DIABETS MELLITUS-TYPEII

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General Illness Information

Medical Term:

DIABETES MELLITUS - NON-INSULIN DEPENDENT (NIDDM)

Common Name:

Type II Diabetes

Description:

Diabetes Mellitus is a disorder in which blood levels of glucose are abnormally high due to either an absolute deficiency of insulin secretion, or as a result of reduced effectiveness of insulin, or both.

Diabetes Mellitus is classified into two major types- Type I (Insulin-Dependent Diabetes Mellitus ), and Type II (Non-Insulin Dependent Diabetes Mellitus).

All body cells need insulin to convert food into energy and chemicals. Inadequate insulin production or reduction in the effectiveness of insulin in adults leads to the condition of Type II diabetes (Non Insulin Dependent Diabetes Mellitus ). This comprises of a milder form of diabetes and occurs predominantly in adults but occasionally in juveniles. Of an estimated 12-15 million Americans with diabetes, 90% have NIDDM, and of these 70-80% are obese.

In the United States, NIDDM is the 7th leading cause of death, and a major contributor to 300,000 additional deaths.

Causes:

In Type II diabetes mellitus, the pancreas ( the organ that produces insulin) continues to manufacture insulin. However, this production may be inadequate or, for some unknown reason, the body develops resistance to insulin , thus resulting in a relative insulin deficiency.

Type II diabetes usually begins after age 30 and becomes progressively more common with age. About 15% of people over age 70 have Type II diabetes.

Prevention:

Type II diabetes may be prevented or its onset delayed by maintaining ideal body weight and by maintaining a regular exercise program.

Signs & Symptoms

	Excessive thirst.
	Frequent urination.
	Fatigue.
	Increased appetite.
	Decreased resistance to infection, especially urinary-tract infections and yeast infections of the skin, mouth or vagina
	Unexplained weight loss.
	Sometimes there are no symptoms.

Risk Factors

	Family history of diabetes mellitus.
	Obesity in adults.
	Stress.
	Pregnancy (gestational diabetes).
	Use of certain drugs, including oral contraceptives, thiazide diuretics, cortisone, or phenytoin.
	Racial and cultural - Blacks and Hispanics have twofold to threefold increased risk of developing Type II diabetes. Recently very high incidence reported in certain American Indian groups, or villages.

Diagnosis & Treatment

Diagnosis of diabetes is made when a person is found to have abnormally high sugar levels. This may be discovered either on a routine blood test performed during a regular annual health examination or blood test was performed because the patient had symptoms of frequent urination and thirst or because the patient has typical risk factors such as a family history of diabetes, obesity, frequent infections, or any of the complications associated with diabetes. To measure the blood sugar level. a blood sample is usually taken after the person has fasted for 10 to 12 hours. Diagnosis of diabetes is made when fasting plasma glucose is greater than or equal to 7.8mmol/liter (>or = 140mg/dL) measured on two occasions. However, the American Diabetes Association has recommended lowering the diagnostic level to 7 mmol/L on two occasions. Alternatively, following ingestion of 75gm of glucose, the finding of plasma glucose of greater than or equal to 11.1mmol/L (> or = 200mg/dL) after 2 hours and at least on one other occasion during the 2 hour test is suggestive of the diagnosis.
General Measures:
	Learn all you can about controlling diabetes and recognizing signs and symptoms and treatment of hypo- and hyperglycemia.
	The main goal in the treatment of diabetes is to keep blood sugar levels within the normal range as much as possible. The aim is to maintain the fasting blood sugar levels at 7 mmol/L (120 mg/dl) or under.
	Treatment of diabetes requires attention to weight control, exercise and diet. Lose weight to a normal level and maintain your ideal weight.
	Learn to test your urine and blood for glucose (sugar). Every diabetic patient must be instructed in the use of a glucometer (instrument for measuring blood sugar levels).
	Obtain prompt medical treatment for any infection or injury.
	Keep regular visits with your family doctor. Patients with diabetes of greater than 5 years' duration should have a retinal examination performed by an ophthalmologist at least every other year and more often if significant diabetic retinopathy is present.
	Wear a medical alerting type pendant or bracelet.

Medications:
	Once diagnosis of diabetes is established, a diet should be instituted that includes an appropriate number of calories based on ideal body weight, an adequate protein, and a carbohydrate intake of about 40-60% of total energy. Appropriate distribution of food intake is also important. When blood sugar levels cannot be controlled by diet, oral hypoglycemic medications may be administered. The usual practice is to prescribe sulfonylureas, increasing the dose to a maximal level as required, and then to add metformin as the second drug.
	Insulin may be needed to be prescribed in patients in whom the oral hypoglycemic medications do not control the blood sugars adequately.
	There are newer drugs such as Toglitazone, which enhance the action of insulin and may be used as an additional drug in NIDDM patients who do not have adequate response to insulin or maximal dose of oral agents. Another drug that may help in controlling blood sugar after meals is Alpha-glucosidase inhibitor (Acarbose ) which is to be taken at beginning of meals.

Activity:
No restrictions. Regular daily exercise is an important part of controlling diabetes.

Diet:

A special diet will be necessary to reduce weight; limit refined sugars; balance unrefined carbohydrates, protein and fat; and increase plant fiber. A dietitian or nutritionist should be consulted.

Possible Complications :
	Cardiovascular disease, especially atherosclerosis, stroke and coronary-artery disease.
	Vision impairment (cataracts, retinal disease).
	Peripheral vascular disease, with gangrene in legs and feet and sexual impotence in men (sometimes).
	Hypoglycemia, if oral hypoglycemic medication is used. Hypoglycemia must be treated quickly, because within minutes it can become severe, leading to increasing confusion, coma, and rarely brain damage. At the first sign of hypoglycemia, the person should eat some form of sugar. Therefore, people with diabetes should always carry candy, lumps of sugar or glucose tablets to treat an episode of hypoglycemia. Other options are to drink a glass of fruit juice, sugar water or even a glass of milk.
	Kidney disease.

Prognosis

This form of diabetes can often be controlled by diet and if needed, weight loss. Good control decreases the chance of complications. Regular follow-up is essential. In some cases, it progresses to insulin-dependent diabetes, a more serious form.

Other

'Nothing Specified'.