Type 2 diabetes or non-insulin dependant diabetes mellitus normally develops in people over 40 old ages old so is besides known as adult-onset diabetes. It is the most common signifier of diabetes where approximately 90 % of diabetes patients are in this class. Type 2 diabetes is a metabolic upset due to high blood sugar ( glucose ) . The disease develops when organic structure cells become immune to insulin or the insulin secreted by the pancreas is non plenty. Insulin moves blood glucose into organic structure cells where the glucose is stored and later used for energy. Insulin opposition is a status where organic structure cell receptors are less sensitive to insulin and can non utilize insulin efficaciously doing a physique up of glucose in the blood and ensuing in high blood glucose degree. Precisely why this job happens is non known, although fleshiness and inaction seem to be one of the of import factors. Since high blood sugar can do a figure of symptoms and wellness jobs including a higher hazard of bosom onslaughts, shots, amputations, and kidney failure, what are the interventions to protect the patients from these complications?
Figure 1.0:
Pancreass, the organ that secretes insulin endocrine.
Possible solution
Oral Anti-diabetic Drugs
The most suited intervention for type 2 diabetes is non known but one of most effectual intervention found to understate the hazards of long-run effects of type 2 diabetes was anti-diabetic drugs. Aiming to command blood sugar degree, they work either by:
- increasing insulin degrees in the organic structure,
- increasing the organic structure ‘s sensitiveness or dercreasing its opposition to insulin, or
- diminishing glucose soaking up in the bowels.
The drugs are divided into two types ; the most normally used drugs and new drugs. Thiazolidinediones, a-glucose inhibitors, and meglitinides are the new anti-diabetic drug groups discovered by scientists whereas sulphonylureas and biguanides are the most normally used drug groups. Despite the presence of a broad scope of drugs at nowadays, biguanides and sulphonylureas are the most widely used drugs compared to the new drugs.
“ A systematic reappraisal of randomized controlled tests found that Glucophage and second-generation sulfonylureas are the preferable picks for most with type 2 diabetes, particularly those early in the class of the status.”
( hypertext transfer protocol: //en.wikipedia.org/wiki/Diabetes_mellitus_type_2 )
The oldest unwritten anti-diabetic drugs, Sulphonylurea such as Glucotrol, DiaBeta, and glimepiride are still prescribed today. They work by hiking the beta cells in the pancreas to bring forth more insulin and doing the organic structure cells more receptive towards insulin. Patients are either prescribed with sulphonylureas one time or twice day-to-day and are to be taken orally before repasts. Get downing with a low dosage normally, which can be increased if necessary every few hebdomads until the patients get a good control over the organic structure ‘s blood sugar degree. However, some drawbacks are sulphonylureas consequences in hypoglycaemia if a good life style is non maintained as it increases the degree of insulin. It besides causes weight addition hence it is non suited for fleshy people.
On the other manus, biguanides like Glucophage play the primary function of cut downing the sum of glucose production by the liver. Metformin besides increases the sensitiveness of organic structure cells to insulin and arouse an addition in cellular consumption of glucose in organic structure cells. Patients are prescribed with an initial dosage of 500mg twice daily or 850mg one time day-to-day. The maximal dosage is 1g twice daily or 850mg three times daily. The dose depends on the patients status.
Diagram 2.0: The chemical construction of metformin hypertext transfer protocol: //diabetesmanager.pbworks.com/f/1255202482/metformin.JPG
Between Glucophage and sulphonylureas, Glucophage has been found to be more effectual in commanding blood glucose degrees for a longer period compared to sulphonylureas. It remains as the first-line drug therapy for type 2 diabetes. Metformin does non bring on addition in insulin production therefore seldom causes hypoglycaemia when taken as a monotherapy unlike sulphonylurea drugs. So, complications of the disease are lowered particularly in fleshy people.
However, since the drugs work otherwise with different mechanisms of action, some patients may be prescribed either with Glucophage as a monotherapy or together with sulphonylurea drugs or even sometimes with insulin injections. Anyway, patients should be examined by physicians to see which drug suits them best and the physician should be told if a patient is under other medicines to avoid complications with a combination of drugs taken by them.
Effectiveness of anti-diabetic drug Glucophage
Of all the old and new drugs available for type 2 diabetes intervention, I have found metformin that can be the best solution presently. Studies every bit good as researches have found that Glucophage has been able to command blood glucose degree and cut down or forestall type 2 diabetes complications for both corpulent and non-obese patients. It is besides suited for patients with bosom failure unlike sulphonylureas which can increase the hazard of bosom onslaughts and congestive bosom failures.
“ Metformin does non advance weight addition and has good effects on several cardiovascular hazard factors. Consequently, Glucophage is widely regarded as the drug of pick for most patients with type 2 diabetes. ”
( hypertext transfer protocol: //www.ncbi.nlm.nih.gov/pubmed/15669880 )
To turn out the effectivity of Glucophage, I found grounds from an article: “ Metformin vs. Sulfonylureas for Diabetes ” by Salynn Boyles from WebMD Health News which was reviewed by Louise Chang, MD ; date-December 4, 2009 which compared Glucophage and other drugs chiefly with sulphonylurea drugs. Based on the article, individual drug intervention with sulphonylureas was said to enforce a higher hazard of decease compared to metformin. Second-generation sulphonylurea users besides had a greater hazard of congestive bosom failure.
