diploma in diabetes education. Ms.Anne Belton and Ms. Marc McGill aided this diploma. They both are superior co-workers of immunodeficiency foundation. They worked hard on the knowledge that was given to healthcare professionals. Significant knowledge and awareness was given to the healthcare professionals on how to handle patients with foot ulcers.

Another program of study was designed which was of two months. It was established to take care of patients with foot ulcers and also the to give awareness to people about how we they can prevent its development. This course was ‘diabetic foot care assistants”. Various international organisations supported and aided all the programs about foot ulcers. International working group on diabetic foot and international diabetes foundation has a consultation department for foot ulcers in diabetic patients. These organisations have completely helped in the spreading of awareness about the disease.

Healthcare professionals are of significant importance in the primary care of diabetes. Special medical education is required for the control of foot ulcers. Diabetic foot care assistants are properly educated and they perform under the management of well trained professionals. National Association for Diabetes Educators of Pakistan was developed in 2010. The main objective of this organisation is to encourage and accelerate the awareness and knowledge of primary prevention and treatment of diabetes. It also involves primary care and treatment of pre-diabetics and diabetics. This organisation also organised various seminars and campaigns that spread the awareness of diabetes. It also monitored several activities in Pakistan. Several seminars and educational workshops were set to spread awareness about the disease.

Baqai Institute of Diabetology and Endocrinology started a program in 2010. The name of this program was “Insulin my life”. This plan worked on the treatment of type 1 of diabetes mellitus. This plan was primarily funded by world’s diabetic foundation. The major purpose of insulin my life program was to provide primary care and prevention specifically to children and people with type 1 diabetes mellitus. It also provided them with all the medicines and insulin supplements.

In 2012, a complete board and organisation for care of diabetes was established in Pakistan. It is “advisory board for the care of diabetes”. This organisation has top doctors for the care of diabetes in Pakistan. This institute has around 10 medical institutions all over in Pakistan. Another agreement was made with the drug industry called as “memorandum of understanding”. This deal provided those 10 medical institutions with medical resources.

Prioritisation Strategies

Main motive of international diabetes federation is to encourage primary healthcare, treatment and elimination of diabetes globally. Healthcare professionals were trained so that while performing operations on the foot ulcers of diabetic patients they will focus on the quality. Total amount on the complete operation of foot ulcer was made very low.

Certain instruments were also developed that were available at low prices. All these measures and actions decreased the proportion to 13.6% from 27.5% within 12 years span.

In 2006, another Organisation was developed with the name of “Pakistan Working Group on the Diabetic Foot”. It was developed in the authority of Dr. Karel Bakker. He is also the president of Pakistan working group on the diabetic foot. There are about 115 healthcare institutions that are treating the foot ulcers in diabetic patients. These medical institutions reduced the proportion to 6.6% from 11.3%.

Knowledge and awareness about diabetes is the infrastructure for the treatment and prevention of diabetes. Baqai Institute of Diabetology and Endocrinology has provided knowledge and degrees to over 100 instructors. 16 years back this institute introduced diabetes recognition seminars and campaigns. Unto 50,000 people came to these awareness programs.

Conclusion

Diabetes is a disease that is spreading all over the globe abruptly. Serious plans of action and measures are to be taken to stop and control this disease. Many strategies have been made to prevent this disease in Pakistan. Still people need education and awareness about this diabetes. Government leaders and stakeholders need to work together to provide essential measures and facilities to completely eliminate this disease.

With there being a drastic increase in the number of cases of type 1 diabetes, there is a serious impact on the ethical and social issues regarding this disease. Diabetes is a hidden disease, one that is not always visible or recognizable. Diabetic patients are often not given the necessary attention and or assistance that is needed; there are often questions as to whether they have a disability. This raises many issues when it comes to perceptions, laws, discrimination, and treatment.

The stigma of poor diet and exercise is linked to both types of diabetes; however, that is not always the case. Many people don’t know that type one diabetes is a condition in which the individual’s pancreas produces little to no insulin due to the immune system attacking and destroying its insulin-producing cells, the beta cells. Diabetics, therefore, have to monitor their blood glucose levels and administer insulin when needed.

A normal daily regimen for a type one diabetic is very complex, but added stress and chaos occur when the public eye and society are involved. There is a constant worry about whether they will be able to bring their diabetic supplies into public places including; theaters, stadiums, courthouses, airport security, and various other places. Not only do their supplies entail medical devices such as pumps, insulin syringes, insulin vials, etc, but this also requires juice or another carbohydrate to treat hypoglycemia.

