Diabetes mellitus (DM) is a family of diseases that is typified by chronic hyperglycemia and the development of long-term complications. Decreased insulin action is characteristic of all forms of diabetes mellitus (Winter & Sognorino 2002). DM usually has its onset in individuals before the age of 25 years, where the essential abnormality is related to absolute insulin deficiency (Venes 2009). Diabetes is a systemic disease that has harmful effects on several organs with potentially devastating effects on a person’s health (2002). In people with DM, there can be adverse effects on the retina, glomeruli, nerves, and arterial blood vessels. This can lead to high morbidity and premature mortality (2002). In general, DM is becoming more and more common in the United States as well as the rest of the world. This is most likely due to the prevalence of foods that are higher in fat and calories and a general lack of exercise among individuals (2002). DM has become such a problem due to the aforementioned facts that even the pediatric population is affected.
Incidence.
DM is a term for a family of disorders characterized by chronic carbohydrate intolerance and the development of long-term medical complications (Winter & Signorino 2002). Health care providers are very concerned about diabetes mellitus and all specialties of medicine treat patients with this disorder — from GPs to pediatricians to gynecologists and cardiologists — among others (2002). The problem is growing as about 2,200 Americans are diagnosed with diabetes every single day (2002) and it is estimated that around 5.4 million people are diagnosed (2002).
Pathophysiology.
Glucose is the energy “currency” that the body uses (Winter & Signorino 2002). Just like a river shouldn’t dry up or flood, the same is true with glucose in the body. For example, drought would be represented by low blood glucose concentrations (hypoglycemia), which can be life threatening or fatal if the case is severe because the brain cannot function properly unless it is constantly getting glucose (2002). Flood, on the other hand, would be represented by high blood glucose concentrations (hyperglycemia). When hyperglycemia is persistent, this is when DM is diagnosed (2002). In general, the body must keep its blood glucose concentrations in a narrow range [60-209 mg/dL (3.3-6.1 mmol/L) during fasting] to avoid hypoglycemia and hyperglycemia (2002). Hormones control blood glucose concentrations that regulate the rates of glucose production and glucose consumption (2002).
If someone is diagnosed with diabetes, the amount of blood glucose is too high, which creates a condition called hyperglycemia. This happens for one of two reasons: 1) the body is producing no insulin — Diabetes Type 1; and, 2) the cells do not respond correctly to the insulin — Diabetes Type 2 (Medical News Today 2009).
In Type 1 Diabetes, the individual’s own body has destroyed the insulin-producing beta cells in the pancreas (Medical News Today 2009). This is known as an autoimmune disease. Any time one’s own body destroys something good in the body is the sign of an autoimmune disease. Because a person with Type 1 Diabetes has a body that is destroying something good, it is considered an autoimmune disease (2009). Therefore, people who have Type 1 Diabetes have to take insulin every single day in order to stay alive. Diabetes Type 1 is not the result of a person’s lifestyle either. It is not preventable, in other words.
Diabetes Type 2 is characterized by one of two main problems — and sometimes both problems together: 1) Not enough insulin is being produced in the body; and, 2) the insulin is not working properly, which is known as insulin resistance (Medical News Today 2009). Unlike Diabetes Type 1, Diabetes Type 2 can be prevented as it is almost always caused by an unhealthy, overweight and unfit lifestyle. It usually occurs in people who have been overweight for quite some period of time and it tends to show up later in a person’s life. However, there have been more and more cases in recent history where people in their 20s are developing Type 2, yet it is still relatively uncommon (2009). Approximately 85% of all diabetes patients have Type 2 Diabetes (2009).
Prognosis.
Diabetes has intrigued medical professionals for ages. A condition that produces excessive thirst, constant urination, and severe weight loss, diabetes mellitus was almost always fatal until the early part of the twentieth century (Poretsky 2010). The most important feature in preventing the complications of DM is early diagnosis, according to Lebovitz (2003). This is especially important in type 2 or late-onset autoimmune type 1 diabetes because these types of disorders start with a relatively asymptomatic period that can last anywhere between 5 and 10 years (2003).
Diabetes is a chronic disease, however, the symptoms can be helped and people can have a long, healthy life with DM if they take the proper steps in caring for themselves (Venes 2009). The isolation and the subsequent production of insulin in 1922 by F.G. Banting and C.H. Best, Canadian physicians, made it possible for people with DM to lead a normal life (2009).
Treatment methods.
