Diabetes

Sodaly Chhun Prof. Linda Mallen Due Date: 4/17/13 Research Paper The Effect of Gum Disease on Human Health. People think the way to have a charming smile is to have white teeth. However, that is not all there is to have good oral health. Healthy gum tissue also is an important part of tooth structure which enables our healthy bright smile. Healthy gums aren’t just important for your oral health, but they can also be important for your overall health. Numerous research studies suggest that other long-term, chronic health conditions can be associated with periodontal diseases, a gum disease.

Most studies suggest a possible link between periodontal diseases to other more serious chronic health conditions including heart disease, diabetes, and pregnancy complications. The most common type of gum diseases is gingivitis which is a mild form of infection of gum. According to Marian Mehegan, DDS, a regional women’s health coordinator, gingivitis causes red, swollen gums, and it can also make the gums bleed easily. This form of gum disease does not lead to loss of bone or tissue around the teeth. However, in a prolonged untreated period, it can become a periodontitis (Womenshealth. ov). Based on PubMed Health, the US National Library of Medicine, periodontitis is defined as an inflammation and an infection of the ligaments and bones that support the teeth (Ncbi. nlm. nih. gov/pubmedhealth). Periodontitis occurs when resulting inflammation or infection of the gums is untreated or treatment is delayed. Infection and inflammation spreads from the gums to the ligaments and bone that support the teeth. As a result, the teeth become loose and eventually fall out. One of the most chronic health conditions like to problem with healthy gum is heart disease.

For a century the idea of a link between oral health and the heart has been around. But it’s only been in the last 20 years that some health professionals have taken this link seriously enough to recommend dental care as a way of reducing the risk of heart disease. They believe that there is a connection between serious gum disease and cardiovascular condition. According to Dr. Kevin Marzo, Chief of Cardiology at Winthrop University Hospital in Mineola, New York, “The bacteria that cause dental plaque may promote inflammation in the body eyond the mouth including the lining of the blood vessels, increasing the risk for cardiovascular disease including heart attacks,”(Cbsnews. com). In the same way, the scientists believe there is a connection between gum disease and atherosclerosis which causes heart disease. Atherosclerosis is a hardening of arteries due to the buildup of fatty deposits on the lining of artery walls. It causes high blood pressure, stroke, and coronary thrombosis (Dictionary of Medicine 24). According to the Fox news interviewed with Dr.

Peter Lockhart, a professor of oral medicine at the Carolinas Medical Center in Charlotte, N. C, there are two main theories are thought to explain how gum disease could contribute to coronary heart disease. One proposes that bacteria, which grow between your teeth and cause plaque to build-up, can enter the bloodstream when your gum starts bleeding, which happens easily if you have gum disease. For example, mouth bacteria can enter the bloodstream during dental procedure and by tooth brushing.

Once in the blood stream, these organisms attach to pre-existing fatty deposits in coronary arteries (those that supply blood to the heart). This leads to inflammation, which may cause blood clots that can decrease blood flow to the heart and cause a heart attack. The second theory proposes these oral bacteria of gum disease cause the body to develop antibodies that attack receptors on the cells lining the blood vessels and cause an inflammatory reaction. This inflammation may play a role in the further development of fatty deposits lining the artery walls that can cause blockages (Foxnews. om/health). However, the evidence supporting the idea that links gum disease to heart disease has always been controversial. Hence, the American Heart Association reviewed 500 journal articles and studies and then concluded that there was no clear evidence that gum disease causes heart disease, or that treating gum disease would have any effect on those with a heart condition. Nevertheless, the review did find gaps in the understanding of the interaction between gum disease and heart disease and called for more research. Scientists have identified the same risk factors for both heart and gum disease.

As Lockhart said, “ Individuals who do not pay attention to the very powerful and well-proven risk factors like smoking, diabetes or high blood pressure may not pay close attention to their overall health, either,”(Foxnews. com/health). In short, if you smoke, have poor nutrition, diabetes, or are from a lower socio-economic background, then you are at higher risk of developing gum disease, but these factors also contribute to heart disease. Next, the scientists believe that there is a two way relationship between gum disease and diabetes.

First, people with diabetes are at special risk for gum disease. There is a clear relationship between degree of blood sugar and severity of periodontitis. In the article, People with Diabetes at High Risk for Developing Gum Disease, by the Academy of General Dentistry, it claimed that diabetes reduces the body’s resistance to infection, so the gums are at risk for gingivitis (Knowyourteeth. com). Studies have shown that those with diabetes are more susceptible to the development of oral infections and periodontal (gum) disease than those who do not have diabetes.

For example, dry mouth, often a symptom of undetected diabetes, can cause soreness, ulcers, infections, gum disease, and tooth decay. According to Preshaw PMet al, “The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology” (Ncbi. nlm. nih. gov). In addition, there’s a suggestion that if a person gum disease, it might predispose them to increase their risk of developing diabetes, because of the persistent infection in their body.

While inflammation plays an obvious role in periodontal diseases, evidence in the medical literature also supports the role of inflammation as a major component in the cause of diabetes and diabetic complications. According Preshaw PM et al. , “Incidences of macroalbuminuria, which is a high levels of albumin in the urine related to kidney disorder, and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis” (Ncbi. lm. nih. gov). Therefore, by controlling your blood sugar, brushing and flossing every day, and visiting a dentist regularly, you can help prevent gum disease. Also, by maintaining good oral hygiene habits, it means you can reduce the risk of infection and inflammation which are the factors in the pathogenesis of diabetes and diabetes complications. Finally, gum disease has been linked to premature birth and low birth weight. Until now, it was thought that having gum disease could raise your risk of having a low-birth-weight baby.

