Diabetes in the United State

Diabetes in the United States

Outline
I) History of Diabetes and Insulin
II) What is Diabetes?
A. What it is
B. Major functions of insulin
III) Types of Diabetes
A. Type 1
B. Type 2
IV) Cause of Diabetes A. Hereditary B. Stress C. Obesity
V) Complications
A) Acute complications
1. Diabetic Coma
2. Insulin reaction
B) Chronic complications
1. Retinopathy
2. Kidney Disease
3. Nervous system disease
VI) Treatments
1. Insulin
2. Insulin pump
3. Transplants
a) Pancreas
b) Kidney
c) Islet
VII) Conclusion

Abstract
The goal of this paper is to give a general idea of the current status of diabetes in the United States.

Introduction
Every sixty seconds a person in the United States is being diagnosed with Diabetes. Diabetes can affect anybody, perhaps a parent, sibling, spouse, or even children have been diagnosed. In the United States diabetes is becoming more frequent, with an average of one million new cases diagnosed each year. Currently, approximately 17 million Americans, regardless of race and ethnicity, twenty years of age or older are living with diabetes. As more people become obese and life expectancy lengthens, Americans will see a five to six percent increase in diabetics every year (Milchovich, 1990, p.1). There is currently no cure for this disease but there are plenty of ways to help manage and keep it under control.
History of Diabetes and Insulin
Diabetes has been around for centuries. In fact it was seen in both Egypt and India on medical scribes in 1500 B.C. They mentioned the affected people having a lot of thirst and passing large amount of sugary urine (Drum, 2006, p.46). The Romans and Greeks give it its name, diabetes that means siphon, frequent urination (Milchovich, 1990, p. 1). In the second century, Aretaeus of Cappadocia was the first person that described this serious condition by describing it as “melting down of flesh and limbs into urine.”He also mentioned “life was short, unpleasant, and painful” (Holt, 2009, p.2). There were some early treatment attempts at limiting the intake of sugar and sweets. In India, about three thousand years ago, treatment involved strenuous exercise (Drum, 2006, p.47). People in the earlier days were only expected to live for a short period of time. In 1889, scientist and medical professionals began to gain interest in diabetes. Oskar Minkowsk and Josef Von Mering were two German scientists who discovered that diabetes was related to the pancreas. They removed a pancreas from a dog and it developed diabetes. However, they never followed up on their findings (Holt, 2009, p.2). In 1920, the discovery of insulin was a major highlight in history. It was discovered at the University of Toronto, Canada by surgeon, Fredrick G. Banting, his student, Charles H. Best, biochemist, James B. Collip, and physiologist, J.J.R Macleud. They made the discovery by cooling the extracts from a dog’s pancreas and then injecting it into a dog with diabetes, which caused the dog’s blood sugar to decline (Holt, 2009, p.3). John Buse, director of the Diabetes Center of the University of North Carolina School of Medicine states, “Before insulin, kids would literally die of starvation because their bodies could not assimilate carbohydrates (Colin, 2001, p.192). On January 1, 1922, Leonard Thompson, a fourteen-year-old boy who had diabetes, was the first person to be treated with insulin. From that time on we have seen development and marketing types of insulin with variety of peak onset and action times, which will be addressed later (Holt, 2009, p.3).
What is Diabetes?
Diabetes is a disease that occurs when the body is unable to produce sufficient amount of insulin or use the body’s natural supply effectively. It is a disease of the metabolism; something goes wrong with the way in which the body utilizes food. Insulin is a protein hormone that is produced in a gland by beta cells in the pancreas, and is located behind the stomach (Edelwich, 1986, p. 33). Insulin is normally secreted, as needed, in perfectly measured amounts and timed matter. Normally, within 10 minutes of eating insulin begins to help tiny particles of glucose, a form of sugar, to move from the blood into the cells of our body (Drum, 2006, p.49). Without insulin, our bodies cannot make use of the foods we eat. When we eat, our food is broken down in the stomach into simple chemicals like glucose and fatty acids; they provide fuel for all the activities of the body. Just imagine insulin as a key that unlocks glucose into the bloodstream. There are two major functions of insulin: one is to transfer glucose (a form of sugar) from blood to the body’s cells, where it gets burned as energy, second function is to convert access glucose to glycogen, which gets stored in the liver and muscles as an energy reserve. Alpha cells in the pancreas produce a hormone called glucagon, which stimulates the conversion of stored glycogen into glucose. Even though physicians have diagnosed diabetes for thousands of years, it wasn’t until recently that they have begun to understand how to treat it. Table 1

