TYPE II DIABETES MELLITUS

What Is Type II Diabetes? Also known as non-insulin dependent diabetes mellitus (NIDDM) and late-onset diabetes, this is a disease characterized by uncontrolled high levels of blood sugar. Normally, blood sugar is controlled by the hormone insulin, produced in the pancreas. Insulin stimulates cells of the body to utilize or store sugar, thus reducing the amount in the blood. Although variable levels of production of insulin are maintained in type II diabetes, the body's response to the hormone is muted; this is known as insulin resistance. Type II diabetes differs from type I in that most patients with type I are diagnosed as children or young adults, and because in type I diabetes, lack of blood sugar control stems from the destruction of insulin-producing B-cells in the pancreas, not from insulin resistance. Type II diabetes is most commonly, but not exclusively, diagnosed in middle-aged to elderly adults.

What Causes Type II Diabetes? Type II diabetes has a strong genetic component; that is, individuals with the disease have likely inherited a predisposition to developing insulin resistance. Although the genes responsible for type II diabetes are not known, the presence of a first-degree relative (parent or sibling) with the disease increases personal risk. Type II diabetes is more common in people of Hispanic, native American, and African descent. The risk of developing diabetes in a genetically vulnerable individual increases with age and obesity. Obesity also reduces the effectiveness of insulin, thereby further increasing insulin resistance.

What Are The Signs And Symptoms Of Type II Diabetes? Here again, type II diabetes differs from type I in that it is often discovered in patients with no symptoms at all. When symptoms are present, they are due to elevated levels of blood sugar and comprise frequent urination, increased thirst and weight loss without reduced dietary intake. Diagnosis is confirmed by direct measurement of high blood sugar levels after fasting for 8 - 12 hours. High blood sugar also renders the patient prone to minor infections like vaginal yeast infections or skin infections. Unlike type I diabetes, type II diabetes does not lead to the serious complication of diabetic ketoacidosis (DKA), in which state a dangerously high level of blood sugar can lead to dehydration, and even coma.

What Is The Treatment For Type II Diabetes? The goal of therapy, as in Type I diabetes, is to maintain blood sugar levels within the normal range, thus preventing the development or worsening of diabetic complications. For type II diabetics, the first step in treatment is lifestyle modification, including consultation with a dietitian and initiation of a physical exercise program. If a healthy body weight is achieved, no other treatment may be necessary. For patients requiring medical treatment, drugs known generally as "oral hypoglycemic agents" are prescribed to reduce blood sugar levels. Three major classes of these drugs exist: sulfonylureas, biguanides and alpha-glucosidase inhibitors. These drugs all act to lower blood sugar, but vary in their mechanism of action, effectiveness, side effects (weight gain), and side benefits (lowering cholesterol), all of which should be discussed with your doctor.

What Are The Complications Of Type II Diabetes? Sustained high levels of blood sugar lead to a number of major complications including retinopathy, kidney disease, neuropathy, diabetic foot, and atherosclerosis. Retinopathy and nephropathy in diabetics are "microvascular" complications; diseases of the small blood vessels supplying the eyes and kidneys. Diabetic retinopathy affects the tiny blood vessels of the retina in the eye, causing growth of new vessels and scar tissue formation which may cause blindness. As some degree of retinopathy occurs in more than 90% of diabetics, yearly referral to an ophthalmologist is recommended. The result of diabetic kidney disease is protein loss in the urine, scarring and atrophy of the kidneys, and in some patients, end-stage renal disease requiring dialysis or transplant. High blood sugar can be detrimental to the nerves supplying all parts of the body. The most common manifestation of diabetic neuropathy is known as "glove and stocking" syndrome, in which the patient loses sensation in the hands and feet, causing susceptibility to cuts and other minor trauma. The combination of vascular problems, neuropathy, and vulnerability to infection can lead to serious wounds, ulcers, and inflammatory conditions in the feet which, unnoticed, can progress so far as to require amputation. The leading cause of death in patients with diabetes is macrovascular disease, i.e. atheroslerotic disease of the larger arteries. The risk of heart attack is doubled in men with diabetes and quadrupled in women; in both sexes, the risk of stroke is doubled. Therefore blood pressure, cholesterol and other cardiovascular risk factors must be closely monitored.