Homeostasis Disruption in Type-2 Diabetes

Introduction

Type-2 diabetes is referred to a chronic condition in which the blood sugar of the individuals is raised in an uncontrolled manner as a result of inclusion resistance or lack of presence of proper amount of insulin in the body (Chatterjee et al. 2017). The presence of type-2 diabetes raises various risks in the body which includes heart diseases, high blood pressure, nerve damage and others (Zheng et al. 2018). In this assignment, the facts and figures regarding type-2 diabetes presence among children who are the target group are to be explained. The overview of homeostasis and the way type-2 diabetes disturbs the homeostasis leading individuals to show different symptoms is to be discussed. The psychological factor which leads to the development of type-2 diabetes is to be mentioned. Moreover, intervention and medication required for type-2 diabetes for children are to be discussed, alongside considerations for healthcare dissertation help to support further research in this area.

Facts and Statistics

Type-2 Diabetes is the condition in which the body shows resistance towards insulin use or the pancreas in the body expresses inability to produce inclusion leading to the accumulation of the excessive amount of glucose in the body (Lips et al. 2017). As per the latest statistics received in 2016-17, it was mentioned that nearly 6,838 children and young people in the UK who are below the age of 25 are suffering from type-2 diabetes in England and Wales. The number is mentioned to be 10 times more than the previously reported statistics regarding type-2 diabetes among children by the Diabetes UK (digital.nhs.uk, 2017). This indicates the prevalence of type-2 diabetes among the children in the UK is rising at a steady and concerned rate. The 2016-17 UK incidence report regarding type-2 diabetes mentions that the presence of the disease among children who are below the age of 17 years is 0.72 per 100,000 populations each year (diabetes.org.uk, 2018; digital.nhs.uk, 2017). In addition, it has been found that the incidence of type-2 diabetes among the children who are girls and children in the South-Asian communities are more compared to others (diabetes.org.uk, 2018). This indicates that the type-2 diabetes is rising at a concerned rate within the children in the UK and the girls along with children who belong from the South-Asian communities are at increased risk of getting affected by the disease.

Homeostasis

Homeostasis is the state of internal equilibrium for optimal functions of the body of an organism. It involves many mechanisms in the internal environment of the body that takes place to achieve a state of equilibrium (Thorens, 2014). For the body to acquire this state of equilibrium for optimal functions and survival, it has to adjust a wide range of different variables such as body PH, blood glucose levels, temperatures, and concentrations of calcium, sodium and potassium ions within the homeostasis range (Ginhoux and Guilliams, 2016). The function may be impaired if the variables fall below or above the homeostasis range and if not corrected immediately then it may lead to illness or even death to the extreme cases. Any prolonged and severe disruption to the homeostasis may pose a threat to the life and survival of an organism (Li and Barres, 2018). Though homeostasis is a physical factor, it may also be affected by some sociological, psychological and spiritual factors within a person. Maintaining the equilibrium, therefore, involves a complete system of both negative and positive feedback loops. The negative loops respond to changes in the body and try to reverse the change back to normal within the range. On the other hand, positive feedback responds to changes by trying to strengthen a change in one of the control systems of the body (Prinz et al. 2017).

Glucose homeostasis

Glucose homeostasis is the process by which the body maintains a steady state of blood glucose by hormonal regulation of carbohydrates (Röder et al. 2016). Glucose is a major source of energy in the tissues and organs of the body. The body though needs this glucose in the right concentrations within the required levels below or above which there develops a complication such as hypoglycemia and hyperglycemia. Gastrointestinal hormones are secreted thus stimulation the secretion of insulin by beta cells in the pancreas (De Vadder et al. 2016). Therefore, the blood glucose needs to be maintained within the narrow limits at all times for an optimal function of the body. In this regard, the body has to adjust the level of glucose by secreting insulin and glucagon that opposes each other functionally (Thorens, 2014). For a person with type-2 diabetes (hyperglycemia), the beta cells secrets more insulin. This is a positive loop of feedback whereby insulin is synthesized in response to increasing glucose. The function of insulin is to counter the change and maintain blood glucose levels within the required limits by regulating glucose metabolism. Glucose taken orally leads to stimulation of higher insulin compared to intravenous glucose. Insulin reduces the output of hepatic glucose through a decrease in glycogenolysis and gluconeogenesis (Chambers et al. 2017). It then facilitates the transport into the adipose tissues and muscles by inhibiting glucagon secretion. The insulin is secreted when the blood glucose level goes above 3mmol/L. An increase in blood glucose level to above 5mmol/L increases the output of insulin from the beta cells (Hasegawa et al. 2018). At this stage, the pancreatic islets of Langerhans that produce the alpha cells hold on their hormones. The secretion of insulin occurs in two phases with an initial fast production of preformed insulin followed by syntheses and release in response to the glucose level (Gusarova et al. 2018). Children with type-2 diabetes are characterized by low oxidation of fats leading to an increase in the circulation of free fatty acids (Thorens, 2014). These fatty acids thus cause insulin resistance by lowering the glucose uptake through the congestion of lipids within the muscle cells. This leads to increased sugar in the blood due to lack of enough insulin or when there is insulin resistance and the body cannot utilize the insulin properly. Type-2 diabetes develops when there are high levels of blood glucose due to a dysfunction of the pancreatic beta cells or when the body cannot utilize the insulin properly (Holst et al. 2016). Glucose homeostasis is impaired if a person has type-2 diabetes. The dysfunction of the pancreatic beta cells leads to the disruption of adipocytes from secreting insulin (Holst et al. 2016).