This table shows the amount of people in the United States that have diabetes who are 20 years of age or older. Retrieved from http://www.cdc.gov/obesity/data/trends.html.
Types of Diabetics
There are two main types of diabetes in humans, type I and type II. People that have type I diabetes are called insulin dependent because they are required to regularly inject themselves with insulin (Edelwich, 1986, p. 33). They produce little to no insulin in their bodies so glucose is not able to metabolize in their bodies. This causes back up in their blood that might be life threatening (Drum, 2006, p. 49). Having an excess glucose in our bodies can damage eyes, kidneys, nerves, and blood vessels. In many cases, people who are insulin dependent have kidney failure and loss of sensations in the feet due to damaged nerves and blood vessels. This can eventually cause them to lose a toe, foot or even legs. This type of diabetes usually appears in younger people under the age of 40, but may occur at any age.
Type II, non-insulin dependent diabetes, is the most common form of diabetes. Millions have been diagnosed in America, and many people are unaware of their high risk (Diabetes statistics, 1995). It is referred to as called adult onset because it usually only occurs after the age of 35. The amount of insulin produced in the pancreas varies from time to time, either the body does not produce enough insulin or the cells ignore the insulin (Type 2, 1995). People have to manage their blood sugar by checking it with either a glucose meter or visual glucose strip (Edelwich, 1986, p. 35). These two methods are different types of blood sugar tests that help monitor blood glucose levels. Glucose meters are small, battery operated machines that, when you place a special strip with a drop of blood, a number will appear on the screen, informing you if your glucose is high or low (Milchovich, 1990, p. 90) Visual glucose strips are thin, plastic strips with two small color blocks. When you provide a drop of blood on the color block, it will cause it to change color, depending on the amount of sugars in the blood (Milchovich, 1990, p. 91). Blood sugar monitoring has become one of the most helpful tools in diabetes. These easy and simple tests can be taken at home, work, and school. It provides the right now blood sugar information, and immediately tells you your range, if its too high or too low, or just perfect (Milchovich, 1990, p. 89). Medication is often prescribed to help maintain the level of glucose in a normal range. Some preventable measures for type II diabetes include having a healthy and balanced diet, exercising regularly, staying physically fit, and keeping weight within normal limits. Avoiding stress can help delay or prevent onset in some individuals, but they could possibility still end up getting diagnosed (Edelwich, 1986, p. 36).
Causes of Diabetes
The causes for diabetes are still not well understood. Type I focuses primarily on the areas of hereditary, severe physical and emotional stress while Type II focuses on heredity, lack of exercise, and obesity (Edelwich, 1986, p. 38). Type I diabetics usually run in families; if one parent has diabetes then the children are more likely to develop this disease then someone without the family history. Insulin-dependent diabetics occur more often in Caucasians than any other racial group (Type II, 1995). Heredity plays a bigger role in people with type II, with a greater likelihood that a person with a non-insulin dependent parent will develop diabetes than a person with an insulin-dependent parent (Edelwich, 1986).
Stress can affect everyone at any age. It can be physical, emotional, or both. When a stressful situation occurs, certain stress hormones are produced in our bodies. These hormones include adrenalin, glucagon, growth hormone, and cortisol. They all work together to raise the blood sugar during a stressful situation. Producing extra glucose can lead to hyperglycemia and ketoacidosis (Milchovich, 1990, p. 151).
Another cause that scientist believe is obesity. In United States it has been increasing, at the same rates as diabetes. 1 out of 7 people who are obese have diabetes (Colin, 2001, p.187). As the population becomes more overweight, type II will develop in younger age groups, and eventually in children. In table 2 below it shows that in 2000 there were few obese people about 15-19% and around Texas there were 20-24%, as we get to the other map in table 3 we can see that it varies from people with 15%- 30%. In the course of 9 years the people diagnosed obesity have increased greatly due to the fast food industry and people becoming less active, and many Americans watch an average of 2-5 hours of television a day.

Table 2

This map shows the percentage of people in the United States who are obese in 2000. Retrieved from http://www.cdc.gov/obesity/data/trends.html.

Table 3

This map shows the percentage of people in the United States who are obese in 2009. Retrieved from http://www.cdc.gov/obesity/data/trends.html.

