Diabetes Mellitus Type 2 Disease

BASICS

DESCRIPTION

Non-ketosis prone hyperglycemia and glucose intolerance due to defects in insulin secretion and peripheral insulin action. Accounts for 80% of diabetic cases.

System(s) affected: Endocrine/Metabolic, Nervous, Renal/Urologic, Cardiovascular
Genetics: Strong polygenic familial susceptibility. Concordance is nearly complete in identical twins.
Incidence/Prevalence in USA:
- Incidence:
  - 300/100,000 (males 230/100,000, females 340/100,000)
- Prevalence:
  - 5,000/100,000
  - More common in some groups such as Pima Indians with 35% prevalence
Predominant age: Typically occurs after age 40
Predominant sex: Female > Male in Caucasian populations

SIGNS AND SYMPTOMS

Related to hyperglycemia and complications including nephropathy, neuropathy, and retinopathy
Polyuria
Polydipsia
Polyphagia
Weight loss
Weakness
Fatigue
Frequent infections

CAUSES

Genetic factors and obesity are important

RISK FACTORS

Family history
Gestational diabetes
Obesity

DIAGNOSIS

LABORATORY

Criteria for diagnosis

Symptoms of diabetes (polyuria, polydipsia, weight loss) plus casual (random) plasma glucose ≥ 200 mg/dL (11.1 mmol/L)
or
Fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L) on 2 occasions
or
2 hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during OGTT with 75 g glucose load

Drugs that may alter lab results:

Pentamidine
Nicotinic acid
Glucocorticoids
Thyroid hormone
Diazoxide
Beta adrenergic agonists
Thiazides
Dilantin
Alpha-interferon

Disorders that may alter lab results: See Differential Diagnosis

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Glucose tolerance test usually not necessary, except when diagnosing gestational diabetes
Hemoglobin A1C not recommended for diagnosis, but helpful in management

IMAGING

N/A

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Regular outpatient follow-up except for complicating emergencies such as severe hyperglycemia, hyperosmolar coma, and severe infections

GENERAL MEASURES

Home monitoring of blood glucose
Regular examination for complications: retinopathy, neuropathy, nephropathy

SURGICAL MEASURES

N/A

ACTIVITY

Regular aerobic exercise can improve glucose tolerance and decrease medication requirements

DIET

American Diabetes Association (ADA) provides dietary recommendations for NIDDM. The emphasis is on achieving glucose, lipid, and blood pressure goals. Mild caloric restriction is recommended to achieve mild to moderate weight loss (5-10 kg).
Food choices are similar to Dietary Guidelines for Americans and the Food Guide Pyramid:
- 10-20% of calories from protein
- < 10% of calories each from saturated and polyunsaturated fat
- Remainder of calories from monounsaturated fat and carbohydrates, depending on individual patient factors
- Sugar is not specifically prohibited

PATIENT EDUCATION

Education is critical for patients with NIDDM. Include information on the disease, medication treatment, self-monitoring, foot care, physical activity and diet management
Support groups and classes certified by the ADA are recommended
The ADA has prepared numerous patient education materials (430 North Michigan Ave. Chicago, IL 60611 or contact local ADA affiliate listed in white pages of telephone directory)

FOLLOW UP

PREVENTION/AVOIDANCE

Avoidance of weight gain and obesity and maintenance of regular physical activity may prevent or delay NIDDM

POSSIBLE COMPLICATIONS

Appear to be due to effects of diabetes mellitus on arterial walls in one form or another
Peripheral neuropathy
Proliferative retinopathy
Nephropathy and chronic renal failure
Atherosclerotic cardiovascular and peripheral vascular disease
Hyperosmolar coma
Gangrene of extremities
Blindness
Glaucoma
Cataracts
Skin ulceration
Charcot joints

EXPECTED COURSE AND PROGNOSIS

Maintenance of normal blood sugar levels may delay or prevent complications of diabetes
In susceptible individuals, complications begin to appear 10-15 years after onset, but can be present at time of diagnosis since disease may go undetected for years

MISCELLANEOUS

ASSOCIATED CONDITIONS

Hypertension is common (strict control may retard renal complications)
Hyperlipidemia
Impotence

AGE-RELATED FACTORS

Pediatric: Occasional cases of nonketosis-prone diabetes mellitus have been seen in children
Geriatric: Common in the elderly and is a significant contributing factor to blindness, renal failure, and lower limb amputations
Others: Generally diagnosed after age 40

PREGNANCY

Diabetes can cause significant maternal complications and fetal wasting. Intensive management has improved the outcome dramatically.

OTHER NOTES

N/A

ABBREVIATIONS

NIDDM = Non-insulin dependent diabetes mellitus
ADA = American Diabetic Association

Clinical Investigations

ROLE OF HOMOEOPATHY

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