Diabetic Mellitus (DM) is an endocrine condition that involves the inability of the body to regulate glucose in the system consequently affecting the metabolism of fats, carbohydrates, and protein. The table below shows interesting facts about the different types of DM for clarification. (Braun et al 2017, & Klandorf et al 2013). DM Type 2 will be the focus of this entire discussion.
|DM Classification (Types)||Lifespan Onset||Etiology (Cause)|
|Insulin Dependent DM (Type 1)||Childhood – Puberty. Peak= 10-14yrs old, increases in adulthood||Insulin Deficit due to inability to produce insulin|
|Non-Insulin Dependent DM (Type 2)||Adulthood with Peak period at 45 years old and increasing under 45 years old||Insulin resistance or impaired inability of the tissue to use insulin in response to the body’s needs.|
|Gestational DM||Pregnancy and peaks at the 5th or 6th-month gestation.||Inability to make additional Insulin that is needed during pregnancy.|
Diabetes is one of the most common health problems in the United States with over 30 million people diagnosed. Of those 30 million 90 to 95 percent have type 2 diabetes (CDC, 2018). Diabetes was listed as the seventh leading cause of death in 2014 (Santos-Longhurst, 2017). Type 2 Diabetes is characterized by a resistance to insulin and a reduction in insulin secretion that is essentially inadequate to maintain healthy blood sugar levels (Braun & Anderson, 2017). One of the main factors contributing to type 2 diabetes is obesity. This may be both genetic and/or environmental and leads to insulin resistance due to free fatty acids and cytokines being released from adipose tissue (Braun & Anderson, 2017). The release of these causes interference with insulin signals, disruption of insulin receptors, and prohibit the entry of glucose into tissues (Braun & Anderson, 2017). Many problems and complications can arise from type 2 diabetes, especially if uncontrolled. These include hypertension, heart disease, stroke, eye issues and blindness, kidney disease, complications with the nervous system, amputations, foot problems and ulcers, skin problems, dental issues, pregnancy complications, and birth defects, and mental health problems (Santos-Longhurst, 2017). These issues should be addressed with all patients diagnosed with diabetes to educate on compliance with treatment and prevention of these complications.
Treatment options include healthy eating, exercise, weight reduction, blood sugar monitoring, as well as numerous medication options and insulin replacement. Metformin is typically the first medication prescribed when diagnosed with diabetes. Metformin increases sensitivity to insulin in the body’s tissues and lowers glucose production in the liver (Mayo Clinic, 2018). Sulfonylureas are a class of medications that increase insulin release. Meglitinides act similarly to sulfonylureas in that they also increase insulin release but are faster acting, although the duration of effects in the body is shorter (Mayo Clinic, 2018). Thiazolidinediones also increase sensitivity to insulin-like Metformin but have more serious side effects (Mayo Clinic, 2018). DPP-4 Inhibitors reduce blood sugars, GLP-1 receptor agonists reduce blood sugars and slow digestion, and SGLT2 inhibitors prevent reabsorption of glucose into the blood by the kidneys (Mayo Clinic, 2018). Insulin injections may also be used.
Braun, C.A. and Anderson, C.M., (2017) Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease. (3rd. Edition) Baltimore: Wolters Kluwer.
Centers for Disease Control and Prevention (CDC). (2018, March 28). Diabetes Home. Retrieved from https://www.cdc.gov/diabetes/basics/type2.html
Eckman, M., & Share, D. (2013). Pathophysiology Made Incredibly Easy!. Philadelphia: LWW.
Klandorf, H. P., & Stark, S. D. (2013). Diabetes mellitus. Magill’S Medical Guide (Online Edition)
Mayo Clinic. (2018, January 03). Type 2 diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199
Nayyar, G. (2012). How to manage diabetes–not be managed by it. mHealth solutions are paving the way toward better disease management. Health Management Technology, 33(12), 14-15.
Phillips, A. (2015). Diabetes and relationships: How couples manage diabetes. Practice Nursing, 26(6), 298-301.
Santos-Longhurst, A. (2017, February 27). Type 2 Diabetes Statistics and Facts. Retrieved from https://www.healthline.com/health/type-2-diabetes/statistics#6
Stuckey HL, Mullan-Jensen CB, Reach G et al (2014) Personal accounts of the negative and adaptive psychological experiences of people with diabetes in second diabetes, attitudes, wishes, and needs (DAWN2) study. Diabetes Care 37(9): 2466–7
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