Insulin

Aim: The aim was to look into urinary elimination of Fe, Cu and Zn and their relation with serum insulin in diabetes worlds. Materials and Methods: 40 patients with non-insulin-dependent diabetes, 30 patients with insulin-dependent diabetes and 20 normal healthy topics were investigated for their serum degrees of glucose and insulin and urinary elimination of Fe, Cu and Zn. There was important addition in the urinary elimination of all the three hint elements in diabetic patient. No important correlativity could be found between serum insulin and urinary elimination of Fe, Cu and Zn.

Consequences: The consequences indicate that there is increased elimination of hint elements in diabetes mellitus but it has no relation with serum insulin.

Keywords: Diabetes mellitus, Serum insulin, Trace elements ( Fe, Cu and Zn ) .

Introduction: Trace elements are inorganic elements, which are required in the diet in really little sums, less than 100 mg/day1 and are present in our tissues in merely highly little measures, with the concentration of mcgs to pictograms per gm of moisture organ.2For this ground, they are referred to as hint elements.

Trace elements have indispensable function in normal growing, development and wellness of worlds. They have their function in diverse activities such as haem synthesis, connective tissue metamorphosis, bone development and as indispensable constituent of many enzymes.3In add-on hint elements have besides been shown to act upon the hormone system. They influence the hormone system in different ways depending upon whether the metal is present in surplus or in low province. Therefore, increasing or diminishing the concentration of several hint metals has been shown to act upon the hormonal synthesis, secernment, hormonal precursor consumption into mark secretory organs, endocrine binding to aim tissues and its utilization.4

Diabetess mellitus is most common endocrine disease of worlds and is due to absolute or comparative lack of endocrine, insuline5.Diabetes mellitus is said to be of multifactorial etiology and three meshing mechanisms are thought to be responsible: familial exposure, autoimmunity and environmental factors. Although no definite environmental agent has been identified, the environmental factors implicated include viruses, fleshiness, gestation and vague environmental agents6.

Research findings have emphasized that lack of certain hint elements consequences in diabetes like conditions in experimental animate beings. The hint elements, the lack of which has been shown to ensue in diabetes like symptoms are chromium7,8, zinc9, manganes10,11 and copper12. As the lack of these hint minerals resulted in diabetes like symptoms and the supplementation of the peculiar hint component readily reversed the ascertained symptoms, it can be concluded, from such surveies, that lack of these hint elements adversely influences the synthesis, secernment or action of insulin.

Merely as the hint elements have been shown to act upon the insulin, alterations in the concentration of insulin have besides been shown to act upon or to be associated with alterations in the concentrations of several hint metals in the blood, urine and other tissues. Changing degrees of go arounding endocrine may either change the distribution of hint elements in assorted cellular compartments, or may bring forth a displacement of the metals to the tissues which are non usually associated with these concentration of these elements or they may alter renal or hepatic handling of hint elements ensuing in increased urinary or faecal loss of the hint minerals, thereby bring forthing entire organic structure loss4.

Surveies on “ the consequence of diabetes mellitus on hint component metamorphosis ” have largely been carried out in animate beings, experimental theoretical account for insulin-dependent diabetes mellitus.

Such surveies have revealed that experimental diabetes produces alternations in the absorption13, tissue distribution14, metabolism15 and excretion16 of hint elements. Metamorphosis of Zn, Cu and Fe is greatly influenced and the hormonal instability nowadays in insulin-dependent diabetes is said to be involved in altered hint metabolism14,15. Surveies on human existences are really limited and even the survey which have been carried out, has failed to see any relationship between urinary elimination of hint elements and serum insulin. If it is true that the hormonal instability nowadays in insulin-dependent diabetes is involved in changing hint component excretion16, so there may be a relationship between urinary elimination of hint elements and serum insulin.

The present survey was hence, aimed to look into the serum insulin and urinary elimination of hint elements ( Fe, Cu and Zn ) in normal, insulin-dependent and non-insulin-dependent diabetes in an effort to happen any correlativity between serum insulin and urinary elimination of Fe, Cu and Zn. Study besides included the comparing of all these parametric quantities among diabetic and normal topics.

MATERIALS AND METHODS:

Patients:

70 human diabetics, including both males and females, on out-of-door intervention at assorted outpatient sections and at diabetic clinic, DHQ, Mirpur, AJ & A ; K, Peshawar were studied. Diabetic patients had fasting plasma glucose degree of more than 140 mg/dl or random blood glucose degree of more than 200 mg/dl on more than one juncture.

Patients were divided into two groups depending on manner of intervention: Insulin-dependent and non-insulin-dependent.

20 normal healthy topics with no household history of diabetes were taken as controls.

Both control and diabetic topics fulfilled the undermentioned standards:

Their ages ranged from 25-60 old ages. They were normotensives, with normal nephritic maps and no albuminuria. None of these had open grounds of liver, enteric or endocrinal upset. Subjects holding steroids, or taking any vitamin or mineral supplementation were non included in the survey.

