Diabetes
By Amanda Mannis
Definition and Background
Diabetes mellitus, commonly known as diabetes or abbreviated DM is a carbohydrate metabolism disorder where the body does not properly yield or respond to insulin, the hormone that regulates glucose (sugar) in the bloodstream (Rogers, Britannica Academic, 2009). Because of this, the body does not maintain proper sugar level within the blood and excess is excreted through the urethra (Rogers, Britannica Academic, 2009). There are four different diabetes: diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and latent autoimmune diabetes in adults (LADA) (Rogers, Britannica Academic, 2009). However, prediabetes is also a noteworthy condition.
Conditions
Diabetes mellitus Type 1
Type 1, also known as juvenile diabetes is characterized by the beta-cells of the islets of Langerhans in the pancreas not producing little or no insulin. This form of diabetes is idiopathic, or the cause is unknown. There are about 200,000 cases in US per year and patients are usually diagnosed under the age of twenty years old. This type of diabetes is more common in whites than in blacks but equally occurs in men and women. Type 1 symptoms include increased thirst, fatigue, and frequent urination. Treatment for Type 1 include insulin therapy by taking insulin injections, which are usually taken before a meal (“Type 1 Diabetes”, American Diabetes Association, 2017).
Diabetes mellitus Type 2
Type 2, is insulin resistance and is categorized by its ability to not recognize the levels of insulin in the body. The body does not produce enough insulin or it resists insulin. There are about 3 million cases of type 2 in the US per year. Symptoms include frequent thirst, urination, and blurred vision. Typically type 2 is different from Type 1 in it is a combination of genetics and lifestyle (like diet and exercise) that causes of this condition. Treatments include insulin therapies, monitoring blood glucose levels, and change in diet and exercise. African American, Mexican Americans, and Indian American are more likely to develop Type 2 because these populations tend to be overweight (“Type 2 Diabetes”, American Diabetes Association, 2017).
Gestational Diabetes
Gestational diabetes, is similar to type 2 in that it involves a both inadequate insulin secretion and responsiveness. Pregnant women are susceptible to getting this type of diabetes because placental hormones can cause high blood glucose levels. Gestational diabetes, occurs in approximately 6-8% of pregnancies. Treatments include change in diet, exercise, monitoring the baby, and medication(“Gestational Diabetes”, American Diabetes Association, 2017).
LADA
LADA, is a form of Type 1 diabetes that takes place in adulthood at a slower progression. Sometimes, LADA is mistaken for Type 2 diabetes because of the age of a patient. Symptoms are the same as those in Type 2 diabetes (Castro, Mayo Clinic, 2017).
Prediabetes
Prediabetes is the stage before being diagnosed with diabetes. Not all symptoms of diabetes are present yet blood glucose levels are high (hyperglycemic) yet not quite high enough to be classified as having Type 2 diabetes (“Learning About Pre-Diabetes”, American Diabetes Association, 2017).
Normal ranges
Internationally, blood glucose levels are typically measured in millimoles per litre (mmol/L, mM). However in the United States levels are measured in milligrams per deciliter (mg/dL). The normal and healthy blood sugar range is 4-6 mmmol/L or 72-108 mg/dL when fasting and up to 7.8 mmol/L or 140 mg/dL after eating (“Normal And Diabetic Blood Sugar Level Ranges”, 2017). Having high blood pressure is known as hyperglycemia while having low blood sugar is known as hypoglycemia (Rogers, Britannica Academic, 2009).
Complications and Treatment
Untreated diabetes can lead to things such as ketoacidosis, having excess acids and ketones in the blood. Other complications from diabetes include heart attacks, strokes, ulceration, gangrene, thickening of artery and capillary walls, kidney failure, blindness, blood clots, and much more. Before the 1920s, many died from the lack of treatment. However, now there are many treatment plans available including diet and exercise, insulin therapies, and medications such assulfonylureas, biguanides, and thiazolidinediones., and glucometer monitoring (Rogers, Britannica Academic, 2009).
