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Diabetes as one of the world’s fastest growing metabolic disease
DIABETES
Introduction
Diabetes is described as one of the world’s fastest growing metabolic disorder, which is highly characterized with a plethora life threatening adverse events and complications, increased cases of morbidity and mortality among populations, and heavy burden to public health care in regard to its treatment and management. It is also described a group of metabolic disorders that results from increased levels of glucose in the blood, and it’s diagnosed in a clinical setting by evaluating the amount of glucose in the blood or by assessing the signs and symptoms predominant with diabetes such as polyuria, polydipsia, polyphagia, presence of urinary ketones, and changes in potassium levels. If this condition is not diagnosed earlier or left untreated for a long period of time, its progression can lead to myriad of complications that range from organ failure, limb amputations, blindness, and severe complications such as nonketotic hyperosmolar coma and diabetic ketoacidosis that can even lead to death.
Diabetes
Diabetes is regarded as one of the world’s fastest growing metabolic disease that is characterized with increased and heightened blood glucose levels, and the current global statistics shows that it affects more than 330 million individuals worldwide inclusive of children, adolescents, and the aged. This condition is categorized into three distinct subtypes that include type 1, type 2, and gestational diabetes mellitus.
Type1 diabetes also regarded as insulin-dependent or childhood-onset diabetes is a chronic T cell-mediated disease, and occurs in situations where the body is unable to produce enough or completely fail to produce insulin to aid metabolic processes. Type 1 diabetes is genetically determined and its pathophysiology is attributed to autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas that contribute to a progressive and irrevocable damage of the pancreatic cells resulting to reduced or no insulin production that is incapable of aiding metabolic processes. The progression and development of this condition is attributed to a myriad of environmental and genetic factors that range from viral infections, poor eating habits, intake of certain medications such as streptozotocin and antineoplastic agent used in chemotherapy and chemicals such as pyrinuron, trauma to the kidney, and diseases affecting the kidney such as pancreatitis and tumors to the pancreas.
Diabetes is regarded as one of the world’s fastest growing endocrine disease that is characterized with elevated blood glucose levels. It is classified into three broad classes namely: type 1, type 2, and gestational diabetes mellitus (GDM) (Rother, 2007). Type1 also known as Juvenile or childhood or insulin-dependent diabetes and occurs in situations where the body is unable to produce enough insulin. This type of diabetes is genetically inherited, and it is often caused by autoimmune destruction of the beta cells of islets of Langerhans in the pancreas, which subsequently result to reduced production of insulin (Wilkins & Williams, 2006). In terms of prevalence, type 1 diabetes is less common and accounts for less than 10% of the total diabetic cases. Type 2 diabetes on the other hand is insulin independent and accounts for more than 90% of all diabetics’ cases (American Diabetes Association, 2010). This type of diabetes is commonly prevalent among adults aged over 40 years old, and occurs in events where the body is unable to respond or utilize the synthesized insulin. Unlike type 1 diabetes that is genetically determined, type 2 diabetes is caused by numerous causes that are not limited to unhealthy eating, sedentary lifestyle, and inappropriate lifestyle behaviours such as alcoholism and smoking. Gestational diabetes mellitus (GDM) is another significant type of diabetes and unlike the other types of diabetes; GDM only affects pregnant women during gestational period. Gestational diabetes mellitus (GDM) is similar to type 2 diabetes in most aspects and affects about 2–5% of all pregnancies (Rother, 2007).
Type 2 diabetes is the most common type of diabetes, and the commonly used antidiabetic medications include the use sulfonylurea such as tolbutamide, glipizide and glyburide (Wilkins & Williams, 2006). This drug act on the liver cells where they enhance insulin secretion from the pancreatic beta cells by stimulating breakdown of glucose in glycolytic pathway, and as well as inhibiting glucose production. This drug is normally used as first-line drug for type 2 diabetes management, and it is administered orally because of its rapid and ensuing absorption from the gastrointestinal tract (Rother, 2007).