Patients were asked to stop insulin for 24-48 hours and unwritten hypoglycaemic drugs for 5 yearss before roll uping the urine samples.

Collection of blood samples:

Blood was drawn from each patient and normal topic after 10-12 hours fast from an antecubital vena between 8.00-10.00 a.m. Serum was separated within one hr. Glucose appraisal was carried out immediately. Serum for insulin appraisal was stored at -20A°C boulder clay analysis.

Collection of urine samples:

24 hours urine samples were collected in 4-5 litre plastic containers, washed with 15 % HCl and rinsed thrice with deionized H2O. Each patient was provided with a labeled container and a bag in which to transport the container at his or her visit to the infirmary and at the same clip, the patient was asked to stop the intervention, and to get down urine aggregation after 5 yearss in instance of unwritten hypoglycaemic drugs and 24-48 hours, in instance the patient was taking insulin. On the twenty-four hours of blood trying container was collected and the patient was asked about figure of times he or she had missed invalidating into the aggregation container. Merely the urine aggregations reported as complete were used in the analysis. Immediately after aggregation, the volume of each specimen was recorded.

20 milliliter of each urine specimen was centrifuged for 10 proceedingss to take bacteriums, cells, dramatis personaes and other particulate stuffs. 15 milliliter of the supernatant was decanted in plastic bottles and stored at -20A°C boulder clay analysis. It was used for appraisal of Fe, Cu and Zn.

1ml of piss was used for sensing of proteins by chemical method utilizing sulfosalicylic acid. All the glass and plastic ware used were soaked in 15 % HCl overnight and so rinsed thrice with deionized H2O.

Serum glucose was measured by glucose oxidase/peroxidase colorimetric method utilizing analytical kit ( Boehringer Manheim GmbH Diagnostica ) . Serum insulin was measured by RIA utilizing analytical kit provided by Diagnostic Products Corporation, Los Angles, USA.

Urinary Fe was measured by method of Olson and Hamlim17, likewise as for serum. Urinary Cu and Zn were measured by method of Dawson et Al. ( Cited by Varley ) 18. Atomic soaking up spectrophotometer model3030-B Perkin Elmer Company, Norwalk was used for the three hint elements.

Students paired’t ‘ trial was used for statistical analysis.

TABLE-1

AGE, SEX AND WEIGHT OF NORMAL SUBJECTS AND DIABETIC PATIENTS:

The tabular array shows the age, sex and organic structure weight of normal and diabetic patients. The values are average A± s. e. m. The entire figure of topics is given in parametric quantities.

DIABETIC PATIENTS

The patients enduring from diabetes were grouped harmonizing to the manner of intervention. The average serum values A± s. e. m for glucose and insulin in different groups are given. Number of topics is given in parentheses.

TABLE-3

Fast SERUM IRON, COPPER AND ZINC IN NORMAL SUBJECTS AND DIABETIC PATIENTS

Serum Fe, Cu and Zn were measured by atomic soaking up spectrophotometery. Concentrations are expressed as mean values A±s. e. m. Number of topics is given in parentheses.

P & lt ; 0.001 = The Valuess are extremely important as compared to normal control topics.

TABLE-4

COMPARISON OF 24-HOUR URINE VOLUME, URINARY IRON, COPPER AND ZINC IN NORMAL SUBJECTS AND DIABETIC PATIENTS

The values are expressed as average A± s. e. m. Number of topics is parentheses.

P & lt ; 0.001 = Valuess are extremely important as compared to command topics.

Consequence:

Table 1 describes the ages, sex and weight of normal topics and diabetic patients. Age and organic structure weight of insulin-dependent diabetics showed no important difference. While in non-insulin-dependent diabetics it was higher ( p & lt ; 0.001 ) as compared to controls.

Fasting serum glucose and immunoreactive insulin in normal topics and diabetic patients are shown in table 2. There is significance addition in serum glucose degrees in diabetic patients ( p & lt ; 0.001 ) and this addition is more pronounced in insulin-dependent diabetics as compared to non-insulin-dependent diabetics.

Serum insulin is significantly increased in non-insulin-dependent diabetics ( P & lt ; 0.001 ) , while in insulin-dependent diabetics, the serum insulin is significantly decreased ( p & lt ; 0.001 ) as compared to normal controls.

Table 3 describes the 24 hours urinary volume and elimination of Fe, Cu and zinc/24 hours in normal topics every bit good as diabetic patients. The consequences of this tabular array indicate that urine volume is significantly increased in diabetic patients as compared to normal topics ( P & lt ; 0.001 ) and this is significantly higher in insulin-dependent diabetics as compared to non-insulin-dependent diabetics ( P & lt ; 0.001 ) . 24 hours urinary elimination of Fe, Cu and Zn is besides significantly increased in both the classs of diabetes ( P & lt ; 0.001 ) , with significantly more elimination in insulin-dependent diabetics ( P & lt ; 0.001 ) than non-insulin-dependent diabetics.

