Report: Homeostatic Changes, Diabetes Mellitus, and Treatment Options

This report provides a comprehensive overview of diabetes mellitus, beginning with the normal physiology of the endocrine pancreas and the roles of insulin and glucagon in maintaining blood glucose homeostasis. It then details the alterations in this homeostasis that lead to the development of both Type 1 and Type 2 diabetes mellitus, including the underlying causes and physiological effects of these conditions. The report further explores various treatment options, including non-medical approaches like lifestyle adjustments and medical interventions such as medications like metformin and acarbose, and insulin therapy. The mechanisms of action for these treatments are explained, highlighting how they work to restore normal blood glucose regulation. The report emphasizes the importance of diagnosis, commitment to treatment, and the chronic nature of the disease, aiming to provide a thorough understanding of diabetes mellitus for students.

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Homeostatic Changes and Treatment of Diabetes Mellitus
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Abstract
Diabetes mellitus is the most common form of diabetes caused by abnormalities in the human
body leading to high blood sugar concentrations. It, therefore, requires that a person is diagnosed
by some qualified medical personnel before beginning to take any form of treatment. Some of
the common symptoms of diabetes mellitus are the loss of weight, increased thirst and hunger
and frequent urination. There are so many causes of diabetes mellitus which include genetic
mutations, unfavorable lifestyles like physical inactivity, use of some medications, and poor diet
among other causes. In this condition, the body pancreatic cells are unable to use the glucose
extracted from food due to lack of insulin, a hormone which is produced by the pancreas. If the
increased blood sugars are not controlled through effective medication, it can result in long-term
diabetes complications. This leads to damage of the beta cells that produce insulin in the
pancreas, further lowering the output of insulin. Diabetes mellitus is also referred to as the non-
insulin dependent diabetes and a chronic disease (Bishal et al., 2016). The high levels of sugar in
the blood in diabetes mellitus patients is caused by alterations in the way the body synthesizes or
uses insulin. Normally, insulin functions to carry sugar inside the body cells. The sugar inside the
cells is stored so that it can be used in future to make energy for the cell. These patients thus do
not effectively use their insulin and also their fat, muscle and liver cells do not respond well to
insulin leading to insulin resistance. This means that the sugar in the blood is not able to enter in
the cells to make energy, leading to a build-up of sugars in the blood. In this report, the normal
functioning of the endocrine pancreas will be discussed including the homeostatic insulin and
glucagon control, followed by the alteration of this homeostasis to develop diabetes mellitus and
finally the treatment and their mechanism in restoring normal regulation.
The normal physiology of the endocrine system
The blood sugar is controlled by insulin and glucagon, two of the hormones produced by the
organ pancreas. Diabetes mellitus develops slowly and in most cases, the medical condition does
not have any symptoms. The endocrine pancreas is a slender and long organ found in the lower
part of the stomach. It is an exocrine gland involved in the production of digestive enzymes and
hence performs some endocrine roles. In the pancreas, there are some specialized cells known as

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islets of Langerhans or pancreatic islets which are involved in the secretion of hormones
glucagon and insulin among others. Glucose is very critical in the respiration processes by living
cells and is the most preferred source of energy as compared to other biomolecules. When
carbohydrates are broken down into digestion, the form glucose, which can either be used
immediately or stored inside the liver and muscle cells for energy production in future (Louise et
al., 2015). The two pancreatic hormones, insulin and glucagon are involved in the control of
either storage of utilization of glucose in the cells. The pancreatic system has some cell receptors
which sense the levels of blood glucose and lead to synthesis and release of either glucagon or
insulin in order to maintain normal glucose levels. For instance, when a person is fasting, the
pancreatic receptors sense low blood glucose and initiates the release of glucagon hormone. In
this case, glucagon hormone causes the following effects: stimulation of the liver to convert
glycogen to glucose for use by cells, the breakdown of lipids into fatty acids, taking up of amino
acids and converting them into glucose.
It is worth noting that the effect of the hormone glucagon is controlled by use of negative
feedback methods such that when the amount of blood sugar is high, the level of production and
secretion of glucagon hormone is inhibited. On the other hand, the hormone insulin is actively
involved in the high activity of blood glucose into the cells for storage. However, it is worth
noting that the cells of the red blood cells, brain, kidney, liver and small intestines have no
insulin receptors, thus they do not need insulin hormone to take up glucose for their use. There
are several cell types that require insulin receptors but skeletal and adipose cells mostly need
insulin to take up blood glucose. When food reaches the stomach, gastrointestinal hormone-like
glucose-dependent insulinotropic peptide secretion is triggered (Aryal et al., 2017). This, in turn,
triggers the synthesis and release of insulin from the pancreatic beta cells. As digestion and
nutrient absorption occurs, blood glucose further rises leading to a further release of more
glucose. Basically, insulin activates a tyrosine kinase receptor which causes the phosphorylation
of several cellular substrates. The effects of these processes are that intracellular vesicles enable
glucose to be transported across the cell membrane.
The excess glucose which is circulating in the blood is taken by the facilitated glucose transport
2 found on the outer surface of the beta pancreatic cells. Under normal circumstances, when