Researchers have not been able to confirm this link, but studies are still under way to learn more. Pregnant women may have the craving for salty and sweet food and develop red, swollen gums that bleed easily. This condition is called pregnancy gingivitis. Pregnancy gingivitis commonly becomes apparent later in the second month of gestation and worsens as the pregnancy progresses before reaching a peak in the eighth month. In the last month of gestation, gingivitis usually decreases andfollwing post-partum the gingival tissues are found to be comparable to those seen during the second month of gestation.

Doctor Mehegan stated that, pregnancy gingivitis is due to both poor oral hygiene and higher hormone levels (Women health. gov). According to a research called Pregnancy Gingivitis and Periodontitis and Its Systemic Effect by Kaur , Kharb and  Rai, pregnant women are likely to have swollen gums and bleeding during brushing because the inflammatory response to dental plaque is increased. With the hormonal changes of pregnancy, also termed as pregnancy gingivitis, both estrogen and progesterone increase gingival inflammation.

However, it is not known if the pregnancy related gingival changes might be explained by increased vascularity and vascular flow alongside alterations in the immune system and/or changes in connective tissue metabolism. Nevertheless, the anatomy structure of tissue of pregnancy gingivitis is not different from that of the gingivitis in non-pregnancy state (Ispub. com). More recently, in the article, Periodontal Disease and Pregnancy by the Academy of General Dentistry suggested that periodontitis may also pose a challenge to the developing fetus.

The excessive bacteria can enter the bloodstream through the pregnancy women’s gums; the bacteria can travel to the uterus, triggering the production of chemicals called prostaglandins, which are suspected to induce premature labor (Knowyourteeth. com). All in all, there is no scientific data, thus far, to support the belief that getting regular dental treatment, particularly regarding scenarios of pregnancy-related periodontal disease, helps reduce the risk of preterm low-birth-weight babies. However, there are other overall health advantages to the mother, not to mention the more obvious oral health advantages.

In conclusion, there is a potential link between gum diseases to chronic health conditions including heart disease, diabetes, and pregnancy complications. The scientists strongly believe in connection between gum diseases and heart disease based on two theories. One theory claimed that certain oral bacteria, which cause heart problems, get into the heart through the bloodstream when there is a cut in the gum. Another theory emphasized that the bacteria of gum disease causes an inflammation reaction in the blood vessel which may resulting in development of fatty deposits that block the artery blood vessel.

Regarding the connection between gum disease and diabetes, the health experts believe that diabetes patients are at high risk for gum diseases, and it is vice versa a serious gum disease could make diabetes patients difficult in control blood sugar. Finally, gum disease might link to preterm labor and low birth weight. Pregnancy women are at risk to pregnancy gingivitis due to the change in hormones, which could change the volume of gum tissues, and the combination of dental plaque. Moreover, if the pregnancy gingivitis delayed untreated, it leads to serious gum disease.

The scientists believe that the bacteria which cause serious gum disease could reach the uterus and cause premature which results in low birth weight. However, there is no clear evidence to proof the connection between the gum diseases to heart disease, diabetes and pregnancy complications due to the same risk factors. Gum disease and heart disease share many common risk factors, including cigarette smoking, age and diabetes, and these factors are more likely to explain why diseases of the blood vessels and mouth occur in conjunction with each other.

Although the scientists have inconclusive evidence to support their beliefs and are working on further research to support their hypothesis, it is known that good oral hygiene is still important for overall health. Hence, individuals should take care of their oral health as follows: brush your teeth at least twice each day with fluoride toothpaste and floss your teeth, have a healthy life styles, and get regular checkups with your dentist. If you follow the suggestions, you possibly be able to prevent chronic systemic diseases. 1. What does your mouth have to say about your health?

Dr. Kevin Marzo, Chief of Cardiology at Winthrop University Hospital in Mineola, New York. http://www. cbsnews. com/8301-504763_162-57353192-10391704/what-does-your-mouth-have-to-say-about-your-health/ 2. Gum disease doesn’t cause heart attacks, experts say Dr. Peter Lockhart, a professor of oral medicine at the Carolinas Medical Center in Charlott Published April 19, 2012 MyHealthNewsDaily Read more: http://www. foxnews. com/health/2012/04/19/gum-disease-doesnt-cause-heart-attacks-experts-say/#ixzz2Pk3DMbvk 3. Periodontitis and diabetes: a two-way relationship.

Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Source School of Dental Sciences and Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK. p. m. preshaw@ncl. ac. uk http://www. ncbi. nlm. nih. gov/pubmed/22057194 Diabetologia. 2012 Jan;55(1):21-31. doi: 10. 1007/s00125-011-2342-y. Epub 2011 Nov 6. 4. People with Diabetes at Higher Risk for Developing Gum Disease The Academy of General Dentistry (AGD http://www. knowyourteeth. com/infobites/abc/article/? abc=p&iid=324&aid=8530 5.

Periodontal Disease Causes Preterm Labor and Low Birth weight Infants Posted on April 28, 2011 ThomasJ. Peltzer, DMD                                                                  http://www. connecticutsedationdentist. com http://connecticutsedationdentist. wordpress. com/2011/04/28/can-gum-disease-actually-affect-your-unborn-child/ 6. Research Pregnancy gingivitis and periodontitis and its systemic effect Author(s):Jasdeep Kaur , Simmi Kharb and Balwant Rai Source:The Internet Journal of Dental Science. (Dec. 10, 2008): Document Type:Report

Full Text: COPYRIGHT 2008 Internet Scientific Publications LLC http://www. ispub. com/ostia/index. php? xmlFilePath=ejournals. xml 7. Periodontal Disease and Preterm Low Birth Weight Babies According to Cannadian Dental Associstion, Studies are still being done to find out exactly how and why periodontal bacteria appears to have the effect it does. Researchers suspect that the prevalence of bacteria may affect the release of hormones responsible for starting contractions or rupturing membranes, though there has been no direct causal link found to date.

