1. Risk factors/ Etiology
1.1. Weight loss
1.1.1. Being overweight is a primary risk factor for type II diabetes
1.1.1.1. More fatty tissue equals more resistant cells become to insulin.
1.2. Fat distribution
1.2.1. Body stores fat primarily in the abdomen, risk of type 2 diabetes is greater if the body stores fat elsewhere, such as hips and thighs.
1.3. Inactivity
1.3.1. Less active increases risk
1.3.2. Uses up glucose as energy and makes your cells more sensitive to insulin.
1.4. Family history
1.4.1. Risk increases when an immediate family member has type II diabetes
1.5. Race
1.5.1. In the United States, type 2 diabetes is more prevalent for certain groups than for Caucasians
1.5.1.1. Native Americans
1.5.1.2. African Americans
1.5.1.3. Hispanics
1.5.1.4. Asian Americans
1.6. Age
1.6.1. The risk of developing type 2 diabetes increases with age.
1.6.2. Adults ages 40 to 59 comprise the world’s age group with the highest diabetes rates.
1.6.3. The number of children diagnosed with type 2 diabetes is growing due to more overweight youth.
1.7. Prediabetes
1.7.1. Blood sugar level is higher than normal, but not high enough to be classified as diabetes.
1.7.1.1. Left untreated, can progress to type II diabetes
1.8. Gestational Diabetes
1.8.1. Developing gestational diabetes while pregnant, risk of developing type 2 diabetes increases.
1.8.1.1. Giving birth to a baby weighing more than 9 pounds increases risk
1.9. Polycystic ovarian syndrome
1.9.1. Common condition increases the risk of diabetes
1.9.1.1. Characterized by irregular menstrual periods, excess hair growth and obesity
2. Treatments
2.1. Healthy eating
2.1.1. No specific diet for diabetes
2.1.2. Center diet on high fiber, low fat foods
2.1.3. Low glycemic index foods
2.1.3.1. Low glycemic index foods may help achieve a more stable blood sugar
2.2. Regular exercise
2.2.1. A combination of aerobic exercises, resistance training, weightlifting, or yoga helps control blood sugar more effectively
2.2.2. Physical activity lowers blood sugar and may need to checked before exercising
2.3. Monitoring blood sugar
2.3.1. Blood sugar levels may need to be checked periodically, or multiple times a day if on insulin
2.4. Diabetes medication
2.4.1. Metformin (Glucophage, Glumetza)
2.4.1.1. Improves sensitivity of body tissues to insulin so the body uses insulin more effectively
2.4.1.2. lowers glucose production in the liver
2.4.2. Sulfonylureas
2.4.2.1. Helps body secrete more insulin
2.4.2.2. Glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl)
2.4.3. Meglitinides
2.4.3.1. Stimulate the pancreas to secrete more insulin, but are faster acting
2.5. Insulin therapy
2.5.1. Must be injected - normal digestion interferes with insulin taken by mouth
2.5.2. Types of insulin
2.5.2.1. Insulin glulisine (Apidra)
2.5.2.2. Insulin lispro (Humalog)
2.5.2.3. Insulin aspart (Novolog)
2.5.2.4. Insulin glargine (Lantus)
2.5.2.5. Insulin detemir (Levemir)
2.5.2.6. Insulin isophane (Humulin N, Novolin N)
2.6. Bariatric surgery
3. Incidence/ Prevalence
3.1. Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases of diabetes in adults (CDC)
3.2. About 1.4 million new cases of diabetes are diagnosed in United States every year.
3.3. 29.1 million people in the United States have diabetes
3.4. 8.1 million may be undiagnosed and unaware of their condition.
3.5. Cases of diagnosed diabetes cost the United States an estimated $245 billion in 2012.
3.6. Men are at a slightly higher risk than women of developing diabetes.
4. Resources
4.1. Type 2 diabetes. (2017, October 06). Retrieved November 19, 2017, from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
4.2. Santos-Longhurst, A. (2017, February 27). Type 2 Diabetes Statistics and Facts. Retrieved November 19, 2017, from Type 2 Diabetes Statistics and Facts
5. Diagnostics
5.1. Glycated hemoglobin (A1C) test
5.1.1. Indicates your average blood sugar level for the past two to three months
5.1.2. A1C level of 6.5 percent or higher on two separate tests indicates diabetes
5.1.3. Result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes
5.1.4. Certain conditions can make the A1C test inaccurate
5.1.4.1. Such as pregnancy or a hemoglobin variant
5.2. Random blood sugar test
5.2.1. A random blood sugar level of 200 mg/dL or higher suggests diabetes
5.2.2. Especially indicative of diabetes when with frequent urination and extreme thrist
5.3. Fasting blood sugar test
5.3.1. Blood sample taken after an overnight fast
5.3.2. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes.
5.3.3. 126 mg/dL or higher on two separate tests indicates diabetes.
5.4. Oral glucose tolerance test
5.4.1. Fasting blood sugar is tested
5.4.2. Sugary liquid is drank and blood sugar levels are tested periodically for 2 hours
5.4.3. A blood sugar level between 140 and 199 mg/dL indicates prediabetes
5.4.4. A reading of 200 mg/dL or higher after two hours may indicate diabetes
5.5. Regular yearly checkups with doctor
6. Pathogenesis
6.1. How insulin works
6.1.1. The pancreas secretes insulin into the bloodstream.
6.1.2. The insulin circulates, enabling sugar to enter your cells.
6.1.3. Insulin lowers the amount of sugar in your bloodstream.
6.1.4. As your blood sugar level drops, so does the secretion of insulin from your pancreas.
6.2. The role of glucose
6.2.1. Glucose comes from two major sources: food and the liver.
6.2.2. Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin
6.2.3. Liver stores and makes glucose.
6.2.4. When glucose levels are low, the liver breaks down stored glycogen into glucose to keep glucose level within a normal range
6.3. With type II diabetes
6.3.1. Instead of moving into your cells, sugar builds up in the bloodstream
6.3.2. Blood sugar levels increase, the insulin-producing beta cells in the pancreas release more insulin
6.3.2.1. These cells become impaired and can't make enough insulin to meet the body's demands.
7. Clinical Manifestations - Signs & Symptoms
7.1. Increased thirst and frequent urination
7.1.1. Excess sugar building up in the bloodstream causes fluid to be pulled from the tissues
7.2. Increased hunger
7.2.1. Without enough insulin to move sugar into cells, the bodies muscles and organs become depleted of energy.
7.2.1.1. Triggers intense hunger
7.3. Fatigue
7.3.1. Cells are deprived of sugar, patient may become tired and irritable
7.4. Blurred vision
7.4.1. If blood sugar is too high, fluid may be pulled from the lenses of the eyes.
7.4.1.1. Affects ability to focus
7.5. Slow healing sores or frequent infections
7.5.1. Type 2 diabetes affects your ability to heal and resist infections.
7.6. Areas of darkened skin
7.6.1. Acanthosis nigricans, may be a sign of insulin resistance.
7.6.1.1. Patches of dark, velvety skin in the folds and creases of the body — usually in the armpits and neck.