Diabetes a Global Challenge ,week (1-12) All Quiz Answers with Assignments.

Diabetes  a Global Challenge

week 12 Assignment 1 :

Assignment: http://www.nature.com/ijo/journal/vaop/ncurrent/full/ijo2014177a.html

Iepsen et al investigated the effects of a glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1RA) in 52 healthy obese subjects.After a diet-induced weight loss (12%) the subjects were randomized to treatment with or without the GLP-1RA and followed subsequently for 12 months. The authors found that subjects who received GLP-1RA treatment maintained their reduction in fasting glucose in contrast to the control subjects, where the fasting glucose levels in the controls increased to the level before weight loss even though the weight loss was maintained with low calorie diet meal replacements.

- Discuss the results of the study and how this can be relevant in relation to obesity and type 2 diabetes?

- Discuss shortly the possible mechanism underlying these effects

Diabetes and Stress: A Review

Stress is a part and parcel of modern-day life. Stressors may be internal and external. Our body responds to stress either as fight or flight response and repeated stress may lead to failing rheostat phenomenon of hypothalamus leading to less efficient hormonal control through feed-backs. This leads to various changes in body functioning at various levels like cellular, organic or systemic and finally leads to various diseases. Diabetes may be an outcome of stress and further sets in a vicious cycle of
stress-diabetes relationship. Stress coping mechanisms are many and it depends on resources available with a wide range of personal variations.

Stress and Diabetes

There is no evidence that stress causes diabetes. However, stress may sometimes unmask diabetes, by causing blood glucose levels to rise (Kahn and Weir, 1996). This is often seen after a heart attack or stroke, where raised blood sugar levels may be encountered for the first time. In people who have diabetes, the fight-or-flight response does not work well. Insulin is not always able to let the extra energy into the cells, so glucose piles up in the blood (ADA, 2007). Making things worse, many
 sources of stress are not short-term threats. For example, it can take many months to recover from surgery. Stress hormones that are designed to deal with short-term danger stay turned on for a long time. As a result, long-term stress can cause long-term high blood sugar levels. Many long-term sources of stress are mental. Like physical stress, mental stress can be short term from taking a test to getting stuck in a traffic jam. It can also be long term, from working for a demanding boss to take care of an 
aging parent. In mental stress, the body pumps out hormones to no avail. Physical stress, such as illness or injury, causes higher blood glucose levels in people with either Type of diabetes. Stress blocks the body from releasing insulin in people with Type 2 diabetes. The diagnosis of diabetes usually comes as a shock and is certainly a stressful time (Wijenaike, 2002; ADA, 2007). Changes in lifestyle including stoppage of smocking, diet and learning to manage injections may all contribute in addition to 
the worry regarding chronic illness (Davis et al., 1999). In people who have diabetes, stress can alter blood sugar levels. It does this in two ways. First, people under stress may not take good care of themselves. People who are anxious are under pressures and may lose appetite and skimp on eating, or reach for not-so healthy quick fixes like candy or chips and sometimes seek refuge in food and drink. This can take the form of chocolates, sweets and crisps, often in between meals. The intake of 
alcohol may be increased. Many people who are under stress turn to food as a source of ‘comfort’. This pattern of ‘comfort eating’ can often play havoc with blood sugar level. Further anxiety leads to less exercise. The results can be disastrous for people with diabetes. They may forget, or not have time, to check their sugar levels or plan good meals. Second, stress hormones may also alter blood sugar levels directly as it antagonizes the action of insulin. While in most people glucose levels go up with 
mental stress, while in others can go down. Diabetic mice under physical or mental stress have elevated glucose levels. The effects in people with Type 1 diabetes are more mixed. People with Type 1 diabetes may develop elevated blood glucose levels and ketoacidosis. Those with Type 2 diabetes usually gain weight and develop obesity and often blood sugar levels are raised (ADA, 2007). Inflammatory signaling pathways can also become activated by metabolic stresses originating from inside
 the cell as well as by extra-cellular signaling molecules. It has been demonstrated that obesity overloads the functional capacity of the endoplasmic reticulum and that this endoplasmic reticulum stress leads to the activation of inflammatory signaling pathways and thus contributes to insulin resistance. Additionally, increased glucose metabolism can lead to a rise in mitochondrial production of reactive oxygen species. Reactive oxygen species production is elevated in obesity, which causes enhanced activation of inflammatory pathways (Wellen and Hotamisligil, 2005). Physical stress, such as illness or injury, causes higher blood sugar levels in people with either type of diabetes. For some people with diabetes, controlling stress with relaxation therapy seems to help. It is more likely to help people with Type 2 diabetes than people with Type 1 diabetes. Stress blocks the body from releasing insulin in people with Type 2 diabetes, so cutting stress may be more helpful for these people. People with Type 1 diabetes do not make insulin, so stress reduction does not have this effect. Reducing stress can help people with Type 1 diabetes take better care of them. Some people with Type 2 diabetes may also be more sensitive to some of the stress hormones. Relaxing can help by blunting this sensitivity. In people with Type 2 diabetes, mental stress often raises blood glucose levels. It is easy to find out whether mental stress affects glucose control. Many glucose meters have the capability to enter personal notes and data when one performs checks, or jot it down in a stress journal (Wijenaike, 2002). Once one begins recording stress levels, most people with diabetes figure out pretty quickly what makes his blood sugar to go up. People with diabetes should stay conscious of eating well and exercising regularly. It’s a good idea to check blood glucose levels more frequently when ill or under stress and to drink plenty of fluids as so as not to get dehydrated. Something else that affects peoples responses to stress coping style. Coping style is how a person deals with stress. People who use them tend to have less blood sugar elevation in response to mental stress (ADA, 2007). Hyperglycemia induces the overproduction of oxygen free radicals and consequently increases the protein oxidation and lipid oxidation. A significance difference in the mean plasma concentration of total antioxidant status was observed in diabetic patients. A statistically significant higher values of protein carbonyl groups and MDA as lipid peroxides were observed in diabetic patients with slight reduction in the synthesis of nitric oxide. It is interesting to note that there was a decrease in the antioxidant levels with corresponding increased protein and lipid oxidation. Decreased levels of proteins - albumin, transferrin, ceruloplasmin and heptoglobulins and variable GC globulin fractions in diabetes were found compared to normal healthy controls (Vadde and Jailkhani, 2007).