The only thing for sure is the definite increased risk to those pregnant mothers who have the disease. Darlene Oakley is a freelance writer for EmpowHER. com How might problems in my mouth be linked to health problems in other parts of my body? Heart disease. Before some dental treatments, patients who have certain heart conditions or joint replacements may take antibiotics. These people may be at risk of getting an infection when bacteria that lives in the mouth goes into the bloodstream during treatment. Antibiotics lower this risk.

Talk to your doctor or dentist if you are not sure whether you should take antibiotics before dental treatment. http://www. womenshealth. gov/publications/our-publications/fact-sheet/oral-health. cfm#g Oral health fact sheet was reviewed by: MarianMehegan,D. D. S. ,M. P. H. CAPT,USPHS RegionalWomen’sHealthCoordinator USDHHS Office on Women’s Health Healthy teeth for a healthy heart? http://www. abc. net. au/health/thepulse/stories/2012/06/19/3528574. htm#. UWOHEpOG2So:But could keeping your gums healthy also help to reduce your risk of having a heart attack?

But to date the evidence supporting this idea has always been controversial. So the American Heart Association (AHA) decided to review the existing research to see what the data suggests. The Association’s review concluded while a link was “biologically plausible”, there was no clear evidence that gum disease causes heart disease, or that treating gum disease would have any effect on those with a heart condition. However, the review did find gaps in the understanding of the interaction between gum disease and heart disease, and called for more research.

Professor Malcolm West, professor of medicine at the University of Queensland and consultant cardiologist at Brisbane’s Prince Charles Hospital, agrees there needs to be more research before we have a definitive answer. The potential link between the two hasn’t been clarified as much as people would like and we’re left with this question mark,” West says. One of the problems with linking the two conditions is that they have many of the same risk factors, West says. “So when trying to say one thing causes another, to try to eliminate how those other risk factors are interfering is quite difficult,” West says.

Example: If you smoke, have poor nutrition, diabetes, or are from a lower socio-economic background then you are at higher risk of developing gum disease, but these factors also contribute to heart disease. Two main theories are thought to explain how gum disease could contribute to coronary heart disease, West says. One proposes that organisms, which grow between your teeth and cause plaque to build-up, can enter the bloodstream when your gum starts bleeding, which happens easily if you have gum disease.

Once in the blood stream, these organisms attach to pre-existing fatty deposits in coronary arteries (those that supply blood to the heart). This leads to inflammation, which may cause blood clots that can decrease blood flow to the heart and cause a heart attack. The second theory proposes these bacteria cause the body to develop antibodies that attack receptors on the cells lining blood vessels and cause an inflammatory reaction. This inflammation may play a role in the further development of fatty deposits lining the artery walls that can cause blockages.

Diabetes. http://www. womenshealth. gov/publications/our-publications/fact-sheet/oral-health. cfm#g  People with diabetes are at special risk for gum disease. Gum disease can lead to painful chewing and even tooth loss. Dry mouth, often a symptom of undetected diabetes, can cause soreness, ulcers, infections, and tooth decay. People with diabetes can also get thrush. Smoking makes these problems worse. By controlling your blood glucose, brushing and flossing every day, and visiting a dentist regularly, you can help prevent gum disease.

If your diabetes is not under control, you are more likely to develop problems in your mouth. http://www. abc. net. au/health/thepulse/stories/2012/06/19/3528574. htm#. UWOHEpOG2So: ————————————————- “There’s an ever expanding list of conditions that have been investigated in relation to gum disease,” says Associate Professor Ivan Darby, head of Population Oral Health and Periodontics at the University of Melbourne. For example, there’s a suggestion that if you’ve got gum disease it might predispose you or increase your risk of developing diabetes, ecause of the persistent infection in your body. Pregnancy. http://www. womenshealth. gov/publications/our-publications/fact-sheet/oral-health. cfm#g Use good oral hygiene to control your risk of gum diseases. Pregnant women may have changes in taste and develop red, swollen gums that bleed easily. This condition is called pregnancy gingivitis. Both poor oral hygiene and higher hormone levels can cause pregnancy gingivitis. Until now, it was thought that having gum disease could raise your risk of having a low-birth-weight baby.

Researchers have not been able to confirm this link, but studies are still under way to learn more. http://www. abc. net. au/health/thepulse/stories/2012/06/19/3528574. htm#. UWOHEpOG2So: Another is the link between preterm birth or low birth weight and gum disease, Darby says. “The original suggestion was that women that had preterm birth had more gum disease than those who went to full term. Some studies say yes and some say no, so it really is inconclusive. But probably like heart disease, having gum disease in addition to other factors adds to your risk,” he says.

Definition of Gumdiseases ————————————————- http://www. womenshealth. gov/publications/our-publications/fact-sheet/oral-health. cfm#g Gum diseases are infections caused by bacteria, along with mucus and other particles that form a sticky plaque on your teeth. Plaque that is left on teeth hardens and forms tartar. Gingivitis (jin-juh-VEYE-tuhss) is a mild form of gum disease. It causes red, swollen gums. It can also make the gums bleed easily. Gingivitis can be caused by plaque buildup. And the longer plaque and tartar stay on teeth, the more harm they do.

Most gingivitis can be treated with daily brushing and flossing and regular cleanings at the dentist’s office. This form of gum disease does not lead to loss of bone or tissue around the teeth. But if it is not treated, it can advance to periodontitis (pair-ee-oh-don-TEYE-tuhss). Then the gums pull away from the teeth and form infected “pockets. ” You may also lose supporting bone. If you have periodontitis, see your dentist for treatment. Otherwise your teeth may loosen over time and need to be removed. Oral health: A window to your overall health What conditions may be linked to oral health?