Below is the portion of the findings from the research:
- “ Compared with Glucophage, single-drug interventions with first- or second-generation sulfonylureas was associated with a 24 % to 61 % increased hazard for decease from all causes.
- Compared to metformin, second-generation sulfonylurea usage was associated with an 18 % to 30 % increased hazard for bosom failure. ”
- ( hypertext transfer protocol: //www.medicinenet.com/script/main/art.asp? articlekey=109066 )
- The American Diabetes Association ( ADA ) shows the same tendency in its latest recommendation like this information. Hence, the information is dependable and the writers of WebMD are medical officers or research workers who are well-versed with such wellness jobs so can be depended upon.
Figure 3.0:
A survey demoing that Glucophage is less hazardous than sulphonylureas but a combination is seen to be better. hypertext transfer protocol: //care.diabetesjournals.org/content/25/12/2244.full
Besides, the graph above besides proves Glucophage is less unsafe than sulphonylureas. So, patients can devour it more safely.
Social and Ethical Implications
Social deductions
Some patient with type 2 diabetes take do non take the disease earnestly and decline to take medicines or intervention. They might hold a incorrect perceptual experience excessively where they think diabetes is related to devouring excessively much sugar so may merely cut down nutrient rich in sugar instead than taking their medicines as advised by physicians. This leads to unwanted consequence.
The drugs do work but besides do side effects to the patients. Besides holding to get by with type 2 diabetes symptoms, they have to bare the side effects caused by anti-diabetic drugs. The drugs will cut down complications from the disease over clip but some patients can endure from jobs like GI intolerance. Therefore, the patients may avoid taking the medicines as required.
Ethical deductions
Using Glucophage for a long term or even taking higher doses has been related to vitamin B12 lack.
“ After seting for confounders, we found clinically of import and statistically important association of vitamin B12 lack with dose and continuance of Glucophage usage . ”
( hypertext transfer protocol: //www.natap.org/2006/HIV/102606_10.htm )
After a long period, malabsorption of vitamin B12 can be a important wellness hazard. This is because vitamin B12 is indispensable for the proper growing and map of every cells in the organic structure.
Furthermore, metformin consequences in a more serious side-effect ; lactic acidosis. It is a status in the organic structure where the blood pH falls making an acidic environment. Lactic acidosis can construct up bit by bit doing other symptoms and doing the patients experience really badly. So, patient have to take extra different medicines to handle this status. Although it is a rare juncture, it has been seen to be fatal 50 % of the clip.
Benefits
Using Glucophage is cheaper and more effectual compared to the new anti-diabetic drugs. As an ideal drug, it besides promotes weight loss and reduces cardiovascular hazard factors. As it does non do increased insulin secernment but merely increases insulin sensitiveness, Glucophage is non associated with hypoglycaemia. So, it is suited for both corpulent and non-obese patients unlike sulphonylurea which causes weight addition and hypoglycaemia. Furthermore, hazards of decease from all causes and hazard of bosom failure is lower in diabetes patient devouring metfromin unwritten therapy.
Hazards
Drugs can take to adverse side-effects excessively. in the instance utilizing Glucophage, some patients face allergic reaction with the drug. If deficient Glucophage is taken for proper blood sugar control, patients may confront high blood sugar degree with symptoms like confusion, dry oral cavity, and purging. There are side-effects, for case GI jobs like sickness and diarrhoea when its first prescribed. More serious side-effects are a bead in pulseand effort every bit good as febrility, grippe, chills together with organic structure achings. Besides, patients with bosom failure, kidney or liver disease should non take this drug in fright of lactic acidosis. When consumed with other certain other drugs contributes to side-effects excessively.
“ On the other manus medical specialties like beta-blockers, sulpha drugs, probenecid, tend to take down blood sugar degrees if they are used with Metformin. Medicines like morphia, Quinidex, Lasix and Lanoxin, tend to respond with Metformin. ”
Many people are able control the side-effects of Glucophage by either taking it with repasts every bit good as get downing with little doses and raising the doses easy whereas the remainder fail to make so. So, patients should besides inform their physicians if they are under other medicines at the same clip and merely devour Glucophage as advised.
Alternate solutions
Duodenal Switch Surgery
An option for type 2 diabetes is duodenal switch surgery particularly in owerweight patients. Type 2 diabetes is greatly related with fleshiness therefore, this surgery can be a good pick of intervention excessively. Combined moderate consumption limitations with significant Calorie malabsorption is the benefit of this surgery. It is carried out in two phases:
Phase 1: Restrictive phase
The tummy is modified, reshaping it into a long, narrow tubing. About 70 % of the tummy along the greater curvature is removed but the staying tummy is non affected in its map. Anyway, the sum a patient can devour is restricted. However, over clip, the tummy stretches leting patients to comsume about 60 % of what they did before the surgery. Unfortunately, this procedure is non reversible.