Type 2 diabetes is a lifelong condition and requires constant monitoring to avert short-term complications or adverse health events that range from hypoglycaemia, nonketotic hyperosmolar coma, and diabetic ketoacidosis (DKA). The most common long-term effect of type 2 diabetes include damage to blood vessels, blindness that results from retinal detachment, diabetic retinopathy, and glaucoma, diabetic neuropathy, renal failure, and limb amputations that results from circulation difficulties (American Diabetes Association, 2010). Another important long-term effect is the idea of living with the disease for life, and this means the affected individual will continue to take medications permanently and as well as adjust their lifestyle in order to prevent any probable adverse events and complications. Although the drugs for treatment are very helpful in restoring glucose levels to normal, they tend to cause several side effects. The most common side effects of antidiabetic medications include weight gain, increased chances of developing cancer, and tremors (Rother, 2007).
Conclusion
Diabetes is one of the world’s most growing epidemics and currently it affects more than 320 million people worldwide inclusive of children, teenagers, and adults. The affected patients exhibit numerous signs and symptoms that include frequent urination (polyuria), increased thirst (polydipsia), and hunger (polyphagia). Being a very diverse condition, it causes are dependent on various environmental, genetic, and social factors that influence the treatment recommendations. In conclusion, diabetes is a lifelong disease and therefore individuals suffering from it are required to take antidiabetic medications for the rest of their lives.
References
American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1:S62-S69.
Rother, K.I (2007). “Diabetes treatment—bridging the divide”. The New England Journal of Medicine 356 (15): 1499–501.
Wilkins, B. & Williams, L.(2006). Diabetes Mellitus: a guide to patient care. New York: John Wiley and Sons
Diabetes Americas Silent Killer
Diabetes: America’s Silent Killer
Diabetes is currently the sixth cause of death in the US resulting to more than 70,000 deaths annually (Colwell, 2008). This number is understated because diabetes is often a secondary cause of death, leading to; fatal renal failure, cardiovascular disease and cerebral vascular disease. Diabetes has compounded effects on the American population. The cost of treating diabetes in 2007 was approximated at 174 billion dollars (ADA, 2007). Diabetes also has various unrelated health costs including reduced work productivity (ADA, 2007). Diabetes is more prevalent among minority populations and the poor who rarely have adequate access to healthcare facilitates (ADA, 2007).The rate of diabetes has steadily doubled in the last decade and is expected to continue escalating (Colwell, 2008). Currently, more than twenty five million Americans have diabetes. This accounts for a significant eight percent of the entire American population (Colwell, 2008). More than half of all diabetes cases are still undiagnosed. Most of these cases are diagnosed too late for any effective preventive or control measures often resulting to death.
Diabetes is a collective term referring to a number of diseases characterized by increased levels of blood glucose. This is as a result of abnormalities in the production of insulin or the mechanism of action of the insulin produced (NIDDK, 2008). A significant percentage of patients have defects in both the production and the action of insulin (Colwell, 2008). Insulin is a hormone produced by the pancreas and it converts blood glucose to a storable form of carbohydrates called glycogen (NIDDK, 2008). Failure in this homeostatic pathway leads to extremely high blood glucose levels. The fasting plasma glucose level test is the most reliable test used to diagnose diabetes. A blood glucose level of more than 126mg/dl is usually indicative of diabetes (NIDDK, 2008).
There are various types of diabetes depending on the cause. The most common types are; gestational, type 1 and type 2 diabetes. Gestational diabetes refers to glucose intolerance in pregnant women (D’Adamo, J & Whitney, 2005). It is more common among minority populations (D’Adamo, J & Whitney, 2005). Research has indicated a higher probability of women diagnosed with gestational diabetes developing type 2 diabetes (Poretsky, 2008).
Type 1 diabetes refers to persistently elevated blood glucose levels as a result of an abnormality in the production of insulin (Colwell, 2008). Type 1 diabetes normally results after the pancreatic cells which produce insulin are destroyed by autoimmune antibodies (NIDDK, 2008). The patient has to rely on continuous insulin injections to supply the body with insulin (NIDDK, 2008). There is no known cause of type 1 diabetes but scientists have attributed it to heredity due to increased familial aggregation (Colwell, 2008).