School of Nursing, Midwifery and Interprofessional Studies. With reference to acid-base balance explore the role of the respiratory system in maintaining blood pH? ‘We live and die at the cellular level’ (Reid, 2011). Homeostasis is crucial for normal cellular function. Acid-base homeostasis is the part of human homeostasis and refers to the balance between the production and elimination of H+ hydrogen ions (pH) within the body fluids (William, Simpkins, 2001, p. 236). Metabolic reactions within the cells often produce a huge excess of H+.

Lack of any mechanism for its excretion would lead H+ levels in body fluids rise quickly to the lethal levels (Tortora, Grabowski 2006, p. 1001); therefore the homeostasis of the right H+ levels is crucial for our survival. In a healthy person several systems work interdependently on maintaining blood’s pH (Sheldon, 2001, p. 23): buffer, renal and respiratory systems. In this essay I will concentrate on the pH of the blood in relation to the acid-base balance and the role that respiratory system has in maintaining it. Blood pH is a measure of its acidity or alkalinity. A pH of 7. is considered neutral in the systemic arterial blood within its narrow range of around 7. 35 and 7. 45. When the pH is greater than 7. 45 the blood is considered to be alkalotic and when the pH is lower than 7. 35 then the blood is considered acidotic (Sheldon, 2001, p. 23). Fig. 1: Diagram of blood pH scale: (JupiterIonizer, 2004) The acidity or alkalinity of blood is a result of H+ concentration within it, and this on the other hand results from the carbon dioxide concentration in the blood. Carbon dioxide is a toxic waste product generated in the oxidation of fats, carbohydrates and proteins within the cells.

The gas itself is not an acid, but it reacts with water to form carbonic acid which then dissociates to form a hydrogen ion and a bicarbonate ion: CO2+H2O- H2CO3-H++ HCO3- The respiratory system helps to control the acidity of blood by regulating the elimination of CO2 and H2O through ventilation and on the other hand, blood pH (H+ concentration) plays a major role in respiratory control. Respiratory muscles belong to the voluntary breathing system and are controlled by the respiratory centre located in the medulla oblongata and the pons of the brain stem (Hinchliff, Montague, Watson, 2005, p. 605). Gregoire and Gallagher (2004, p. 24) suggest, that the breathing centre controls a number of inseparable parts, which work together to ensure that any inspiration is harmoniously followed by an appropriate expiration. Also, the frequency and the volume of air per inspiration are regulated. In order to regulate the breathing in an efficient manner, the respiratory centre must be informed of the need for the ventilation in the body mainly by chemoreceptors which are sensitive to the PCO2 (carbon dioxide pressure) or the pH of the blood. Those chemoreceptors can be found in the aortic arch and in the carotid artery (Thomson, Adams, Cowan, 1997, p. 1). According to Tortora and Derrickson (1006, p. 1002), the pH of bodily fluids and breathing rate react via the negative feedback loop. When the aforementioned chemoreceptors detect any changes in blood pH, they will stimulate the respiratory centre to alter the ventilation rate in order to bring the acid-base balance to its homeostatic level. When the blood acidity increases, the pH decreases and causes the chemoreceptors to stimulate the inspiratory area in the brain. This results in diaphragm and other respiratory muscles to contract more frequently and forcefully (resulting in increased CO2 excretion).

This will cause less H2CO3 to form, therefore less H+ will be present in the blood, resulting in increase of blood’s pH. When this response will bring blood pH back to normal, its acid-base balance will be back to its homeostatic level (Tortora, Derrickson, 2006, p. 1002). The same negative feedback will respond, when the blood CO2 level will increase (increase in ventilation, therefore CO2 excretion from the blood, reducing its H+ concentration and finally increase in pH). Hypoventilation= CO2 = H+ =pH = Acidosis Hypoventilation= CO2 = H+ =pH = Acidosis CO2 CO2

H+ H+ pH pH Normal blood pH (7. 35-7. 45) Normal blood pH (7. 35-7. 45) Chemoreceptors stimulate the respiratory centre Chemoreceptors stimulate the respiratory centre Breathing becomes slower and shallower Breathing becomes slower and shallower Chemoreceptors stimulate the respiratory centre Chemoreceptors stimulate the respiratory centre Breathing becomes deeper and faster Breathing becomes deeper and faster pH pH H+ H+ CO2 CO2 Hyperventilation=CO2 = H+ =pH = Alkalosis Hyperventilation=CO2 = H+ =pH = Alkalosis Fig. 2: Respiratory regulation of blood pH.

Simple act of breathing also regulates blood’s pH.. When the ventilation rate increases, more CO2 will be excreted, leading to decreased H+ concentration and raise in pH. Contrarily, when the ventilation rate decreases, less carbon dioxide will get excreted, leading to its accumulation, therefore increase in H+ and decrease in blood’s pH (Tortora, Derrickson, 2009, p. 1002). As we can see, lungs and brain control blood’s pH minute by minute. When the respiratory system fails to control the pH of the blood through ventilation it can lead to respiratory acidosis or alkalosis.

Respiratory acidosis is an excess of carbonic acid that is caused by conditions resulting in hypoventilation and CO2 retention. The major effect of acidosis is depression of the central nervous system (Disney, 2002, p. 281). When the pH of the blood falls below 7. 35, the central nervous system starts to malfunction, and the patient will become disoriented and possibly comatose as the condition worsens Respiratory alkalosis occurs in case of deficit of carbonic acid caused by conditions resulting in alveolar hyperventilation and CO2 deficit.

First, the peripheral nerves will be affected leading to spontaneous nervous stimulation of muscles (spasms) and extreme nervousness. Severe alkalosis can lead to death as a result of contraction of respiratory muscles (Disney, 2002, p. 283). Although in this essay I am concentrating on the role of the respiratory system in regulating the pH of blood it is worth mentioning the role of buffer and renal systems in their connection to the role of the respiratory system. Renal system is the slowest mechanism in regulating of the blood pH, however the only way to eliminate acids other than carbonic acid responsible for raise in the blood pH.