Phase 2: Malabsorptive phase
A drawn-out part of the little bowel is rerouted. Two separate tracts and one common tract is created. The digestive cringle, the shorter of the two tracts carries nutrient from tummy to big intestine whereas the bilio-pancreatic cringle, the much longer tract, conveyances bile from liver to the common way. The common way: a stretch of little bowel about 75-100 centimeter long, is where the contents of the digestive way mix with the gall from the bilio-pancreatic cringle before traveling into the big bowel. So, the little bowel is altered to diminish the sum of it can absorb.
Figure 2.0: The anatomy after duodenal switch surgery
( hypertext transfer protocol: //www.duodenalswitch.com/procedure/procedure.html )
The metabolic consequence from this surgery has been believed to be the ground for decreased demands of unwritten hypoglycaemic agents or even insulin.
“ Although this surgery is ab initio aimed as fleshiness treaments, the duodenal switch surgery process has seen the highest rate of type 2 diabetes remedy. Type 2 diabetics have had a 98 % “ remedy ” about instantly following surgery which is due to the metabolic consequence from the bowel switch. ”
( hypertext transfer protocol: //www.dsfacts.com/benefits-of-duodenal-switch.html )
An article: Duodenal Beltway: Remedy for Type 2 Diabetes? by Field Correspondent Nancy Wride on May 17, 2010 agrees with this surgery as a solution. However, it states that clinical tests are being done to happen the ground why it ends up taking type 2 diabetes symptoms.
Unfortunately, this surgery is merely a better pick for corpulent patients. Patients with normal Body Mass Index ( BMI ) are non suited to choose for this surgery as it causes weight loss so will be less effectual on them. But there is grounds to demo that this surgery can be effectual in patients who are somewhat corpulent or fleshy. As with any other surgeries, there are both short term every bit good as long term hazards to be considered and this surgery is dearly-won as it costs about $ 20,000 or more.
However, I feel duodenal switch surgery should merely be done when patients failed to react to anti-diabetic drugs or even with insulin. Not to be ignored healthy feeding and moderate exercising should be followed.
Lifestyle alterations
A patient can normally cut down the blood glucose degree by one of these alterations to his life style:
Eating a healthy balanced diet – Patients should eat a diet low in fat, Calories but high in fiber with plentifulness of fruits and veggies. They should restrict their glucose consumption. Meal plans should accommodate their day-to-day life style and wonts. Eating a well-balanced diet are of import.
2 ) Losing weight if you are fleshy – If a patient is corpulent or fleshy, losing weight can assist cut downing or commanding blood glucose degree. Keeping an ideal organic structure weight has other wellness benefits besides.
Making some physical activity on a regular basis – Patients are advised to make a lower limit of 30 proceedingss ‘ brisk walking at least five times a hebdomad because regular aerophilic exercising lowers blood sugar degree without medicine and helps fire extra Calories and fat so pull offing a patients weight. It alsodecreases insulin opposition even without weight loss.
No any individual life style alterations is proven to be clearly effectual when carried out entirely. Doctors will normally advice patients to use all these alterations to their lifestlye to acquire a better control over their blood sugar degree. Any other type of intervention is improbable to assist patients accomplish long term control over the blood glucose degree unless coupled with a healthy lifestlye. Both medicines and surgery mentioned earlier, have to be followed with a healthy life style practise to be trully helpful in avoiding the hazards of type 2 diabetes. Patients should avoid unhealthy practises like smoke and intoxicant ingestions excessively particularly when they are under medicines to avoid serious side effects.
Even though, complications of type 2 diabetes can non be avoided wholly from this method entirely, I would still state that this is the cheapest and safest method. Patients besides can forestall developing other wellness jobs by following a healthy life style.
Beginning rating
- The website hypertext transfer protocol: //www.diabetes.org/ or known as the American Diabetes Association is aimed to give information associating to diabetes. It is a really trustable beginning and in my sentiment the informations in this web site are factual as it has assorted current issues related to diabetes and the current issues are based from existent life state of affairss. Military officers in the direction squad have old ages of experience excessively. The informations based from this web site are relevant with many other beginnings besides. One of it is the WebMD:
( hypertext transfer protocol: //www.webmd.com/about-webmd-policies/default.htm? ss=ftr ) .
This web has a mixture of successful expertness in medical specialty, and wellness communicating.
2. The book “ Diabetes For Dummies ” provides good information about diabetes. The disease is good explained with the proper solutions besides harmonizing to the type of diabetes and the writer is qualified extremely. The facts in this book agree largely with other books excessively like the book “ Diabetes A practical usher to pull offing your wellness ” . For case, it tells clearly about type 2 diabetes and its solutions. Both these books were published non long ago ( 2004 ) and the informations can be relied on.
