Diabetes Mellitus Type 2

Type 2 diabetes mellitus is a disorder that disrupts the way your body uses glucose (sugar).All the cells in your body need sugar to work normally. Sugar gets into the cells with the help of a hormone called insulin. If there is not enough insulin, or if the body stops re-sponding to insulin, sugar builds up in the blood. This is what happens to people with di-abetes mellitus.There are two different types of diabetes mellitus. In type 1 diabetes mellitus, the prob-lem is that the pancreas (an organ in the abdomen) does not make enough insulin. In type 2 diabetes mellitus, the pancreas does not make enough insulin (the body be-comes resistant to normal or even high levels of insulin, or both. This causes high blood glucose (blood sugar) levels, which can cause problems if untreated. In the United States, Canada, and Europe, about 90 percent of all people with diabetes have type 2 diabetes.Type 2 diabetes is a chronic medical condition that requires regular monitoring and treatment throughout your life. Treatment includes lifestyle changes, self-care mea-sures, and sometimes medications. Fortunately, these treatments can keep blood sugar levels close to normal and minimize the risk of developing complications.

INTRODUCTION

Type 2 diabetes mellitus is characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secre-tion. Its pathogenesis is poorly understood, but is heterogeneous and both genetic factors affecting insulin re-lease and responsiveness and environmental factors, such as obesity, are important.

CAUSES OF TYPE 2 DIABETES1.Genetic causes : Many people with type 2 diabetes have a family member with either type 2 diabetes or other medical problems associated with diabetes, such as high cholesterol levels, high blood pressure, or obesity.The lifetime risk of developing type 2 diabetes is 5 to 10 times higher in first- degree relatives (sister, brother, son, daughter) of a person with diabetes compared with a person with no family history of diabetes.The likelihood of developing type 2 diabetes is greater in certain ethnic groups, such as people of Hispanic, African, and Asian descent.2.Environmental conditions : Environmental factors such as what you eat and how active you are, com-bined with genetic causes, affect the risk of developing type 2 diabetes.3.Pregnancy : A small number (about 3 to 5 percent) of pregnant women develop dia-betes during pregnancy, called "gestational diabetes." Gestational dia-betes is similar to type 2 diabetes, but usually resolves after the woman delivers her baby. Women who have gestational diabetes are at in-creased risk for developing type 2 diabetes later in life.

TYPE 2 DIABETES DIAGNOSISThe diagnosis of diabetes is based upon your symptoms and the re-sults of blood tests

Symptoms  Before being diagnosed with type 2 diabetes, most people have no symptoms at all. In those who do have symptoms , the most common include:

Needing to urinate frequentlyFeeling thirstyBlurred vision

Laboratory tests : Several blood tests are used to measure blood glucose levels, the pri-mary test for diagnosing diabetes. Random blood sugar test : For a random blood sugar test, you can have blood drawn at any time throughout the day, regardless of when you last ate. If your blood sugar is 200 mg/dL (11.1 mmol/L) or higher and you have symptoms of high blood sugar it is likely that you have diabetes.

Fasting blood sugar test :A fasting blood sugar test is a blood test done after not eating or drinking for 8 to 12 hours (usually overnight). A normal fasting blood sugar level is less than 100 mg/dL (5.55 mmol/L).

Hemoglobin A1C test : The "A1C" blood test measures your average blood sugar level over the past two to three months. Normal values for A1C are 4 to 5.6 percent. The A1C test can be done at any time of day (before or after eating).

Oral glucose tolerance test: Oral glucose tolerance testing (OGTT) is a test that involves drinking a special glucose solution (usually orange or cola flavored). Your blood sugar level is tested before you drink the so-lution, and then again one and two hours after drinking it.

Criteria for diagnosis The following criteria are used to classify your blood sugar levels as normal, increased risk (blood sugar levels that are higher than normal and indicate a risk of future diabetes), or diabetes.Normal  Fasting blood sugar less than 100 mg/dL (5.55 mmol/L).Categories of increased riskImpaired fasting glucose is defined as a fasting blood sugar level be-tween 100 and 125 mg/dL (5.6 to 6.9 mmol/L).Impaired glucose tolerance is defined as a blood sugar level of 140 to 199 mg/dL two hours after an oral glucose tolerance test.A1C – persons with 5.7 to 6.4 percent are at highest risk, although there is a continuum of increasing risk across the entire spectrum of subdiabetic A1C levels.At least 50 percent of people with impaired glucose tolerance eventu-ally develop type 2 diabetes. Even if they don't develop diabetes, these people are at increased risk of heart disease. Impaired glucose toler-ance is very common; about 11 percent of all people between the ages of 20 and 74 have impaired glucose tolerance.

Diabetes mellitus  A person is considered to be diabetic if he or she has one or more of the following:

Symptoms of diabetes  and  a random blood sugar of 200 mg/dl or

higher

A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher

A blood sugar of 200 mg/dL (11.1 mmol/L) or higher two hours after

an oral glucose tolerance test

An A1C of 6.5 percent or higher

The blood tests must be repeated on another day to confirm the diag-

nosis of diabetes.

Type 1 versus type 2 diabetes

Doctors can usually tell whether a person has type 1 or type 2, but there are situations when the diagnosis is difficult to determine. In such

cases, doctors often run additional blood tests

complications in diabetes mellitus:

Diabetes mellitus is a chronic condition that can lead to complications

over time. These complications can include:

Coronary heart disease which can lead to a heart attackA number of measures are important to reduce the risk of cardiovascu-lar (heart and blood vessel) disease.●Quit smoking.●Manage high blood pressure with lifestyle modifications and/or medication ●Have a blood test to measure cholesterol and triglyceride levels, and modify the diets if needed. Some people will also need a medication to lower their low-density lipoprotein (LDL) (“bad cholesterol”) or triglycerides. 

If medication is needed, a statin drug should be included whenever pos-sible. The statin drugs have been shown to decrease the future risk of heart attacks, strokes, and death in people with diabetes who are over age 40 years, even when cholesterol levels are normal.

The initiation of statins should be based upon cardiovascular risk rather than an LDL cholesterol level. Statins are recommended for anyone with clinical cardiovascular disease or over age 40 years, regardless of baseline lipid levels. For patients without clinical cardiovascular dis-ease and under age 40 years, statins can be added (in addition to lifestyle intervention) if there are multiple cardiovascular disease risk factors. The intensity of statin therapy can be adjusted based upon side effects, tolerability, and LDL cholesterol levels. The Ameri-can Diabetes Association (ADA) recommends that people with diabetes have an LDL cholesterol level less than 100 mg/dL (2.59 mmol/L) Some studies suggest lowering LDL even further, to 70 to 80 mg/dL(1.81 to 2.07 mmol/L).

Cerebrovascular disease which can lead to stroke

Retinopathy (disease of the eye) which can lead to blindness

Nephropathy (disease of the kidney) which can lead to kidney fail-

ure and the need for dialysis

Neuropathy (disease of the nerves) which can lead to, among other

things, ulceration of the foot requiring amputation