It helps to restore long term acid-base imbalance but is not quick enough to react in sudden changes (Powers, 2001, p. 312-313). The pH buffer systems are a combination of body’s own natural weak acids and bases. They exist in balance under normal pH, however when any changes in pH solution occur, they change their proportions to chemically restore the balance (Appel, Downs, 2008). The important buffer systems include proteins, carbonic acid-bicarbonate buffers and phosphates (Thomson, Adams and Crown, 1997, p. 53). Prolonged acid imbalances of any kind are not well tolerated by the body as they disturb its normal functions.

A chronically over-acidic pH corrodes body tissue and if left unchecked, it will interrupt all cellular activities and functions. The blood pH has a serious effect on all of the body’s systems and that’s why it is important for the body to maintain its acid-base balance, as even minor deviations from the normal range can severely affect every cell in our body. Due to close connection between the respiratory system and blood’s acid-base balance any malfunctions of the respiratory system will lead to blood pH imbalances. Word Count: 1099 SCENARIO 2 (1000 words)

With reference to negative feedback loops explore the role of the pancreas in glycaemic homeostasis. PLEASE TYPE YOUR ANSWER BELOW: Cells need a stable environment in order to survive. Negative feedback is the mechanism by which our body maintains its conditions at a homeostatic level (Guyton, Hall, 2006, p. 861). When the conditions exceed the above range of homeostasis, negative loop will release a hormone to bring those conditions back to normal. Contrarily, when the conditions exceed the lower range of homeostasis, the production of the second hormone will be triggered.

Negative feedback loop requires a receptor, a control centre and an effector. Located in the body are eight major endocrine glands that secrete hormones. Blood glucose concentration regulation through the negative feedback shows, how the endocrine system maintains the homeostasis within our body using two antagonistic hormones: insulin and glucagon (CliffsNotes, no date), released in the pancreas. In this essay I will explore what is glycaemic homeostasis and why is it essential for the health of cells and therefore for the health of the entire body.

I will find out how is it maintained within our body by the negative feedback loops and what is the role of the pancreas in this process. Glucose is the main source of energy for majority of cells in the human body (Tortora, Grabowski, 2006, p. 614). Its molecules are broken down in the cells to produce adenosine triphosphate (ATP) molecules, which provide energy for many cellular processes. Circulating blood delivers glucose molecules to cells and therefore the constant supply of glucose is reliable on the glucose levels being maintained at continuous and adequate level.

However, it is equally important, that the concentration of glucose in the blood and tissues is not excessive (Paul, 1999). The homeostatic level of glucose is achieved through the negative feedback systems of endocrine system which ensure that the glucose concentration is maintained within the normal range of 70 to 110 milligrams of glucose per decilitre (Paul, 1999). In a healthy person the homeostatic glucose levels are restored by one of the organs of the endocrine system- the pancreas. Fixed firmly in the pancreas is a large of endocrine tissue called the islets of Langerhans.

Simpkins and Williams (2001, p316) suggest, that the islets contain two types of cells- ? – and ? – cells, are responsible for the production of glucagon and insulin. Tissues use glucose at different rates, depending on the metabolic activity (Simpkins, Williams, 2001, p. 317). More glucose would be used by our body during exercise than during the rest time. The concentration of glucose will also rise after a meal, when the nutrients are being absorbed. After the glucose enters the bloodstream (following food digestion), the ? ells detect that the blood glucose concentration has raised and release the enzyme- insulin (Tortora, Derrickson, 2009, p. 340-341). Insulin has several functions. One of them is accelerating the conversion of glycogen from glucose. Blood leaving the gut contains the absorbed products of digestion and then passes them to the liver. The liver cells contain enzymes controlled by insulin, which help to synthesize the glycogen, the polymer of glucose. Glucose absorbed from the gut is stored in a form of glycogen in the liver and some of the skeletal muscles (Simpkins, Williams, 2001, p. 316).

Glucagon has the opposite role to the insulin. It stimulates the transformation of glycogen to glucose (Guyton, Hall, 2006, p. 861). The other functions of insulin include speeding up the entry of glucose from the blood into the respiring cells, increasing the cellular rate of glucose utilization as an energy source and stimulating of the fat synthesis from glucose in the liver cells (Paul, 1999). All these effects would together cause the decrease in the blood glucose concentration and the insulin secretion discontinuation (from negative feedback from declining levels of glucose).

Contrarily, when the blood glucose concentration decreases (for example during starvation), the pancreas will respond by stopping the insulin secretion and stimulating the alpha cells to secrete glucagon. Apart from accelerating the breakdown of glycogen to glucose, it increases the breakdown of fats to fatty acids and glycerol in adipose tissue as well as it stimulates liver cells to increase the synthesis of glucose from glycerol absorbed from the blood (Paul, 1999).

