Type II Diabetes: Prevention, Treatment, & Management
Netanel Kamel, Tahseen Chowdhury, Ibrahim Eloudi, Steven Samaroo, & Israt Jahan
Professor Coppola
City College of New York
ENG 21003 – Writing for the Sciences
May 6th, 2019
Type II diabetes is a chronic disease which affects million of individuals. Type II diabetes results from the development of insulin resistance in the body, leading to the production of extra insulin to counteract the resistance. Over time your body is unable to keep up with this high demand. Recent research has linked type II diabetes to obesity. Overeating may result in the stressing of the endoplasmic reticulum which in turn dampens insulin receptors (Newgard & Dansinger 2015). According to a statistics report done in 2017, type II diabetes is the 7th leading cause of death in the United States. Also the CDC, states that 79,535 deaths occur each year due to diabetes. This proposal will explore ways in which people can prevent the onset of type II diabetes as well as managing it post diagnosis.
I. Summary
Type II diabetes is caused by an abnormally large increase in blood sugar level also known as “blood glucose.” As a person eats food, it enters the body and begins to decompose to separate the different nutrients, allowing the body to spread them to parts where they are required. One of those nutrients, glucose, is used as fuel by the cells in a person’s body. Insulin, which is a substance produced in the pancreas helps move the glucose from the bloodstream and into the cells. A person with diabetes is unable to allow the glucose to enter their cells due to the inability to produce enough insulin to or they cannot use the insulin that they can make.
In type II diabetes, the body cannot use insulin properly, a process called “insulin resistance,” which results in the glucose not being able to used as a source of energy (Understanding Blood Sugar Balance). In figure 1 which describes insulin resistance (Nature Aid, 2018), it shows that even though insulin is being produced, it is not accepted by the organs like the liver or muscle tissues for storage. This leads to the excess glucose staying in the blood vessels and clogging up the bloodstream, a process known as hyperglycemia. At the start the beta cells try and make up for any shortage of insulin in the body but eventually it can no longer do so which leads to the blood sugar levels in the body to be higher than normal. Due to the fact that glucose is not reaching the organs, they continue to send signals to the brain to get more food which makes losing weight almost impossible since the body is constantly craving sugar intakes.
(Figure 1. Nature Aid, 2018)
Obesity rates have been increasing dramatically among countries especially in the United States. There are many factors that are to blame for the rising obesity. One obvious factor are food industries. However, the article “The whys of rising obesity” by Alvin Powell provides other factors that may be overlooked. One factor is the changing of eating habits, where eating while watching television is one example. The article describes this relationship as, “displaying what public health officials call a “dose-response” relationship with obesity — meaning the more television we watch, the fatter we get” (Powell 2013). The article further states that children are spending drastically more time in front of screens whether it be television screens or computer screens leading to “mindless eating.” Another major factor is the change in American diet. Since the 1980’s, the article states that portion sizes have increased along with the drastic increase in consumption of sugary drinks. This problem of rising obesity falls on the individual to have the willpower in order to resist and restrain their eating habits in an attempt to eat healthy as well.
Many studies have been conducted proving that obesity in fact plays a major role in the development of type II diabetes, but the specific way this occurs has not been clear. However, Harvard University researchers have found reactions that lead to insulin resistance throughout the cells of the body which results in the development of type II diabetes. It has been found the obesity leads to stress in the Endoplasmic Reticulum, which suppresses the insulin receptor signals ultimately leading to insulin resistance. The endoplasmic reticulum is responsible for producing protein and processing fats. In his “Why Does Obesity Cause Diabetes?” Michael Dansinger presents a quote from Christopher Newgard stating, “As you enter a state of overnutrition, as we often do living in our supersized society, all of those nutrients that come in need to be processed, stored, and utilized and the ER factory is overworked and starts sending out SOS signals” (Newgard & Dansinger 2015). These SOS signals result in the dampening of the insulin receptors, making your cells resistant to the insulin your body produces. The article also states that along with the dampening of insulin receptors, endoplasmic reticulum stress causes inflammation which can lead to potential cardiovascular disease.
Many statistical studies have been conducted regarding diabetes and obesity, as presented in figure 2. The article “Statistics and facts about type II diabetes” by Jennifer Barry provides statistics regarding type II diabetes and obesity. Due to obesity being a leading cause of type II diabetes, an increase in obesity yields an increase in the type II diabetes rates. The article states, “In 2013, more than 1 in 3 people in the U.S. were considered to have obesity, and over 2 in 3 were either overweight or had obesity” (Barry 2019). The article states that from 1995 to 2009 obesity in Americans increased from 15.3 percent to 25.6 percent. It was also found that in incidence of diabetes increased by 90 percent from 1998 to 2008. It is found that 9% of the United States population has diabetes. Diabetes is also the the 7th leading cause of death in the United States. The article states, “According to the CDC, 79,535 deaths occur each year due to diabetes. The number of fatalities related to diabetes may be underreported” (Barry 2019). These deaths can easily be avoided with proper lifestyle adjustments to avoid obesity. The graph below shows the relative increase in the risk of diabetes as well as the prevalence of diabetes in men and women relative to weight increase.
(Figure 2, Haffner 2006)
II. Purpose
Currently, type II diabetes can be managed but not cured. The purpose of this proposal is to identify and evaluate ways in which people at risk of getting diagnosed can: alter their lifestyle to prevent getting the disease, identify early symptoms which can allow a person to get diagnosed as early possible, and managing the disease by changing their lifestyle and utilizing current medications that are available, once diagnosed.
III Proposal
The first and most important step in managing diabetes is preventing it from developing to begin with. Being that diabetes and obesity have a statistical correlation, maintaining a healthy lifestyle can help decrease chances of developing type II diabetes. Unhealthy eating habits such as consuming processed foods, without healthy nutrients such as protein and vitamins.
