Introduction cells in the pancreas which secrete insulin


Diabetes is a multi-system
disease that affects people in all age brackets.  An increased level of plasma glucose beyond
normal ranges is characteristic of this syndrome. Diabetes is diagnosed when
the blood sugar is found to be constantly equal to or greater than 11mmol/L including
after fasting (American
Diabetes Association, 2014).

            It can be caused by many things
leading to the different classes used in describing it such as Type I and II, gestational
and juvenile diabetes (American
Diabetes Association, 2014).). These descriptive classes could
be different in terms of the commonest population affected, median age at
diagnosis and the symptomatology.

of Diabetes

Type I variant is commonly
because of the body’s immune system wrongly identifying the beta cells in the
pancreas which secrete insulin as foreign and initiates a response against
them. This leads to total insulin deficiency in the blood stream. It is the
insulin that is responsible for breaking down glucose used by other body tissues
and for storage into fats. Continuing loss of these cells happens over a long
period of time during which the patient could be symptomless (Katsarou et al., 2017).
Evidence has shown a genetic component involving human leukocyte antigens (HLA)
in its pathogenesis. Some presenting features due to the hyperglycemic state
are considered classical like polyuria, polydipsia and polyphagia. Others include
fatigue, unintentional loss of body weight, increased levels of ketones in the
body, increased risk for infections more so involving the genitourinary systems
and has a common age at diagnosis below forty years (Katsarou et al., 2017).

In Type II diabetes on
the other hand, there is insulin production but the quantities produces are not
sufficient to offset the cellular sugar imbalance. This causes glucose levels
to be higher in the blood stream but very low in the tissues for utilization
like the peripheral muscles. This variant of diabetes is believed to be caused
by decreased sensitivity of peripheral tissues to insulin (DeFronzo et al., 2015).
The initial pancreatic response is to attempts to compensate by increasing rate
of production but this is also overwhelmed. It is commonly diagnosed in older
patients but of late, it has been diagnosed in the younger population. This is
because risks that predispose to its development among the younger population
have become many. The appeal of sedentary living and poor eating habits normally
involving lots of junk and sweetened foods leading to obesity has been deemed
the main culprit for this state, though there is also a genetic component
involved it its pathogenesis. The presenting signs are the same as in Type I
with the exception of associated weight gain  (DeFronzo et al., 2015).

Gestational diabetes is
the syndrome of hyperglycemia that occurs in pregnant women. In order to support
the growth of a fetus, some of the metabolic changes that occur in a gravid woman
include increase in resistance to insulin with concomitant decrease in the
sensitivity to the same and is caused by the hormones secreted by the placenta.
It has been demonstrated in women who were previously diabetic or in previously
normal patients. However, some levels of impairment in glucose tolerance is
usually evident from previous medical history. The symptoms are the same as in
Type II disease and some women return to normal glucose levels after delivery
while others continue to have diabetes post-partum (Imam, 2013).

Juvenile diabetes
refers to the presentation of clinical and laboratory signs of diabetes in
children. It is commonly referred to as Type I since both occur in childhood with
commonly similar  symptoms,therefore,
both names could be used interchangeably (Katsarou et al., 2017).

in treatment Type II Diabetes

Metformin is an
anti-diabetic drug of the biguanide class that functions to reduce the
production of glucose from the liver and its absorption from the gastrointestinal
tract and is excreted through the tubules of the kidneys (Robertson,  Maibach, Katzung, & Trevor, 2015).

It is recommend as a
first lime therapy for Type II diabetes and can be given alone or combined with
other anti-diabetes such as sulfonylureas and insulin. Additionally, it has
been found to be more effective in achieving glycemic control when used combined
with insulin. It is administered as tablets of immediate or extended release
dosed at 500mg to 1000mg for adults and children. The oral formulation is often
dosed at 100mg/mL. It is not recommended in the very old patients because of
reduced kidney functions (Robertson
et al., 2015).


Type II diabetes is  considered part of the spectrum of emerging  lifestyle diseases making nutrition-based
therapy an integral component in its prevention and management (Shrivastava, Shrivastava, &
Ramasamy, 2013). All affected people are considered for personalized
nutrition management by a qualified nutritionist. The advised route is to avoid
complete overhaul of the patient’s diet and instead focus of calorie intake
restriction, consumption of lesser quantities of foods having high amounts of saturated
fats and those containing lots of sugar. Consumption of greens foods, fruits
and vegetables is also prescribed in that they aid in weight reduction (Shrivastava et al., 2013).

of Diabetes

usually occur mainly as a direct influence of the excess glucose on body
tissues. The development of ketoacidosis due to dehydration with electrolytes
loss can lead to cerebral edema and cardiac problems due to potassium depletion
which are medical emergencies. More short term effects include Hyperglycemic
hyperosmolar states and hypoglycemia. Other effects are due to the presenting
signs and symptoms like respiratory distress, excessive thirst and hunger, dyslipidemias,
hypertension, infections and obesity (Papatheodorou,
Banach, Edmonds, Papanas, & Papazoglou, 2015).

Long Term:
these long term effects of diabetes occur slowly over time and patients usually
present with symptoms in other systems of the body. They are usually classified
into micro-vascular and macro-vascular. Hyperglycemia affects the small blood
vessels of major organs such as the kidney, heart and the eyes and causes their
hardening. This can lead to blockage of these vessels causing diabetic
retinopathy which can cause blindness, diabetic nephropathy which can lead to
renal failure (Papatheodorou,
et al., 2015). The accompanying dyslipidemias can cause
cerebrovascular accidents and myocardial infarctions which can lead to
paralysis and death. Other complication is diabetic neuropathy resulting in
dysfunction involving the peripheral nerves. Loss of peripheral limbs
sensations is the common feature with occasional foot ulcers (Papatheodorou et al., 2015).


of drug treatment

Oral anti-diabetic
medications just as with majority of other classes of drugs have unintended effects
on their users. Some of these include hepatotoxicity, gain of weight and risk
for fractures as observed with thiazolinediones, gastrointestinal discomfort,
rashes, and kidney dysfunction among many more. These effects may vary from one
patient to another and each is required to seek medical help if they notice any
unusual effects

The commonest side
effect of insulin is rebound hypoglycemia especially when not taken according to
prescription. This calls for proper patient education on the usage of insulin.