Psychosocial Risk Factor

The psychosocial factors are those that influence the psychological and social life of an individual as well as their health (Hackett and Steptoe, 2017). One of the major psychological factors which raise the risk among individuals to develop type-2 diabetes is their hindered lifestyle. The lifestyle of an individual indicates the way they are leading their life and the unhealthy eating habit which includes intake of high-fat and increased sugary foods is the key lifestyle issue that leads individuals to develop type-2 diabetes (Al Sadat et al. 2017). In the study of Coelho et al. (2017), it is mentioned that the exact mechanism regarding the way high-fat foods leads individuals to develop type-2 diabetes is not know. It is determined that high-fat foods negatively affect the cell membrane composition of the individuals which eventually acts to alter the functioning of the cell membranes of the body such as the ion permeability, membrane fluidity, insulin receptor binding and affinity, interaction of glucose transporters with secondary messengers and others. This alteration, in turn, affects the tissues of the entire body making them insensitivity to insulin which eventually leads the individuals to develop type-2 diabetes (Harte et al. 2012). This is because insulin is the hormone released by the pancreas which acts to store the extra glucose in the body by converting it into glycogen to be stored in the liver (Joseph et al. 2017). Thus, insensitivity of the body to use insulin leads the extra glucose in the body unable to be converted into glycogen in turn leading to raise the glucose level in the body (Joseph et al. 2017).

The study by Greger (2016) mentions that increased presence of fat in the bloodstream is seen due to intake of high-fat food which gets build up on the inner side of the muscle cells. This leads the leads to produce toxic fatty breakdown products and free radicals which block the insulin signalling process of the body. It leads the individuals to have high blood sugar as the body becomes unable to use insulin in controlling the blood sugar. This act can occur within three hours after the intake of high-fat foods creating insulin resistance within just 160 minutes (Greger, 2016). In another study Ohtsubo et al. (2011) it was mentioned that when they fed high-fat foods to the experimental subject the genes which are coding the GnT-4a protein along with Slc2a2 which is glucose-sensing protein were less active in the pancreatic cells. The further experiments revealed that the effects were seen because the high-fat diet created negative impact on two other proteins which are Hnf1A and Foxa2 which are involved to control the gene activity of other genes in the body including the genes which are coding Slc2a2 and GnT-4a. The proteins to execute this impact enters inside the cell compartment of the body known as nucleus where the key DNA‘s of the body are present (Ohtsubo et al. 2011). However, in the experiment, it was seen that low amount of the proteins are found to be entering the nucleus of the experimental subject making the individuals express high blood sugar. The study by Barrière et al. (2018) mentioned that sugars are regarded to be the primary drivers for creating incidence of diabetes among individuals. This is because the sugars added to the processed foods are in the form of monosaccharide fructose which alters the metabolism of the liver leading to the development of type-2 diabetes. For instance, liver fructose in the fed state leads to generate increased amount of lipogenic substrates in an unregulated manner that causes the hepatic de novo lipogenesis as well as lowers the fatty acid oxidation. This leads to the development of increased insulin resistance in the body. Thus, the study mentions that the sugar present in the processed food which is consumed by the individuals as a preference of their lifestyle leads them to be prone to get affected by type-2 diabetes. The intake of sweetened beverages as a result of unhealthy eating lifestyle is seen to contribute to the rise of type-2 diabetes among individuals. This is evident from the study of Weber et al. (2018) where it is mentioned that within subgroup of population regarding collection of data based on insulin resistance index informed that high energy-adjusted intake of sucrose along with non-sucrose bound fructose from the sweetened sugar beverages is found to be highly associate with lower insulin resistance among type-2 diabetic individuals.

