essay about type 2 diabetes

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Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems.

In type 2 diabetes, there are primarily two problems. The pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into the cells. And cells respond poorly to insulin and take in less sugar.

Type 2 diabetes used to be known as adult-onset diabetes, but both type 1 and type 2 diabetes can begin during childhood and adulthood. Type 2 is more common in older adults. But the increase in the number of children with obesity has led to more cases of type 2 diabetes in younger people.

There's no cure for type 2 diabetes. Losing weight, eating well and exercising can help manage the disease. If diet and exercise aren't enough to control blood sugar, diabetes medications or insulin therapy may be recommended.

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Symptoms of type 2 diabetes often develop slowly. In fact, you can be living with type 2 diabetes for years and not know it. When symptoms are present, they may include:

• Increased thirst.
• Frequent urination.
• Increased hunger.
• Unintended weight loss.
• Blurred vision.
• Slow-healing sores.
• Frequent infections.
• Numbness or tingling in the hands or feet.
• Areas of darkened skin, usually in the armpits and neck.

When to see a doctor

See your health care provider if you notice any symptoms of type 2 diabetes.

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Type 2 diabetes is mainly the result of two problems:

• Cells in muscle, fat and the liver become resistant to insulin As a result, the cells don't take in enough sugar.
• The pancreas can't make enough insulin to keep blood sugar levels within a healthy range.

Exactly why this happens is not known. Being overweight and inactive are key contributing factors.

How insulin works

Insulin is a hormone that comes from the pancreas — a gland located behind and below the stomach. Insulin controls how the body uses sugar in the following ways:

• Sugar in the bloodstream triggers the pancreas to release insulin.
• Insulin circulates in the bloodstream, enabling sugar to enter the cells.
• The amount of sugar in the bloodstream drops.
• In response to this drop, the pancreas releases less insulin.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues. The use and regulation of glucose includes the following:

• Glucose comes from two major sources: food and the liver.
• Glucose is absorbed into the bloodstream, where it enters cells with the help of insulin.
• The liver stores and makes glucose.
• When glucose levels are low, the liver breaks down stored glycogen into glucose to keep the body's glucose level within a healthy range.

In type 2 diabetes, this process doesn't work well. Instead of moving into the cells, sugar builds up in the blood. As blood sugar levels rise, the pancreas releases more insulin. Eventually the cells in the pancreas that make insulin become damaged and can't make enough insulin to meet the body's needs.

Risk factors

Factors that may increase the risk of type 2 diabetes include:

• Weight. Being overweight or obese is a main risk.
• Fat distribution. Storing fat mainly in the abdomen — rather than the hips and thighs — indicates a greater risk. The risk of type 2 diabetes is higher in men with a waist circumference above 40 inches (101.6 centimeters) and in women with a waist measurement above 35 inches (88.9 centimeters).
• Inactivity. The less active a person is, the greater the risk. Physical activity helps control weight, uses up glucose as energy and makes cells more sensitive to insulin.
• Family history. An individual's risk of type 2 diabetes increases if a parent or sibling has type 2 diabetes.
• Race and ethnicity. Although it's unclear why, people of certain races and ethnicities — including Black, Hispanic, Native American and Asian people, and Pacific Islanders — are more likely to develop type 2 diabetes than white people are.
• Blood lipid levels. An increased risk is associated with low levels of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — and high levels of triglycerides.
• Age. The risk of type 2 diabetes increases with age, especially after age 35.
• Prediabetes. Prediabetes is a condition in which the blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
• Pregnancy-related risks. The risk of developing type 2 diabetes is higher in people who had gestational diabetes when they were pregnant and in those who gave birth to a baby weighing more than 9 pounds (4 kilograms).
• Polycystic ovary syndrome. Having polycystic ovary syndrome — a condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.

Complications

Type 2 diabetes affects many major organs, including the heart, blood vessels, nerves, eyes and kidneys. Also, factors that increase the risk of diabetes are risk factors for other serious diseases. Managing diabetes and controlling blood sugar can lower the risk for these complications and other medical conditions, including:

• Heart and blood vessel disease. Diabetes is associated with an increased risk of heart disease, stroke, high blood pressure and narrowing of blood vessels, a condition called atherosclerosis.
• Nerve damage in limbs. This condition is called neuropathy. High blood sugar over time can damage or destroy nerves. That may result in tingling, numbness, burning, pain or eventual loss of feeling that usually begins at the tips of the toes or fingers and gradually spreads upward.
• Other nerve damage. Damage to nerves of the heart can contribute to irregular heart rhythms. Nerve damage in the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. Nerve damage also may cause erectile dysfunction.
• Kidney disease. Diabetes may lead to chronic kidney disease or end-stage kidney disease that can't be reversed. That may require dialysis or a kidney transplant.
• Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness.
• Skin conditions. Diabetes may raise the risk of some skin problems, including bacterial and fungal infections.
• Slow healing. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Sleep apnea. Obstructive sleep apnea is common in people living with type 2 diabetes. Obesity may be the main contributing factor to both conditions.
• Dementia. Type 2 diabetes seems to increase the risk of Alzheimer's disease and other disorders that cause dementia. Poor control of blood sugar is linked to a more rapid decline in memory and other thinking skills.

Healthy lifestyle choices can help prevent type 2 diabetes. If you've received a diagnosis of prediabetes, lifestyle changes may slow or stop the progression to diabetes.

A healthy lifestyle includes:

• Eating healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains.
• Getting active. Aim for 150 or more minutes a week of moderate to vigorous aerobic activity, such as a brisk walk, bicycling, running or swimming.
• Losing weight. If you are overweight, losing a modest amount of weight and keeping it off may delay the progression from prediabetes to type 2 diabetes. If you have prediabetes, losing 7% to 10% of your body weight may reduce the risk of diabetes.
• Avoiding long stretches of inactivity. Sitting still for long periods of time can increase the risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes.

For people with prediabetes, metformin (Fortamet, Glumetza, others), a diabetes medication, may be prescribed to reduce the risk of type 2 diabetes. This is usually prescribed for older adults who are obese and unable to lower blood sugar levels with lifestyle changes.

