Impact of Type 1 Diabetes on Physical and Mental Health in UK Adults

Introduction:

Type 1 diabetes is defined as the chronic autoimmune condition in which immune cells of body work against insulin-producing Beta cells of Pancreas that is involved in insulin production, thereby enhancing glucose level in blood. This study has selected Diabetes type 1 as health condition and the adults as the client group, to discuss that how Type 1 Diabetes has impacted on the overall physical and mental health of adults in the UK. The reason behind choosing the topic, type 1 diabetes in adults across the UK is to describe that how majority of the adults in the UK are prevalent to and suffered from Type 1 Diabetes, by evaluating its deadly impact on their overall biological system. In addition to this, this assignment is going to highlight the link of type 1 diabetes with the abnormal homeostatic condition in body. The assignment will also determine as well as evaluate the link between Type 1 diabetes and community acquired pneumonia. Through using relevant resources, this assignment is going to evaluate the psychosocial factors of this chronic health condition, in which the assignment will discuss how type 1 diabetes is linked to different psychological and social aspects. The assignment will also discuss the pharmacology and clinical intervention for treatment and management of this disease. In addition to this, the study will also discus the treatment initiatives taken by the NICE in improvising clinical management and treatment process for this disease. Finally, the study will conclude the main aspects reading diabetes type 1 that are analysed and depicted in the study.

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Fact and statistics:

Type 1 diabetes is the autoimmune disease in which immune system of body destroys Beta cells of Pancreas (Thomas et al. 2018). Beta cells of Pancreas produce Insulin hormone which is involved in allowing glucose to be absorbed by muscles cells and adipose tissues, thereby maintaining proper balance of glucose level into blood. In pancreas there are two types of cells in the islets of Langerhans region. Both the alpha and beta cells are endocrine cells which are involved in production two different hormones such as glucagon and insulin respectively. As mentioned by Baxter et al. (2016), alpha cells produce glucagon which is involved in glucogenesis, the production of glucose from glycogen and enhance the glucose level in blood. On the contrary insulin work on the blood glucose to allow the muscles and adipose tissues cells into blood and absorb the extra glucose thereby maintaining the prefect balance of glucose in blood. In this context Al‐Qaissi et al. (2019) mentioned by , in adult people the unhealthy food habits and irregular life style are involved in disruption of Beta cells by body’s immune system which leads to poor or no absorption of extra glucose in blood that is produced by produces by glucagon, thereby increasing glucose level in the blood than normal ranges, that leads to occurrence of Type 1 diabetes.

As mentioned by Chatterjee et al. (2018), in the UK, along with children, adults are also quite vulnerable to this long-term health condition, that not only impact on health and wellbeing of adult population, but also makes potential changes in their food habits, lifestyles and regular activities. From the report of National Institute of Care and Excellence [NICE], it is shown that, in the UK, more than 370,000 adults are affected by the Type 1 diabetes [NICE, 2020]. The statistical figure represents that more than 10% of adult population across the UK suffer from Type 1 diabetes, due to disruption of insulin producing Beta cells in their pancreas. As mentioned by Thomas et al. (2018), Type 1 diabetes is highly common in adults and young people because of their irregular lifestyles, unhealthy food habits, lack of sufficient rest and sleep and lack of proper exercise which make adverse changes in immune system. Recent clinical database of WHO, has shown that, more than 85% of the adults in the UK who are affected by Type 1 diabetes have no family history of this chronic condition (Abbasi et al. 2017). Although there is increasing number of adults in the UK in their recent years who are highly prevalent towards Type 1 diabetes, children are the most vulnerable and affected clinical group in UK as compared to adults, due to the irregular as well as unhealthy food habits. The report published by NICE has shown that, there is increasing rate Type 1 diabetes prevalence for adult population in England and wales with the estimation of more than 187 adults per 1000,0012 individuals are affected by this chronic condition [NICE, 2010]. In addition to this, NICE database also suggests that among the half of the newly released cases off Type 1 diabetes in the UK, there are majority of population who have poor insulin production by their Beta calls with increases the blood glucose level.

Homeostasis and its link with the type 1 diabetes:

