Diabetes Type 1 and 2

Diabetes

Introduction

Over than 2 million people in the UK have the condition, and shockingly up to 750,000 more are believed to have it without realising they do. I am going to write about the two main types of diabetes: Type I and Type II. I will research the main causes of these types, the symptoms, how diabetes is tested for, how it’s treated and how genetic engineering is used in the treatment of diabetes. I will also explain about what people think about the treatment of diabetes, showing the ethics of this. I will also put in about the two practical’s we did where we had to test how much diabetes was in the urine. I will show the data and graphs from this experiment. Diabetes is caused by the lack of the hormone insulin. This can result in high levels of glucose in the blood which can lead to coma and death, it cannot be cured but it can be controlled by a sensible diet and daily injections of insulin.

Theory

In this part I will write about Benefits and risks of science, where insulin comes from, where we get it from now, the risks of the rejection from injecting insulin, the benefits and ethical issues to do with this.

After we eat, all the different foods are broken down into sugars in the gut. The main sugar is called glucose. This is absorbed through the gut wall into the bloodstream. Glucose is used by the cells in the body to generate energy. To remain healthy, the blood glucose level should not go too high or too low. So, when the blood glucose begins to rise after we eat, the level of a hormone called insulin should also rise. Insulin makes the cells in the body take glucose into the cells from the bloodstream. Some of the glucose is used by the cells for energy, and some is converted into glycogen or fat which stores energy. When the blood glucose level begins to fall between meals, or when we don’t have any food, the level of insulin falls. Some glycogen or fat is then broken down back into glucose and some is released back into the bloodstream to keep the blood glucose level normal. Diabetes develops if the body doesn’t make enough insulin, or if the insulin in the body doesn’t work properly on the body's cells.

Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually first develops in children or young adults. In the UK about 1 in 300 people develops type 1 diabetes at some stage. With this diabetes the illness usually develops quite quickly, over days or weeks, as the pancreas stops making insulin. It is treated with insulin injections and a healthy diet. In most cases, type 1 diabetes is thought to be an autoimmune disease. The immune system normally makes antibodies to attack bacteria, viruses, and other germs. In autoimmune diseases the immune system makes antibodies against part or parts of the body, which means that the antibodies made attach to the cells in the pancreas. These are thought to destroy the cells that make insulin. It is thought that something triggers the immune system to make these antibodies. The trigger is unknown, but a popular theory is that a virus triggers the immune system to make these antibodies. Rarely, type 1 diabetes could occur due to other causes like a severe inflammation of the pancreas, or surgical removal of the pancreas for various reasons. The symptoms that usually occur when you first develop type 1 diabetes are: You are very thirsty a lot of the time; you pass a lot of urine, tiredness, weight loss, and generally feeling unwell. These symptoms tend to develop quite quickly, after treatment is started, the symptoms soon settle and go. However, without treatment, the blood glucose level becomes very high and acids form in the bloodstream called ketosis. If this continues you will become dehydrated, and are likely to get into a coma and die. Type 1 diabetes can be inherited although it is not an inherited disease, there is some genetic factor. Someone who is a relative (which ca be sister, brother, son, daughter) with type 1 diabetes could give you a 6 in 100 chance of developing type 1 diabetes. This is higher than the chance of the general population, which is about 1 in 300. This is probably because certain people are more likely to develop an autoimmune disease such as diabetes, and this is because to their genetic make-up, which is inherited.

