Type 2 diabetes
Diabetes, type 2: One of the two major types of diabetes, the type in which the beta cells of the pancreas produce insulin but the body is unable to use it effectively because the cells of the body are resistant to the action of insulin. Although this type of diabetes may not carry the same risk of death from ketoacidosis, it otherwise involves many of the same risks of complications as does type 1 diabetes (in which there is a lack of insulin).
The aim of treatment is to normalize the blood glucose in an attempt to prevent or minimize complications. People with type 2 diabetes may experience marked hyperglycemia, but most do not require insulin injections. In fact, 80% of all people with type 2 diabetes can be treated with diet, exercise, and, if need be, oral hypoglycemic agents (drugs taken by mouth to lower the blood sugar).
Type 2 diabetes requires good dietary control including the restriction of calories, lowered consumption of simple carbohydrates and fat with increased consumption of complex carbohydrates and fiber. Regular aerobic exercise is also an important method for treating both type 2 diabetes since it decreases insulin resistance and helps burn excessive glucose. Regular exercise also may help lower blood lipids and reduce some effects of stress, both important factors in treating diabetes and preventing complications.
Type 2 diabetes is also known as insulin-resistant diabetes, non-insulin dependent diabetes, and adult-onset diabetes.
Usually type 2 DM has slow and insidious onset.
Many persons have a long history of mild symptoms which may come and go and which may frequently be ignored or miss diagnosed for years before true diagnosis is made. Some persons present with classical symptoms of diabetes including thirst, polydypsia, polyuria, nocturia, tiredness, loss of weight, pruritis vulva or balanitis, Impotence, loss of libido, change in refraction usually in-direction of myopia, parasthesiae of limbs. The severity of many of the classical symptoms are directly related to the severity of glycosuria. Long standing diabetes type 2 will be associated with an abnormal thickening of basement membrane of capillaries through out the body. This per se is not pathognomonic of diabetes. It is a part of normal aging, however increased permeability of thickened basement membrane in diabetes is a unique pathological feature and this impact is seen as micro-angiopathy in kidney's, retina and nervous system presenting as diabetes neuropathy- presents with symptoms of dizziness, abdominal fullness, nausea, vomiting, diarrhea, incontinence, anhydrosis, and impotence. There may be chronic and perforating ulcers in feet and painless arthropathy called as Charcot's joints. There may also be some motor involvement causing muscle weakness and muscle wasting.
Physical signs of Type 2 Diabetics: Loss of tendon reflexes in lower limbs, diminished vibration sense distally, glow and stocking impairment.
Vascular: Signs like arteriosclerosis
of coronary, peripheral ad cerebral arteries.
Dermatological lesions: May be seen commonly as vulvitis or balanitis since external genitalia are especially prone to infection by fungi (Candida) flourish on skin and mucous membrane contaminated by glucose. Other skin lesion includes boils, carbuncles, spotted leg syndrome.
Sexual: Reduction in fertility and libido in females. Not frequently poor obstetric and impotence indicate possibility of DM. Hepatomegaly due to fatty or glycogen infiltration. Onset with coma is very rare in type 2 DM. Some times some people have an accidental discovery of diabetes (asymptomatic glycosuria).
Some of the most common treatment options for diabetes are: balanced diet, drugs, insulin and Islet Cell Transplantation.
Diet: A diet with balanced amounts of fat, protein and sugar is very important for diabetics. The sugar should be natural, unrefined. Fruits and vegetables are the best places to find natural, unrefined sugar. Diabetics should also be cautious of their weight.
Drugs: Drugs are used but should not be a substitute for a healthy diet. Sulphonylurea drugs stimulate the pancreas to release more insulin and are best for individuals who are not overweight. Biguanide drugs help sugar be absorbed by cells as well as reducing the absorption of carbohydrates from the intestinal system.
Insulin: Modern devices allow diabetics to inject insulin. This usually occurs when they need an insulin boost. Insulin cannot be taken by mouth because the body will digest it. Diabetes becomes a medical emergency if it is not properly controlled.
Causes and Risk factors:
1. A close member of your family has Type 2 diabetes (parent or brother or sister).
2. You're overweight.
3. You have high blood pressure or you've had a heart attack or a stroke.
4. You're a woman with polycystic ovary syndrome and you are overweight.
5. You've been told you have impaired glucose tolerance or impaired fasting glycaemia.
6. If you're a woman and you've had gestational diabetes.
7. You have severe mental health problems.
: There are no clear-cut guidelines for when to screen for diabetes. Some experts recommend that everyone over age 45 be tested regularly for diabetes, although others do not feel this necessary in people without symptoms or risk factors. In fact, early screening may identify some people with impaired glucose levels that would eventually normalize.
Fasting Plasma Glucose
: The fasting plasma glucose (FPG) test is the standard test for diabetes. It is a simple blood test taken after 8 hours of fasting. Results indicate:
1. FPG levels are considered normal up to 100 mg/dL.
2. Levels between 100 and 125 mg/dL are referred to as impaired fasting glucose or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
3. Diabetes is diagnosed when FPG levels are 126 mg/dL or higher.
The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes, or if the test is normal in people who have symptoms or risk factors for diabetes. For example, people who take the test in the afternoon and show normal results may actually have abnormal levels that would be revealed if they were tested in the morning.