More Information

• Diabetes prevention: 5 tips for taking control
• Professional Practice Committee: Standards of Medical Care in Diabetes — 2020. Diabetes Care. 2020; doi:10.2337/dc20-Sppc.
• Diabetes mellitus. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm. Accessed Dec. 7, 2020.
• Melmed S, et al. Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 3, 2020.
• Diabetes overview. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/all-content. Accessed Dec. 4, 2020.
• AskMayoExpert. Type 2 diabetes. Mayo Clinic; 2018.
• Feldman M, et al., eds. Surgical and endoscopic treatment of obesity. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Oct. 20, 2020.
• Hypersmolar hyperglycemic state (HHS). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hyperosmolar-hyperglycemic-state-hhs. Accessed Dec. 11, 2020.
• Diabetic ketoacidosis (DKA). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka. Accessed Dec. 11, 2020.
• Hypoglycemia. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hypoglycemia. Accessed Dec. 11, 2020.
• 6 things to know about diabetes and dietary supplements. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/tips/things-to-know-about-type-diabetes-and-dietary-supplements. Accessed Dec. 11, 2020.
• Type 2 diabetes and dietary supplements: What the science says. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/digest/type-2-diabetes-and-dietary-supplements-science. Accessed Dec. 11, 2020.
• Preventing diabetes problems. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/all-content. Accessed Dec. 3, 2020.
• Schillie S, et al. Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports. 2018; doi:10.15585/mmwr.rr6701a1.
• Caffeine: Does it affect blood sugar?
• GLP-1 agonists: Diabetes drugs and weight loss
• Hyperinsulinemia: Is it diabetes?
• Medications for type 2 diabetes

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Essay: Type 2 Diabetes (T2DM)

