DIABETES TYPE II

NON INSULIN DEPENDENT

Diabetes mellitus type 2 or type 2 diabetes (formerly called

non-insulin-dependent diabetes mellitus (NIDDM), or adult-
onset diabetes) is a disorder that is characterized by high
blood glucose in the context of insulin resistance and
relative insulin deficiency. While it is often initially managed
by increasing exercise and dietary modification, medications
are typically needed as the disease progresses. There are an
estimated 23.6 million people in the U.S. (7.8% of the
population) with diabetes with 17.9 million being diagnosed,
90% of whom are type 2. With prevalence rates doubling
between 1990 and 2005, CDC has characterized the increase
as an epidemic.

Traditionally considered a disease of adults, type 2 diabetes

is increasingly diagnosed in children in parallel to rising
obesity rates, due to alterations in dietary patterns as well
as in life styles during childhood.

Unlike type 1 diabetes, there is very little tendency toward

ketoacidosis in type 2 diabetes, though it is not unknown.
One effect that can occur is nonketonic hyperglycemia which
also is quite dangerous, though it must be treated very
differently. Complex and multifactorial metabolic changes
very often lead to damage and function impairment of many
organs, most importantly the cardiovascular system in both
types. This leads to substantially increased morbidity and
mortality in both type 1 and type 2 patients, but the two
have quite different origins and treatments despite the
similarity in complications.

PATHOPHYSIOLOGY

Insulin resistance means that body cells do not respond

appropriately when insulin is present. Unlike type 1 diabetes mellitus,
insulin resistance is generally "post-receptor", meaning it is a problem
with the cells that respond to insulin rather than a problem with the
production of insulin.

Other important contributing factors: increased hepatic glucose

production (e.g., from glycogen -> glucose conversion), especially at
inappropriate times (typical cause is deranged insulin levels, as those
levels control this function in liver cells)

• decreased insulin-mediated glucose transport in (primarily)

muscle and adipose tissues (receptor and post-receptor defects)
• impaired beta-cell function—loss of early phase of insulin release
in response to hyperglycemic stimuli

This is a more complex problem than type 1, but is sometimes easier

to treat, especially in the early years when insulin is often still being
produced internally. Type 2 may go unnoticed for years before
diagnosis, since symptoms are typically milder (eg, no ketoacidosis,
coma, etc) and can be sporadic. However, severe complications can
result from improperly managed type 2 diabetes, including renal
failure, erectile dysfunction, blindness, slow healing wounds (including
surgical incisions), and arterial disease, including coronary artery
disease. The onset of type 2 has been most common in middle age and
later life, although it is being more frequently seen in adolescents and
young adults due to an increase in child obesity and inactivity. A type
of diabetes called MODY is increasingly seen in adolescents, but this is
classified as a diabetes due to a specific cause and not as type 2
diabetes.

Diabetes mellitus type 2 is presently of unknown etiology (i.e., origin).

Diabetes mellitus with a known etiology, such as secondary to other
diseases, known gene defects, trauma or surgery, or the effects of
drugs, is more appropriately called secondary diabetes mellitus or
diabetes due to a specific cause. Examples include diabetes mellitus
such as MODY or those caused by hemochromatosis, pancreatic
insufficiencies, or certain types of medications (e.g., long-term steroid
use).

Diabetes mellitus type 2 is often associated with obesity, hypertension,

elevated cholesterol (combined hyperlipidemia), and with the condition
often termed Metabolic syndrome (it is also known as Syndrome X,
Reavan's syndrome, or CHAOS). Secondary causes of Diabetes mellitus
type 2 are: acromegaly, Cushing's syndrome, thyrotoxicosis,
pheochromocytoma, chronic pancreatitis, cancer and drugs.

Drug induced hyperglycemia:

 • Atypical Antipsychotics - Alter receptor binding characteristics,
leading to increased insulin resistance.
• Beta-blockers - Inhibit insulin secretion.
• Calcium Channel Blockers - Inhibits secretion of insulin by
interfering with cytosolic calcium release.
• Corticosteroids - Cause peripheral insulin resistance and
gluconeogensis.
• Fluoroquinolones - Inhibits insulin secretion by blocking ATP
sensitive potassium channels.
• Naicin - They cause increased insulin resistance due to increased
free fatty acid mobilization.
• Phenothiazines - Inhibit insulin secretion.
• Protease Inhibitors - Inhibit the conversion of proinsulin to insulin.
• Thiazide Diuretics - Inhibit insulin secretion due to hypokalemia.
They also cause increased insulin resistance due to increased
free fatty acid mobilization.

Additional factors found to increase risk of type 2 diabetes include

aging, high-fat diets and a less active lifestyle..

PATIENT PROFILE
Name: Palomera Carolino
Age: 62
Gender: male
Birth date: January 15, 1947
Educational attainment: Commerce graduate
Religion: Catholic
Occupation: Retired custom representative

Patient history: He has no maintenance of meds. Only self

discipline on terms of diet and exercise but because of his
depression on his job early retirement he stopped his healthy
lifestyle that lead to below the knee amputation.

Present condition: Right leg amputated last Nov. 23, 2009

Past illnesses: none

Family history of illness: Diabetes and hypertension on father

side.

Past hospitalization: Last Oct. because of unhealed wound on the

dorsum on the right foot.

Diet: Before, he is very conscious about his diet but when he

retired on his job he become depressed and did not care about
what he eat. He always drinks coke zero because he believes
that it is zero sugar.

Exercise: before, he does a lot of exercises but when he become

depressed because of his retirement he stopped.
Sleep pattern: Mr. Palomera sleeps at around 8-9pm and woke
up as early as 3am.
Voiding pattern: he voids 3x a day.
Vices: None. Because they know that it can induced high blood
sugar.