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glucose is transported into the cells, it goes through the process of glycolysis leading to a higher
ATP/ADP ratio. It is this ratio adjustment which in turn causes the closing of ATP sensitive
potassium ion channels. However, without high ATP concentrations, these channels are ever
open in order to maintain the resting potential, whereby the positively charged potassium ions
are transported down their concentration gradient to the cell surface. When the channels close,
the lowered amount of potassium ions cause the depolarization of the cell membrane which
causes the opening of the voltage-dependent calcium ions. The high concentration of calcium
ions enables the fusion of granules that hold insulin on the cell membrane and eventually cause
the release of their contents, i.e. insulin hormone (van Duinkerken et al., 2016). The process of
insulin secretion occurs in a biphasic manner so that the first or initial peak takes place for
approximately five minutes upon the stimulation by glucose so that insulin is released in the first
round. The second phase is, however, a little slower but the rest of the glucose is released.
Moreover, insulin molecules are found in the dense vesicles close to the cell membrane, when
such stimulation occurs so that insulin can be readily available upon need, i.e. when the blood
glucose sugar builds up. The fusion of the vesicles containing insulin to the cell membrane is the
synaptosomal-associated protein and other similar proteins. Insulin hormone facilitates the fusion
of the glucose transporter vesicles and the cell membrane so that facilitated diffusion makes
glucose to move from the exterior of the cell to the interior. In other cases, insulin hormone
controls the levels of blood glucose by stimulating the process of glycolysis to break down
glucose into energy. Insulin also enables the liver to convert glucose into glycogen for further
storage (Louise et al., 2015). Again, insulin hormone concentration is controlled by use of the
negative feedback mechanisms such that when blood glucose is low, the secretion of insulin
reduces.
Physiological effects of the endocrine system during diabetes mellitus development
When the production and secretion of the hormone insulin are not functional, or when the cells
become insensitive to insulin, diabetes mellitus ensues. The rates of diabetes mellitus have been
progressively increasing among all genders and ages of the people globally. In type 1 diabetes
mellitus, this condition develops as an autoimmune disorder which affects the beta cells in the

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pancreas. In type 1 condition, the beta cells become unable to produce insulin leading to
accumulation of high levels of glucose in the blood (Bishal et al., 2016). In type 2 diabetes
mellitus, lifestyles, unbalanced diet (more of carbohydrates) and pre-diabetes existence are the
major causes. It is a common observation that most people suffering from type 2 diabetes
mellitus are overweight, obese or both. In type 2 diabetes mellitus, the skeletal and muscle cells
are not sensitive to the effects of insulin. This makes the pancreatic beta cells to increase the
secretion of more of this hormone leading to the exhaustion of these cells (Aryal et al., 2017). In
this case, the condition can be reversed by engaging in regular physical activities, taking a
balanced diet and lowering the body weight., else the patient might require the use of synthetic
insulin injections.
Treatment of diabetes mellitus
Before treatment of diabetes begins, it is important that diagnostic tests are carried out by
qualified personnel. Treatment of diabetes depends on the type, ability to adjust lifestyles and the
severity of the condition. Some of the non-medical treatment options for the diabetes mellitus
include being physically active, weight loss, and eating a healthy diet. However, it has been
noted that there is some diabetes type 2 mellitus patients who cannot control this condition
through the above-mentioned nonmedical methods. This means that the next option is the use of
medical or therapeutic agents to the blood glucose sugar levels. Initially, insulin was for a long
period of time used as the first line treatment option (van Duinkerken et al., 2016). However,
with advances in the pharmaceutical industries, there has been the development of therapeutic
agents which improve the functions of the pancreas as an organ. Basically, it is not possible to
treat diabetes but the condition can only be managed. This decision, however, requires a fulltime
commitment in order to keep the blood glucose levels under control. There are several
medications that the doctor can prescribe to a diabetes mellitus patient. The most commonly used
drugs include alpha glucose inhibitors like acarbose, injectable such as exenatide,
thiazolidinediones, biguanides like metformin and sulfonylureas like tolazamide.
For instance, metformin falls under the class of insulin sensitizers and functions by lowers the
release of glucose by the liver through diminishing glycogen breakdown and glucose build up.