Diabetic Complications
There are two acute complications for an insulin dependent diabetic, type I. One is diabetic coma, it occurs when the supply of insulin in a period of time is inadequate to utilize the glucose in the blood. Some symptoms include weakness and fatigue, flushed, dry skin and mouth, fruity breath and loss of consciousness (Edelwich, 1986, p. 37). Diabetic coma can be fatal if not treated; it develops slowly so there should be enough time to get insulin treatment and stabilization (Edelwich, 1986, p. 38). This type of complication can occur in type I diabetes and can happen at any stage of illness. When insulin and blood sugar are out of balance, restoring the proper amount of insulin in the body can easily reverse them.
Another complication is insulin reaction, which happens when your blood sugar levels fall abnormally low because of excessive insulin dosage, exercise, or delay in eating. To help avoid insulin reaction diabetics should remember the three C’s: cold, clammy, and confused, which are the main symptoms of hypoglycemia, low blood sugar (Edelwich, 1986, p.38). Many people confuse these, so it’s important to know what each is, its symptoms and how to treat it. If the symptoms of low blood sugar are seen and recognized early, they can stop a reaction. If a reaction is occurring, eating or drinking at least 15 ml of something sweet like orange juice, or soft drinks, or eating something with sugar, like candy helps. If left untreated, brain damage can occur or even death but only after prolonged unconsciousness (Edelwich, 1986, p.39).
Both types of diabetics can come with the risks of long-term complications, but these usually these occur only in those who have had the disease for more than 15 years. Unlike the acute complications, these are chronic and progressive (Edelwich, 1986, p. 37). Some long-term complications include eye disease, and kidney disease.
Many people develop some degree of diabetic retinopathy (disease of the retina). Background retinopathy doesn’t cause visual problems but affects the capillaries that nourish the retina. Proliferated retinopathy is when a new blood vessel grows in the retina and leaks blood into the vitreous cavity. Only small amount develop this and can cause temporary or permanent vision loss (Edelwich, 1986, p. 39).
Diabetic nephropathy (disease of the kidney) can occurs when there’s a change in the small blood vessels in the kidneys filtering system, causing them to be more vulnerable to infection which will eventually cause kidney failure over time. The kidneys keep the right amount of water in the body and help filter out harmful wastes. These wastes, called urea, then pass from the body in the urine. Diabetes can cause kidney disease by damaging the parts of the kidneys that filter out wastes. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week or has to get a kidney transplant. It primarily affects middle aged and elderly men, with the loss of sensation to hands and feet, causing them to be unable to react to injuries, heat, pressure, or cold. They have muscle weakness, skin and circulation disorders. It could possibly be prevented with improved metabolism control.
Eye and kidney problems occur frequently in type I while cardiovascular complications occur in type II. These complications are highly preventable, diabetics get these complications because they maintain a “tight” blood sugar control, or other reasons scientists are not sure of (Edelwich, 1986, p. 40).
Treatments for Diabetics
Most people with type I diabetes take insulin by injecting it with a standard needle and syringe. The goal of insulin therapy is to mimic normal insulin release as closely as possible. Insulin therapy should relate directly to ones health and life choices (Touchette, 1997, p. 36). There are six main types of insulin currently available but I’m just going to talk about four of them. First, the rapid acing analogue insulin is usually injected immediately before, with or within 20 minutes of eating a meal because it has a peak action time of 0-3 hours, and last for about 1-3 hours. This method gives the correct amount of insulin and prevents hypoglycemia. Short acting insulin is the insulin that needs to be given 30 minutes prior to meals to ensure that it has broken down molecules in time to cover the rise of blood sugar levels that occur after food. It has a peak action time of 2-6 hours and lasts up to 8 hours (Holt, 2009, p. 31). Medium acting insulin is to be taken one to two times a day to meat insulin requirements. The body requires small continuous supply of insulin through out the day and night to provide energy for things like tissue repair, cellular activity and regeneration. These are usually taken with short acting insulin to control the sharp rese in blood sugars (Holt, 2009, p. 31-32). Finally, long lasting insulin is to be injected one time per day at the same time, usually taken at bedtime. It really doesn’t matter what time of day you’re injected the insulin but their need to be a 24-hour period. It doesn’t have peak action time; there fore it doesn’t need to be taken with food.