Type 1 diabetes is treated by regular injections of insulin; these are given daily or several times a day, depending on the type of insulin used. This involves injecting insulin under the skin in the fat for it to get absorbed into the blood stream where it can then access all the cells of the body that require it. Insulin cannot be taken as a pill because the juices in the stomach would destroy the insulin before it could work. Even if it did make it through the stomach, the digestive enzymes secreted by the digestive part of the pancreas would digest the insulin protein molecule. Scientists are looking for new ways to give insulin. But at the moment, injections are the most widely used method. Although in spite of this too much insulin can make the blood glucose level go too low and give you hypoglycemia which is sometimes called a hypo. This can cause the feeling of sweatiness, confusion, and ill, and there is also the chance of going into a coma. Emergency treatment of hypoglycemia is with sugar, sweet drinks, or a glucagon injection a hormone which has the opposite effect to insulin. Then eating something starchy like bread or something with carbohydrates could also help. The person also needs to be staying physically active and getting plenty of exercise, maintaining a steady weight and eating a proper diet containing a controlled amount of carbohydrates. Treatment for diabetes depends on the individual. It starts the first time they are given an insulin injection, and continues through starting an exercise programme and eating the right types and amounts of food.

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Type 2 usually develops after the age of 40 but sometimes it occurs in younger people. It is more common in people who are overweight or obese. With type 2 diabetes, the illness and symptoms tend to develop gradually over weeks or months. This is because with this diabetes you still make insulin (unlike type 1 diabetes). However, you either do not make enough for your body`s needs, or the cells in your body are not able to use insulin properly. This can be called insulin resistance. In the UK about 1 in 20 people aged over 65 and around 1 in 5 people over 85 have diabetes. Type 2 diabetes is now becoming more common in children and in young people. The number of people with type 2 diabetes is increasing in the UK, as it is more common in people who are overweight or obese. It also tends to run in families. It is around five times more common in South Asian and African-Caribbean people for developing the disease before the age of 40. It is estimated that there are around 750,000 people in the UK with type 2 diabetes who do not know that they have the condition. Having a relative with type 2 diabetes, being overweight or obese, having a waist measuring more than 80 cm if you are a woman or more than 94 cm if you are a man, having impaired glucose tolerance which is when your blood glucose levels are higher than normal but not high enough to have diabetes or having diabetes or impaired glucose tolerance when you were pregnant could all be risks of getting type 2 diabetes. The symptoms for type 2 diabetes are the same as type 1 but the difference is that you don’t develop them as quickly as you do for type 2 as it could take up to 6 months for the symptoms to develop. Some people also develop blurred vision and frequent infections, such as recurring thrush. However, some people with type 2 diabetes do not have any symptoms if the blood glucose level is not too high. But even if there aren’t any symptoms, you should still get treatment to reduce the risk of developing complications.

The treatment for type 2 diabetes is most importantly the change in lifestyle. Eat a healthy and balanced diet. Diabetic foods still raise blood glucose levels, contain just as much fat and calories and are usually more expensive than non-diabetic foods. Basically, the diabetic should aim to eat a diet low in fat, salt and sugar and high in fibre and with plenty of fruit and vegetables. If the person is overweight/obese then they need to lose weight. Losing some weight if you are obese or overweight will not only help to reduce your blood glucose level but it will also have other health benefits too. Exercise can also help it is advised that they do 30 minutes a day 5 times a week and something that gets you out of breathe and sweaty. There are also various drugs that can be used that can reduce the blood glucose level. Different ones suit different people. It is fairly common to need a combination of drugs to control your blood glucose level. Some drugs work by helping insulin to work better on the body's cells. Some work by boosting the amount of insulin made by the pancreas. Other types work by slowing down the absorption of glucose from the gut. There is also a type which suppresses a hormone called glucagon, which is released into the bloodstream by the pancreas and stops insulin from working. Insulin can also be taken in addition to the medication. The complications with type 2 diabetes is similar to type 1 diabetes but hypoglycemia can’t happen if treated with diet alone.

To test for diabetes you have to take a simple dipstick test can detect glucose in a sample of urine. This may suggest the diagnosis of diabetes. However, the only way to confirm that you have the disease is to have a blood test to look at the level of glucose in your blood. If this is high then it will confirm that you have diabetes. Some people have to have to take two samples of blood and they may also be asked to fast which is to have nothing to eat or drink, other than water, from midnight before the blood test is performed.

