Diabetes Mellitus and its Age Long Fight With Humanity. Will the Fight Ever Favour Us?

Introduction

The war wedged by diabetes mellitus on man is really gruesome and for centuries now, it has been a major concern to the human population as a whole. It has made life miserable for some and has turned out to be one of the major guns mercilessly firing at the endangered who unfortunately and helplessly get shot by it.

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I personally, have had a friend whose mum had a really tough time battling this condition; believe me when i say, it is neither fun nor easy to cope with.

Notwithstanding though, as each day progresses, and years turn to decades, various studies and progresses have been made in the management and prevention of this disease. Thus; offering mankind the ability to live, though not completely above destruction by it, but at a more advantaged level. In this post, I will be evaluating the ways through which mankind can successfully achieve supremacy over diabetes mellitus.

What Really is Diabetes Mellitus(DM)?

To understand the mechanisms through which DM is prevented and tackled, we would first have to understand how it takes hold and affects its patients.

To a majority of our friends out here, DM is nothing but a state in which one urinates in drum-like quantities and also a state where one's urine is sugary when tasted. This layman's understanding and definition is not completely wrong as both signs (polyuria and glycosuria) are noticeable in a diabetic patient with glycosuria being mostly seen in the late stage of diabetes, when the kidneys cannot filter adequately, the amount of sugar in the blood due to its increased concentration .

However, from a medical perspective, DM is a disorder in the metabolism of glucose arising either due to an error in the production and release of Insulin, the inability of body cells to utilize Insulin to aid metabolism of glucose or from both errors at the same time.

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Insulin is a double chained polypeptide hormone produced by Beta-cells of the pancreas which helps in the absorption and utilization of glucose by cells. It happens to be the only antidiabetic hormone produced by the body as no other hormone is directly involved in the metabolism and utilization of glucose. It contains 51 Amino acids and has a molecular weight of 5808.

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So, someone might be wondering at this point; Diabetes, glucose and sugar, how do they really connect? Okay, lets examine Mr peter who is normal and undergoes normal physiological changes in glucose and insulin concentration. It's afternoon and he just had lunch. The normal blood sugar level just before he had the meal would have been seen between 70-130mg/dL and the normal insulin level would have been around 10 µU/mL.

Immediately after the breakfast, there is digestion and absorption of the food he just ingested and this brought about a rise in blood glucose to about 180mg/dL and the insulin level in the first 15 minutes all the way up to about 100 µU/mL. That is due to the excitatory effect the increase in concentration of glucose has on the beta-cells of the pancreas. This causes a sudden release in the insulin which was already produced and stored in the pancreas.

Once this already stored insulin has been depleted, about 10 to 15 minutes later, his insulin level will drop to about a half of the upshot value. Some minutes later, insulin level Will rise again but this time, due to the production of new insulin into circulation by beta-cells of the pancreas

The relative increase in the amount of insulin in circulation is to help in the metabolism of glucose and its utilization by the cells of the body. Insulin at this point, is like a key to a house. It has to be retrieved from wherever it was being kept safe, used on the door and unlocked successfully, before anyone can successfully enter the room. Lets consider the cells to be the room in this illustration and glucose the frustrated soul that really needs to get right inside the room.

However, in a diabetic patient, this mechanism is distorted and the key is either not available or the door would not just open for no reason. There are classically two forms of distortion which give rise to the two major types of Diabetes Mellitus.

Type 1 Diabetes Mellitus(DM1)

This type of DM could also be called Insulin dependent DM because the patient is dependent on externally supplied insulin and was also previously known as Juvenile DM because it most of the time starts from childhood. This results from the inability of the beta-cells to produce insulin due to an autoimmune disease in which antibodies in the body attacked and destroy the insulin producing cells; Beta-cells of the pancreas.

In this type of DM, genetics and family history play major roles as someone with a family history with this form of DM has a higher risk of having the disease than someone with a zero history. There is little or no insulin in circulation thus; the glucose level is gravely elevated and causes damage to some parts of the body like the retina, nerves, and kidneys over the long run. Also associated with type 1 DM is a condition known as Ketoacidosis.

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Ketoacidosis is a condition where there is accumulation of large amount of ketones in the system. These Ketones are accumulated due to the breakdown and utilization of fats by the body for its energy requirements because insulin is not available to help in the utilization of Glucose. This condition is usually characterised by polyuria (frequent urination), polydipsia (thirstiness), weakness and fruity smell on breath(smell of ketones released through exhalation).