Insulin pumps are tiny computerized pumps that send steady measured amounts of insulin through a piece of flexible plastic tubing under the skin and taped in place. Insulin pump therapy is also known as continuous subcutaneous insulin infusion (CSII) therapy. It is a method of giving insulin subcutaneously without the need for injecting. It is a small pump that usually is carried around on a belt that has a small needle and is inserted beneath the skin. The pump is worn 24 hours a day (Rodgers, 2008, p.1). The amount of insulin that is delivered to their needs. User can give additional insulin doses, when they are done eating or if their blood sugar is too high by pressing button on the pump (Rodgers 2008, 1). People who frequently inject themselves with insulin should consider getting an insulin pump, because the weight of the pumps are less than four ounces which makes them easy to wear, and don’t have to constantly inject themselves. The cost of this pump usually cost around $2000 -$5000 dollars, which is expensive but is a good investment.
People with type I diabetes, their islets cells in the pancreas no longer produces insula. Which is responsible for making insulin. Its reasonable to think that by giving a new pancreas to a person with diabetes would cure the disease, but the body has a way to distinguish between its own parts from foreign parts so about half of the people who get a pancreas transplant reject the new organ. To fool the body into accepting the organ, doctors match the donor and recipient for a blood protein called human leukocyte antigen. Also patients with a transplanted organ take immunosuppressive drugs in order to prevent the immune system from fighting the new organ. The new pancreas is attached to the bladder so it can drain into it, its been proven to get rejected less than if you attach it to another body site. Pancreas transplants are taken very serious; one out of 10 people die within a year of getting the transplant. If the transplant fails the person has diabetes again, but if the transplant takes, the patient no longer has diabetes and most likely will never get it again (Transplantations, 1995-2011).
In diabetes the kidneys are damaged so bad that they no longer work, so when the kidneys fail, the person need to replace their function with either dialysis or a transplant. Dialysis is the way of cleaning the blood with an artificial kidney. There are to types of dialysis: hemodialysis, and peritoneal dialysis. In hemodialysis a surgeon has to create an access site where blood can be easily taken from the body and sent to the artificial kidney for cleaning. The access, usually is made in the forearm, and can be made from the blood vessels and is inside the body so it cannot be seen from the outside. The surgery is done 2-3 months prior to starting dialysis so the body has time to heal. Hemodialysis is done 2-3 days per week and last up to 5 hours each time. Problems can develop over time like nerve problems, anemia, bone disease, and poor nutrition. Usually these complications are the result of diabetes not hemodialysis.
Another form of dialysis is called peritoneal dialysis. It is when he inside lining of the abdomen becomes the filter. Plastic tubes are put into the abdomen by surgeons. Dialysate (cleansing fluid) is put through a tube that passes the abdomen into the dialysate. There are two types of peritoneal dialysis, first is continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). Diabetics with CAPD can perform this treatment themselves by attaching a bag filled with cleansing fluid to the tube in the abdomen and in several hours the fluid is drained out and thrown away, and is usually done 4-5 times a day. In CCPD a machine puts the cleaning fluid into the abdomen and drains it automatically and is usually done at night during sleep (Transplantation, 1995-2011).
Finally the last treatment for a person with diabetes is a kidney transplant. They are most successful when the kidney comes from a living relative, and another option is cadaver kidney, which is a kidney from an unrelated person that just died. 97% of all people with diabetes who get a kidney from a relive are still alive and for the cadaver kidney its at 93%. There are few kidneys for all the people who need them. Many people don’t sign up to be organ donors. With this shortage people usually only get one kidney at time. Even thou the body had two, people can live a healthy live with just one kidney. There is a change of infection because the body may not recognize the new kidney so the patient has to take a drug called immunosuppressant that they will have to take for the rest of their lives. With Because of all the risks, kidney transplants are the only done on a person who’s kidneys are failing (Transplantation, 1995-2011).
In conclusion, living with a chronic disease of any type isn’t easy. Diabetes has its own specific set of challenges…unpredictable ups and downs, tedious testing schedules, cautions and warnings about potential problems with every part of the body imaginable. But yet living with diabetes successfully is entirely possible. Millions of people do it every day. Keeping blood sugar in good control prevents the premature onset of diabetes complications. Keeping blood pressure and blood fats at good levels adds to the evidence.
Diabetes is a slow killer with no known curable treatments. However, its complications can be reduced through proper awareness and timely treatment.

