Top-Rated Free Essay

Diabetes

Topics: Insulin, Diabetes mellitus, Diabetes / Pages: 22 (5467 words) / Published: Jan 6th, 2013
INTRODUCTION
Diabetes is not a single disease with a single cause. It is one of the chronic diseases that cannot be cured but can be controlled. It is happen due to a defect in the body’s ability to convert glucose to energy.
When food is consumed, it is digested and converted into fats, protein or carbohydrates. Foods that affect blood sugars are called carbohydrates. When carbohydrates are digested they are converted into glucose. Individuals with diabetes should eat carbohydrates but must do so in moderation. Glucose is then transferred to the blood and is used by the cells for energy. A hormone (body regulator) called insulin which is produced by the beta cells of the pancreas is needed to lower blood sugar by transferring of glucose from the blood into the cells. Another function of insulin is to convert excess glucose into glucagon, which is stored in the liver and muscles as the energy reserve. Alpha cells in the pancreas produce glucagon hormone to stimulate the conversion of stored glycogen back to glucose.
In individuals with diabetes, this process is impaired. Diabetes develops when the pancreas fails to produce sufficient quantities of insulin. When insulin is lacking or cannot be used properly, the body loses its ability to process glucose. As a result, glucose accumulates in the blood. This condition is called as hyperglycemia (high blood sugar). Some of the excess sugar is excreted through kidney into the urine, thus the presence of sugar in the urine will be a sign of high blood sugar. One of the symptoms of diabetes is frequent urination. When diabetes is untreated, as the blood sugar increases and more glucose is lost in urine, other symptoms such as extreme thirst, blurred vision, weakness and weight loss will occur.
Somewhere in the world every 10 seconds two people develop diabetes, every 10 seconds one person dies of diabetes and every 30 seconds a limb is lost to diabetes. According to The Star article that published on January 11, 2010, the number of diabetics in Malaysia has increased by almost 80 percent in the last 10 years from 1996 to 2006 to 1.4 million adults above the age of 30. In 5 years later, 2011, the number has doubled to over 3 million Malaysians were diabetic. According to the Second National Health and Morbidity survey it is estimated that 3.4 million Malaysians are diabetes sufferers in 2010.
Diabetes is the chronic disease that may cause other chronic disease such as heart disease and kidney failure. From my article reading, 4 out of 5 people with diabetes will die of heart disease which is diabetes is the number one killer disease in Malaysia. Besides that, six new cases of stroke occur every hour in Malaysia. These clearly show that this complication is very frequently happening on diabetic’s patient in Malaysia.
These statistics show that diabetic in Malaysia become the serious problem as it increases from one year to another year and it is expected that the statistics will continue to increase if Malaysian do not take the responsibility to take care of themselves and their health.

HISTORY OF DIABETES
Diabetes is not the new diseases. The earliest record of diabetes was mentioned on third Dynasty Egyptian papyrus by physician Hesy-Ra. He mentioned polyuria which is the frequent urination as the symptom of diabetes. In 1500 B.C. Aretaeus was the first physician who was identified diabetes and gave it is name. In the second century A.D. he described diabetes as “a wonderful affliction not very frequent among men, being a melting down of the flesh and limbs into urine.” The full name, diabetes mellitus was given to the disease later. It comes from the Greek and Latin words meaning “to pass through” and “honey,” describing the major symptom, sugar in the urine.
In medieval Persia, Avicenna provided a detailed account on diabetes mellitus in his book, ''The Canon of Medicine'' in 980 to 1037. He described the abnormal appetite and the collapse of sexual functions and he documented the sweet taste of diabetic urine." Like Aretaeus, Avicenna recognized primary and secondary diabetes. He also described diabetic gangrene, and treated diabetes using a mixture of lupine, trigonella and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times. He also described diabetes insipidus very precisely for the first time, though it was later Johann Peter Frank who first differentiated between diabetes mellitus and diabetes insipidus in 1745 to 1821.