Although prevention is very important, certain factors such as genes, age, or past behavior, can’t be changed. Prevention is far superior for any available treatment for obesity and type II diabetes. Obesity can be being treated by eating a health diet, being physically active and making lifestyle changes that help maintain a normal weight (Obesity, The Gale Encyclopedia of Diets). Prevention of type 2 diabetes includes changing your lifestyle as well as some of the following methods: managing weight, exercise, drinking water as a primary beverage, and frequent visits to your primary care physician (Harvard Health 2018).
Early diabetes symptoms can be a key factor to know when to get these tests and whether you should seek medical attention. Andrei (2017) studied how spotting early symptoms and whether or not if you’re at high risk of type II diabetes can help prevent you from contracting the diseases. The study found that “…of 5084 participants, 100 (4.4%) of the 2281 patients with normal HbA1c and 772 (27.5%) of the 2803 patients with prediabetes developed DM within 5 years” (Brateanu & Barwacz, 2017, p.4). This proved that those who knew that there were at high risk developed diabetes slower than those who didn’t. The symptoms of type II diabetes are hard to spot as they develop slowly.
Some of these symptoms are easier to spot such as darkened spots on the skin usually form in the neck or armpits. Other symptoms, such as increased thirst, increased urination, sudden weight loss, increased hunger, fituage, and blurred vision are also an early indication of prediabetes or diabetes but are more difficult to spot as the cause can be mistaken for something else (Harvard 2018). Another very rare symptom that occurs mostly to people of old age is hyperosmolar hyperglycemic nonketotic syndrome (HHNS), which is similar to type I diabetic ketoacidosis but less risky. HHNS symptoms are easier to spot but they require immediate medical attention or taking prescribed medications that control the glucose levels in the blood. The symptoms of HHNS are leg cramps, severe dehydration, vision problems, and altered levels of consciousness. HHNS isn’t an early symptom of type II diabetes but it’s an indication that the sugar levels in the blood are high and must be controlled.
Getting diagnosed early is very important as type II diabetes progressively causes more damage to various organs in the body. There is multiple ways to diagnose type II diabetes, the most common way is the glycated hemoglobin (A1C) test. EZSCAN is another test that was proposed that gave people an easier access to self testing. Antonio (2017) conducted an experiment to test if EZSCAN is a good replacement to the A1C test and other tests such as the fasting blood sugar and random blood glucose test. The studies found that “results of the EZSCAN performance can be secondary to characteristics of the context and individuals: predictive values as well as likelihood ratios can depend on baseline risk of evaluated subjects.” (Bernabe-Ortiz & Ruiz-Alejos, 2017, P.6) and it was determined that the results of EZSCAN aren’t consistent and not a good replacement for A1C test. A1C is a test that calculates your average blood level for the past two or three months. If the results are between 5.7 and 6.4 it’s considered prediabetes and if the results are above 6.5 in multiple tests it means that the person is diagnosed with diabetes. There are other ways to diagnose Type II diabetes in case of the inability to perform the A1C test, such as fasting blood sugar and random blood glucose test. Fasting blood sugar test is when a blood simple is taken after an overnight fast and if the results are 126 milligrams per deciliter (mg/dL) or higher in multiple separate tests it means you have diabetes. The random blood glucose test is taking a blood simple at any give point and if it shows 200 mg/dL on multiple occasions it can mean diabetes especially if you are showing some diabetes symptoms.
Although there isn’t currently a cure for type II diabetes, there are various ways to treat and manage the disease. To properly manage type II diabetes, one must live a ‘healthy’ lifestyle by losing weight, eating healthy, and regular exercise. Body weight contributes to blood sugar levels. Therefore, losing 5-10% of your body weight can significantly help manage blood sugar levels. In addition to losing weight it is important for one to implement healthy eating habits. Foods like fruits and vegetables and foods with a good source of fiber are beneficial to a healthy diet. People should eat foods with less calories, less carbohydrates, and less saturated fats. Exercise is also an important factor in managing a healthy diet, not just for people with type II diabetes, but for everyone. A mixture of aerobic exercise (also known as cardio), strength training, and yoga offer the most benefits rather than a single exercise alone. By losing weight and managing a healthy diet, blood sugar levels can be kept at a healthy level (Harvard Health 2018).
Additional ways to treat type II diabetes include medication, insulin therapy, and blood sugar monitoring. The most common medication prescribed to patients with type II diabetes is Metformin. Metformin works by lowering the glucose production in the liver and improving the body’s sensitivity to insulin. In essence, the medication restores the body’s proper response to insulin. Other medications such as, sulfonylureas, meglitinides, and thiazolidinediones, are less common due to their numerous side effects. However, they are still an option for those who Metformin and eating healthy habits don’t sufficiently regulate blood glucose levels. Being that the issue type II diabetes presents is the inability for the pancreas to produce sufficient insulin to overcome insulin resistance, some people take some type of insulin injection. Insulin therapy can be administered either through “short-acting” or “long-acting.” Short acting insulin is commonly taken before a meal to help the body control the sudden increase in sugar levels (Harvard Health 2018). There is one surgery that can potentially help with patients diagnosed with type II diabetes called Bariatric Surgery (also known as weight-loss surgery). This is a common option for patients with a body mass index greater than 35. This surgery can help as obesity is a key factor which can lead to the onset of type II diabetes. After surgery, blood sugar levels may be restored leading to better insulin sensitivity and secretion (Kashyap, et. al 2018).
Although there is no cure to type II diabetes, the current treatment and management options can make it much more easy to live with the disease. The current eating habits and food industry are only contributing to the increase in obesity and potential for onset of type II diabetes. Individual and industrial measures must be taken to help stop this epidemic.
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