Course Code PHYL2067
Course Title Human Function in Health and Disease B
Course Coordinator Dr Louise Ainscough
Due Date 8/10/2024
Assignment Title Information sheet Assignment
Word Count 1155 words
Date Submitted 7/10/2024
Extension applied for Yes / No Revised Date
Student Number Surname First Name
47692156 Lai Po Ching
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Diabetes 2: Its importance
Type 2 Diabetes is s common syndrome globally and requires a
multidisciplinary approach to the management of the disease
Type 2 diabetes is a chronic syndrome that constitutes the majority of diabetes cases. It is characterised by
insulin resistance and hyperglycaemia due to the impaired production of insulin in the pancreas where insulin is
produced but has become dysfunctional. This differs from type 1 diabetes, where the body produces no or
almost no insulin. According to the WHO, the prevalence of type 2 diabetes has been rising more rapidly in low
and middle-income countries, with the number of patients increasing to 537 million in 2021, making it one of
the leading public challenges (Galicia-Garcia et al., 2020). It is also the core of other acute and chronic diseases
such as blindness, kidney failure and stroke. Some of its risk factors are obesity, poor lifestyle, and an
imbalanced diet. By eliminating or minimising these risk factors, the onset of the disease could be prevented or
delayed. Occupational therapy holds a fundamental role in managing the impact of type 2 diabetes, particularly
in assisting patients with self-care activities and regulating glucose levels. Early intervention, coupled with
a multidisciplinary approach, is essential to managing the disease effectively. OT professionals focus on
enhancing patients' independence and facilitating their participation in daily activities, ultimately improving
their quality of life.
Normal Physiology
Under normal circumstances, beta cells within the pancreas are essential for the production of insulin, which
plays a fundamental role in maintaining blood glucose homeostasis, especially after meals. After food is
ingested, the blood glucose level rises, and insulin is secreted in response to signals from the pancreas. Once
released, insulin circulates through the bloodstream to the liver, where it promotes glucose storage by
binding to receptors on liver cells, facilitating the uptake and storage of glucose as glycogen, thereby
lowering blood sugar. Insulin also acts on target tissues especially muscle and fat tissue, where it stimulates
the translocation of glucose transport molecule (GLUT4) to the cell membrane by a cascade of signalling
pathways, allowing glucose to enter the cells from the bloodstream by the transport protein. In muscle cells,
glucose is stored as glycogen, while in adipose tissue, it is converted to triglycerides. Insulin further inhibits
glycogenolysis by deactivating enzymes responsible for breaking down glycogen into glucose and suppresses
gluconeogenesis in the liver, helping to maintain normal blood glucose levels(Tokarz et al., 2018).
Diabetes Pathophysiology
In Type 2 Diabetes, three major metabolic abnormalities occur, with insulin resistance being one. Insulin
resistance occurs mainly in the muscle, fat and liver cells of the body. The body continues to produce
enough insulin, but the GLUT4 transporter cascade is disrupted and insulin receptors become
unresponsive or insufficient, preventing proper glucose uptake (Olaogun et al., 2020). The pancreas
compensates by producing more insulin, but its effects are limited, leading to glucose accumulation in the
blood. It is known that fat tissue, once it accumulates, would increase its resistance to insulin. The second
abnormality is beta-cell dysfunction. Over time, the demand for insulin exhausts beta cells, leading to
reduced insulin production and eventual beta-cell death. It may also be the result of glucose and lipid
toxicity to beta cells due to its potential harm that could be imposed on vascular and nerve tissues. The
toxicity nature, alongside the fatigue of beta cells, would continue to deteriorate insulin production and
cause further increases in glucose levels, turning it into a vicious cycle. Lipids are shown to be toxic to
beta cells. When insulin deficiency occurs, the lipase enzyme activates and breaks down fats to
triglycerides and causes damage to the function, shape and even death of beta cells. The third
abnormality involves excessive glucose production by the liver, where glucose is released even during
fasting, causing persistent hyperglycaemia. Prolonged high blood sugar causes both acute and chronic
complications, some of which are irreversible(Guthrie & Guthrie, 2004).