During a twelfth-century, Maimonides who was the physician thought that diabetes was a disease of hot climates because he saw it frequently in Egypt but never in Spain. Paracelsus was the most famous physician of the fifteenth century thought that salt was the culprit and he also identifies diabetes as a serious disorder on sixteenth-century.
In 1700 Matthew Dobson demonstrated that the urine of a diabetic actually contained sugar, that the true nature of the disease was known. He proved this by tasting the urine.
In the early 1800s Rollo, Naunyn and Cantani were all advocates of a severely restricted carbohydrate diet, high in fat and protein. Their methods of getting patients to follow the diet ranged from one or more days of forced fasting per week for those who did not comply. So the patient preferred distasteful for the disease treatment.
It had been quite a long time been suspected that there was a connection between diabetes and the pancreas. In 1869 the body’s insulin source, tiny clumps of insulin-producing cells in the pancreas was identified by Langerhans and thus these cells were name as islet of Langerhans. The relationship between pancreas and diabetes was proved in1889 when the scientists von Mering and Minskowski produced diabetes in dogs by removing their pancreas.
In the early 1900s Dr. Frederick M. Allen noticed in his experiments that when a part of pancreas was removed, the remaining islet cells would be degenerated and diabetes would be developed. He believed that the cells were being overworked and he concluded that by resting the cells periodically they would rejuvenate themselves. To accomplish this, he introduced a diet that alternated days of very meagre nourishment with days of total fasting. This treatment would keep patient alive but it do not provide that patient with much energy.
In 1921, Drs. Banting and Best were discovered of insulin that extract from cattle foetal pancreas. In 1921 also the first dose of insulin was given to a young man with diabetes and his condition improved dramatically. Then, in 1923 the commercial production of insulin was begun in the United States and Canada. Indirectly, insulin became available for all persons with diabetes.
In 1935 Roger Hinsworth discovered there were two types of diabetes: "insulin sensitive" (type I) and "insulin insensitive" (type II).
Starting in the late 1930s, new types of pork and beef insulin were created to better manage diabetes. PZI, a longer acting insulin, was created in 1936. In 1938 NPH insulin was marketed.
A group of physicians concerned with the increasing incidence of diabetes in United States formed a society on 1940 which was known as the American Diabetes Association. Their purpose was to create better understanding of diabetes among patients, to promote the free exchange knowledge and standard treatment among physicians, to disseminate accurate information on the early recognition and need for medical supervision to the general public and to promote research into the causes and the possible cure for diabetes. Besides that, in 1940 also the link is made between diabetes and long term complications such as kidney and eye disease.
The standard insulin syringe was developed in 1944 to make diabetes management more uniform.
In 1950 the concept of diabetes was brought by a research of Drs. Berson and Yalow, who developed a radioimmunoassay test.
In 1952 Lente, containing high levels of zinc which promotes a longer duration of action was invented. Oral medications-sulfonylurea was developed in 1955, for people with type II diabetes to help lower blood glucose levels.
In 1959, two major types of diabetes are recognized: Type I diabetes (insulin-dependent) and Type II diabetes (non-insulin dependent).
By the mid 1960, diabetes had become a major health problem. So, the purity of insulin was improved and home testing sugar levels in urine also being invented in 1960s. The single use syringe was introduced by Becton-Dickinson in 1961. The first pancreas transplant was performed in 1966 to treat diabetes.
In 1969 the first portable glucose meter, Eyetone meter was created by Ames Diagnostics. Later in the late 1970s the insulin pump was designed to mimic the body's normal release of insulin. Laser therapy for retinopathy was also developed in 1970 to help slow or prevent blindness in some people with diabetes.
In 1974, Maturity Onset Diabetes of the Young (MODY) was described by Tattersall and Fajan. MODY is a genetic form of diabetes which caused by a single gene not working correctly.
In 1978, David Goeddel indicated that the first rDNA human insulin was created. Later that year, Eli Lily commercialized biosynthetic human insulin.
The first needle-free insulin delivery system, the Derma-Ject was released in 1979 by Derata.
