Diabetes Research and Management

This assignment delves into the multifaceted aspects of diabetes, encompassing its epidemiology, economic burden, various treatment modalities, and effective management strategies. It examines the causes, prevalence, and impact of both type 1 and type 2 diabetes, highlighting the significance of early diagnosis, appropriate care, and self-management techniques for improving patient outcomes.

Running head: TYPE 1 DIABETES
TYPE 1 DIABETES
Name of the Student
Name of the university
Author’s note

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Q1. Pathophysiology of Diabetic Ketoacidosis-
DKA is a major, acute life threatening condition that is normally associated to patients
with type 1 diabetes. It is rarely seen in patients having Type 2 diabetes.
DKA is normally caused due to the active or the relative deficiency of insulin, accompanied by
the increase of counter regulatory hormones involved in DKA, such as cortisol, glucagon,
epinephrine growth hormone (Atkinson et al., 2014). This type of imbalance of the hormones of
our body leads to hepatic gluconeogenesis (generation of glucose from non carbohydrate
substrate), lypolysis (breaking down of lipids) (Knip & Siljander, 2008).
The excessive counter regulatory hormones, hepatic gluconeogenesis, glycogenolysis
leads to severe hyperglycemia. Lack of insulin results in the release of fatty acid from the
adipose tissue (lypolysis), increasing the amount of free fatty acids in the serum. Hepatic
Metabolism of the fatty acids leads to the formation of the acidic intermediates and metabolites
such as ketones and ketoacids (Atkinson et al., 2014).
Hormonal imbalance causes increased gluconeogenesis, renal and hepatic production of
glucose and impaired utilization of glucose by the peripheral tissues. This results in
hyperglycaemia and hyperosmolarity. Studies have revealed that the inflammatory biomarkers
(e.g., C-reactive protein [CRP], oxidative stress markers, pro-inflammatory cytokines,
cardiovascular risks and, lipid peroxidation is also associated with hyperglycemic risks. when the
accumulated ketone bodies in the body exceeds the maximum capacity they are then found in the
urine (Ketonuria) (Knip & Siljander, 2008).
Greater accumulation of the acids leads to acidosis, which can cause respiratory distress such as
shallowed breathing (Kassmaul respiration). Normally kidney has a low threshold value for the

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keto-acids which gets excreted out through the urine. More amount of ketoacids leads to
electrolyte loss resulting in acute dehydration with a large loss of sodium ions.
Signs and symptoms
The common early signs and symptoms associated to DKA is polyuria. other signs and
symptoms of this clinical condition involves malaise, fatigue, vomiting ,nausea, can have
abdominal or muscular cramps, anorexia, loss of appetite, drastic weight loss in some patients,
reduces perspiration, coma can occur at severe stages of the disease (Padgett et al., 2013). Fever,
chills, chest pain, arthralgia and dyspnea can also occur. Unusual smell in the breadth is often
found.
Q2. Difference between Type 1 and Type 2 diabetes
Causes
Type 1 diabetes is an autoimmune disease, where the immune system of the body
mistakenly attacks the beta cells of the pancreas that is responsible for producing insulin. There
are some genetic markers that are responsible for the T1D.
In type 2 diabetes the beta cells are not attacked by the immune system of the boy, rather
the body normally stops responding to the secreted insulin and becomes insulin resistance. The
body tries to compensate this condition and tries to produce more insulin, eventually it creates
stress on the beta cells which may lead to their destruction, ceasing insulin production (Knip &
Siljander, 2008). T2D is a life style disease and is mainly caused due to improper diet, obesity,
use of alcohol, excessive consumption of the fatty food, excessive consumption of carbohydrate

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rich food. Stress can worsen the effects of T2D. Patients having family history of T2D are more
likely to have T2D in future. Genetic factors obviously play a role in diabetes, although 2
persoms having same genetic mutation might not have the same effects of diabetes as diabetes
largely depends on the life style.
Pathophysiology
Type 1Diabetes – T1D is an autoimmune disease caused due to the development of an
autoimmune response against the Beta cells antigen due to which very less amount of insulin is
produced inside the body, due to which the plasma glucagon level is increased. Increase in the
counter regulatory hormones causes volume depletion of the extracellular fluids, hyperglycemia,
and decreased potassium ions in the body. Hormonal imbalance increases the rate of
gluconeogenesis, renal and hepatic glucose production, impaired utilization of glucose by the
body tissues leads to hyper glycemia (Knip & Siljander, 2008). Free fatty acids are released into
the serum from the adipose tissues. Hepatic metabolism of the fatty acids leads to the formation
of the ketone bodies. Greater accumulation of the acids leads to acidosis, which can cause
respiratory distress such as shallowed breathing or Kussmaul respiration.
Type 2 Diabetes- T2D is mainly caused due to the combination of insulin resistance and
decreased secretion of insulin by the beta cells of pancreas, impaired regulation of glucose
production in the liver. Beta cell glucotoxicity is caused by the inhibitory effect of the glucose
secretion upon the release of insulin. Glycogen is accumulated in the beta cells due to prolonged
glycemia (Kahn et al., 2014).
Medicinal, dietary & exercise recommendations
T1D

