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patient is a 35-year-old (male?), he was diagnosed with diabetes twenty five years ago at the age of ten years old, he claims that this is hereditary in his family. He has one sister who has Type 2 diabetes and a brother who has type 1 diabetes. He manages his diabetes and other illnesses from home and through a medical clinic; for most of his life he has known he has diabetes and manages to regulate it through insulin shots, glucose tablets as well as through the right nutrition, however he claims that this is difficult and there are most days where he experiences draw backs. Many complications have arisen from his diabetes. This patient was selected because of the certain case he has in regards to his diabetes and other complications which had developed from it. His treatment and management also includes an extensive study. At the young age of 35, the patient has already lost an eye, had both kidneys fail and developed leukemia through diabetes.
Studies have shown that among a number of chronic diseases found in children, are those which have underlying immune dysfunction. Examples of the diseases are diabetes and leukemia. These are two diseases which the patient has developed throughout his life.
Diabetes mellitus type 1 is a form of diabetes which is the cause when there is an autoimmune destruction of insulin-producing beta-cells in the pancreas. Because of this lack of insulin, an increase in blood and urine glucose is seen. The common symptoms which can be seen through the development of this disease are: frequent urination (polyuria), increased thirst (polydipsia), increased hunger (polyphagia) and a decrease in weight. Type 1 diabetes can be fatal and needs to be treated with insulin. The injection is the most common way of administering insulin in the body. However, there are alternatives which can be used such as insulin pumps and inhaled insulin; this depends on the needs of the patient. Pancreas and islet transplants are seen to be done to treat type 1 diabetes; however the islet transplants are still at the experimental stage as of now. Most people who do develop diabetes are healthy; the development of the disease can be seen as both hereditary and of immunological origin. Diet may also play a prevalent role in diabetes; it is through the influencing of gut flora intestinal permeability. Immune functions in the gut; such as wheat in particular, has been shown to have a connection with the development of the disease, however the relationship between the two is not yet fully understood and needs further study.
Type 1 diabetes treatment must be done regularly and monitoring of the disease is very necessary. Treatment does not necessarily affect normal activities in the patient's life if there is sufficient training, awareness, appropriate care and discipline in testing, as well as the dosage of insulin taken. Treatment, however, can be burdensome for some people, this is when the treatments are not well managed, or are not paired with a healthy lifestyle.
There is evidence that type 1 diabetes is a polygenic disease. This means that different genes contribute to its development. It all depends on locus or the combination of loci in a person; it can either be dominant, recessive or somewhere in between. The strongest gene found, IDDM1, is located within the MHC Class II region on chromosome 6. Researchers believe that this is responsible for the histocompatibility disorder which is a characteristic of Type 1 diabetes that is that insulin-producing cells display improper antigens to T cells.
Type 1 Diabetes was known in the past as juvenile diabetes since it is one of the most frequent chronic diseases in children; however now the majority of new-onset type 1 diabetes is seen in adults. There are scientific studies which use antibody testing -- this is the use of glutamic acid decarboxylase antibodies (GADA), islet cell antibodies (ICA), and insulinoma-associated autoantibodies (IA-2) -- to distinguish between Type 1 Diabetes and Type 2 Diabetes. Research has found that Type 1 Diabetes is two to three times more common than the classic-onset autoimmune diabetes. In the case of Type 1 Diabetes, the body does not produce enough insulin. Insulin is an important hormone which is needed to maintain the normal blood glucose level within the body when there are spikes seen in the blood sugar level or intake. One mechanism by which insulin does such is by causing the liver to take up glucose molecules and convert them to glycogen for storage in the liver.
To be able to determine if a person has diabetes, a criteria has been created; a person with two fasting plasma glucose levels of 126 mg per dL (7.0 mmol per L) or greater is considered to have diabetes mellitus. Some doctors are seen to use a postprandial (after eating) test instead where blood glucose is measured 2 hours after 75 g of glucose is given. Any 2-hour postprandial reading over 200 is considered diabetic. And any two casual readings of 200 mg/dL or higher is also considered diabetic.
The fasting glucose tolerance test is generally preferred for diagnosis, however, any two abnormal tests are sufficient to classify a person as diabetic. Type 1 diabetes mellitus is characterized by beta cell destruction which is caused by an autoimmune process; this usually leads to an absolute insulin deficiency where the pancreases cease to produce the hormone. Onset is rapid, this usually occurs over a period of days or weeks. Studies have shown that over 95% of persons with type 1 develop the disease before the age of 25. Persons who develop type 1 diabetes over the age of 25 may be diagnosed with Latent Autoimmune Diabetes of Adults (LADA) this sometimes may also be called "slow onset diabetes" or type 1.5, this is initially misdiagnosed as type 2 diabetes. There is an equal incidence of diabetes mellitus in both sexes, but an increased prevalence is seen in Caucasians, also the disease is seen to disproportionately affect certain ethnic groups more than others. A family history of type 1 diabetes mellitus is often found in those with "immune-mediated form" of diabetes mellitus. Persons with type 1 diabetes have in increased risk of having Addison's disease, vitiligo, Polycystic Ovarian Syndrome (PCOS), Hashimoto's Thyroiditis, Celiac Disease, or pernicious anemia. All persons diagnosed with type 1 should also be tested for antibodies for Hashimoto's thyroiditis and for celiac disease. Some, usually those of African or Asian origin, have no antibodies but because they meet clinical criteria for diabetes they are classified as having idiopathic type 1 diabetes.
Diabetes can be treated with therapies such as insulin replacement therapy. This can be done through injection, insulin pump or other types of dietary managements. The monitoring of blood glucose levels can be done using glucose meters. Untreated diabetes can lead to comatose which is often from diabetic ketoacidosis -- this is fatal if left untreated. Pancreas transplantation are performed together with a kidney transplant. The reason for this is because the introduction of a new kidney requires the intake of drugs such as ciclosporin, which is an immunosuppressive drug. This allows the functioning of the pancreas; this allows the hormone to be produced without any additional immunosuppressive therapy.
Leukemia is a cancer of the blood or the bone marrow. This is when there is an abnormal increase in white blood cells. Leukemia is the broad term for covering the vast spectrum of the chronic disease. Leukemia can be generally classified into two groups: Acute leukemia and Chronic Leukemia. Acute leukemia is when there is a rapid increase of immature blood cells. This crowding within the body makes it difficult for the bone marrow to produce healthy blood cells. This type of leukemia is more commonly found in children. Chronic leukemia is when there is an excessive production of relatively mature, yet still abnormal blood cells. This takes months or even years to progress, the cells are said to produce at a much higher rate than normal cells; this results in a high number of abnormal blood cells within the body. This can be seen mostly in older people, yet can also occur in any age group.
There are many forms of treatment for leukemia, as a type of cancer, it is mostly dealt with through pharmaceutical medications which is combined with a chemotherapy regimen; this is also sometimes treated with radiation therapy. If the leukemia is found in the bone marrow, a bone marrow transplant is useful.
The patient was diagnosed with diabetes after being administered a four-hour glucose test. He was aware that it ran in the family, and was too young to recognize the disease's implications at that time. He controls his diabetes with the use of an insulin pump. The administration of insulin is constant because of the pump, and he monitors his blood sugar between 4 to eight times a day. When he finds that his blood sugar is too low, he is required to…[continue]
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