Diabetics should not have to sacrifice or risk their medical safety to participate in society. That is why there are laws set in place that pertain to diabetics in order to help them continue to monitor their disease while engaging and participating in life. The Americans with Disabilities Act (ADA) is a law that “prohibits discrimination against qualified individuals on the basis of disability” (Fact Sheet, 2015). Title II, of the ADA, ensures that the government provides the same services for people with a disability, and not excluding them because of their condition. This ensures that places modify their rules and policies in order to accommodate the disabled. For example, the airport security should authorize the diabetic to carry their supplies with them- modifying the policy against food, drinks, and sharp objects.

The ADA also protects children and their admission into camps, recreational programs, daycare centers, etc., due to title III. Title III states that “providers of public accommodations must provide you with services that are not any different from those they provide people without a disability” (Fact Sheet, 2015). These laws enforce that public and private entities make reasonable accommodations, however limiting these modifications so they don’t put a burden on the program and/or organization.

There have been raised concerns with driving safety and diabetics. Some people feel that there is an ethical issue with diabetics driving; diabetes and driving are both complex tasks and some feel that the two tasks should not have coincided. Driving demands multitasking, with full use of cognitive, visual, and motor skills. There are people who believe that both acute and chronic effects of diabetes cause danger to both the patient and the general public. For example, acute complications include hypoglycemia and hyperglycemia. These would impair judgment, awareness, motor, and perceptual ability. The ADA has released a statement in regards to the legal and ethical issues that have arisen. They feel that “people with diabetes should be assessed individually, taking into account each individual’s medical history as well as the potential related risks associated with driving” (Gupta, & Arora., 2014). It is also a responsibility of the individual’s health care physician to notice warning signs and act if they become a risk for themselves and bystanders. The physicians should educate the patient on driving safety.

Cultural values also have a great impact on diabetes. A big concern is the medication needed in order to attain glycemic control and its restrictions on certain cultural values and/or norms. Some cultures, don’t believe that insulin should be incorporated in the treatment or control. There are various reasons as to why some culture’s beliefs inhibit them from using insulin. Some of the reasons are due to religion, social factors, language barriers, and the perceptions of insulin safety. For example, Hispanics believe that insulin will cause more complications and/or be harmful, that it implies failure, and they have a fear of insulin injections (Rebolledo, J. A., & Arellano, R., 2016, August).

The Korean culture also feels that insulin as a treatment plan should be inhibited. They believe that people diagnosed with diabetes should entirely cut out carbohydrates. They feel that the administration of insulin is not safe and that cutting carbohydrates will eliminate the need for insulin. This is not a safe treatment for diabetics, as individuals’ blood glucose levels don’t only rise with the intake of carbohydrates, there are other factors that play a role. Some examples of other factors that affect blood sugar include stress, hormones, exercise, etc.

Culture plays a big role in all aspects of health care. A physician works with a diverse population, culture sometimes being a barrier between the treatment plan and the patient. The only way to overcome these barriers is to observe and understand the barrier, providing individualized care for each patient. Often times the issues revolve around disparity, the inability to pay for appropriate care. In order to overcome this, “President Clinton announced a new initiative that sets a national goal of eliminating by 2010 longstanding disparities in health status that affect racial and ethnic groups” (Tripp-Reimer, et al, 2001). This means that all American’s health goals are the same, not having lower goals set for minority groups. The issues that will need to be attended to are the quality of health services provided, poverty, and environmental hazards. For example, Mexican Americans’ income raises obstacles for the treatment and management of diabetes. It is often a struggle for them to afford payments, often having no health insurance. This creates restrictions on the ability to control and manage diabetes, as it is impossible for them to afford the expenses of medicines, supplies, physician visits, and etc. Another disparity is financed, prohibiting the consumption of healthy foods.

There was a study conducted to display the effects of poverty on hospital admissions for ketoacidosis. They interviewed approximately 40 patients that had been admitted to the hospital due to lack and/or stop of insulin administration. 20 of the patients explained that they stopped administering insulin because they couldn’t afford the medication. Many of the individuals interviewed were uneducated about diabetic management. The study showed that a majority of the ketoacidosis cases could have been prevented if the patient was educated and had access to affordable care (Tripp-Reimer, et al, 2001).

In conclusion, cultural and ethical perspectives have a great effect on diabetes and its treatment plan. In order to overcome the barrier set due to ethical and cultural perspectives, there should be various diabetes educational courses carried out worldwide for all races and ethnic groups. It would be spreading awareness and knowledge on diabetes and its appropriate treatment plan. The intention of these courses should be to encourage diabetic patients to control and manage their condition, providing them with the knowledge they need to live with this disease. A wide variety of diabetics lack knowledge of the disease due to cost, distance, and the lack of educators. This lack of knowledge and understanding of the disease is one of the main reasons for complications associated with diabetes. Education will allow these individuals to be actively responsible for the daily management of their situation. These educational programs, being easy to access, will have a positive effect and attract the public. Better education and knowledge on diabetes will reduce complications minimizing the mortality rate in diabetics.