Diabetes - type 2

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Description

An in-depth report on the causes, diagnosis, treatment, and prevention of type 2 diabetes.

Alternative Names

Type 2 diabetes; Maturity onset diabetes; Noninsulin-dependent diabetes

Highlights

Diabetes Statistics

According to the U.S. Centers for Disease Control and Prevention’s (CDC) National Diabetes Fact Sheet, nearly 26 million American adults and children have diabetes. About 79 million Americans aged 20 years and older have pre-diabetes, a condition that increases the risk for developing diabetes.

Diabetes and Cancer

Type 2 diabetes increases the risk for certain types of cancer, according to a consensus report from the American Diabetes Association and the American Cancer Society. Diabetes doubles the risk for developing liver, pancreatic, or endometrial cancer. Certain medications used for treating type 2 diabetes may possibly increase the risk for some types of cancers.

Screening for Gestational Diabetes Mellitus

The American Diabetes Association recommends that pregnant women without known risk factors for diabetes get screened for gestational diabetes at 24 - 28 weeks of pregnancy. Pregnant women with risk factors for diabetes should be screened for type 2 diabetes at the first prenatal visit.

Aspirin for Heart Disease Prevention

The American Diabetes Association now recommends daily low-dose (75 - 162 mg) aspirin for men older than age 50 and women older than age 60 who have diabetes and at least one additional heart disease risk factor (such as smoking, high blood pressure, high cholesterol, family history, or albuminuria).

Guidelines for Treatment of Diabetic Neuropathy

The anticonvulsant drug pregabalin (Lyrica) is a first-line treatment for painful diabetic neuropathy, according to recent guidelines released by the American Academy of Neurology (AAN).

New Drug Warning

In 2012, the Food and Drug Administration (FDA) warned that statin drugs, which are used to treat high cholesterol, may raise blood sugar levels and increase some people’s chances of developing type 2 diabetes. Studies have found that this risk is more likely with high doses of statins. However, for most people with diabetes the benefits of statin drugs still outweigh the risks. Other types of cholesterol drugs, such as niacin, can also increase blood sugar levels.

New Drug Approvals

  • Juvisync is a two-in-one pill that combines the diabetes medication sitagliptin (Januvia) with the cholesterol drug simvastatin.
  • Bydureon is a longer-lasting version of exenatide (Byetta) that requires injection only once a week. Byetta is injected twice a day.
  • Peginesatide (Omontys)  is a new erythropoiesis-stimulating drug approved specifically for patients with chronic kidney disease who are on dialysis. It is given as a once-a-month injection. Similar anemia drugs require more frequent injections.

New Vaccination Recommendation

The CDC now recommends that adults ages 19 - 59 years diagnosed with diabetes should receive vaccination to prevent hepatitis B. The hepatitis B virus is transmitted through blood. Unvaccinated patients with diabetes can become infected with hepatitis B through sharing fingerstick or blood glucose monitoring devices.

Introduction

The two major forms of diabetes are type 1 (previously called insulin-dependent diabetes mellitus, IDDM, or juvenile-onset diabetes) and type 2 (previously called noninsulin-dependent diabetes mellitus, NIDDM, or maturity-onset diabetes).

Insulin

Both type 1 and type 2 diabetes share one central feature: elevated blood sugar (glucose ) levels due to insufficiencies of insulin. a hormone produced by the pancreas. Insulin is a key regulator of the body's metabolism. It works in the following way:

  • During and immediately after a meal the process of digestion breaks down carbohydrates into sugar molecules (including glucose ) and proteins into amino acids.
  • Right after the meal, glucose and amino acids are absorbed directly into the bloodstream, and blood glucose levels rise sharply.
  • The rise in blood glucose levels signals important cells in the pancreas, called beta cells. to secrete insulin, which pours into the bloodstream. Within 10 minutes after a meal, insulin rises to its peak level.
  • Insulin enables glucose to enter cells in the body, particularly muscle and liver cells. Here, insulin and other hormones direct whether glucose will be burned for energy or stored for future use.
  • When insulin levels are high, the liver stops producing glucose and stores it in other forms until the body needs it again.
  • As blood glucose levels reach their peak, the

    pancreas reduces the production of insulin.

