Type two diabetes mellitus is a metabolic disorder that affects how the body metabolizes glucose resulting from carbohydrates digestion. The condition can affect people of all ages, gender, and ethnicity. In the recent past, demographic studies indicate a high prevalence of type two diabetes in adults and all genders. Teenagers are at risk as well, as findings show increased incidence rates among this cohort. Some of the common factors associated with the high prevalence of diabetes include but are not limited to a sedentary lifestyle, poor dietary habits, age, and heredity (Cleland, 2017, pp. 211). Therefore, this paper expounds more on type two diabetes, its causes, prevalence, risk factors and populations at risk, complications associated with this condition, and recommends reducing the high prevalence of the disorder.
Introduction to Type 2 Diabetes Mellitus
Diabetes mellitus is a non-communicable metabolic disorder that affects the metabolism of carbohydrates. After the digestion of carbohydrates, glucose is the end product, and its main role in the body is to provide energy. However, when someone has diabetes, the glucose is not taken into the cells, which gets converted into energy. Instead, it remains in the bloodstream and circulates throughout the body. There are different types of diabetes, and the most common are gestational diabetes, type 1 diabetes, and type 2 diabetes (Cleland, 2017, pp. 212). As the name suggests, gestational diabetes is a condition whereby pregnant women experience altered glucose metabolism. This type of diabetes is often diagnosed after the 28th week of pregnancy and is associated with hormonal imbalance, altering insulin production and sensitivity. Often, gestational diabetes resolves after delivery, but women with a history of gestational diabetes should be careful as they are at a high risk of acquiring type 2 diabetes.
On the other hand, type one diabetes is a condition of altered glucose metabolism due to insulin insufficiency. Insulin is a hormone that helps regulate blood glucose levels by allowing the cells to convert it into energy. Another hormone involved in blood glucose regulation is called glucagon, and it works the direct opposite of insulin. Glucagon is produced when the body’s glucose levels are low, thus allowing the body to convert stored glucose into energy. In type 1 diabetes, the beta cells of the pancreas do not secrete adequate insulin (Cleland, 2017, pp. 213). Insulin insufficiency is mainly due to autoimmune destruction of beta cells or genetic error, making the body have lesser beta cells.
In contrast, type 2 diabetes mellitus results from either insulin resistance or insulin insensitivity. In this case, one produces adequate insulin, unlike in type 1 diabetes, but this insulin is not useable in the body. Initially, this type of diabetes was most common among elderly people. However, studies show that the prevalence of type 2 diabetes among teenagers and rand young adults is high both in developed and less developed countries. According to Garg, 2018, pp. 59, 79% of people with diabetes in the world have type 2 diabetes, while only 21% represent the population with other types of diabetes. Single and multiple risk factors have significantly contributed to type 2 diabetes mellitus.
Causes and Risk Factors for Type 2 Diabetes Mellitus
Type 2 diabetes is a result of insulin resistance or insulin insensitivity. The body makes adequate insulin, but the cells cannot utilize it. When the blood glucose levels are high, the brain signals the pancreas to start producing insulin. However, when the body cells cannot use this insulin to regulate blood sugar levels, the pancreas produces more and more insulin while blood sugars remain high (Garg, 2018, pp. 58). When blood sugars remain uncontrolled for a long time, they damage the vital organs such as the kidneys and eyes, and cell receptors, thus aggravating the issue of insulin insensitivity.
Weight and Type 2 Diabetes
One of the main risk factors for type 2 diabetes mellitus is overweight and obesity. The body mass index (BMI) measure categorizes an individual’s weight status. The BMI measures body fat derived by dividing a person’s weight by height and comparing the values to a healthy general population. According to Garg (2018, pp. 68), BMI is not an accurate indicator of the nutritional status of older adults and bodybuilders. Older adults often suffer a condition called sarcopenia, characterized by losing lean body tissues. Additionally, the curving of the spine causes them to look short in stature, thus making BMI measurement inaccurate. On the other hand, bodybuilders accumulate weight due to increased muscle mass, making them appear overweight or even obese when they are healthy.
Obesity and overweight causes fat accumulation in the cells, i.e., the fat cells. Also, excess fat is deposited beneath the skin and around vital organs, such as the heart, lungs, kidneys, and liver. According to Kuball and American Diabetes Association (2018, pp. 119), excessive fat accumulation causes inflammation in the cells and insulin insensitivity. Additionally, insulin is not accessible to the cells where it is mainly needed to convert glucose into a usable form of energy. Mckittrick and Anderson (2017, pp.8) state overweight and obesity are the leading causes of type 2 diabetes. It is a concerning issue among people of all ages.
