Differences between Type 1 and Type 2 Diabetes was posted on Type 2 Diabetes Advice.

Type II Diabetes has got several diagnostic procedures. The most commonly used diagnostic procedures are Random Blood Sugar(RBS), Post Prandial Blood Sugar(PPBS), Fasting Blood Sugar(FBS), HbA1C (Glycosylated Haemoglobin), Oral Glucose Tolerance Test(OGTT) and Urine analysis. Besides the above tests the symptoms also help in diagnosis.

DIAGNOSIS:

SYMPTOMS:

The preliminary diagnosis of any disease is done by considering the symptoms and signs of the patient. The most common symptoms like polyuria, polydypsia and polyphagia associated with asthenia and weight loss give a clear picture that the person is suffering from diabetes. Other symptoms like weakness and energy loss also suggest diabetes.

URINE TESTS:

The urine of a patient suffering from diabetes mellitus and renal glycosuria shows high amounts of glucose. The amount of glucose in urine gives a clear picture of the severity of the disease in the patient.

In urine analysis, Benedict’s test is performed which is a semi-quantitative test. Other tests include glucose oxidase method.

BLOOD TESTS:

O-Toluidene test is a colorimetric test employed for determining the blood glucose which needs 10 to 15 minutes. Here an absorptiometer or a photometer is used to measure the intensity of the color of the blood sample treated with reagent. The instrument works on Beer-Lambert’s law. The intensity of the color is measured in optical density which is then converted to mg/dl by mathematical calculations.

The amount of glucose in blood after an overnight fast should be in between 70-110 mg/dl. This is called fasting blood sugar (FBS). The glucose after taking a meal should be 120-140 mg/dl. This is called postprandial blood sugar (PPBS) which is to be done two hours after taking a meal. Random blood sugar is the amount of glucose in blood when tested at any time. Random blood sugar (RBS) should be less than 200 mg/dl. Any values above these ranges are said to be abnormal and the patient is said to be diabetic or prone to diabetes.

Latest advancement in technology has brought in glucometers which are electrical instruments that can give the concentration of glucose in blood in just 10 seconds and from a single drop of blood. Here a drop of blood is obtained by puncturing the tip of the finger. This drop has to be put on a small stick or special paper provided with the instrument. Then the reading of the instrument has to be adjusted as per the instructions given and the stick is introduced into the glucometer. From now on within 10 seconds the glucose reading is displayed on the instrument. This procedure is very easy, convenient, less time consuming and simple. It is a bit costlier as per the present scenario.

Glycosylated Hemoglobin or HbA1c is another test which gives a picture of the blood glucose levels over a span of 4 months. In hyperglycaemia, the hemoglobin in RBC gets glycosylated. Measuring the concentration of the glycosylated Hemoglobin is an indication of the glucose levels in the blood. The concentration of HbA1c is directly proportional to the blood glucose levels. Life span of an BC is 120 days or 4 months. Hence HbA1c indicates the blood glucose levels over a period of 120 days. A concentration of HbA1c > 6.5% means that the patient is diabetic.

OGTT

Oral Glucose Tolerance Test is a test employed to determine the risk and susceptibility of a person to diabetes. It is not a diagnosis, but it is an early indicator of diabetes. Here the patient is made to drink 300 ml of water which contains 75 g of glucose in 5 minutes, after an overnight fast. One blood sample and one urine sample are collected before drinking the glucose water. Later blood and urine samples are collected at every 30 minutes interval for nearly 2 hrs. All the blood samples are tested for glucose and all the urine samples are quantitatively estimated for glucose.

A person is said to be diabetic if the fasting blood glucose exceeds 126 mg/dl and the 2 hrs sample exceeds 200 mg/dl. For pregnant women 100g of glucose is given in 300 ml water to drink. The person is said to have Impaired Glucose Tolerance(IGT) if his blood sample collected at first half an hour after glucose load or drinking glucose water is above 180 mg/dl. The people with impaired glucose tolerance are susceptible to get diabetes. In IGT the PPBS is in between 140 and 200 mg/dl.

CONCLUSION:

These are some of the most commonly employed diagnostic procedures for diagnosing Diabetes Mellitus.

How to Diagnose Type 2 Diabetes was posted on Type 2 Diabetes Advice.

Can Type 2 Diabetes be Reversed?