References
(1995-2001). Type 2. American Diabetes Association. Retrieved from www.diabetes.org.
This article explains what type 2 diabetes is and how millions are getting diagnosed every year with the increase in obesity.
(1995-2011). Diabetes Statistics. American Diabetes Association. Retrieved from www. diabetes. Org
This article just gives data from 2011 national diabetes, gives statistics about age, ethnicity, and gender. Talks about some of diabetes complications like heart disease, high blood pressure, and kidney disease. Also gives a estimate on how much it costs a person with diabetes in the united states
(1995-2011). Transplantations. American Diabetes Association. Retrieved from www.diabetes.org.
In this article it talks about three transplants, pancreas, kidney replacement, and islet that are sometimes used to treat diabetes.
Drum, D, E. (2006). Type 2 Diabetes Sourcebook. Blacklick, OH, USA: McGraw-Hill Professional Publishing.
In this book, Drum explains what and how diabetes develops and affects the human body. When It starts out by talking about when they first start mentioning the disease and describing it as great thirst and the passing of large amounts of sugary urine. Then it goes into the biology of diabetes and how to understand it. Drum also writes about how glucose and insulin are important and essential in the human body.
Edelwich, J., & Brodsky, A. (1986). Diabetes: Caring for your Emotions as well as your Health. Georgetown: MA, Addison-Wesley Publishing.
In this book, Edelwich explains what diabetes is, its causes, preventions, symptoms, complications and treatments. Also it talks about the stages of adaptation, concerns that people usually have, and support groups. They also talk about the new technology and how much it costs to have diabetes. Fox, C. (2007). Type I Diabetes: Answers at your Fingertips. London, GBR: Class Publishing.
This book, Fox explains and describes the two different types of diabetes that are known today. Talks about how the pancreas function is in the body, and why the body needs insulin. Without insulin doesn’t make use of the food we eat, because food is broken down into glucose which stays in the blood stream and can be very dangerous for ones health. It describes the discovery of insulin, and the different types of insulin.
Fox, C. (2007). Type II Diabetes: Answers at your Fingertips. London, GBR: Class Publishing.
In this book, Fox talks about new developments and improvements and how it is important to research treatments. He talks about searching for causes and cures, transplants, and new drugs that are becoming available for treatment of diabetes.
Holt, P. (2009). Diabetes in Hospitals: A Practical Approach for Health Professionals. Hoboken, NJ, USA: Wiley.
Holt talks about the history of diabetes and insulin, and that it was first used by Aretaeus of Cappadocia and observed how its characteristics. Also talks about the anatomy and physiology of diabetes, and pancreas. Explains the main types of insulin that are currently available for use in clinical practice.
Milchovich, S, K., & Dunn-long, B. (1990). Diabetes Mellitus: A Practical Handbook. Palo Alto, CA: Bull Publishing.
In this book, Milchovich talks about the two types diabetes and how hereditary, and stress can be causes this disease. It also gives us an insight on some of the complications diabetics encounter.
Rodgers, J. (2008). Using Insulin Pumps in Diabetes: A Guide for Nurses and Other Health Professionals. Chicester, GBR: Wiley.
In this book, Rodgers provides information on what insulin pump therapy is, and how they have developed over the years since they were first introduced in 1970. It talks about how today’s insulin pumps are really sophisticated. Current technological advances in insulin pumps therapy will start increasing and being more sophisticated, and smaller. She also briefly talks about the different insulin pumps like wireless, implantable, and closed look.
Touchette, N., Welch, B.C. (1997). Americans Diabetes Association Complete Guide to Diabetes: The authoritative Resource from the Diabetic Experts. Alexandria, VA: Science Designs. Touchette talks about what diabetes, the types there are and how to manage each type.

References: (1995-2001). Type 2. American Diabetes Association. Retrieved from www.diabetes.org. This article explains what type 2 diabetes is and how millions are getting diagnosed every year with the increase in obesity. (1995-2011) Edelwich, J., & Brodsky, A. (1986). Diabetes: Caring for your Emotions as well as your Health. Georgetown: MA, Addison-Wesley Publishing. Fox, C. (2007). Type II Diabetes: Answers at your Fingertips. London, GBR: Class Publishing. Milchovich, S, K., & Dunn-long, B. (1990). Diabetes Mellitus: A Practical Handbook. Palo Alto, CA: Bull Publishing. Touchette, N., Welch, B.C. (1997). Americans Diabetes Association Complete Guide to Diabetes: The authoritative Resource from the Diabetic Experts. Alexandria, VA: Science Designs.