What is diabetes

What is diabetes, and why is it on the rise for adults
Diabetes is a chronic disease that can affect the blood sugar levels of a person, which can cause life-long problems to the individual’s blood vessels and nerves (2017). This disease affects the ability of the pancreas to produce insulin. Insulin is a hormone that regulates the control of glucose in the body. Without insulin, glucose would remain in the body, and cause damage to the blood vessels, nerves and have other damages to the body.
The individual diagnosed with diabetes can have the chronic disease in three forms; type 1 diabetes, type 2 diabetes and gestational diabetes. Type 1 diabetes, also known as insulin-dependent, is the types of diabetes were, as the pancreas cannot produce insulin, so the individual has to inject insulin into the body manually. Type 2 diabetes, also known as insulin-resistant, is the type of diabetes that does not use insulin correctly or ineffectively. This is usually a result of physical inactivity and obesity in adults. Type 1 and type 2 diabetes are very similar in affects to the body, and symptoms it poses (2017). The third type of diabetes is gestational diabetes that only happens with women during pregnancy. Their blood glucose levels are above normal range, which may cause problems in delivery such as C-sections and increasing the risk of type 2 diabetes in their children. Of these three types of diabetes, the most common and universal on is type 2 diabetes (2017).
Census of diabetes between the U.S. and Guam
Here are some charts from CDC (2016) that shows the percentages of people who have been diagnosed with diabetes and those who have not for adults in the US.
Table A1
Percentages of adults in the US that have been diagnosed with diabetes by age.
The chart is a statistical show of US adults both diagnosed and undiagnosed with diabetes in 2015. The chart below shows the statistics from 2010. According to this chart, it states that adults 18 and over have 1.5 million new cases arise every year. The chart below is a break down of all the states that have the biggest outbreak of diabetes.
Table A2
Diabetes rates between each state.

According to the chart above, the states with the most prevalent outbreak of diabetes are the lower southern states and Puerto Rico. Now we will see the percentage of diabetes for Guam residents in the chart below.
Table A3
Diabetes rates among adults on Guam according to age and gender.

The chart showcases the statistical report of fiscal years 2014 to 2016. According to the chart obtained from the Guam statistical yearbook 2016, adults age 45-54 and up make 20-29% of those diagnosed with diabetes on Guam for fiscal year 2016.
With the comparison of these two charts, it shows that Guam has a higher prevalence of diabetes than the US. In the 45-64 ranges on both charts, Guam has a 10% higher rate of diabetes than those in the mainland. With the increase of diabetes on Guam, the risk for other chronic diseases also increases as well. Higher prevalence’s of stroke, heart diseases and obesity all come as secondary conditions as a result of prolong diabetes.
Secondary conditions. The US does not shy from those secondary conditions as well. According to World Health Organization(2016) those individuals diagnosed with diabetes also have high risks for hypertension, obesity and physical inactivity. Among 7.2 million of those diagnosed with diabetes, 7.2 million of them were hospitalized (2016). The reasons for the hospitalizations among the age group of 18 and up were heart-related problems. According to WHO (2016), 400,000 young adults were hospitalized for ischemic heart disease and 251,000 young adults were hospitalized due to stroke. 108,000 were also admitted for a lower limb amputation due to their pro-longed diabetes (2016).
Guam’s diabetes rate also has its high prevalence of secondary conditions such as hypertension, obesity and heart diseases. Diabetes also list as the top third main causes of death on Guam, according to Health data(2016). Below is a chart of all the top causes of death on Guam.
Table A4
Ranking of causes of deaths comparison to year 2005 to year 2016.

According to the chart by Health data, diabetes ranks as the third leading cause of death on Guam, compared to it being the fourth leading cause of death back in 2005.
Health determinants of adults with diabetes
Diabetes is a chronic disease that has social factors that may determine being at risk. According to Healthy People 2010, social-economic determinants are what play the main role of an adult being able to maintain a sustainable life. The determinants that define a person’s ability to sustain an enjoyable life after being diagnosed with diabetes are education, economic stability, social and community support, health care and a built environment (Clark, M. et al 2014). All these factors mentioned are the building blocks needed for the quality of life for an individual according to a research conducted by Clark, M. et al(2014).
Table B1
Factors that build the quality of life after being diagnosed with diabetes.

