Diabetes mellitus is a assorted group of diseases characterized by high blood glucose levels due to defects in insulin secretion, insulin action, or both (Eiselein et al. 2004). It is expected that Americans born after 2000 are faced with a 1 in 3 chance of developing diabetes in their lifetime (Pollan 2009). There are three distinct types of diabetes. Type 1, Type 2, and gestational diabetes. Pre-diabetes is a condition in which the blood sugar is elevated to a chronic level and if this not corrected then diabetes is imminent (Bittman 2009). It is estimated that 54 million Americans have pre-diabetes and the majority of these will be unaware of the risks associated (Pollan 2009). This is also called impaired fasting glucose (IFG). The onset of diabetes can be prevented or at least delayed by increasing the amount of activity undertaken, eating healthy foods and maintaining or if needed losing weight (virginiamason 2014). If this is followed then the risk of developing type 2 diabetes is said to be reduced by 30%–60% (Davies et al. 2016). There is no cure for diabetes instead medical nutrition therapy (MNT) is needed to control the condition. The sort of diet that a person diagnosed pre-diabetes should follow is simply is eating more foods that are considered healthy and cutting back on those that are not (Bilous 2009). In type 1 diabetes (also called insulin dependent diabetes) blood insulin is almost completely absent, leading to hyperglycaemia and alterations in the person’s ability to metabolise lipids (Eiselein et al. 2004). This happens as the body’s immune system destroys the cells that release insulin. Without insulin the cells cannot absorb glucose consumed in the diet. The most common symptoms of type 1 diabetes are polyuria, increased thirst, unexplained weight loss and blurred vision (WHO 2014). Type 1 diabetes accounts for around 10% of all cases of diabetes mellitus and generally affects a younger population, with a peak age of around 14 years (Eiselein et al. 2004). Type 1 diabetes is thought to be induced by a toxic or infectious insult that occurs in genetically predisposed individuals.(Eiselein et al. 2004) Researchers studying identical twins and family trees of patients with both types of diabetes have found that heredity is an important factor in both type 1 and type 2 diabetes, and also have found there is a 5% chance of a child developing diabetes if the parent has it (Bilous 2009). When the insulin has failed the by-products of the breakdown of fat and muscle build up in the person’s blood and lead to the production of substances called ketones. If diabetes has not been diagnosed or nothing done to prevent this, then the level will rise until the person enters a keto acidotic coma. This occurs much less today than 20 years ago as awareness and knowledge of diabetes has grown meaning in most cases it is diagnosed before this happens. (Bilous 2009)
Diabetic experts recently revised the criteria for diagnosing type 1 diabetes. Diagnosis is based on one of three criteria. A random plasma glucose concentration of more than 11.1mmol/L, a fasting plasma glucose of 7.0mmol/L after an overnight fast or a post load of 11.1mmol/L two hours after consuming 75g of glucose in a tolerance test. A single diagnosis is not enough to confirm type 1 diabetes the results must be confirmed on a subsequent day. (King et al. 1998)Commonly children who have type 1 diabetes often have weight related issues commonly obesity. This trend has been shown to be accurate in Germany, Austria and most problematic in the USA. Obesity has been shown to contribute to the control of blood sugar levels in adolescents with type 1 diabetes (DuBose et al. 2015). A person with type 1 diabetes must regularly monitor and control blood glucose levels. The level of glucose in the blood is monitored using a finger prick. Blood is removed using a prick and this is placed on a monitor which will digitally display the blood glucose levels if levels are high then insulin must be administered if the levels are low then carbohydrates mustbe consumed to encourage normal levels which are between 4.7 and 6.4mmol/L.(PaleoDiabetic 2011) Type 2 diabetes means that the body cannot use its insulin properly. Commonly at the onset of type 2 diabetes the body will make extra insulin but as the condition worsens the pancreas will be unable to make enough insulin to keep blood sugar levels down. The most notable difference between type 2 diabetes and type 1 is that type 2 diabetics will have no episodes of low blood sugar or hypoglycaemia unless insulin is taken incorrectly or with some diabetics medicines.(WebMD 2016) Another notable difference is that there is medication available for control of type 2 diabetes where-as those with type 1 must take insulin. However these medications are not suitable for everyone. If the person is injecting more than 20units of insulin daily then medication will not be sufficient to control the blood sugar levels. They are however very effective for a person who has recently been diagnosed or who needs little insulin to maintain blood glucose levels. Taking medication does not mean the complete elimination of insulin it will still be required in cases of infection, or if pregnant as the medication is not suitable for pregnant women. (Diabetes.org 2016b) Type 2 diabetes affected 135 million people worldwide in 1995 and has been increasing by 5% annually since.(Pollan 2009) According to the World Health Organization this number will see an increase to 300 million individuals by 2025 (King et al. 1998). This condition is said to reduce the life expectancy of the individual by up to 12 years and deaths are commonly caused by cardiovascular diseases (CVD) (Davies et al. 2016).
