What is Type II diabetes?

Type II diabetes mellitus or NIDDM is an endocrine abnormality caused by insulin resistance or insufficient levels of insulin. Insulin is necessary for the transportation of glucose from the blood to the cells and tissues of the body.

Diabetes mellitus, of both types I and II, is the most common endocrine disorder and a serious disease of adults. NIDDM usually has a gradual onset of symptoms and is more commonly diagnosed in adulthood, usually after the age of 40. Ninety percent of all diabetic cases fall into this category. Obesity is a major factor leading to this condition, although it is not clearly understood why.

How is it diagnosed?

Though symptoms can point to diabetes, the only way for a physician to diagnose diabetes is with blood tests. When physicians determine that a blood test result is outside of normal range, they may order repeat tests to verify results or additional tests to determine the underlying causes behind the abnormality. Common tests for diagnosing diabetes include:

• Random plasma glucose test. This test may be conducted as a part of a routine physical examination. Glucose levels above 200 milligrams per deciliter (mg/dL) accompanied by symptoms will lead to a diabetes diagnosis. A fasting glucose test may be obtained to confirm the results.
• Fasting blood glucose test (FPG). Normal fasting blood glucose is below 100 mg/dL. Glucose levels of 126 mg/dL or above will lead to a repeat test. If the results of the second test are the same, the patient will most likely be diagnosed with diabetes.
• Oral glucose tolerance test (OGTT). Normal blood sugar is below 140 mg/dL two hours after consuming a glucose-rich drink. If the level rises to 200 mg/dL or above, the person will most likely be diagnosed with diabetes.

The American Diabetes Association (ADA) recommends that anyone age 45 or older have a FPG, especially if overweight or obese. If results are normal, the patient should be retested again every three years. Patients diagnosed with prediabetes should be checked for type 2 diabetes every one to two years.

For overweight adults younger than 45, a physician may recommend testing if any other risk factor for diabetes is present.

Children and adolescents who are at risk should be screened for diabetes every two years after the age of 10, or at the onset of puberty if it occurs at an earlier age.

How is Type II diabetes treated?

Once diagnosed, the immediate goal for patients is to stabilize their glucose (blood sugar) levels. Their physician will recommend a target glucose range. The patient will aim to keep glucose levels within the physician-recommended range with a combination of diet and exercise, usually along with antidiabetic agents and sometimes insulin.

Usually, the first treatment for type 2 diabetes is meal planning, weight loss and exercise. Nutrition counseling and meal planning often involve cutting calories, replacing a few large meals a day with several small meals, replacing sugars and starches with nutritious high-fiber complex carbohydrates, and trading saturated fats and trans fats for lean protein and monounsaturated and polyunsaturated fats.

Losing weight and increasing activity levels can help lower the body's resistance to insulin. Exercise also reduces glucose levels by taking glucose from the blood and using it for energy. For those with various medical conditions outlined below, exercise programs need to be carefully monitored by a physician.

When these steps are not enough to bring glucose levels down near the normal range, the physician may recommend medication.

Type 2 diabetes may be treated with glucose-lowering medications, and if these agents fail to control blood sugar, the physician may prescribe insulin.

The physician may also prescribe other medications including diet pills to reduce obesity, antihypertensives to lower blood pressure and cholesterol drugs to improve levels of blood fats.

A physician may also recommend insulin therapy. According to the American Diabetes Association, 30 to 40 percent of patients diagnosed with type 2 diabetes use insulin therapy to control their diabetes. Patients may need to take insulin on its own or in addition to antidiabetic agents. Forms of insulin administration include syringe injections, insulin pens, insulin pumps, jet injectors and inhaled insulin.

Daily glucose testing may be necessary. Glucose monitoring can alert patients when their glucose levels are above or below their target range. If readings are frequently out of range, a physician may recommend a change in the patient's diabetes management plan.

Type 2 diabetes increases a person's risk of developing many serious complications such as nerve, eye, kidney and blood vessel damage. Patients can delay or prevent the onset of these complications by controlling their glucose, cholesterol and blood pressure. However, many diabetic individuals do not meet their recommended goals.

Patients will require regular medical checkups to screen for developing problems. According to recommendations of national healthcare organizations, at each visit with their healthcare provider, patients should have the following checked:

• Blood pressure
• Weight
• Feet
• Eyes

At least twice a year, patients should have:

• Glycohemoglobin tests
• Dental exams and teeth cleanings (every three months for many patients)
• Visit with their endocrinologist

Once a year, the ADA recommends that diabetic individuals have:

• A cholesterol test. (Some people may need to be tested more often.)
• A dilated eye exam by an ophthalmologist.
• A complete foot exam, including inspection and sensation checks. (Patients with neuropathy or deformities such as hammertoes or bunions may need to have more frequent foot exams.)
• Urine tests for proteinuria
• A flu shot

In addition to these guidelines, patients with type 2 diabetes should also have a pneumonia vaccination at least once in their lifetime. Patients who are 65 and those suffering from chronic illness or a weakened immune system may require an additional pneumonia shot five to 10 years after their first one.

A physician can create a sick-day plan in advance to help patients cope with infections and other health problems.

Patients may need to see various specialists to screen for or treat complications ranging from heart conditions to sexual dysfunction. Recent research suggests suggests that screening procedures such as a stress test can find coronary artery disease in many people with type 2 diabetes, even those with no cardiac symptoms or risk factors. Patients may wish to ask their physician if such screening methods are recommended for them.

Medications

Oral medicines to reduce blood sugar (hypoglycemics) may be prescribed. These are not always necessary. They can often be discontinued when body weight becomes normal.

Actos (Pioglitazone), Avandia (Rosiglitazone)

What might complicate it?

Complications of NIDDM include hypoglycemia, infection, diabetic retinopathy, cataracts, diabetic neuropathy, atherosclerosis, heart attack, stroke, or kidney failure. Diabetic coma and ketoacidosis, seen in Type I diabetes, are rare in this disease.

Predicted outcome

Exercise and weight loss seem to make the body more sensitive to the action of insulin and helps control the blood glucose levels. With good control of the blood glucose and compliance with self-care, the outcome is good. Presence of complications will impact outcome.

Alternatives

Differential diagnosis may be Type I diabetes. Gestational diabetes seen during pregnancy may be the first sign of developing NIDDM. Diseases of the endocrine system or pancreas and reactions to certain drugs can have the same symptoms of diabetes.

Appropriate specialists

Endocrinologist.

Last updated 8 July 2015