Education. According to WHO(2016), people who attain a higher education that of after high school, are more likely to engage in activities that promote health. Researchers have shown that people with higher education eat healthier foods and exercise regularly to decrease the chances of obesity.
Economic stability. Research has shown people with a degree, a stable job and stable income shows that they have economic status (Clark, M. L, et al 2014). Having this status boost up the individuals moral and makes them improve their health as well. It also places the person above the normal social line and gives the person a sense of peace in the community.
Social and community support. Research shows that adults with social and community support from family and friends, improves health (Clark, M.L, et al 2014). Support from friends and family has been shown to boost up morals of adults with diabetes. They are more eager to improve their health and attend more medical check ups.
Health care. Access to different forms of health care is due to social status as well. Having a higher education and having a good job indicates that you may have good health insurance. Having good health care improves social status and the quality of life you can have after being diagnosed with diabetes (2016).
Built environment. Physical features such as transportation, food insecurity and neighborhood safety play a part in the social status and well-being of an individual (Clark, M.L, et al 2014). Lack of transportation can hinder the person’s resources of health care due to not being able to travel. Food insecurity will cause the individual to not eat all the required nutrients and calories, which may inhibit the individual’s chances of losing weight (Clark, M.L, et al 2014). Neighborhood safety diminishes the opportunity for the person to exercise freely outside.
These social-determinant of diabetes plays a role in how the individual will try to improve the health and well being of themselves. Each one of them plays a part in the well being of the person (Clark, M.L, et al 2014). Those factors even rely on each other for the social status of the person. The social status of a person will determine how the person will sustain life after being diagnosed with diabetes.
Root cause of adult diabetes
As mentioned in the introduction part of the paper, diabetes is split into three types, type I, type II and gestational. The main cause of diabetes is the body’s ability to correctly use or produce insulin. Insulin is what regulates the blood glucose in our bodies, and without insulin, glucose may remain in the blood stream and cause several life-threatening problems (2017). With insulin being main problem of diabetes, it is not the root cause of it. The root cause of diabetes is our diet (2017). The more carbohydrates we consume, the more glucose gets stored in our liver and muscles and the pancreas produces more insulin. With overconsumption of carbohydrates, the glucose maybe stored as fat. That fat will build up causing the individual to be pre-diabetic(2017).
Since the blood sugar will remain in the blood vessels because not enough insulin is produced to regulate it (2017). A way to tackle this situation is control what we are eating. Eating a diet in low-carbs is a great way to start. Our pancreas would be able to produce enough insulin to regulate the blood sugar in our bodies. Fat stores would start to slowly deplete and glucose levels would return to normal. Another way would be to do light exercises such as walking, jogging or going up and down a few staircases. This will help with the weight loss, but at a very slow pace.
Research shows that diabetic adults go to workshops about how to manage their lives. These workshops have been shown to increase the likelihood of losing weight for diabetic adults, and as well as making a nutritional plan for them to follow (Clark M.L et al 2014). Being in these types of workshops increases the social status of the individual because he or she is getting help from people who are in the same situation that wants them to get better.
Table C1
Root analysis chart