Table 4 gives the urinary elimination of Fe, Cu and Zn per millilitre, in normal and diabetic topics. The consequences indicate that urinary elimination of Fe, Cu and Zn per millilitre is besides significantly increased in diabetics as compared to controls and once more this addition is significantly more pronounced in insulin-dependent diabetics than in non-insulin-dependent diabetics.

Discussion:

Marked alterations in hint component metamorphosis have been demonstrated in streptozotocin-diabetic rate14,15.

Prolonged streptozotocin induced diabetes besides interferes, with normal form of bone mineralization19.

Increased elimination of Fe, Cu and Zn has been reported in experimental diabetes in rates16. Surveies of triumph et al.20 provided direct grounds of influence of hormonal instability on hint metals.

Our findings support and widen the old work. Zinc elimination among normal topics is 420.07A±14.7 Aµg/day and is in conformity with the by and large stated average Zn elimination of 300-600 Aµg/day18. Similarly urinary elimination of Fe and Cu is besides within the normal international mention scope.

Consequences besides demonstrate that diabetic status is associated with increased 24 hours urinary elimination of the three micronutrients zinc, Cu and Fe. Among the diabetics in both insulin-dependent and non-insulin-dependent diabetics average elimination was in surplus of 600 Aµg/day. Similarly Fe and Cu elimination was besides significantly higher in both the insulin-dependent and non-insulin-dependent diabetics as compared to controls. Hyperzincuria has antecedently been reported in diabetic humans21.22.23.24.

Although exact mechanism of increased urinary elimination has non been elucidated, assorted possible mechanisms have been proposed. Diabetic status consequences in increased glomerular filtration rate and it is suggested that such an change in nephritic map may lend to the increased urinary losingss of the hint elements16. But, the observation that addition in urine volume brought approximately by imbibing extra H2O did non change the entire urinary Zn elimination in non-diabetics21 would on the other manus indicate that the polyuria of diabetes may non be an of import determiner of Hyperzincuria or increased elimination of other hint elements in diabetes. This is farther supported by fact that when the concentrations were expressed per millilitre of piss, statistically important differences were still observed.

Increased urinary loss of Fe Cu and Zn could be explained by increased dietetic consumption but urinary loss of Fe, Cu and Zn varies small with dietetic consumption because the predominant healthy excretory path in healthy adult male is the enteric piece of land. Increased urinary elimination reflects acute alterations in biologic stores25. No addition in urinary Zn has been seen when dietetic consumption is doubled in human topics. The surplus is eliminated via the feces24. The possibility of difference between diabetics and normal in their selective soaking up of hint elements in the intestine can non be ignored but information on this facet is non available.

Pidduck et al.24 has proposed three possible mechanisms.

It could be that Hyperzincuria or increased elimination of Fe and Cu indicates an abnormalcy of production or dislocation of metalloenzymes or metal-enzymes composites.

It is possible that some portion of organic structure is bring forthing its ain metabolites with chelating belongingss, it could be the pancreas of the diabetic which is disorganized in the manner, suggested.

Family surveies suggest a important heritability of urinary Zn elimination in 19 households. Some households be givening to be low urinary Zn excreters and others high. It would look possible that urinary elimination of Zn or perchance other hint elements is controlled by allelomorphs at a figure of venue and that diabetics possess a different mixture of allelomorphs to those possessed by non-diabetics.

It is besides believed that increased elimination is chiefly of endogenous beginning for illustration, musculus breakdown16 or diabetic bone loss. However, the bone mineral loss in diabetics can merely account for less than 10 % of the diabetic hyperzincuria22. Urinary Zn losingss are specially increased during katabolic states26.

Intense exercising may increase urinary losingss and it has been shown that exercising additions skeletal musculus protein dislocation and such phenomena could increase urinary Zn losses27. Zinc elimination is shown to increase under assortment of katabolic conditions and Zn is reported to be derived from skeletal musculus. Although the surveies have been carried out for Zn, the skeletal musculus protein breakdown my lead to increased, urinary elimination of Fe and Cu.

Untreated diabetes may stand for a katabolic province and addition in skeletal musculus protein turnover and it is likely that urinary elimination of Fe, Cu and Zn may be derived from skeletal musculus tissue.

As none of the patients had albuminurias, the increased urinary losingss of these trace metals may possibly be due to altered hormone position seen in diabetes and non due to diabetic kidney disease. This decision is supported by fact that improved metabolic control in diabetic rats by insulin intervention resulted in significantly reduced elimination of Fe, Cu and Zn in the urine16 in diabetic worlds in the Restoration of normozincuria16.

No relation could be found between serum insulin and day-to-day urinary elimination of Fe, Cu and Zn in either normal persons or diabetic patients. This may be due to the ground that endocrine relationships in uncontrolled diabetes become extremely complex because glucagon and glucocorticoids degrees are increased in response to insulin lack. Both of these are shown to act upon the serum or urinary degrees of hint elements. Other ground may be that the go arounding immunoreactive insulin in diabetics may non be active biologically.

