Type 2 Diabetes Mellitus

          Type 2 diabetes mellitus (also called type 2 diabetes, adult-onset diabetes mellitus, non-insulin-dependent diabetes mellitus or just diabetes) is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes mellitus is the most common form of diabetes mellitus.

          Type 2 diabetes mellitus affects the way the body processes and uses carbohydrates, fats and proteins. During digestion, food is broken down into its basic components. The liver processes these nutrients into one type of sugar -- glucose. Glucose is the most basic fuel for the body. Glucose enters your body's cells with the help of insulin. Insulin is a hormone produced by the pancreas. Without insulin, glucose cannot pass through the cell wall.
Type 2 diabetes mellitus occurs when your body's cells do not react efficiently to insulin. This condition is called insulin resistance.

          In people with insulin resistance, the pancreas first makes extra insulin to maintain a normal blood sugar. Over time, the body's insulin resistance gets worse. The pancreas cannot keep up with the demand for more and more insulin. As a result, blood glucose levels rise. Untreated, type 2 diabetes mellitus can be life-threatening.

          Type 2 diabetes mellitus runs in families. It most often affects people who are older than 40. But type 2 diabetes mellitus is now being seen in more and more young people. Obesity greatly increases the risk of type 1 diabetes mellitus.

          There's no cure for type 2 diabetes mellitus, but you can manage — or even prevent — the condition. Start by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to control your type 2 diabetes mellitus, you may need diabetes medications or insulin therapy to manage your blood sugar.

Symptoms of Diabetes Mellitus.

The classic symptoms of diabetes mellitus are

  • polyuria (frequent urination),
  • polydipsia (increased thirst),
  • polyphagia (increased hunger), and
  • weight loss.

Other symptoms that are commonly present at diagnosis include:

  • history of blurred vision, itchiness,
  • peripheral neuropathy,
  • recurrent vaginal infections, and
  • fatigue.
Many people however have no symptoms during the first few years and are diagnosed on routine testing. People with type 2 diabetes mellitus may rarely present with nonketotic hyperosmolar coma (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).

Causes of type 2 Diabetes Mellitus

          When sugar cannot enter cells, high levels of sugar build up in the blood. This is called hyperglycemia.

          Type 2 diabetes mellitus usually occurs slowly over time. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way. Type 2 diabetes mellitus can also develop in people who are thin. This is more common in the elderly. Family history and genes play a large role in type 2 diabetes mellitus. Low activity level, poor diet, and excess body weight around the waist increase your risk

          Type 2 diabetes mellitus develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. When you have type 2 diabetes mellitus, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy. Exactly why this happens is unknown, although excess weight and inactivity seem to be contributing factors.

          Insulin is a hormone that comes from the pancreas, a gland situated just behind and below the stomach. When you eat, the pancreas secretes insulin into the bloodstream. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

          The liver acts as a glucose storage and manufacturing center. When your insulin levels are low — when you haven't eaten in a while, for example — the liver metabolizes stored glycogen into glucose to keep your glucose level within a normal range. In type 2 diabetes mellitus, this process works improperly. Instead of moving into your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin.

Risk Factors of Type 2 Diabetes Mellitus

        Researchers don't fully understand why some people develop type 2 diabetes mellitus and others don't. It's clear that certain factors increase the risk, however, including:
  • Weight. Being overweight is a primary risk factor for type 2 diabetes  mellitus . The more fatty tissue you have, the more resistant your cells become to insulin. 
  • Fat distribution. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes mellitus is greater than if your body stores fat elsewhere, such as your hips and thighs.
  • Inactivity. The less active you are, the greater your risk of type 2 diabetes mellitus . Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
  • Family history. The risk of type 2 diabetes mellitus increases if your parent or sibling has type 2 diabetes mellitus.
  • Race. Although it's unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are more likely to develop type 2 diabetes mellitus than whites are.
  • Age. The risk of type 2 diabetes mellitus increases as you get older, especially after age 45. That's probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes mellitus is also increasing dramatically among children, adolescents and younger adults.
  • Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes mellitus. Left untreated, prediabetes often progresses to type 2 diabetes mellitus.
  • Gestational diabetes mellitus. If you developed gestational diabetes mellitus when you were pregnant, your risk of developing type 2 diabetes mellitus later increases. If you gave birth to a baby weighing more than 9 pounds (4.1 kilograms), you're also at risk of type 2 diabetes mellitus

Diagnosis of Type 2 Diabetes mellitus

Fasting blood glucose level -- diabetes mellitus is diagnosed if it is higher than 126 mg/dL two times
Hemoglobin A1c test --

Normal: Less than 5.7%
Pre-diabetes: 5.7% - 6.4%
Diabetes mellitus: 6.5% or higher
Oral glucose tolerance test -- diabetes mellitus is diagnosed if glucose level is higher than 200 mg/dL after 2 hours

Complications of Type 2 Diabetes mellitus

          Type 2 diabetes mellitus can be easy to ignore, especially in the early stages when you're feeling fine. But type 2 diabetes mellitus affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent these complications.

          Although long-term complications of diabetes mellitus develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes mellitus include:

  • Heart and blood vessel disease. Diabetes mellitus dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure. The risk of stroke is two to four times higher for people with diabetes mellitus, and the death rate from heart disease is two to four times higher for people with diabetes mellitus than for people without the disease, according to the American Heart Association.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputation.
  • Skin and mouth conditions. Diabetes mellitus may leave you more susceptible to skin problems, including bacterial and fungal infections. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.
  • Osteoporosis. Diabetes mellitus may lead to lower than normal bone mineral density, increasing your risk of osteoporosis.
  • Alzheimer's disease. Type 2 diabetes mellitus may increase the risk of Alzheimer's disease and vascular dementia. The poorer your blood sugar control, the greater the risk appears to be. So what connects the two conditions? One theory is that cardiovascular problems caused by diabetes mellitus could contribute to dementia by blocking blood flow to the brain or causing strokes. Other possibilities are that too much insulin in the blood leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose.

