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Type 2 Diabetes

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The term diabetes mellitus implies disorders that are characterized by chronic hyperglycemia with fat, protein metabolism and carbohydrate disturbances and result from defects of the insulin action or insulin secretion. The World Health Organization (WHO) recognizes diabetes as a progressive glucose metabolism disorder, in which people may proceed from diabetes, normoglycemia (glucose of fasting plasma venous is <5.5 mmol/L), impaired fasting glycemia (glucose of fasting venous plasma is 5.6 – 7.0 mmol/L), impaired glucose tolerance (glucose of fasting plasma venous is <7.0 mmol/L). When the body is unable to use glucose as the source of energy, the levels of blood glucose rise, and it may result in the development of such symptoms as polyuria, thirst, blurred vision or weight loss. Diabetes is usually diagnosed on the basis of a single plasma glucose, which is 11.1 mmol/L or more, and the presence of symptoms. In case symptoms are absent, the diagnosis is based on the results of blood glucose in the diabetes range taken at different time points. Uncontrolled diabetes that is called hyperglycemia over time leads to a serious damage to the body system.

There exist type 1 diabetes and type 2 diabetes. Type 2 diabetes is considered to be the most common diabetes form,which makes up approximately 90% of diabetes cases with other 10% due to type 1 diabetes mellitus and gestational diabetes.This form of diabetes is very common in Native Americans, Native Hawaiians, Latinos, African Americans, Asian Americans, and other Pacific Islanders. The disease is often widespread among the aged population. Type 2 diabetes is widely known as diabetes that is non-dependent on insulin. In most cases, it develops in people, who are over 40. Nowadays, type 2 diabetes is becoming more common in the younger generations.

 In type 2 diabetes, insulin is either not produced by the body or ignored by the cells. When one eats, the body absorbs all of the nutrients from that food, including proteins, fats, vitamins and sugars. All of them are necessary to fuel the body. During the process of eating,  nutrients go into the blood stream and travel throughout the body moving to the tissues. Red and brain cells use sugar as a source of energy. However, muscles are the biggest consumer of sugar. Insulin, a natural hormone, helps the body to use glucose that is necessary for energy and takes part in moving sugar to the muscle. Glucose is stored in the cells to be later used for energy. During the process of eating, all of the sugars are broken down into glucose, which is the fundamental cell fuel in the body. Insulin is responsible for extracting the sugar from the blood, and then, it is moved to the cells. A lack of insulin does not move sugar to the muscle, and it is left in the veins. Spending some time in the veins, sugar damages them, causing circulation problems and diseases. Therefore, building up of glucose in the blood, but not in the cells, leads to complications of diabetes. The development of type 2 diabetes is influenced by genetic factors and a lifestyle combination. A lack of sleep is also linked to the disease.

The symptoms and illness of type 2 diabetes are quite vague at first and develop gradually, sometimes taking months and even years. Due to symptoms, which are sometimes very difficult to notice, the disease got the name ‘the silent killer’. It takes such a long time as in type 2 diabetes insulin is still produced, but the body does not use it properly or the amount of produced insulin is not enough. It is called the insulin resistance that means that the body cells become resistant to normal insulin levels. Hence, a person needs more insulin than usual to keep the level of blood glucose down. Among the risk factors for type 2 diabetes are as follows: overweight, obesity, first-degree relative genes, impaired glucose tolerance and others. Genetic background is considered to be among the greatest risks. It has been estimated that 30-70% of people, who suffer from type 2 diabetes, have relatives with the same disease.90-95% of the diagnosed cases of diabetes accounts to type 2. As a rule, type 2 is associated with the older age (over 40), family history of diabetes, obesity and gestational diabetes history.

