Type II Diabetes

Happy Monday, and welcome to Medical Mondays! This week’s topic is…diabeetus Type II Diabetes Mellitus–just in time to kick off November, which is Diabetes Awareness Month!

I’ve been somewhat absent online lately because of my AI (Acting Internship). :O Over the weekend, I worked a 16 hour shift through Halloween and the time change, and a 14 hour shift through Sunday to Monday. Tis the first time I’ve ever worked nights (and this is my first AI), but I got a lot of learning in, so it is a-okay!

They’re giving me today off because they’re awesome, so I’m using it to take fun classes in town (BJJ + pole!) and to work up a draft for another article I’m writing! :] And sleep. Can’t forget the sleep.

Type II diabetes is characterized by hyperglycemia (high blood sugar), insulin resistance, and relative impairment in insulin secretion. (This one’s also part of the “big 3” seen in primary care.)

It is one of the major causes of early illness and death in the world, accounts for >90% of patients with diabetes, and ~14% of U.S. healthcare expenditures, at least half of which are related to diabetic complications (e.g. myocardial infarction, stroke, end-stage renal disease, retinopathy, foot ulcers).

Type II diabetes has risen in prevalence rather alarmingly over the past decade, due in part to the increasing trends of obesity and a sedentary lifestyle.

• Obesity causes peripheral resistance to insulin-mediated glucose uptake, and may also decrease the sensitivity of pancreatic beta-cells (responsible for secreting insulin).

It is also commonly associated with other conditions, including hypertension (read more on its diagnosis/screening and prevention), high LDL and low HDL, which all contribute to an increased risk of cardiovascular disease.

Risk Factors

• Age >45
• Overweight (BMI >25), with significantly increased risk for obese individuals (BMI >30)
• Diabetes mellitus in a 1st-degree relative
• High-risk racial/ethnic group (Native American, African American, Latino, Asian American or Pacific Islander)
• History of delivering a baby weighing >9 lb, or of gestational diabetes
• Hypertension (BP > 140/90)
• Dyslipidemia (HDL <35 and/or triglyceride concentration >250)
• A1C >5.7%, impaired glucose tolerance, or impaired fasting glucose
• History of vascular disease
• Polycystic ovary syndrome

Symptoms

Many can be asymptomatic for a long period of time, and people often won’t feel that something is “wrong” until much, much later (hence, my preventative care soapbox), but the main symptoms include:

• Polydipsia (increased thirst)
• Polyuria (increased frequency of urination)
• Nocturia (the need to wake up at night to urinate)
• In adolescent girls, vaginal discharge or vulvovaginitis due to candidiasis can be a common initial complaint

Diagnosis/Testing

• Hemoglobin A1C (HbA1C) tests a patient’s 3-month blood glucose average
  • >6.5% on 2 occasions is sufficient for diagnosis
  • 5.7-6.4% has been considered to indicate risk for diabetes
• Oral glucose tolerance test (OGTT) can detect patients with diabetes early in the development of the disease
  • >200 mg/dL measured 2 hours after a glucose load is diagnostic
  • >140-199 mg/dL measured 2 hours after a glucose load demonstrates impaired glucose tolerance (IGT) and indicates increased risk
• Fasting plasma glucose (FPG) is convenient, and less expensive/invasive than the OGTT, but also less sensitive
  • >126 mg/dL on 2 occasions is sufficient to diagnose diabetes
  • >100-125 mg/dL is impaired fasting glucose (IFG), and indicates increased risk

Complications

So why do we care anyway?

It can lead to a host of conditions that you really probably wouldn’t want. For instance:

• Retinopathy, an important cause of visual loss worldwide, and is the principal cause for impaired vision in patients between 25-74
• Nephropathy, which can progress to end-stage renal disease
• Neuropathy, which affects both the autonomic (heart rate, blood pressure control, etc.) and peripheral (e.g. nerve conduction and sensory perception) nervous systems
• Cardiovascular complications, including increased arterial stiffness, which indicates premature aging of the cardiovascular system
• Youth with type II diabetes also seem to have an increased risk for depression + binge eating
• Increased risk for hypertension, dyslipidemia, and nonalcoholic fatty liver disease

Prevention

The goal of diabetes “prevention” is to delay the onset of diabetes, preserve beta cell function, and prevent or delay microvascular and cardiovascular complications.

• Lifestyle Modifications
  • Maintaining a healthy diet high in fruits, veggies, whole grains, beans, nuts & seeds, with low to moderate amounts of fish, poultry and dairy products, seems to reduce the incidence of diabetes
  • Exercise seemed to show a lower risk of developing diabetes with regular moderate physical activity, including brisk walking (vs. being sedentary). Either weight training or aerobic exercise for >150 min/week was also associated with a lower risk.
  • Weight loss/lifestyle intervention can substantially improve glycemic control in patients with type II diabetes, and can also improve glucose tolerance.

---

Disclaimer: The information in this post was gleaned from UpToDate articles and other med school resources. This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)