Type 2 diabetes is the most prevalent form of diabetes in America, afflicting more than 95% of the entire population with diabetes (NIDDK, 2008). It refers to elevated blood glucose levels as a result of insulin resistance. The body is unable to use the produced insulin properly. This results to an overworked pancreas that may be destroyed requiring direct insulin intake (Poretsky, 2008). Type 2 diabetes is commonly associated with adults but there has recently been increased prevalence in children and teenagers with type 2 diabetes (Poretsky, 2008). This diabetes is mostly caused by a sedentary lifestyle and poor eating habits (Colwell, 2008). It is most common in minority groups especially; African Americans, Latino Americans and American Indians and researchers have concluded that there is also familial aggregation (NIDDK, 2008). Type 2 diabetes is often associated with obesity and hypertension (D’Adamo, J & Whitney, 2005).
Most cases of diabetes are diagnosed when it is too late to apply any meaningful corrective measures. In early diagnosis, diabetes can be effectively addressed and corrected with a change in lifestyle (D’Adamo, J & Whitney, 2005). It is therefore imperative that the entire American population understands the onset of diabetes so that they are able to seek necessary medical and behavioral interventions to avoid diabetes complications.
The earliest symptom of diabetes is the increased tendency to produce urine and increased thirst (Colwell, 2008). The elevated blood glucose spills into the urine causing glucose in urine. This in turn causes increased water re absorption at the kidneys, leading to increased urine output and thirst (Poretsky, 2008). The uncontrollable fluctuation in blood glucose causes blurred vision (Colwell, 2008). Diabetes may also lead to loss of body weight. The inability of insulin to metabolize blood sugar interferes with carbohydrate, fat and protein metabolism (D’Adamo, J & Whitney, 2005). Diabetes patients may also experience; increased fatigue and nausea. Undiagnosed cases may also cause bladder, vaginal and skin infections (Poretsky, 2008).
The mode of therapeutic intervention of diabetes depends on the type of diabetes. Diabetes can lead to various health complications. The elevated blood glucose levels leads to destruction of the micro vascular system which causes renal failure and blindness (Colwell, 2008). It may also cause macro vascular damage resulting to; coronary thrombosis, stroke, comma and lower limb amputations (Poretsky, 2008). These complications can however be avoided by an early diagnosis and implementing controls to manage blood; glucose, pressure and lipid levels.
Patients with type 2 diabetes, who comprise 95% of the entire diabetes population in America, can prevent complications of diabetes by applying relevant changes in lifestyle and taking oral medication. These interventions usually entail; proper diet, exercise and loosing excessive weight. Some type 2 patients with destroyed pancreas also use insulin injections (Poretsky, 2008). Individuals with type 1 diabetes depend on direct delivery of insulin. This is either done through injections or an insulin pump (Colwell, 2008).
For both type 1 and type 2 diabetes, the medication may change over the course of the disease. Due to the effect of insulin on lipid, carbohydrate and protein metabolism, most of these patients also take medication to control cholesterol levels and hypertension (D’Adamo, J & Whitney, 2005). Effective address of diabetes largely depends on self management. After diagnosis, the patient is charged with the task of implementing the necessary self care behaviors which include; appropriate healthy eating, blood glucose monitoring and physical exercise.
With the steadily increasing prevalence, mortalities and the high costs associated with managing and controlling diabetes; preventing diabetes among the American population has become a national agenda. Researches have advocated giving increased focus to people who are at increased risk (Colwell, 2008). This includes minority populations and patients with pre-diabetes and gestational diabetes. Studies have indicated that individuals with pre-diabetes, who implement the right self management care strategies including the right diet and exercise, are able to prevent or delay the onset of diabetes (D’Adamo, J & Whitney, 2005). These self management interventions among individuals with diabetes are more cost effective and efficient than medication (D’Adamo, J & Whitney, 2005).
