1/26/2012

Diabetes Mellitus

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Diabetes Mellitus A disorder of carbohydrate metabolism resulting from insufficient production of insulin or reduced sensitivity of the body’s cells to insulin.





Etiology Cause & Origin of


Type 1 DM A condition in which the body is unable to produce insulin, a hormone that regulates blood sugar levels by facilitating the uptake of glucose into most cells in the body (mainly skeletal and adipoctyes). It is understood that this disorder is caused by the body’s beta cells of the islets of Langerhan’s in the pancreas to be destroyed, requiring the patient to inject insulin regularly, approximately three times a day. It is thought that genetics may have some role in the cause of this disorder considering that in runs in families. Another theory is that environmental factors, such as certain types of viral infections, lack of breast-feeding for at least three months, and the exposure to certain food additives such as nitrates and nitrosamines also contribute to the development of the disease.


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Type DM A condition caused by inadequate pancreatic insulin secretion and tissue resistance to insulin. Mainly this type of DM is associated with a genetic link. Yet several other factors can play a significant role in the development of Type DM such as high blood pressure, high triglyceride (fat) levels, having diabetes while pregnant or giving birth to a child weighing more than nine pounds, a high fat diet, increased or prolonged alcohol intake, a sedentary lifestyle, being obese or overweight, and more.


Epidemiology Incidence, distribution, and factors controlling presence


Diabetes Mellitus affects approximately 7.8 to more than 10 million individuals in the United States population. Type DM affects more people, about 0% of all 65,000 new reported cases each year, while Type 1 DM affects the other 10%. Although more than half of those with Type will eventually require insulin to control their blood sugar levels.


-Type 1 DM is usually recognized in childhood through puberty leading to its alternate name juvenile onset diabetes. It is more commonly found in people of non-Hispanic white, Northern European descent, followed by African Americans and Hispanic Americans and is relatively rare in those of Asian descent. It si also more slightly found in males than females.


-Type DM is usually recognized in adulthood and typically affects obese individuals. It may be controlled initially by weight loss, exercise, or medications. More than 85% of obese children will develop type DM. Certain racial groups such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans are at an increased risk of developing this type along with increasing age. Risk begins to rise significantly at about age 45, and rises considerably after 65. Also, this type affects more females than males.


Preventive efforts should be aimed at type DM


• Control weight to normal or near normal levels through eating a healthy low-fat, high fiber diet


• Regular exercise is crucial


• Keep alcohol consumption down


• Stop smoking


Facts


• About 15% of people with Type 1 DM will die before the age of 40 without prognosis.


• A person who is diagnosed with Type DM in their 40s can expect to take 5-10 years off their life expectancy.


Clinical Signs and Symptoms


Early signs and symptoms of both types include an increased urine volume, increased thirst, increased hunger, itching, extreme weight loss, and fatigue. These signs and symptoms typically occur because the body is trying to combat the increased blood sugar levels.


Excessive urination The body is essentially trying to flush the excess sugar out through urination which leads to dehydration because sugar carries large amounts of water out along with it.


Excessive thirst (polydipsia) The body is trying to counteract high sugar levels by sending a message to the brain and translates as thirst. The body encourages more water consumption to dilute the high blood sugar to normal levels. Also, as mentioned above, excessive urination leads to dehydration which leads to increased thirst.


Excessive eating (polyphagia) If the body is able, it will secrete more insulin in order to uptake the excess glucose into the cells. Increased insulin production translates as hunger in the brain. Despite increased caloric consumption, the person notices minimal weight gain and some experience weight loss since the body uses only a small portion of the food calories as fuel.


Fatigue The body is insufficient and unable to use the glucose for adequate fuel. The body switches over to metabolizing fat, also causing weight loss, as a fuel source which requires one to use up more energy (ATP). This in turn leaves the individual feeling fatigued all the time.


Poor wound healing High blood sugar levels prevent leukocytes from functioning normally and defending the body from invading particles and bugs. When these cells don’t function properly, wounds take much longer to heal and become infected more frequently. Certain infections such as frequent yeast infections, skin infections, and urinary tract infections may result from the suppressed immune system.


Altered mental status Decreased levels of consciousness, agitation, or confusion all can be signs of increased blood sugar levels.


Risks caused by DM Over a long period of time, this condition develops into hyperglycemia which can cause damage to retina of the eye, the kidneys, the nerves, and blood vessels.


• Elevated blood sugars lead to impairment of the body’s normal ability to fight infections


• Damage to the retina leads to blindness


• Damage to kidneys leads to kidney failure


• Damage to the nerves leads to foot wounds and ulcers


• Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach, chronic diarrhea, and an inability to control heart rate and blood pressure with posture changes


• Diabetes accelerates atherosclerosis, formation of fatty plaque inside artery walls which can lead to blockages which can lead to a heart attack or stroke.





Acute and Chronic Complications


-Type 1 DM Signs and symptoms are often dramatic and very acute, often associated with a childhood illness or injury. The extra stress can cause diabetic ketoacidosis (DKA), a potentially life-threatening condition in which the body loses most or all of its ability to use sugar for fuel. Thus, the byproducts, ketones, of using fat accumulates. High levels of ketones can increase the acidity of the blood and cause nausea and vomiting. Dehydration and often-serious disturbances in blood salt levels follow. DKA can lead to coma and death. Acetone is a volatile ketone in the body that accounts for the characteristic “fruity odor” of Diabetic individuals.


-Type DM Symptoms are often subtle and may be attributed to aging or obesity. A condition related to DKA, hyperglycemic, hyperosmolar, nonketotic syndrome (HHNS), can occur in these individuals. The life-threatening problem in this case is caused by severely elevated blood sugar levels and can also lead to coma and death.


Treatment/Management Protocols


Management of this disorder includes maintaining a healthy, well balanced and consistent (eating roughly the same amount of calories and eating at approximately the same time of day) diet high in fiber, low in saturated fat, and low in concentrated sweets. Regular exercise helps reduce complications such as heart disease, stroke, kidney failure, blindness, and leg ulcers. Any form of exercise is recommended and one can even gain effectiveness through just walking 0 minutes a day three times a week. Finally, it is crucial to monitor one’s blood glucose levels.


Treatment of DM is highly individualized, depending on the type one has, whether other medical problems exist, whether complications are present, and one’s age and general health at time. Education is essential in its treatment.


• Type1 DM Treatment almost always involves routine insulin injections, usually a combination of short-acting insulin such as regular or lispro insulin and long-acting insulin such as NPH, lente, oltralente. Usually injections are given - times per day around mealtimes. Keeping accurate records of blood sugar and insulin dosages and eating consistent healthy meals helps aid one’s treatment.


• Type DM Depending on how elevated one’s blood sugar and glycosylated hemoglobin are, treatment may simply consist of weight loss for -6 months and then one is rechecked. If they remain high one is placed on oral medication, usually sulfonylurea (Tolbutamide, Glipizide), which stimulates insulin release, blocking potassium channels on beta islets and depolarization opens calcium channels. One’s doctor may also use a combination of oral medications and insulin injections to control blood sugar levels.





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