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