In conclusion, diabetes is Americas leading silent killer disease. More than half of all diabetes cases are undiagnosed and remain unaddressed until it is too late for meaningful preventive and control strategies. More than seventy thousand annual mortalities are directly caused by diabetes in America. Many more patients however die from complications caused by diabetes. This is either due to retinopathy, cerebral and coronary complications and nephropathy. These figures are undocumented. The link between type 2 diabetes and obesity means that more than half of the entire American population is at increased risk of diabetes. Minority groups and especially African American males are at an increased risk for diabetes. More than 95% of the diabetes patients in America have type 2 diabetes. This type can be effectively prevented and controlled by implementing the appropriate lifestyle changes. This includes; adequate exercise and dietary changes. Researchers have advocated targeting people with pre diabetes as an effective and cost efficient way of delaying and preventing the onset of type 2 diabetes.
References
American Diabetes Association (ADA). (2008). Economic costs of diabetes in the US in 2007. Diabetes Care March 1,596-615
Colwell, A. (2008). Diabetes. New York: Elsevier Publishers.
D’Adamo, J & Whitney, C. (2005). Diabetes: fight it with the blood type diet. New York: Berkley Books.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2008). National Diabetes Statistics, 2007 fact sheet. Bethesda: National Institutes of Health. Retrieved on March 23, 2010 from http://diabetes.niddk.nih.gov/DM/PUBS/statistics/#pre-diabetes.
Poretsky, L. (2008). Principles of diabetes mellitus. New York: Springer
Dharma is a word that describes the act of doing the right thing depending on an individual’s perception of morality (Naravan
Alana Hunter
2-7-15
Asian Great Books
Prof. Thompson
Dharma
Dharma is a word that describes the act of doing the right thing depending on an individual’s perception of morality (Naravan & Jampar 58). The Mahabharata and Ramayana are both well known, lengthy, epics that serve as a great source of influence in Indian culture (Naravan & Jampar 58). Both epics demonstrate that when one goes against the steady stream of their sacred duty or dharma, punishment ensues. The characters still pursue it, eventually leading to self-destructive tendencies.
In the Ramayana, when Rama is about to kill Vali, it appears that he is about to kill someone who has never wronged him. Rama’s primary defense is “It is my primary duty to help the weak and destroy the evil wherever I see it”. Therefore, the death of Vali becomes his business in order for progression (Naravan & Jampar 57). In the Mahabharata, the events of Arjuna slaying Karna in his vulnerable state, and when Bhima “unfairly killed the righteous Kind Duryodhana,” seem to negate the goal of being virtuous. However, these events have a validation since they are the reaction to initial immoral acts. The Hindu idea of appadharma, in which one’s actions are morally right in moments of crisis, surprisingly justifies these actions since these characters are still working to pursue their duties. Ultimately, the characters are still following their moral destiny, as Dharma becomes more flexible in the pursuit of a larger purpose.
According to Ramayana, Dharma has the power that propels the world and the society as every character tries to perform his/her moral obligation and keep the natural law. Dharma is a person’s obligation and does not impose any rules since nature guides the moral duty of every creature. The period 1000BCE there was a hero Ramayana, who observed all the dharma guides in India and was perfect according to many people. He married Sita and became a ruler of Aydohya, and many people would tell their children to behave like Ramayana or Sita. The two had a son Prince Rama, who was to become the next king, but when the time for crowning came, his stepmother asked the father to Crown Prince Rama’s younger stepbrother. Rama did not oppose, as he was a keen observer of Dharma (Ramayana67). The world’s activities run smoothly because of dharma all creatures have the mandate to do what is morally right to them. The moral uprightness according to dharma differs from one person to another, as some things are either rightful or wrongful depending on the individual. “Man is an intellectual being and has a conscious mind and can decide to do the right or the wrong thing. So Karma has to follow Dharma, meaning action has to follow right action” (Ramayana 36).”Good actions produce good results; the bad action produces bad results” (Ramayana 36).