Homeostasis had been first discussed and as well as depicted by Claude Bernard, the French psychologist. Homeostasis is defined as the self-regulatory process, in which internal chemical and physiological variables that interact with one another to maintain a balance states in response to the changes in external environment (Choudhary et al. 2018). Homeostasis is crucial biological system which is important for any organism to survive in any kind of environment. Homeostasis can be mentioned as the process through which an organism can make a balanced situation by using internal variables inside the body in terms of assisting the organism to cope up with the changes in externa environment. Evidence-based researches have suggested that, nervous system and endocrine system is involved in maintaining homeostasis. According to Bravis et al. (2018), homeostasis can be maintained through controlling as well as adjusting the number of variables inside the body such as blood glucose, Blood ph and body temperature. During homeostasis, body controls fluid balance by maintaining perfect concentration of potassium, sodium and calcium ions inside the body. Three different elements within body are associated with managing homeostasis, such as receptor, control centre and effector. Receptor receives the sensation of changes occurs in external environment which then is transferred to the control centre (Abbasi et al. 2017). The control centre is also called integration centre in which the information received from receptors is possessed. After that the processed information is sent to effector which is associated with initiating proper action in terms of preparing body to cope up with the changes in external environment. Endocrines glands play important roles in maintaining body homeostasis. In case of adult population suffering from type 1 diabetes, there is poor or lack of production of insulin hormone that is unable to allow muscle and adipose tissue cells to absorb extra glucose in blood cells, thereby making the body unable to maintain homeostatic condition.

Homeostasis

Glucose homeostasis:

Glucose homeostasis is the condition in which body maintains balanced state or normal range of glucose in blood stream. As mentioned by England et al. (2017), glucose is used in body as a sources of energy production which is important for regulation of biological functions and activities of body. During homeostatic condition, human body has normal range of glucose in bloodstream (100mg/dl in fasting and 140mg/dl after two hours of taking food). If the blood glucose enhances than the normal range, body starts doing some adjustment of internal variables inside the body in terms of maintaining the normal blood glucose range. In normal people (who are non-diabetic), the sensation of rising blood glucose level is transferred to the brain via nerve cells receptors, which then triggers the effectors that located on the outer wall of pancreas to make necessary changes in endocrine system. In response to the information received from brain, Beta cells located in the Islets of Langerhans area of pancreas are activated. As mentioned by Choudhary et al. (2018), beta cells are involved in production on sufficient amount of insulin. After producing enough amount of Insulin hormone, the hormone now works work on additional blood glucose in blood stream and instigate the muscle and adipose tissues cells to absorb extra glucose to maintain balanced state of glucose into blood stream. In this context Bain et al. (2020) mentioned that, in case of adults with Type 1 diabetes, there is poor or lack of production of sufficient insulin hormone by Beta cells of pancreas which leads to poor absorption of glucose by muscle cells and thereby increasing the kevel glucose into blood stream. During absorption of glucose by muscle and tissues cells, insulin convert the glucose into glycogen which is then stored into these cells for future use (especially future energy reduction). For example, after absorption of extra blood glucose by adipose tissues in Liver, glycogen is produced from the glucose by insulin hormone which is them stored in these tissues.

On the other hand, if blood glucose level is reduced from the normal ranges, then Alpha cells situated in Islets of Langerhans region in pancreas are activated. Then the cells produce sufficient amount of glucagon hormone. As mentioned by Choudhary et al. (2018), glucagon hormone works on opposite direction as that of insulin hormone in terms of enhancing level of glucose into blood stream for maintaining glucose homeostasis inside the body. Here the glucagon, acts on muscle and adipose tissue cells to convert glycogens stored into these cells into glucose which then again goes to the blood stream, thereby maintaining normal range of blood sugar again.

Glucose homeostasis

In case of Type 1 diabetes adults:

In case of type 1 diabetic adults, the entire glucose homeostatic process is disrupted due to insufficient production and release of insulin hormone from the Beta cells of pancreas. As mentioned by Sinclair et al. (2020), although the exact causes of type 1 diabetes are unknown as well as obscure to the doctors, it is considered by many researchers that, exposure to environmental factors as well as viruses and genetical reason are associated with type 1 diabetic condition in people. In this autoimmune chronic condition, body’s immune system disrupts the Beta cells of pancreas which is then unable to produce proper amount of insulin that is required for maintaining proper balance in blood glucose level in human body. In the context Evans‐Cheung et al. (2018) argued that, it is not like that all time there will be insufficient production of insulin hormone by the Beta cells of pancreas in type 1 diabetic condition, rather sometimes the disruption of Beta cells by body immune system is so severe that there is no production of insulin by the cells. Therefore, due to the inability of beta cells to produce proper amount insulin hormone, when blood sugar increases in Type 1 diabetic adults, there is poor or lack of absorption of additional glucose from blood stream by muscle and adipose tissues cells. Due to lack of sufficient insulin hormone, additional glucose cannot not be converted into glycogen which thereby enhancing blood sugar level.

Type 1 diabetes

Psychosocial factors:

There are many psychosocial factors that are associated with developing provenance of Type 1 Diabetes in adult people across the UK. As mentioned by Oram et al. (2016), common psychosocial factors that are linked to the diabetic condition of adult population in community are social position, unemployment, job stress, depression, social perception and attitudes, lack of education and low social support. In the UK, large number of adults are affected by Type 1 diabetes (nearly 10 % of the entire adult population). Although the actual causes od Type 1 diabetes are still unknown and obscure to the researches as well aa doctors, different biological, environmental and genetic processes are considered to be linked to the occurrence of this chronic condition. Following are the psychosocial factors that are associated with occurrence of this chronic condition into adult population across the UK.