These effects will cause an increase in blood glucose level and the secretion will discontinue when reaching the homeostatic level (negative feedback). Blood glucose concentration declines Blood glucose concentration declines Blood glucose concentration rises Blood glucose concentration rises Pancreas stimulates alpha cells to release glucagon Pancreas stimulates alpha cells to release glucagon Pancreas stimulates beta cells to release insulin. Pancreas stimulates beta cells to release insulin. Increased breakdown of glycogen to glucose

Increased breakdown of glycogen to glucose Homeostasis- normal blood glucose level Homeostasis- normal blood glucose level Increased rate of glucose transport to the cells Increased rate of glucose transport to the cells Increased breakdown of fats to fatty acids Increased breakdown of fats to fatty acids Increased rate of glucose utilization Increased rate of glucose utilization Increased breakdown of protein to amino acids Increased breakdown of protein to amino acids Increased conversion of glucose to glycogen Increased conversion of glucose to glycogen

Increased protein synthesis Increased protein synthesis Increased synthesis and release of glucose Increased synthesis and release of glucose Increased fat synthesis Increased fat synthesis Blood glucose concentration rises Blood glucose concentration rises Blood glucose concentration decline Blood glucose concentration decline Fig. 1: The homeostatic regulation of blood glucose concentration via the negative feedback loop. In relation to negative loop system, the glucose transporters that bind glucose are the receptors. The ? – and ? cells act as the control centres, as by processing the information from the receptors they act by releasing effectors- insulin and glucagon- in order to restore the internal conditions back to their normal level (Haaland, 2001). Maintenance of glycaemic homeostasis is crucial, as glucose is the only nutrient that can be used by brain to supply it with energy required for its functioning (Guyton, Hall, 2006). Contrarily, raised glucose concentration can produce a large amount of osmotic pressure in the extracellular fluid and lead to cellular dehydration.

High glucose concentration will also cause loss of glucose in the urine, which can deprive body of its fluids and electrolytes. Long-term increases in blood glucose may cause damage to many tissues, especially blood vessels and can lead to heart attack, stroke, blindness and renal diseases. Any disturbances in the glucose levels will be an indication of disease. For example, raised glucose levels would be present in diabetes mellitus, Cushing’s syndrome, liver disease and hyperthyroidism. Contrarily, decreased glucose levels are present in Addison’s disease, hypoinsulinism and hypothyroidism (Paul, 1999).

The most common of all aforementioned diseases is diabetes mellitus. In type 1 diabetes body’s immune system attacks and destroys the beta cells in the pancreas. This means that pancreas is unable to secrete insulin (Tortora, Derrickson, 2001, p. 341). People affected by the disease will need external source of insulin in order to survive Type II is the most common type of diabetes. In this disease insulin secretion is not reduced, however the tissues in the body become resistant to insulin over time. Person affected by type II diabetes can control their glucose levels with the medication and the right diet.

Glucose is needed for the cells to function. Pancreas has a major role in maintaining right glucose levels as it is responsible for secretion of two antagonistic hormones responsible for the glucose regulation. Negative feedback loop stimulates the pancreas to release the right hormone at the time to bring the blood glucose to its homeostatic level. Any disturbances in the secretion of aforementioned hormones can lead to many diseases and body dysfunctions. Any pancreas malfunction will automatically lead to blood glucose level disturbances. Word count: 1098

PLEASE TYPE YOUR REFERENCE LIST BELOW: Appel, S. , Downs, Ch. , (2008) ‘Understanding acid-base balance’. Nursing. 38 (9), pp9-11. CliffsNotes Antagonistic Hormones. [online] Available at: http://www. cliffsnotes. com/study_guide/topicArticleId-277792,articleId-277669. html (no date) (Accessed 11 Jan 2013). Disney, J. (2002) Acid-base disorders. In: Marx, J. et al. Rosen’s Emergency Medicine: Concepts of Clinical Practice. 5th ed. Oxford: Elsevier. Esmond, G. , (2001) Respiratory Nursing. London: Bailiere Tindall. Gregorie, L. , Gallagher, P. 2004) Life Sciences: Anatomy and Physiology for Health Care Professionals. Edinburgh: Nelson Thornes Limited. Guyton, A. C. , Hall, J. E. (2006) Textbook of medical physiology. 11th ed. London: Elsevier. Haaland, W. (2001) Homeostasis. [online] Available at: http://www. bioedonline. org/slides/slide01. cfm? tk=25 (Accessed 16 January 2013). Hinchliff, S. M. , Montague, S. M. , Watson, R. (2005) Physiology for Nursing Practice. 3rd ed. London: Elsevier. | | | | Jupiterionozer, 2004. Are you overly Acidic? [online] Available at: http://www. jupiterionizer. om/are_you_overly_acidic. htm (Accessed 02 January 2013). Marino, P. , Sutkin, K. , (2006) Acid-base interpretations. 3rd ed. [e-book] Lippincott Williams & Wilkins. Available at: Scribd. >http://www. scribd. com/doc/35400593/The-ICU-BOOK-Paul-Marino-Complete< (Accessed 3 January 2013). Paul, I. (1999) Blood sugar regulation. [online] Available at: http://www. biologyreference. com/Bl-Ce/Blood-Sugar-Regulation. html (Accessed 09 January 2013). Powers, A. (2001). Acid-Base Balance. In: Curley, M. , (2001). Critical care nursing of infants and children. nd ed. Michigan: Elsevier. pp. 309-321. Reid, J,. (2011) Undersatnding acid/alkaline balance. [pdf] Manchester: Integrative Complementary Wellness Centre. Available at: http://www. byregion. net/images/pdfs/1019_9. pdfn (Accesses: 06 January 2013). Simpkins, J, Williams, J. I. (2001) Advanced Human Biology. London: Collins Educational. Sheldon, L. (2001) Oxygenation. Thorofare: Slack. Tortora, G. , Derrickson, B. (2009) Principles of Anatomy and Physiology: Maintainance and Continuity of the Human Body. 12th ed. Volume 2. Hoboken: Wiley. Tortora, G. , Grabowski, S. 2006) Principles of Anatomy and Physiology. 10th ed. Hoboken: Wiley. Thomson, W. , Adams, J. , Cowan, R. , (1997) Clinical Acid-Base balance. Oxford: Oxford University Press. Triplitt, C. L. (2012) ‘Understanding the mechanisms to maintain glucose homeostasis: A review for managed care’. The American Journal of Managed Care, 18(1), pp. 4-27. [Online] Available at: https://secure. pharmacytimes. com/lessons/pdf/201201-02. pdf (Accessed 09 January 2013). Waugh, A. , Grant, A. , (2010) Ross and Willson: Anatomy and Physiology in Health and Illness. 11th ed. London: Elsevier.

