1 Endocrine Diseases Research Paper Research Paper: Endocrine Endocrine Diseases Endocrine Diseases Research Paper 2 The paper will present research data on two endocrine diseases, type 1 diabetes, and type 2 diabetes. For each disorder, a summary of the history and the causes and symptoms of each disease will be presented. Clinical tests that are utilized to help a doctor diagnose each disease will be outlined and discussed. The recommended treatment protocols will be detailed for each endocrine disease together. And finally, the current morbidity and mortality of each disease will be assessed and discussed. The paper will present the disease topics for both type 1 and type 2 diabetes together. Documenting the history for both diseases in the paper will begin with the first recognition of the linkage between the pancreas organ and diabetes. Dr. Frederick Banting and his assistant, Charles Best, in 1921, conducted experiments that demonstrated that administering the islets of Langerhans, the cells that produce insulin in the pancreas, from healthy dogs to dogs with their pancreas removed could treat high blood glucose level. A year later, James Collip purified the secretion from a pancreas and treated the first human, a 14-year-old by the name of Leonard Thompson. The process was deemed a great success. In the early 20th Century, the life expectancy for a child with type 1 diabetes was approximately one year. The young man lived until 27, when he succumbed to pneumonia. It was not until 1936 that type 1 and type 2 were differentiated. Sir Harold Percival is credited with being the first to recognize the different insulin sensitivities in patients. By 1945, with continued improvement in insulin treatments, life expectancy for a diabetic patient had gradually increased. An example is a child diagnosed with type 1 diabetes has a life expectancy of 45 years. By 1947, Dr Elliot Proctor Joslin along with his staff, develop the first ever blood glucose monitoring system in a hospital setting. This leads to innovation in individual glucose monitoring. (Diabetes.co.uk). By 1955 the first oral medication, carbetamide, is designed to help an individual lower their blood glucose levels. In the 1960’s, urine strips allow individuals the opportunity to get blood Endocrine Diseases Research Paper 3 glucose readings at home. In the 1970’s the first continuous insulin pump is developed by Dean Kamen. By 1977 the HbA1c clinical test was introduced to doctors to evaluate over a period of time, blood glucose levels. In the early 1990’s, Medtronic invents the MiniMed 506 insulin pump which has the ability to capture data for a doctor to review. A nutritional trial was conducted in 1993 known as the Diabetes Control and Complications Trial. A report was published that demonstrated through the trial that regular activity and good nutrition helps the body control blood glucose levels and reduce the long-term side effects of type 2 diabetes. ‘Diabetes Solution’ is released by Dr. Richard Bernstein in 1997. It represents the first advocate of reducing carbohydrate consumption to better control an individual’s blood glucose level. In 2008, Suzanna de la Monte is the first to coin the term “type 3 diabetes” to describe insulin resistance in the brains of Alzheimer’s patients. Dr Edward Damiano invented the iLet which was a bionic pancreas that regulated insulin and glucagon every five minutes. The inventor hailed the device as a “bridge to a cure”. (Diabetes.co.uk). The exact cause for type 1 diabetes is still unknown. The body’s immune system which normally attacks foreign invaders, instead attacks the insulin producing cells in the pancreas. The cells the body attacks in the pancreas are the islet or islets of Langerhans cells. Insulin is a hormone produced by the gland function of the pancreas organ. The organ is situated behind the stomach. The pancreas is designed to assist in the digestive process with the secretion of insulin. Even though the exact cause is unknown, there is a genetic component to type 1 diabetes for some individuals as well as a theory that a virus or pathogen sometimes attacks the pancreatic, insulin producing cells. This attack is an autoimmune response which destroys the body’s ability to produce insulin. Type 1 diabetes can occur in adults over 30 as well. It is known as latent autoimmune diabetes in adults (LAPD). This is a slow progressing form of diabetes that ultimately destroys the insulin producing cells in the pancreas. Unlike early onset type 1 diabetes, someone with LAPD will not need insulin Endocrine Diseases Research Paper 4 injections immediately upon diagnosis. It may be months or years before insulin is required. Once diagnosed, there is no medical intervention to stop the destruction of the insulin production of the pancreas. (Mayo Clinic, 05/10/2019). Most type 1 diabetics need to