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American Diabetes Association (2015) describes “Diabetes as a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. Type 2 Diabetes(T2DM), the most prevalent form of the disease is caused by a series of metabolic disorders which results from insulin resistance in muscles and tissues, unrestricted glucose secretion, reduced insulin secretion from the pancreas and or declining beta cell function. which lead to elevated levels of sugar in the blood (Talachai et al 2012). Diabetes of all types can lead to complications in many parts of the body, increasing the overall risk of dying prematurely (Lind 2013 ). Complications include heart attack, stroke, kidney failure, leg amputation, vision loss and nerve damage. In pregnancy, poorly controlled diabetes increases the risk of fatal death and other complications (Diabetes UK 2015). Both Diabetes UK (2015) and WHO (2016) makes us aware of the substantial economic loss diabetes and its complication can bring to people with diabetes, their families, health systems and national economies through direct medical costs, loss of work and wages. Because of the huge burden of mortality and morbidity attributed to diabetes through micro and macro vascular completion (Lind 2013), people with diabetes require access to systematic, ongoing, and structured care delivered by a team of competent healthcare professionals (NICE 2017).The U.K. prospective diabetes study group UKPDS (1998) had indicated that this was necessary in order to achieve strict glucose control, blood pressure and cholesterol which can reduce the risk of diabetes related complication. Diabetic care in the primary care involves the use of medication, health education, counselling, consistent follow up and periodic referral for specialist services (Long 2011) in accordance with National Institute of Clinical Excellence (NICE) (2017) guidelines for managing diabetes. The initial recommendation is to follow a healthy diet and exercise regime and usually followed with one or more hypoglycaemic agents to prevent micro and macrovascular complication (American Diabetes Association 2015). Despite the benefit of medication, numerous studies have indicated that that recommended glycaemic targets are not achieved by majority of patients. America Diabetic Association (2015) makes us aware that about 50% of patients with type 2 diabetes fail to achieve glycaemic control that is HBA1c less than 7%. As a result, two third of patients die prematurely of cardiovascular diseases (Bailey and Kodack 2011). Edege et al (2016) further believes that the problem is due to poor patient adherence to prescribed medication. Particularly In primary care population. Anecdotal evidence from practice, gathered from HBA1c results suggest that even with the wide range of oral pharmacological available to patients, achieving recommended glycaemic control among adult patients’ groups on oral medication is a challenge. This results in a greater number of patients remaining at risk of long term complication, premature mortality, and increased healthcare cost. It well documented that reasons for non-adherent may be difficult to modify, partly due to factors beyond patient control such as demographic and healthcare structures (Luis Emilio et al 2013). Never the less, Salker (2016) believes if primary care nurses understand the barriers to medicine adherence, they will be able to intervene to increase adherence and improve patient outcome. Pathophysiology of Type 2 Diabetes The characterises hyperglycaemia associated with Type two diabetes is caused by a series of metabolic disorders which results from insulin resistance in muscles and tissues, unrestricted glucose secretion, reduced insulin secretion from the pancreas and or declining beta cell function (Ruso et al 2014) Talachi et al (2012) further explains that, although beta cell disfunction may be partly due to genetics, it can also be caused by inflammation, obesity, insulin resistance, overconsumption of saturated fats and free fatty acid. Beta cell disfunction is characterized by impairment in the first phase of insulin secretion during glucose stimulation followed by the inability of the pancreas to compensate for insulin resistance. This leads to hyperglycemia and the onset of diabetes with symptoms as tiredness, polyphagia, polyuria, polydipsia, blurred vision, slow healing wounds, loss of muscle mass and thrush (Barr, Myslinksi, & Scarborough, 2008). Russo et al (2014) further comments, it is the β-cell dysfunction along with glucotoxicity, lipid toxicity, and other inflammatory agents on pancreatic insulin production all play a contributing role in the development of type 2 diabetes mellitus. Tissue resistance to glucose uptake is also recognized as a major cause of DMT2.Cerf (2013) explains that tissue resistance is linked to elevated levels of pro-inflammatory cytokines which trigger endothelial cell dysfunction leading to vascular abnormalities. These mechanisms may also lead to atherosclerosis and coagulation tendencies which can also be present with DMT2. Although these causes are not linked to diabetes alone, they are found in other chronic diseases such as dyslipidemia and hypertension which are known risk factors of diabetes. (Cerf 2013). Incidence of Type 2 diabetes Global incidence of diabetes is on the rise (World Health Organization (WHO) (2016). Similarly, International Diabetes Federation (IDF) (2015) predict the cases of type 2 diabetes are set to double particularly in US, Australia, and Europe, by 2040 making type 2 diabetes the seventh-biggest cause of death worldwide (Long 2011, WHO 2016). Type 2 diabetes in United Kingdom is estimated to double by 2040, causing 16% of deaths (Diabetes UK 2011, Basu et al 2014, IDF 2015). As the UK’s fifth-biggest cause of death, it accounts for one tenth of NHS expenditure (Paulweber et al 2010, Hex et al 2012, WHO 2016). The incidence of type 2 diabetes in a locality in outer London borough is not an isolated case. Of the 15000 active patients within the health facility 810 do suffer from type 2 diabetics. Type 2 diabetes affect more men than women and affect people from black and south Asian ethnic minority groups (PHE 2011). The increase in T2DM is associated with the increases in obesity, and an increasingly elderly population (PHE 2011) Management of type two diabetes and Quality and outcome framework NICE (2017) guideline NG28 provides evidence-based management system for the management of type 2 diabetes in primary care. This is based on the intervening to promote and support healthy lifestyle, pharmacological control of hyperglycaemia, hypertension, and hyperlipidaemia regular exam for early detection of cardiovascular risk and standard criteria for referral of patients to specialist care The guideline is supported by Quality and Outcomes Framework (QOF) introduced in 2004 and provides financial incentives to general practices for the provision of high-quality care Diabetes UK (2018). Contrary to the limited evidence of improving healthcare quality (PRUComm 2016, NHS 2017), diabetic outcomes and care process under QOF has improved according to National Diabetic Audit Report (2017) Poor Medicine adherence and Glycaemic control The suggestion that people are achieving the recommended target for glycaemic control (NDA 2017) is debatable. Indeed, some practices may be achieving recommended targets according to QOF (NDA 2017), yet poor glycaemic control remains a problem among patient groups (Hendelsman et al 2015). Hendelsman et al (2015) further argue that, the present high morbidity and mortality associated with the disease and its associated high healthcare bill is attributed to poor glycaemic control which is a result of poor medicine adherence among patients ((DiBonaventura et al 2014) Medicine adherence is crucial if the recommended glycaemic control, essential to prevent long term micro and macro vascular complication of the disease is to be achieved (American diabetic association 2013). Aside poor glycaemic control, Poor medicine adherence is also associated with increased healthcare costs (Nasseh et al 2012), and higher morbidity and mortality rates (Currie et al 2012). Improved medication adherence has the potential to reduce healthcare related with care T2DM (Jha et al 2012) and improve patient outcomes (Egede et al 2014.) it is obvious that therefore that improving medicine adherence in patients with T2DM offers real opportunity for improving outcomes as well as reducing health care costs. Numerous studies have evidence non-adherence in patients on one or more to oral hypoglycaemic medications, all with wide variation the in actual occurrences. An extensive study of electronic records on patients on oral hypoglycaemic agents revealed that only 39.6 % of patients filled their prescription after two years although 53% had HBA1C over 7 % (Karter et al 2009). A retrospective analysis of health records of patients who had recently initiated oral diabetic medication showed an overall adherence of 81% (Garzia-Perez et al 2013) Similarly, a recent meta-analysis of 40 studies in which patients taking oral antidiabetic drugs found that medication adherence rates were suboptimal, with only 67.9% of patients showing an overall adherence of about 80% (Iglay et 2105).all studies recognize the scope of the problems and its key contributors. Factors influencing adherence to oral antiglycaemics Studies have been conducted in attempt to identify the factors that influence patients’ adherence to prescribed medication (Houston et al 1997, Ho et al 2006 and Maningat et al 2013). Most of the factors identified. include relationship between patient and healthcare professional, healthcare systems and environment. Hsu et al (2014) explains the factors as lack of education about treatment regimes, lack of support to help patients establish a routine for taking their medicine and poor communication between healthcare professionals as the major barriers to medication adherence. Experience from practice also reveals four major reasons of non-adherence among the patient groups. These include medication side effect, complexity of regime, beliefs about diabetic medication and communication between patients and healthcare professionals These are explored. Medication side effects The first line of treatment in type 2 diabetes are lifestyle modification and metformin Bartolomeo et al (2010). If glycaemic control is not achieved and or is contraindicated, a second drug such as sulphanylureas, meglitinide thiazolidines, alpha-glucosidase inhibitors incretin mimetics and incretin enhancer are used (Bartolomeo et al 2010) However, patients’ knowledge of and or experience of side effects of medication can prevent them from adhering to medication especially when the side effect(s) is/are not communicated to healthcare professionals. Side effect associated with oral medication includes bloating or diarrhoea, weight loss or weight gain, feeling sick and swollen ankles (NHS 2017), erectly dysfunction and hypoglycaemia (Garcia-Pérez et al 2013). For example, the link between obesity and type 2 diabetes is known (Russo et al 2014), so if patients who are overweight or obese are gaining weight because of side effects of medication, and do not report for medication