This is a common question which has been asked by diabetic patients since centuries. In the past, it was assumed that type 2 diabetes cannot be reversed. But as per the latest research it has been found that type 2 diabetes in newly diagnosed patients can be reversed.

PROCESS:

Though it has been said it can be reversed, still some experts say that it will be expressed later again and this is not a reversal but just a delay of the onset. There are many controversies regarding the issue.

As per a recent study it was shown that seven out of eleven people survived from type 2 diabetes and their blood glucose levels returned to normal. These people had a restricted diet with low calories which reduced the levels of fat in liver and pancreas which further brought the insulin production back to normal. But here again, all the people could not survive the effects. This shows that the change depends on the susceptibility of the person. Greater is the susceptibility of the person to diabetes lesser is the chance of reversal. Besides this, the reversal is possible only in the initial stages when the beat cells are not completely exhausted and the insulin production can be restored by just reducing the burden on them.

Some experts state that, starvation can reduce the severity of type 2 diabetes because the blood glucose levels are reduced. They say that this has been an age old practice and is known since long and there is nothing new regarding reversal of type 2 diabetes by a low calorie diet.

It has also been shown that a period of marked weight loss can also produce reversal of type 2 diabetes. It should also be seen that this drastic weight loss and low calorie diet should be under constant medical supervision, so that these things do not lead to any other complications.

Some of the measures which may be employed to reverse type 2 diabetes are:

• Taking a high fiber content food with plant based foods.

• Eating foods of low glycemic index.

• Regular Exercise of atleast 30 minutes a day nearly five times a week.

• Intake of multivitamins, fish oil, vitamin D. A good balance should be achieved in between glucose and insulin levels in the blood.

CONCLUSION:

Reversal of type 2 diabetes promises a good future for the diabetic patients of today. But it is still in the pipeline and the effects are yet to be proved. Though the effects are good but it is not clearly known how long they last. Another restriction is that it is helpful only if the diabetes is in initial conditions and there is only a partial loss of the beta cell function. So, for reversal the condition should be diagnosed as early as possible. The measures for reversal are of no use if the disease is diagnosed in the later stages.

Can Type 2 Diabetes be Reversed? was posted on Type 2 Diabetes Advice.

Type 2 Diabetes Mellitus can occur at any age. However, type 2 diabetes in children is not as common as in the case with adults.

Type 1 diabetes mellitus in infants occur due to some congenital disorder is called ‘Juvenile Diabetes”. So, juvenile diabetes is type 1 diabetes and should not be confused with type 2 diabetes.

Type 2 diabetes mainly occurs in individuals aged more than 35 years. Obesity is the prominent cause of type 2 diabetes mellitus. As type 2 diabetes is seen in adults, it is called adult onset or maturity onset diabetes mellitus. But nowadays the occurrence of type 2 diabetes has increased in children mainly due to sedentary lifestyle and junk food.

As per the current statistics nearly 1,86,000 individuals below the age of 20 years are suffering from type 2 diabetes mellitus.

TYPE 2 DIABETES IN CHILDREN:

Family history of type 2 diabetes:- Specific ethnic groups like American-Indians, Asian, African-American etc. and female children are prone to type 2 diabetes. But these are only very minor causes. The major cause for type 2 in children is obesity i.e. overweight.

Obesity is the major cause of type 2 diabetes in children. Obesity is due to lack of physical activity and a sedentary life. Nowadays, everything has been mechanized and computerized. All our day-to-day activities are done by machines and computers. Even for climbing upstairs we have got lifts and escalators. We have vehicles for transportation and we need not walk or engage in a lot of physical activity. So, the children are habituated to a sedentary lifestyle early in life.

Children nowadays are always also busy studying. In this competitive world, they do not have a place unless they study. While concentrating on their studies and future career, they often forget about their health. They just study without any physical work. Even the institutions are aimed at getting the best results for flourishing of their business. So, they too just make the children mug up and study. The children are deprived of any kind of exercise needed for keeping themselves fit. After coming home they get tired of the mental strain put at schools and so they either study if they have any homework or just sleep or sit in front of the television. As a result of all these factors and also the facilities like vehicles and lifts, the children are getting obese.

The life of the modern child is completely sedentary with a lot of mental activity. This is the leading cause of obesity in the modern world. This obesity is in turn leading to to type 2 diabetes mellitus as per the mechanisms which have already been discussed.

In a recent survey, nearly 40 percent of children studying in various schools the state of Mississippi were found to be diabetic. All these children were obese because of the above discussed reasons. They had only mental work and no physical activity.