In the Ramayana, Dharma is a term that can imply to the duty or the responsibility of an individual with respect to the moral and the righteousness as held by the Society (Naravan & Jampar 56). Through dharma, people live a righteous life and perform their duties depending on their age, gender, or the position they occupy in the society. For example, In the Dunar dynasty, there was a king by the name Shibi in the family of Bharata. He observed justice and kept his promise, but the king of Dharnaraji tested his character since he vowed to protect everybody. One day a dove told the king to hide him to escape the eagle and told him to save his life. The eagle also cried and told the king to offer him the dove since he was hungry…….. The king finally passed the Dharma test of righteousness (Mahabharata 34). Individuals who obey Dharma should live a life of righteousness and avoid actions so that they will inherit eternal life. Ramayana notes the case of Liza. Lingza Chokyi was a famous Delok and lived in the 1600s, who died but never realized it, when her spit escaped from her. The family did all the rituals on her body as her children grieved, yet she could not talk to them. Her father beckoned her, and they went to the place with a bridge leading to hell and another one to heaven. Afterward, the Lord of Death sent her back to the earth (Ramayana 56). Following one’s dharma is very important to Hindus, since they believe that there is liberation, which include the death or rebirth, a phenomenon called Samsara. In Mahabharata, the Buddha says to his disciple Vasettha:”Tathāgatassa h’etam Vasettha adivacanam Dhammakayo iti pi …. “” (Ramayana 58).
According to Dharma, an individual is free to do something if the action makes him or her happy. “ There is more joy in doing one’s duty badly than there is in doing another man’s well” (Ramayana 100). In fact, people are happy when doing their duties badly than when they are doing good things for other people. When one lives, according this his/her dharma, there is great satisfaction and inner peace. If one lives according to other people’s dharma, there is destruction of the peace he/she enjoys. Living in one’s dharma ensures that one lives according to his beliefs, and the satisfaction is very big, which increases the individual’s confidence (Naravan & Jampar 57).
In Mahabharata, Dharma has a relationship with the shraddha, which defines an individual as who he/she is. Shraddha brings a lot of happiness and joy since it defines one’s deep emotions of anger, joy, or anxiety. Dharma defines one’s moral values and is dependent on peoples’ emotional state of mind to exercise it. Dharma has the capability of curing some illness, especially the psychological and the mental sicknesses as Mahabharata notes the personal experience of Dharma cure to David. “After integrating the experiences, I faced stage IV Lung Cancer that ate away part of my spine causing it to collapse. Again, the Light came to my side, assisting me to overcome the obstacle of terminal cancer. A few spine surgeries later, and after learning to walk again, I can now share my personal transformation and consciousness. I call them Dharma Talks, insights” (Mahabharata 89). Following one’s morals is very important, because it brings a lot of satisfaction to the individual, when they what they believe it is right to them. Dharma brings a lot of self-satisfaction and self-recognition to a person since he/ she engages in his/her excellent activity, which can bring a lot of happiness.Dharma raises the self-confidence and the self-esteem of a person when he/she engages in his/her moral values as expressed in the Ramayana. “In order to live from our soul, there must be recognition of who we are, and that often involves making peace with our pain. None of us is immune to pain. Suffering is part of the human realm. However, the key is to transcend it, and learn from it. To deny its existence is pure ego and has nothing to do with matters of the spirit” (Ramayana 23)
Dharma can have some limitations, especially if everybody is free to practice his/her dharma as depicted in some parts of the Ramayana. Some people’s dharma is causing harm, stealing, and violence; therefore, there must be other laws, such as religious and the national laws governing the peoples’ way of life. In the Vakkali Sutta, Buddha said to his disciple Vakkali that, “Yo kho Vakkali dhammaṃ passati so maṃ passati” “O Vakkali, whoever sees the Dharma, sees me the Buddha” (Mahabharata 104). The quote is in reference to the observance of the religious laws as Buddha wants.
Conclusion
Dharma is very important in the Hindu culture, and many people believe in it and its effect on the individual and the society’s way of life as depicted in the Ramayana and Mahabharata. Dharma defines a person’s moral authority and responsibility in a manner that causes some happiness. Although there are laws, religious values, and culture, Dharma plays a very big role in shaping the behavior of humans. Success does not depend on the societal moral values, but the dharma of a person, as some things that are morally wrong to some individuals are not wrong to others. There are some health benefits of Dharma such as treatment of stress, anxiety, and fatigue (Narasimhan 59). Happiness sometimes comes from one’s dharma, which also contribute to the health of an individual.
References
Narasimhan, C. V. The Mahābhārata. New York: Columbia University Press, 1965. Print.
Narayan, R. K. The Ramayana. New York: Penguin Books, 2006. Print