review, they are likely not to adhere to the medication Garcia-Pérez et al (2013) and Skyler et al (2009) evidence this, that obese or severely obese patients and patient who have experience symptoms hypoglycaemia are more likely to have low or moderate low compliance to medication as compared to non-obese individuals. Also, contrary to the assertion that Intensive treatment of hyperglycaemia reduce HBA1C levels and reduce in cardiovascular events (Mannuci et al 2009), Terry et al (2012) makes us aware that, intensive glucose control does not reduce macrovascular diseases in older patients with long standing diabetes but may be associated with increased mortality. Which way, if patients have knowledge or have experience side effects of medication and do not report the side effects for appropriate intervention, they are more likely not to take their medication Perceived complexity and inconvenience Type 2 diabetes mellitus is a chronic complex disease which implies patients will not only have to be on medication for life but also faced the reality of doses and types of medication increasing over time. For example, the progressive nature of the disease may mean that at oral therapies may over time not be effective in achieving the recommended HbA1c levels, and most patients over time are eventually prescribed injectables which further reduce adherence (cook et al 2010) Furthermore, Medication for T2DM and related complication can involve up to 10 tablets per day (Gaede et al 2003).This has a profound influence on adherence It has been observed in practice that non adherence to medication tend to be more prevalent when the number of prescribed doses per day increases and more so where patients indicates the treatment was complex and/or inconvenience .Hauber et al ( 2006 )put this in context; that, the number of prescribed dosed in a day is inversely associated with medication adherence with mean adherence decreasing sharply from 79% on once daily dose to 51% on four times daily dose. Adding to the effect of dose regime, de Vires et al (2014) further Comment that where treatment regime has been viewed as complex, adherence ifs further reduced. Medication beliefs The perceptions of patients’ effectiveness of medication and fear of the long-term risks associated with diabetic medication contributes to non-adherence to medication in patient groups. Mann et al (2009) indicates that when patients hold negative beliefs or hold sceptical beliefs about their prescribed medications, often fearing that the long-term risks outweigh any benefits. They are more likely not to adhere to prescribed medication and this will be indicated in HBAIc results Although the general believe that when patients view medications as necessary, they are more likely to adhere to prescribed medication, it is equally valid too that patients’ concerns about their medications are more strongly linked to adherence than their beliefs in the necessity of those same medications (Foot et al 2016) .Particularly In patients with T2DM,Mann et al (2009) makes us aware that concerns, about the possible negative impact of medications are associated with poor adherence including reluctance to starting new medications Communication between Healthcare Professionals and Patients Communication between patients suffering from type 2 diabetes and their healthcare providers can have a profound impact on adherence. In practice, where a good rapport has been established and patients understand very well their diseases and the need for medication, adherence is good. Likewise, where effective communication has not been established adherence is poor. Tiv et al (2012) evidence this; that good adherence is associated with good relationship between patients and health professionals whiles poor relationship between patient and healthcare professional is observed in patients with poor adherence to medication and glucose monitoring which is associated with higher HBA1C levels Rubin et al (2006) goes further comment that where there is not only a good relationship between patient and healthcare provider but also have a diabetic specialist nurse at the premises, adherence to both medication and lifestyle is improved. Effective communication between patients and healthcare providers resolves patient distress, patients become aware of treatment options and decisions which leads to patients becoming empowered to self-care. this improves adherence and glycaemic control Improving adherence Nurses owe duty of care to their patient in accordance with the requirements of Nurse and Midwifery (NMC) 2015 code. General practice nurses remain crucial in screening, maintaining, and supporting people with diabetes (Royal College of Nursing 2017). This is because it they are privileged to meet patient at least on annual basis and hence best placed to identify incidences on non-adherence and positively influence the patients. General practice nurses provide the crucial supportive role by providing information (Hick 2010) and developing patients knowledge to be able to take ownership of their care process, through this process patients, can overcome barriers and modify their lifestyles to attain a better quality of life, Evidence evaluating the long-term impact of interventions to improve adherence is limited and results from existing studies are inconsistence (Newman et al (2013), however where there is evidence, the suggestion is that interventions to improve adherence may be beneficial (Sapkota et al 2015). Which way, the case for nurse intervention in improving adherence to diabetic medication is firmly held (Farmer et al 2006). Farmer A et al (2012) recommend that interventions targeted at improving adherence in patients with chronic conditions such as Type 2 diabetes could help to reduce the burden of the disease. Although Farmer et al (2006) and Hick (2010) continues to make the case for improving medicine adherence, Gorter et al (2011) makes the case that healthcare professionals including general practice nurse often do not prepare patient well enough to take responsibility of their care. This leads to misunderstanding between the two parties. The lack of effective communication inhibits partnership building and results in limitation of patients sense of ownership in the care process and adhering to medication. There is therefore the need for general practice nurses to build effective partnership with patients diagnosed with type 2 diabetes right form the onset of the care process, to earn patients trust to empower patients to own the treatment process (Garcia-Perez et al 2013). Patient empowerment is a predictor of self-care behaviours and HBAIc (Yang et al 2015). Therefore, intervening to enhance and promote empowerment must be key in diabetic education programs to improve self-behaviour including medicine adherence for glycaemic control. (Yang et al 2015). Yang et al (2015) even challenges the notion of medicine adherence as a dysfunctional concept in diabetes care which must replace by collaboration between patients and healthcare professional. In all, patients will only attain growth and personal maturity if healthcare professional not only tailor relationships but also help them to reflect on their lives and formulate new meaning in their modified lives. The complex nature of T2DM and real possibility of increase in medication types and doses have been noted, (Bartolomeo et al 2013), this requires that patients are armed with coping skills to deal with the complexities of living with T2DM.Here practice nurse can make a difference by early referral for intervention when that challenge has been identified. Garter et al (2010) notes that although patients with higher education may have the capacity to cope with complexities associated with diabetes medication regime, those with lower education may not. Referrals can be made to both commissioned services as well as voluntary services available within the practice locality. It requires adequate knowledge of commissioned services as well as a voluntary service that are available to patients. There is robust evidence that early referral and engagement with diabetic services result in significant decrease in HBA1c levels (Chrvala et al 2016), yet the experience is sometimes some patient may be seen for several times without referral to structured education program or when the referrals have been made, it had not been followed through Also, Patients ability to cope can be adversely affected if they feel thay have little or no imput regarding decision about their care (Dutton et al 2012). The notion of patient centred care is further stressed in diabetes care (Inzucchi et al 2012). Primarily general practice nurse not only promote health but also facilitate the care of individuals within their practice population.it will therefore self-defeating for general practice nurse to accept or even to be inclined to think that they have no contribution to make to help people develop coping strategies and that a patient ability to cope is down to the person individual characteristics. Schulman-Green et al (2012) point out that often healthcare professionals focus on management of illness through improved medication adherence rather than focussing on the emotional aspects of having the diseases and the impact the emotional aspects plays in the patient’s medicine adherence. Obviously, general practice nurses can positively influence adherence when they pay greater attention to patient’s emotions too rather than focusing on the illness alone in efforts to improve adherence. General practice nurses (GPNs) provide knowledge and skill training, facilitate problem solving, motivate for lifestyle adaptation, developing coping skills to achieve goals. Patients including those suffering from T2DM relies on the services of general practice nurses for health and well-being of themselves and family (Madan 2016). General practice nurses, therefore, need to be confident and capable of providing evidence-based information that will instil confidence in patients and carers. This requires a personal commitment to improving practice for better patients’ outcomes thorough ongoing personal and professional development such as attending conferences supervision and regular updates. It is an also worth noting that although GPNs are well placed to be health promotions champion in their communities, let us not forget the challenges they also face which could affect their ability to effect the much-needed changes in patients within their practice community. GPNs are faced with increased patients’ demand, an ageing population, increase in number of people suffering from long term conditions including T2DM, (Cumings 2017) against the backdrop of a shrinking workforce and this is likely to impact on care patients receive. This calls for a need for nurses including customary practices nurses involved in diabetic care to be well supported and recognized. (While 2004) The need to develop and support GPN workforce is widely acknowledged (NHS 2016) Although it may be too early to realize its impact, it has provided an opportunity to develop the much-needed confidence, capability, and capacity to support general practice nurses to effect changes that will ensure that will ensure better outcomes for patients suffering fromT2DM  