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Medications such as Insulin, short acting insulin like novolog and humulin, rapid acting insulins
such as insulin aspart, Angiotensin converting enzyme can be given. Amylinomimetic drugs such
as pramlintide acetate can be given that elicit endogenous amylin by decreasing the postprandial
glucagon release. (Padgett et al., 2013).
Fibrous food, cereal with milk without fat, whole grain fibers, carbs, fruits, and lentils can
serve to be best for the type 1 diabetes patients. Sugary drinks, trans-fats, simple carbohydrates
like processed and refined sugars, foods containing saturated fats should be avoided should be
avoided. It is advisable to eat smaller portion of well balanced meals for about six times a day
(Knip & Siljander, 2008).
Aerobic exercises like walking, jogging, strength training exercises for about 30-40
minutes a day can be done for efficient muscles and strong bones. Stretching exercises can be
done to maintain flexibility in the body. Other than this, games such as badminton, volleyball can
be played to maintain fitness and to burn the extra calories.
T2D
Oral hypo-glycaemic class of medications is used in case of T2D. Alpha glucosidase inhibitors
like acarbose and miglitol, which helps to break down the starchy food. Biguanides, dopamine
agonist, DPP-4 inhibitors like alogliptin, Incretin mimetics increases the B- cell growth,
meglitinides, sodium glucose transporter (SGLT) 2 inhibitor. Sulphonylureas stimulates the
pancreas for secreting insulin, thiazolidinediones (Knip & Siljander, 2008).
Food- diet for Type 2 diabetes includes carbs, non-starchy vegetables, and complex
carbohydrates such as brown rice, whole wheat, lentils beans and fruits. Sugary beverages, high-
calorigenic food, saturated and Trans fats should be avoided. It is advisable to avoid alcoholic

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drinks (Padgett et al., 2013).Repeated eating with balanced meal is advisable rather than large
single meal.
Exercises- Daily exercises such as running, aerobics and yoga for about 30-40 minutes in
about 5 days a week can be done to maintain T2D.
Diabetic Keto-acidosis
This condition occurs when the body cannot produce enough insulin. Absence of insulin
and the increase in the glucagon level results in the release of glucose by the liver.
Insufficient insulin does not allow enough glucose to enter the cells, as a result the fatty acids are
broken down as an alternative energy source, producing acidic ketone bodies. DKA is mainly
caused in people with T1D (Kahn et al., 2014).It can cause excessive urination, flushed and dry
skin, drowsiness and rapid breathing, fruity smell breath. It can also cause severe illness or coma.
Hyperglycemic Hyperosmolar state
This condition occurs when there is extremely high blood sugar level (Plasma glucose
level of 600mg/dL or more) caused due to insulin deficiency. Due to this the serum osmolarity
level is greater than 320 mOsm. Excessive urination occurs due to this condition, which leads to
hemo-concentration and volume depletion that further increases the blood sugar concentration
(Padgett et al., 2013).
It can cause motor and sensory impairment. Hyper viscosity can increase the risk of
clotting of bloods, which can be linked to cardiovascular diseases.

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In this case ketoacidosis does not occur because the insulin inhibits the fatty tissue breakdown by
the hormone sensitive lipase. It is found mainly in patient with type 2 diabetes.
Q.3. Different procedures to measure the blood glucose level
OGTT
Procedures for OGTT (Stumvoll et al., 2010)
1. The patient should be abstained from food 8 hours before the test.
2. Patient should fast for 8-12 hours before the conduction of the test.
3. A fasting sample of venous blood is extracted in a vial and tested for glucose level.
5. The patient is given aqueous solution of glucose of about 50 gram. The time is noted.
6. A fasting blood glucose is at first taken. The patient is then administered glucose drink orally
and then after 2 hours another blood sample is taken and measured.
7. The blood sample is tested in the laboratory and a curve is plotted by taking time on the x axis
and plasma glucose level on the Y axis and a glucose tolerance curve is made.
Normal range level of glucose in blood
Normal range
Fasting <110mg/dl
(<6.1 m mol/L)
1 hour after glucose administration <160 mg/dl

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(<9.0 m mol/ L)
2 hours after glucose administration <140 mg/dl
(<7.8 m mol/L)
Positive diagnostic marker
1. Fasting glucose level is higher than 110mg/dl or 6.1mmol/L in the blood.
2. The highest value of the curve is reached within 1.5 hours.
3. The blood glucose level does not match the fasting level even after the 2.5 hours.
4. Over 11.0 mmol/L of Glucose is found in the blood sample.
Fasting blood glucose test
Procedure (Rohlfing et al., 2002)
1. The patient should not consume any food or drink for at least 8 hours before the collection of
the blood sample.
2. Blood is collected from the patient and is stored in a vial for the testing of glucose.
Normal range level
A blood glucose level of 100–125 mg/dL (5.54 – 6.9mmol/L) determines prediabetes.
Positive diagnostic marker
Blood glucose level of 126 mg/dL (Over 11.0 mmol/L) and higher indicates diabetes.

