Table Of Contents
- Type 2 Diabetes definition
- What Is Type 2 Diabetes definition?
- What is insulin?
- What is Diabetes nature?!
- Diabetes risk factors:
- type 2 diabetes symptoms
- type 2 diabetes management:
- How to lower blood sugar without medication (treatment without medications)
- Medical type 2 diabetes treatments:
- We have also to make each diabetic patient know how to deal with hypoglycemia:
- Diabetes complications:
Type 2 Diabetes definition
Type 2 Diabetes definition is also a chronic degenerative disease that needs a lifelong therapy with insulin (in type 1) or oral tablets (in type 2) but also type II diabetes mellitus may need insulin treatment in some selected cases.
Diabetes is a very common disease that affects people in all age groups, children, teenagers, adults, or old age.
.. If a patient asks that he unfortunately discovered that he is a diabetic, he is a young man, and asks “Do I need a lifelong treatment?! “We say that fortunately NO!!!!
As some cases with type II diabetes don`t need just life style modification, weight loss or some more exercises.
Now, Our Concern Is Type 2 Diabetes definition, what is the disease nature, what can cause diabetes, what are the disease symptoms, how can we manage this chronic disease, what are the disease complications ….
To answer these questions and more questions that may have a respect for doctors, patients and their Relatives, we need to complete this article.
What Is Type 2 Diabetes definition?
“Be nice to diabetics, we deal with enough pricks already.” Diabetics mostly have to deal with daily insulin injections but is that the only treatment? First let me explain type 2 diabetes definition.
Type 2 diabetes definition is a disease characterized by high blood sugar levels due to either decreased insulin secretion or increased insulin resistance.
What is insulin?
Insulin is a hormone produced by the pancreas that allows body cells to utilize glucose, the body’s fuel. Insulin deficiency may be due to a genetic abnormality; this is type 1 diabetes.
Another reason is exhaustion of beta cells of the pancreas; this is type 2 diabetes.
A second cause of type 2 diabetes is cell’s resistance to utilize insulin known as insulin resistance.
Now, let us continue what type 2 diabetes definition is.
is a disease of a very high prevalence that is a common disease all over the world. Type 2 diabetes definition is also a systemic disease that has an effect on all body cells and of course each organ in our body is affected by this degenerative disease.
After we talked about type 2 diabetes definition, you may ask yourself, Is it a dangerous disease?!
This question has a very complicated argument. To answer this question, we have to know the disease nature.
What is Diabetes nature?!
Diabetes is a group of diseases that mainly creates a problem with the hormone “insulin”, it is in fact a pancreatic disease.
Diabetes is of two main types:
Diabetes Type 1: which is a beta cell degeneration of the pancreas, mainly affects young ages.
Type 2 diabetes: which is our point of focus, which is increased insulin resistance in body tissues.
the insulin secretion in this patient is all or non-normal, but the main pathophysiology in this case is increased insulin receptors on the cell surface that makes insulin secreted by the pancreas can`t satisfy the cell and creates the need to increase the activity of the pancreatic cells to produce insulin, and this is surely the disease fact.
when the amount of insulin is not sufficient to the body cells, sugar “glucose “accumulates in the blood stream and causes damage to the body tissues and when the cells can`t take the proper amount of sugar they can`t play their role in the body causing general illness to the patient. as insulin is the regulator or the maestro of body levels of glucose.
To a varied point this disease nature is unknown. So the treatment can`t stop the disease effects on the body later on. But with good management, we can delay these effects by treatment and good management to a very high extent.
This creates very complicated and hard challenges on the disease observers and investigators, but this is the science
“Science is a challenge “.
As this is a common disease and a chronic disease, can we avoid to be affected with this it?!
To answer this question we need to know exactly the disease risk factors.
Diabetes risk factors:
Generally, type II diabetes has a genetic link, and tends to run in families.
So type 2 diabetes definition is also known as a familial degenerative chronic disease.
But this can`t replace the other risk factors role in increasing the risk of having diabetes.
We advise him to revise his doctor if he has one or more of the following risk factors diabetes:
- Obesity or being overweight.
- Hypertension or other cardiovascular disease.