Prevention of Type 2 Diabetes Mellitus

          Healthy lifestyle choices can help you prevent type 2 diabetes mellitus. Even if type 2 diabetes mellitus runs in your family, diet and exercise can help you prevent the disease. If you've already been diagnosed with type 2 diabetes mellitus, the same healthy lifestyle choices can help you prevent potentially serious complications. And if you have prediabetes, lifestyle changes can slow or halt the progression from prediabetes to diabetes mellitus.

          Eat healthy foods. Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains. For every 1,000 calories you consume, try to have at least 14 grams of fiber, because fiber helps control blood sugar levels.

          Get physical activities. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride a bike. Swim laps. If you can't fit in a long workout, spread 10-minute or longer sessions throughout the day.

          Lose excess pounds. If you're overweight, losing 5 to 10 percent of your body weight can reduce the risk of diabetes mellitus. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

          There's some evidence that coffee and, possibly, tea drinking may decrease your risk of developing type 2 diabetes mellitus, but more research is needed.

          Sometimes medication is an option as well. Metformin (Glucophage), an oral diabetes medication, may reduce the risk of type 2 diabetes  mellitus— but healthy lifestyle choices remain essential.

Management of Type 2 Diabetes Mellitus

          Management of type 2 diabetes mellitus focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining blood glucose levels in the normal range. Self-monitoring of blood glucose for people with newly diagnosed type 2 diabetes mellitus was recommended by the National Health Services in 2008, however the benefit of self monitoring in those not using multi-dose insulin is questionable. Managing other cardiovascular risk factors including: hypertension, high cholesterol, and microalbuminuria, improves a person's life expectancy. Intensive blood sugar lowering (HbA1C<6%) as opposed to standard blood sugar lowering (HbA1C of 7-7.9%) does not appear to change mortality. The goal of treatment is typically an HbA1C of less than 7% or a fasting glucose of less than 6.7 mmol/L (120 mg/dL) however these goals may be changed after professional clinical consultation, taking into account particular risks of hypoglycemia and life expectancy. It is recommended that all people with type 2 diabetes  mellitus get regular ophthalmology examination.


          A proper diet and exercise are the foundations of diabetic care with a greater amount of exercise yielding better results. Aerobic exercise leads to a decrease in HbA1C and improved insulin sensitivity. Resistance training is also useful and the combination of both types of exercise may be most effective. A diabetic diet that promotes weight loss is important. While the best diet type to achieve this is controversial a low glycemic index diet has been found to improve blood sugar control. Culturally appropriate education may help people with Type 2 diabetes mellitus control their blood sugar levels, for up to six months at least. If changes in lifestyle, in those with mild diabetes mellitus, has not resulted in improved blood sugars within six weeks medications should then be considered.

Diet and Weight Control

          Work closely with your doctor, nurse, and dietitian to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your daily lifestyle and habits, and should try to include foods that you like.

          Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes mellitus can stop taking medications after losing weight (although they still have diabetes mellitus).

Medications for Type 2 Diabetes Mellitus

Metformin 500mg tablets

          There are several classes of anti-diabetic medications available. Metformin is generally recommended as a first line treatment as there is some evidence that it decreases mortality. A second oral agent of another class may be used if metformin is not sufficient. Other classes of medications include: sulfonylureas, nonsulfonylurea secretagogues, alpha glucosidase inhibitors, thiazolidinediones, glucagon-like peptide-1 analog, and dipeptidyl peptidase-4 inhibitors. Metformin should not be used in those with severe kidney or liver problems. Injections of insulin may either be added to oral medication or used alone.

          Most people do not initially need insulin. When it is used, a long-acting formulation is typically added at night, with oral medications being continued. Doses are then increased to effect (blood sugar levels being well controlled). When nightly insulin is insufficient twice daily insulin may achieve better control. The long acting insulins, glargine and detemir, do not appear much better than neutral protamine Hagedorn (NPH) insulin but have a significantly greater cost making them, as of 2010, not cost effective. In those who are pregnant insulin is generally the treatment of choice.

Surgery for Type 2 Diabetes Mellitus

          Weight loss surgery in those who are obese appears to be an effective measure to treat diabetes mellitus. Many are able to maintain normal blood sugar levels with little or no medications following surgery and long term mortality is decreased. There however is some short term mortality risk of less than 1% from the surgery. The body mass index cutoffs for when surgery is appropriate are not yet clear.


          Your treatment plan is likely to require adjustment over time. Insulin resistance increases with age. And the insulin-producing cells in the pancreas may wear out as the pancreas tries to keep up with the body's extra insulin needs.

          After the first few years, the majority of people with type 2 diabetes mellitus require more than one medicine to keep their blood sugar controlled. About one out of three people with type 2 diabetes mellitus requires insulin.

          The prognosis in people with type 2 diabetes mellitus varies. It depends on how well an individual modifies their risk of complications. Heart attack, stroke and kidney disease can result in premature death. Disability due to blindness, amputation, heart disease, stroke and nerve damage may occur. Some people with type 2 diabetes mellitus become dependent on dialysis treatments because of kidney failure.

There is a tremendous amount you can do to decrease your risk of complications:

  • Eat a healthy diet
  • Get regular exercise
  • Pay careful attention to your blood sugar levels
  • Reduce your other risks of heart disease

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