Diabetes
Diabetes is one of the most common diseases of the modern age, influencing global health and quality of life. Statistics show that about 10% of the population suffers from the illness, and there is a tendency towards increasing the number of people with it (Zaccardi et al., 2016). Among these people, type 1 diabetes affects only 8% of patients, while type 2 influences 90% (Zaccardi et al., 2016). This difference is preconditioned by the pathophysiology of various types of the disease. At the moment, there is no clear understanding of risk factors leading to the emergence and development of type 1 diabetes. Speaking about type 2, family history, ethnic background, age, and obesity can be the central risk factors leading to the emergence and development of the disease (Zaccardi et al., 2016). Thus, the case of patient M.S. proves this statement, as obesity could have triggered the condition.
All forms of diabetes have differences in pathophysiology as they are caused by various factors. A person with type 1 suffers from an autoimmune condition meaning that the body attacks and destroys cells responsible for insulin production (Roep et al., 2021). It means that patients lose their ability to produce this hormone anymore and suffer from the critically high glucose levels in the blood (Roep et al., 2021). Specifically, insulin is synthesized in the pancreas by the b-cells of the islets of Langerhans as a result of glucose stimulus (Roep et al., 2021). However, type 1 DM is preconditioned by the autoimmune destruction of these cells. The decline in beta-cell mass results in the reduction of insulin secretion till all available insulin cannot suffice the demands of the body and maintain normal blood glucose levels (Roep et al., 2021). Following this condition, the patient starts to experience all symptoms typical for the disease and suffers from multiple adverse effects.
For type 2 DM, different processes are typical because of the peculiarities of the body’s functioning. If a person has this condition, his/her body does not produce enough insulin, or it does not work properly (Galicia-Garcia et al., 2020). It results in the development of insulin resistance. It is a heterogeneous disorder that prevails among specific ethnic groups. Recent research in the USA shows that naïve Americans, Hispanic, and Asian Americans are more subjected to the disease (Galicia-Garcia et al., 2020). As stated above, the pathophysiology of type 2 DM presupposes peripheral insulin resistance, worse regulation of hepatic glucose production, and reduced beta-cell function (Galicia-Garcia et al., 2020). Considering the fact that insulin release and its appropriate activity are vital processes for glucose homeostatic, all mechanisms at the molecular level involved in the synthesis and release of insulin are regulated and interdependent (Galicia-Garcia et al., 2020). The emergence of the problem in any of these systems or mechanisms results in a metabolic imbalance the onset of type 2 DM (Galicia-Garcia et al., 2020). In such a way, defective secretion of insulin by beta-cells and insulin-sensitive tissues’ inability to respond become the major causes for the development of the problem (Galicia-Garcia et al., 2020). It also explains the problems with glucose levels in the blood.
In such a way, type 1 DM is viewed as a specific and complex autoimmune condition. The body starts to attack cells in the pancreas and cannot produce the hormone insulin needed to take glucose off the blood. For the second type, the insufficient levels of insulin are typical. The differences in these processes precondition different bodies’ responses to the disease and different approaches to managing type 1 and 2 DM (Zaccardi et al., 2016). Today, there are still attempts to understand why the body interferes in the production of beta-cells and starts to attack them. However, there is still a gap in knowledge related to the causes preconditioning these alterations at the molecular levels and the emergence of insulin resistance (Zaccardi et al., 2016). It means the necessity to continue investigating the pathophysiology of two conditions to acquire new data and use it to help patients.
The symptoms of the two types are also different and result from the peculiarities of the disease. For type 1 diabetes, the fast appearance of the major signs is typical, while patients with the second form might fail to notice symptoms as they emerge slowly. They include feeling thirsty, blurred vision, tiredness, frequent urinating, especially at night, losing weight (Zaccardi et al., 2016). The common symptoms come from the lack of insulin and the mechanism of how the disease affects the body of a person. The only difference is the speed of the onset and the development of the central symptoms.
Both diabetes 1 and 2 cannot be completely cured today as there are no effective measures to restore the appropriate functioning of the body and its production of insulin. However, speaking about the second type, the recent research shows that patients losing weight and following a low-calorie diet can put the disease into remission and enjoy an improved quality of their lives (Zaccardi et al., 2016). Both conditions demand specific management and changes in the lifestyle. For type 1 diabetes, the constant income of insulin is critical to control blood sugar levels (Zaccardi et al., 2016). Blood should also be tested to measure glucose levels. For patients with type 2 diabetes, diet and a healthy lifestyle are vital. However, in complex cases, insulin can also be demanded to manage the condition and avoid adverse effects or undesired conditions.