Type 2 diabetes is
associated with an increased risk to the individual of Non-alcoholic related liver disease it also has an effect on other kinds of chronic liver disease but the extent of these effects is
unclear (Wild et al.). High consumption of refined carbohydrates in particular High Fructose corn syrup is said to be responsible for the rapid increase of type 2 diabetes (Bittman 2009, Pollan 2009). It is also said that the processing techniques in food could be responsible for the rise of diabetes one culprit that warrants investigation is bleached flour and products containing these. Chlorine dioxide is commonly used to bleach these foods and it reacts with the residual proteins forming Alloxan. Alloxan is commonly used in laboratory studies in order to induce diabetes (Mercola 2014). The validity of this is further strengthened by the knowledge that a diet that is high in wholegrain foods has been shown to decrease the risk of diabetes.(Pollan 2009)The most common precursor to type two diabetes is a person’s BMI status. A BMI of over 25.0 is an indication that the person is overweight and the risk of type 2 diabetes is increased. Over 30.0 is an indication obesity and the risk of diabetes is even further increased. Pritikin has stated that type 2 diabetes is entirely preventable through removing the “food toxic” and sedentary lifestyle to which much of the population is accustomed to (Pritikin 2016). Omega 3 consumption has also been shown in reduce the risk of developing type 2 diabetes. This is based on the fact that Eskimos living in Greenland consume high amounts of Omega 3 and that the incidence of diabetes here is low. This prevention method has been studied by added omega-3 to the diet of rats to protect them against insulin resistance, although the results have yet to be replicated in humans. One of the most prevalent measures in place today which may or may not have an effect on the rates of diabetes is the introduction of a tax on the culprit foods in Ireland (Webster 2016). Although there is many treatments out there for a person to manage their diabetes diagnosis there is room for facilities to reduce the risk of type 2 diabetes which accounts for 90% of all diabetes cases. “Let’s prevent” was set up in the UK and Australia in order to educate the public in how to prevent type 2 diabetes using the existing infrastructure for the delivery of education in diabetes. The effectiveness of this program was tested using subjects with prediabetes and was shown to be effective.(diabetesaustraila 2016) However if type 1 diabetes is diagnosed then all the person can do is live with it. Programs have been set up in the UK and then Ireland in order to help both children and adults have a relatively normal life after diagnosis. The Choice program was originally developed by Dr David Chaney, in the University of Ulster, specifically for children and young people with diabetes.(Plus 2012) This program is attended by both children and their parents with the aim of educating both on control of blood sugar through carbohydrate counting and insulin injection. It is thought that better understanding of the condition will ensure less hypo and hyper glycaemic states which may have the indicator for insulin injection or carbohydrate consumption prior to attending the meeting.