Glucose Tolerance Test
: The oral glucose tolerance test (OGTT) is more complex than the FPG and may overdiagnose diabetes in people who do not have it. Some experts recommend it as a follow-up after FPG, if the latter test results are normal but the patient has symptoms or risk factors of diabetes. The test uses the following procedures:
It first uses an FPG test, a blood test is then taken 2 hours later after drinking a special glucose solution.
The following results suggest different conditions:
1. OGTT levels are considered normal up to 140 mg/dL.
2. Levels between 140 mg/dL and 199 mg/dL are referred to as impaired glucose tolerance or pre-diabetes.
3. Diabetes is diagnosed when OGTT levels are 200 mg/dL or higher.
Both the FPG and OGTT require that the patient not eat for at least 8 hours prior to the test.
Test for Glycated Hemoglobin
: Tests for blood levels of glycated hemoglobin, also known as hemoglobin A1c (HbA1c) are not currently used for an initial diagnosis, but they are useful for determining the severity of diabetes. Some experts think this test can help predict complications in people who have FPG levels between 110 and 139, which are above normal but do not indicate full-blown diabetes.
The basis for its use as a diagnostic measurement in diabetes is as follows:
Hemoglobin is a protein molecule found in red blood cells. When glucose binds to it, the hemoglobin becomes modified, a process called glycosylation. Glycosylation affects a number of proteins, and elevated levels of glycolated hemoglobin are strongly associated with complications of diabetes. A glycated hemoglobin level of 1% above normal range identifies diabetes in 98% of patients. Normal HbA1c levels do not necessarily rule out diabetes, but if diabetes is present and levels are normal, the risk for complications is low. The test is not affected by food intake so it can be taken at any time. A home test has been developed that might make it easier to measure HbA1c. In general, measurements suggest the following:
1. Normal HbA1c levels should be below 7%.
2. Levels of 11 - 12% glycolated hemoglobin indicate poor control of carbohydrates. High levels are also markers for kidney trouble.
Testing for Insulin Resistance
: Investigators hope that some day a simple test for insulin resistance will be available that will be able to identify people at risk for diabetes. The presence of insulin resistance may also be a predictor of heart disease, independent of the presence of diabetes. Some research suggests that measuring insulin and triglyceride levels during a fasting period may predict a person's sensitivity to insulin.
Screening Tests for Complications
:Screening for Heart Disease. All patients with diabetes should be tested for hypertension and unhealthy cholesterol and lipid levels and given an electrocardiogram. For cholesterol, people with diabetes should aim for LDL levels below 100 mg/dL, HDL levels over 50 mg/dL, and triglyceride levels below 150 mg/dL. Blood pressure goals should be 130/80 mmHg or lower. Other tests may be needed in patients with signs of heart disease.
The electrocardiogram (ECG, EKG) is used extensively in the diagnosis of heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults. Several different types of electrocardiogram exist.
Screening for Kidney Damage
: The earliest manifestation of kidney damage is microalbuminuria, in which tiny amounts (30 to 300 mg per day) of protein called albumin are found in the urine. About 20% of type 2 patients show evidence of microalbuminuria upon diagnosis of diabetes. (However, only a small percentage of people with type 2 diabetes eventually develop kidney disease.) Microalbuminuria typically shows up in patients with type 2 diabetes who have high blood pressure.
The American Diabetes Association recommends that people with diabetes receive an annual microalbuminuria urine test. Patients should also have their blood creatinine tested at least once a year. Creatinine is a waste product that is removed from the blood by the kidneys. High levels of creatinine may indicate kidney damage. A doctor uses the results from a creatinine blood test to calculate the glomerular filtration rate (GFR). The GFR is an indicator of kidney function; it estimates how well the kidneys are cleansing the blood.
Medicine and medication:
Diabetes pills are grouped in categories based on type. There are several categories of diabetes pills each works differently.
Sulfonylureas: These diabetes pills lower blood sugar by stimulating the pancreas to release more insulin. The first drugs of this type that were developed - Dymelor, Diabinese, Orinase and Tolinase - are not as widely used since they tend to be less potent and shorter-acting drugs than the newer sulfonylureas. They include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab, and Amaryl. These drugs can cause a decrease in the hemoglobin A1c (HbA1c) of up to 1%-2%.
Side effects: Upset stomach, skin rash or itching, weight gain
Biguanides: These diabetes pills improve insulin's ability to move sugar into cells especially into the muscle cells. They also prevent the liver from releasing stored sugar. Biguanides should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients. Biguanides can decrease the HbA1c 1%-2%. An example includes metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza).
Side effects: Upset stomach (nausea, diarrhea), metallic taste in mouth.
Thiazolidinediones: These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of sugar released by the liver and make fat cells more sensitive to the effects of insulin. Actos and Avandia are the two drugs of this class. A decrease in the HbA1c of 1%-2% can be seen with this class of oral diabetes medications. These drugs may take a few weeks before they have an effect in lowering blood sugar. They should be used with caution in people with heart failure.
Side effects: Elevated liver enzymes, liver failure, respiratory infection, headache, and fluid retention.
Alpha-glucosidase inhibitors, including Precose and Glyset: These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.
Meglitinides, including Prandin and Starlix: These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. The effects of these diabetes pills depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.
Side effects: Stomach upset (gas, diarrhea, nausea, cramps).
Dipeptidyl peptidase IV (DPP-IV) inhibitors, including Januvia: The DPP-IV inhibitors (Januvia) work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control sugar without causing weight gain. The medication may be taken alone or with other medications such as metformin.
Combination therapy: There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.