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This drug also increases the absorption of glucose into the peripheral system and skeletal
muscles through the activation of 5' ADP associated protein kinase. Metformin also promotes the
loss of weight by reducing the rate at which food is eaten by a patient (low appetite). Acarbose
falls under the class of glucosidase inhibitors and reverts the homeostatic control by lowering the
rate if breaking down starch into glucose in the stomach. This means that less of glucose is
available for entering the bloodstream. This class of drug also aids in loss of weight, improves
insulin sensitivity by beta receptors and lowers the blood pressure (Bishal et al., 2016).
Depending on the severity of the condition, these medications can either be used alone or in
combination with insulin. The injections must be made on the skin by use of insulin pen or sterile
syringe. In insulin therapy, the type 1 diabetes mellitus patients need to use several insulin
injections on a daily basis to maintain insulin levels (Aryal et al., 2017). In place of insulin
injections, an insulin pump can as well be used. The insulin pump is worn on the belt such that
insulin is delivered by use of a small catheter which is placed on the abdomen. There are several
types of insulin used to treat diabetes mellitus which include rapid-acting, long acting, short
acting and intermediate acting insulin, depending on the severity of the condition. There is,
however, no standard dosage used for insulin because the prescribed dose
Conclusion
This essay has generally explored the topic on diabetes mellitus. More specifically, the aspects of
the normal functioning of the endocrine pancreas in terms of homeostasis control has been
explored. The pancreas has sensitive receptors which detect the levels of blood glucose and act
appropriately by stimulating the production of relevant hormones to revert the condition. In
diabetes mellitus, basically, there are type 1 and type two conditions all of which have different
treatment options although insulin injections may be recommended for both. The treatment for
diabetes mellitus is thus a lifetime commitment which requires continued use of insulin
injections, tablets, and adoption of lifestyle changes like diet composition or physical activity
(Norris et al., 2016). However, it is important that the pharmaceutical companies do more
research in the search for a probable drug for curing diabetes mellitus. At the moment, it is
important that preventive strategies are adopted so as to avoid the probable development of

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diabetes mellitus. This involves engaging in physical activities and taking balanced diet. It is
important that diagnosis is made early enough and treatment initiated in good time as well.
Reference List
Aryal, S., Pradhan, A., Shrestha, S.M., Shukla, H.R., Mathur, A., Shetty, N., Makhijani, B.,
Manohar, B., Bhattarai, R., Khanal, S. and Rao, G.N., 2017. Does Improved Periodontal Health
Affect Metabolic and Inflammatory Markers in Patients with Diabetes Mellitus? A Comparative
Study. Journal of Nepalese Society of Periodontology and Oral Implantology: Vol, 1(1).
Bishal, G., Alessandra, F., Edwin van, T., and Per K., 2016. Challenges in diabetes mellitus type
2 management in Nepal: a literature review. LSE research Online.
Louise Z., Marcele, M., and Ceres, B., 2015. Possible hearing implications of diabetes mellitus:
A literature review.
van Duinkerken, E., Ryan, C.M., Schoonheim, M.M., Barkhof, F., Klein, M., Moll, A.C.,
Diamant, M., IJzerman, R.G. and Snoek, F.J., 2016. Subgenual cingulate cortex functional
connectivity in relation to depressive symptoms and cognitive functioning in type 1 diabetes
mellitus patients. Psychosomatic medicine, 78(6), pp.740-749.