In another study by Basu et al. (2013), the researcher examined individuals of more than 175 countries where it is found that increased sugar intake through the food leads to rise in diabetes rates among individuals. The study mentions that for each additional intake of 150 calories per day by each person led to raise the type-2 diabetes level among the population by 1%. The change was perceived by researchers even after factors such as obesity, exercise, calories consumption and others are controlled. However, the study did not biologically support link between increased sugar intake and type-2 diabetes development among the wider population.

Specific Intervention

The specific intervention which would be effective for the target group that is the children suffering from type-2 diabetes would be raising awareness among them regarding the nature of modifications in their lifestyle to be made to ensure good health. This is to be made under the guidance created regarding diabetes prevention in the National Diabetes Prevention Programme (england.nhs.uk, 2018). The intervention of awareness regarding adoption of healthy lifestyle can be created by the nurses through education of the children as well as their parents. As mentioned by Hamilton et al. (2017), informing children regarding the negative impact of fast foods and sweetened beverages would influence them to avoid its intake. This is because the children would be made aware of the way the intake of such foods are adversely affecting their health, in turn, making them avoid it. Thus, nurses are required to indulge into personal session with the children where they by using pictures and various other informative sources are to educate the children regarding the way their current unhealthy lifestyle of intake of beverages and fast food in increased amount is affecting their health to develop type-2 diabetes (Victor et al. 2017). The school nurses present in the educational institutions are to arrange activity session for the children to educate them about the benefits of healthy diet adoption in their lifestyle. This is because in this way the children would learn regarding the foods they are to have to ensure healthy condition and avoid being at risk of development of type-2 diabetes (Candler et al. 2018). The school nurses are required to arrange session separately for the parents of the children to educate them regarding the changes in the lifestyle of their children is to be made so that health can be ensured. Since the children are dependent for care on the parents, thus the school nurses are to target the parents to educate them about the type of foods to be included in everyday diet of the children and the foods to be avoided to ensure they adopt a healthy lifestyle to avoid risk of developing type-2 diabetes (diabetes.org.uk, 2018). The nurses to empower the parents to lead the children make modifications in lifestyle are to mention specific exercise to be executed by the children based on their health condition (diabetes.org.uk, 2018). This is because not all the children have similar health condition or financial or logical condition to execute all exercise. The nurses to support children and their parents adopt healthy eating habit as their lifestyle is to be referred to as proper dieticians. The dieticians are the individuals who have the proper expertise and trained in the science of nutrition to advice people regarding healthy eating (Colberg et al. 2016). Therefore, referring to dieticians by the nurses would help the parents of the children develop specific diet chart according to their health which they are to follow to create change in eating habits in their everyday lifestyle. The nurses to support lifestyle modifications in the children to avoid them from facing type-2 diabetes are to instruct that they have to engage in moderate to extensive physical activity on daily basis for minimum of 60 minutes. The moderate physical activity to be performed by the children includes perspiration and respiration (Colberg et al. 2016).

Medication Intervention

The Food and Drug Association along with the NICE guidelines in the UK recommends that Metformin is the key medication to be used for the treatment of type-2 diabetes among children as well as adults (nice.org.uk, 2018). The Metformin is the biguanides class of drugs which is mainly composed of cellulose acetate, candelilla wax, magnesium stearate, polyethylene glycols, sodium lauryl sulfate, titanium dioxide, polyabsorbate 80, synthetic iron oxides, povidone and triacetin (accessdata.fda.gov, 2018). This initiation dosage of the medication for the children is 500 mg each day with meals twice a day. The dosage is to be increased by 500mg on weekly basis up to maximum of 2000mg each day given the amount by dividing it by twice (accessdata.fda.gov, 2018). Metformin is to be administered orally to the children. The Metformin is a nature of hyperglycemic agent that acts to increase tolerance of blood glucose among patients suffering from type-2 diabetes, in turn, acting to lower postprandial and basal plasma glucose level. It mainly acts on the liver for controlling the blood glucose level to normal (Prathap et al. 2018). The pharmacological mechanism related to Metformin is different from other oral antihyperglycemic medications used. In the study by Wu et al. (2017), it is mentioned that gluconeogenesis is an energy-intensive process and the hepatocytes require balancing demand for the supply of ATP with the latter initially provided by mitochondria. In relation to this, the metformin accumulates in the mitochondria for concentration reaching to 1000-fold higher compared to extracellular medium as it carries a positive charge and the presence of membrane potentials across the mitochondrial inner membrane and plasma membrane drives the medication into the cells of the body subsequently making them reach the mitochondria. After reaching the mitochondria, it acts to decrease mitochondrial respiration by inhibiting Complex I leading it to create fraction of the mitochondrial respiration to be contributed to uncoupling reaction. This result the cells treated with metformin to behave energetically inefficient and show delayed aerobic glycolysis along with lower glucose metabolism with the help of citric acid cycle (Abdul-Ghani and DeFronzo, 2017). The molecular mechanism of the action of metformin mentions that with inhibition of mitochondrial respiration it can also act to activate the cellular energy sensors that are AMP-activated protein kinase (AMPK). The increased activation of ratios of ADP: ATP and AMP: ATP leads AMPK to restore energy balanced by switching the catabolic pathway that is involved in generating ATP while the cellular process that involves consuming the ATP to be switched off (Rena et al. 2017). The benefit of using Metformin is that it is a less costly drug-related to create low risk of hypoglycemia among type-2 diabetes patients (Sanchez-Rangel and Inzucchi, 2017). Thus, the drug can be prescribed to wide number of individuals who may have financial constraints making them unable to avail costly medication for their children to have controlled blood sugar. The usual of Metformin though do not create hypoglycemic impact on the type-2 diabetic patients but when the medication is used under calorie deficient condition or when the exercise performed by the body is not properly compensated by effective intake of food then it leads to create hypoglycemic impact (Sanchez-Rangel and Inzucchi, 2017). Therefore, to ensure proper use of the medication effective dietary supplements are to be taken by the children as it would make them avoid hypoglycemic effects.