Social position:

Social position is one the most common psychosocial factors that is considered to be linked to the occurrences of Type 1 diabetes in adult population (Gordon et al. 2018.). Evidence-based studies have shown that, there are many adult populations who resides in the economically lower social class that impact on social, demographic, governmental and healthcare opportunities. As mentioned by England et al. (2017), adults belonging to the poor social class are generally devoid of proper educational, job opportunities and healthcare facilities due to lack of economic strength, which impact on their food habit and lifestyles, that can have strong impact on biological system and genetic factors associated with maintaining the glucose level in blood. Evidence based studies have shown that, while evaluating the overall psychosocial background of adults are affected by the Type 1 diabetes, it is seen hat, majority of them belong to economically backward social class that makes them devoid of proper healthcare, housing a and employment facilities. On the contrary Oram et al. (2016) argued that, although there is relation between poor social class and occurrences of diabetic condition in people, in many cases of adult population in the UK, the individual belongs to higher social class with better education, strong economic support and good designation inn the professional field. In the UK, social class is strongly connected to the psychology, behaviour and perception of people residing in this country. Although there are some cases of which adult population despite belonging to the higher social class is affected by Type 1 diabetes, it is acknowledged that majority of the Type 1 diabetes cases in adult population in UK is reported from the lower and economically downward community. As mentioned by (majority of the adult population in the UK are sufferer of social isolation, bullying and discrimination in their professional and personal life which not only impact on their mental status but also can make some changes in their biological system. Clinical intervention regarding the Type 1 diabetes, have stated that, level of depression and psychological distress is associated indirectly with initiating potential changes in glucose homeostatic condition by affecting the production of Insulin hormone by the Beta cells Dyson et al. (2018). There’re, it can be stated that, although there is many criticism regarding acknowledging the link between social class and Type 1 diabetes, t need to stated that poor social class has potential impact on psychology and attitude which in turn make potential changes in the biological factors that is associated with marinating glucose homeostasis.

Job stress:

Job stress can also be considered by many psychologists as one of the common reasons behind occurrence of Type 1 diabetes in adults in the UK. Due to increasing number of competitions in the job market across the UK, majority of the adult individuals struggle for maintaining sustainability of their job designation in the offices. As mentioned by Gordon et al. (2018), in the highly competitive job market of UK, majority of adult individuals suffer from high level of depression and psychological stress. Many evidence reports have stated that, depression and poor mental states are associated with making potential changes in et biological and genetic system of individual. Many studies have shown that, diagnosis and clinical intervention of diabetic condition in a adult in UK, it is seen that they suffer from high level of depression and mood swing. As argued that, Leslie and Lernmark (2018) there are many cases of Type 1 diabetes condition in which the adults cannot have any type of job stress and depression in professional field. However, it is evident from researches that, majority of adult population residing in poor poor social class and economically lower social class struggle for attaining good designation in their professional field. The depression coming from inability to get a good job position or excess job stress pose adverse impact on overall physical and mental condition of people which can indirectly affect their blood sugar level.

Analysis:

While it comes to analyse the overall topic, Type 1 diabetes in adult population across the UK, it is important to evaluate that why adult population in UK is affected by and prevalent to the Type 1 diabetic condition. Evidences based studied have suggested that, there may be some common reasons behind increasing rate of Type 1 diabetes in adult population across the UK such as irregular life styles, unhealthy food habits, eating disorders and lack of exercise. In this context Macfarlane and Dhatariya (2019) mentioned that, Type 1 diabetes is associated with adverse changes in body’s immune system which then triggers the lower or no production of insulin by Beta cells. Although the overall reason behind Type 1 diabetes is obscure to healthier professionals it is stated that, poor food habits, irregular life styles and unhealthy eating choices can damage the entire immune system of body. In the UK, there are lots of adult individuals who suffer from eating disorder due to job stress, extreme wish to be slim, poor healthcare facilities and lack of family as well as social support, which can make potential changes in variables inside the body that regulate the entire immune system, thereby enhancing the chances of occurring autoimmune diseases such as Type 1 diabetes. On the contrary Choudhary et al. (2018), although there is connection between psychological condition and occurrences of Type 1 diabetes, many evidence-based studied have strongly suggested that, genetic and hereditary factors are also linked to developing Type 1 diabetes in next generation. Recent studies on Type 1 diabetes in UK adults have suggested that, majority of adult population in the UK who are highly prevenient to Type 1 diabetic condition, there is no family history of having this chronic disease. In addition to this, clinical trial of appropriate drug on conducted on randomly selected adult population group in the UK have shown that, in case of majority of adults affected by this chronic condition there is high level of psychological distress and depression due to poor social support, lack of intended job designation, poverty and social isolation (Leslie and Lernmark, 2018). On the other hand, as compared to the other group of population in UK such as children, middle age and older people, the adult population have more stubborn attitude and negligence regarding their eating process, life styles and food choices which not only impact on their overall biological conduction but also sometimes makes genetic changes that can make adverse alteration in body’s immune system, thereby enhancing their prevalence to Type 1 diabetes. As argued by Macfarlane and Dhatariya (2019), not only the job stress and social isolation, there are some poor habits and malpractices in adult population of UK such as smoking, alcohol and drug addiction which has direct impact one the activities of pancreas. For example, it is evident that, high level of smoking and alcohol consumption can make infection on both the inner and outer wall of pancreas which is known as pancreatitis, in which there is severe disruption of Insulin producing Beta cells, thereby enhancing prevalence of patient to Type 1 diabetes.