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Essay on Diabetes for Students and Children

500+ words essay on diabetes.

Diabetes is a very common disease in the world. But people may never realize, how did they get diabetes and what will happen to them and what will they go through. It may not be your problem but you have to show respect and care for the one who has diabetes. It can help them and also benefited you to know more about it and have a better understanding of it. Diabetes is a metabolic disorder which is identified by the high blood sugar level. Increased blood glucose level damages the vital organs as well as other organs of the human’s body causing other potential health ailments.

Types of Diabetes

Diabetes  Mellitus can be described in two types:

Description of two types of Diabetes Mellitus are as follows

1) Type 1 Diabetes Mellitus is classified by a deficiency of insulin in the blood. The deficiency is caused by the loss of insulin-producing beta cells in the pancreas. This type of diabetes is found more commonly in children. An abnormally high or low blood sugar level is a characteristic of this type of Diabetes.

Most patients of type 1 diabetes require regular administration of insulin. Type 1 diabetes is also hereditary from your parents. You are most likely to have type 1 diabetes if any of your parents had it. Frequent urination, thirst, weight loss, and constant hunger are common symptoms of this.

2) Type 2 Diabetes Mellitus is characterized by the inefficiency of body tissues to effectively respond to insulin because of this it may be combined by insulin deficiency. Type 2 diabetes mellitus is the most common type of diabetes in people.

People with type 2 diabetes mellitus take medicines to improve the body’s responsiveness to insulin or to reduce the glucose produced by the liver. This type of diabetes mellitus is generally attributed to lifestyle factors like – obesity, low physical activity, irregular and unhealthy diet, excess consumption of sugar in the form of sweets, drinks, etc.

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Causes of Diabetes

By the process of digestion, food that we eat is broken down into useful compounds. One of these compounds is glucose, usually referred to as blood sugar. The blood performs the job of carrying glucose to the cells of the body. But mere carrying the glucose to the cells by blood isn’t enough for the cells to absorb glucose.

This is the job of the Insulin hormone. Pancreas supply insulin in the human body. Insulin acts as a bridge for glucose to transit from blood to the body cells. The problem arises when the pancreas fails to produce enough insulin or the body cells for some reason do not receive the glucose. Both the cases result in the excess of glucose in the blood, which is referred to as Diabetes or Diabetes Mellitus.

Symptoms of Diabetes

Most common symptoms of diabetes are fatigue, irritation, stress, tiredness, frequent urination and headache including loss of strength and stamina, weight loss, increase in appetite, etc.

Levels of Diabetes

There are two types of blood sugar levels – fasting blood sugar level and postprandial blood sugar level. The fasting sugar level is the sugar level that we measure after fasting for at least eight hours generally after an overnight fast. Blood sugar level below 100 mg/dL before eating food is considered normal. Postprandial glucose level or PP level is the sugar level which we measure after two hours of eating.

The PP blood sugar level should be below 140 mg/dL, two hours after the meals. Though the maximum limit in both the cases is defined, the permissible levels may vary among individuals. The range of the sugar level varies with people. Different people have different sugar level such as some people may have normal fasting sugar level of 60 mg/dL while some may have a normal value of 90 mg/dL.

Effects of Diabetes

Diabetes causes severe health consequences and it also affects vital body organs. Excessive glucose in blood damages kidneys, blood vessels, skin resulting in various cardiovascular and skin diseases and other ailments. Diabetes damages the kidneys, resulting in the accumulation of impurities in the body.

It also damages the heart’s blood vessels increasing the possibility of a heart attack. Apart from damaging vital organs, diabetes may also cause various skin infections and the infection in other parts of the body. The prime cause of all type of infections is the decreased immunity of body cells due to their inability to absorb glucose.

Diabetes is a serious life-threatening disease and must be constantly monitored and effectively subdued with proper medication and by adapting to a healthy lifestyle. By following a healthy lifestyle, regular checkups, and proper medication we can observe a healthy and long life.

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Type 2 diabetes

Affiliations.

• 1 Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK.
• 2 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
• 3 Family Medicine Department, Korle Bu Teaching Hospital, Accra Ghana and Community Health Department, University of Ghana Medical School, Accra, Ghana.
• 4 Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK. Electronic address: [email protected].
• PMID: 36332637
• DOI: 10.1016/S0140-6736(22)01655-5

Type 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Technology might improve outcomes, but its potential is yet to be realised. Despite advances, substantial barriers to changing the course of the epidemic remain. This Seminar offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions.

Copyright © 2022 Elsevier Ltd. All rights reserved.

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Conflict of interest statement

Declaration of interests EA has received fellowship funding from AstraZeneca. SL has been a member on advisory boards or has consulted with Merck Sharp & Dohme, and NovoNordisk. He has received grant support from AstraZeneca, Merck Sharp & Dohme, and Astellas. He has also served on the speakers' bureau of AstraZeneca, Boehringer Ingelheim, Eli Lilly & Co, Merck Sharp & Dohme, Chong Kun Dang Pharmaceutical, and Novo Nordisk. RL has received a research grant from Novo Nordisk. She has also received funds for serving on an advisory board for Sanofi and consultancy fees from Sanofi, AstraZeneca, Novo Nordisk, and Boehringer Ingelheim. DRW has received honoraria as a speaker for AstraZeneca, Sanofi-Aventis, and Lilly, and received research funding support from Novo Nordisk. MJD has acted as consultant, advisory board member, and speaker for Boehringer Ingelheim, Lilly, Novo Nordisk, and Sanofi; an advisory board member and speaker for AstraZeneca; an advisory board member for Janssen, Lexicon, Pfizer, and ShouTi Pharma; and as a speaker for Napp Pharmaceuticals, Novartis, and Takeda Pharmaceuticals International. She has received grants in support of investigator and investigator-initiated trials from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, AstraZeneca, and Janssen.

• Cancer is becoming the leading cause of death in diabetes. Wang M, Sperrin M, Rutter MK, Renehan AG. Wang M, et al. Lancet. 2023 Jun 3;401(10391):1849. doi: 10.1016/S0140-6736(23)00445-2. Lancet. 2023. PMID: 37270233 No abstract available.

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• Type 2 diabetes. Chatterjee S, Khunti K, Davies MJ. Chatterjee S, et al. Lancet. 2017 Jun 3;389(10085):2239-2251. doi: 10.1016/S0140-6736(17)30058-2. Epub 2017 Feb 10. Lancet. 2017. PMID: 28190580 Review.
• Pharmacogenetics in type 2 diabetes: precision medicine or discovery tool? Florez JC. Florez JC. Diabetologia. 2017 May;60(5):800-807. doi: 10.1007/s00125-017-4227-1. Epub 2017 Mar 10. Diabetologia. 2017. PMID: 28283684 Review.
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Clinical Research on Type 2 Diabetes: A Promising and Multifaceted Landscape

Type 2 diabetes constitutes an imposing epidemiological, economic, and scientific global challenge. The chronic complications of type 2 diabetes are a major cause of mortality and disability worldwide [ 1 , 2 ]. Clinical research is the main way to gain knowledge about long-term diabetic complications and reduce the burden of diabetes. This allows for designing effective programs for screening and follow-up and fine-targeted therapeutic interventions. However, new research methodologies are needed to obtain more accurate and useful insights into the biological and clinical processes involved in diabetic complication development.

