Disorders Of Homeostasis In Type 2 Diabetes

The present report is focused on a patient suffering from diabetes mellitus Type 2 and the problems associated with the patient. The report will focus on the pathophysiology of the process of the disease and its bio-psychological effect.

Confidentiality

For the purpose of completing the report, a patient is being focussed on. The patient is a 78-year-old female who is suffering from diabetes mellitus II and also showing reluctance to change her habits and improve her health. The person will be referred to as “Joy” for confidentiality Midwifery Council and Nursing.

Diabetes/ Type 1 and 2

Diabetes mellitus or simple diabetes is known to be a group of metabolic disorders in which a person suffers from high levels of sugar in the blood. This is because of the pancreas which is not able to produce enough insulin in the body. The other case may be that some of the cells are not able to respond to the insulin that is being produced which then results in an increase in the level of sugar (Haheim, 2011).

There are mainly two types of diabetes mellitus. One is diabetes mellitus type 1 in which the body of the individual has destroyed the beta cells which produce insulin in the pancreas. In the case when own body destroys some kind of good stuff in the body then it is known as the type of autoimmune system (Goldstein, and Wieland, 2008). Thus, diabetes type 1 is an auto-immune disease. In this case, the body does not produce insulin and this leads to an increase in the level of blood sugar. In most cases, this occurs before a patient is 40 years of age and therefore is also known to be Childhood Diabetes or Juvenile Diabetes. People with this type of diabetes have to regularly take in insulin so that they can stay alive (Barnett and Kumar, 2009). This type cannot be prevented and does not result from any type of lifestyle of a person. This means that it is not affected that a person is fat, thin fit or unfit to occur in an individual (Differentiating Between Type 1 and Type 2 Diabetes, 2003).

In type 2 diabetes mellitus, the cells are not able to respond properly to insulin and therefore they show an increase in the accumulation of glucose. The accumulation of glucose in blood is known as hyperglycemia which disturbs the metabolism of glucose due to a reduction in the secretion of insulin by the pancreatic cells. This then results in a condition when either enough insulin is not being produced in the body or it is not able to work in the appropriate manner (Young and Unachukwu 2012). The condition in which the insulin is not working properly is known as insulin resistance. The resistance of insulin is the decrease in sensitivity of tissues that are present in the pancreas which makes insulin. Due to a decrease in sensitivity, the efficiency of insulin is lessened in order to stimulate the uptake of glucose (Charles, 2000). This then leads to demand for more production of insulin as a part of the counter mechanism. When the cells are not able to meet the increased demand for insulin then the beta cells in the pancreas impair slowly and slowly. The result is that enough insulin is not present to break the glucose which leads to its accumulation (Anderson and Kendall, 2003).

Diabetes mellitus type 2 appears later on in life and the majority of patients develop this because they are either overweight or unfit. This is mainly attributed to problems in body weight, lifestyle and fitness. It is linked with the sedentary lifestyle factors of today's generation that are able to trigger genetic elements which become the cause of this disease. The patient, Joy, who is referred here is suffering from diabetes type 2 and is experiencing fluctuations in her glucose levels (Anderson and et. al., 2001).

Epidemiology

Epidemiology is said to be the study of causes or patterns of a particular disease in a defined population. It also describes the effects on the health of a particular disease. Diabetes type 2 is said to be a systemic and chronic disease that is related to the metabolic functioning of the body functions. This results from the resistance to insulin and impairment is caused by the secretions of insulin. This is more common in individuals over 45 years of age (Stoppler and Sheil, 2012). The patient Joy is 70 years old and lives alone without a proper lifestyle which could be the reason of diabetes type 2 in her. 

The pattern of diabetes type 2 is given by the statistics in the UK and also the world. 

UK Statistics

The patterns of diabetes in the UK for 2011 are as follows-

• More than one in 20 people suffer from diabetes.
• 2.9 million people have been diagnosed with diabetes
• There are approximately 850,000 people who suffer from diabetes but are still to be diagnosed (DIABETES IN THE UK 2012, 2012).

World Statistics

In 2011, the prevalence worldwide was 366 million and is expected that 552 million people will be affected by 2030. The (IDF) International Diabetes Federation has given that the five countries of the world have the largest number of people with diabetes the United States of America, China, Russia India and Brazil.
Aetiology

Etiology 

Etiology is a part of epidemiology, which tells about the causes of the disease. The main causes of diabetes type 2 include obesity and lifestyle.