DAFNE (Dose Adjustment for Normal Eating) is a way of managing Type 1 diabetes for adults. DAFNE is a service that provides the skills required to estimate the carbohydrate count of each meal and to inject the right dose of insulin.(DAFNE 2016) Although many attendees of the DAFNE program have been managing their own diabetes without problems for years DAFNES main function is to eliminate any guesswork which is often times associated with insulin dosage. This reduces the ever present risk of hypoglycaemia or hyperglycaemia. DAFNE is a five day course and is similar to choice in that in incorporates support from healthcare professionals. The group setting is useful as the attendees can learn not only from the professionals but from each other (Diabetes.uk 2016). DAFNE has been proven to be very useful in helping people manage their diabetes as sometimes people are diagnosed and have little knowledge of the severity of the disease. Knowledge in the science of the disorder means that people find it easier to understand the insulin dosage required if glucose levels go too high, or the carbohydrates needed if glucose levels are too low. Gestational diabetes develops during pregnancy. Like other types of diabetes, gestational diabetes affects how the body’s cells metabolise sugar. Gestational diabetes causes high blood sugar that can affect the pregnancy and if not properly controlled the baby's health. (MayoClinicStaff 2016) During pregnancy the woman’s body is flooded with hormones which can impair the action of the insulin and raise the blood sugar to a higher level that prepregnancy. In the later stages of the pregnancy more hormones are produced and the insulin is further inhibited (Clinic 2016). The onset of gestational diabetes is normally in the second half of the pregnancy. (DiabetesIreland 2016) As gestational diabetes displays similar symptoms to pregnancy itself (tiredness and excessive urination) all women in Ireland are tested during the second half of their pregnancy (around 28weeks). This test is the same as the testing method for type 1 diabetes and involves 8 hours of fasting and consuming a glucose drink and monitoring the glucose levels of the blood at regular intervals afterwards (DiabetesIreland 2016). The treatment for gestational diabetes is similar to that of common diabetes, there is no cure. Instead blood sugar levels should be carefully monitored and controlled. In some cases insulin injections may need to be used but this extra insulin does not cross the placenta and so has no effect on the baby. Medical experts have yet to pinpoint the exact cause of gestational diabetes but there are a number of theories as to what can cause the condition. The condition normally occurs in women who are over 25, had prediabetes prior to pregnancy, and are overweight, or have a family history of diabetes (Clinic 2016). Although most women with gestational diabetes will deliver healthy baby there are some risks associated with the condition which could affect the infant. The chances of having a large child which will eliminate the possibility for a natural birth are increased.
(Choices 2015) If the size of the child is underestimated and macrosomia not detected there could be complications during the natural birth, such as Shoulder dystocia.(Babycentre 2016) There is also the possibility that the child may be born premature which carries its own risks. The baby may have low blood sugar levels (hypoglycaemia) due to its own overproduction of insulin. (Choices 2015) After birth blood sugar will normally return to normal levels. However as they had gestational diabetes they are now at risk for type 2 diabetes. They will be advised to continue working with a dietician or diabetic nurse in order to control and manage glucose levels. (MayoClinicStaff 2016) Treatment of diabetes has rapidly changed in the past decade. The traditional method involved using a lancing device to retrieve a drop of blood from the fingertip and placing this on a test strip in a meter in order to get the blood sugar levels displayed on the screen (Diabetes.org 2016). This result was then used to calculate the amount of insulin required in order to bring glucose levels within the desired range. Also traditional carbohydrate counting would have been more problematic in the past than it is today. The introduction of easy to read carbohydrates on the front of packets and more clearly stated on the back of the packaging has made counting and choosing carbohydrates in a meal much easier, although this may lead of overconsumption of processed foods.(Bell et al. 2015) Today a new device is available to remove the need for calculating the amount of insulin required. An insulin pump is a small device which contains a vile of rapid acting insulin. It enables diabetics to input their blood sugar level after consuming carbohydrates and the pump will inject the insulin through a thin plastic tube. The insulin pump will also release small amounts of rapid actin insulin between meals and during sleep. (Animas 2014) This insulin released outside of mealtimes is referred to as the basal rate and is determined by a healthcare professional (Medtronic 2016). This insulin pump also removes bias when a diabetic patient visits a dietician as Hb1Ac levels are recorded in the system and the dietician can help the patient with any difficulties they may be having. In 90% of cases diabetes appears to be avoidable. Although there has been much research in helping those who have diabetes live with the condition, it appears that there is much still to be done in preventing those people developing the condition. These measures must be done at a worldwide level. Measures such an introduction of a sweet food tax which has already been rolled out in With Ireland currently on the way to becoming the most obese country in Europe now is the time to introduce these measures before an entire population is lost to this epidemic. Although it may appear that the introduction of sugar tax in Ireland is just another tax that aims to empty the nation’s pockets it may be the only way forward, in the same way that increasing the tax on cigarettes did decrease the numbers of people smoking in Ireland.
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