During the last few years, new approaches for clinical research have incorporated digital tools to analyze the complex physiopathological background of type 2 diabetes. In this Special Issue, entitled “ Clinical Research on Type 2 Diabetes and Its Complications ” and published in the Journal of Clinical Medicine ( https://www.mdpi.com/journal/jcm/special_issues/Type_2_Diabetes_Complications ), some valuable digital methodologies were used in different studies focusing on the type 2 diabetes syndrome. Novel machine learning techniques for predicting long-term complications are one of these approaches, as the studies of Huang, Rashid, and Shin et al. depict [ 3 , 4 , 5 ]. The data presented by these authors suggest that machine learning may be more accurate in predicting diabetic microvascular complications than traditional methods. Additionally, digital tools such as artificial intelligence and machine learning can be implemented through an automated and rapid process.

Among the frequent causes of frustration for people with diabetes and the health care providers involved in their management is the delayed detection of diabetic complications. The outlook of clinical research appears promising in the near future owing to the development and implementation of advanced methods for the detection of early alterations in the micro- and macrovascular complications associated with diabetes. Two papers in this Special Issue cover the use of specific biomarkers tracing the progress of diabetic cardiovascular complications [ 6 , 7 ]. In another contribution, Lee et al. revisit the long-term glycemic variability and its relationship with end-stage kidney disease [ 8 ].

Besides the genetic approach, the application of digital techniques, including machine learning and artificial intelligence, and novel biomarkers could be crucial for individualized type 2 diabetes management, which is the backbone of precision medicine.

Two review papers address the complications that are non-traditionally linked to type 2 diabetes, although currently under exhaustive research: bone health and non-alcoholic fatty liver disease [ 9 , 10 ]. The multifaceted nature of type 2 diabetes is clearly visualized owing to the holistic angle used by these approaches.

The efficacy and safety of new type 2 diabetes pharmacological treatment are covered by three original papers [ 11 , 12 , 13 ]. The Yu-Chuan Kang et al. study includes a large population sample and an extended follow-up to evaluate the association between dipeptidyl peptidase-4 inhibitors and diabetic retinopathy [ 13 ]. This could be the first signal for a new safety risk of a pharmacological class of drugs used by millions worldwide.

The COVID-19 pandemic was first reported in China in December 2019 and continues to be a devastating condition for global health and economy. The COVID-19 disease has immediate implications for common chronic metabolic disorders such as type 2 diabetes. Both direct infection and the associated distress due to preventive measures in the general population have worsened the control of type 2 diabetes. Some factors indicate that COVID-19 or other coronavirus-caused diseases can be seasonal or persistent in the future. Type 2 diabetes has a strong negative effect on the prognosis of patients with COVID-19. Three papers in this Special Issue review the implications of this disease in relation to diabetes [ 14 , 15 , 16 ].

Finally, the aim of researchers in this field should be to make all these remarkable advances accessible to those populations experiencing more difficulties due to sociodemographic factors such as cultural deprivation, sex discrimination, or limited income [ 17 , 18 , 19 ].

Acknowledgments

The authors acknowledge the continuous editorial assistance of Nicole Quinn, Always English S.L.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, writing—original draft preparation, writing—review and editing were equally done by F.G.-P. and C.A. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Type 2 Diabetes Mellitus and Its Implications Essay

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Case Description

Case analysis, reference list.

You visit White Horse Farm to give William Jones his fortnightly depot injection of Zuclopenthixol Decanoate 200mg. While you are there his mother collapses and starts vomiting approximately 500 mls of coffee ground liquid. You call an ambulance and she is taken in to the ED. She was admitted to the ward with a provisional diagnosis of bleeding peptic ulcer. She is to remain nil by mouth, continue with IV fluids and newly prescribed proton pump inhibitor (IV), please monitor 4 hourly and review.

Background:

• Jean is still very active and works on the farm 3 days a week.
• Jean has had Type II diabetes for 40 years.

Medication:

• Metformin 500 mgs twice a day (35 years)
• Glipizide 2.5 mg orally once a day 30 mins before breakfast (20 years)
• Aspirin 75 mg/day (15 years)
• Simvastatin 10 mg at night (15 years)

Type 2 diabetes mellitus is a disease accompanied by chronically elevated blood glucose levels. This diagnosis develops as a result of the reaction of insulin with the cells of the body. This mechanism subsequently affects the functioning of the pancreas, which cannot produce enough insulin. The main accompanying symptoms of this disease are intolerance to physical activity and sleepiness. Subsequently, this can manifest itself in a sedentary lifestyle and excessive weight gain. Rather often in the course of second-degree diabetes, visual impairment due to the malfunctioning of the blood vessels of the eyes is noticed. This affects the patient’s ability to work with documents or study, moreover, many scientists have noted memory disorders in diabetics. The hormone insulin triggers the transport of glucose from the blood to the cells.

But in type 2 diabetes, insulin resistance develops – when muscle, fat and liver cells become less sensitive to the orders of this hormone and therefore cannot absorb glucose easily. As a result, excess sugar accumulates in the blood. If diabetes is left untreated, glucose gradually damages many body systems, especially the nervous and circulatory systems. This is why people with type 2 diabetes have a higher risk of cardiovascular disease. Fat cells release many hormones and inflammation-inducing bioactive molecules (Kuball and American Diabetes Association, 2018). Scientists suggest that if there is too much adipose tissue, the substances it secretes begin to interfere with insulin’s ability to do its job. In most cases, calculating your body mass index (BMI) can help you know if you are obese. To find it out, you need to divide your weight in kilograms by the square of your height in meters. It is usually a good indicator of how much body fat a person has.

The causes of type 2 diabetes are not yet fully understood. It is believed that in most cases, the disease occurs in people with a genetic predisposition, who have additional risk factors. Over the course of life, the heart and brain will suffer the most from insulin deficiency. Without carefully maintaining their function, there is a risk of stroke, heart attack, or arrhythmia. Since, in Jean’s case, second-degree diabetes was diagnosed as a result of working on a farm, it could be argued that the heart is particularly stressed (Kuball and American Diabetes Association, 2018). Because of the frequent heavy lifting or cardio-loads typical of this kind of work, the blood vessels need to pump a large volume of blood. However, due to the lack of insulin, the walls of the arteries become thickened, and the capacity of the blood flow decreases. This creates a significant risk for arrhythmias and heart attacks afterward.

In everyday life, farm work is likely to be perceived by patients as more difficult than by healthy people in similar conditions. Jean experiences more fatigue per unit of time than people who do not have a bathing diagnosis. This will also affect the psychological state of the patient; moreover, diabetics are characterized by some behavioral changes, that over time become an integral part of life. First, one can observe overeating as a consequence of dissatisfaction with the quality of life. This further increases the risk of obesity in the future. Second, the emotional sphere of diabetics is characterized by constant anxiety.

