Diabetes, the Endocrine System, and Rehabilitation Care

Introduction: Diabetes and the Endocrine System

The endocrine system comprises the various glands that produce hormones. The importance of these hormones cannot be overstated when it comes to regulating bodily processes including, but not limited to, growth, respiration, and appetite. Apart from diabetes, other disorders associated with the endocrine system include Hashimoto's thyroiditis, Graves' disease, Cushing's syndrome, and Addison's disease.

Diabetes has been identified as a leading cause of death in the United States, as well as in other parts of the world. According to the Centers for Disease Control and Prevention (CDC, 2021), data available for the years 2015–2018 indicates that 11.3% of U.S. adults aged 20 and above had been diagnosed with diabetes. At present, the disease is the 7th leading cause of death within the country (CDC, 2021). This is a clear indication that much more needs to be done to address this condition.

Efforts to decrease the number of persons diagnosed with diabetes each year—and to bring down the death rate attributed to the disease—must begin with a thorough understanding of how diabetes affects various bodily systems. They must also include assessment of the most effective medical and assistive technology interventions, as well as evaluation of the cultural concerns that could hinder or promote rehabilitation.

Pathophysiology: Insulin, Glucagon, and the Pancreas

In essence, diabetes disrupts the body's regulation of blood glucose levels. In individuals who have not been diagnosed with diabetes or pre-diabetes, blood glucose levels are kept in check by two hormones: insulin and glucagon. Insulin reduces blood glucose levels, while glucagon increases them. The two hormones function in tandem to maintain balanced blood glucose. Among those diagnosed with diabetes, there is an imbalance between the effects of glucagon and insulin—the body either fails to manufacture sufficient insulin or fails to respond to it appropriately.

According to Wu, Ding, Tanaka, and Zhang (2014), in type 2 diabetes the body's response to insulin is ineffective; the body cannot make proper use of insulin due to its resistance to the hormone's action. As a consequence, blood glucose levels remain higher than normal. This is the most common type of diabetes. In type 1 diabetes, by contrast, the body is incapable of producing insulin in sufficient quantities, so failure to inject exogenous insulin results in high blood glucose levels. Other categories of diabetes also deserve mention, including monogenic diabetes, gestational diabetes, and pre-diabetes.

Before examining medical interventions and treatment options, it is useful to consider the role of the pancreas in blood sugar control. Past studies have confirmed that a clear correlation exists between diabetes and the pancreas (Marshall, 2020). The pancreas produces hormones and enzymes that assist in food digestion, and insulin is one of those hormones. This peptide hormone is central to glucose regulation because it facilitates the transport of glucose from the blood into cells. When the pancreas fails to manufacture sufficient insulin—due to the immune system destroying beta cells—glucose accumulates in the bloodstream, a condition known as hyperglycemia, resulting in type 1 diabetes.

Types, Symptoms, and Risk Factors

Common symptoms of type 1 diabetes include blurred vision, weakness and fatigue, significant mood changes (such as irritability), unexplained weight loss, hunger, frequent urination, and increased thirst (American Diabetic Association, 2020). This type of diabetes primarily affects children and adolescents (American Diabetic Association, 2020).

When it comes to type 2 diabetes, the body becomes resistant to the insulin that is produced. To compensate for elevated blood glucose levels, the pancreas is required to produce additional insulin. When it cannot meet this demand, a person may gradually begin to experience type 2 diabetes symptoms. Many of these symptoms overlap with those of type 1 diabetes; however, persons with type 2 diabetes may also experience darkening of certain skin areas such as the neck and armpits, as well as tingling sensations or numbness in the feet and arms (American Diabetic Association, 2020). Sometimes these symptoms take several years to appear.

In terms of risk factors for type 2 diabetes, previous studies have identified overweight and obesity, age, ethnicity and race, and family history as among the most common (Wu, Ding, Tanaka, and Zhang, 2014). Regarding weight, Al-Goblan, Al-Afifi, and Khan (2014) note that "in obese individuals, the amount of non-esterified fatty acids, glycerol, hormones, cytokines, pro-inflammatory markers, and other substances that are involved in the development of insulin resistance is increased" (p. 590). Regarding age, the older a person is, the greater their risk of developing this form of diabetes. With respect to family history, research has shown that individuals whose siblings or parents have been diagnosed with type 2 diabetes face a higher risk of developing the condition themselves (Al-Goblan, Al-Afifi, and Khan, 2014). Concerning ethnicity and race, Cheng, Kanaya, Roario, and Araneta (2019) observe that higher prevalence rates of type 2 diabetes have been recorded in Asian and Hispanic populations compared with African and European populations. The authors suggest that this difference may stem from a range of factors, including environment, lifestyles, epigenetics, and genetics.

For type 1 diabetes, the principal risk factors include exposure to certain environmental elements and genetic predisposition (Al-Goblan, Al-Afifi, and Khan, 2014). Other organs that play an active role in blood sugar control include the liver and the kidneys.