inject insulin on a regular basis to allow for the “feeding” of the cells with glucose. Insulin is the key that unlocks the cell so it can receive the required glucose. The individual with type 1 diabetes needs to monitor and regulate the blood glucose levels in their body. There needs to be a balance, otherwise critical conditions can present themselves. If there is too much insulin injected into the bloodstream, this allows the cells of the body to absorb too much glucose and the liver releases less glucose. The combination causes glucose levels to become dangerously low. This condition is known as hypoglycemia and can cause blurred vision, headache, and disorientation. When the body does not receive enough insulin, glucose can no longer enter the cells from the bloodstream which causes high blood glucose levels. If the level becomes high enough the excess glucose is disposed of through urine. That is why, in the 1960’s, urine strips were developed to test blood glucose levels. (Mayo Clinic, 08/22/2020). The main cause of type 2 diabetes is insulin resistance. Insulin resistance is when cells in the body’s muscles, stored fat and the liver start to resist and ignore the signals from the hormone insulin which is trying to unlock the cell to deposit glucose from the bloodstream which serves as fuel for the cells. The glucose comes from the consumption of carbohydrates such as vegetables, fruits, grains, dairy products, and sugary drinks. A key factor in developing type 2 diabetes and insulin resistance is excess body fat particularly belly fat, lack of exercise, smoking, and the lack of sleep. Insulin resistance increases as the body resists and ignores the insulin signals as the body produces more insulin. As significant insulin demand continues over several years, the insulin producing cells in the pancreas become worn out and cannot keep up with the demand for more and more insulin. And as insulin Endocrine Diseases Research Paper 5 resistance increases, the blood sugar level in the bloodstream increases since the insulin is becoming “tired and worn out”. Too much blood sugar eventually deposits in the liver to create fatty liver disease and a negative impact in contributing to heart disease. (Mayo Clinic, 08/26/2020). The symptoms of type 1 diabetes can present themselves suddenly. Extreme hunger and frequent urination are signs of type 1 diabetes. Bed-wetting at night for a child that never exhibited such a habit is a danger sign of type 1 diabetes. Becoming irritable and moody as well as fatigue and weakness are symptoms. Unintended weight loss can also point toward type 1 diabetes. Some of the symptoms of type 2 diabetes are a duplication of type 1, such as frequent urination, increased hunger, fatigue, and blurred vision. The symptoms of type 2 diabetes develop more slowly, sometimes taking years before a formal diagnosis of type 2 diabetes is pronounced. Pre-diabetes is the precursor to developing type 2 diabetes. Other symptoms of type 2 diabetes are increased thirst, slow-healing sores, and unintended weight loss. Areas of darkened skin can indicate type 2 is present in an individual. (Mayo Clinic, 08/22/2020). An important clinical test for type 1 and type 2 diabetes is the glycated hemoglobin, A1C test. Doctors use this test because of its ability to determine the average percentage of blood glucose levels for the past two to three months. A normal A1C level is below 5.7. If the A1C is between 5.7 and 6.4, it is considered prediabetes. An A1C level of 6.5 or higher on 2 separate tests, the doctor will diagnose diabetes. A doctor can also use a fasting blood sugar test to evaluate blood glucose levels in an individual. The test is performed with a blood sample. A reading of 100 mg/dL is considered normal. A level between 100 to 125 mg/dL is considered prediabetes. A diabetes diagnosis is made when an individual’s blood glucose level reaches 126 mg/dL. There is no definitive clinical test that will differentiate between type 1 and type 2 diabetes. The doctor will use the A1C and consider the individual’s age, Endocrine Diseases Research Paper 6 weight, and other lifestyle factors to estimate type 1 or type 2 diabetes. It is important to distinguish because the treatments are often differentiated. The doctor may do blood tests to assess an individual’s level of autoantibodies that are common for type 1 diabetes. Also, the doctor will ask the lab to evaluate ketone levels in the blood test. Ketones are produced by the liver and result from fat breakdown. Ketones can also be tested with a urine strip. Ketones are indicative of type 1 diabetes. The doctor will also use blood tests to check cholesterol levels, thyroid function, liver and kidney function. (Mayo Clinic, 08/26/2020). Type 1 diabetes treatment plan has insulin at the center of the plan. A type 1 diabetic can no longer produce insulin