There are several different types of medicines that are used for treating diabetes. Each group of medicines work in different ways and more than one may be taken at a time. For example, sulfonylureas help a person’s pancreas make insulin. They can be taken once or more a day (Milchovich & Dunn-Long 2007). Meglitinides are another type of medication that helps the cells in the pancreas increase the production of insulin (2007). DPP-4 Inhibitors have a few different actions: 1) they lower blood sugar, especially right after meals and between meals; 2) they improve the amount of insulin produced by the pancreas; and, 3) they decrease the amount of sugar made by the liver, especially at meal time. DPP-4s are used to treat Type 2 diabetes and there are several side effects of using them (e.g., stuffy or runny nose; sore throat, cold; headache; stomachache; and, diarrhea) (2007). Byetta/Exenatide is in the category of Incretin Mimetic medication and it has several actions as well: 1) it helps produce insulin in the pancreas right after a meal; 2) it stops the liver from producing too much sugar when it is not needed; 3) it slows the rate in which food leaves the stomach; and, 4) it helps with weight loss (2007).
Another way for a patient to get insulin is through an insulin pump (Milchovich & Dunn-Long 2007). These pumps are battery operated and about the size of a pager, only weighing a few ounces (2007). Insulin is quickly delivered to the body through a thin plastic tubing into a needle that is inserted under the skin in the abdomen. This needle is changed every 2 days. A steady amount of insulin (basal insulin) is given constantly and additional doses of insulin (boluses) are given at mealtimes (2007). The blood sugar must be tests frequently throughout the day and the pump must be adjusted to deliver the right amount of insulin that the body needs (2007).
Insulin pumps are great for patients because they actually provide better blood sugar control because of the constant infusion of insulin into the body, as well as the constant monitoring of blood sugar and the frequent adjustment of insulin doses (2007).
A person with DM must not only take medication, but he or she must also do other consistent practices such as following a meal plan, exercising, and testing blood sugar (Milchovich & Dunn-Long 2007).
For a patient with DM, the best thing he or she can do is to learn to recognize symptoms of low blood sugar — for example, confusions, sweating, and heart palpitations — as well as those symptoms of high blood sugar — for example, polyuria and polydipsia (Venes 2009).
In order to prevent complications related to DM, patients should avoid smoking, manage their serum lipid levels on a regular basis, and keep hypertension under control (failure to do so could result in a risk of atherosclerosis) (Venes 2009). Receiving regular vaccinations to prevent influences and pneumococcal pneumonia is also another vital step that patients with DM must take in order to stay as healthy as possible and avoid complications of DM (2009).
Cost.
According to the American Diabetes Association (2007), the national cost of diabetes (as of 2007) exceeds $174 billion. This estimate includes $116 billion in excess medical expenditures related to diabetes, as well as $58 billion in reduced national productivity (2007). People who are diagnosed with diabetes have, on average, medical expenditures that are estimated to be 2.3 times higher than the expenditures would be for a person who did not have diabetes (2007). An estimated $1 in $10 health care dollars is ascribed to diabetes (2007). Indirect costs of diabetes include increased factors like absenteeism, reduced productivity, and lost productive capacity because of early mortality (2007).
Current research.
Lebovitz (2011) notes that patients with Type 2 DM, the most common form of diabetes, are normally treated with pharmacologic agents in combination with lifestyle modifications. The development of new antidiabetic agents — for example, insulin analogs and incretin-based therapies — has led to new treatment strategies that will allow those patients with Type 2 DM to achieve target HbA1c levels (2011). However, he notes that there are many factors that can interfere with the ability of some patients to reach metabolic targets (2011). Clinical data shows that HbA1c concentration, blood pressure, and serum levels of lipids in patients with Type 2 DM are progressively decreasing toward the target goals set by the American Diabetes Association (2011). These improvements in metabolic regulation have resulted in a 30-40% decrease in reported microvascular and macrovascular complications of DM in the United States (2011). Gastric bypass surgery in morbidly obese people with Type 2 DM leads to remission of the DM in the majority of patients and improvement in the rest of them (2011). A major contributor to this improvement is a change in gastrointestinal hormone secretions (2011). Interventional surgery therefore might be considered a logical therapeutic alternative for overweight and obese people with Type 2 DM who do not respond well to medical therapy (2011).
