Diabetes mellitus is chronic condition that occurs when either the beta cells of the pancrease are unable to secrete insulin, or they secrete insufficient insulin or when the target cells become resistant to insulin resulting to elevated blood glucose levels. Generally there are two types of diabetes mellitus. Type I diabetes, also known as insulin-dependent diabetes mellitus (IDDM) occurs when the pancreas is unable to produce sufficient insulin. On the other hand Type II diabetes, also known as non–insulin-dependent diabetes mellitus (NIDDM) occurs when the target cells become resistant to insulin so that insulin has no effect on the cells. In both cases there is a disorder in the metabolism of carbohydrates, fats and protein. As a result of the low utilization of glucose by cells there is an elevated blood glucose level. Secondly, the utilization of glucose by the cells also decreases while the utilization of fats and protein increases[ CITATION HKr08 \l 2057 ].
2.0 Regulation of Blood Glucose Levels
Blood glucose level is regulated by two hormones secreted by the pancreas, namely insulin and glucagon. These two hormones regulate glucose metabolism hence glucose level in the opposite direction. Insulin is secreted by the beta cells of the pancreas in response to high blood glucose levels. Insulin acts on various cells, including muscle, red blood cells, and fat cells causing these cells to absorb glucose from the blood. This results in lowering of the high blood glucose levels into the normal range. On the other hand, Glucagon is secreted by the alpha cells of the pancreatic islets in response to low blood glucose levels. Glucagon acts on many cells but most specifically the liver stimulating the liver to release stored glucose into the blood and thus increasing the blood glucose level. In addition, glucagon stimulates the liver to synthesis glucose from other building blocks obtained from other nutrients in the body such as protein. Through this hormonal system the level of glucose in the blood is maintained within a range of 70-110 mg/dl of blood[ CITATION LAK03 \l 2057 ].
3.0 Diabetes type 2
In Diabetes type 2 the liver, muscle and adipose cells fail to respond to insulin therefore the levels of glucose in the blood remains constantly high because the cells are not able to absorb glucose from the blood. The cells are said to be resistance to insulin probably due to a defect in the insulin receptors on the cells. Increased blood glucose levels triggers secretion of more insulin but this does not lower the blood glucose levels as expected. Diabetes type 2 is associated with obesity and overweight. As fats levels in the body interfere with the body’s ability to utilize insulin. It may also occur in thin people at advanced age due to failure in the cellular glucose metabolism[ CITATION LAK03 \l 2057 ].
4.0 Cortisol and its effect
Cortisol is a hormone that is secreted by the adrenal glands in response to stress. It enhances proper glucose metabolism among other functions. With regard to glucose metabolism cortisol increases the blood sugar level by a process called gluconeogenesis which involves the production of glucose from non-carbohydrate molecules such as proteins, glycerol and lactate. Stress in could therefore complicate diabetes because it results in release of cortisol which in turn increases the blood sugar level in person with a dysfunctional glucose regulation mechanism[ CITATION HKr08 \l 2057 ].
5.0 Management of Diabetes Type 2
Unlike type 1 Diabetes type 2 Diabetes is not managed by insulin injection because the cells do not respond to diabetes. The management of the condition is mainly by strategies that lower the blood sugar levels. Dietary management of diabetes is the most important strategy for type 2 and mainly involves doing away with sugary foods and especially those with refined sugar that enters the blood directly without going through much metabolism. People living with diabetes are therefore advised to take well balanced diet that is low in simple sugars and fat (especially cholesterol). Exercise and weight reduction help in controlling the blood sugar by increasing sensitivity of cells to insulin. Stress management is also helpful in preventing over secretion of cortisol which aggravates diabetes[ CITATION Ari10 \l 2057 ].
Finally the doctor may recommend drugs for the management of diabetes. Sulfunylureas such as chlopropamide, tolbutamide, glipizide, gyburide and glimepiride lower blood sugar by increasing insulin output. Biguanide such as glucophage (metformin) treat type 2 diabetes by decreasing glucose production by the liver. Thiazolidinediones such as rosiglitazone and pioglitazone increase sensitivity of cells to insulin. Precose is another drug used and it works by decreasing the absorption of carbohydrates from the intestines to the blood circulation[ CITATION Rucnd \l 2057 ].
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