Not only lack of physical activity but also unhealthy eating habits contribute to obesity. Sometimes this obesity may be inherited.

SYMPTOMS OF TYPE 2 DIABETES IN CHILDREN:

Weight loss, increased hunger and thirst even after eating, dry mouth, frequent micturition, fatigue, blurred vision, heavy breathing, slow healing of sores and cuts, itchy skin, numbness or tingling in hands and feet. The symptoms are almost same as that in adults.

CONCLUSION:

We know that it takes nearly 15 to 20 years for development of the chronic complications of type 2 diabetes. If the age of onset of type 2 diabetes itself is very early, that is in childhood, then the age of onset of these complications will be very early, nearly by 35 years. This shows that, these children have a high risk of mortality.

“What is the use of a high qualification and good merit when there is no life?”

This shows that all this stress and strain and these modern educational patterns are useless because they are endangering the precious life of children. So, there is a necessity to think over the matter. Children should enjoy their childhood, they should play and do exercise and not just sit in front of books or computers.

Type 2 Diabetes in Children was posted on Type 2 Diabetes Advice.

The presence of large amount of glucose in the blood leads to injury and dysfunction of many tissues. This dysfunction of tissues leads to many complications. The greater is the sugar level the greater is the degree of complication. The more is the duration of hyperglycaemia, the more is the severity of the complication. So, a patient who keeps diabetes under control can delay the onset of these complications and thereby prolong his life.

COMPLICATIONS:

The complications can be broadly divided into acute complications and chronic complications. The acute complications are the ones which occur quickly and can be treated easily, while the chronic ones are the ones that appear late and last for a longer duration.

ACUTE COMPLICATIONS:

These are:

1. Diabetic Ketoacidosis(DKA) for Type 1 diabetes and for some cases of type 2 diabetes.

2. Hyperglycemic Hyperosmolar state(HHS) for type 2 diabetes.

DKA and HHS are associated with absolute or relative insulin deficiency, volume depletion and acid base abnormalities.

CHRONIC COMPLICATIONS:

The chronic complications can be grouped into four major categories.

They are:

1. Neuropathy
2. Nephropathy
3. Retinopathy
4. Cardiomyopathy

VASCULAR COMPLICATIONS AND CARDIOMYOPATHY:

The first complication that results due to hyperglycaemia is in blood vessels. The altered lipid metabolism in diabetics leads to formation of atheromatous plagues and their deposition along the inner wall of the blood vessels which leads to occlusion of the lumen of the blood vessel. This is called atherosclerosis. This occlusion of the lumen of the blood vessels leads to reduced blood supply to the organs which leads to iscahemia and thereby necrosis of the tissue supplied by that blood vessel.

The narrow blood vessels result in hypertension which may in turn lead to Myocardial Infarction. This is cardiomyopathy. The atherosclerosis also increases the risk of stroke. The diminished blood supply also leads to the gangrene of the lower extermity which may lead to diabetic foot.

The complications of blood vessels can be grouped into macrovascular and microvascular complications. The macrovascular complications include large and medium sized arteries whereas the microvascular complications involve capillaries in the target organs. Cardiomyopathy is due to macrovascular complications while nephropathy, neuropathy and retinopathy are due to microvascular complications.

NEUROPATHY:

Diabetic neuropathy is seen in both type 1 and type 2 diabetes. It may manifest as mononeuropathy, polyneuropathy or autonomic neuropathy. In addition to hyperglycaemia neuropathy worsens with smoking and increase in BMI (Body Mass Index) of the person. In neuropathy both myelinated and unmyelinated nerve fibers are damaged.

In mono and polyneuropathy there is distal sensory loss. In some patients there may also be Hyperaesthesia, Dysaesthesia and Paraaesthesia. There may also be numbness, tinglng, sharpness or burning that begins in the distal part of the limbs and then spreads proximally. Pain is usually present in lower limbs. It occurs at rest and worsens during night. There may also be sensory loss and loss of ankle reflex. As per latest research vibration therapy has proved to be very useful in reducing the symptoms of numbness and tingling and pain in the lower limb caused by diabetic neuropathy.