In a study conducted by Pirkola, Pouta, Bloigu, Hartikainen, Laitinen, Jarvelin, and Vaarasmaki (2010), it was found that maternal prepregnancy overweight is an independent risk factor for offspring overweight and abdominal obesity at 16 years of age. The risks are highest in offspring with concomitant prenatal exposure to maternal prepregnancy overweight and GDM (gestational diabetes mellitus), whereas the risks associated with GDM are only small (2010).
Alternative treatments.
There are alternative treatments for DM and some of those treatments have to do with nutrition and diet plans, hydrotherapy, detoxification, mud therapy, massage, herbal medicines, and chromotherapy.
A dietician can create a healthy diet consisting of foods that control diabetes, foods to avoid, potassium rich foods, and foods rich in antioxidants (Diabetes Mellitus Information 2011).
Hydrotherapy is a natural method for treating DM using water. It is one of the oldest therapies for managing physical dysfunctions as the solvent property of water and its ability to absorb and conduct heat has benefits for the body (Diabetes Mellitus Information 2011). Studies have shown that hydrotherapy can be especially beneficial to those suffering from Type 2 DM. It can help improve sleep, reduce blood sugar level, and boast the moral of the patient with DM (2011).
Detoxification is another alternative to regular medicine. Detoxification uses fasting as well as controlled diets and supplements to help the body get rid of toxic substances. Methods of detoxification are used to control stress, help people relax, and modify their diets in ways that support the adrenal gland (Diabetes Mellitus Information 2011).
Diabetes involves a disturbance of the metabolic process of the entire body, according to Diabetes Mellitus Information (2011). When the digestive system and the endocrine glands don’t work as they should, the outcome is an accumulation of impurities and toxemia in the body (2011). This means that eliminating toxins becomes very important. Mud bath treatments can aid in naturally detoxifying the body from the inside out.
Massage is another alternative type of treatment for DM. Massage can influence the activity of the musculoskeletal, circulatory, lymphatic and nervous systems (Diabetes Mellitus 2011). Massage helps relieve tension in individuals and bring about a feeling of relaxation and calm, which can be beneficial to those with DM (2011).
Dr. Andrew Weil states that Salacia oblonga (or S. oblonga) has been used traditionally in Indian medicine to help control the increase in blood sugar right after one has eaten a meal (2005). He notes that a study published in 2005 in an issue of the Journal of the American Dietetic Association found that a drink made with this herb blunts the increase in blood sugar and also reduces insulin levels in the body (2005).
Chromotherapy is when colors are used to aid in treatment of various disorders. The belief is that using certain colors can help the body achieve a natural balance (Diabetes Mellitus 2011). It is used as a supportive therapy, usually in combination with a healthy, controlled diet, exercise, and other medications (2011).
References
American Diabetes Association. (2007). “Diabetes cost calculator.” American Diabetes
Association. Accessed on March 11, 2011:
http://www.diabetesarchive.net/advocacy-and-legalresources/cost-of-diabetes.jsp
Lebovitz, H. (2003). Therapy for diabetes mellitus and related disorders. American Diabetes Association; 3rd edition.
Lebovitz, H. (2011). “Type 2 diabetes mellitus — current therapies and the emergence of surgical options.” Nature reviews endocrinology.
Medical News Today. (2009). “What is the difference between Diabetes 1 and Diabetes
2?” Medical News Today. Accessed March 11, 2011:
http://www.medicalnewstoday.com/articles/7504.php
Milchovich, S.K., & Dunn-Long, B. (2007). Diabetes mellitus: a practical handbook.
Bull Publishing Company; 9th edition.
Pirkola, J., Pouta, a., Bloigu, a., Hartikainen, a., Laitinen, J., Jarvelin, M., & Vaarasmaki, M. (2010). “Risks of overweight and abdominal obesity at age 16
years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus.” Diabetes care,33(5): 1115-1121.
Poretsky, L. (2010). Principles of diabetes mellitus. Springer; 2nd ed. edition.
Venes, D. (ed.) (2009). Taber’s cyclopedic medical dictionary. F.A. Davis Company; 21st edition.
Weil, Andrew. (2005). “Herbal treatment for diabetes?” Dr. Andrew Weil, M.D. Accessed
on March 11, 2011: http://www.drweil.com/drw/u/id/QAA357497
Winter, W.E., & Signorino, M.R. (2002). Diabetes mellitus: pathophysiology, etiologies, complications, management, and laboratory evaluation: special topics in diagnostic testing. AACC Press; 1st edition.
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