Programs facing the problem of diabetes
The most prevalent type of diabetes that is globally known is type II. Many programs around the world are tackling this problem with help from other countries, and implementing laws. According to WHO(2016), organization implemented a healthy diet plan to counter diabetes type II. They believe with proper nutrition and exercise they can lower the risk and prevent diabetes. One of the diet plans is having a high fiber diet to help with weight loss (2017). This type of strategy would make the insulin sensitive to glucose, and thus use insulin in the body more effectively.
Another plan that WHO (2016) has made is instill physical activity to younger people at a very early stage in life. Implementing exercises to children will most likely make them turn it into a habit and continue doing so during adulthood. From then on those children will begin doing eating healthy as well.
Supportive environments for physical activity. World health organization (2016) has developed a plan to make the environment more exercise friendly. They plan to implement more sidewalks for longer walks, and cycling path-ways for bikers. They plan on making the environment safer for outdoor activities, and installing more gyms or recreational centers for physical activities. They also plan on promoting the use of stairs instead of using elevators or escalators. According to World Health Organization (2016), they plan on creating partnerships with other local and non-governmental organizations to help promote fitness and a healthy life style.
Setting-based interventions. This program reaches out to families and communities where people work, eat, study or play and introduce different types of interventions for diabetes(2016). They use their settings and implement interventions that may increase fitness levels and nutrition status of the people, without moving or adding things to their setting. Workplace interventions include the company offering gym vouchers for their employees to use the gym. They also may implement healthy food options in their menus and adding posters and signs to eat healthy foods instead.
Fiscal, legislative and regulatory measures for healthy setting. Prices are often said to be a barrier for people to eat healthy food or maintain a healthy diet. So World Health Organization(2016) is looking into policies to try and decrease the cost of healthy food and try to lower the purchase rate of unhealthy foods. Some states have already implemented the soda tax in order to prevent people from purchasing soda from time to time. This type of fiscal policy should be a key to any major component of any chronic disease (2016). With this policy implemented into work places, it can have a major affect on those working with different. Such as going on lunch break during work, if that individual can only buy a healthy option, they may be able to benefit their health.
Trade and agricultural policy that promote healthy diets. This is one of the most successful ways of preventing an unhealthy diet. The trade and agriculture policy, if implemented, can stop the sell or use of any unhealthy foods sold in a store or restaurant. One example given by the World Health Organization (2016) is that once a restaurant has passed the trades act, they are not longer allowed to sell any food that is high in sugar, salt or trans fatty acids. With this policy, restaurants will have no other choice but to use a different type of ingredient to their dishes, and most of the time they substitute it for a healthier option.
Regulation of marketing of foods in high in sugars, fats and salts. World Health organization’s research about the media influencing young people about what to eat is true. Most young adults or children will eat what they see on the TV. Whether it be promotion of fast food or sugary foods, children will always want to try it. WHO (2016) decided to create a set of regulations and implementing a framework on the marketing of sugary foods. This regulation was the implementation of the nutrition label on those snacks so that people can make a healthy choice to eat the food or not.
Education, social marketing and awareness. World Health organization(2016) is promoting healthy living and physical activity through the use of social media. Using the media will be able to spread healthy living tips and awareness. This process can be very costly and shows the most results. A lot of people are influenced by the media and tend to follow what ever is trending on social media. Once healthy living becomes a trend through social media, people will be able to learn more about healthy living and fitness. Using social media will be able to reach out to the younger generation and educate them on eating healthy and living a physically active life.
Healthy people 2020. Healthy people 2020 has created a one year long plan that focuses on long-term changes and lasting results for people diagnosed with diabetes (2015). Healthy People 2020 have three main objectives to help manage the lifestyle of people with diabetes. The first goal is to have a diabetes class lessons approved by commutable disease control center (2014). During these class sessions, participants are given handouts and exercise plans to follow that will improve their healthy lifestyle and fitness. The second main goal is having a life coach teaching the classes. The coach will be certified in different aspect of health promotions, and will be leading the class in fun and informative lessons. The third main goal of the program is the support group that comes with the program. Everyone in the program all have one common goal to achieve and that is to improve their health and lifestyle. When being surrounded with people that have the same goal of achieving a better life style, the task of leading a healthy lifestyle would be obtainable. Research shows that doing these challenges with other people is way better than doing it by yourself (2014).
Outcomes of the program. Research has shown that people who participated in the program learned better skills at improving their health (2016). The program will teach the participant five things during the program. The first learned aspect of the program is how the participant will learn how to enjoy food without giving up their favorite types of foods (2016). The second learned aspect would be to add physical activity into the day, without thinking that you do not have time for. The third learning aspect would be dealing with stress. Stress is a major factor into what we do and eat during those times in our lives (2016). We tend to eat anything when we are really stressed or too busy to make our own food. Stress would restrain the individual from exercising because they would be too busy to busy doing work than to exercise. The fourth learned factor would be how to cope with challenges that may or may not derail you from your healthy choices, like when you eat out with friends (2016). Peer pressure tends to play another part in what we eat. We could be in a big table with friends and most of them are eating things that are high in saturated fat and sugar. Being surrounded by that type of environment can influence the individual on what to eat. The fifth learned factor would be learning to get back on track once you accidentally let it slip (2016). Following a plan for an entire year can be very tedious and draining to follow. There will be slip-ups but the program lets you know to not let that slip up determine the outcome of the program. Once the first half of the program is over, the second half will help the participant learn how to improve their knowledge and help them keep on track.
Guam Diabetes association. According to the statistical yearbook 2016, Guam has a high prevalence of diabetes. According to Guam diabetes association (2016), the people of Guam have easier to access to food high in saturated fats, due to the common fiestas held on island. Guam diabetes association tries to fix the problem by having public service announcements and monthly meetings in each village addressing the issue of diabetes. They also point out tips about how to eat healthy and try to incorporate some type of physical activity through out the day. According to World Health Organizations (2016), meetings and classes with groups of people is an effective way in tackling the problem with diabetes.
Guam Diabetes control and prevention program. The Guam Diabetes control and prevention program (2002) develops different policies and promote activities that enhances the quality care and access to diabetes care. The program works with different local organizations that help promote an education geared towards diabetes awareness and education. A lot of the local organizations are around populated places with high prevalence of diabetes.

Recommendations for course of action
According to a research conducted by the diabetes prevention program group, 1079 participants participated in a diabetes intervention study (Baig, A et al 2015). Over 58% of them reduced the risk of diabetes by applying the interventions during the experiment. The experiment conducted, made the participants exercise for 150 minutes a week. Doing so, the participants noticed a 7% decrease in their body weight. The participants were also all contacted by a coach who checked on the progress of the participants and to make sure they did not derail from the research project. The participants were also following a high fiber diet meal plan throughout the experiment. Once a week, the participants would meet up again in groups and talk about their experience with the experiment and how it is affecting them. The research also found that the participants were also willing to stay longer in the project if other participants were enthusiastic about preventing diabetes as well. A longitudinal study was also conducted on several participants to show that what they learned in the program would remain with them throughout their lives (Baig, A et al 2015). 40% of the participants found that after the research project, they were able to apply the knowledge they learn on themselves to promote their healthy lifestyle.