In autonomic neuropathy there may be damage to both cholinergic and adrenergic neurons which may result in a variety of symptoms based on the nerves involved. The symptoms may be cardiovascular, genitourinary, gastrointestinal etc. The symptoms may be resting tachycardia, orthostatic hypotension, hydronephrosis of upper limb, anhydrosis of lower limb, bladder emptying abnormalities, gastroparesis, etc. Neuropathy should be taken care of or else the foot may get calloused or ulcerated because of constant injury and friction which is not being perceived as a result of neuropathy.

RETINOPATHY:

Diabetes has been the culprit for blindness of people in the age of 20 to 74 years. Diabetic retinopathy and macular oedema are the causes of blindness. Retinopathy is classified into proliferative and non proliferative stages. The cause is defect in the microvasculature of the retina which is due to diabetes.

NEPHROPATHY:

There is microalbuminuria seen nearly 10 years after onset of type 2 diabetes. This later results in gross proteinuria. Hypertrophy of kidney and glomerular hyperperfusion occur in the first few years after onset of type 2 diabetes. Structural changes occur in kidney like basement membrane thickening and mesangial expansion. The patient with diabetic nephropathy will also have diabetic retinopathy.

CONCLUSION:

The above mentioned are the major and most common complications of type 2 diabetes. Besides there are also some other minor complications like Diarrhea, gastropareis, uropathy, sexual dysfunction, dermatological complications, infections, cataract, glaucoma, periodontal disease and hearing loss.

Complications of Type 2 Diabetes was posted on Type 2 Diabetes Advice.

There is a saying “Prevention is better than cure”. For type 2 diabetes mellitus also there are some preventive measures which can be adopted. By adopting these measures, prevention of type 2 diabetes can be successful up to some extent. These measures help in delaying the onset of the symptoms and the disease. The preventive measures can prolong the healthy or disease free period of a person’s life. In some cases, these measures may completely prevent the occurrence of the disease.

PREVENTIVE MEASURES:

The preventive measures for type 2 diabetes are just the reverse of the causative factors. If the causative factors are well known, then the preventive measures are also well understood.

The major cause of Type 2 diabetes is obesity which is due to the present day sedentary lifestyle. To remain healthy and fit, a person should do regular exercise. A sedentary life with ultramodern lifestyle just adds to the obesity of the person by reducing the overall physical activity done by the person.

Each and every person need not undergo strenuous physical exercise. Only those prone to diabetes can follow these preventive measures. A person’s susceptibility to diabetes can be known by performing OGTT (Oral Glcose Tolerance Test). A person with Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IGF) should follow the preventive measures to delay the onset of type 2 diabetes. Even HbA1c levels between 5.7 and 6.4% predict the upcoming of the catastrophe.

The preventive measures are:

1. Regular exercise for 30 min a day for five days a week along with some changes in diet to delay the onset of type 2 diabetes by 58%. This effect has been seen regardless of age, sex or ethnic group.

2. Some oral hypoglycaemic drugs like metformin prevents the onset of type 2 diabetes by 31%.

3. The body weight of the people who changed their lifestyles reduced by 5-7% during 3 years of a survey done which helped a lot in delaying the onset of type 2 diabetes.

4. Other drugs like alpha glucosidase inhibitors, metformin, thiazolidinedones and orlistat helped in preventing as well as delaying the onset of type 2 diabetes in many cases, but these drugs have not been approved for this
purpose.

5.In families having diabetics, the other members should take care that their BMI is strictly maintained in the normal and they should also see that they are involved in regular adequate physical activity to prevent the occurence of type 2 diabetes. These people are at the highest risk of getting diabetes. so, they should be very careful regarding their diet, BMI and exercise.

6.Presently there are some pharmacotherapies for patients in pre-diabetic conditions to prevent them from getting type 2 diabetes, but these are very costly and are still under research and the safety and effectiveness of these
therapies have not yet been proved.

CONCLUSION:

These are the preventive measures that can be adopted by people susceptible to Type 2 Diabetes Mellitus for preventing the disease to a large extent.

Prevention of Type 2 Diabetes was posted on Type 2 Diabetes Advice.

The diet of a diabetic patient should be specific. It should be such that, it does not cause any more worsening of the situation. The diet should be planned taking into consideration the following points:

1. The diet should be in coordination with the glucose levels in the blood. The diet should neither cause hyperglycaemia nor hypoglycaemia.

2. The diet should also be planned carefully so as to balance the treatment or therapy being given to the patient. The effect of the therapy, whether it may be insulin or oral hypoglycaemic drugs, should be carefully noted. Based on the therapeutic effect achieved, the diet should be planned so that it does not lead to any other complications.