- High carbohydrate and fat diet.
- Sedentary life style.
- High blood triglycerides.
- High alcohol intake.
- If a female, having gestational diabetes or giving birth of a baby with more than 5 kilograms weight is a risk factor and needs to revise the doctor frequently.
- Ethnicity: certain groups of people have more affinity than others to develop diabetes.
10- Aging: age development is a significant risk factor to develop the disease begins to rise significantly at about forty years and rises considerably at 65 years.
Screening for patients at risk is a must to discover the cases as early as possible.
type 2 diabetes symptoms
A patient asks about developing diabetes. “Can I observe these disease symptoms in my body?! “
We say of course you can, if you develop these criteria, this is a red sign to visit your doctor:
- Polyuria: frequent toilet use.
- Polydipsia: water hunger.
- Polyphagia: very frequent and rich meals.
- Severe weight loss with balanced diet.
- Ketonurea: ketone bodies in the urine that are produced from fat use by the body to produce energy.
- Signs of diabetic ketoacidosis that precedes the diabetic coma such as: acetone odor in the patient`s breath, high breath rate, easy fatigue with minor effort, and arterial blood gases analysis showing increased carbon dioxide level in the blood.
- Fasting plasma glucose level of 126 mg/dL or higher
fasting is defined as no caloric intake for at least 8 hours.
- A 2-hour post prandial plasma glucose of 200 mg/dL or higher during a 75-gm oral glucose tolerance test.
- A random plasma glucose level of 200 mg/dL or higher in a patient with classic symptoms of hyperglycemia that we showed previously or a hyperglycemic crisis.
- A hemoglobin A1C (HbA1c) of 6.5% or higher.
** These ratios are according to the American association of diabetes criteria for the diagnosis of diabetes.
After the diagnosis, we have to set a plan for the disease management.
And we don`t lie if we said that up to 95% of diagnosed patients improve without medications!!
As the healthy diet and regular exercise have a golden role in type II diabetes management.
type 2 diabetes management:
The treatment of diabetes is mainly medical but lifestyle modifications have a role in the progress of diabetes.
How to lower blood sugar without medication (treatment without medications)
- Healthy life style, so you have to avoid risk factors that we showed above.
- Weight loss is a very important part of the treatment as obesity is the most common cause of developing type II diabetes in all age groups.
- Regular exercise is very efficient to control the case with no needs to prescribe medications, but it must be regular and of simple degree to avoid hypoglycemic comas.
- Healthy balanced diet: rich in protein, fruit and vegetables and low in carbohydrates and fats. Taking five meals daily is recommended for the diabetic patient, two of them are simple meals “snacks “as one piece of fruit, cheese or a plate of vegetables.
Medical type 2 diabetes treatments:
There are many guidelines and regimens for the disease management. They are varied according to the target of treatment that is measured by hemoglobin A1C level in the blood at the time of diagnosis, the comorbidity of other diseases such as cardiovascular diseases, the patient age, weight, physical state and life style, costs, post prandial blood sugar, psychosocial and cultural considerations.
There is a variety of medications that are prescribed for the disease management. Each of them has a different mechanism of action, different side effects and different drug interactions.
The physician considers all these aspects in the prescription to achieve the best point of success in the patient. We start treatment with a single drug and sometimes we need to combine more than one drug to control the case, which is a complicated treatment.
A patient who is just diagnosed as a diabetic type II, he is confused and depressed, saying “I will complete my life on insulin?! “
We need to assure this patient and keep him calm, cooperative and satisfied about his life as fortunately, the need for insulin in type II diabetes is very limited and the need for insulin is only for cases under stress physically or mentally.
The first line of treatment in type II diabetes is the oral medications, but sometimes we need to shift to insulin for a period of time and return again into the oral medications. The goal of all these medications is to lower the hyperglycemia and the choice of the medication must be individualized for each patient.
- The available oral medications are:
It is an oral antidiabetic drug in the biguanide class. it is called “insulin sensitizer “.
- Mechanism of action: the main action is the reduction of serum glucose levels by several and different mechanisms by a non pancreatic action without increasing the insulin it increases the insulin efficiency and so called “insulin sensitizer “. it has a hepatic action as it decreases the endogenous glucose production by the liver as it suppresses the process of gluconeogenesis with very low effect on glycogenolysis.