The case of patient M.S. demonstrates how type 2 DM works and its peculiarities. The age (45 years) is typical for the onset of the disease, while obesity is another factor that can trigger the development of problems with insulin and the emergence of resistance. The current medications help to control the blood sugar at appropriate levels with is vital for patients with such conditions. At the same time, the long story and the low speed of the symptoms’ development correlate with the peculiarities of the pathophysiology described above. It is possible to predict improvement of the situation. Although the patient has a high BMI, he adheres to the diet and healthy lifestyle. Altogether, type 1 and 2 DM are caused by different factors and have various mechanisms of their development. The first one is an autoimmune condition characterized by autoimmune destruction of beta-cells produced in the pancreas, which results in the inability to control glucose levels and the development of multiple symptoms. For the second one, peripheral insulin resistance, worse regulation of hepatic glucose production, and reduced beta-cell function are typical.
Insulin
Insulin is a hormone playing a critical role in the functioning of the body. It is a hormone produced in the pancreas needed to use glucose for energy (Chawla et al.,2020). When this type of sugar occurs in the bloodstream, insulin affects other cells in the body to absorb the sugar and use it as a source of energy (Chawla et al.,2020). Insulin is also vital for controlling blood glucose levels and avoiding its accumulation (Chawla et al.,2020). That is why insulin is viewed as an effective pharmacological treatment for these conditions. There are several types classified according to how quickly it starts to work and how long it remains active: rapid-acting, short-acting, immediate acting, and long-acting (Chawla et al.,2020). Prescription and regimens depend on the peculiarities of the case and the patient.
For patients with type 1 DM, the constant income of insulin is vital to control glucose levels. Most of them should follow a regiment with multiple daily injections of basal insulin (Janez et al., 2020). However, for people with specific glycemic targets or patients with severe hypoglycemia, continuous subcutaneous insulin infusions can be a preferable option (Janez et al., 2020). Today, basal insulin analogs with a reduced peak profile and extended duration are preferred as they promote the following benefits: better efficacy, lower risk of hypoglycemic episodes, reduced injection burden, and reduced weight gain (Janez et al., 2020). For patients with the need for prandial glycemic control, rapid-acting analogs can be recommended instead of regular human insulin (Janez et al., 2020). In general, nowadays, there are multiple options for using insulin effectively to manage type 1 DM.
For people with type 2 DM, recommendations for using insulin are different. First of all, this pharmaceutical treatment should be initiated only if the patient fails to achieve the current glycemic goal using oral hypoglycemic agents (Lee et al., 2017). Furthermore, insulin can become an initial treatment in the presence of metabolic decompensation or symptomatic hyperglycemia (Lee et al., 2017). The choice of the regimen and type of treatment also depends on patients. Basal insulin or premixed injections can be prescribed only by a therapist regarding the patients’ demands (Lee et al., 2017). If the glycemic goal is not achieved, a multicomponent insulin regiment should be initiated (Chawla et al., 2020). Finally, it is possible to combine oral hypoglycemic agents and insulin in special cases (Lee et al., 2017). This pharmaceutical treatment demonstrates good results and helps to support the high quality of patients’ lives.
Complementary & Alternative Therapies
Acupuncture is one of the alternative therapies that can be used to treat different conditions in patients. It presupposes using thin needles and inserting them in a body through a person’s skins at special points to various depths. From the perspective of traditional Chinese medicine, it helps to restore balance due to the effect on certain lines and spots on the human body. In general, this form of treatment is linked to spiritual and harmonious practices aimed at helping a person to find inner comfort and relax. Rating its effectiveness, it is possible to accept acupuncture’s ability to release muscle tension and the level of stress caused by everyday pressure; however, its ability to treat complex conditions is doubtful and remains weak.
References
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Chawla, R., Madhu, S. V., Makkar, B. M., Ghosh, S., Saboo, B., Kalra, S., & RSSDI-ESI Consensus Group (2020). RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020. Indian Journal of Endocrinology and Metabolism, 24(1), 1–122.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & MartĂn, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275.
Janez, A., Guja, C., Mitrakou, A., Lalic, N., Tankova, T., Czupryniak, L., Tabák, A. G., Prazny, M., Martinka, E., & Smircic-Duvnjak, L. (2020). Insulin therapy in adults with type 1 diabetes mellitus: A narrative review. Diabetes Therapy: Research, Treatment and Education of Diabetes and Related Disorders, 11(2), 387–409.
Lee, B. W., Kim, J. H., Ko, S. H., Hur, K. Y., Kim, N. H., Rhee, S. Y., Kim, H. J., Moon, M. K., Park, S. O., Choi, K. M., & Committee of Clinical Practice Guideline of Korean Diabetes Association (2017). Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017. The Korean Journal of Internal medicine, 32(6), 967–973.
Roep, B. O., Thomaidou, S., van Tienhoven, R., & Zaldumbide, A. (2021). Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?). Nature Reviews. Endocrinology, 17(3), 150–161.
Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. Postgraduate Medical Journal, 92(1084), 63–69.