Intervention:

Different initiatives are taken by NHS in terms of supporting adults as well as other age group people to get rid of Type 1 diabetic condition.

Diabetes education:

Diabetes education is the free course conducted by the Public Health England (PHE), National Health Service (NHS) and Department of Health (DOH) for people suffering from type 1 and type 2 diabetes. This education programme makes it easier for people to live with diabetes. As mentioned by Leslie and Lernmark (2018), diabetes education is one of the most important and effective programmer in many countries which has reduced the prevalence of type 1 and type 2 diabetes in the community. This program is highly effective for adult population across the UK, who suffer from Type 1 Diabetes and also who are prevalent to this chronic disease. The higher health professional and healthcare acts and nurse of NHS are invited in this programme as the mentors and coach who provide information regarding the symptoms, cause and home treatment of type 1 and type 2 diabetes. In addition to this, the education program also highly effective for adult population to guide them regarding selection of right food and dietary plan, do proper exercise and lie healthy life.

National NHS Diabetes Prevention Programme:

This programmed is arranged by PHE, Diabetes UK and NHS, with the intention of reducing prevalence and attack of Type 1 as well as Type 2 diabetes in the UK. This programme is involved in conduiting health promotion on the entire community by developing their concern about adverse impact of diabetes on overall mental and physical health. In addition to this the programme is involvement in empowerment of adult population by providing proper education, health literacy and knowledge regarding management and prevention of diabetes condition. In case of adults in the UK who suffer from Type 1 diabetes, the program is highly helpful in gaining proper knowledge regarding how to manage diabetic condition by using home remedy. National NHS Diabetes Prevention Programme is also intended to improve the overall living standard, healthcare support, social facilities and healthcare and government advantages for adults residing in the economically backward community to improve their living standard that can improve their health and wellbeing. The programme is also involved in providing proper training and education to adults and young population in terms of improving their physical and mental health through regular exercise which can reduce the prevalence to diabetic condition.

Pharmacology:

NICE has recommended Dapagliflozin, which is marketed as Forxiza, for treatment of Type 1 diabetic condition in adult to older people. This drug is clinically proved to be highly effective in reducing blood glucose level. Here the drug is involved in allowing kidney to remove the additional amount of sugar from blood, which is then passes out of the body through urination.

NICE has recommended that Dapagliflozin is can b given as replacement of insulin in terms of reducing blood glucose. In addition to this, NICE also suggested that, although this drug is used as the replacement of insulin it can also be used along with insulin if some criteria are considered such as body mass of patient, age of patient and appropriate dose of insulin and Dapagliflozin. NICE has stated that, Dapagliflozin can be used in the adult who has the body mass 27kg/m2 or above and has Type 1 diabetes with high sugar level.

Dosage:

In Type 1 diabetes patient the correct dosage of Dapagliflozin is 5 mg orally once in day (medicinenet.com, 2020)

If the blood sugar cannot reduce through the lower dose then 10 mg per day is recommended for patient. In this context health professions check whether the lower dosage is tolerable in the patient. If it is tolerable then only the higher dose of Dapagliflozin is given to the patient

Side effects:

Side effects of Dapagliflozin in type 1 diabetic adults are as follows:

Urinary Tract infection

Nasopharyngitis (respiratory tract infection)

Vaginal infection and yeast infection in penis

Changes in urination (endocrinologyadvisor.com, 2020)

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Conclusion:

From the above-mentioned discussion iv can concluded that, type 1 diabetes is the auto immune disease, which occurs when there is lower or no production of insulin by Beta cells of pancreas. In UK adult population is highly prevalent to Type 1 diabetes condition due to their irregular food habits, poor social as well as family support, smoking and alcohol addiction and eating disorders. NHS has conducted Diabetes Prevention Programme is proved to be helpful for adult population in UH who suffer from type 1 diabetic condition. NICE recommend Dapagliflozin for successful treatment of type 1 diabetes in adjust and young people.

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