The first successful insulin preparations came from cows and then later pigs. The pancreatic stuff and the insulin protein contained within them were bought from animals slaughtered for food in a similar but more complex than used by a doctor or medical student. The cow and pig insulin were purified, bottled, and sold. Pig and cow insulin worked very well and they still do, for the vast majority of patients using it, but some people could have developed an allergy or other types of reactions to the protein which is not native to humans. In the 1980's technology had advanced to the point where we could make human insulin. The advantage would be that human insulin would have a much lower chance of getting a reaction because it is not a protein from something that is different to humans. The technology which made this possible was the development of combaining DNA techniques. Which simply means that the human gene which codes in the insulin protein was copied/cloned and then they put it inside of bacteria. Lots of things were performed on this gene to make the bacteria want to use it to constantly make insulin. Big vats of bacteria now make tons of human insulin, so this can make pure human insulin. This is called genetic engineering.

Until the 1980s, all insulin was extracted from the pancreases of cattle and pigs. The sequence of amino acids (the building blocks that make up the protein) is slightly different in insulins from the different species. When it is compared to human insulin, the pig insulin has one different amino acid and the cow insulin three different amino acids. These very slight differences do not affect the way in which the insulin works inside the human body. Pig insulin is structurally closer to human insulin than is cow insulin. These days, animal insulins are made from highly purified pancreas extracts and are marketed as 'natural' insulins. The risks of injecting pig or cow insulin is the rejection or allergic reactions. There are some people that are affected in a specific area, such as rashes at the injection site, so they are trying to get rid o the harmful bacteria to help lower the affect of rejection insulins by doing this it will reduce some allergic reactions to about 2-3% of people treated with pork or cow insulin. There are also some people that are affected around the whole body but these reactions are classed as very rare and can occur at the start of insulin treatment or many years after. In these sorts of cases the allergy is usually due to the insulin molecule itself rather than additives. Using cow and pig insulin can also bring many ethical issues to do with many religions and vegetarians. In Hinduism the cow is known as sacred and they worship it, the cow is so very important in the religion that it is illegal to kill cows in most of India. So this may create problems for anyone with diabetes in India that needs animal insulin though there is the alternative of pig insulin. Eating pork in Islam is also forbidden as they believe it is a filthy animal, and although they do not eat it and think of it in a bad way they cannot harm it s they believe that god created all animals for a purpose. So they can’t inject insulin because they know that the animal has been slaughtered for the purpose of insulin, so they know it has been harmed. Vegetarians and Buddhists are also against this as they believe that a plant-based vegetarian diet is healthier and can prevent diseases. As most vegetarians have reduced risk of heart disease, obesity, colon cancer, Type 2 diabetes, osteoporosis, gout, gallstones, kidney stones, lung cancer, and breast cancer. A low fat vegetarian diet, combined with regular exercise, helps reduce blood pressure and can control, or even eliminate, non-insulin dependent diabetes. So because of this they believe that there is no need for using cow or pig for insulin.

Genetic engineered insulin is good as it is made to ensure that there is enough insulin for all who need it. The insulin produced by genetic engineering is identical to human insulin which is an added advantage of this process. Researchers found the part of a human chromosome that has the gene for making insulin. Then they carefully cut out the gene using a restriction enzyme and put it into some bacterial DNA. Afterwards this DNA is put into a new bacterium. The bacterium then grows and multiplies to produce very large numbers of bacteria each with the insulin making gene inside, so this large number of bacteria could make a large amounts of insulin. One advantages of genetic engineered insulin is that there won’t be any more problems with the animal cruelty so strict vegetarians can use it because no animals are involved and human insulin does not violate religious beliefs the way that animal products did. . With the help of genetic engineering, human genes could be transferred into other mammals for the production of insulin. The mammals like sheep and goat are used as a medium with human genes acting as the 'software' or the 'brain' containing the necessary genetic information to produce insulin. But there is also a down side of using genetic engineering for insulin as there can be some allergic reactions. The most common is an immediate hypersensitive reaction. The symptoms vary in this and it start at the where the injection was with swelling, redness and itching but they may progress to the rest of the body. This reaction can be very difficult and even life threatening. The main reaction is described as reaction which tends to inflate under the skin which develops 30 minutes to 6 hours after an insulin injection. Inflammations of the lymph glands, a serum sickness and muscle pains have all been a reaction. There is another reaction which is a delayed allergic reaction which usually occurs when the insulin contains zinc. Although the problem with cow and pig insulin is more or less solved with genetic engineering there are some people who are against it and think it is un-natural. Or less solved with genetic engineering there are some people who are against it and think it is un-natural. They think this because it is thought that it is decreasing the value of human and animal life as everything can be made the scientific way by just producing genes instead of getting it from an animal and not making things like they are disposable.

