Diabetes mellitus type 2 is a metabolic disorder primarily characterized by the following symptoms: insulin resistance, relative insulin deficiency and hyperglycemia.
The condition is also known as non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes. Presently there is no cure for this condition, which is rapidly increasing in the developed world, and there is some evidence that this pattern will be followed in the rest of the world in the coming years. That’s why scientists like to say that diabetes is increasingly showing the characteristics of an epidemic.
Different types of Diabetes
The three main kinds of diabetes are type 1, type 2, and gestational diabetes.
Type 1 Diabetes
Type 1 diabetes, also known as insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. That’s why some call it juvenile diabetes. The beta cells of the pancreas make no insulin because the body’s immune system has destroyed them. That’s why the treatment for type 1 diabetes is based on replacing the insulin by taking insulin shots or using an insulin pump.
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes. People can develop this type of diabetes at any age, even during childhood. This form of diabetes usually begins with insulin resistance; at first the pancreas keeps producing insulin. After some time, however, it loses the ability to secrete enough insulin in response to meals.
Some women develop gestational diabetes late in pregnancy. This form of diabetes is caused by the hormones of pregnancy or a shortage of insulin. Research has shown that although this form of diabetes usually goes away after delivery, a woman is more likely to develop type 2 diabetes later in life.
Incidence of the condition
Recent research has established that 90-95% of all North American cases of diabetes are type 2, and about 20% of the population over the age of 65 has diabetes mellitus type 2. The incidence and frequency of type 2 diabetics in other parts of the world varies substantially depending on environmental and lifestyle specifics.
Possible causes and pathophysiology of the condition
Genetic factors, usually polygenic, are present in great majority of patients. Scientists believe that some environmental factors such as obesity, lack of exercise and a sedentary lifestyle could also contribute to insulin resistance.
Insulin resistance is a condition in which body cells do not respond appropriately to the presence of insulin. Although it may sound simple, this is actually a far more complex problem than diabetes type 1. It is sometimes easier to treat, especially in the initial years when insulin is still being produced internally. Diabetes mellitus type 2 is presently of unknown etiology. 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.
Other associated conditions
Diabetes mellitus type 2 is often associated with:
* obesity and hypertension
* elevated cholesterol
* Metabolic syndrome (also known as Syndrome X, Reavan's syndrome, or CHAOS)
* Cushing's syndrome
* other endocrinological disorders
Risk factors for developing DM-type 2
Scientists still don't fully understand why some people get type 2 diabetes and others don't. However, certain factors increase the risk of developing DM-2:
Being overweight is one of the main risk factors for type 2 diabetes. The more fatty tissue a patient has, the more resistant his or her body becomes to its own insulin. Not only that, weight distribution is also believed to be of critical importance.
The less active a patient is, the greater the risk of type 2 diabetes. Physical activity helps control weight, uses up glucose, makes cells more sensitive to insulin, increases blood flow, and improves circulation in the blood vessels.
The risk of type 2 diabetes increases significantly if the patient’s parent or parents also suffer from the disease.
There is also an expressed correlation between age and onset of the disease. The risk of type 2 diabetes increases as the patient grows older, especially after age 45. Unfortunately, this isn’t a hard-set rule because diabetes incidence is also increasing dramatically among children and adolescents.
People of certain races are believed to be more likely to develop diabetes, although scientists still can’t really explain or confirm this.
Depression seems to increase the risk of type 2 diabetes as well. Experts believe that it could be because people with depression often gain weight and lack physical activity.
Treatment of Diabetes Mellitus type 2
Controlling blood sugar is essential for an effective management of diabetes type 2, and avoiding long-term complications. Some people are able to control blood sugar levels with diet and exercise alone, while others require medications.
* Sulfonylurea drugs
These medications stimulate human pancreas to produce and release more insulin. Most commonly used medications of this kind are second-generation sulfonylureas such as glipizide (Glucotrol®, Glucotrol XL®), glyburide (DiaBeta®, Glynase®, Micronase®) and glimepiride (Amaryl®).
These medications are extremely effective, and not as likely to lead to hypoglycemia. One of the most common is repaglinide (Prandin®).
Metformin (Glucophage®, Glucophage XR®) is the only drug in this class available in the United States. It works by inhibiting the production and release of glucose from the patient’s liver, which means that the patient will need less insulin to transport blood sugar into the cells. It has side effects such as metallic taste in mouth, loss of appetite, nausea or vomiting, abdominal bloating, or pain, gas and diarrhea.
* Alpha-glucosidase inhibitors
These medications block the action of enzymes in human digestive tract that break down carbohydrates, so less sugar is absorbed into the bloodstream. This could be extremely helpful because it prevents the rapid rise in blood sugar that usually occurs right after a meal. Most common medications in this class are acarbose (Precose®) and miglitol (Glyset®).
Some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce. Unfortunately, unlike other medications, insulin can't be taken in pill form because enzymes in the stomach break it down.
The best way to prevent diabetes type 2 is to make healthy lifestyle choices. Even in the cases when diabetes runs in the family, diet and exercise can help a patient prevent or delay the onset of the disease. Not only that - those diagnosed with diabetes can also benefit from making healthy lifestyle changes by preventing potentially serious complications.
Eating healthy is crucial in prevention; only food low in fat and calories should be eaten and the focus should be on fruit, vegetables, and whole grains.
Physical activity is another key point of prevention. Although losing excess pounds could be difficult, in order to keep weight in a healthy range, a patient should focus on permanent changes to his eating and exercise habits.