Definition of "Type 2 diabetes"

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Type 2 diabetes (aka diabetes [mellitus] type 2, formerly noninsulin-dependent diabetes mellitus, NIDDM, adult-onset diabetes) is a metabolic disorder involving hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin.

Patient information

What is type 2 diabetes?
Diabetes is blood sugar that is higher than it's supposed to. Type 2 means that the body isn't responding to insulin as it's supposed to.

What is insulin?
Insulin is a hormone, that helps take up glucose from blood, to be stored as fat. it thus helps reduce blood glucose.

So if the body isn't responding to insulin as it's supposed to, it doesn't take up glucose from blood as it's supposed to?
Yep. So that means there's more glucose in blood, than there's supposed to.

Sx
  • Polydipsia (excess thirst)
  • Polyuria (frequent urination)
  • Polyphagia (constant hunger)

Patient information

What's it like to have high blood sugar?
You are really thirsty. Really hunger. You need to pee more often.

Cause
  • Obesity, primarily
  • Genetic predisposition

Patient information

What causes high blood sugar, due to non-responsiveness to insulin?
Being fat. And it's also partly inherited.

Dx

Dx as recurrent or persistent hyperglycemia, is demonstrated by:

  • 2x fasting blood glucose >=7mmol/L
  • 75g OGTT >=11.1mmol/L at 2 hours 
  • Sx of hyperglycemia + casual blood glucose >=11.1mmol/L
  • HbA1c>= 6.5 DCCT%

A positive result in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the methods on a different day

Tx
  • Lifestyle changes:
    • Increasing exercise
    • Dietary changes
  • Drugs, if BSL's are not adequately lowered by lifestyle changes:
    • Metformin (i.e. decreases glucose production by the liver), first line. Pt's can suffer from a "relative" insulin deficiency because they are often insulin resistant. Thus, insulin may eventually be required if diet and medications fail to control blood glucose adequately (in 40% of cases)
    • Insulin (i.e. helps store blood glucose, as fat), which requires routine checking of BSL's

Patient information

What can you do about high blood sugar, due to non-responsiveness to insulin?
You can modify lifestyle, by increasing exercise, and improving diet. You can also use various drugs, if lifestyle changes itself doesn't work.

What drugs can you use?
Metformin. And if necessary, insulin. Metformin makes it so the liver produces less glucose. And insulin, just like the body's natural insulin, helps store blood glucose, as fat.

Complications
  • Acute complications:
    • Hyperosmolar hyperglycemic state (type 2 version of ketoacidosis)
  • Long-term complications:
    • Heart disease
    • Stroke
    • Diabetic retinopathy, where eyesight is affected
    • Kidney failure, which may require dialysis
    • Poor blood flow in limbs, causing amputations

Patient information

What can happen if you have high blood sugar, due to non-responsiveness to insulin?
There's stuff that can happen in the short run, and in the long run. In the short run, blood sugar can be so high, it causes severe dehydration that is so bad, it causes coma. In the long run, you can also get various blood problems, including effects to the heart, brain, eyes, kidney, and the body's limbs.

Prognosis
  • Chronic disease
  • Associated w/ 10-year shorter life expectancy
Epidemiology
  • Constitutes 90% of diabetes (type 1 diabetes and gestational diabetes constitutes the other 10%)
  • Rates of type 2 diabetes have increased markedly since 1960 in parallel w/ obesity
  • Approximately 285m Pt's Dx w/ the disease, compared to 30m in 1985
See also

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Definition of Type 2 diabetes | Autoprac


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