Another advantage of Metformin is that it acts as mono-therapy due to which during intake of the drug no additional medications are required to take by the patient to progress its effects (Kuan et al. 2017). Thus, the metformin is effective to create stress among children related to taking increased medication for controlling their blood sugar level. As mentioned by Prattichizzo et al. (2018), Metformin reacts to alter the gut microbiome and increases the gut population of bacteria Akkermansia sp. The increase in the population of the gut bacteria helps in controlling the body to avoid various diseases. Thus, the use of metformin is beneficial as it helps to promote effective health management. The Metformin by acting on the gut helps to lower chronic inflammation as well as control suppressed hyperglycemia in individuals (Weir et al. 2018). Metformin is seen to prevent the rise of cardiovascular complication among individuals as well as acts to lower cancer risk, offer anti-ageing effects and promote the immune response of the body (Weir et al. 2018). Therefore, use of the medication allows enhancing the health of the children as well as effectively allows controlling their blood sugar level to normal. The disadvantage related to Metformin use for children is that it acts as a panacea because of the large-sized tablet (accessdata.fda.gov, 2018). Therefore, children may avoid complying properly while taking the making orally creating issues for the nurses and parents to force them to take the medication. The disadvantage of metformin is that it contributes to the development of lactic acidosis as side-effect among individuals who have hindered renal functions. The lactic acidosis is development of lactate in the blood that leads the blood to show excessive low pH in the bloodstream and it makes the individual develop muscle cramps, body weakness and others (DeFronzo et al. 2016). Therefore, the drug is avoided to be used for children who are undergoing dialysis or have kidney problems as it would deteriorate their health condition. The metallic taste of Metformin creates issues for the patients to continue adherence to the medication (accessdata.fda.gov, 2018). Thus, the use of the medication has the disadvantage to retaining it used by the children for longer time to control their blood glucose level as the metallic taste may lead the child ignore taking it after some time. The side-effect of metformin is that it may lead the body to become impaired to absorb folic acid or vitamin B12 making the individuals develops risk of neuropathy or anaemia (accessdata.fda.gov, 2018).

Conclusion

Since most children in the UK are at high risk of developing type-2 diabetes, therefore, discussion regarding the way it occurs and the way to be used along with medication to the implemented to resolve it is to be discussed. The society and the practitioners should also be a position to be mindful and detect any symptoms of type-2 diabetes in children and promptly refer them to appropriate diabetes teams. The diabetes medical specialists and should be experienced to offer psychological, education and dietary support to children from the onset of a type-2 diabetes diagnosis. Additionally, the community health practitioners should offer individual support, motivation, physical exercise programs and proper dietary to minimize the effects of the condition. Psychological factor such as lifestyle choices relating to eating and executing exercise is seen to contribute to the development of type-2 diabetes. Negative psychosocial factors have also shown an increase in the risk of type-2 diabetes in school children, especially among healthy populations. Several interventions have a beneficial outcome on psychosocial factors in children with type-2 diabetes. Therefore it is important to prioritize in improving the psychological well-being of children with type-2 diabetes to prevent the increase in the adverse effects on glycemic control. The use of Metformin is seen to be effective for the children with type-2 diabetes to control their blood sugar levels but the side-effects of the medication include lactic acidosis due to which it is to b avoided to be used for children with renal complication or diseases.

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