3. If the patient already has any of the complications of Diabetes, i.e., if he is already a chronic diabetic then the diet should be planned according to the prevailing circumstances. For example, if the person is suffering from diabetic nephropathy, then protein intake should be reduced to 0.8g/kg body weight of the person per day.

DIET:

The diet should have the following features:

1. It can contain fruits, vegetables, fiber containing foods and low fat.

2. Sucrose and other sugars should be avoided. But as per the latest research in some complicated conditions they are being used to minimize other complications of diabetes like hyperlipidemia and hypertension.

3. Glycaemic Index of the foods should be taken into consideration. Low glycaemic index foods should be given so that there is no elevation of post prandial blood sugar levels.

4. Calorific food should be reduced. (e.g., sugar in coffee, tea, etc.)

5. Artificial sweetners like aspartame, alitame, sucrolose and saccharin can be used in place of sugar in beverages like coffee and tea. Artificial sweeteners are non calorigenic.

6. Obesity is the major cause of type 2 diabetes. Hence, type 2 diabetes diet should be such that the weight of the person should be reduced. So, low calorie diet is needed for weight reduction. Hypocaloric diet constitutes of low carbohydrate and low fat.

7. Sucrose containing foods should be avoided as far as possible. However, the intake may be adjusted as per the insulin dosage being given.

8. Routine supplements of vitamins, antioxidants or trace elements are not preferable.

9. Protein content in diet may be normal but it should be reduced in case of diabetic nephropathy.

10. Soluble dietary fiber consumption improves glycaemic control in case of type 2 diabetes patients.

11. Mostly a lunch of rice meal and a dinner of bread (dry flat bread preferably without curry) is advised.

12. Patients should have control on themselves. They should not consume too many sweets and should also try to avoid sugar in coffee and tea.

13. Finger millet malt gives a good glycaemic control.

14. It is said in ayurveda that, a guava leaf should be soaked in water for the entire night and that water should be drunk early in the morning after brushing teeth on empty stomach. They say that it helps a lot in controlling diabetes especially of type 2 diabetes.

CONCLUSION:

A careful well planned diet, though may not cure diabetes, helps a lot in controlling the symptoms and delaying the onset of complications of diabetes. If the diet is strict then just oral hypoglycaemic drugs are enough to control diabetes or else there may be a need of insulin therapy which is a costly affair.

Type 2 diabetes diet was posted on Type 2 Diabetes Advice.

Insulin resistance, impaired insulin secretion, excessive hepatic glucose production and abnormal fat metabolism are the characteristic features of type 2 diabetes mellitus.

PATHOPHYSIOLOGY OF TYPE 2 DIABETES:

INSULIN RESISTANCE:

Insulin resistance is the failure of target tissues to respond normally to insulin. So, there is a decreased uptake of glucose by muscles, there is also reduced glycolysis and reduced fatty acid oxidation in liver. These lead to conditions like hyperglycemia, lack of energy and fatigue. Due to insulin resistance, there is also inability to suppress hepatic gluconeogenesis which leads to hyperglycemia. Experiments in mice have demonstrated that loss of insulin sensitivity by hepatocytes is the largest contributor for the pathological changes in type 2 diabetes. Many types of functional defects have been identified in the signalling pathway of insulin (e.g., defect in tyrosine kinase function, increased serine phosphorylation). There are some factors responsible for development of insulin resistance. (e.g., obesity)

OBESITY AND INSULIN RESISTANCE:’

Most of the type 2 diabetics cases have been associated with obesity and more than 80% of the cases have been associated with visceral obesity. Even body fat has a profound effect in reducing insulin sensitivity. Mostly central fat i.e., fat in abdomen is more likely to cause insulin resistance rather than peripheral fat i.e., gluteal and subcutaneous fat. Obesity leads to insulin resistance in the following ways:

1. NONESTERIFIED FATTY ACIDS:

Increase in nonesterified fatty acids leads to increased insulin resistance. The excess nonesterified fatty acids circulating in the blood get deposited in the visceral organs leading to increased triglycerides in muscles and liver. Excess fat or nonesterified fatty acids in the cells overwhelm fatty acid oxidation leading to accumulation of intermediates like diacylglycerols and ceramide in the cells. These substances are toxic and activate serine kinases which lead to phosphorylation of serine which leads to insulin resistance. Insulin is needed for blocking hepatic gluconeogenesis which is not possible due to insulin resisytance thereby leading to hyperglycemia.