Non-insulin-dependent diabetes had significantly higher organic structure weight every bit compared to controls. Association between increased organic structure weight and no-insulin-dependent diabetes has antecedently been described26. Obesity is of much greater importance than either race or sex in the etiology of non-insulin-dependent diabetes29. Therefore, a recommendation against going fleshy might be given. A sum of 25 patients ( 35.7 % ) out of 70 had a positive household history of diabetes. High per centum of patients holding positive household history of diabetes suggests a insouciant relationship of this factor with the disease.

This survey may hold clinical and pathological deductions. If there is increased elimination of hint elements in diabetes, this may connote that when dietetic degrees are deficient, the patient ‘s tissues are depleted in favour of increased urinary elimination. In this instance, it is speculated that physiological degrees of these foods may be low and some of the pathological events seen in diabetics may be related to or partially explained by lack of these hint elements. For illustration, there is increased incidence of inborn deformities in diabetic pregnancy30 and lack of Cu and Zn has besides been reported to be associated with inborn malformations31.

Copper lack is associated with impaired collagen synthesis and increased incidence of breaks. Increased incidence of self-generated breaks has besides been reported in diabetes19. But verification of cause and consequence relationship of these phenomena necessesitates farther surveies.

Diabetes is a disease in which the body does not produce or properly use insulin. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. This Metabolic disorder causes the body to lose its main source of fuel considering that the blood contains large amounts of glucose (since diabetic people are usually obese people or people who have large contents of glucose in their bodies). After digestion, glucose passes into the bloodstream, where it is used by the human cells for growth and energy.

In order for glucose to get into cells, a hormone called insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. Insulin is a hormone that is needed to convert sugar, starches and other food into energy (glucose), this substance is essential for a human being’s continued existence. Upon food consumption, the pancreas automatically produces the right amount of insulin to move and synthesize glucose from the blood into the human cells.

However, the pancreas either produces little or no insulin for people affected with diabetes, the cells in these cases do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine. This causes the glucose to be discharged out of the human body in the form of urine. This is basically a metabolism disorder – the problem lies with how the food is digested by the human body ingesting it (National Diabetes Clearing House).

There are 2 main types of Diabetes; the first being known as “Insulin dependent diabetes” or what is now being termed as “Type 1 diabetes”, and the second type known as “Non- insulin dependent diabetes” also known as “Type 2 diabetes”. II. Type 1 Diabetes (Insulin Dependent Diabetes) Type 1 Diabetes (Insulin-dependent diabetes) is a disorder best characterized with the occurrence of frequent urination, extreme thirst, constant hunger, blurred vision, and extreme fatigue on the part of the subject.

This strain unlike the type 2 diabetes strain is most prevalent in young individuals, who usually contract this disease around the age of 14. Type 2 diabetes is in contrast acquired during the latter stages of an individuals life probably due to an unhealthy lifestyle. The Insulin dependent diabetes strain — accounts only for approximately 5 percent or less of diabetes in the U. S. (Armstrong, C. 1990). People affected with Type 1 Diabetes like others affected with other diabetes strains, have defective pancreas glands.

These glands are supposed to be the ones which secretes the insulin hormone. The insulin hormone is the hormone which facilitates the conversion of Glucose to a form which allows for assimilation by the human cells. Since the pancreas releases a very limited amount of insulin (in some cases none at all) the glucose which is not assimilated is diverted to the bloodstream to be excreted by the kidneys in the form of urine. It is on this stage that the kidneys, would be forced to try to remove the excess sugar, excreting large amounts of water and essential body elements in the process.

Kidney failure, and Heart problems are among those complications which may arise from the said illness. Modern Science has allowed type 1 diabetes victims another lease on life when alternative medical solutions were developed. As of the moment the only cure available today for type 1 diabetes is a pancreas transplant, which is needless to say quite dangerous, expensive and very rarely done. However, even if the said transplant was a success (new pancreas is rejected by half of the people who get this operation), the organ which was transplanted, incur a very high risk of being rejected by the subject’s body.

If rejection occurs (as in most cases) this would entail constant usage of suppression drugs to maintain immune reaction suppression. The side effects of immune-suppressive drugs can be very severe and even worse than the disease. Statistics show that one or two people out of every 10 who get the surgery die within a year. Of course it follows that if the surgery fails the disease would eventually return. Recently, experimental treatments with stem cells have shown some promise. For most people, type 1 diabetes is a life-long disease that can be effectively managed with insulin.

Margolis S. 2006. ) II. Non-Insulin-Dependent Diabetes The Non-insulin dependent diabetes strain also known as type 2 diabetes is the most common form of diabetes. Some complications of type 2 diabetes would include: heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy). The main difference between the first and second strain of diabetes is that the first one occurs in the early phases of an individuals life, while the latter occurs usually in the later stages.

