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PUBH6150 Quality And Safety In Health Care

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PUBH6150 Quality And Safety In Health Care Question: Topic: Diabetes mellitus type 2 is a chronic condition that affects the way the body processes blood sugar (glucose). Explain the causes of diabetes mellitus type 2. List the pathophysiological changes caused by diabetes mellitus type 2.   Describe how these pathological changes relate to the clinical manifestations of the disorder. Answer: In the year 2010 alone it was reported that 290 million people are suffering from diabetes mellitus or type 2 diabetes which is 90 % of all cases of diabetes. These numbers show that about 6% of the world’s population suffers from it (Imperatore et al., 2012). Diabetes Mellitus type 2 or also called type 2 diabetes is a metabolic disorder that is characterized by relative lack of insulin, high blood sugar and insulin resistance. In this medical condition the glucose level builds up in the blood. A chain reaction causes numerous symptoms. The cause of this disorder is a combination of genetic and lifestyle factors (Moscou, 2013). Some other factors such as female gender, increasing age and genetics are not under the control of a person. It is also believed that lack of sleep which affects our metabolism is associated with this disorder. Lifestyle factors such as being overweight, obese, stressed, urbanization, having a poor diet and lack of physical activity is associated with it (TOUMA &PANNAIN, 2011). According to the book written by D G Gardner, and D Shoback,  excessive body fat is associated with about thirty percent cases of Diabetes Mellitus 2 (Gardner & Shoback ,2011). They studied that some people who may not look obese but have a high waist hip ratios are at risk of developing this disease.  Those who smoke are also at risk of developing this disorder. Consumption of excessive sugar, saturated fats, white rice and excessive trans fatty acids in the diet appears to increase the risk of developing this disease. Genetics also play a crucial role in developing Diabetes Mellitus 2 as many genes have been recognized to be passed as hereditary factors from parents to children. Some medications can also predispose an individual to diabetes as medications like statins, thiazides, glucocorticoids and beta blockers have been found to be associated with this disease. (Sampson , Linton , & Fazio, 2011) Diabetes Mellitus 2 is caused by inadequate production of insulin. “Insulin” is an hormone created by our pancreas that breaks down sugar in our blood stream. Glucose is obtained from carbohydrates in the diet that are then broken down into glucose.  This glucose is then  absorbed by numerous cells in the body when energy is needed. In a person that has a healthy level of insulin the blood sugar rise that occurs after a meal starts a trigger for the pancreatic beta cells to release insulin(Pasquel &, Umpierrez , 2014). This hormone “insulin” absorbs glucose from the blood and breaks it down. This induces the stimulation of conversion of glucose to pyruvate that releases energy. Excess glucose is converted to glycogen which is stored in the liver in the process called “glycogenesis”. Sometimes the inability of the beta cells to respond to normal levels of hormone insulin also causes this disorder. This is called “insulin resistance”. In case of a person suffering from “insulin resistance” the liver instead of suppressing glucose release, starts releasing glucose into the blood stream. This resistance could be primarily insulin resistance which is only a minor defect in the secretion of insulin or some having a slight lack of insulin hormone. There can be an increased breakdown of lipids that are present in the fat cells, high glucagon levels, resistance to incretin and increased retention of water and salt in the kidneys. However it has been absorbed that not all people who have insulin resistance would develop diabetes. Many people will not experience any symptoms in the starting of the disease(Maruthur et al, 2016) It is a mild and slow disease but when it progresses the symptoms become dangerous and severe. Later the symptoms of the disease would include frequent urination and increased thirst (polydipsia) which is caused by excess sugar build up in the blood which causes the tissues to accumulate fluid in them. This will make the individual more thirsty than usual. When the person drinks too much water they feel a need to urinate often that is called “polyuria”. Increased hunger is also a symptom of diabetes mellitus 2 as when the sugar is not reaching the cells due to insufficient insulin, the organs and muscles starve. This causes depletion of energy which triggers the body to feel