In 1979 the haemoglobin A1c test was devised in order to create a more precise blood sugar measurement. The A1c became a standard measurement for blood sugar control in the comprehensive ten-year study from 1983 to 1993.
In 1982, the first biosynthetic human insulin, Humulin which is identical to in chemical structure to human insulin was approved to several markets in several countries. Later in 1986, insulin pen delivery system was introduced.
In 1992, the first MODY gene was found and there are now six known genes in which defects will cause MODY.
In 1993, Diabetes Control and Complications Trial (DCCT) report was published and clearly demonstrated that intensive therapy to keep their blood glucose levels as close to normal as possible delays the onset and progression of long term complications such as eye, kidney and nerves disease in individual Type I diabetes.
Besides sulfonylurea drugs, Metformin drugs was created in May of 1995 and Precose which was approved in September 1995 for people with Type II diabetes
Lispro, new fast-acting insulin, was released in August of 1996 by Eli Lilly under the brand name Humalog.
In 1998, United Kingdom Prospective Diabetes Study (UKPDS) was published. UKPDS identified the importance of good glucose control levels and good blood pressure control to delay and prevention of type II diabetes.
In March 1999, the first successful islet transplant was conducted at University of Alberta Hospital. The surgical procedure known as The Edmonton Protocol.

DEVELOPMENT DIABETES
Diabetes started to develop when the first symptom of diabetes, polyuria (the frequent urination) was identified in the third dynasty Egyptian. In 1500 B.C. diabetes was identified and the abnormal appetite and the collapse of sexual functions which are the second symptom of diabetes were identified in 980 to 1037.
Primary and secondary diabetes were recognized in 980 to 1037. Primary diabetes can be called as diabetes mellitus. It is happen due to a defect in the body’s ability to convert glucose to energy while secondary diabetes is the diabetes that characterized by damage to the body's ability to regulate glucose and insulin.
Diabetic gangrene and diabetes insipidus also were described in that year. Diabetic gangrene is the destruction of tissue in the body of diabetic patients. It develops when the blood supply to an affected body part is cut off because of various factors such as infection, vascular disease, or trauma. Diabetes insipidus is the diabetes that caused by problems related to the hormone antidiuretic hormone (ADH) or its receptor and causes frequent urination. In 1700, it was proven that urine of a diabetic actually contained sugar when the person tasted the urine.
The first differentiated between diabetes mellitus and diabetes insipidus were done in 1745 to 1821. Diabetes Mellitus is mainly caused by deficiency of insulin due to either destruction of Istet of Langerhans present in the pancreas or any autoimmune cause while Diabetes insipidus is caused by defect in secretion of Antidiuretic Harmone (ADH) which is secreted from pituitary gland present in hypothalamus.
In 1869, body’s insulin source which is tiny cells in the pancreas known as islet of Langerhans was identified. Due to the discovery of insulin, diabetes treatment started to widely develop. Then in 1935 two types of diabetes which is Type I diabetes and Type II diabetes were identified. Type I diabetes is insulin sensitive diabetes while Type II diabetes is insulin insensitive diabetes.
After the identification type of diabetes, the long term complication of diabetes also started to being identified. There was a link is made between diabetes and long term complications. Long term complications occur only when the person already had diabetes for at least fifteen years and they are chronic and progressive. The diseases that include in the long term complication of diabetes are eye disease, cardiovascular complication and kidney disease. The first disease that include in long term complication is eye disease. Most of diabetic’s patient may develop some degree of diabetic retinopathy which is the disease of retina. Most of this disease develops into background retinopathy which affects the capillaries that nourish retina but not cause visual problems. But there is also small cases that diabetic’s patient develop proliferative retinopathy, in which blood vessel grow in the retina and leak blood into the vitreous cavity thus temporary or permanent vision loss may occur. Diabetes also would cause cardiovascular complications as diabetes developing arteriosclerosis (hardening of arteries) and atherosclerosis (a build up fatty deposits). These complications may increase risk of hypertension (high blood pressure), heart attack and strokes. The next long term complication is kidney disease. It is occur as a result of changes in the small blood vessels in the kidney’s filtering systems. High blood pressure increases the risk of kidney failure. Diabetes also makes kidneys more vulnerable to infection. In a general eye and kidney disease is occur as a complication of Type I diabetes while cardiovascular complication is due to Type II diabetes.
