The Explainer| What is Diabetes Mellitus?

Diabetes is a disorder of glucose control, which causes high blood glucose. 280 Australians develop diabetes every day and is the fasted growing chronic condition in Australia. Diabetes is the single most common cause of kidney failure requiring dialysis, It is the most cause of blindness in people below the age of 60 and is the most common cause of non-traumatic limb amputation. Diabetes is a major cause of disability and of premature death due to the development of premature vascular diseases.

There are two types of diabetes mellitus, type 1 and 2, diabetes mellitus can be described as a malfunction in glucose balance or homeostasis. This paper is going to look at the early discovery, pathogenesis, treatments and the people at risk of having the disease with the focus on Aboriginal and Torres Islanders.

History

  • The word diabetes was first described by Apollonius of Memphis in 250 BC and basically means to go through. A British doctor named Thomas Willis later added mellitus after noticing the sweetness of urine; the Mellitus basically means sweet, honey. Mathew Dobson later described the cause of the sweetness in urine to be caused by the extra sugar in the urine.

Pathophysiology

  • Type 1 diabetes, also known as insulin-dependent diabetes is caused by continuous inflammation of the beta cells in the islets of Langerhans in the pancreas that produces insulin or the autoimmune destruction of the beta cells of in the pancreas. This results in the decline of insulin production.
  • A critical phase of diabetes is when the body starts to produce ketoacids as result of processing fatty acids and proteins to meet metabolic demands in the absence of glucose. Factors that trigger type 1 diabetes include genetics, environmental, chemical and drugs.
  • Type 2 diabetes is lifestyle related, it happens when there is a breakdown in the relationship between the beta cell secretion of insulin and the ability of the body to regulate insulin. The first sign of a malfunction in this relationship is the elevated sugar levels in the levels in the blood and urine.

Role of insulin

  • Insulin helps in the metabolism of carbohydrates, fats and proteins and it also helps to maintain the blood glucose levels at a constants level. It does this allowing glucose to enter the cells and the conversion of excess glucose into glycogen
  • Inhibits the release of excess glucose from the liver and slows down fat metabolism. It also prevents the breakdown of fat, proteins and the production of glucose in the liver.
  • Low levels of insulin lead to a condition called hyperglycemia which means there is too much sugar in the bloodstream; this is brought about the failure of the body to regulate glucose production.
  • The opposite of hyperglycemia is hypoglycemia which is brought about by an overproduction of insulin in the pancreas. The insulin inhibits glucose production while continuing the breakdown of fuel. As glucose levels fail the brain send regulatory hormones causing sweetness, confusion and behavioural change.

Statistics 2011-2012

  • According to the Australian Bureau of statistics, 875400 people reported having some sort of diabetes and of this number 85. 3% had type 2 while 12.4% had type 1 and 2.3 had unspecified diabetes. 4.3% of men reported having diabetes as compared to 3.6% women. The incidence of diabetes increases with age.

Risk factors for type 1 diabetes

  • Poor health in infancy
  • Having an older mother
  • Having an autoimmune disease

Risk factors for type 2

  • Obesity
  • If an individual suffers from hypertension or cardiovascular disease
  • Smoking
  • Drug use
  • If an individual is aboriginal or Torres islander

Aboriginal and Torres Islanders

The highest rate of type 2 diabetes is found in Aboriginal and Torres Islanders in Australia. An estimate of 10-30% of the aboriginals and Torres Islander suffer from some sort of diabetes in comparison to non-Australian aboriginals. The prevalence of diabetes during pregnancy is also higher in Aboriginal women than the general Australian population. This can be attributed to the following factors

  • Genetic susceptibility, some theories suggest that aboriginal have a frugal genetic makeup which is programmed for glucose intolerance and high levels of cholesterol, this helped them when they were hunters and gathers, this is so that the body’s weight can be maintained during the time’s famine. However, the western diet which is readily available makes obesity and cardiovascular diseases prevalent.
  • Dietary changes, aboriginal eat foods that high in fats and sugars and low in carbohydrates and fibre. This probably due to limited access to fresh foods, which may have an indirect reason why Aboriginals and Torres Islander have a poor diet. Which in turn contributes the high prevalence of Type 2 diabetes. Also, a diet that is high in sugar and fat causes the build-up of toxic fat around the worst this is seen especially in aboriginal women, which is why diabetes affects more aboriginal women than men.
  • Lack physical activity, hunting and gathering provided physical activity for Aboriginal and Torres Islander, easily available western food means they do have to hunt and gather food.
  • lastly, Social economic status is linked to a person wellbeing, research has shown that low-income and poor education and low economic prospects increase the probability of a person engaging in high-risk behaviours like smoking and drug use.

Treatments and management

Type 1

  • Treatments for type 1 diabetes is a combination regular insulin injection because people who suffer from this kind of diabetes cannot produce insulin and proper dietary meal planning. People with type 1 diabetes should eat meals at the sometime and try by all means to eat the same quantity of food this prevents the blood sugar levels from being too high or low.

Type 2

  • The treatment for type 2 diabetes is mainly a change in lifestyle, such as, eating healthy and exercise,  occasionally insulin tablets and injections can be used in cases were high glucose levels are not caused poor diet.

The care for individuals with diabetes requires a multidisciplinary team approach by providing advice, education and screening. The care aims to promote independence and self-management of the condition by the patient and in so doing minimising potential and long-term complication of diabetes.

Refferences

Nankervis, A., McIntyre, H. D., Moses, R., Ross, G. P., Callaway, L., Porter, C., & Jeffries, W. (2014). ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia. Modified June.
Barr, E. L., Barzi, F., Hughes, J. T., Jerums, G., Hoy, W. E., O’Dea, K., … & Ekinci, E. I. (2018). High Baseline Levels of Tumor Necrosis Factor Receptor 1 Are Associated With Progression of Kidney Disease in Indigenous Australians With Diabetes: The eGFR Follow-up Study. Diabetes care41(4), 739-747.
Mendham, A. E., Duffield, R., Marino, F., & Coutts, A. J. (2015). A 12-week sports-based exercise programme for inactive Indigenous Australian men improved clinical risk factors associated with type 2 diabetes mellitus. Journal of science and medicine in sport18(4), 438-443.
DisclaimerThe above article should not be used as a diagnostic tool, it is purely for information purposes. If you suspect you have diabetes seek medical help. 
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