2.ADIPOKINES:

A variety of proteins secreted by adipose tissues are collectively termed as adipokines. Some adipokines favor hyperglycemia while some inhibit them. Leptin and adiponectin are anti hyperglycemic. In obese people there is reduction in levels of adiponectin which is the cause of insulin resistance. Adiponectin is needed for improving insulin sensitivity.

3.INFLAMMATION:

Pro-inflammatory cytokines like tumor necrosis factor (TNF), Interleukin 6 (IL-6) etc. are secreted by the adipose tissue. These cytokines increase insulin resistance by increasing the stress on the cells. The stress on the cells activates several other signalling cascades which have a negative or antagonistic effect on the insulin signalling pathway, thereby leading to insulin resistance.

4.PEROXISOME PROLIFERATOR ACTIVATED RECEPTOR GAMMA:

Activation of the receptors of the above name lead to secretion of anti hyperglycemic adipokines like adiponectin thereby helping in improving insulin sensitivity. Drugs of the group thiazolidinediones act as ligands to these receptors.

BETA CELL DYSFUNCTION:

Initially to compensate for the insulin resistance there is an increased secretion of insulin from beta cells which leads to hypoglycemia. But later on there is exhaustion of beta cells and they are unable to meet the demands of the body. The beta cells get exhausted and finally they fail which leads to elevated levels of blood glucose in later years of life.

CONCLUSION:

All the above sited mechanisms lead to the characteristic features of type 2 diabetes like insulin resistance, impaired glucose and fat metabolism and decreased secretion of insulin.

Pathophysiology of Type 2 Diabetes was posted on Type 2 Diabetes Advice.

The treatment of type 2 diabetes involves usage of oral hypoglcemic drugs. Insulin is used in cases of type 2 diabetes associated with impaired beta cell function. Exercise and proper diet control is also needed.

TREATMENT:

Glycemic control is the chief treatment of diabetes. Treatment involves being cardiovascular complications. Even the lipid levels and blood pressure of the patient should be maintained normal.

Glycemic control is done by diet and exercise. Medications needed for lowering blood glucose are based on different mechanisms. Some of the oral hypoglycaemic drugs are:

1. Biguanides:- Decreases hepatic glucose production. (e.g., Metformin.)

Metformin is the most commonly used oral hypoglycemic drug. Advantages of metformin are it is inexpensive and it does not lead to hypoglycaemia. Disadvantages of metformin are diarrhea, nausea and lactic acidosis. Contraindications of metformin are increase in serum creatinine levels, acidosis and congestive heart failure.

2. Alpha-glucosidase inhibitors:- Decreases glucose absorption from gastro intestinal tract. (e.g., acarbose, miglitol)

3. Dipeptidyl peptidase IV inhibitors:- Prolongs endogenous GLP-1 action. (e.g., saxagliptin, sitagliptin, vildagliptin)

4. Insulin secretagogues, Sulfonylureas:- Increases insulin secretion. (e.g., Tolbutamide, Chlorpropamide, Glipizide, Glimepiride)

5. Insulin secretagogues, non-sulfonylureas:- Increases insulin secretion.

6. Thiazolidinediones:- Decreases insulin resistance, increase glucose utilization. (e.g., rosiglitazone, Pioglitazone)

7. Bile acid sequestrants:- Bind bile acids, mechanism of glucose lowering action is not known. (e.g., colesevelam)

Parenteral glycemic control:

1. Insulin:- Increases glucose utilization, decreases hepatic glucose production and other anabolic actions.

Insulin should never be given orally, because it is a protein and is hydrolysed by the enzymes in stomach, thereby making it of no use. Hence, insulin should be injected into the body and sub-cutaneous route is the best route
for optimal activity. Preferred site of injection are front or side of thigh and anterior abdominal wall.

In type 2 diabetes insulin is used to reduce the glucose levels in blood if diet and exercise fail to bring it to normal. The dosage of insulin for type 2 diabetes is 0.2-1.6 units per kg body weight per day.

Insulin is produced by recombinant DNA technology from Escherichia coli bacteria. Human insulin produced by recombinant DNA technology is called Humilin.

The actions of Insulin on liver are increased glucose uptake, glycogen synthesis, inhibition of glycogenolysis, inhibition of gluconeogenesis from protein, pyruvate, free fatty acids and glycerol.