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Moreover, there is actually a relationship of onset of the disease on monozygous twins but, what really is a thing of concern is the discordance between about a half of them. The twins carry same genes and would be expected that both of them would come up with diabetes or non of them would but, this seems to not be so. In a majority of them, one of them comes up with the disease and the other does not. This portrays that yes, genetics and autoimunity remains a major cause of type 1 DM but, there are also other factors to be considered in its study.

Also, it has been noticed, the incidence of type 1 DM from environmental factors. What these factors could be and how they affect the onset of type 1 DM still remains a thing of concern to scientists all over the world. However, Prenatal factors, nutrition, viral infections and environmental chemicals are to be considered among the determining environmental factors.

Type 2 Diabetes Mellitus(DM2)

In type 2 DM, there is also an increased amount of blood sugar, but this is due to the inability of cells to utilize insulin for the metabolism of glucose and not due to lack of insulin in circulation as in the case of type 1 DM. It is also called Insulin non-dependent DM because insulin therapy has little or no use on the patient. There is insulin resistance and the cells fail to respond to insulin, whether biologically produced or applied externally.

As a matter of fact, this can result from various factors ranging from problems or deformities to the insulin structure, cells not having enough receptors for insulin binding, problems in hormone-receptor signaling, destruction of insulin receptors, or non-functionality of the glucose transporters which help transport glucose through the cell membranes. Also, enormous amount of fat in body(especially in the abdomen) along with obesity pose problems by providing a larger surface area and hindering the action of insulin on cells. Age too, happens to be a factor as the risk of having type 2 DM increases with increased age.

However, in the initial phase of this type of DM, the pancreas simultaneously increases its production of insulin to compensate and allow for maintenance of blood sugar level. At some point when the situation is left unmanaged, the pancreas gets tired and the B-cells gets worn out leading to a combination of both the insulin-resistance and low amount of insulin being produced.

Risk of having type 2 DM later in life also increases with the incidence of a type of DM known as Gestation diabetes Mellitus(GDM). The particular cause of gestational DM is yet to be known, as scientists all over the world are still working on finding the exact reason and cause of the high blood sugar level noticed in some pregnant women which usually goes away after the pregnancy. For the mean time, it is suggested that this type of DM occurs in probably due to the counter-insulin effects of the hormones produced by the placenta during pregnancy.

Any ideas on Winning this Great Fight?

Some years ago, when the cause of type 1 diabetes mellitus was discovered to be autoimmunity, the future looked really bright with a promising cure in the nearest future. Well, the future is still bright, we only have to sit tight, be optimistic and wait for it to show up. For now, all mankind has on type 1 DM is treatment/management. The treatment includes insulin therapy to compensate for the insulin lacking in circulation, regular exercise to reduce weight and a proper healthy diet.

A healthy diet here means cutting down on fatty meals and consuming more of fibers.

Type 2 DM on the other hand can be prevented to a great extent and so much can be done to reduce the risk of ever getting to know what it feels like. Upping one's physical game is one of the great ways of staying away as far as possible from diabetes as regular exercise does a great job of keeping body fat low thereby preventing obesity which is like a pathway to type 2 DM.

One other wonderful way to combat DM is avoiding overfeeding. overfeeding has a way of leading to obesity which also has a way of leading to DM. Avoiding too much sugar/carbohydrate content in one consumption is good for the pancreas and avoiding too much fatty food is good to reduce the amount of fat being deposited in the body.

The major treatment for type 2 diabetes is a drug which goes by the generic name, metformin. Metformin actually acts by increasing the peripheral utilization of insulin, decreasing the rate of absorption of glucose in the Gastrointestinal Tract, and increasing the sensitivity of body cells to insulin. apart from being used in the treatment of type 2 DM, it could also be used in combination with insulin therapy and regular exercise for the treatment and management of type 1 diabetes.

summary

The war against diabetes is, though not yet pronounced a victory to man, turning around in a positive way, as different studies have been made and different methods have been put up in combating it. Science over the years has come up with ways of preventing and managing the condition and this has been a major advantage to mankind as it reduces the mortality rate and leaves man with a hope that soon, the future will be reached and the problem of diabetes mellitus will be long gone. Can we then say that the fight is in our favour?

References

<sub>Sembulingam K and Sembulingam P (2010). Essentials of medical physiology. 5th ed. Jaypee Brothers Medical Limited. pg 406.

Ketoacidosis Retreived on July 30th, 2018

The Environment and Type 1 Diabetes Retreived on July 30th, 2018

Discordance in Monozygotic Twins Retreived on July 29th, 2018

Treatment of Type 1 DMRetreived on July 30th, 2018

Metformin Retreived on July 31st, 2018</sub>

Image Sources

All images are from flickr and Pixabay licensed under creative commons and eligible for commercial use.

Thanks for reading.

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