Type 2 Diabetes
Type 2 Diabetes is also known as Diabetes mellitus type 2. It is a widespread disease that affects more than 10% of the population and its incidence is gradually growing. Let us just add that type 2 diabetes is completely different from type 1 diabetes. It has similar manifestation and symptoms but completely different cause and pathophysiological mechanism.
Type 2 diabetes is a metabolic disease that is related to many factors such as abdominal obesity, untreated hypertension and dyslipidemia. There is also a genetic predisposition making some people more sensitive to impact of these factors. Abdominal obesity means that there is a higher risk in men with waist circumference over 90 centimeters and women over 100 centimeters.
Fat stored in the abdominal organs has the ability to increasingly release the fatty acids (components of fat) into the bloodstream. In addition, the lack of physical activity causes that muscle tissue begins to develop resistance against insulin effect. This insulin resistance is the basic problem of type 2 diabetes as pancreatic cells produce enough insulin but its effect is simply not sufficient. Blood glucose levels elevates slowly, especially after meals. Fatty acids released from the fat tissue together with higher blood glucose are toxic and damage insulin-producing cells of the pancreas. Insulin overproduction and above mentioned toxic effect exhaust the pancreatic cells and that disrupts insulin production.
Type 2 diabetes can be randomly found by a general practitioner during preventive examination in a patient with no obvious symptoms. On the other hand untreated diabetes is usually accompanied with a number of signs including fatigue, night sweats, weight loss and abdominal pain. Accumulated sugar in blood is filtered to urine in kidneys and it takes fluid and minerals with. This causes excessive urination, dehydration, mineral deficiency and abnormal thirst.
Hyperglycemic and hypoglycemic coma
Hyperglycemic condition occurs in untreated or insufficiently treated type 2 diabetes. High blood sugar level causes disruption of homeostasis and that can result in unconsciousness and death without the proper treatment. Hypoglycemic coma is a state of unconsciousness that is caused by too low sugar blood level. In type 2 diabetics it occurs after administration of a too high dose of oral antidiabetic drugs or insulin. The best first aid is administration of glucose orally or intravenously leading to the quick return of consciousness.
Damage to the small blood vessels (microangiopathy)
Higher blood sugar in chronic diabetes damages little arteries in the eyes, kidneys and nerve-nourishing arteries. This results in complications such as diabetic retinopathy (that may cause a complete loss of vision), nerve disorders (diabetic polyneuropathy manifesting with disrupted stomach emptying, abdominal pain, problems with erection, etc.) and chronic renal failure.
Damage to the major blood vessels (macroangiopathy)
Large blood vessels are mainly affected by accelerated atherosclerosis. The diabetes is associated with increased production of substances causing the oxidative stress and this causes faster deterioration of blood vessel walls. Diabetics are endangered by all complication of atherosclerosis (see related article) including the increased risk of a heart attack.
The so-called diabetic foot is a combination of disorders of both large and small blood vessels. Diabetic polyneuropathy damages sensitivity of feet and this increases the risk of an injury. High blood sugar damages large and small blood vessels and the limbs are poorly vascularized and less oxygenated. Elevated blood sugar is a suitable “food” for bacteria and chronic diabetes leads to the weakened immunity. These factors increase risk of wound infection and reduce wound healing. The infection may become uncontrollable and lead to the amputation.
Diagnosis may be done accidentally or according to the above mentioned symptoms. It is important to do both the blood tests and urinalysis. In blood we find elevated level of blood sugar and in urine, we find glucose as well. If the blood sugar level is slightly elevated and the diagnosis is unclear, it is advisable to perform the oral glucose tolerance test. It consists of drinking a fluid with a certain volume of dissolved sugar followed by repeated glycemia measurement after some time. It shows the ability of the organism to utilize the glucose.
The prevention is simple and difficult as well. It is necessary to reduce the risk factors. People need enough regular physical exercise and healthy diet to prevent obesity, they should not smoke and lower the alcohol intake (maximally one glass of wine a day is recommended). Any present hypertension or dyslipidemia should be further treated pharmacologically.
In this case, the patient's compliance is essential. Regular physical exercise and healthy diet are necessary and can improve the situation. Weight loss of 10% has a huge positive health effect and reduces risks of further complications. These lifestyle changes decrease the insulin resistance and negative effect of the abdominal fat tissue. High cholesterol and fat levels may be treated by hypolipidemic drugs.
The pharmacological therapy of type 2 diabetes consists mainly of administration of oral antidiabetic drugs that in various ways improve the utilization of glucose in cells. In late stages of the disease accompanied with decreased insulin production it is usually necessary to start the insulin application or combine the insulin with previously mentioned oral antidiabetic drugs.