It is said that obesity is the one factor, which plays a significant role in the occurrence of diabetes type 2 among individuals. The reason behind this is that pathogenic activity is related to the high amount of adipocytes and free fatty acids, which causes a mismatch in the secretion of insulin. This can be prevented or delayed by making use of techniques of weight control and participation in exercises (A Codependent Relationship: Diabetes & Obesity, n.d.).
Diabetes type is one such disease that results in high risks to individuals who are over the age of 45. With this, people with high blood pressure, and obesity along with low cholesterol and high triglyceride levels are also prone to this. People who are inactive with respect to a healthy lifestyle and exercise are often prone to the disease. Because of adopting the wrong type of lifestyle, this is often referred to as lifestyle disease (Diabetes Mellitus Pathophysiology, 2012).

The lady Joy who is taken as the patient is suffering from this disease and has been reported to have unstable levels of glucose in her body. This is because she avoids her routine medications and diet, which leads to an unhealthy lifestyle. Her age and the environment in which she is living are the causes of her disease. She is living in a lonely environment and is 70 years of age with a lifestyle in which there is no exercise. She also has varying levels of glucose in her blood due to which the disease can be more hazardous to her health. 

Anatomy of the Pancreas

The pancreas is an elongated organ being located behind the stomach across the back of the abdomen in the human body. The right side of the organ is the widest part which is the head and lies in the curve of the duodenum. The narrow portion of the pancreas is extended slightly upwards and ends near the spleen. It is made up of two types of glands, namely, exocrine and endocrine. The former secret is the digestive enzymes. The other one consists of it the islets of Langerhans that secrete hormones into the bloodstream (The Pancreas: Anatomy, 2013).
The hormones, which are secreted by the endocrine gland in the pancreas are glucagon and insulin. They are the ones, which perform the function of regulating the level of glucose in the blood of the body. The pancreas contains the disorders-of-homeostasis-in-type-2-diabetes-samplea type of cells known as beta cells from which insulin is released in response to the rising level of glucose in the bloodstream. After eating food, it is the pancreas that helps detect the rising level of glucose and starts the secretion of insulin (Turner, 2012). Insulin, in turn, works by improving the uptake of glucose from the blood as per the requirement of the body. Thus, it takes the glucose out of the bloodstream and into the cells of the body. Once glucose has reached the cells it is used up as the source of energy while an individual does its different physical jobs. This results in a drop of glucose levels in the blood and the pancreas is triggered to switch off the release of insulin (Facts about Diabetes and Insulin, 2009).
In this way, the pancreas plays an important part in maintaining the level of sugar in the human body.

Physiology

Physiology in the human body is the study of functions of the organisms and their parts. The physiology of a patient with diabetes can be explained with the help of both homeostasis and imbalance in the nature of functions due to which diabetes is caused.

Homeostasis

Homeostasis is the tendency of a cell or any part of the body to regulate the internal conditions while dealing with the changes in the environmental conditions in order to stabilize health. In the case of the given patient Joy, the homeostasis is explained by the help of optimum levels of glucose in her body (Eriksson, Lindstrom and Tuomilehto, 2001).
In the physiology of diabetes, the internal cells of the body are able to regulate the internal environment of the body by triggering the pancreas to release insulin when the food is taken in by the body. This causes the transfer of glucose in the cells which is then used up while doing the physical work. Thus, the level of glucose is reduced in the bloodstream. In this way the internal conditions of the body, that is, the blood glucose level in the given case, are being controlled by the cells as well as organs like the pancreas in the body (Drucquer and Mc Nally, 1998).
The patient, Joy, here is suffering from diabetes type 2. Thus, the internal cells are not able to maintain proper homeostasis as her blood glucose levels show a lot of variations.

Imbalance

Imbalances in the physiology of the body's organs cause a lot of metabolic problems, which then result in diseases. Imbalances in the level of blood in the case of the patient “Joy” occur due to diabetes mellitus 2. It has occurred because of the resistance of insulin which means that it is either not working properly or it is not secreted in an appropriate amount, which is required to maintain the level of glucose in the blood (Lindsay and Bennett, 2001).
The patient, Joy, is a patient with an insulin-resistant disorder and is of quite old age. She is not even able to take her insulin properly. As a result of the lack of proper secretion of insulin into the body, glucose is not able to get clear from her bloodstream and case of high blood glucose levels occur in the body. Then with the high level of glucose, the body tries to clear it by various other methods like that of increase in urination. Joy is also suffering from leg ulcers, which are again serious physiological diseases (Reaven and Laws, 1999).

