Kanlayanee Phothiworn

Paul Roberts
Nutrition
28 November 2017
Type II Diabetes

According to the American Diabetes Association, about 30.3 million Americans are

affected by both types of diabetes, of which about 1.25 million Americans are affected by Type I

diabetes, which indicates that about 29 million Americans are affected by type 2 Diabetes. (1) In

order to understand more about diabetes, their pathophysiology, prevention, risk factors and

control should be understood. Due to time limit during the presentation, I only had time to talk

about type II diabetes. Therefore, only type II diabetes will be thoroughly discussed in this article.

Diabetes can be referred to as a chronic disease characterized by high levels of sugar

(glucose) in the blood. The pancreas is responsible in sensing the level of blood glucose and thus

synthesizing insulin and glucagon. Insulin is an anabolic agent used to take up blood glucose into

the cells for ATP production and energy storage. It is also used to single the liver for glucose

uptake for glycogen conversion. Glucagon is a metabolic agent used to mobilize stored glucose

to be released into the bloodstream. The imbalance of the coordination of these two hormones

causing problems and complications to the body, sometimes it is even life threatening.

There are different ways to test for diabetes and monitor blood glucose level. Because of

the fact that excess glucose is stored in red blood cells and their average survival time of about

120 days, the level of glucose found there can be used to determine average blood glucose level

for the last 2 to 3 months. This test is called the A1C test. Although the A1C test uses percentage,

the percentage can be converted into mg/dl which is the same unit used by a glucometer that
shows eAG value. (2) The American Diabetes Association states that percentage from an A1C

test should be between 4% and 7% for patients with diabetes, which is equivalent to 154 mg/dl or

lower.

Type II Diabetes

Pathophysiology

Receptors for insulin are not responsive effectively to insulin, a situation called insulin

resistance, which leads to abnormal glucose uptake into the cells and leave glucose in the

bloodstream. This condition also leads to a higher production of insulin by the pancreas to reach

to the normal amount of glucose uptake. (3) Insulin resistance can be caused by genetic or

environmental factors. Both insulin resistance and beta cells dysfunction play a role in

developing diabetes. The endocrine hypothesis states that the adipose tissue secrets

adipocytokins such as leptin, which behaves like an endocrine gland, contribute to the changes in

insulin resistance and beta cell function. Type II is highly linked to obesity because level of

adipose tissue is higher in obese people than people with normal weight. (4)

Signs and Symptoms

Type II has a chronic onset because the problem, signs and symptoms can be developed

over a longer period of time and the symptoms for early diabetes can even be and usually

subclinical. In a later stage, it will eventually affect major organs which include the heart, blood

vessels, the eyes and kidneys. Although diabetes is increasingly affecting more children, adults

are those who are commonly seen with this disease. (5)
 Common symptoms include polyuria, polydipsia and unintended weight loss. In addition

to symptoms of type I, type II also include paresthesia in the lower extremities, easily infected by

yeast, and reduced healing ability. Type II does not have a specific age period for its onset. (5)

On the one hand, it is still wondered by researchers about the development and causes of

type II. On the other hand, risk factors can be identified, which include obesity and physical

inactivity, previous family history of parents and siblings who had diabetes, races such as

Hispanics and American Indians have higher potential of developing type II, gestational diabetes

and untreated prediabetes. (5)

Long-term Complications

High blood glucose level can cause loss of vision. The accumulation of glucose causes

hemorrhage or leakage in the blood vessels or capillaries of the retina. The damages lead to the

formation of scarring tissue on the retina or abnormal angiogenesis, which may cause decrease

ability for light sensitivity of the retina. (6)

High blood glucose level also leads to higher viscosity of the blood, which then leads to

poor blood circulation. People with diabetes have poor healing after an injury because the

healing mediators that are carried by the blood are not able to reach the injured sites effectively

and efficiently to initiate tissue repair.

The kidney is used to secret unnecessary waste out of the body. For patients with diabetes,

the kidney is functioning in a higher rate trying to secret more glucose with urine. The water is

also reabsorbing less water so that higher amount of water can follow glucose to be secreted,

therefore creating symptoms such as polyuria and polydipsia. In the case of high flow in the

distal convoluted tubule, the afferent arteriole release a hormone called renin, which is combined
with angiotensin from the liver to make angiotensin II. Angiotensin II stimulates the medulla

cortex for the release of aldosterone which increases Na+ reabsorption from the loop of nephron.

More water is also reabsorbed because water follows Na+. Therefore blood fluid volume is

increased, which causes hypertension. Chronic hypertension can lead to kidney damage and

diseases. (7)

It can also cause diabetic neuropathy. There are many potential mechanisms of

neuropathy. One of them includes the insufficient of oxygen and nutrients delivery to the nerves

because of elevated viscosity caused by high blood glucose and inflammation initiated by the

immune system trying to repair some of the damaged tissues around the nerves. One of the other

factors also include glycation in which covalent bonds are formed by glucose on the nerves, thus

damaging the nerves. (8)

Prevention/Control

It is important of patients who have type II to control their glucose intake through close

monitoring of their diet and to exercise more through modified programs. Pharmacological

control are also used to suppress the effect of insulin resistance. Agents include those that are

helping in controlling glucose, such as medicine, called Biguanides that can lower the production

of liver glucose and facilitate muscle cells in up taking glucose. Sulfonylurea is also utilized in

increasing the secretion of insulin because of dysfunction of pancreatic beta cells. (9) Blood

glucose level are hard to be monitored for some individuals because they may not know if the

levels are off until serious complications become clinical, such as retinopathy and neuropathy.

Unfortunately, there is not yet a cure for diabetes. But prevention all starts with a better

lifestyle. Eating healthier makes it possible for people to live without taking any diabetic
medications. According to the American Diabetes Association, smoking is the leading cause of

mortality and has a strong association with vascular complications. Therefore, quit smoking is a

way to control diabetes. Being active helps facilitate uptake of glucose by the muscles cells. One

of the good exercise program includes radio exercise. It is important to make sure that people

check in with their doctors at least once a month and use monitoring device to check blood

glucose levels daily. Remember that you can take control of your life! Dont let diabetes control

you!
 References
1. Statistics About Diabetes. American Diabetes Association.
http://www.diabetes.org/diabetes-basics/statistics/. Accessed November 24, 2017.
2. Why the A1c Test Is Important. Kaiser Permanente.
https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=%2Fcommon%2F
healthAndWellness%2Fconditions%2Fdiabetes%2Fa1c.html. Accessed November 24,
2017.
3. Insulin. Diabetes.co.uk. http://www.diabetes.co.uk/body/insulin.html. Accessed
November 24, 2017.
4. Scheen AJ. Pathophysiology Of Type 2 Diabetes. Acta Clinica Belgica. 2003;58(6):335-
341. doi:10.1179/acb.2003.58.6.001.
5. Type 2 diabetes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-2-
diabetes/symptoms-causes/syc-20351193. Published October 6, 2017. Accessed
November 24, 2017.
6. Facts About Diabetic Eye Disease. National Eye Institute.
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November 24, 2017.
7. J Manag Care Spec Pharm. The Renin-Angiotensin Aldosterone System:
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https://doi.org/10.18553/jmcp.2007.13.s8-b.9
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we now and where to go? Journal of Diabetes Investigation. 2011;2(1):18-32.
doi:10.1111/j.2040-1124.2010.00070.x.
9. Khardori R. Type 2 Diabetes Mellitus Medication.
https://emedicine.medscape.com/article/117853-medication. Published November 7,
2017. Accessed November 24, 2017.