Type 2 Diabetes

Pathogenesis

Decreased pancreatic beta cell secretion.

Poor regulation of glucose production

Hyperinsulimia

Insulin resistance, which happens due to hyperinsulinemia by the pancreas.

T-cells of the immune system destroy insulin-secreting B-cells, resulting in less insulin made by the pancreas.

Excessive glucose secretion and insulin resistance creates hyperglycemia.

Insulin resistance

There are many reasons why cells become insulin resistant such as decreased physical activity, pancreatic beta cells wear out due to resistance, and pancreas is unable to produce enough insulin to keep up with the high glucose levels.

Incidence/Prevalence

Typically develops around 45.

8.5% of Americans have diagnosed type 2 diabetes.

1.4 million new cases of type 2 diabetes are diagnosed every year.

This disease develops very slowly and causes a slow, chain reaction involving insulin resistance, decreased beta cell production, and hyperglycemia.

Early signs and symptoms of type 2 diabetes can be so mild that people are unaware they have it for long periods of time.

Risk Factors

Genetic Factors

Environmental Factors

Family history

Obesity

Gender

Inadequate exercise

Lack of physical activity can cause muscle cells to become resistant to insulin.

Obese individuals have more triglyceride content, which leads to B-cell destruction and insulin resistance.

Men are more at risk for diabetes than women

Children learn eating habits and exercise habits from their parents, therefore, parents who demonstrate an unhealthy lifestyle predispose their children.

Diagnostics

Glycated hemoglobin test

Glucose tolerance test

Random blood sugar test

Tests for average blood sugar level in the past three months, a score above 6.5% indicates diabetes.

This test involves fasting overnight and then getting your blood glucose levels tested after drinking a liquid that contains glucose. Test results of 200 mg/dL or higher indicates diabetes.

This test can be taken anytime without fasting, measures the amount of glucose circulating in one's blood. 200 mg/dL indicates diabetes.

Clinical Manifestations

Excessive hunger

Excessive thirst

Fatigue

Poor wound healing

Increased urination

This is caused by extra glucose being excreted by the kidneys, which brings other fluids and electrolytes with it.

Glucose in the blood is not able to enter the cells due to defective insulin. This lack of cellular energy makes diabetics feel fatigued.

The lack of every at the cellular level causes an increase in hunger.

Excessive urination and excretion of electrolytes causes dehydration. The feeling of thirst is the body's way of compensating for constant low fluid volume and electrolytes

Hyperglycemia causes blood vessels to stiffen and the body's circulation begins to slow down and reduce in tissue oxygenation.

Treatments

Blood sugar monitoring

Insulin therapy

Lifestyle changes

Healthy eating, regular exercise, avoiding stress, and drinking water are all positive changes that can improve physical health

Regular sugar monitoring is important because it allows those with diabetes to be aware of their high or low blood sugar and determines if they need to administer insulin.

Administering insulin helps diabetics by keeping high, uncontrolled glucose levels at a normal rate.

Healthy eating examples: decreasing the intake of foods with high fat content, implementing fresh fruits and vegetables daily, drinking water instead of soda or sugary juice.

Effective ways to exercise: going on short walks, avoid sitting down for long periods of time, taking the stairs, swimming

Normal blood sugar ranges

Fasting: 80-100

After eating: 170-200

2-3 hours after eating: 120-140

Pre-diabetes blood sugar ranges

Fasting: 101-125

After eating: 190-230

2-3 hours after eating: 140-160

Diabetic blood sugar ranges:

Fasting: 126+

After eating: 220-300

2-3 hours after eating: 200+

Prolonged symptoms

Cardiovascular disease

Neuropathy

Kidney damage

Microvascular complications

Neurpoathy

Retinopathy

Nephropathy

Damage to the blood vessels behind the eye due to poorly controlled blood sugar. Blurry vision and dark spots are early symptoms. May eventually lead to blindness.

May result from diabetes. Causes a painful pins and needles sensation due to nerve damage.

Kidney function begins to deteriorate. Hands and feet swell, proteinuria, less control of blood pressure.

Macrovascular complications

Coronary heart disease

Peripheral artery disease

Stroke

Plaque buildup on the walls of blood vessels causes them to narrow. Common in type 2 diabetes due to common high cholesterol.

Arteries of the heart cannot deliver adequate blood flow to the tissues. Typically results from high blood pressure.

High amounts of sugar in the blood increase chances of stroke because it makes the vessels stiff.

Hyperosmolar hyperglycemic state

Signs

Excessive urination, extreme thirst, dry skin, vomitting, disorientation, and loss of consciousness

What to do

Call 911, 0.9% isotonic solution given IV

Medications

Biguanides

Metformin, decrease glucose release from the liver, decreases intestinal absorption of glucose, and improves insulin sensitivity

GLP -1 analogs

Exenatide, Liraglutide, and Albigutide. Increase the secretion of insulin, reduce glucose release after meals, promote satiety (the felling of satisfaction after meals).

Stimulators of insulin release

Tolbutamide, Glipizide, and Glyburide. Increase insulin release from the pancreas.

Different types of insulin

Rapid acting insulin

Begins to work 15 minutes after injection to lower blood sugar

Mixed insulin

Mixture of a short acting and a intermediate or long lasting insulin. Taken before meals

Long acting insulin

Lasts up to 24 hours, stabilize blood sugar throughout the entire