Method

In school we did two practicals on testing how much glucose is in the urine as the presence of glucose in urine is one of the first signs of diabetes. In the first practical we were given 5 samples of urine to test this was a clinistix qualitative test which means that we knew if there was glucose in the urine but we didn’t know how much. We made this test valid because the independent variable was the urine. We also used a fresh pipette for each solution as if we used the same one then we would have mixed the samples and then it wouldn’t be reliable, we had also repeated the test to make sure there wasn’t any anomalous results; we also made sure that we didn’t touch the end bit of the chemical on the clinistix so that wouldn’t mess with the results.

Apparatus

5 test tubes
5 samples of ‘urine’ labelled A, B, C, D, E
Clinistix
5 pipettes (fresh one for each solution)

Method

Put 3ml depth of urine A into a test tube.
Dip the bit on the end of a clinistix into the urine, then wait for one minute and then compare it with the colour chart. If glucose is present it will turn purple.
Repeat the same thing with samples B, C and D and E.
Make a note of which samples contain glucose.

The second test we did was a quantative test which means that we were testing to see how much glucose is present in each sample exactly. We used Benedict’s solution to help test this. To make the test fair we used the exact same amount of Benedict’s solution to each sample and for the colorimeter tubes we held it from the cloudy sides so that wouldn’t ruin the results. To make it reliable we repeated the test to make sure we got continues results. Then we made a graph and plotted down the results to see how much percentage of the glucose is in the unknown samples.

Apparatus

8 test tubes
4 samples of unknown urine B, C, D, E
4 samples of known urine 1%, 2%, 4%, 12%
Benedict’s Solution
8 pipettes (fresh one for each solution)
Bunsen burner
Boiling water
Colorimeter
Cloudy colorimeter tubes

Method

Put about 1ml of the known urine sample in a test tube.
Add ten drops of Benedict’s solution to the urine.
Heat the test tube in a boiling water bath on a Bunsen burner.
If the urine contains glucose then it will go yellow, orange or red.
Then repeat this with the rest of the known and unknown samples.
The put the samples in a special tube with the cloudy bit on the sides (make sure to hold it from the cloudy bit)
Then put each sample in the colorimeter, the light should shine through the clear side.
Make note of how much light obsourbant is in the samples.

Data/Results

These are the results to my practials.

The table for the first test:

Clinistix Qualitative Test

This table shows that the urine was present in B, C, D, E but A didn’t have any glucose in it we know this because the clinistix turns purple if there is any glucose although with A 4 people said there wasn’t any glucose and 2 said that there was a small amount of glucose inside it so we do not know exactly if there is or not but we said no because it the majority said there wasn’t any glucose.

This test doesn’t tell us exactly how much glucose is in each sample but it just simply says if t has any in it o not.

This is the graph for the second test

Benedict’s test

On my graph it shows that the 1% had 0 light absorbance, 2% had 0.13 light absorbance, 4% had 0.62 light absorbance and 12% is 0.36 light absorbance. The highest result was 4% which had 0.62 light absorbance and the lowest was 1% which had 0 light absorbance. We found out that as the glucose concentration increases the light absorbance increases however there was an anomalous result which was 12% which had 0.36 light absorbance.