  • About 2 - 4 hours after a meal, both blood glucose and insulin are at low levels, with insulin being slightly higher. The blood glucose levels are then referred to as fasting blood glucose concentrations .

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The pancreas is located behind the liver and is where the hormone insulin is produced. Insulin is used by the body to store and use glucose.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes, accounting for 90 - 95% of cases. In type 2 diabetes, the body does not respond properly to insulin, a condition known as insulin resistance. The disease process of type 2 diabetes involves:

  • The first stage in type 2 diabetes is insulin resistance. Although insulin can attach normally to receptors on liver and muscle cells, certain mechanisms prevent insulin from moving glucose (blood sugar) into these cells where it can be used. Most patients with type 2 diabetes produce variable, even normal or high, amounts of insulin. In the beginning, this amount is usually enough to overcome such resistance.
  • Over time, the pancreas becomes unable to produce enough insulin to overcome resistance. In type 2 diabetes, the initial effect of this stage is usually an abnormal rise in blood sugar after a meal (called postprandial hyperglycemia ).
  • Eventually, the cycle of elevated glucose further damages beta cells, thereby drastically reducing insulin production and causing full-blown diabetes. This is made evident by fasting hyperglycemia. in which glucose levels are high most of the time.

Type 1 Diabetes

In type 1 diabetes, the pancreas does not produce insulin. Type 1 diabetes is considered an autoimmune disorder. The condition is usually first diagnosed in childhood or adolescence. Patients with type 1 diabetes need to take daily insulin for survival.

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Gestational Diabetes

Gestational diabetes is a form of type 2 diabetes, usually temporary, that first appears during pregnancy. It usually develops during the third trimester of pregnancy. After delivery, blood sugar (glucose) levels generally return to normal, although some women develop type 2 diabetes within 15 years.

Because glucose crosses the placenta, a pregnant woman with diabetes can pass high levels of blood glucose to the fetus. This can cause excessive fetal weight gain, which can cause delivery complications as well as increased risk of breathing problems.

Children born to women who have gestational diabetes have an increased risk of developing obesity and type 2 diabetes. In addition to endangering the fetus, gestational diabetes can also cause serious health risks for the mother, such as preeclampsia, a condition that involves high blood pressure during pregnancy.

Causes

Type 2 diabetes is caused by insulin resistance, in which the body does not properly use insulin. Type 2 diabetes is thought to result from a combination of genetic factors along with lifestyle factors, such as obesity, poor diet, high alcohol intake, and being sedentary.

Genetic mutations likely affect parts of the insulin gene and various other physiologic components involved in the regulation of blood sugar. Some rare types of diabetes are directly linked to genes.

Diabetes Secondary to Other Conditions. Conditions that damage or destroy the pancreas, such as pancreatitis (inflammation), pancreatic surgery, or certain industrial chemicals, can cause diabetes. Certain genetic and hormonal disorders are associated with or increase the risk of diabetes.

High doses of statin drugs, which are used to lower cholesterol levels, may increase some people’s chances of developing type 2 diabetes. Some types of drugs can also cause temporary diabetes including corticosteroids, beta blockers, and phenytoin.

Risk Factors

Nearly 26 million American children and adults have diabetes. Up to 95% of these cases are type 2. In addition, 79 million American adults have pre-diabetes, a condition that increases the risk for developing diabetes. Type 2 diabetes used to mainly develop after the age of 40, but it is now increasing in younger people and children. Obesity is likely the major factor behind this dramatic growth rate.

According to the National Institutes of Health, people have an increased risk for diabetes or pre-diabetes if they have:

Age of 45 years or older

Family history of diabetes

Source: umm.edu

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