Unfortunately, it happens very often that people have diabetes during a long period of time, before it is diagnosed. The common symptoms of diabetes are tiredness, being thirsty all the time, weight loss, increased urine passing, hunger, blurred vision, frequent skin, bladder or kidney infections, erectile dysfunction, numbness or pain in the hands and feet. Urine passing and the state of being thirsty happen because of glucose leaks into the urine pulling out the extra amount of water through the kidneys. As the sugar buildup in the blood can result in an urination increase, the kidneys lose the glucose together with a large amount of water and cause the dehydration of the body. In case of a severe dehydration, long-term and life-threatening complications may develop. The loss of weight is caused by the fact that fat makes it harder for the body to use insulin in the appropriate way. Unfortunately, people may become used to the diabetes symptoms, which develop gradually, and cannot recognize that they are ill. The greatest problem is that some people with type 2 diabetes have no symptoms at all, because the level of glucose in blood in not too high. Despite the absence of symptoms, such people need a treatment in order to reduce the risk of disease complications. However, people, who suffer from type 2 diabetes, may in rare cases have a nonketotic hyperosmolar coma. The disease also causes a 20-fold lower limb amputation increase, the risk of dementia, Alzheimer's disease and acanthosis nigricans. The severity of a long-term complication usually varies from one case to another. Moreover, they may not develop at all.In spite of the fact that type 2 diabetes is more common than type 1, the causes of the disease are less understood as they are influenced by multiple factors. Type 2 diabetes sometimes runs in families, and it is difficult to trace the exact nature of the inheritance or genetic factor of the disease.

Due to the fact that type 2 diabetes has been growing particularly rapidly, it is considered to be one of the most common long term health conditions around the world. It has been stated that over 360 million people have diabetes in the world, making 8.5% of the whole population. The number of people, who suffer from type 2 diabetes, is increasing and tends to run in families. It is almost five times more common in the African-Caribbean and South Asian people. Around 750,000 people suffer from type 2 diabetes in the UK. Thus, about one in 20 people, who are over 65, and one in 5 people, who are over 85, suffer from diabetes.It has been estimated that about 3 million people die every year because of the disease. About every tenth man around the world and every eleventh woman in the world suffer from diabetes. It has been researched that 70% of those with diabetes suffer due to the aging and 30% because of the growing obesity, which is considered to be the major factor of risk for diabetes. The disease has the greatest growth among the nations of the Pacific Island. Statistics claims that in the Marshall Islands, every third woman and every fourth man suffer from diabetes. The level of glucose is particularly high in Latin America, South Asia, Central Asia, the Caribbean, the Middle East and North Africa. The rise of diabetes is also seen in high-income countries, including Greenland, the United States, Malta, Spain and New Zealand.    

Type 2 diabetes has already reached epidemic proportions in disadvantaged minorities in the developed countries (Torres Strait Islanders, Australian Aboriginals, some groups in the Middle East Arab states, migrant Asian Indians, African-, Mexican-, and Native Americans), as well as many developing nations. The diabetes epidemic dynamics is changing rapidly. The International Diabetes Federation claims that there are at least 285 million people, who suffer from diabetes worldwide. It has been expected that this number will be twice increased by 2030. The obesity and overweight are driving the global epidemic of diabetes. Both of them affect a considerable number of adults in most developed countries and have been increasing rapidly in developing countries. In Asia and India, the level of obesity is low, and it does not directly correspond to the rate of type 2 diabetes. However, even a modest overweight increases the diabetes risk among the population to a considerable degree. Asians have a tendency toward a less muscle mass and greater abdominal obesity. It leads to an increased insulin resistance propensity.

The insulin crisis has been documented in Iraq. In 2010, almost 10.2% of the Iraqi population had diabetes, in most cases type 2. This number is almost equal to that of the USA (10.3%) and is higher than the total prevalence in the North Africa and Middle East region (9.3%). The country has experienced an epidemiological transition, which requires an increased need for controlling and treating diabetes. However, continuous conflicts, economic and political isolation, funding cutbacks of public health devastated the Iraqi health care system. In April 2011, WHO published the information that diabetes mellitus deaths in Iraq reached almost 2000 or 1.03% of total deaths. In Iraq, diabetes mellitus is very frequent among people, who are aged under 20 or over 40. The overall diabetes prevalence in Iraq is 21.8% per 1000. The rate reaches 25.3% in urban areas and 23% in the centre of the country. The Iraq Family Health Survey Report indicates that the country faces the increased rate of diabetes in the 30-49 age group with the onset of type 2 diabetes. A further rate increase is seen after 50 with the prevalence rate of 143.8% per 1000 persons.

