Type2Spring23

Type 2 Diabetes Overview

  • Definition: Type 2 Diabetes (T2D) is often referred to as adult-onset or non-insulin dependent diabetes.

  • Prevalence: Type 2 Diabetes is the most common form of diabetes, accounting for over 90% of diabetes cases.

  • At-Risk Populations: Increased prevalence among Native American, Hispanic, and African American demographics.

Pathophysiology of Type 2 Diabetes Mellitus

Pancreas

  • Insulin Secretion: When the pancreas's beta cells don’t work properly, not enough insulin is produced.

Insulin Resistance: At first, when the body's cells resist insulin, the pancreas makes more insulin to try to help. However, this can wear out the beta cells over time, causing them to work less effectively.

Liver

  • Excessive glucose production happens when the liver makes too much sugar, which leads to high blood sugar levels.

Adipose Tissue

  • Hormonal Changes: When levels of a hormone called adiponectin go down and another hormone called leptin goes up, it causes problems with how the body uses sugar and fat.

Muscle

  • Insulin Receptors: When insulin receptors do not work properly, they make it harder for the body to use insulin effectively. This leads to insulin resistance, which means the body needs more insulin to lower blood sugar levels. As a result, this can cause high blood sugar levels, known as hyperglycemia.

Risk Factors for Type 2 Diabetes

  • Diet: High consumption of food with animal fat.

  • Physical Inactivity: Insufficient exercise contributes to overweight and obesity.

  • Genetic Predisposition: Hereditary factors influence hunger and insulin production capabilities.

  • Obesity: Increased fat deposition leads to heightened insulin requirements and greater insulin resistance.

Case Study: Bart Bunyan

  • Profile: 62-year-old man from Bloomington, Indiana, recently diagnosed with pre-diabetes.

  • Medical History: Managed hypertension, BMI at 34.4, family history affecting lifestyle and dietary habits.

Pre-Diabetes Indicators

  • Criteria:

    • A1C level between 5.7% and 6.4%

    • Fasting glucose between 100 and 125 mg/dL

    • 2-hour oral glucose tolerance test results between 140 and 199 mg/dL

  • Concerns: Without intervention, there's a high risk of progressing to Type 2 Diabetes within 10 years, with existing complications developing silently.

Prevention Strategies for Pre-Diabetes

  • Weight Loss: Essential in delaying or preventing progression to diabetes.

Clinical Manifestations of Type 2 Diabetes

  • Symptoms: Often undetected; possible symptoms include fatigue, recurrent infections, prolonged wound healing, and vision changes. Bart exhibits typical symptoms during assessment.

Diagnosis of Type 2 Diabetes

  • Criteria:

    • A1C of 6.5% or higher

    • Fasting plasma glucose ≥ 126 mg/dL

    • 2-hour plasma glucose ≥ 200 mg/dL

  • Autoantibody Testing: To distinguish between Type 1 and other diabetes types.

Treatment Options

Oral Medications

  • Initial Treatment: Primarily involves oral medications and non-insulin injectables targeting key defects in diabetes.

  • Goals:

    • Reduce liver glucose production

    • Enhance insulin sensitivity

    • Improve glucose transport into cells

    • Aim for weight loss and improve lipid profiles.

Specific Oral Agents

  • Sulfonylureas: Glipizide and Glyburide, effective in stimulating insulin production but risk hypoglycemia and weight gain.

  • Other Agents: Meglitinides and Thiazolidinediones, focusing on insulin production and sensitivity respectively.

Non-Insulin Injectables

  • GLP-1 Receptor Agonists: E.g., Exenatide, Liraglutide, Semaglutide. Benefits include increased insulin secretion while reducing glucagon, enhancing satiety, and possible weight loss. However, they have risks, including pancreatitis.

Bart’s Progression Evidence

  • Late Outcomes: Bart's condition deteriorated, leading to emergency intervention due to extreme hypoglycemia.

  • Healthcare Focus: Review Bart’s previous chart for significant findings and understand contributors to his health issues.

Management During Illness

  • Sick Day Rules: Manage diabetes during acute illnesses by maintaining regular medication, monitoring glucose levels every few hours, staying hydrated, and being vigilant for concerning symptoms indicating ketoacidosis.

Recommended Actions for Bart

  • Care Plan: Enhance daily activity despite arthritis, adjust dietary habits, and monitor closely for any concerning symptoms.