The Latino population in the US is about 14 % (in 2006) and would rise to about 25 % within a few years. This population has very important healthcare needs, and they cannot be ignored as they form a very important part of the population of the US (Caballero, 2006). The incidence rates of diabetes are very high in the Latin American population that resides in the US. Hipics have a high chance of developing diabetes due to genetic predisposition. The occurrence of type I diabetes is similar in Hipic and Whites, but the prevalence of type II diabetes is almost twice higher.

Environmental factors (associated with urbanization, lifestyle and leading a sedentary lifestyle) tend to impact the manner in which the disease develops and progresses in Hipics. The outcome of diabetes of Latinos who reside in the US is particularly poor (Caballero, 2006). These rates are especially high in those above the age of 60 year. About 33 % of the female population and about 31 % of the male population suffer from diabetes. The incidence rates could be higher due to a number of unreported cases. At the moment, the Hipic population is experiencing a lot of problems with relation to accessing the healthcare services in the US.

These include a reduced provision of healthcare services, poor knowledge about the availability of the healthcare services, poor insurance coverage, poor policies framed to cover the healthcare needs of the immigrants, absence of procedures in order to secure the healthcare services, inability to afford the high cost of healthcare, poor transportation facilities, cultural problems that are experienced whilst interacting with the healthcare professionals (difference in language, culture, ethnicity, values, etc), discrimination, fear, etc (Sotomayor, Pawlik & Dominguez, 2007).

Healthcare services are provided at rather inconvenient hours and the transportation facilities, to and fro the healthcare unit is very poor. Some individuals belonging to the Latin Communities fear using the healthcare system as they feel that they get discriminated and deported to their home nation. Individuals belonging to the Latin communities are unable to build a rapport with the healthcare professional (Kaleidoscope). The CDC began to understand that the Latin Communities were unable to obtain effective healthcare services in the US.

Hence, it launched the Latin Education Project in the year 2000 to educate the Latin Communities, make them understand their health problems, encourage health promotion and prevent the development of chronic diseases. The incidences, complications and mortality of diabetes were high in the Texas region of the Latin Communities. The communities had very poor knowledge of their health problems, as they were basically illiterate, uneducated, lived in villages and worked as farmers. Their economic situation was also very poor in the US.

About 42 % of the population that reside in the Coastal Bend Area of Texas is basically Hipic and a sizeable amount belongs to the elder age group. In some areas, the Hipic population is about 80 to 90 %, and this would mean that the health problems that arise due to not using the healthcare facilities are even higher. About 28 % of the elder aged-group Hipic population lives below the poverty line. The unemployment rates are also very high in the Hipic population (about 6 %).

About 50 % of the population that live in Texas meets with fatal outcomes due to a chronic disease such as diabetes and CVS disease (Sotomayor, Pawlik & Dominguez, 2007). The Latin populations also have a lot of beliefs about healthcare, which affects the manner in which they seek healthcare services in the US. In 4 different parts of the World, Weller et al performed a study in 1999, to determine the beliefs the Latin communities had about diabetes. It was performed in Latin Communities in Connecticut, Texas, Mexico and Guatemala.

A survey tool in the form of a questionnaire was utilized that had about 130 items regarding their beliefs about the cause, characteristics and the management of diabetes. Different populations were utilized to determine the consistency patterns. The study demonstrated that there were homogeneous beliefs in all the four communities with regards to Diabetes. As the incidence of diabetes was higher in the population, so were their knowledge levels of the disease. The cultural knowledge of diabetes was associated with greater educational levels.

Sharing and transmission of knowledge was higher in populations living in developed areas. The cultural knowledge of diabetes seemed to be true and proven through modern medicine. However, there were some wrong beliefs, which existed in the population regarding diabetes. This may be due to a lack of information in a particular area, and could be easily corrected through education. The population was aware that diabetes developed due to the lack or a problem of insulin in the body.

There were also aware of the frequent symptoms of diabetes such as tiredness, frequent urination, dizziness, excessive thirst, visual disturbances, etc (Weller, Baer, Pacher, et al 1999). The Latin populations do not belief in preventive care (which is given a lot of priority and importance in the US). Economic and spiritual factors influence the need to seek preventive medical care. The population may not like to seek unnecessary medical check-ups, as it may be very costly for them. Only if the patients were sick and terribly unwell, would he/she seek medical care.

Hence, they are at a very high risk of developing serious complications that may arise in association with several chronic diseases. Many people end up with fatal outcomes in the hospitals. Hence, they soon begin not to trust the local healthcare providers, and tend to lose confidence in the . The uninsured rates are also very high in the Latino populations. The Latin population believes that curses and spiritual issues could result in the development of illness, and hence, would first seek care from a spiritual healer.

Rituals, local herbs and medicines are utilized to treat the disease, frequently without much success (Kaleidoscope). The Healthcare system in the US is beginning to change in order to meet the needs of the Latino population. Awareness programs are being launched by the CDC, American Diabetic Association, etc, to educate the Latino population of their health problems and the manner in which it is to be addressed. Physicians in certain parts of the US get extra academic benefits if they serve the minority population.

Several organizations in the US are conducting relevant research and studies to identify the factors that could accelerate disease and worsen their health problems. Accordingly, the health system is being modified. Physicians and other healthcare personnel belonging to Latin origins are being recruited in the healthcare system to ensure that the patients can speak in their native language to the professionals. Many organizations are also visiting the Latin populations to identify their health problems and develop a solution for them.

