Hello everyone and welcome to this week's blog post which is about diabetes, a serious condition which is estimated to affect over 4 million people in the UK. In this article, I will explain what diabetes is and how it causes health problems in sufferers, before moving on to explore its symptoms, treatment options and a potential cure.
Diabetes is a very serious, lifelong condition where the glucose concentration in a person is too high. The two main types of diabetes are type 1 and type 2 diabetes. Type 1 diabetes, which typically onsets in children and teenagers, is where your own immune system mistakenly attacks the Islets of Langerhan cells in the pancreas, destroying them and preventing the body being supplied with the hormone insulin. Normally, T-lymphocyte cells which attack your own body cells are destroyed in the thymus gland when they mature, however, in people who suffer from type 1 diabetes, the lymphocytes escape destruction. This means that they accidentally recognise the insulin-producing cells in the pancreas as non-self and destroy them, preventing the body from producing insulin.
Meanwhile, in type 2 diabetes, either the amount of insulin produced is reduced or the body cells stop reacting to insulin as they normally would. The causes of this are not yet fully understood, however, it is likely that multiple factors could be responsible such as obesity and a lack of regular exercise. In addition, new research suggests that type 2 diabetes may also be an autoimmune disease, meaning genetic factors could also be at play. This is because the immune system can attack insulin receptors on body cells and destroy them, thus preventing them from getting stimulated by insulin.
The hormone insulin is essential in maintaining blood glucose concentration. Insulin and another hormone called glucagon work together to ensure that the blood glucose concentration is correct at all times, helping provide sufficient energy to respiring cells and preventing damage to other tissues in the body (such as nerves). They are both released as part of a negative feedback loop.
When blood glucose concentration is too high, such as after a meal, insulin is released into the bloodstream by the beta cells in the Islets of Langerhans in the pancreas. The hormone then attaches to receptors on target organs, such as the liver, and respiring cells. These cells are stimulated to take up glucose, reducing its concentration in the blood. Meanwhile, the liver also absorbs glucose and changes it into the storage molecule glycogen.
In contrast, when blood glucose concentration falls below a certain level, the hormone glucagon is secreted by alpha cells in the Islets of Langerhans. This hormone has the opposite effect, stimulating the liver to convert glucagon into glucose and release it into the bloodstream.
Obviously, this negative feedback loop doesn't happen in people with diabetes. As such, the blood glucose concentration of people who suffer from diabetes remains high even hours after eating, resulting in potentially life-threatening problems.
According to the NHS, symptoms of diabetes include feeling very thirsty, lethargy, blurred vision, weight loss, fruity breath and having glucose in urine. Diabetes can also lead to more serious health problems, depending on the type of diabetes you have.
People suffering from type 1 diabetes are likely to suffer from episodes of both hypoglycaemia and hyperglycemia. These are both very serious events, which have the potential to be life-threatening due to the speed at which they come about. Hypoglycaemia, which often occurs if meals are delayed or too much insulin is taken, is when your blood glucose concentration drops dangerously low and causes increases sweating, blurred vision and potentially causes the sufferer to fall unconscious. To treat it, you need to eat or drink something sugary or inject glucagon in an emergency.
Conversely, hyperglycemia occurs when blood glucose levels are too high, usually because enough insulin hasn't been taken. This must be treated as soon as possible as very high blood glucose concentrations can lead to diabetic ketoacidosis, where respiring body cells begin to breakdown fat (as they can't access glucose). This is incredibly dangerous as it leads to a build-up of acidic ketones, which need hospital treatment to prevent damage to your body.
Sufferers of type 2 diabetes have a greater risk of getting numerous diseases such as heart disease, stroke, kidney problems. Additionally, diabetes can also damage the feet, as increased blood glucose concentration can damage nerves of the foot and reduce sensation. Furthermore, diabetes also decreases blood flow to the feet, increasing the risk of foot ulcers and cramps. Sufferers of diabetes must regularly monitor their feet and ensure problems are dealt with quickly, otherwise they may get infected and need amputation.
The treatment of diabetes depends on the type of diabetes you have. Sufferers of type 1 diabetes must inject insulin to reduce blood glucose concentrations after meals, as well as make lifestyle changes and track the quantities of carbohydrates they consume. Meanwhile, sufferers of type 2 diabetes are encouraged to lose weight, change their diets and lead a more active lifestyle. In addition, type 2 diabetes can also be treated with a range of medication, including insulin and medication which works to reduce blood glucose concentration, either by increasing the bodies sensitivity to insulin or increasing glucose excretion.
Currently, there is no cure for diabetes, however, the disease can go into remission, which means the sufferer is able to maintain normal blood glucose levels without the use of medication. Remission of type 2 diabetes is very achievable by losing weight, through changing diet or doing regular exercise. Indeed a study by the University of Cambridge found that 30% of those who achieved a 10% loss in weight were able to get remission of diabetes for at least 5 years. Extreme weight loss, through restricting daily calory intake to 700 calories for eight weeks was also effective, leading to remission in 50% of people diagnosed with diabetes for a significant period of time and remission in 90% of those who were recently diagnosed.
An experimental procedure is being trialled to cure type 1 diabetes, where islet cells are harvested from multiple donors and transplanted into the pancreas of the recipient. According to diabetes.co.uk, this is much less risky than transplanting the whole pancreas as if the transplant is rejected, only the islet cells are destroyed, not the whole pancreas (which is needed for other body functions).
Trials are also currently underway using stem cells to potentially cure type 1 diabetes. By using progenitor cells, which are similar to stem cells as they can differentiate to form numerous types of somatic cells, scientists hope to be able to grow insulin-producing cells which have your own body's antigens, meaning that immuno-suppressant drugs don't have to be taken to prevent the immune system from attacking and destroying the transplanted cells.
In conclusion, while we are still far away from having a medical cure for type 1 diabetes, islet cell transplantation could prove to be an effective treatment option in the future. While islet cell transplantation has many risks, including the risk of rejection and risks of surgery, it prevents the patient from suffering major hypoglycemia. In addition, patients are also able to get back to a normal lifestyle, only needing to take small doses of insulin to maintain the health of the transplanted tissue. With more research and the use of stem cells, it is possible that the cost of islet cell transplantation could reduce enough to be an economical treatment option. Nevertheless, in my opinion, the treatment is currently too experimental and expensive to be offered as a mainstream treatment option on the NHS.
Sources:
Comments