Type 2 Diabetes Symptoms Signs Diagnosis Treatment New Advances

The Term Type 2 Diabetes was formerly known as non-insulin dependent diabetes.   The full medical name of diabetes is Diabetes mellitus. Diabetes is a disease characterized by high levels of blood sugar and its resultant complications. Diabetes during pregnancy is termed Gestational Diabetes and it is covered in a separate essay. Diabetes insipidus is a separate condition covered in a separate essay. Diabetes  is subdivided into two subtypes - Type 1A and Type 1B.

Type 2 Diabetes (Maturity Onset Diabetes)

Introduction

This is also characterized by deficient production of insulin. However, the mechanisms that underline this condition are not known. Many of the patients who suffer from Type 2 diabetes are of African - American or Asian - American descent.These cases comprise about 85% of all diabetes cases.

Genetics / Pathophysiology (What causes diabetes?)

This is a heterogeneous group of disorders characterized by insulin resistance at the level of the skeletal muscle and liver, impaired insulin secretion and increased glucose production.
 Individuals with Type 2 diabetes between the ages of 20 and 40 years may have characteristics of both types of diabetes.

Type 1 vs. Type 2 Diabetes

 In general, antibodies are more prevalent in Type 1 diabetics and absent in patients with Type 2 diabetes. Insulin resistance is not present in Type 1 diabetics, but is present in patients with Type 2 iabetes. Family history of diabetes is uncommon in Type 1 patients and is common in Type 2 diabetics.

Onset is quick in Type 1 patients and it is gradual in Type 2 patients. Ketosis is common in Type 1 patients and ketosis is not usually seen in Type 2 patients. Age at onset is less than 40 years in Type 1 patients and more than 40 years in Type 2 patients.

Type 1 patients are typically not obese wherteas Type 2 patients are obese. Hypertension, dysbetalipedemia, procoagulant states and endothelial dysfunction are either uncommon or nopt sen in T5ype 1 patients whereas these are common in Type 2 patients. HLA association is present in Type 1 patients and it is not present in Type 2 patients. The higher level of cardiac deaths seen in Type 2 patients are not seen in well treated Type 1 patients. Insulin is required in treatment of Type 1 patients and it may not be necessary in Type 2 patients.

Type 1A diabetes is immune mediated whereas Type 1B diabetes may not be immune mediated. Thus, circulating antibodies are likely to be present in Type 1A patients and are not present in Type 1B patients. However, absence of circulating antibodies in Type 1A patients may be due to diminution with time due to progression of disease. Both Type 1A and Type 1B diabetes patients are ketosis prone and require insulin. 

Clinical Presentation (Symptoms of Diabetes Type 1, Early Symptoms of Diabetes, Warning Signs of Diabetes) and Complications ('Can you die from diabetes?')

Central obesity, hypertension, dysbetalipedemia, increased tendency to form clots, endothelial cell dysfunction and increased cardiovascular abnormalities are characteristic of Type 2 diabetics. Other characteristics of Type 2 diabetics are listed in the preceding paragraph.

Newer Therapies (Diabetes Research)

Treatment of Type 2 Diabetes generally involves: 1. Diet and lifestyle modification;       2. Oral hypoglycemic agents (tablets); 3. Insulin; 4. Other injectable medicines. News: Oral hypoglycemic agents - new drugs are being introduced every year. Novel combinations of older drugs are also tested every year. Insulin pump is becoming easier to use. Injectable medicines such as Pramlintide and Exenatide have been approved by the Food and Drug administration recently.

Conclusions

Diabetes patients are subdivided into various types based on etiology and requirement for insulin. Type 1 diabetes patients have a definite requirement for insulin but Type 2 diabetes patients may not need insulin.Copyright (c) 2009 A. N. Munsif.

References

1. Diabetes mellitus handbook, Morristown Publishing Company, P.O. Box 672, Livingston, New Jersey 07039, 2009.
2. Centers for Disease Control (CDC),MMWR 2008; 57(43);1169-1173 (http://cdc.gov).
3. Geiss LS, Pan L, Cadwell B, Gregg EW, Benjamin SM, Engelgau MM. Changes in incidence of diabetes in U.S. adults, 1997--2003. Am J Prev Med 2006;30:371-7 (http://www.ajpm-online.net/).
4. CDC. State-specific prevalence of obesity among adults---United States, 2007. MMWR 2008;57:7658 (http://www.cdc.gov/mmwr/).
5. Knowler WC, Barrett-Conner E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention. N Engl J Med 2002;346:393-403 (http://content.nejm.org/).
6. United Nations - Department for Economic and Social Information - Population Division. World urbanization prospects: the 1994 revision. Estimates and projections of urban and rural populations and of urban agglomerations. United Nations, New York, 1995(http://www.un.org/esa/population/publications/ http://www.un.org/esa/population/publications/ http://www.un.org/esa/population/publications/ http://www.un.org/esa/population/publications/ http://www.un.org/esa/population/publications/ wup2007/2007wup.htm).
7. American Diabetes Association has several diabetes diet recommendations, souces of diabetes supplies, etc. and description of activities scheduled on Diabetes Alert Day on its website.

References(2):

1. Diabetes Mellitus Handbook - Morristown Publishing Company, P.O. Box 672, Livingston, New Jersey 07039.
2. Centers for Disease Control - Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, U.S.A.

Description

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