This type of diabetes is preventable but un-curable unlike the first type. It is a possibility for a human being to actually be affected with this kind of disease without actually knowing it. Scientists nowadays are still looking into the factors which may have caused insulin resistance. Unfortunately, the answer to this question is yet to be unearthed. In the case of Type 2 diabetes, the problem would either be caused by the fact that the body does not produce enough insulin or it may be that the cells ignore the insulin.

It was found out by common observation and research that the frequency of occurrence of this disease usually occurs among obese or overweight individuals. It is a known fact that most people who develop this type of diabetes are overweight. Scientists are still looking for a clue as to why obesity increases the risk of developing diabetes, but the common consensus agreed upon is that obesity is a major factor leading to non-insulin-dependent diabetes.

Scientists are continually studying cells to see why this might happen (What Causes Non-insulin Dependent Diabetes? . The usual symptoms to identify whether if an individual is affected or not would be the Increased thirst and frequent urination, Extreme hunger, Rapid weight loss, Fatigue, Blurred vision, Slow healing sores or frequent infections, and in some cases Patches of dark velvety skin in the folds and creases of Subject’s bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, is a sign of insulin resistance (Mayo Clinic Staff, 2007).

In this particular strain of diabetes the only possible action which could be done is prevention, since as mentioned earlier there is no known cure to this chronic disease. To combat the effects of this disease, the advisable things to do would be to watch or monitor the level of blood glucose, proper exercise, good eating habits, and occasional insulin dosages. Apparently the said measure is capable of reducing the risk and dangers brought about by complication of this disease to about 50% (Mayo Clinic Staff, 2007). III. Conclusion

Diabetes is a chronic disease which still baffles even the most learned of physicians since as far as technology is concerned, the immediate, reliable and consistent cure is yet to be had. As far as affected individuals are concerned the best cure is still prevention, and this could be done by living a healthy lifestyle (eating healthy food and proper exercise), and by taking necessary medication. The hope that the cure is on the verge of being discovered still looms on the horizon. Hopefully, the said cure would be found soon to relieve the millions suffering worldwide.

Human life is marked with many difficult conditions which are costly to deal with and can leave some one desperate and hopeless with life. One of these conditions is diabetes which is defined as an illness generally characterized by the presence of sugar in the urine or excessive water in the urine, depending on the type of diabetes. It is a complex condition that has been on the fore front of scientific research and scientists have in the recent past introduced several measures . which when put in practice can reduce the corresponding complication of this condition which otherwise could result to premature loss of life.

It is in this interest that this research paper is written and it focuses on the current developments pertaining to diabetes as a condition. It gives a brief introduction, defines the different type of diabetes, causes, symptoms and the current impacts of diabetes to the society and economy. It also gives the current preventive measures aimed at reducing the effects of this condition. Types of diabetes Diabetes is defined as an illness which is generally characterized by the presence of glucose in the urine. There are three fundamentally different types of diabetes.

Type 1 diabetes is associated with the failure of the body (Cummings, & Decoster, 2005). It occurs when body’s infection fighting system fails against a particular part of the body. In this case, the pancreas is affected and rendered capable of only producing little or no insulin. Most victims of this type of insulin are young adults and children. This type of diabetes requires the injection of insulin for life time. The second type of diabetes is referred to as type 2 and is the most popular type of diabetes. It results from the resistance of the body to utilize the available insulin (Walker, et al, 2005).

It is insulin independent and is associated with the old age, overweight and family history. On diagnosis, the pancreas is found to produce enough insulin but with time the insulin production decreases and there it also accommodates type 1 diabetes with time. The last type of diabetes is gestational and is commonly developed by pregnant women. It is associated with historical diabetes back ground and can result to diabetes type 2. Causes of diabetes Over time, scientist have tried to found out the major causes of diabetes but up to date there is no clearly identifiable solution to this importance issue (Judd, Fox, & Sonksen, 2003).

However, several factors have been identified as risk and should be overcome by everybody who is conscious of diabetes and wiling to eliminate it. The question of whether diabetes is hereditary is not clear but some research studies have shown that if a family is known to have been affected by diabetes then there is a high probability of passing the disease to the young generation (Judd, Fox, & Sonksen, 2003).. Diabetes type 2 is commonly transmitted through hereditary. But can be prevented if the blood sugar level of the pregnant mother is controlled to normal.

This makes it difficult for it to be passed to the child. Another major factor responsible for causing diabetes is diet. Eating a lot of starch, proteins and fats is risk to health (Decoster, 2001). A balanced diet is therefore essential for producing the necessary energy sufficient for the required body function. Eating much of these foods renders the pancreas incapable of producing enough insulin and hence an increase in the blood sugar level leading to diabetes. Excessive body weight which his often referred to as obesity is also known to another factor responsible for the cause of diabetes.

Obesity means that there is excess fat in the body and insulin produce is insufficient to break down these fats to energy and this can amount to increased blood sugar level and hence diabetes (Decoster, 2001). Further to this, various viral infections are can affect the proper functioning of the pancreas and hence the production of insulin. This undoubtedly can lead to diabetes. In addition to this age, frequent smoking and emotional stress are other commonest causes of diabetes. As a person gets old, he becomes less active, increases in weight resulting to kidney failure (Zieve, & Wexler, 2009).