It also activates the enzyme adenosine monophosphate kinase (AMPK) causing inhibition of key enzymes involved in gluconeogenesis and glycogen synthesis by the liver and increases insulin signaling and glucose transport in muscles. it also regulates the cellular and organ metabolism.
Nearly, metformin is the only available biguanide all over the world. it is a very safe drug that is very tolerated by patients and used as monotherapy or may be combined with other drugs from other groups that have another mechanism of action (synergism).
Metformin is used for type 2 diabetes mellitus control especially in obese patients with good renal functions. it was shown that metformin has reduced diabetes mortality and complications by 30% in comparison with other drugs such as insulin and chlorpromide.
But as a chemical synthetic drug, it has surely some side effects that are reported by a very low percentage of patients such as:
- Gastrointestinal upsets such as nausea, vomiting, stomach upset, diarrhea, weakness and metallic taste may also occur.
- Serious allergic reactions are rare and with seldom reports.
- Lactic acidosis is the most common and serious side effect that may occur. it has the following alarming signs: stomach pain, nausea, vomiting, diarrhea, muscle pain, slow and irregular heartbeat, chills, blue and cold skin, tiredness, drowsiness, dizziness and shallow and rapid difficult breathing.
Lactic acidosis occurs due to mainly drug overdose or in some contraindicated conditions in cases of kidney, liver diseases, severe infections, recent surgery, recent stroke, recent heart attack, congestive heart failure, heavy smoking or alcohol use or dehydration.
It may occur following some scanning procedures that require injectable iodinated contrast drugs or in patients older than eighty years.
- Hypoglycemia is not rare to occur with metformin use, but it is still being presented and reported especially if it is used in combination with other antidiabetic drugs. it may also occur with heavy exercises or not consuming sufficient amounts of carbohydrates in diet.
A recently diagnosed diabetic patient reported hypoglycemic coma and presented to the emergency room and fortunately treated and he is now in a very good health status and asks about avoiding this to occur again?!
We have to assure the patient that it is a common condition that may occur daily with diabetic patients. Any diabetic patient has to have a candy in his pocket and have to know the hypoglycemia symptoms which are:
- anger and blurred vision.
We have also to make each diabetic patient know how to deal with hypoglycemia:
Consume 15-20gm of glucose or simple carbohydrates
Recheck your blood sugar 15 minutes later
If hypoglycemia is still present, repeat.
Once your blood sugar level returns to normal, eat a small snack if your planned following meal or snack is after one or two hours. here are some examples of the commonly used simple sugars:
- tablespoon of sugar, honey or corn syrup.
½ cup of juice.
It lowers hyperglycemia by enhancing insulin secretion.
This group of drugs has a major side effect that is hypoglycemia which is severe and life threatening. So, large doses should be generally avoided.
They have the same mechanism of sulfonylureas, but with shorter circulating half life period, so hypoglycemia is less frequently reported.
There are other many drugs that are used in diabetes control such as: thiazolidinedione, insulin, glucagon like peptide-1 agonists, amylin agonists and dipeptidyl peptidase four inhibitors.
The disease is increasing all over the world in an alarming rate and the disease complications are responsible for increased morbidities, disabilities and mortalities and represent a challenge for all the economies of all countries especially the developing ones.
These complications could be classified to
- Micro-vascular complications: as diabetic nephropathy, neuropathy and retinopathy.
- Macro-vascular complications: as atherosclerosis which is the most common complication.
- Miscellaneous complications: diabetic cardiomyopathy which is a specific complication develops independently of coronary heart disease or hypertension.
But, we have to know the pathogenesis of the diabetes complications:
Recently, the reviews proved that diabetic complications have genetic factors, nutritional factors and life style factors.
And diabetic good control could not prevent the occurrence of complications, but delay them.
- Type 2 diabetes definition is systemic disease results from lack of insulin or insulin
- The nature depends on the type.
- Obesity and sedentary life are major risk factors for the disease.
- Frequent toilet use is the main symptom.
- Complications will occur definitely but good control delays it.