Diabetes Type II

Kusic, Heskett, Cameron, O'Connell, Kastle

Pathogenesis of Diabetes

Many factors go into the pathogenesis of this disease. First there is insulin resistance and insulin deficiency. Both genetics and environmental factors go into this disease process. Elevated levels of free fatty acids and inflammatory cytokines in the plasma. Alpha and beta cells ability to secrete insulin is lost, and that leads to hyperglucagonemia and then hyperglycemia. This leads to insulin resistance which then decreases glucose transport to muscle cells, high liver glucose production, and increased breakdown of fat cells as a result of that. This can cause insulin concentrations to be high, but low level of glycemia. High carbohydrate intake leads to high blood glucose, caused also by decreased peripheral glucose uptake, decreased insulin secretions, and increased hepatic glucose production. Cellular insulin resistance and obesity are present in 60% to 80% of those with type 2 diabetes. Obesity contributes to the development of insulin resistance and diabetes through hormones produced in adipose tissues called adipokines. Obesity is correlated with hyperinsulinemia and decreased insulin receptor density, which is an important mechanism in the development of diabetes.

Risk Factors for Diabetes

Weight: a large risk factor for diabetes, as the extra fatty tissue makes your cells more resistant to insulin. However, being overweight is not a requirement for type II diabetes.

Fat distribution: weight stored in the abdomen increases the risk for type II diabetes, while it is less likely to develop if the fat is distributed more in the other areas like thighs or arms.

Inactivity: being active burns the glucose to use as energy and makes your cells more sensitive

Race: It isn’t known why, but people of different races are more likely to develop diabetes type II. These races include African-American, Asian, American-Indian, and Hispanics.

Age: The risk of developing diabetes type II increases as you get older because the population exercises less, loses muscle mass, and gains weight more commonly as you age. However, the age for getting diabetes type II is getting younger because of the childhood obesity epidemic in the country.

Prediabetes: This is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes can progress to type 2 diabetes.

Gestational diabetes: If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.

Polycystic ovary syndrome: This disease, characterized by irregular menstrual periods, excessive hair growth, and obesity, increases risk of developing diabetes.

Diagnostic Tests

Since diabetes is a metabolic disease in which blood glucose levels are elevated, the diagnostic tests are blood tests. The fasting plasma glucose test is when the patient fasts for 8 hours and has his blood drawn. This test is used to either diagnose diabetes or prediabetes. Normal blood glucose can range up to 99mg/dL; Prediabetes is a blood sugar level of 100-125 mg/dL; and diabetes if the blood sugar level exceeds 126 md/dL. The oral glucose tolerance test is performed after fasting for 8 hours. The technician retrieves a sample of the patient’s blood and then gives him a prepared sugary drink containing 75 mg of glucose. The patient drinks it and then two hours later his blood is taken to measure how well his insulin responded to the drink. Normal blood sugar at 2 hours after the sugary drink is 139 mg/dL or below; prediabetes is 140-199 mg/dL; diabetes is 200mg/dL or above. The random plasma glucose test is done at any time to measure blood sugar levels. It is not accurate enough to diagnose prediabetes, but it can diagnose diabetes if the blood sugar is 200 mg/dL or more and the patient is exhibiting symptoms such as excessive urination, thirst, and loss of weight. The A1C test is a blood sugar test that estimates how the patient’s glucose levels have been controlled over a period of time. This test is an indicator of the patient’s average glucose over the past three months. Diabetes increases the patient’s risk for numerous diseases, such as high cholesterol, high blood pressure, vision problems, and orthopedic complications. This may cause the patient to need extra diagnostic tests related to his diabetes.

Clinical Manifestations

Symptoms of type 2 diabetes may occur in very slow progression, sometimes taking years to develop into their full effect. Untreated type 2 diabetes may result in increased thirst, frequent urination, increased hunger, weight loss, fatigue, blurred vision, and slow- healing sores.

Increased Thirst: this is due to an excess level of glucose in the blood. The increased concentration of glucose in the blood forces the body to pull water from tissues and put back into the blood stream which causes dehydration. The dehydration causes thirst.

Frequent urination: This is also a result of the increased glucose in the blood. The glucose needs to be filtered out of the blood and when there is a large amount of it. The more glucose there is, the more it is filtered into urine causing an increased amount of urine and more frequent bladder voiding.

Increased Hunger: The lack of insulin means sugar (the fuel of the cell) cannot move into the cells and the muscles and organs and they do get the energy they need. The lack of energy in the muscles and organs causes hunger.

Weight Loss: The body does not have the ability to metabolize glucose. Because of this, the body must pull energy and fuel from other sources like muscles and fats. Calories in the unprocessed glucose are eliminated as glucose is released into urine.

Fatigue: When cells are not getting glucose, they are not able to function properly which causes lethargy and slowness of the body in other words, fatigue.

Blurred Vision: In severe cases of untreated type 2 diabetes, dehydration can be so severe that fluid can be pulled from the lenses of the eyes which can cause a alack of ability of the eyes to focus.

Slow Healing- Wounds: When there is a lack of glucose and energy in the cells, they lose the ability to perform cellular repairs which slows the healing process of infections and trauma.

Treatments

Management of type 2 diabetes includes:

-Healthy eating

-Regular exercise

-Possibly, diabetes medication or insulin therapy

-Blood sugar monitoring

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications. It's important to center your diet on high fiber, low fat foods, such as fruits, vegetables and whole grains. A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. He or she can also teach you how to monitor your carbohydrate intake and let you know about how many carbohydrates you need to eat with your meals and snacks to keep your blood sugar levels more stable.

A combination of exercises — aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week — often helps control blood sugar more effectively than either type of exercise alone. Monitoring your blood sugar is also important for treatment - Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

Several drugs can work to treat or assist symptoms of diabetes, such as:

Metformin - It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively. Metformin also lowers glucose production in the liver.

Sulfonylureas - help your body secrete more insulin.

Meglitinides - encouraging the body to secrete more insulin, but they're faster acting, and they don't stay active in the body for as long.

Thiazolidinediones - these medications make the body's tissues more sensitive to insulin.

DPP-4 inhibitors - These medications help reduce blood sugar levels, but tend to have a modest effect.

GLP-1 receptor agonists - These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas.

SGLT2 inhibitors - They work by preventing the kidneys from reabsorbing sugar in the blood. Instead, the sugar is excreted in the urine.

Insulin therapy - Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

Bariatric surgery - Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries.

Pregnancy - Women with type 2 diabetes may need to alter their treatment during pregnancy. Many women use insulin therapy during pregnancy.

Sources

Romesh, K. (2015). Type 2 Diabetes Mellitus. Retrieved December 1, 2015, fromhttp://emedicine.medscape.com/article/117853-overview#a3


Type 2 diabetes. (2014, July 24). Retrieved December 1, 2015, fromhttp://www.mayoclinic.org/diseases-conditions/type-2-diabetes/basics/treatment/con-20031902


Vann, M. (2014, October 13). How Is Type 2 Diabetes Diagnosed? Retrieved December 1, 2015, from http://www.everydayhealth.com/type-2-diabetes/diagnosis/


Huether, S. (2012). Understanding pathophysiology (5th ed.). St. Louis, Mo: Elsevier.