Emotional stress affects the metabolic system and can alter the glucose level in the body. Heavy smoking affects joint mobility and metabolism and can result to alteration of the blood sugar level in the body. Symptoms of diabetes Diabetes type 1 is marked by symptoms which developed within a very short time despite the fact that destruction of beta cells earlier. The common symptoms are increased urination and desire to drink water, high rate of loss of weight, constant hunger, high fatigue and blurred vision (Ligaray, & Isley, 2010). Diabetes type is characterized by gradual development of symptoms.

These symptoms include slow healing of wounds, often infections, increased thirsty and loss of weight and fatigue. Prevention and cure of diabetes Up to date, a cure for diabetes type 2 has not yet been found but type1 can be cured by pancreas or beta cells replacement. Since it is insulin dependent, it can be suppressed by daily injection of insulin to sustain life (Judd, Fox, & Sonksen, 2003). Type 2 cannot be cured since it is insulin independent but can be prevented and managed through the following methods. One is by controlling deity.

Eating a well balanced diet reduces the chances of increasing the blood sugar level and hence increasing the chances of getting diabetes or more complications for the diabetic people. Another mechanism of preventing the development of diabetes or diabetic related complications is by preventing obesity. This is achieved by doing exercise and eating less fat. Good diet and reduction of weight will slow the aging process which has been described as a factor responsible for the cause of diabetes (Cummings, & Decoster, 2005). Still, quitting or reducing smoking and avoiding emotional stress helps in maintaining the blood sugar content normal.

Lastly is carrying out a diabetic test and following the instructions of the doctor. This is because diabetes is easily managed when diagnosed at early stages. Complication and Impact of diabetes Diabetes in the recent past was declared a world deserter and pledged with the international community to join hands in compacting diabetes. Some of the complications that can be developed as a result of diabetes are; damage of the retina hence loss of sight, damage of the kidney and therefore kidney failure, damage to the nervous system and hence mental retardation and lastly is high and low blood pressure (Walker, et al, 2005).

Conclusion In conclusion therefore, diabetes is a chronicle condition which should be addressed by the international community because of the incurable complications it can bring to the body. The three types of diabetes discussed above are more preventable than curable and therefore it is the responsibility of everyone who is conscious of his health to control diet, do physical exercise and often have a test of the blood sugar level.

Text Version- ABCDEFG Algorithm Look A Airway B Breathing C Circulation

For any signs of airway obstruction For evidence of mouth/neck/swelling/haematoma For security of artificial airway Look At the chest wall movement, to see if it is normal and symmetrical To see if the patient is using their neck and shoulder muscles to breathe (accessory muscles) At the patient to measure to measure their respiratory rate Look At the skin colour for pallor and peripheral cyanosis At the capillary refill time At the patient’s central venous pressure and jugular venous pressure Look At the level of consciousness For facial symmetry, abnormal movements, seizure activity or absent limb movements At pupil size, equality and reaction to light Listen For noisy breathing e. g. gurgling, snoring or stridor Feel For the presence of air movement For security of artificial airway Feel For the position of the trachea to see if it is central For surgical emphysema or crepitus If the patient is diaphoretic (Sweaty) Listen To the patient talking to see if they can complete full sentences For noisy breathing e. g. stridor, wheezing

Listen To the patient for complaints of dizziness and headaches For patient’s blood pressure and heart sounds Feel Your patient’s hands and feet to see if they are warm or cold Your patient’s peripheral pulses for presence, rate, quality, regularity and equality. Feel For patient’s response to external stimuli For muscle power and strength D Disability Listen To patient’s response to external stimuli and pain For slurred speech For patient’s orientation to person, place and time. E F Exposure Fluids G Glucose Give oxygen Position your patient Call for help if you can’t manage Never leave a deteriorating patient without a priority management and review plan Look Listen Feel For any bleeding e. g. nvestigate wounds and drains For air leaks in drains The patients abdomen that may be hidden by bed clothes For bowel sounds Look Listen Feel At the observation and fluid charts, noting the fluid For patient’s complaints of thirst The skin turgor input and output At losses from all drains and tubes At the amount and colour of the patient’s urine and urinalysis results Look Listen Feel At blood glucose levels For patient’s complaints of thirst If the patient is diaphoretic, (sweaty, cold or clammy) For signs of low glucose, including confusion and For patient’s orientation to person, place and time decreased conscious state At medication chart for insulin and oral hypoglycaemics Based on your assessment (above) decide an appropriate oxygen flow rate or percentage.

If in doubt commence on 4L/min on a Hudson mask and increase as indicated by oxygen saturation or patient condition. Position your patient to optimise their breathing-usually this is as upright position as possible and as tolerated by the patient. Place the patient in the left lateral position if they are unconscious but have adequate breathing and circulation and where there is no evidence of spinal injury Establish IV If not present, +/- fluids Document and communicate clearly all treatment provided, outcomes of treatment implemented what care is still required The plan should include expected outcomes and when the patient will be reviewed again.