In 1940 diabetes continued to develop as two major types of diabetes were recognized in 1959 which is Type I diabetes (insulin-dependent) and Type II diabetes (non-insulin dependent). Type I diabetes or also would be called as juvenile-onset diabetes because it usually strikes children, adolescent and young adult. It is the insulin-dependent diabetes mellitus. Type I diabetes is believed to be caused by a combination of genetics and environmental stressors. The pancreas produces little or no insulin. When insulin is absent, the cells are in state of starvation, while the excess sugar in the form of glucose may present in the blood. The body is unable to transport the glucose into the cells because lack of insulin and has to use its reserve fat for energy. People who are suffering with Type I diabetes require regular injection or a continuous infusion of insulin to make up for the lack of insulin production by the pancreas. Insulin dosage must be balanced against food eaten and energy expended on a meal by meal basis. If this balanced is disrupted, diabetes Type I patients may get diabetic coma at one extreme or insulin reaction (hypoglycaemia) at the other. The classic symptoms of out of control diabetes are extreme weakness, irritability, nausea, frequent urination (polyuria), excessive thirst (polydipsia) and excessive hunger (polyphagia) and weight loss in spite of large amount of food eaten. This type of diabetes is more serious and need daily injection of insulin, a prescribe diet and exercise in order to achieve control.
Diabetes Type II is contrast than diabetes Type I. It is the non insulin dependent diabetes. Type II diabetes also can be known as adult or maturity onset diabetes because it usually develops in person over 35 years of age. But, the overweighed children also may have Type II diabetes. The pancreas of Type II diabetes patients can enable to produce insulin but either it is not sufficient for normal energy production or it is ineffective to be used. The increase in insulin is believed to be the results of resistance. The excess of insulin causes or results from the inability to use the receptor sites which is the links to get the insulin into the cells. The result from the inability of receptor sites to function well is diabetes. The elevation in blood glucose levels may lead to polyuria, polidipsia and polyphagia (as in Type I diabetes). Type II diabetes also would be cause by the excess of the hormone. Hormone can be excess due to inherited characteristics interacting with some lifestyle problems. The lifestyle problems include aging, obesity and inactivity. The symptoms for Type II diabetes are the same as the symptoms for Type I diabetes as well as slow healing of cuts, fatigue, blurred vision, cramps in the legs, fingers and feet, itching and drowsiness. These symptoms are obscure until the routine medical examination reveals it. Type II diabetes can be controlled by bringing the weight down to normal and maintaining the loss. Some Type II diabetes patient would be given an oral drug or insulin, in addition to diet, to achieve control.
In 1970, laser therapy for retinopathy was developed to help slow or prevent blindness in some people with diabetes. Retinopathy which is the eye disease is the long term complication of diabetes. Then, Maturity Onset Diabetes of the Young (MODY) was described in 1974. MODY is a genetic form of diabetes which caused by a single gene not working correctly.
Diabetes Control and Complications Trial (DCCT) report was published in 1993 and clearly demonstrated that intensive therapy to keep their blood glucose levels as close to normal as possible delays the onset and progression of long term complications such as eye, kidney and nerves disease in individual Type I diabetes. After a few years later, United Kingdom Prospective Diabetes Study (UKPDS) was published in 1998. UKPDS identified the importance of good glucose control levels and good blood pressure control to delay and prevention of type II diabetes.

DEVELOPMENT DIABETES TREATMENT
Development diabetes treatment was started in 1800s when diet that restricted carbohydrate diet, high in fat and protein was proposed. Then in 980 to 1037 diabetes was treated using a mixture of lupine, trigonella and zedoary seed, which produces a considerable reduction in the excretion of sugar. Another diet was proposed in 1900s which was the diet that alternated days of very meagre nourishment with days of total fasting. This treatment would keep patient alive but it do not provide that patient with much energy.
