Type II Diabetesby Gunnar Spethman

Famous People with NIDDMElvis PresleyHalle BerryBret MichealsRay KrocThomas EdisonGeorge Lucas

Non-Insulin-dependent diabetesAdult-onset or Type II diabetesMetabolic disorderAffects approximately 15 million90% of all diabetics9-10 NIDDM’s are obeseObesity not cause of diabetes

NIDDM FactsType II – primary genetic component –secondary environmental componentGene’s responsible for obesity?80% of identical twins who have it, both have itA leading cause of death

More FactsChief reason for:BlindnessKidney failureLimb amputationsDialysis alone costs over $1 billion annually

Genes and NIDDMWebMD/Lycos - Article - Genetics of Diabetes Mellitus (Type 2)

PhysiologyMcDonaldsSmall IntestineGlucose Pancreas – beta cells InsulinPhospholipid layer—muscle’s receptors

Physiology Cont.Liver—glycogenGlucose—fatty acidsFatty acids—fat cellsTriglycerides

PathophysiologyType I—no insulinType II—insulin resistance or insensitivityPancreatic compensationGlucotoxicityCells starveComplications

ComplicationsHypo/hyperglycemiaKetoacidosis/hyperosmolar nonketotic comaNeuropathyCVDInfectionsGum diseaseSkin problems

ComplicationsKidney DiseaseImpaired wound healingObesity

Hypoglycemia (Low Blood Sugar)Shakiness. Dizziness. Sweating.

  Hunger. Headache. Pale skin color.

HypoglycemiaSudden moodiness or behavior changes,such as crying for no apparent reason.

Clumsy or jerky movements. Difficulty paying attention, or

confusion. Tingling sensations around the

mouth.

Hyperglycemia (High Blood Sugar)Increased urinationIncreased thirstHigh Levels of sugar in urineCan cause ketoacidosis

KetoacidosisLife threatening condition caused by a build-up of ketones in the blood. Caused by breakdown of fatSymptoms include: tired, flushed skin, nausea, vomiting, abdominal pain, SOB, fruity breath, confusionMust be medically treated

RetinopathyDisorders of the retina caused by diabetes2 typesNonproliferativeProliferative

TreatmentPhotocoagulationFocal photocoagulationScatter photocoagulationvitrectomy

NeuropathyCommon complication for diabeticsAffect peripheral nerves: motor, sensory, and autonomicNerve fibers are lostComplications correlate with the type of nerve affected

NeuropathyDiabetic footCaused by lost sensation and reduced healing capabilityPoor circulation and observation

Cardiovascular DiseaseOf all cases of diabetes, 80% die of cardiovascular diseaseMore than half, especially women, likely to be hypertensive by age 50Prevalence of hypertension in NIDDM is two to three times greater than non-diabetic

Cardiovascular Disease2-3 times the incidence of MI than non-diabeticInsulin resistance inc. vascular resistance & sympathetic tone (ACE inhibitor or beta-blocker)Greater incidence of atherosclerosisSilent ischemiaCongestive heart failure

Cardiovascular DiseaseHypertension, obesity, coronary heart disease, and diabetes linked by insulin resistanceCalled metabolic syndrome, syndrome x, or civilization syndrome

Diagnostic StudiesFinger stick (glucose—fasting < 120mg%Urine dipstick for glucose (if can’t get stick)Hgb A1C every 3-4 months <8%Urine micro albuminuria <30If elevated ACE inhibitorLipid panel (LDL < 100, total <200--yearly

Diagnostic StudiesOphthalmologic exam (yearly)Podiatrist (yearly or more if symptomatic)Dental preventative care yearly or biannuallyEducation (dietician, exercise, smoking & alcohol cessation, identification bracelet, and foot care)

PhamacologySulfonylureasBiquanideGlucosidase inhibitorThiazolidinedioneMeglitinideInsulinBIDS

Exercise/DietExercise—probably the best treatment for type II diabetesLowers blood sugarDecrease insulin resistanceRaise metabolismImprove blood flow through capillaries

Exercise/DietIncrease stroke volumeImprove blood lipidsControl & prevent moderate hypertensionDecrease body massDecrease stress/cigarette smoking

DietReduce caloric intake—drop blood sugarSmaller more frequent mealsReduce intake of simple sugarComplex carbs for slower digestion

Exercise Precautions/Recommendations

Oral medications/insulinRetinopathySilent ischemiaProper footwareFluidsTemperatureNot if sugar >300 or <100

Exercise Precautions/Recommendations

KetoacidosisCarry a snack (if needed)4-6 days/week at low to moderate intensity50-85% of max VO2Maximize caloric expenditure

QuizAmerican Diabetes Association - Exercise your brain