Diabetes is often psychosomatic in nature, making the nervous system particularly vulnerable to external stimuli. Moreover, the difficulties of life due to this diagnosis create a chronic stress background, which, without proper psychological support, can form mental disorders. The latter most often manifests in the form of neurotic, asthenic, and depressive syndromes (Kuball and American Diabetes Association, 2018). In addition to a purely psychological condition, these conditions arise as a consequence of intoxication or oxygen deprivation, which accompany hypoglycemia and create changes in the functioning of the nervous system. Researchers note that the most rastrotransmitted psychological effects of type 2 diabetes in the long term are mild cognitive impairment and dementia.

This is due primarily to organic abnormalities in the vascular system of the brain, affecting the quality of memory and thinking. Often it is accompanied by other disorders of consciousness, including amnesia or delirium. This means that in the direct diagnosis of patients, it is necessary to detect all possible preconditions for the formation of cognitive disorders (Kuball and American Diabetes Association, 2018). It is important to monitor memory impairment, confusion, or difficulty in formulating ideas over time. For each diabetic, it will be helpful to use various questionnaires and tests that allow doctors to identify these impairments early on.

Diabetics exhibit a variety of mood disorders in everyday life. Scientists have noted such manifestations in 20 percent of patients (Kuball and American Diabetes Association, 2018). At the same time, depression, especially in the chronic form, although possible, is quite rare. The most widespread manifestation of disorders in the emotional sphere is mixed conditions, aggravated by affective symptomatology. Patients exhibit depression, joylessness, passivity, and frozenness. Anxiety disorders often begin in diabetics in the form of apprehension and vague negative expectations. The patient is constantly afraid of potential catastrophic events that may occur because of the diagnosis. In rare cases, anxiety attacks may lead to panic attacks, but in everyday life, they are most often expressed in a person who is highly anxious, irritable, and fidgety (Kuball and American Diabetes Association, 2018). Conditions of this nature observed in a patient for more than 6 months require therapeutic intervention.

The risk of an eating disorder in the case of diabetes should not be overlooked. The above-mentioned obesity is a consequence of a variety of malnutrition scenarios. Patients commit eating excesses, showing an inability to stop eating (Kuball and American Diabetes Association, 2018). Furthermore, night eating syndromes, hedonic eating, and other forms of overeating may be formed. In some cases, eating disorders in diabetics take the form of anorexia nervosa and bulimia nervosa (Kuball and American Diabetes Association, 2018). However, such cases are in the minority. It is important for diabetics to stay in contact with a nutritionist or dietitian even if they do not show signs of an eating disorder because the risk of developing one remains high.

From a social point of view, there are also many preconditions for the emergence of an unstable state. By comparing himself with others, the patient comes to an unfair conclusion about his inferiority, which is often fueled by bullying in adolescence. As a consequence, the individual develops complexes, feelings of emotional abandonment, and guilt. In everyday communication, this may manifest as withdrawal or aggression toward others. Consequently, diabetics tend to be unsuccessful in building social contacts. Without proper psychotherapy, these patients have unstable self-esteem, which often becomes an obstacle to networking and career building (Kuball and American Diabetes Association, 2018). Diabetes cannot help but have an impact on Jean’s immediate environment. Relatives have to monitor constant access to medications, monitor the condition, and be there when help is needed. This creates some risks for a healthy family atmosphere, as the focus of attention is kept on the person with the diagnosis. It is not uncommon in such cases for parents or siblings to stop paying attention to their personal lives and interests.

Kuball, E. and American Diabetes Association (2018). Managing type 2 diabetes . Hoboken, New Jersey: John Wiley & Sons, Inc.

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Home — Essay Samples — Nursing & Health — Diabetes — The Type 1 and Type 2 Diabetes

The Type 1 and Type 2 Diabetes

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Essay on Pathophysiology: Type 2 Diabetes

Type 2 diabetes is metabolic disorder characterized by the high level of hyperglycemia in the context of insulin resistance and relative lack of insulin. This is a serious health problems that undermines the quality of life of patients, may trigger serious complications and eventually result in the death of patients. Therefore, the accurate diagnosis and effective treatment of type 2 diabetes is crucial for the survival of patients and maintenance of high standards of living, but patients should be collaborative and responsible to make their treatment effective.

Type 2 diabetes is traditionally viewed as the diseases that is triggered by heredity of patients. Genetics is one of the major factors that increases the risk of the development of type 2 diabetes in patients. Patients inherit the health problem from their parents and ancestors but it does not necessarily mean that patients will develop type 2 diabetes. Instead, the impact of genetics implies that patients are inclined to the development of type 2 diabetes but the higher vulnerability of the disease can trigger the development of the disease in patients.

At the same time, environmental factors are also important for the development of type 2 diabetes to the extent that they may trigger the genetically predisposed disease in patients. In fact, insulin resistance may be caused by an insulin signaling defect, glucose transporter defect, or lipotoxicity, and β-cell dysfunction is postulated to be caused by amyloid deposition in the islets, oxidative stress, excess fatty acid, or lack of incretin effect (Bostock-Cox, 2014). The impact of environmental factors leads to the development of type 2 diabetes. In fact, environmental factors are very important factors that cause the disease. The insulin resistance becomes a serious threat to the health of patients.

The impact of type 2 diabetes on the health of patients and their quality of life can hardly be underestimated. The morbidity related to the type 2 diabetes is high. To put it more precisely, the morbidity level is high since over 25 million of Americans had diabetes in 2010 and over 29 million in 2012. At the same time, the risk of the development of the disease differs depending on the racial background of individuals. To put it more precisely, the highest level of morbidity is marked among Native Americans and comprises 15,9%; the African American community has 13,2% of patients with diabetes; Hispanics have 12,8% of cases of diabetes; Asian Americans have 9,0%; and whites have 7,6% of diabetic population (Casey, 2011). Therefore, the high morbidity rate proves the negative impact of type 2 diabetes on patients.

            Moreover, the mortality rate 7-7.9% per year is the high rate of death among patients with type 2 diabetes. At the same time, many researchers (Kahn, et al., 2014) insist that cases of type 2 diabetes often remain under-reported. This is why the mortality rate 7-7,9% may be inaccurate and underestimated. On the other hand, even this level of mortality is very high because patients with type 2 diabetes have the high risk of the consistent deterioration of their health condition and serious complications may lead to death.

            In such a context, the understanding of the major risk factors can help to prevent the development of type 2 diabetes in patients. In this regard, genetics is one of the main factors that cause the development of type 2 diabetes. At this point, it is worth mentioning the fact that genetics is important but not determinant factor that causes the development of type 2 diabetes. In fact, genetics is a serious risk factor that increases the risk of the development of type 2 diabetes but what causes the development of the diseases are environmental factors mainly, including the lifestyle of people, their medical conditions, and other factors. For example, being exposed to the same environmental risk factors, individuals, who are genetically predisposed to the development of diabetes, are more likely to develop the disease compared to individuals, who are not genetically predisposed to the development of the disease.