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HbA1c Test
Glycated hemoglobin (A1C) test helps in indicating the average blood sugar level for the past
two to three months. It helps to assess the amount of blood sugar linked to hemoglobin. More
the hemoglobin with sugar attached, more is the blood sugar level.
Procedure
Blood sample is collected from the patient. They can be tested for the presence of glucose
with the help of these 3 methods-
1. Chromatography based HPLC assay (Newman & Turner, 2005).
2. Antibody based immunoassay
3. Enzyme based enzymatic assay (International Expert Committee, 2009).
Normal range levels
The normal range for the hemoglobin A1c level for people without diabetes is between
4% and 5.6%.
Positive diagnostic marker
Hemoglobin A1c levels between 5.7% and 6.4% indicates higher chance of
getting diabetes. 6.5% or higher levels that the patient is having diabetes.
Q.4. Multidisciplinary approach to manage type 1 diabetes

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In the following case study, James has been newly diagnosed with TID. Management of
TID can be done with effective collaborative approach (Barlow et al., 2002)
Diabetes educator- Diabetes educators are the members of the multidisciplinary team who
impart education to the patient regarding the pathophysiology and the self management of
diseases. A diabetes educator will be able to provide all the information regarding diabetes, to
the patient and would help the patient in the self management of diabetes.(Zurich et al., 2003).
Oral care professionals – People suffering from diabetes bears greater chance of periodontal
diseases such as dry mouth, gingivitis, thrush .Therefore a dental care doctor would be able to
help the patient in managing oral health by frequent checkups such as once in every three
months. (Maahs et al., 2010).
Dieticians- The dieticians help to prepare proper diet chart for the diabetic patient. Since
diabetes can be managed at large by controlling the food habits and proper exercises, a dietician
is professionally qualified to prepare a suitable diet chart for the diabetes patient consisting of
non -glycemic food such as fibers, proteins; switching the meal plan from white bread and flour
to whole grain, bran, barley, oats and lots of vegetables and maintenance of the electrolyte
balance in the body by the intake of oral fluids.
Eye care professionals- They are responsible for taking care of the eyes, as eyes are largely
affected due to diabetes. Persistently high blood sugar level can cause eye diseases such as
retinopathy, muscular degeneration, cataract, glaucoma. (Maahs et al., 2010). It is advisable to
have an eye check up at least once in every 6 months.

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Podiatrist- They mainly study disorders related to foot, ankle and lower extremities of the leg.
James with diabetes can be vulnerable to nerve damage in his feet, so podiatrists will assess his
general foot health and function. They educate him how to prevent feet problem and keeping him
healthy. Foot ulcers can cause amputation, so for someone like James it is very important to
check his feet regularly. The examination should be done every two to three months.
Q5. The items to monitor and manage diabetes at home are as follows-
1. Traditional home monitoring device-Blood glucose meters contain a test strip for taking the
blood and a meter that will calculate the glucose levels (Orchard et al., 2015).
2. Some glucose monitoring devices tests blood from other parts of the body other than finger
tips, although the results are not much reliable.
3. Continuous glucose monitoring system combined with insulin pumps.
4. Monthly blood glucose monitoring diary
5. A daily monitoring diaries to record the doses of the medications.
6. Suitable syringes (4-5mm long)
7. Injection aids such as automatic injectors or temporary injection ports (For those who are
afraid of needles)
8. Insulin pen (Prefilled pens- which are disposable insulin pens or Durable pens- they contain
replaceable insulin cartridges)
Q. 6

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National Diabetes Services Scheme (Australia)
The National Diabetes Services Scheme (NDSS) is an initiative taken up by the
Australian government in collaboration with the diabetes Australia (Rabi et al., 2006). The main
aim of NDSS is to impart knowledge to the Australian regarding the self management of
diabetes. They have also taken initiatives to support the people by providing timely care and
management to the patients (Lee et al., 2013).
Registering under NDSS helps the patient to access a wide range of service. For the
member ship cost it is advisable to contact the territory organization. Registration to NDSS is
free of cost and requires only one time registration (Lee et al., 2013).
Eligibility criteria (Lee et al., 2013)
 The patient should be a resident of Australia. If someone is visiting from the other
country, he should have a health agreement visa.
 The patient should have diabetes confirmed by a doctor.
 They should hold a Department of Veteran's affairs card or a Medicare card.
 One is not eligible to register if he has impaired glucose tolerance and pre-diabetes.
Sample Membership card

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