from the pancreas. Another key to the plan is constant blood glucose monitoring. A doctor would also encourage a type 1 diabetic to focus on a healthy diet and exercise. Maintaining a healthy weight will help to not acquire metabolic disease and all the negative conditions it brings to the patient. Maintaining a blood glucose level before meals of 80 to 130 mg/dL and after meal numbers no higher than 180 mg/dL, two hours after eating. A type 1 diabetic cannot receive insulin through oral means because the acidic environment of the stomach would break down the insulin and prevent it from getting to the bloodstream. The insulin must be injected by needle or by an insulin pump. (Mayo Clinic, 08/22/2020). The treatment plan for a type 2 diabetic centers on lifestyle changes that allow the patient to acquire a healthy habits that include diet, that can lead to weight loss, exercise and sound sleeping habits. In recent years there have been many doctors that have recognized that lifestyle changes can give a type 2 diabetic a chance to reverse their disease. Some think it is no longer a chronic disease if the patient acquires the necessary lifestyle changes. Until the lifestyle changes can take effect, sometimes the patient requires medications or even insulin. Often a doctor will prescribe Metformin for its ability to lower glucose production in the liver and making the body more sensitive to insulin which lowers insulin resistance. A doctor will also prescribe sulfonylureas and Meglitinides. They are designed to help the 7 Endocrine Diseases Research Paper pancreas secrete more insulin. However, sometimes these drugs offset the lifestyle change a patient might achieve by causing weight gain. Insulin is sometimes required in a treatment plan for a type 2 diabetic. (Mayo Clinic, 08/22/2020). The mortality and morbidity for type 1 and type 2 diabetes is interesting. The data often demonstrates that someone with type 1 or type 2 diabetes often dies of a disease that is made worse by diabetes. An example is a 5-year study that reviewed the autopsies of diabetic individuals. The leading cause of death of type 2 diabetics was cardiovascular disease, 56.6% of the deaths. Following cardiovascular disease is unnatural causes, 15.4% and infections, 9.4%. Type 1 diabetics, primary cause of death was also cardiovascular disease, 44.7%. Cardiovascular deaths were equally distributed across all age groups. This data is indicative of diabetic factors also cause other metabolic diseases. (Chong Zhou). To conclude this paper and summarize the content, a review of the history of type 1 and type 2 diabetes was researched from the point of recognition that insulin sensitivity is a cause type 2 diabetes and that type 1 diabetes is an autoimmune disorder. The causes for both diseases were outlined for type 2 or theorized for type 1 diabetes. The symptoms were documented and discussed. The clinical tests the doctors utilize in the diagnosis of both type 1 and type 2 diabetes were identified and the purposes discussed. The treatment plans for both type 1 and type 2 diabetes were presented together. The morbidity and mortality were identified and discussed. The positives going forward for the treatment of type 2 diabetes is that many doctors are now considering that lifestyle changes could potentially allow an individual to reverse their disease. The protocol for reversal of a healthy diet, exercise and sleep also applies to a type 1 diabetic. References: Endocrine Diseases Research Paper 8 Abdelaziz Elnaggar, Van Ta Park, Sei J Lee, Melinda Bender, Lee Anne Siegmund, Linda G Park, Patients’ Use of Social Media for Diabetes Self-Care: Systematic Review, Journal of Medical Internet Research, https://onlinelibrary.wiley.com/doi/abs/10.1111/15564029.13674 10.2196/14209, 22, 4, (e14209), (2020). Accessed, 09/29/2020. Diabetes.co.uk. (01/15/2019). Diabetes History. https://www.diabetes.co.uk/diabeteshistory.html, Accessed,09/29/2020. Mayo Clinic. (05/10/2019). Latent Autoimmune Diabetes in Adults (LADA): What is it? https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/expert-answers/ladadiabetes/faq-20057880, Accessed, 09/28/2020. Mayo Clinic. (08/22/2020). Symptoms and Causes for Type 1 Diabetes. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc20353011, Accessed, 09/28/2020. Mayo Clinic. (08/22/2020). Diagnosis and Treatment for Type 1 Diabetes. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/diagnosis-treatment/drc20353017, Accessed, 09/30/2020. Mayo Clinic. (08/26/2020). Symptoms and Causes for Type 2 Diabetes. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc20351199, Accessed, 09/28/2020. Zhou, Chong PhD, Byard, Roger M.D. (12/11/2017). An Analysis of the Morbidity and Mortality of Diabetes Mellitus in a Forensic Context. https://onlinelibrary.wiley.com/doi/abs/10.1111/1556-4029.13674, Accessed, 09/30/2020.
