Diabetes mellitus type 2
Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - insulin-dependent diabetes mellitus (NIDDM), or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency and hyperglycemia. It is often managed by increasing physical activity and dietary modification, although medications and insulin are often needed, especially as the disease progresses. It is rapidly increasing in the developed world, and there is some evidence that this pattern will be followed in much of the rest of the world in coming years.[citation needed] CDC has characterized the increase as an epidemic.[1] In addition, whereas this disease used to be also... seen primarily in adults over age 40, in contrast to Diabetes mellitus type 1, it is now increasingly seen in children and adolescents, an increase thought to be linked to rising rates of obesity in this age group, although it remains a minority of cases.[2]
Unlike Type 1 diabetes, there is little tendency toward ketoacidosis in Type 2 diabetes, though it is not unknown. One effect that can occur is nonketonic hyperglycemia which also is quite dangerous, though it must be treated very differently. Complex and multifactorial metabolic changes very often lead to damage and function impairment of many organs, most importantly the cardiovascular system in both types. This leads to substantially increased morbidity and mortality in both Type 1 and Type 2 patients, but the two have quite different origins and treatments despite the similarity in complications.
Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes
Pre-diabetes:
Impaired fasting glycaemia
Impaired glucose tolerance
Disease Management
Diabetes management:
•Diabetic diet
•Anti-diabetic drugs
•Conventional insulinotherapy
•Intensive insulinotherapy
Other Concerns
Cardiovascular disease
Diabetic comas:
•Diabetic hypoglycemia
•Diabetic ketoacidosis
•Nonketotic hyperosmolar
Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Diabetes and pregnancy
Blood tests
Blood sugar
Fructosamine
Glucose tolerance test
Glycosylated hemoglobin
Contents
[hide]
* 1 Pathophysiology
* 2 Diagnosis
* 3 Screening and prevention
o 3.1 Prevention
o 3.2 Accuracy of tests for early detection
o 3.3 Benefit of early detection
* 4 Treatment
o 4.1 Treatment goals
o 4.2 Self monitoring of blood glucose
o 4.3 Dietary management
o 4.4 Exercise
o 4.5 Antidiabetic drugs
+ 4.5.1 Oral drugs
+ 4.5.2 Injectable peptide analogs
+ 4.5.3 Insulin preparations
o 4.6 Alternative medicines
o 4.7 Antihypertensive agents
o 4.8 ACE inhibitors
o 4.9 Hypolipidemic agents
o 4.10 Gastric bypass surgery
+ 4.10.1 Suspected action mechanism
* 5 References
* 6 External links
[edit] Pathophysiology
Insulin resistance means that body cells do not respond appropriately when insulin is present. Unlike insulin-dependent diabetes mellitus (Type 1), the insulin resistance is generally "post-receptor", meaning it is a problem with the cells that respond to insulin rather than a problem with insulin production.
Other important contributing factors:
* increased hepatic glucose production (e.g., from glycogen degradation), especially at inappropriate times (typical cause is deranged insulin levels, as insulin controls this function in liver cells)
* decreased insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects)
* impaired beta-cell function—loss of early phase of insulin release in response to hyperglycemic stimuli
* Cancer survivors who received allogenic Hematopoietic Cell Transplantation (HCT) are 3.65 times more likely to report type 2 diabetes than their siblings. Total body irradiation (TBI) is also associated with a higher risk of developing diabetes.
This is a more complex problem than Type 1, but is sometimes easier to treat, especially in the early years when insulin is often still being produced internally. Type 2 may go unnoticed for years before diagnosis, since symptoms are typically milder (eg, no ketoacidosis, coma, etc) and can be sporadic.[citation needed] However, severe complications can result from improperly managed Type 2 diabetes, including renal failure, blindness, slow healing wounds (including surgical incisions), and arterial disease, including coronary artery disease. The onset of Type 2 has been most common in middle age and later life, although it is being more frequently seen in adolescents and young adults due to an increasing rate of obesity in these groups.[citation needed] A type of Type 2 diabetes called MODY is occasionally also seen in adolescents.
Diabetes mellitus type 2 is presently of unknown etiology (i.e., origin). Diabetes mellitus with a known etiology, such as secondary to other diseases, known gene defects, trauma or surgery, or the effects of drugs, is more appropriately called secondary diabetes mellitus. Examples include diabetes mellitus caused by hemochromatosis, pancreatic insufficiencies, or certain types of medications (e.g. long-term steroid use).
About 90–95% of all North American cases of diabetes are type 2[3], and about 20% of the population over the age of 65 has diabetes mellitus Type 2. The fraction of Type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons, though these are not known in detail. Diabetes affects over 150 million people worldwide and this number is expected to double by 2025[3]. There is also a strong inheritable genetic connection in Type 2 diabetes: having relatives (especially first degree) with Type 2 increases risks of developing Type 2 diabetes very substantially. In addition, there is also a mutation to the Islet Amyloid Polypeptide gene that results in an earlier onset, more severe, form of diabetes[4],[5]. About 55 percent of type 2 are obese[6] —chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue (especially that in the abdomen around internal organs) is a (recently identified) source of several chemical signals to other tissues (hormones and cytokines). Other research shows that Type 2 diabetes causes obesity as an effect of the changes in metabolism and other deranged cell behavior attendant on insulin resistance.[7]
Diabetes mellitus Type 2 is often associated with obesity, hypertension, elevated cholesterol (combined hyperlipidemia), and with the condition often termed Metabolic syndrome (it is also known as Syndrome X, Reavan's syndrome, or CHAOS). It is also associated with acromegaly, Cushing's syndrome and a number of other endocrinological disorders. Additional factors found to increase risk of type 2 diabetes include aging[8], high-fat diets[9] and a less active lifestyle[10].