After the discovery of insulin, insulin development started to progress. Insulin was extract from cattle foetal pancreas was discovered in 1921. Then the new types of pork and beef insulin were created in the late 1930. Longer acting insulin was created in 1936 which is PZI insulin. After that, NPH insulin was marketed in 1938. In 1944 the standard insulin syringe was developed to make diabetes management more uniform.
In order to control diabetes diabetic patient need to measure the amount of insulin in the blood. In 1950, radioimmunoassay test was developed to measure the amount of insulin in the blood. Besides that, oral medications also can be used to treat diabetes. The first oral medication, sulfonylurea was developed in 1955 for people with type II diabetes to help lower blood glucose levels. This drug was used to stimulate pancreas to produce more insulin to help people with Type II diabetes keep tighter control over their blood sugars. Other than oral medication, self-monitored glucose also should be taken in order to treat diabetes. In 1960s, home testing sugar levels in urine being invented to measure glucose level in urine.
In 1961, single use syringe was introduced for the injection of insulin. The insulin must be injected because it is a protein hormone that would be broken down by the body’s digestive processes if it were taken orally. Diabetes that can be treated by having one or more daily injection of insulin is Type I diabetes. But Type II diabetes normally does not require insulin injections. This invention had greatly reduced the amount of pain from injections of insulin as well as the time-consuming ritual of boiling needles and glass syringes.
Later in 1966, pancreas transplant was performed to treat diabetes that can restore complete insulin independence and normal blood sugar levels. But this technology is only succeeding on Type I diabetes, not on Type II diabetes. People with type I diabetes require lifelong treatment with regular injections of insulin. Pancreas transplantation is the only the treatment for diabetes that can restore complete insulin independence and normal blood sugar levels.
The first portable glucose meter which is Eyetone meter was created in 1969. This creation had improve a lot in diabetes treatment as the diabetic patient can easily do the self-monitored glucose anytime they want due to the glucose meter is portable. Then in the late 1970s insulin pump was designed to mimic the body's normal release of insulin. The pump dispenses a continuous insulin dosage through a cannula (plastic tube), using a small needle that is inserted into the skin. The first pumps, created were large and bulky and had to be carried in a backpack, but the pumps of today are light and compact and can easily be carried in a pocket or clipped to a belt.
In 1978, the production of insulin was improved as the first rDNA human insulin was created. Diabetes treatment continue to develop as the first needle-free insulin delivery system, the Derma-Ject was released in 1979. The Derma-Ject carried the insulin on the side and had no pressure adjustment feature. The modern needle-free injectors later were created and having the adjustable pressure, so they are relatively pain free. In addition it was lighter and compact in comparison to the older one. It was injected just 15 minutes before a meal, giving those who used it more freedom in timing their meals.
Later in that year, haemoglobin A1c test was also devised in order to create a more precise blood sugar measurement. With this test, haemoglobin, the oxygen-carrying pigment in red blood cells, is used to track glucose. Haemoglobin links with the glucose in blood, the more glucose present, the greater amount of haemoglobin linked with glucose. Blood test is more accurate than urine test because it shows the exact amount of glucose, whereas urine test shows only the percentage of glucose. Blood sugar levels should be checked frequently, at least before meals and at bedtime, then the results must be recorded in a logbook. The A1c became a standard measurement for blood sugar control in the comprehensive ten year study from 1983 to 1993.
Biosynthetic human insulin was commercialized in 1978 but it was approved in 1982 to several markets in several countries. The first biosynthetic human insulin is Humulin which is identical to in chemical structure to human insulin. Later in 1986 insulin pen delivery system was introduced. It is small enough and easily to bring so that diabetic patients can easily take the insulin without have to bring a syringe and needle.