Excess glucose in the bloodstream limits its availability for use as energy by body
cells. Hyperglycaemia damages blood vessels, impairing clotting mechanisms and reducing blood flow.
Thin-walled vessels in insulin-independent tissues can still absorb glucose without insulin, but excessive
glucose can damage these blood vessels, nerves, and organs. Endothelial cells in blood vessels
undergo glycosylation, where glucose binds to proteins to form advanced glycation end products (AGEs),
leading to dysfunction of body cells. This would then enhance the chance for the above circumstance to
evolve into symptoms and complications in the next section (Guthrie & Guthrie, 2004).
Moreover, it should that type 2 diabetes not only has physical factors but also both genetic and
environmental risk factors that could be underlying causes. Certain genes increase susceptibility,
alongside lifestyle factors for example poor diet, obesity, and urban living contribute significantly to the
development of the disease(Galicia-Garcia et al., 2020).
Symptoms and complications
Individuals with Type 2 Diabetes often experience fatigue and unexplained weight loss despite increased hunger
(polyphagia) due to the body's inability to use glucose efficiently. This is due to glucose being left in the blood
when it is unable it to be transported to the cells for usage through the GLUT4 transporter proteins.
Common symptoms include frequent urination (polyuria) and glucose in the urine (glycosuria), which result
from elevated blood glucose levels caused by insulin resistance. Excess glucose is excreted in urine because the
kidneys cannot reabsorb it for the tissues during blood filtration. This also leads to polydipsia (excessive thirst)
due to dehydration from polyuria when more urine is loss which leads to dehydration (Chatterjee et al., 2017).
Over time, chronic hyperglycaemia leads to both microvascular and macrovascular complications.
Microvascular damage, the leading cause of blindness and kidney disease, results from the glycosylation of
blood vessels, making them fragile and prone to leakage. In the retina, vessel damage causes haemorrhaging and
the growth of new, abnormal vessels, obstructing vision. In the kidneys, glycosylation increases vessel
permeability, leading to protein leakage, reduced blood flow, and high pressure. Atherosclerosis, the hardening
of arteries, is a major macrovascular complication that increases the risk of heart attacks and poor circulation,
especially in the legs and feet, which can result in tissue damage (Guthrie & Guthrie, 2004). Cerebral vessels are
also prone to damage when clotting occurs leading to increased pressure and enhancing the risk of rupture and
burst, which leads to stroke.
Impact on occupational performance
Type 2 Diabetes can severely impact an individual's ability to participate in daily activities and
maintain independence, presenting physical, cognitive, and emotional challenges. Peripheral
neuropathy often causes pain, numbness, or muscle weakness in the extremities (hands and feet),
hindering participation in tasks that require the use of hands, walking, or maintaining balance. This
makes tasks like dressing, grooming, and engaging in leisure activities, such as sports, more difficult
when the capacity of movement within the extremities is hindered (Schlevis et al., 2015). Vision
impairments also create challenges with tasks requiring prolonged focus. Assistive technology can
help improve mobility, such as compression gloves or socks to reduce pressure and numbness, or AI-
based hearing guides. Environmental modifications, like installing soft pads on sharp corners, can
enhance safety for those with vision impairments, reducing the risk of falls.
Fatigue, resulting from blood sugar fluctuations, limits participation in energy-demanding
activities. Energy conservation strategies, such as planning tasks, eliminating redundant steps, and
prioritising important activities, are key techniques used by occupational therapists (OTs) to manage
energy levels (Caron et al., 2016).
Additionally, depression and anxiety are common comorbidities in Type 2 Diabetes, making it
difficult for individuals to form social connections or engage in social activities. Cognitive-
behavioural therapy (CBT) can be beneficial, with techniques such as anxiety management (e.g., deep
breathing exercises) and depression education to help patients identify and challenge negative
automatic thoughts (Clarke et al., 2019). Including family-centred practice within the intervention
would also be helpful. More insight would be provided that allows a more personalised plan to be
made, utilising the strengths and interests of the patients to enhance motivation and self-efficacy
(Bahadır Ağce & Ekici, 2020). It would also become a source of environmental support for the
patient that gives them a sense of security.
Reference
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