Case Study Type 2 Diabetes Mellitus Y. L. makes an appointment to come to the clinic where you are employed. She has been complaining of (C/O) chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she as a vaginal yeast infection that she has treated numerous times with the over-the-counter (OTC) medication. She admits to starting smoking since going back to work full time as a clerk in a loan company essay writer world.

She also complains of having difficulty reading numbers and reports making frequent mistakes. She also says, “By the time I get home, and make supper for my family, then put my child to bed, I am too tired to exercise. ” She reports her feet hurt, they often “burn or feel like there are pins in them. ” She reports that, after her delivery, she went back to her traditional eating pattern, which is high in carbohydrates (CHO). In reviewing Y.

L’s chart, you notice she has not been seen since the delivery of her child 6 years ago. You note that in her 26th week of pregnancy she was diagnosed with gestational diabetes mellitus (GDM). You also note that she is 5’3” and her pre pregnancy BMI was 25. Her father has type 2 diabetes mellitus and both paternal grandparents had type 2 DM. She has gained considerable weight; her current weight is 173 pounds. Today, her blood pressure is 152/97 mm Hg, and her plasma glucose is 291 mg/dl.

Her primary care provider (PCP), which of course is a Family or Adult Nurse Practitioner, orders the following labs: urinalysis, hemoglobin A1C, fasting complete metabolic panel (CMP), CBC, fasting lipid profile, and glomerular filtration rate (GFR). The lab values are as follows: fasting glucose 184 mg/dl, Hb A1C 10. 4, UA +glucose, -ketones, cholesterol 256 mg/dl, triglycerides 346 mg/dl, LDL 155 mg/dl, HDL 32 mg/dl, ratio 8. 0. A subsequent fasting glucose is also elevated and Y. L is diagnosed with type 2 diabetes mellitus.

After meeting with Y. L. and discussing management therapies, the PCP decides to start multiple-dose injection (MDI) insulin therapy and have the patient count CHO. Y. L. is scheduled for education classes and is to work with the diabetes team to get her blood glucose under control. You may use your text book and you must also use 2 additional references (not Wikipedia). List your references at the end. Refer to the rubric for guidance. Double space and make sure your name is on the attachment. 1. Identify the three methods used to diagnose DM.

The recommended screening and diagnostic test for diabetes is to measure fasting plasma glucose, oral glucose tolerance test, and use of the glycated hemoglobin A1c measurement (A1C). The American Diabetes Association provides criteria for diagnosing diabetes and are as follows: In nonpregnant adults: symptoms of diabetes and casual plasma glucose greater than or equal to 200 mg/dl, or fasting plasma glucose greater than or equal to 126 mg/dl, or 2-h plasma glucose greater than or equal to 200 mg/dl during an oral glucose tolerance test.

Certain individuals should be screened more often (every 1-2 years) than others when they have any of these following issues: overweight (BMI greater than 25), history of gestational diabetes, history of vascular disease, first-degree relative with diabetes, high-risk ethnic group, previously found to have impaired glucose tolerance or impaired fasting glucose, and signs of insulin resistance, such has acanthosis nigricans, hypertension, dyslipidemia, or polycystic ovary syndrome. The patient Y. L. has many of these issues that qualify her for screening. She is overweight, (BMI 30. ),she is hypertensive, she has a history of gestational diabetes, her father has diabetes. Y. L. was diagnosed with DM with an A1C of 10. 4, fasting glucose of 184 mg/dl, and a subsequent fasting glucose that was also elevated. 2. Explain Type 2 DM. Type 2 DM has a complex pathology. Most individuals with Type 2 DM have insulin resistance combined with varying degrees of insulin deficiency (according to the American Diabetic Association). Later in diabetes, insulin deficiency is often more pronounced. . When there isn’t enough insulin or the insulin is not used as it should be, glucose can’t get into the body’s cells.

When glucose builds up in the blood (hyperglycemia) instead of going into cells, the body’s cells are not able to function properly. Other problems associated with the buildup of glucose in the blood include: damage to the body such as damaged nerves and small blood vessels of the eyes, kidneys, and heart. High levels of glucose also predispose a person to atherosclerosis of the large arteries that can cause cardiac arrest and strokes. The build up of glucose in the blood can also cause an increase in urination. Most patients with Type 2 DM are overweight with increased abdominal adipose tissue.

It’s most commonly seen in adults. The onset of Type 2 DM is usually slow and progressive. Early symptoms of Type 2 DM include bladder, kidney, skin, or other infections that are more frequent or heal slowly, fatigue hunger, increased thirst, increased urination, blurred vision, erectile dysfunction, and pain or numbness in the feet or hands. The patient Y. L. presents with all of the symptoms, with the exception of erectile dysfunction. Treatment for T2 DM should include modifying lifestyle with monitoring and controlling blood glucose levels, appropriate diet changes, weight control and exercise.