Another risk factor for type 2 diabetes mellitus is age. As mentioned earlier, aging causes physiological changes in the body, such as weight gain. People above 45 years have a higher risk of developing type 2 diabetes than those younger than 45 years. Although age alone cannot cause type 2 diabetes, coupled with other factors such as having a history of gestational diabetes, metabolic syndrome, and a sedentary lifestyle, it can lead to this disease. Additionally, aging causes the metabolic rate to slow down, affecting how major nutrients are digested, absorbed, and metabolized (Kuball and American Diabetes Association, 2018, pp. 115). Lastly, with aging, the body’s capacity to produce adequate insulin is compromised, putting older adults at a higher risk of developing type 2 diabetes.
Commonly, type 2 diabetes is referred to as a lifestyle disorder. According to Verma, 2018, pp. 1042, lifestyle is the general overview of how people carry out their daily activities. This includes but is not limited to dietary choices, physical activity, and work. A sedentary lifestyle has been shown to increase the risk of developing type 2 diabetes (Lee, 2017, pp.43). In a study carried out among 173 adults living with diabetes, 90% of the respondents reported having a sedentary lifestyle and rarely participating in any form of physical exercise.
According to the current advances in technology and hard economic times, people, especially the working class, spend most of their time seated while working. On the other hand, technology has made working easier and more comfortable, and people expend very little energy while working (Cleland, 2017, pp. 212). Regardless, the amount of energy expended daily does not match the daily intake, which causes a rise in the cases of obesity.
Similarly, consumption of highly processed foods has also greatly contributed to the rise in type 2 diabetes cases among the general population. Refined sugars, polished grains, processed meat, and foods with added sugars are dense in calories and promote weight gain. Additionally, refined sugars and other processed carbohydrates are digested faster and easily absorbed into the circulatory system, causing spikes in blood glucose levels (Mckittrick and Anderson, 2017, pp.11). When the body’s regulatory system is already compromised, it becomes difficult to lower the higher glucose levels in the blood. According to Verma (2018, pp. 1041), people who often consume unprocessed foods, limit alcohol intake, and regularly engage in physical exercise are at a reduced risk of developing type 2 diabetes.
Heredity and Other Metabolic Disorders
As mentioned earlier, 90% of type 2 diabetes cases are associated with lifestyle, overweight, obesity, and poor lifestyle. Studies have shown an association between metabolic disorders such as hyperthyroidism and the risk of developing type 2 diabetes. There is a significant risk of any slight alteration to the endocrine hormones, whereby insulin production is affected. However, this only accounts for about 5% of all type 2 diabetes cases. According to Mckittrick and Anderson, 2017, pp.8, mutations in certain genes can also increase a person’s risk of developing type 2 diabetes. These mutations or incomplete gene expression occur during the formation of the fetus. According to Stingl, 2018, pp. 5, only 3% of type diabetes cases result from heredity. Finally, pregnant women with uncontrolled diabetes are at a higher risk of delivering macrosomic babies. Macrosomia can lead to type 2 diabetes, especially in cases involving early childhood and teenagers.
Prevalence of Type 2 Diabetes
According to the center for disease control (CDC), more than 37 million of the American population have diabetes in which approximately 95% of the population have type 2 diabetes. Stingl (2018, pp. 9) argues that 68% of the people with type 2 diabetes are adults while 38% are teenagers and children below ten years. These figures are consistently rising, and the rates of type 2 diabetes among the American population are expected to double by 2030. The main reasons for the high prevalence of type 2 diabetes in western countries are high consumption of processed foods and a sedentary lifestyle (Akram Zaidan, 2020, pp.14). The high rates of type2 diabetes have been recorded in the less developed countries such as African countries.
According to Verma, 2018, pp. 1042, 49% of the population has type 2 diabetes in east Africa. Although these countries are less developed economically, the people have limited dietary choices and often consume staple foods, predominantly carbohydrates. The high cost of living has seen most African residents opt for cheaper foods, mainly carbohydrates. This also explains why the prevalence of obesity and overweight is high in these countries. For instance, people from less developed countries work extra hours, leaving little or no time for exercise. Additionally, they often get little or no rest, worsening the condition.
Complications Associated With Type 2 Diabetes
One of the complications associated with type 2 diabetes is neuropathy. Neuropathy is nerve damage, which happens when the blood glucose levels remain too high in the blood and injure the capillary walls. The capillaries are the smallest blood vessels that deliver nutrients and oxygen to the nerves. When capillaries are damaged, the nerves lack nourishment and thus get damaged (Stingl, 2018, pp. 5). The feel is affected once the nerves get damaged, especially on the lower and upper extremities. If neuropathy is left untreated, the damage can progress even to the muscles around the gastrointestinal tract and causes erectile dysfunctions in men.