            Another risk factor is the lifestyle of patients. In fact, the lifestyle is a very important factor that contributes to the development of type 2 diabetes. The problem of the lifestyle causes the development of type 2 diabetes, if individuals have the genetic predisposition to the development of the disease. The diabetes results from the sedative lifestyle, irregular nutrition, poor food culture, the excessive use of alcohol, drugs, tobacco and other negative environmental factors. In the course of time, the negative environmental impact can trigger the development of type 2 diabetes in patients.

            Furthermore, the medical condition of patients is another important factor that contributes to the development of type 2 diabetes. In this regard, many researchers (O’Shea, 2010) place emphasis on the high risk of the development of type 2 diabetes as the complication of diabetes and some other health problems. In this regard, hypertension, unstable insulin level, and other factors can be indicators of the development of type 2 diabetes. At the same time, the treatment of serious health conditions may trigger the development of type 2 diabetes as the result of the complication or side-effects of the medication and treatment of other serious health conditions.

            The development of the disease evokes considerable changes in patients. Type 2 diabetes is characterized by a combination of peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells (Spollett, 2014). The insulin resistance becomes a serious challenge for the normal functioning of human body to the extent that it may lead to the lethal outcome, unless the level of insulin is balanced.

 Insulin resistance and β-cell dysfunction are known to be the major pathophysiologic factors driving type 2 diabetes; however, these factors come into play with very different time courses. Insulin resistance in muscle is the earliest detectable abnormality of type 2 diabetes. In contrast, changes in insulin secretion determine both the onset of hyperglycemia and the progression toward insulin therapy (Casey, 2011). The combination of insulin resistance and β-cell dysfunction can cause the development of disease and deterioration of the condition of the patient’s health.

            Reversal of type 2 diabetes to normal metabolic control by either bariatric surgery or hypocaloric diet allows for the time sequence of underlying pathophysiologic mechanisms to be observed. In reverse order, the same mechanisms are likely to determine the events leading to the onset of hyperglycemia and permit insight into the etiology of type 2 diabetes (O’Shea, 2010). In such a way, the development of the disease starts progressing fast and its manifestations should draw the attention of health care professionals, who should address the obvious symptoms of type 2 diabetes to start its treatment at the early stage of its development.

Within 7 days of instituting a substantial negative calorie balance by either dietary intervention or bariatric surgery, fasting plasma glucose levels can normalize. This rapid change relates to a substantial fall in liver fat content and return of normal hepatic insulin sensitivity (O’Shea, 2010). Over 8 weeks, first phase and maximal rates of insulin secretion steadily return to normal, and this change is in step with steadily decreasing pancreatic fat content (O’Shea, 2010). In such a way, 8 weeks period leads to the full phathophysiological development of type 2 diabetes. In such a way, patients face considerable health problems and need the immediate assistance of health care professionals.

The glucose metabolism occurs in the course of the development of type 2 diabetes and is the major factor leading to the development of the disease. In the progression from normal to abnormal glucose tolerance, postprandial blood glucose levels increase first. Eventually, fasting hyperglycemia develops as suppression of hepatic gluconeogenesis fails (Spollett, 2014). In such a way, patients develop type 2 diabetes in the result of the abnormal glucose metabolism.

Researchers (Spollett, 2014) distinguish the following genomic factors that determine, to a significant extent, the pathophysiology of type 2 diabetes:

Decreased beta-cell responsiveness, leading to impaired insulin processing and decreased insulin secretion ( TCF7L2)

Lowered early glucose-stimulated insulin release ( MTNR1B, FADS1, DGKB , GCK )

Altered metabolism of unsaturated fatty acids ( FSADS1 )

Dysregulation of fat metabolism ( PPARG )

Inhibition of serum glucose release ( KCNJ11 )

Increased adiposity and insulin resistance ( FTO  and  IGF2BP2 ) [

Control of the development of pancreatic structures, including beta-islet cells ( HHEX )

Transport of zinc into the beta-islet cells, which influences the production and secretion of insulin ( SLC30A8 )

Survival and function of beta-islet cells ( WFS1 )

These factors are crucial for the development of type 2 diabetes, but the problem is the difficulty associated with tracing the change and impact of the aforementioned factors on the physical condition of patients.

            In face of such risk factors, patients and health care professionals should be able to diagnose type 2 diabetes at the early stage of its development to minimize the negative impact of the disease on the health and life of patients. Researchers (Phillips, 2014) distinguish the following symptoms, which are distinct symptoms of the type 2 diabetes: frequent urination, increased thirst, increased hunger, weight loss, blurred vision, itchiness, peripheral neuropathy, fatigue, frequent infections of skin, urinary tract, or vagina.

            To diagnose type 2 diabetes, health care professionals use either blood tests or Zinc transporter 8 autoantibody test/ Blood tests are the most widely-spread types of tests, which are applied to diagnose type 2 diabetes. These tests are accurate, fast to conduct and easy to manage. Zinc transporter 8 autoantibody test is applied in the most complicated cases of type 2 diabetes, when health care professionals face difficulties with the diagnosis of the disease with the help of blood tests. As a rule, this test is applied, when patients have already had some problems and face serious complications.

            On diagnosing the disease, health care professionals starts the treatment of patients with type 2 diabetes. The injection of insulin is the traditional treatment of type 2 diabetes which focuses on stabilization of the level of insulin in patients. This treatment is accompanied by medication, which may vary depending on the patient and specific case of type 2 diabetes. Often physicians prescribe metformin lowers blood glucose mainly by decreasing the amount of sugar (glucose) (Phillips, 2014). Sulfonylurea medicines also increase the amount of insulin made by pancreas of patients (Phillips, 2014). Nateglinide and repaglinide have a similar action to sulfonylureas and they books the insulin level fast that discourage health care professionals from their frequent use (Phillips, 2014).

            In addition to medication, physicians may and normally do recommend their patients to change their lifestyle because the wrong lifestyle is one of the major causes of the development of type 2 diabetes. In this regard, diet, weight control and physical activities are key factors contributing to the overall decline of the physical shape of patients and increase of the risk of the development of type 2 diabetes.

            Thus, type 2 diabetes is extremely dangerous disease but its complications are even more dangerous. Possible complications of type 2 diabetes include retinopathy, kidney damage, poor blood circulation, nerve damage, HHNKC, which involves the severely high glucose level leading to the coma of the patient and requires the immediate medical care. This is why health care professionals should diagnose the disease accurately and at possibly early stage to conduct the treatment effectively.

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