Oral medication treatment for diabetes continued to develop as Metformin drugs, was created in May 1995 for people with Type II diabetes. It does not increase insulin production but it heightens sensitivity to insulin and increases the muscles' ability towards the use of insulin. Metformin promotes weight loss thus it decreases hyperglycemia and improves lipid levels. This drug has additional benefits, such as low blood sugar reactions, which are extremely rare, and this drug helps to prevent cardiovascular disease. In rare cases, this drug may cause a serious, life-threatening condition called lactic acidosis. Later in September 1995 another oral medication which is Precose was approved for use by people with Type II diabetes. It delays the digestion of carbohydrates, and hence reducing the sudden increase in blood glucose after taking a meal. It can be used in conjunction with diet to lower blood sugar in people with type II whose glucose levels cannot be regulated through diet alone.
The new fast-acting insulin which is Lispro was released in August of 1996 under the brand name Humalog. It will simulate the body's natural insulin output. Because of lispro's fast-acting tendencies, patients can take this insulin 15 minutes or less before eating a meal, instead of waiting as they would with regular insulin.
Diabetes treatment successfully developed as the first successful islet transplant was conducted in March 1999 at University of Alberta Hospital. After pancreas transplantation is successful patients do not need insulin, have no special dietary requirements, do not need to pierce them regularly to check their blood sugar levels and are not at any risk of becoming hypoglycaemic. Pancreas transplants are safest in people who do not have heart or blood vessel disease. But the cure can be worse than the disease. Patients with a transplanted organ must take immunosuppressive drugs in order to prevent the immune system from fighting the new organ. Immunosuppressive drugs are hard on the body, but people who get transplants must take these drugs the rest of their lives. Azathioprine and cyclosporine, two commonly used drugs, make it more likely for the patients to get infections and have other side effects. Patients need to avoid people who have infections, such as a cold or the flu and also should not be immunized without first checking with the doctor. These drugs can also damage the kidneys. For example, using either of these medicines for many years could increase the risk for some cancers. The side effects of these drugs may be worse than the problems caused by diabetes, and the operation itself is serious.

CURRENT DIABETES DEVELOPMENT
Diabetes current diabetes development is started at the beginning of this century, new long-acting insulin was introduced called Glargine. This insulin has a 24 hours action period, but no peaks and valleys, making more stable blood sugar control possible for some.
Then, inhaled insulin was being developed in 2004 under the brand name Exubera. A positive opinion was given in October 2005 and it was approved and brought to market in 2006. Exubera is the inhalation powder which is a white powder in a unit dose blister. After an Exubera blister is inserted into the inhaler, the patient pumps the handle of the inhaler and then presses a button, causing the blister to be pierced. The insulin inhalation powder is then dispersed into the chamber, allowing the patient to inhale the aerosolized powder. However, Exubera is a short acting insulin. This means that it will not remove the need for injections entirely, as people with insulin dependent diabetes will still need to use injections for their long-acting insulin. Exubera will be licensed for adults over 18 years only and there may still be some concerns about the long-term effects of delivering insulin to the lungs. Hypoglycemia which is low blood sugar is the most common side effect of insulin inhalation.
Later in 2007 Cygnus GlucoWatch Biographer was invented. GlucoWatch is worn on the arm like a wristwatch. It pulls tiny amounts of fluid from the skin and measures the glucose in the fluid without puncturing the skin. The device requires 3 hours to warm up after it is put on. After this, it can provide up to 3 glucose measurements per hour for 12 hours. GlucoWatch displays results that can be read by the wearer, but these readings are not meant to be used as replacements for fingerstick-based tests. The results are meant to show trends and patterns in glucose levels rather than report any one result alone. It is useful for detecting and evaluating episodes of hyperglycemia and hypoglycemia. However, diabetic patient must confirm its results with a standard glucose meter before corrective action is taken.
On 12 August 2008, the discovered disturbances in lipid and amino acid metabolism in children was found out that later will progress to type 1 diabetes, also known as juvenile diabetes. Type 1 diabetes is an autoimmune disease in which the immune system attacks the insulin producing pancreatic beta cells. The gradual loss of beta cells results in life-long dependence on exogenous insulin.