Over time, high blood levels of glucose levels may result in such complications as heart disease, blindness, kidney problems, erectile dysfunction and nerve damage. However, a good care and management of the disease can delay or prevent the complication onset. It has been proven that diabetes can also lead to serious problems, including kidney damage, skin and feet sore and infections, infections of female genital tract, itching and pain in different parts of the body, which are caused by infections, difficulty to control cholesterol and blood pressure, loss of feeling, digesting problems cause by nerve damage, weakness, trouble seeing and light sensitivity.

In general, people, who suffer from type 2 diabetes, have a five to ten years smaller lifespan than those without the disease. It has been investigated that the most common long-term effect of type 2 diabetes is the blood vessel damage. That is why diabetics are likely to develop a cardiovascular disease, resulting in blocked arteries, heart attack or stroke. The cardiovascular disease and associated complications are the main cause of death among people, who suffer from type 2 diabetes. Type 2 diabetes has the ability to speed the atherosclerosis progression.

The long term complications of the disease substantially depend on the individual’s abnormality of blood sugar levels. As a rule, the nearer the levels of one’s blood sugar are to normal, the less opportunity one has to develop long term conditions. However, in case an individual counters any risk factors, including overeating or not exercising, his or her risk of the complication developing is further reduced.

It has been considered that the most difficult long term effect is to accept the fact that in case of the chronic diabetes, the disease is for life. It means that a person should permanently adjust his or her lifestyle in the way, which prevents the disease from getting worse, and minimize the complications.

It has been stated that about 80% of type 2 diabetes can be easily prevented by increasing the physical activity and eating a healthy diet. The weight management and an appropriate well-balanced diet are highly significant for all people, not only for those, who suffer from type 2 diabetes. They can even stop taking medications after they lose weight, despite the fact that they still have the disease. Regular physical exercises are crucial not only for those, who have diabetes, whereas they also help to prevent the disease. Thirty minutes of the physical activity and a healthy diet can not only prevent type 2 diabetes, but also reduce the risk of the disease development. An insufficient awareness about the disease can lead to long term complications. Exercises, which make one breathe faster and his or her heart beat faster, help in lowering the level of blood sugar without medication. They also cause a calorie burning, improve the blood flow and blood pressure, lower the tension, increase the level of body's energy, improve the ability to handle stress and manage the weight. There is a strong relationship between type 2 diabetes and BMI (Fig. 1).

Type 2 diabetes is considered to be a global crisis of the public health that threatens the economies of all nations. Developing countries are the epicentres of the disease. The disease has been fuelled by the nutrition transition, rapid urbanization and increasingly sedentary lifestyles, being grown together with the worldwide rise in obesity. Diabetes poses a significant and ever-growing health problem for the population throughout the world. The disease is predicted to cause a massive health-care crisis in the future. Type 2 diabetes, the metabolic syndrome, obesity and cardiovascular problems are relevant and interrelated.

Advances in the genome-wide association study (GWAS) have improved the people’s understanding of diabetes pathophysiology, but there are still insufficient in terms of explaining a rapid rise of the diabetes rate over the past year and the risk of diabetes across different ethnic groups. The numerous population of Asia and rapid economic development have made it the epidemic epicentre.

Thus, being a strong risk factor for the cardiovascular disease and mortality, type 2 diabetes is an impaired glucose tolerance and impaired fasting glucose. The disease affects millions of people throughout the world and results in long term and short term complications. Clinical and epidemiologic studies show that type 2 diabetes can be largely preventable through lifestyle and diet modifications. Nonetheless, in order to translate these findings into practice, it is necessary to change the food environments, health systems and public policies. The evidence shows that the majority of type 2 diabetes cases can be prevented through lifestyle modification and diet. However, the adoption of a healthy lifestyle as well as diet requires some individual changes in behaviour, shape, food and social environment.

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