There are imbalances in her body as her glucose level is also quite stable and the reason behind it is that she is not following her lifestyle properly. She is showing reluctance to follow her daily medications and her diet recommended by her doctors. The imbalances occur because of the abnormalities in the level of insulin because of the differences in the growth hormones which lead to the disorder. In addition to this, environmental factors like high amounts of stress or lack of physical activity can also cause imbalances in the insulin level. Joy is suffering from stress as she is living all alone without any support from family and neighbours and because of her old age, she is not able to do any kind of physical activity which could lead to imbalances in the level of insulin.

Psychological Impact

The impact of diabetes type 2 is not only related to the physiological effect on the body but can also be related to the psychological one. This can be both stress and the sociological impact. Joy, a patient with diabetes type 2, has been living alone for two years without her family and husband as her husband died two years ago. The only source of income here is the state income. Their social life of Joy is also not good as she has very little social input. She is not in much contact with her family members and neighbours and so she is socially isolated. The only social support, which is present with her is the visit of a nurse from the district to treat her and check her blood glucose levels.
The impact of diabetes type 2 is seen with respect to the sociological issues of Joy. It is very difficult for the patient to go through the treatment process of the disease as she is all alone without her family. High blood sugar levels along with poor control of sugar lead to a lot of other medical complications like that of the heart or brain. Joy is also suffering from leg ulcers which are assumed to be a serious metabolic disorder. This has hampered her ability to do other physical activities in her routine life (Nebika-Pedrotti, Keller, Iselin et al.,2009). Apart from this, it is necessary for the patient to control her blood glucose daily for which she has to undergo tasks which are related to the daily treatment. All this has a mental as well as a sociological effect on the life of the patient. This is so because with the disease the patient feels completely different from others and isolated from her family and neighbours (3 ways stress affects diabetes, 2013).

According to the nurse who is visiting Joy daily, Joy is not able to take her insulin as recommended which can lead to further increase her diabetes. The sociological impact of this disease on Joy is that since she is all alone she is not able to take her treatment properly as it should be taken as she does not have mental or social support. Diet and exercise along with monitoring of the blood glucose levels require special care and attention. For the patient, it is also necessary to maintain the proper timing and provide the dosage of diabetes medications which are prescribed like insulin (Koopmanschap, 2002). All this is possible with the care and attention of not only the nurse but also the support of her groups or family. This is lacking for Joy and therefore it is becoming difficult for her to take the proper medication and her prescribed diet (The Psychological and Social Impact of Type 2 Diabetes, 2008).
The changes which are to be incorporated in the lifestyle because of the diabetes type 2 is done with the help of family but the patient Joy is not able to bring in the changes as she is all alone without any social life.
The disease has an impact in sociological terms as diabetes demands a lot of changes in the lifestyle of the patient. Due to this, the life of the patient becomes quite threatening and leads to a lot of complications (Vileikyte, 2001). Due to this, it has an overall negative impact on the well-being of the patient. The social life is also influenced as people with this disease are left all alone as is happening with Joy. This shows that her social contacts and life are totally ruined because of diabetes type 2. The social implication of the disease is also seen as the patient feels totally different from others and has the feeling of being left out and all alone. This also leads to a kind of negative emotion in the patient and this is the reason she is not being able to take and respond to her treatments in the proper manner.

Conclusion

Diabetes type 2 has become one of the major concerns for all people. It has become a health issue which is being spread all over the globe. This has become one of the major contributors towards the high rate of mortality and also death at an early age. This disease is increasing at a fast pace because of the changing lifestyle, obesity and chronic stress. The sedentary lifestyle which is being followed today includes a lack of exercise and a healthy diet. The impact of this disease is not only seen in physiological terms but also in psychological terms like that of stress and sociological terms. Therefore, it is very important for the patients dealing with this disease that they be given special attention and care (Edelman, Olsen, Dudley et al., 2002).

