Diabetes Symptom and Prevention: A Comprehensive Guide

Work Based Learning Project
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Diabetes symptom and prevention :
Diabetes is one of the metabolic disorders in which blood sugar level remains elevated for the
prolonged time. Pre prandial glucose level for non-diabetic and diabetic patient should be 4.0
to 5.9 mmol/L and 4 to 7 mmol/L respectively. Post prandial glucose level for non-daiabetic
and diabetic should be under 7.8 mmol/L and 5 to 9 mmol/L respectively. HbA1c in normal,
prediabetes and diabetes patient should be below 6 %, 6 to 6.4 % and above 6.5 %
respectively. Prominent symptoms of diabetes include frequent urination (polyurea),
increased thirst (polydipsia) and increase hunger (polyphagia). In type 1 diabetes, these
symptoms develop very rapidly and in type 2 diabetes these symptoms develop slowly over a
period of duration (Thomas & Philipson, 2015). Diabetic patient particularly in the older age
is mostly associated with acute diabetic complications like diabetic ketoacidosis and
hyperosmolar hyperglycemic state. Few of the symptoms are not associated specifically with
the diabetes; however, these symptoms indicate onset of the disease. These symptoms include
blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Alteration in the vision
of the diabetes patient occurs due to absorption of glucose in the lens. Rashes on the skin of
the diabetes patient are collectively known as diabetic dermadromes. Diabetic condition also
produces effects like uneasy feeling, sweating, trembling, confusion, aggressiveness, seizures
and unconsciousness (Wiley, 2016; Pippitt et al., 2016).
It is also associated with chronic complications like cardiovascular condition like damage to
the blood vessels, stroke, peripheral artery disease, chronic kidney disease (diabetic
nephropathy), foot ulcers, damage to nerves (diabetic neuropathy) and damage to the eyes
(diabetic retinopathy). Diabetic retinopathy mainly caused due to damage to the blood vessels
of retina and it leads to sustained vision impairment and finally blindness. Older diabetes
patients are more prone to risks like glaucoma and cataracts. Older people are more prone to
eye problems due to anatomical changes in the eye due to older age. In older people, diabetes
nephropathy lead to problems like tissue scarring and protein loss in the urine. Diabetic
neuropathy is most common complication of diabetes and it leads to occurrence of numbness,
tingling, pain, and altered sensitivity to pain. As a result of altered sensitivity to pain, skin
become more susceptible to the injury. Foot problem like diabetic foot ulcer is difficult to
treat.
No effective prevention measures are available for type 1 diabetes and however, type 2
diabetes can be effectively prevented. Due to complex nature of diabetes, medical, physical
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and nutritional interventions need to be carried for the treatment and management of diabetes
(Garrison, 2015). Most prominent interventions to be carried out for the treatment and
management of diabetes include healthy diet, regular physical exercise, a normal body
weight, and avoiding use of tobacco. It is evident that physical activity for more than 90
minutes per day can reduce risk of diabetes in approximately 30 % of the patients.
Appropriate diet can also be useful in the prevention of diabetes. Diet useful for the
prevention of diabetes include whole grains, fibres, and polyunsaturated fat (Li et al., 2014;
ADA, 2015). Prevention of consumption of sugary beverages and food containing saturated
fats can be useful in the prevention of diabetes. Tobacco smoking can increase the
susceptibility of diabetes and its complications; hence prevention of tobacco smoking can be
useful in prevention of smoking (Handelsman et al., 2015).
Epidemiology :
Prevalence of diabetes in adult population above 18 years of age is approximately 10 % and it
is estimated to rise upto 12 % by 2030. It is still higher in people above 65 years of age. In
older people above 65 years of age, prevalence of diabetes is estimated to be 19 %. Diabetes
prevalence increases with increase in the age of the patient. It has been estimated that
diabetes prevalence in approximately 20 % in age group people between 60 – 70 years of age.
It is approximately 22 % in age group people between 70 – 80 years of age and it is
approximately 23.5 % in age group people between 80 – 90 years of age. In age group above
65 years of age, incidence of obesity is estimated to be 14 cases per 1000 adults. It has
estimated that person lose life by approximately 10 years when diagnosed in the middle age
of life. Mortality rate is approximately double in patients with diabetes as compared to the
normal people. Prevalence of diabetes is higher in women as compared to the men (Sánchez
Martínez, 2014)
Types of diabetes mellitus:
Diabetes can be classified in two categories like insulin dependent diabetes mellitus (IDDM;
type 1 diabetes mellitus) and non-insulin dependent diabetes mellitus (NIDDM; type 2
diabetes mellitus). IDDM is more prevalent in children and young people. It can also be
termed as juvenile diabetes. In this type of diabetes, there is occurrence of abrupt onset of
symptoms, it depends on the exogenous insulin and these patients are more susceptible to
ketoacidosis. It can be considered as catabolic disease in which diabetic patient is with
deficiency of circulating insulin, with raised levels of glucagon and pancreatic B cells
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become resistant to insulin stimulation. Autoimmunity plays major role in the development of
IDDM. Infectious and toxic environmental substances affect immune system of people whose
immune system is susceptible to autoimmune response against pancreatic B cell antigens.
Genetic defect also plays important role in the impaired B cell function and replication. These
patients become more susceptible for type 1 diabetes due to failure of B cells development
after viral infection. Specific HLA genes can augment susceptibility to infection by
diabetogenic virus. These HLA genes can also augment susceptibility of autoimmune
destruction of their own islet cells. Hence, immunosuppressive drugs like cyclosporine and
azathioprine are proved to useful in the management of initial stage of type 1 diabetes
mellitus (ADA, 2015).
Approximately 80% of the diabetes patients are of type 2 diabetes. Patients of this type of
diabetes are not reliant on the exogenous insulin source for management of ketonuria and
these patients are not at risk of ketosis. However, these patients can develop ketosis due to
severe stress aggravated by the infection and trauma. Type 2 diabetes patients might require
insulin for the control of fasting hyperglycaemia when it is not controllable by proper diet
and after consumption of oral hypoglycaemic agents. In type 2 diabetes, body can produce
optimum amount of insulin; hence it can not be used effectively by the body. This mainly
occurs because peripheral tissues become insulin resistance. Moreover, insulin receptors and
other intermediate signalling pathways become insensitive to insulin. Hence, glucose can not
enter in the tissues and hence, blood sugar level increases. Both lifestyle and genetic factors
are responsible for the occurrence of type 2 diabetes (Selph et al., 2015).
Type 2 diabetes can be managed by medications which can improve the insulin sensitivity
and reduce the glucose production by the liver. Lifestyle factors play important role in the
development of type 2 diabetes. It includes obesity measured in terms of body mass index,
lack of physical activity, improper diet and stress. Excess body fat is associated with
approximately 50 % cases of the diabetes. Sugary sweetened drinks, saturated fats and trans
fats are responsible for the development of type 2 diabetes. Polyunsaturated and
monounsaturated fats can decrease the risk of development of type 2 diabetes mellitus.
Approximately, 7 % cases of the develop type 2 diabetes due to lack of physical activity (Siu,
2015).
Pathophysiology:
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