2. GLP-1 receptor agonists:- Increases insulin secretion, decreases glucagon secretion, slows down gastric emptying and produces satiety. e.g., Exenatide, liraglutide (GLP-Glucagon Like Peptide)

3. Amylin agonists:- Slows down gastric emptying, decreases glucagon levels. (e.g., Pramlintide)

Nutrition and exercise:

They decrease insulin resistance and increase insulin secretion.

Not only glucose levels but even ketoacidosis has to be treated if present. However, it is not so common in type 2 diabetes. The treatment of ketoacidosis involves rapid use of regular insulin to correct the metabolic abnormalities. An initial dose of 0.1 to 0.2 U/kg intravenously is followed by 0.1 U/kg/hr. Along with insulin, intravenous fluids are given to control dehydration. KCl should be given intravenously as it is lost during ketoacidosis but even the ECG is to be constantly monitored while giving KCl. Antibiotics and other supportive measures should be given as may be necessary.

The symptoms of ketoacidosis are dehydration, hyperventilation and impaired consciousness.

CONCLUSION:

These are the treatment measures to be adopted for Type 2 Diabetes Mellitus.

NOTE: Treatment for type 2 diabetes might differ as per the medical condition of the patient. So, please consult your physician for the appropriate drugs or treatment relevant to your medical condition.

Treatment for Type 2 Diabetes was posted on Type 2 Diabetes Advice.

Type 2 Diabetes may be caused due to several reasons. The causes for development of hyperglycemic state and development of other symptoms of type 2 diabetes are insulin resistance which is also associated with impaired insulin secretion in chronic cases.

The underlying causes for insulin resistance are obesity and genetic predisposition. Besides insulin resistance, the other causes for development of the symptoms of type 2 diabetes are abnormal fat metabolism and excessive hepatic glucose production.

CAUSES:

OBESITY:

Obesity means increased percentage of fat in the body mass. Increased fat in the body leads to increased free fatty acids and other products of fat cells in blood circulation. Some of the examples of products of adipocytes or fat cells are non-esterified free fatty acids, retinol binding protein-4, leptin, TNF alpha, resistin and adiponectin. These substances released from fat cells are called adipokines. These adipokines modulate the sensitivity of insulin.
Increased levels of free fatty acids and adipokines cause insulin resistance in skeletal muscles and liver. This further leads to decreased utilization of glucose by skeletal muscles and increased production of glucose by liver. They also impair beta cell function. All these sum up to form hyperglycaemia.

In normal physiology, insulin is needed for uptake of glucose by skeletal muscles, but this is hindered due to insulin resistance. Insulin resistance is the decreased ability of insulin to act effectively on target tissues.

Adiponectin is a product of adipocytes which is reduced in obesity. Adiponectin is an insulin sensitizing peptide. So, this leads to hepatic insulin resistance.

The underlying causes of obesity are lack of physical activity and ultramodern lifestyle. Hence, these are also the causes of type 2 diabetes.

GENETIC:

Type 2 diabetes has a strong genetic component. In identical twins there are 70-80% of chances of getting type 2 diabetes if one of them is effected. If one parent is diabetic, there is an increased risk of getting type 2 diabetes in children. If both the parents are known type 2 diabetics then the chance of getting type 2 diabetes in their children increases to 40%. As per recent genomic studies more than 20 genes have been identified which contribute to type 2 diabetes but the risk contributed by them is very less. The gene which has been identified as a cause of type 2 diabetes in many affected people is Transcription Factor 7-like gene. Genetic polymorphisms associated with type 2 diabetes have also been found in genes encoding peroxisome proliferators-activated receptors gamma. The mechanism by which these genetic changes cause type 2 diabetes are not properly known but it is expected by many scientists that the pancreatic islet cell function is impaired. These islet cells include alpha, beta and delta cells which secrete glucagon and insulinand somatostatin respectively.

IMPAIRED INSULIN SECRETION:

The reason for this in type 2 diabetes is unknown but the genetic factors are thought to be the cause for it.

Besides there is also an increased hepatic glucose and lipid production which are also the causes of hyperglycemia and dyslipidemia.

CONCLUSION:

These are the causes underlying the pathologenesis of Type 2 Diabetes Mellitus.

Causes of Type 2 Diabetes was posted on Type 2 Diabetes Advice.