References

Online

• 3 ways stress affects diabetes. (2013). [Online]. Available through: http://www.besthealthmag.ca/get-healthy/diabetes/3-ways-stress-affects-diabetes [Accessed on 24th May 2013].
• A Codependent Relationship: Diabetes & Obesity. (n.d). [Online]. Available through: <http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity> [Accessed on 24th May 2013].
• DIABETES IN THE UK 2012. (2012). [pdf]. Available through: <http://www.diabetes.org.uk/Documents/Reports/Diabetes-in-the-UK-2012.pdf>. [Accessed on 24th May 2013].
• Diabetes Mellitus Pathophysiology. (2012). [Online]. Available through: <http://www.nodiabetes.info/diabetes-mellitus-pathophysiology.html>. [Accessed on 24th May 2013].
• Differentiating Between Type 1 and Type 2 Diabetes. (2003). [Online]. Available through: <http://www.medscape.com/viewarticle/449804 >. [Accessed on 24th May 2013].
• Facts about Diabetes and Insulin. 2009. [Online]. Available through: <http://www.nobelprize.org/educational/medicine/insulin/diabetes-insulin.html>. [Accessed on 24th May 2013].
• Stoppler, M. C., and Sheil, W. C., (2012). What causes diabetes? [Online]. Available through: <http://www.medicinenet.com/diabetes_mellitus/page3.htm> [Accessed on 24th May 2013].
• The Psychological and Social Impact of Type 2 Diabetes. (2008). [Online]. Available through: <http://www.health.am/db/more/the-psychological-and-social-impact-of-type-2-diabetes/>. [Accessed on 24th May 2013].
disorders-of-homeostasis-in-type-2-diabetes-sample
• Turner, R.L., 2012. Exercise Your Diabetes Away. [Online]. 16th March. Available through: <http://www.fyiliving.com/diet/special-diets/diabetes-diet/exercise-your-diabetes-away/> [Accessed on 24th May 2013].
• Type 2 diabetes. (2012). [Online]. 25th January. Available through: http://www.mayoclinic.com/health/type-2-diabetes/DS00585 [Accessed on 24th May 2013].

Books and journals

• Anderson RJ, and et. al., (2001). The prevalence of co-morbid depression in adults with diabetes. Diabetes Care. 24. Pp. 1069-78.
• Anderson, J.W., and Kendall, C.W.C., (2003). Importance of weight management in type 2 diabetes. Review with meta-analysis of clinical studies. American journal of clinical nutrition. pp. 331-339.
• Barnett, T., and Kumar, S., (2009). Obesity and Diabetes. John Wiley & Sons.
• Charles, M.A., (2000). Diabetes management: complication risk assessment, diagnosis, and therapeutic options. M.A. Liebert.
• Drucquer, M.H., and Mc Nally, P.G., (1998). Diabetes Management: Step-by-Step. Wiley.
• Edelman, D, Olsen MK, Dudley TK, and et al. (2002). Impact of diabetes screening on quality of life. Diabetes Care. 25. Pp. 1022-6.
• Eriksson, J., Linddtrom, J., and Tuomilehto, J., 2001. Potential for the prevention of type 2 diabetes. Oxford Journals. 60(1). pp.183-199.
• Goldstein, B.J., and Wieland, D., (2008). Type 2 Diabetes: Principles And Practice. CRC Press.
• Haheim, L.L., (2011). Oral Infections and Cardiovascular Disease. Bentham Science Publishers.
• Koopmanschap, N., (2002). Coping with type 2 diabetes; the patient's perspective. Diabetologia. 45. Pp. 18-S22.
• Lindsay, R.S., and Bennett, P.H., 2001. Type 2 diabetes, the thrifty phenotype - an overview. Oxford Journals. 60(1). pp.21-32.
• Nebika-Pedrotti, P.M., Keller, U., Iselin, H.U., et al.(2009). Perceived discrimination against diabetics in the workplace and in work-related insurances in Switzerland. Swiss Med Wkly. 139. Pp. 103-9.
• Reaven, G.M., and Laws, A., (1999). Insulin Resistance: The Metabolic Syndrome X. Springer.
• Vileikyte, L., (2001). Diabetic foot ulcers: a quality of life issue. Diab Metab Res Rev. 17. Pp. 246-9.
• Young, E.E. and Unachukwu, C.N. (2012). Psychosocial aspects of diabetes mellitus. African Journal of Diabetes Medicine. 5. 20(1).

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