Type
2 Diabetes (Type 2 DM)Overview:
Patients with type 2 diabetes are usually older than 30 years of age. That's why
they are called "mature onset diabetes" or "adult onset diabetes".
For several decades a patient may "incubate" diabetes and have one or
more of the diabetes risk factors, such as high blood pressure, obesity, high
cholesterol or high triglycerides, but have normal blood sugars.
Physicians
have followed patients like this for several decades in the well known Framingham
Study and found that a high percentage of them do come down with diabetes type
2 later in life. In the past this time of incubation was termed "pre-diabetes".
Now we call it "syndrome of insulin resistance" or "metabolic syndrome".
In contrast to type 1 diabetes, ketoacidosis is rare in patients with type
2 diabetes. Type 2 diabetes is often associated with other endocrinological diseases
such as Cushing's syndrome (an adrenal gland hyperactivity) or acromegaly (increased
growth hormone production). In these diseases other hormones are tilting the hormone
balance by counteracting insulin thus leading to a relative shortfall of insulin,
which is another cause for type 2 diabetes. There is confusion among scientists
regarding possible genetic reasons for type 2 diabetes. There might be various
genetic loci that need to be triggered by the environment or by weight gain. The
syndrome of insulin resistance has shown some connections between hypertension,
obesity and type 2 diabetes and Ref. 1 suggests that the common denominator might
be the production of amylin, which is deposited around the beta cells of the pancreas
in late type 2 diabetes patients. Amylin can also be found in high percentages
of patients who died from complications with hypertension or type 2 diabetes.
However, the exact meaning of these findings is not clear. Type
2 diabetes symptoms: Most of the time type 2 diabetes is found
by diabetes screening in the doctor's office and through lab tests the doctor
has ordered. A less common presentation is, if a patient suddenly presents in
the Emergency Room of a hospital in an unconscious state. Doctors call
this a "hyperglycemic hyperosmolar nonketotic coma". These patients
are often elderly ( 70 years of age or more), possibly unaware of their diabetes,
dehydrated and have an infection such as a lobar pneumonia.
Tests
for diabetes ketones in the blood are negative, but there are often extremely
high blood sugar readings coupled with a severe metabolic acidosis and possibly
kidney failure signs. The mortality rate in this setting is often 50% or more
even with the best treatment. Other symptom presentations are due to hyperglycemia
as discussed under type 1 diabetes (follow diabetes link below). This consists
of frequent urination, thirst and dehydration coupled with weight loss. Often
these symptoms are overlooked and the first symptoms might be due to the complications
of diabetes as follows. Diabetes tests: The standard
test used to be the fasting blood sugar and the 2 hour post prandial blood sugar
(post prandial means "after a meal"). This is now largely replaced by
the hemoglobin A1C blood test.
| Hemoglobin
A1C | | This is a blood
test and measures the sugar content of red blood cells. It is a very reliable
predictor for how much damage is done by the diabetes through the process of incorporating
sugar into the protein layer of the body's cells. Red blood cells live about 100
days between production in the bone marrow and absorption in the spleen. This
is why the hemoglobin A1C level will give an average of the blood sugar control
for the past 1 to 3 months. With chronically poor hemoglobin A1C values there
will be micro damage in the filter organs in the kidney, called glomeruli. This
leads to a poor kidney function. For instance, after 5 years of poorly controlled
type 2 diabetes a significant number of diabetics will show positive albumen tests
of their urine as a sign for leakage of this blood component and we know that
these patients have now a reduced glomerular filtration rate, which can be confirmed
with special kidney function tests. Within 10 years of poorly controlled diabetes
a high percentage of patients either need dialysis or a kidney transplant to replace
their damaged kidneys. |
Fructosamine
level: A newer test to supplement the hemoglobin A1C test
is the fructosamine level. This is a blood test, which
measures how well the blood sugar has been controlled in the last 1 to 3
weeks (rather than months) and is based on a chemical reaction between
the blood sugar and the plasma protein. This test might be useful as a tool to
the physician in the beginning when time is of essence in seeing a positive effect
of the treatment.
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