Historical Context
Diabetes is a condition that dates back to ancient and medieval times. The Greeks would prescribe starvation, drinking wine, and horseback riding for this undiscovered disease. It was not until 1776, pioneer Matthew Dobson was the first to confirm that the sweet taste of urine of diabetics was because of excess sugar in the blood. In 1921, Frederick Banting, Charles Best, J.J.R. Macleod, and James Collip discovered dog’s insulin could be used help patients suffering from diabetic disorders. Finally in 1940, the American Diabetic Association was founded to increase the production of knowledge and awareness of this disease through campaigns and public service announcements (“History of Diabetes”, American Diabetes Association, 2017). This organization was found by 28 physicians and receives money from the federal government. However, minorities suffer a disproportionately amount from diabetes. Many have argued this is because of the black box of knowledge for lower income, ethnically-populated regions. There has been no transparency how to improve these conditions. However slowly but surely interventions and outreach programs have been established to combat this issue (Brindal, 2016, 800)
Controversy/Perspectives
The controversy surrounding diabetes is the evident health disparities with minority groups, particularly African Americans and Latinos. African Americans are sixty percent more likely to have diabetes than whites (Peek et. al, 2017). Typically, African Americans and Latinos tend to have higher rates of diabetes, worse diabetes management, and a higher rate of comorbidity. (Peek et. al, 2017). Many have attributed these issues to cultural differences such as diet, lifestyle, exposure to stressors, access to healthcare, income, education, trust of doctors, health literacy and numeracy, quality of care, and spirituality. A study by Peek et al. (2017) found that interventions that targeted these patients had a better outcome. Such interventions they found to effective were having culturally tailored programs, one-on-one education and feedback, and increasing accountability by assigning case managers and nurse clinicians (Peek et al., 2017).
Correspondence to Politics of Health
Diabetes is linked to politics of health through the concept of medicalization, that is human problems become associated and treated as medical conditions. According to H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, patients now days are more susceptible of being over diagnosed with conditions such as diabetes. Diabetes diagnoses have gone up yet deaths due to this condition have remain at a rather consistent pace (Chedekel, 2017). With economic stakes in medicine, doctors might be misidentifying normal bodily and behavioral tendencies as abnormal. The fact is that healthy is determined by more than just numerical measurements. Some argue that there are pre-determined normal blood sugar ranges back by scientific research yet it is true that these ranges are changing and evolving as medicine also is evolving. Dr. Welch states, “For example, a fasting blood sugar of 130 was not considered to be diabetes before 1997, but now it is. And these numbers are always changing in one direction: the direction of labeling more and more people as abnormal” (Chedekel, 2017). This is not to undermine known scientific evidence but to show that diagnosing healthy patients might do more harm than good Dr. Welch states “For example, as we recently learned in diabetes, while trying to move people with mildly elevated blood sugars towards “normal,” the death rate increased.” Big pharma and drug companies, doctors, and even hospitals benefit from expanding their market (Chedekel, 2017).
References
Brindal, Emily. 2016. The Lancet Diabetes & Endocrinology , Volume 4 , Issue 10 , 800 – 801. http://thelancet.com/journals/landia/article/PIIS2213-8587(16)30115-2/fulltext
Castro, Regina. 2017. “Latent Autoimmune Diabetes In Adults (LADA): What Is It? – Mayo Clinic”. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/type-1- diabetes/expert-answers/lada-diabetes/faq-20057880.
Chedekel, Lisa. 2017. “Overdiagnosis: Bad For You, Good For Business – Bostonia Web Exclusives”. Bu.Edu. http://www.bu.edu/bostonia/web/overdiagnosis/.
“Gestational Diabetes”. 2017. American Diabetes Association. http://www.diabetes.org/diabetes- basics/gestational/?loc=db-slabnav
“History of Diabetes”. 2017. American Diabetes Association. http://www.diabetes.org/research- and-practice/student-resources/history-of-diabetes.html
?referrer=https://www.google.com/
“Learning about Pre-Diabetes”. 2017. American Diabetes Association. http://www.diabetes.org/diabetes-basics/diagnosis/.
“Normal And Diabetic Blood Sugar Level Ranges – Blood Sugar Levels For Diabetes”. 2017. Diabetes.Co.Uk. http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html.
Peek ME, Cargill A, Huang ES. Diabetes Health Disparities: A Systematic Review of Health Care Interventions. Medical care research and review : MCRR. 2007;64(5 Suppl):101S- 156S. doi:10.1177/1077558707305409.
Rogers, Kara. 2009. Britannica Academic.. “Diabetes mellitus,” accessed April 5, 2017, http://academic.eb.com.proxy.library.vanderbilt.edu/levels/collegiate/article/diabetes- mellitus/1565.
“Type 1 Diabetes”. 2017. American Diabetes Association. http://www.diabetes.org/diabetes- basics/type-1/?loc=db-slabnav.
“Type 2 Diabetes”. 2017. American Diabetes Association. http://www.diabetes.org/diabetes- basics/type-2/?loc=db-slabnav.
« Back to Glossary Index