This is the graph for the unknown urine samples:

This shows that urine sample c has the highest glucose concentration which is 5% it light absorbency is 0.7. The lowest glucose concentration is urine sample d which was 0% and the light absorbency is also 0. B had the glucose concentration of 3.5% and the light absorbency is 0.51. E has glucose concentration of 4.7% and the light absorbency is 0.3. This was the same as the other result as the light absorbency goes up so does the glucose concentration.

Evaluation

I could have improved Benedict’s test by repeating the anomalous result which was the glucose concentration of 12% and the light absorbency was 0.36, to make the graph have more of a standard curve. I think that there was an anomalous result for many reasons, one of them is that we might have not read the colorimeter properly and we might have touched the bit on the colorimeter test tube thing on the clear side which may have had our finger prints on, and so this would mess with the colorimeter. I think next time we should were gloves to help prevent this. I also think that next time we should also repeat the whole test a few times to make sure that our results are right. To make it more valid I would make sure that there was the exact same amount of Benedict’s solution in each urine sample as one might have more than the other and that could get anomalous results as the test is not fair. Another thing we could do is make sure that we boil all the test tubes for the same time as we boiled one for about three minutes and another for about five minutes we probably didn’t know if there was glucose in it because we didn’t let it boil for enough time or we let it boil for too long as one of them had turned brown and another was green so I think this could help quite a lot with improving the experiment. I think to extend the practical next time we should test urine with no glucose inside it and see what the light absorbency is for that and compare it with the urine with glucose inside it. This would be good as we would know what the light absorbency would be with people who do have diabetes and people who don’t. I think we could also do a test for people with diabetes type 1 and diabetes type 2 and compare the differences between the two as you never know there might be great differences between them and it may also work to help from keeping the disease from getting worse. Hopefully if I do things in the next experiment then it would have improved and I wouldn’t get any anomalous results.

Conclusion

The first experiment showed that b,c,d,e had glucose in this is because a normal person’s urine wouldn’t have any glucose in because the body absorbs it but when somebody is a diabetic they need to get rid of glucose someway so it gets rid of it in the urine. In the samples in the second experiment if the urine had glucose in they went either yellow orange or red, depending on the concentration of glucose. In conclusion I think that diabetes is becoming a big problem, especially as obesity is the leading cause of it and although type 1 diabetes is more common with children, the number of kids with type 2 diabetes is increasing every year because of obesity. Obesity is when a person is 15kg or more over weight. So I think that people and kids being healthier could reduce the type 2 diabetes rapidly. In a BBC article it said that 45% of type 2 newly diabetes incidents is in children this is probably because more children are sat in front of the TV or on computer games eating junk food rather than being outside getting exercise. As I said before about vegetarians I think they had a point as them not eating meat (most of the junk food is meat example, burgers, fried chicken ext) this makes them healthy and reduces possibility of getting diabetes, so what I’m saying is not that everyone turns into vegetarians but they think more about what they eat. I also think that there will always be a problem of where insulin comes from, as when it comes from pigs or cows there religions and vegetarians that always have a say about how its cruelty or something to do with that. Also when the insulin is genetically engineered people say that it is unnatural and how that it has lowered the purpose of animals and humans, I think that this debate will continue for a long time and there will never be an end to it as people will always have different opinions. I think that all these things should be taken into account as we should respect what people think I also think that to all children who are obese for them to be at more of a healthier weight so there is less chance for them to get diabetes.

Bibliography

en.wikipedia.org/wiki/Diabetes_mellitus

www.patient.co.uk ›

hcd2.bupa.co.uk/fact_sheets/html/diabetes2.html

en.wikipedia.org/wiki/Human_genetic_engineering

GCSE Core book- Pages 72-73

GCSE Extension book- Pages 24-27

Worksheet B1b.3.a

GCSE Biology edexel 360 science pg 26