Continuous glucose monitoring (CGM) system was developed on 7 June 2010. It is used to help improve diabetes management. This is valuable for detecting high and low glucose fluctuations that can lead to dangerous health complications, which often go undetected with traditional A1C tests and glucose meter measurements. CGM that invented on 7 June 2010 was iPro2 Professional CGM. It is easy for clinicians and patients to use. It includes a disposable glucose sensor and a small data recorder, which automatically record glucose information. This next-generation product is simple to start and significantly reduces the amount of clinical staff time needed to implement the therapy. Reports containing continuous glucose information are well-organized and capture important glucose trends, such as hyperglycemic and hypoglycemic episodes, that can inform treatment decisions. The reports are useful for educating and motivating patients to implement changes in their diabetes management after viewing the effects that specific foods, exercise, stress, and medications have on their glucose levels.
The latest development of diabetes is in 20 Nov 2012, scientists in Ireland are set to begin a major new European project that will investigate the ability of adult stem cells in treating diabetes. Besides that, in Nov 2012 also there was a research made for new diabetes drugs which are NN1250/Insulin Degludec and Dapagliflozin. NN1250/Insulin Degludec is being developed for the treatment of both diabetes Type I and Type II. This is a completely neutral, soluble, and subcutaneous ultra-long-acting new-generation insulin that lasts for over 24 hours. Dapagliflozin is a new types of drug for the treatment of Type II diabetes. Dapagliflozin works by preventing glucose from being reabsorbed by the kidneys and therefore causes a higher amount of glucose to be removed from the blood and excreted via the urine.

CONCLUSION
Diabetes is a slow killer with no known curable treatments. The diabetes population are expected to at least double in the next 25 years. Without significant changes in public or private strategies, this population are expected to add a significant strain to an overburdened health care system.
However, its complications can be reduced through proper awareness and timely treatment. It is important to keep the blood glucose levels of patients under strict control for avoiding the complications.
The world researchers now look for alternative methods for diabetes treatment. In a future time I think one day diabetes treatment will be much more improve. I think, pancreas transplant will be improve one day so that the complication from the transplant operation will be avoided and the drugs that given after the organ being transplanted also would be improved so that the drugs will not damage the kidney and increase the risk of cancer. Other than that, I think the oral medication would also be always developed so that one type of medication can treat all types of diabetes.
Lastly, it is not impossible that one day diabetes can be cure so that human will do not have to take insulin injection because the injection is a little bit painful and it is little bit fussy to take insulin and check the glucose level before taking the meal.
I hope Malaysian will take care of their health by practising the healthy life. For example, Malaysian should follow the food pyramid when taking the meal and at the same time they have to exercise at least three times a week. By doing these, the number of diabetic patients could be decrease in Malaysia one day.
REFERENCES
Website: 1. All about diabetes, http://www.diabetesmalaysia.com.my 2. Diabetes, http://www.diabeteswellness.net 3. Diabetes drugs in development for the treatment Type I and TypeII diabetes, November 2012, http://www.diabetes.co.uk/research/diabetes 4. The development of continuous glucose monitoring (CGM) system, 7 June 2010, http://wwwp.medtronic.com 5. The History of Diabetes, 17/12/08, http://www.diabeteshealth.com
Books:
1. Diabetes, Jerry Edelwich and Archie Brodsky, Addison-Wesley publishing Company, Inc, third printing, March 1988. 2. Diabetes in the Family, American Diabetes Association, Prentice Hall Press, 1987. 3. The Diabetes Sourcebook, Diana W. Guthrie, PhD., A.R.N.P., and Richard A. Guthrie, M.D, McGraw.Hill componies, fifth edition, 2004.
Newspaper article: 1. Alarming rise in number of diabetics in Malaysia, Bernama, The Star, 11/1/10. 2. Diabetes-the new Malaysian epidemic, The Star, 22/7/12.

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