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Diabetes occurs when the body is unable to produce insulin (type 1 diabetes) or is unable to use the insulin that is released (type 2 diabetes); in all cases, the result is compromised glucose transport and hyperglycemia. Type 1 diabetes is characterized by a genetic proclivity expressed in one of the human leukocyte antigens. The immune system targets and kills the beta cells in the pancreas that contain insulin in this form (beta-cell deficiency causing total insulin deficiency). Research proposes that the hereditary predisposition, combined with an unknown element, initiates a progressing autoimmune process that methodically terminates beta-cells located in the pancreas, in this manner meddling with the body’s capacity to produce insulin (Vojdani, 2014). Subsequently, is it labeled as an autoimmune disease. The blood contains anti-islet or anti insulin cell antibodies which lead to lymphocytic penetration and decimation of the pancreas islets. The destruction of the pancreas islets can take time; however, the disease’ onset is fast and may happen over a couple days to weeks. There might be other immune system conditions related to type 1 diabetes such as hypothyroidism and vitiligo. Type 2 diabetes involves either an imperviousness to the action of insulin originating from an abatement in the quantity of receptor sites in the peripheral tissues (peripheral insulin resistance), or a deformity in the pancreas’ insulin release sites. Peripheral insulin resistance implies that despite the fact that blood levels of insulin are high, hypoglycaemia is lacking or there is low blood sugar. Obesity is the primary cause of insulin resistance (Budd & Peterson, 2015). In both types, the outcome is impedance with glucose transport over cell membranes in adipose tissue and peripheral muscle prompting flawed oxidation and energy generation. Protein, carbohydrate, and fat metabolism becomes debilitated, as well as glycogen storage in the liver and muscle and triglycerides fatty acid storage in adipose tissue. Also, transport of amino acid cells gets interrupted. Uncontrolled glycogenolytic and gluconeogenic processes within the liver lead to glucose overproduction. When blood glucose levels increase, renal tubules are unable to reabsorb the glucose; this leads to production of osmotic diuresis and glucosuria, and the loss of electrolytes and water through the urine. Hyperglycemia additionally harms myelin nerve covers, prompting to neuropathy. Glycosylation in the blood vessels causes microangiopathy and capillary membranes to thicken. Atherosclerotic procedures are quickened, and vessel flexibility decreases.
Prevention of type 1 diabetes is impossible; however, type 2 diabetes is preventable. Where one has a family history of the disease or if one is overweight the risk of diabetes is high, and prevention is necessary. The first preventive measure is weight loss, which improves health and reduces the risk of developing diabetes. Obesity makes a person more likely to have diabetes as opposed to an individual a with a healthy weight (Budd & Peterson, 2015). Regular physical activity helps prevent diabetes by using excess sugar in the blood. The muscles use sugar from the blood to replace the sugar used during exercise, and this helps in lowering blood sugar levels and increase insulin sensitivity. Physical activity also contributes to maintaining weight loss, psychological well-being and improve body composition. Healthy balanced diet minimizes the risk of developing diabetes. Balanced diets should contain vegetables and healthy natural fats such as olive oil, dairy fat, avocado and oily fish. Foods that do not cause the body to produce a lot of insulin are essential, such as the reduced intake of carbohydrate will help reduce the risk of diabetes since carbohydrates demand a lot of insulin. Avoiding food that is processed and sugary is important in preventing diabetes. Foods high in fiber improve blood sugar control and thus, reduce the risk of diabetes. Whole grains also help in maintaining blood sugar levels. Smokers should quit smoking, and this is because smoking increases insulin resistance and accumulation of fat in the abdomen. These patient-centered approaches are preferred to medication which is often not adhered to by the patient (Clark, 2004).
Family history is among the factors that signal the higher risk of type 1 diabetes. If a sibling or parent has type 1 diabetes, the risk of developing diabetes is high. Exposure to viral illnesses increases the risk of type 1 diabetes. Other factors include diets such as deficiency of vitamin D, early exposure to cereals, and geographical location, where some countries have higher rates of diabetes. Risk factors for type 2 diabetes such as obesity, where fat tissues cause cell resistance to insulin. Lack of exercising also increases the risk of diabetes, through physical activity one can control their weight, use up excess glucose in the blood and make cells more sensitive to insulin. The risk also increases with age; the older one gets, the higher the risk. There is, however, a dramatic increase of type 2 diabetes among adolescent and children. If a woman developed gestational diabetes during pregnancy, then she can, later on, develop type 2 diabetes. A woman who also gives birth to an overweight child is also at risk of type 2 diabetes. People from different races have different risks; Hispanics, African Americans, Native Americans and Asian Americans have a higher risk of diabetes. High blood pressure, family history, and abnormal cholesterol levels increase the risk of type 2 diabetes.
Insulin injections, use of insulin pumps, carbohydrate counting, and blood sugar checks are the primary treatments for type 1 diabetes. Insulin injections are essential for survival of people with type 1 diabetes. The pancreas transplant is another option for people with type 1. A successful operation stops the need for insulin therapy. However, the process of transplant is risky and the lifetime use of immune-suppressing drugs have severe side effects of organ injury, cancer and increased risk of infection. The high risk associated with transplants make them available for patients whose diabetes control is not possible. Treatment of type 2 diabetes includes monitoring of blood sugar. This check is done several times a day to ensure blood sugar level is within accepted range. Blood sugar levels change in response to different foods, stress, physical activity, illness and medications; and can at times be unpredictable therefore one needs to learn how the sugar levels change. Type 2 diabetes patients also need insulin. The insulin is injected to lower blood sugar levels and cannot be taken orally because enzymes in the stomach will interfere with insulin’s action. The insulin pump is an alternative to insulin injection. The insulin pump is a small device worn on the body, programmed to dispense insulin to the blood through a tube connected from the insulin pump to the abdomen. The insulin pump can be set to dispense more or less insulin depending on activity level, meals, and blood sugar. Prescription of oral or injected medications aid in treatment. Some medications inhibit production of glucose; thus less insulin is required to transport sugar. Others increase the production of insulin in the pancreas and others prevent the breakdown of carbohydrates or make the cells more sensitive to insulin.
Diabetes is a difficult disease, with millions of people diagnosed yearly and many more others not knowing they have the disease. Diabetes occurs when the blood sugar levels are high due to the production of little or no production of insulin, or the body does not respond to insulin. Type 1 diabetes is caused by genetic and environmental factors while the leading causes of type 2 are obesity, lack of physical activity, and environment and genetic factors. People living with diabetes manage the disease by staying healthy. Exercising, checking weight and eating healthy helps control diabetes. Monitoring blood glucose levels and taking prescribed medication is also necessary for the treatment of diabetes.

References
Budd, G. M., & Peterson, J. (2015). The Obesity Epidemic, Part 2: Nursing Assessment and Intervention. American Journal of Nursing, 38-46.
Clark, M. (2004). Adherence to treatment in Patients with Type 2 Diabetes. Journal of Diabetes nursing, 389-390.
Vojdani, A. (2014). A Potential Link between Environmental Triggers and Autoimmunity. Journal of Autoimmune Diseases, 1-18.

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