MEDICAL INFORMATION
TYPE II DIABETES
Diabetes Type II consists of a diagnosis of Diabetes Mellitus that usually appears after age 30, usually over the age of 40 Years. It is also known as Adult Onset Diabetes and may also be considered Insulin Dependent, if the individual is receiving insulin injections to control their diabetes. Diabetes Type II is a result of a relative insulin ineffectiveness, or an insulin resistance, and in latter stages it is due to insulin deficiency. In contrast, early stages of this disorder are associated with blood levels of insulin greater than normal. Diabetes that occurs in individuals less than 25 years of age is usually Juvenile Diabetes and is due to insulin deficiency. It is known as Type I Diabetes.
Diabetes, Types I and II, is associated with increased frequency of illness. Diabetes is considered less than well controlled when the fasting blood glucose (blood sugar) is above 120 mg/dl (normal 80-110). There is also more hypertension (high blood pressure) and obesity (overweight) in diabetes. The major effects are accelerated cardiovascular disease manifested by damage to small blood vessels leading to 1. myocardial infarction (heart attacks), 2. nephropathy (kidney damage leading to protein loss in the urine, and kidney failure), 3. peripheral vascular disease (leading to stroke, aneurysms of arteries, decreased blood flow to the feet causing sores and gangrene, and intermittent claudication) and 4. effects on nerves (neuropathy).
The purpose of treating diabetes is to improve quality of life and to minimize the chances of accelerated cardiovascular and neurological disease.
In 2000, the population of Oklahoma was approximately 3.5 million of which the prevalence of diabetes was 5.5% or 150,000 persons. The ethnic distribution of the diabetic population was 76% white or Caucasian, 7.6% Black or African American, 5.2% Hispanic and 7.9% Native American Indian. The prevalence of diabetes was 4.6%, 7.7% 6.9% and 8.3%, respectively.
The initial therapy recommended in most Type II patients is a modification of the diet. The next line of therapy is with Oral Hypoglycemic agents, of which there are several available by prescription and in which they have various mechanisms of actions to lower the blood sugar.
Sulfonylureas (glyburide, glipizide, glimepiride, chlorpropamide) decrease levels of glucose by increasing secretion of insulin from the pancreas. Many patients experience weight gain, even with reduction of blood glucose (improve glycemic control). After several years of treatment, many patients fail.
Repaglinide increases secretion of insulin from the pancreas.
Biguanides (Metformin) decrease blood glucose by decreasing productions of glucose form the liver and by increasing uptake of glucose by muscle. The blood glucose lowering effect of metformin may also decrease with time.
Thiazolidinidiones (Troglitazone) sensitize muscle to the effect of insulin and leads to reduction of blood glucose. Many patients experience weight gain, as well as becoming less sensitive to the medication.
When diet plus single or combinations of oral hypoglycemic agents given to Type II diabetic subjects fails to give satisfactory treatment of diabetes, then Type II patients are treated with daily subcutaneous injections of insulin. Administration of insulin is made difficult because patients may be subject to large low and high swings in blood levels of glucose with hypoglycemic reactions (fast heart rate, mental confusion, death) or hyperglycemic reactions (thirst, mental confusion, diabetic coma, death). Patients may develop resistance to the effect of insulin and may have local skin reactions and other allergic reactions.