Another complication of diabetes is kidney damage, also known as nephropathy. Anatomically, kidneys have millions of small blood vessel clusters, referred to as glomeruli. The main function of glomeruli is to carry out ultrafiltration of the blood to reabsorb nutrients and excrete waste products and toxins (Kumar, 2020, pp.21). Uncontrolled blood sugars damage these blood vessel clusters by shifting the osmolarity of the blood and consequently changing the pressure. When these blood vessels get damaged, the kidneys can no longer execute their role of ultrafiltration and excretion (C.V, 2020, pp.39). Depending on the degree of kidney damage, it can be reversed by controlling the blood sugar levels. However, in the case of kidney failure and end-stage renal disease, the only solution to the problem is a kidney transplant or dialysis.
Type 2 diabetes can also damage the eyes, a condition known as retinopathy. Diabetic retinopathy occurs when the blood capillaries supplying blood to the retina are damaged due to high blood sugars, leading to potential blindness. Other eye complications associated with type 2 diabetes include a high risk of developing cataracts and glaucoma. On the other hand, diabetes also causes foot damage (A. Schwartz, 2018, pp2). As mentioned earlier, nerve damage on the lower extremities causes numbness, which is risky as one may get wounds and cuts without noticing. In case of an infection, the wound worsens and does not heal easily. According to Verma, 2018, pp. 1043, the main reason why many people with diabetes do not easily heal their wounds is due to altered immunity.
Finally, type 2 diabetes also causes skin conditions such as fungal and bacterial infections. Too high blood sugars damage the skin barrier and weaken immunity, leaving the body with no defense against these diseases (Elhadd et al., 2017, pp.22). In women, vaginal thrush and vaginal dryness are very common when one has uncontrolled type 2 diabetes.
Treatment Options for Type 2 Diabetes
Treatment options for type 2 diabetes are not very different from other types of diabetes. Medication and insulin therapy have been proven to be the most effective diabetes treatment. In most cases, doctors hesitate to use insulin therapy on patients with type 2 diabetes. The first treatment option is medications (Cleland, 2017, pp. 212). However, doctors recommend using both insulin and drugs when the blood sugars are too high, and the drugs prove ineffective.
Nutrition also plays a vital role in managing diabetes, whether type 1, 2, or gestational. The main goal of nutrition intervention is to balance the amount of energy consumed and energy expended. Additionally, nutritionists ensure that patients consume adequate calories by distributing the energy into different food groups and avoiding overconsumption of carbohydrates (Stingl, 2018, pp. 7). Tools such as meal plans play a big role in ensuring that people living with diabetes consume adequate calories from appropriate sources.
Recommendations for Reducing the High Prevalence of Type 2 Diabetes
From the discussion above, it is clear that lifestyle is the main risk factor for developing type 2 diabetes. Therefore, recommendations for reducing the high prevalence of type 2 diabetes focus on lifestyle adjustments. According to Verma, 2018, pp. 1045, adopting a healthy lifestyle, reducing inactivity, and adhering to medications helped put diabetes in remission among patients living with type 2 diabetes.
First, maintaining a healthy weight is a key factor in preventing and managing type 2 diabetes. Overweight and obesity are the leading causes of insulin resistance. Patients on drugs and insulin therapy should ensure that their BMI lies between the normal ranges of 18.5 to 24.9 kg/m2. Additionally, all people should target this BMI range as it will avoid the risk of type 2 diabetes and cardiovascular diseases, and certain types of cancer (The Lancet Diabetes & Endocrinology, 2019, pp.413). A healthy weight can be achieved by exercising and cutting down on alcohol and refined foods.
Second, people living with diabetes should strictly adhere to their medications as directed by the physician. Also, going for reviews from time to time helps assess the risk of complications, thus increasing the chances of optimum blood sugar control. Finally, following a healthy dietary pattern is paramount in preventing and managing type 2 diabetes. Refined sugar, foods with added sugar, processed carbohydrates, and meats are risk factors. These foods are calorie-dense and quickly elevate blood glucose (Greener, 2018, pp.102). Instead of choosing these foods, a diet that comprises more fruits, vegetables, and whole grains significantly reduces the risk of type 2 diabetes. Finally, people living with diabetes should adhere to all nutrition and dietary recommendations such as meal portioning, meal timing and carbohydrate counting. These guidelines help them to control the amount of carbohydrates ingested, and consequently controlling blood sugar levels.
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