It’s hard to dispute that most of us live life at breakneck speed. Stress is a feeling that’s created when one reacts to particular events. It’s the body’s way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina, and heightened alertness. The events that provoke stress are called stressors, and they cover a whole range of situations- physical, like injury or illness. Or they can be mental, like problems in marriage, job, health, or finances.The body gears up to take action in response to stress. This preparation is called the fight or flight response. In the fight or flight response, levels of many hormones like catecholamines, cortisol and growth hormone shoot up. Their net effect is to make a lot of stored energy, glucose and fat available to cells. Insulin is not always able to let the extra energy into the cells, so glucose piles up in the blood. These results in increase propensity of various diseases and diabetes may be an outcome of stress, which further sets in a vicious cycle of stress-diabetes relationship. The most helpful method of dealing with stress is learning how to manage the stress that comes along with any new challenge, good or bad. Stress-management skills work best when they’re used regularly, not just when the pressure’s on. Knowing how to “de-stress” and doing it when things are relatively calm can help one get through challenging circumstances that may arise.

Psycho social work stress has been linked to higher risk of type 2 diabetes (T2DM), with the effect being consistently higher among women than men. Also, work stress has been linked to prospective weight gain among obese men but weight loss among lean men. Stress is a potential contributor to chronic hyperglycemia in diabetes. Stress has long been shown to have major effects  on metabolic activity.

Week 12 Assignment 2 :

1.American Diabetes Association. Official Home Page of American Diabetes Association. 2007. How       Stress Affects Diabetes.  Retrieved on 14. 2. 2007 from http://www.diabetes.org/type-1-                           diabetes/stress.jsp.

2.Davis, R. M., E. H. Wagner and T. Groves. 1999. “Management of Chronic Diseases.” British                  Medical Journal, 318: 1090-1.

3. Dilman, V. M. 1989. The Grand Biological Clock. Moscow: Mir Publishers.

4. Heiden, M., E. Lyskov, M. Nakata, K. Sahlin, T. Sahlin and M. Barnekow-Bergkvist, M. May 2007. 
  “Evaluation of cognitive behavioural training and physical activity for patients with stress-related            illnesses: a randomized controlled study.” Journal of Rehabilitation Medicine, 39(5): 366-73.

5.Hidaka, O., M. Yanagi and K. Takada. 2004. “Mental Stress-induced Physiological Changes in the          Human Masseter Muscle.” Journal of Dental Research, 83(3): 227-231.

6.Huang, C. Y., V. D. Sousa, H. F. Chen, S. Y. Tu, C. J. Chang and I. J. Pan. 2007. “Stressors,                      depressive symptoms, and learned resourcefulness among Taiwanese adults with diabetes mellitus.”     Research and Theory for Nursing Practice, 21(2): 83-97.

7. Kahn, C. R. and G. C. Weir. (Eds.). 1996. Joslin¢s Diabetes Mellitus. New Delhi: B.I. Waverly Pvt.        Ltd

8.Meadows-Oliver, M., L. S. Sadler, M. K. Swartz and P. Ryan-Krause. 2007. “Sources of stress and          support and maternal  resources of homeless teenage mothers.” Journal of Child and Adolescent              Psychiatric Nursing, 20(2): 116-25.

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