An insulin regimen is also used to treat T2 DM. 3. Discuss the lab results and how they relate to or impact DM. The patient’s A1c was 10. 4. In terms of her history, take a look at her Hemoglobin A1c. This indicated that her blood glucose level has been elevated consistently of an extended period of time. The A1c is an indication of glycosylation in the body which is damaging to the blood vessels and peripheral nerves. It causes thickening of the basement membrane which will impair oxygen transport to the tissues and carbon dioxide removal. Oxygen is the source of all life to all living tissues.

Any pathologic condition that affects the delivery of oxygen will eventually result in cell damage and ultimately death if not corrected. This is why you will see poor wound healing and necrotic lesions in diabetics. The circulation to distal tissues is impaired because of glycosylation. Her high HgbA1c is an indication of increased risk for neuropathy and micro/macrovascular damage. This correlates with her complaints of pain in her feet. Her blood pressure is elevated, 152/97. A high blood pressure is damaging to organs, because constricted blood vessels will decrease tissue perfusion.

This patient’s fasting lipid profile is also elevated. Her HDL was 32 mg/dl, LDL 155, ration 8. 0. These elevated levels are probably resulting in plaque accumulation in her vascular system, which will further impede circulation and tissue perfusion. Her high triglycerides are probably resulting from her excessive carbohydrate consumption. Her fasting blood glucose level of 184 mg/dl is also damaging, because elevated blood glucose indicates the body’s poor performance of utilizing glucose. This can be a result of an insufficient amount of produced or the body’s resistance to nsulin. Regardless, without insulin, the body is unable to carry glucose into the cells. The elevated blood glucose decreases tissue perfusion, further damaging organs. 4. Discuss hemoglobin A1C. Use of the glycated hemoglobin A1c measurement is a standardized test for monitoring glucose in patients with diabetes. A markedly elevated A1C is virtually diagnostic of diabetes. Hemoglobin A1c provides an average of your blood glucose control over a six to 12 week period and is used in conjunction with home blood glucose monitoring to make adjustments in your diabetes medicines.

Hemoglobin is a substance within red blood cells that carries oxygen throughout your body. When your diabetes blood glucose is not controlled), sugar builds up in your blood and combines with your hemoglobin, becoming “glycated. ” Therefore, the average amount of glucose in your blood can be determined by measuring a hemoglobin A1c level. If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher. For people without diabetes, the normal range for the hemoglobin A1c test is between 4% and 5. 6%. Hemoglobin A1c levels between 5. 7% and 6. 4% indicate increased risk of diabetes, and levels of 6. % or higher indicate diabetes. Because studies have repeatedly shown that out-of-control diabetes results in complications from the disease, the goal for people with diabetes is a hemoglobin A1c less than 7%. The higher the hemoglobin A1c, the higher the risks of developing complications related to diabetes. 5. Identify three functions of insulin. Three functions of insulin are to allow glucose to pass into the cell where it can be used for energy, to “turn off” excess production of glucose in the liver, and to “turn off” fat breakdown which results in the breakdown of ketones. . Insulin’s main action is to lower blood glucose levels. Several hormones produced in the body inhibit the effects of insulin. Identify three and explain. 7. Y. L. was started on lispro (Humalog) and glargine (Lantus) insulin with CHO counting. Explain the action of both. What is the most important point to make when teaching the patient about glargine? 8. Because Y. L. has been on regular insulin in the past, you want to ensure she understands the difference between regular and lispro. What is the most significant difference between these two insulins? . What is the peak time and duration of lispro insulin? 10. Y. L. wants to know why she can’t take NPH and regular insulin. She is more familiar with them and has taken them in the past. Explain the advantages of glargine and lispro over NPH and regular insulin. 11. Y. L. ’s culture prefers foods high in CHO. What is CHO counting, and why would this method work well for Y. L.? 12. Which of the symptoms that Y. L. reported today led you to believe she has some form of neuropathy? 13. Discuss foot care in DM. 14. What findings in Y. L. s history place her at increased risk for the development of other forms of neuropathy? 15. What are some changes that Y. L. can make to reduce the risk or slow the progression of both macrovascular and microvascular disease? Explain macrovascular and microvascular disease. 16. Y. L. is enrolled in a smoking cessation class. Why is it so important that she stop smoking? 17. Discuss the financial impact of DM (include cost of insulin, strips, meters, etc. ) 18. What additional medication (other than DM medication) might the PCP prescribe and why? 19.

Discuss 2 different classes of oral medication for DM. 20. Discuss nephropathy in DM. 21. Discuss yeast infections in the patient with DM. 22. Discuss how exercise benefits a patient with DM. 23. Y. L. has questions about the injection. She states she developed a “large knot in her leg when she took insulin injections during her pregnancy”. What instructions will you give Y. L.? 24. Discuss 2 alternative therapies that have been used in the treatment of diabetes. 25. How does acute and chronic stress impact DM? Adapted from a Mosby Critical Thinking case study.