The government and local agencies are also making an effort to provide health insurance coverage for these Latin populations. Transportation facilities that serve the Latin populations are also being improved. The communities are being reassured that they would not be discriminated, abused or deported to their home nation whilst accessing healthcare services. Pictures are frequently utilized at the healthcare unit to ensure proper communication. Brochures and graphics in local languages are utilized to create greater awareness for the Latin populations.

The CDC and other health organizations in the US are creating a separate segment in their websites that would help the Latin population access health information (Kaleidoscope). References: Caballero, A. E. (2006), Culturally Competent Diabetes Care and Education for Latinos, American Diabetic Association, 3(12), 3. http://docnews. diabetesjournals. org/cgi/content/full/3/12/3 Kaleidoscope – Latinos / Hipics, Retrieved on June 22, 2007, from Kaleidoscope Website: http://cnnc. uncg. edu/pdfs/latinoshipics. pdf Nelson, K. , Geiger, A. M. & Mangione, C. M.

(2002), Effect of Health Beliefs on Delays in Care for Abnormal Cervical Cytology in a Multiethnic Population, J Gen Intern Med, 17(9), 709–716. http://www. pubmedcentral. nih. gov/articlerender. fcgi? artid=1495105 Sotomayor, M. , Pawlik, F. & Dominguez, A. (2007), Building Community Capacity for Health Promotion in a Hipic Community, Prev Chronic Dis, 4(1), A16. http://www. pubmedcentral. nih. gov/articlerender. fcgi? artid=1832126 Weller, S. C. , Galzer, M. , Baer, R. D. (1999), Latino Beliefs about Diabetes, Diabetes Care, 22(5), 722-728. http://care. diabetesjournals. org/cgi/reprint/22/5/722. pdf

NUTRITION AND DIABETES (TYPE-1)

The purpose of this paper is to define diabetes and see the impact different factors like breastfeeding and nutrition have on it state.

DIABETES

Diabetes is a metabolic disorder in which the body is unable to break down insulin, a chemical that the body produces that is responsible to convert sugar, starches and carbohydrates etc in to energy. This results in abnormal sugar production in the body and the patient typically faces the problem of ‘sweet urine’ which is produced excessively. The exact cause of this disease is still unknown as there are a number of hereditary and environmental factors including a low-physical-activity lifestyle and being over weighted.

Types of Diabetes:

The WHO recognizes three major categories of this disorder according to cause and population distribution as Type 1, Type 2 and Gestational Diabetes. Almost 18.3% of US population is affected by diabetes. Of the affected, only 8-10% of patients have type 1 which is more common in children and young adults and the remaining population is reported to be effected by Type 2 diabetes. Gestational diabetes usually occurs in women immediately after pregnancy. Only 5 to 10% of women report this disorder.

Type-1 Diabetes:

Type-1 diabetes typically occurs because the body totally fails to produce insulin at all; hence sugar is not converted in to energy and thus the excess sugar disorder. Type 1 diabetes can occur due to several other reasons. Sometimes, it follows viral infections like influenza, mumps etc or polio attacks. Other times it follows injury to, or surgical procedures like removal of, pancreas etc. Common symptoms include increased thirst, fatigue, excess urination, weight loss, yeast infection (affecting the genitals) etc

This state, if not taken good care of, can dangerously lead to other complications in later stages. Type-1 diabetes exposes a patient to the risk of getting various heart, kidney, oral and eye related disorders including the increased risk of suffering with strokes or heart attacks, damaged kidneys, blindness, gum disease, and some skin problems. Diabetic patients are also vulnerable to several neurological complications including acute depression, diabetic neuropathy etc.

AFFECT OF BREASTFEEDING

It is commonly believed that a diabetic mother can’t breastfeed her newborn. Research proves otherwise. It’s clinically proven that breastfeeding is good for both a breastfeeding mother and the health of the newborn. In fact research has shown that breastfeeding can actually reduce the risk of developing type-1 diabetes in kids [1]. Breastfeeding can actually help mother’s body regulate insulin levels and even lose weight. Therefore the necessity to breastfeed should be emphasized over mothers for healthier babies with reduced risks of developing diabetes. Mothers need to take special care of their health and monitor blood glucose level carefully.

NUTRITION AND DIABETES

The patients need to regulate the amount of sugar intake and include exercise in their routine to properly burn fats and carbohydrates. They can take sugar but need to watch its quantity really carefully. A typical diabetic diet consists of 60% calories from carbohydrates, 20% from proteins and 30% from fats.  Patients are advised to talk through the diet in detail with the doctor. Including the right mix of food and nutrition, patients can live healthy and long.

References

American Academy for Family of Physicians/ FamilyDoctor.org (2006). Diabetes and Nutrition. Retrieved mar 18th, 2009 from   <http://familydoctor.org/online/famdocen/home/common/diabetes/living/349.html>

American Diabetes Association/ diabetes.org (2009). All about diabetes. Retrieved mar 18th, 2009 from <http://www.diabetes.org/about-diabetes.jsp.>

Juvenile Diabetes Research Foundation/ JDRF.org (2009). What is diabetes. Retrieved mar 18th, 2009 from <http://www.jdrf.org/index.cfm?page_id=101982>

Nagin, Melissa Kotlen (2009). The Diabetic Breastfeeding Mother. New York Times Company/ Retrieved mar 18th, 2009 from  <http://breastfeeding.about.com/od/problemssolutions/a/diabetes.htm>

National Diabetes Information Clearinghouse. Diabetes Overview <http://diabetes.niddk.nih.gov/dm/pubs/overview/index.htm>

NetDoctor.co.uk/ Dr Jan Erik Henriksen, Dr Ole. (22.09.2008). Type1 Diabetes. Retrieved mar 18th, 2009 from <http://www.netdoctor.co.uk/diseases/facts/diabetesinsulindependent.htm>