[edit] Diagnosis
The World Health Organization definition of diabetes is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either[11]:
* fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl)
or
* With a Glucose tolerance test, two hours after the oral dose a plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
source : http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2
Unlike Type 1 diabetes, there is little tendency toward ketoacidosis in Type 2 diabetes, though it is not unknown. One effect that can occur is nonketonic hyperglycemia which also is quite dangerous, though it must be treated very differently. Complex and multifactorial metabolic changes very often lead to damage and function impairment of many organs, most importantly the cardiovascular system in both types. This leads to substantially increased morbidity and mortality in both Type 1 and Type 2 patients, but the two have quite different origins and treatments despite the similarity in complications.
Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes
Pre-diabetes:
Impaired fasting glycaemia
Impaired glucose tolerance
Disease Management
Diabetes management:
•Diabetic diet
•Anti-diabetic drugs
•Conventional insulinotherapy
•Intensive insulinotherapy
Other Concerns
Cardiovascular disease
Diabetic comas:
•Diabetic hypoglycemia
•Diabetic ketoacidosis
•Nonketotic hyperosmolar
Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Diabetes and pregnancy
Blood tests
Blood sugar
Fructosamine
Glucose tolerance test
Glycosylated hemoglobin
Contents
[hide]
* 1 Pathophysiology
* 2 Diagnosis
* 3 Screening and prevention
o 3.1 Prevention
o 3.2 Accuracy of tests for early detection
o 3.3 Benefit of early detection
* 4 Treatment
o 4.1 Treatment goals
o 4.2 Self monitoring of blood glucose
o 4.3 Dietary management
o 4.4 Exercise
o 4.5 Antidiabetic drugs
+ 4.5.1 Oral drugs
+ 4.5.2 Injectable peptide analogs
+ 4.5.3 Insulin preparations
o 4.6 Alternative medicines
o 4.7 Antihypertensive agents
o 4.8 ACE inhibitors
o 4.9 Hypolipidemic agents
o 4.10 Gastric bypass surgery
+ 4.10.1 Suspected action mechanism
* 5 References
* 6 External links
[edit] Pathophysiology
Insulin resistance means that body cells do not respond appropriately when insulin is present. Unlike insulin-dependent diabetes mellitus (Type 1), the insulin resistance is generally "post-receptor", meaning it is a problem with the cells that respond to insulin rather than a problem with insulin production.
Other important contributing factors:
* increased hepatic glucose production (e.g., from glycogen degradation), especially at inappropriate times (typical cause is deranged insulin levels, as insulin controls this function in liver cells)
* decreased insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects)
* impaired beta-cell function—loss of early phase of insulin release in response to hyperglycemic stimuli
* Cancer survivors who received allogenic Hematopoietic Cell Transplantation (HCT) are 3.65 times more likely to report type 2 diabetes than their siblings. Total body irradiation (TBI) is also associated with a higher risk of developing diabetes.
This is a more complex problem than Type 1, but is sometimes easier to treat, especially in the early years when insulin is often still being produced internally. Type 2 may go unnoticed for years before diagnosis, since symptoms are typically milder (eg, no ketoacidosis, coma, etc) and can be sporadic.[citation needed] However, severe complications can result from improperly managed Type 2 diabetes, including renal failure, blindness, slow healing wounds (including surgical incisions), and arterial disease, including coronary artery disease. The onset of Type 2 has been most common in middle age and later life, although it is being more frequently seen in adolescents and young adults due to an increasing rate of obesity in these groups.[citation needed] A type of Type 2 diabetes called MODY is occasionally also seen in adolescents.
Diabetes mellitus type 2 is presently of unknown etiology (i.e., origin). Diabetes mellitus with a known etiology, such as secondary to other diseases, known gene defects, trauma or surgery, or the effects of drugs, is more appropriately called secondary diabetes mellitus. Examples include diabetes mellitus caused by hemochromatosis, pancreatic insufficiencies, or certain types of medications (e.g. long-term steroid use).
About 90–95% of all North American cases of diabetes are type 2[3], and about 20% of the population over the age of 65 has diabetes mellitus Type 2. The fraction of Type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons, though these are not known in detail. Diabetes affects over 150 million people worldwide and this number is expected to double by 2025[3]. There is also a strong inheritable genetic connection in Type 2 diabetes: having relatives (especially first degree) with Type 2 increases risks of developing Type 2 diabetes very substantially. In addition, there is also a mutation to the Islet Amyloid Polypeptide gene that results in an earlier onset, more severe, form of diabetes[4],[5]. About 55 percent of type 2 are obese[6] —chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue (especially that in the abdomen around internal organs) is a (recently identified) source of several chemical signals to other tissues (hormones and cytokines). Other research shows that Type 2 diabetes causes obesity as an effect of the changes in metabolism and other deranged cell behavior attendant on insulin resistance.[7]
Diabetes mellitus Type 2 is often associated with obesity, hypertension, elevated cholesterol (combined hyperlipidemia), and with the condition often termed Metabolic syndrome (it is also known as Syndrome X, Reavan's syndrome, or CHAOS). It is also associated with acromegaly, Cushing's syndrome and a number of other endocrinological disorders. Additional factors found to increase risk of type 2 diabetes include aging[8], high-fat diets[9] and a less active lifestyle[10].
[edit] Diagnosis
The World Health Organization definition of diabetes is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either[11]:
* fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl)
or
* With a Glucose tolerance test, two hours after the oral dose a plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
source : http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2