intense hunger. A person who is suffering from diabetes mellitus 2 would experience weight loss even after eating more than normal(Malik et al., 2010). This is caused due to the fact that the body’s ability to metabolize glucose has been disturbed. The body turns to using alternate fuels such as fat and muscle(Tfayli & Arslanian , 2009). A person loses more calories when excess glucose is being released in the urine. Fatigue is another symptom that is caused as the cells are starved of sugar and the person will become irritable and tired. People suffering from this disease also experience blurred vision as the fluid from their lenses is drained due to excess sugar in the blood. This in turn affects the ability of the person to focus and see things clearly. Type 2 diabetes is a disease that is associated with shortening the life expectancy of  the person suffering it by almost ten years (Pasquier , 2010). This is due to the fact that the person suffering from this disease suffers from numerous complications such as being at risk of developing cardiovascular disease by over 4 times, people are more prone to having strokes and developing ischemic heart disease. Sores and wounds of the person suffering from this disease don’t heal normally and develop infection. So much so that many face amputations  and frequent hospitalizations (Zaccardi et al., 2015). Velvety and dark patches of skin in creases and folds in the body usually around necks and armpits which is a sign of insulin resistance called as acanthosis nigricans. Type 2 diabetes can be managed and even delayed with regular exercise and nutrition. Risk of developing the disease can even be slashed by half by intensive lifestyle changes. (Malanda et al., 2012) References Gardner D, Shoback D. “Chapter 17: Pancreatic hormones & diabetes mellitus”. 1st ed. New York: McGraw-Hill Medical; 2011. ISBN 0-07-162243-8 Imperatore G, Boyle J, Thompson T, Case D, Dabelea D, Hamman R et al. Projections of Type 1 and Type 2 Diabetes Burden in the U.S. Population Aged <20 Years Through 2050: Dynamic modeling of incidence, mortality, and population growth. Diabetes Care. 2012;35(12):2515-2520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507562/ Maruthur N, Tseng E, Hutfless S, Wilson L, Suarez-Cuervo C, Berger Z et al. Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes. Annals of Internal Medicine. 2016;164(11):740. https://annals.org/aim/article/2513979/diabetes-medications-monotherapy-metformin-based-combination-therapy-type-2-diabetes Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev.2012, 18(1):675-679.https://www.ncbi.nlm.nih.gov/pubmed/22258959Malik V, Popkin B, Bray G, Despres J, Hu F. Sugar-Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular   Disease Risk. Circulation. 2010;121(11):1356-1364.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862465/ Moscou, S. "Getting the word out: advocacy, social marketing, and policy development and enforcement". 2nd ed. Burlington, MA: Jones & Bartlett Learning.; 2013. Sampson U, Linton M, Fazio S. Are statins diabetogenic?. Current Opinion in Cardiology. 2011;26(4):342-347.  https://www.researchgate.net/profile/Barak_Zafrir/publication/263288554_Lipidlowering_Therapies_Glucose_Control_and_Incident_Diabetes_Evidence_Mechanisms_and_Clinical_Implications/links/00b4953b03899095e8000000.pdf Pasquel F, Umpierrez G. Hyperosmolar Hyperglycemic State: A Historic Review of the Clinical Presentation, Diagnosis, and Treatment. Diabetes Care. 2014;37(11):3124-3131. https://www.researchgate.net/publication/267370380_Hyperosmolar_Hyperglycemic_State_A_Historic_Review_of_the_Clinical_Presentation_Diagnosis_and_Treatment Pan A, Wang Y, Talaei M, Hu F, Wu T. Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. The Lancet Diabetes & Endocrinology. 2015;3(12):958-967.https://pubmedcentralcanada.ca/pmcc/articles/PMC4656094/ Pasquier F. Diabetes and cognitive impairment: how to evaluate the cognitive status?. Diabetes & Metabolism. 2010;36:S100-S105.https://www.diabet-metabolism.com/article/S1262-3636(10)70475-4/abstractTOUMA C, PANNAIN S.   Does lack of sleep cause diabetes?. Cleveland Clinic Journal of Medicine. 2011;78(8):549-558.https://www.isdbweb.org/documents/file/4e53ad3849ade.pdf Tfayli H, Arslanian S. Pathophysiology of type 2 diabetes mellitus in youth: the evolving chameleon.   Arquivos Brasileiros de Endocrinologia & Metabologia. 2009;53(2).https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302009000200008 Zaccardi F, Webb D, Yates T, Davies M.   Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. Postgraduate Medical Journal. 2015;92(1084):63-69.https://leicesterdiabetescentre.org.uk/Pathophysiology-of-type-1-and-type-2-diabetes-mellitus-a-90-year-perspective-

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