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Clinical Presentation Of Type 2 Diabetes

Type 2 Diabetes

Type 2 Diabetes

Print Overview Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's important source of fuel. With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy. Symptoms Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for: Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. Fatigue. If your cells are deprived of sugar, you may become tired and irritable. Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. Slow-healing sores o Continue reading >>

Clinical Presentation Of Diabetes Mellitus

Clinical Presentation Of Diabetes Mellitus

The body appears unable to sense glucose levels directly, but people with diabetes learn to appreciate when their blood glucose is outside the normal range by indirect cues, such as thirst when the glucose is too high and sweating and palpitations when it is too low. Diabetes may present acutely, with the three classic symptoms of thirst, polyuria and weight loss; even so, clinical recognition may be delayed until the patient is seriously ill. Many forms of diabetes, including type 2, present less dramatically. Increased thirst and polyuria may not be noticed because they develop slowly, and weight loss may be welcomed by those who are trying to diet. People at this stage of diabetes may call on their doctor with a range of non-specific symptoms such as tiredness and loss of energy; alternatively they may come to notice because of acute complications of diabetes, including hyperglycaemia emergencies and infections, or longer term complications including retinopathy, neuropathy, cataracts, cardiovascular or cerebrovascular disease. People with type 2 diabetes may have had the condition for several years before they come to clinical notice, and many countries now have screening policies to allow earlier detection and treatment. Background Early recognition of diabetes is important, not least because delayed recognition may result in hospital admission with a metabolic emergency. Delayed recognition of type 2 diabetes may mean that avoidable long term complications of diabetessuch as retinopathyor neuropathyare already present at diagnosis. The classic symptoms of diabetes form the triad of thirst, polyuria and weight loss: Thirst arises as a consequence of dehydration resulting from loss of fluid, salt and other electrolytes in the urine. The acute thirst of type 1 diabet Continue reading >>

Clinical Presentation Of Type 2 Diabetes Mellitus In Children And Adolescents.

Clinical Presentation Of Type 2 Diabetes Mellitus In Children And Adolescents.

Int J Obes (Lond). 2005 Sep;29 Suppl 2:S105-10. Clinical presentation of type 2 diabetes mellitus in children and adolescents. Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany. [email protected] Recent reports indicate an increasing prevalence of type 2 diabetes mellitus (TD2M) in children and adolescents around the world in all ethnicities, possibly due to increasing prevalence of obesity. Therefore, it is essential that clinicians are aware of the clinical features of T2DM in these age groups. All published cases of T2DM in children and adolescents were evaluated and the different clinical presentations of T2DM in minorities and Caucasian described. Manifestation of T2DM is usually at mid-to-late puberty with few symptoms such as mild-polyuria or polydipsia. Most of the children and adolescents are extremely obese. The great majority of children and adolescents with T2DM have relatives with T2DM, and show other clinical features of the insulin resistance syndrome such as hypertension, dyslipidemia, polycystic ovarian syndrome (PCOS) or acanthosis nigricans. One-third of the minority children with T2DM and the majority of the Caucasian children with T2DM were detected by screening in the absence of symptoms. It is becoming increasingly clear that overweight children above the age of 10 y with (1) clinical signs of insulin resistance (acanthosis nigricans, dyslipidemia, hypertension, PCOS), or (2) relatives with T2DM, or (3) of particular ethnic populations (Asian, Indians, Africa-Americans, Hispanics), or (4) extremely obese children should be screened for T2DM. Continue reading >>

Clinical Features Of Type 1 Diabetes Mellitus

Clinical Features Of Type 1 Diabetes Mellitus

As described in Chapter 13.2.3, type 1 diabetes results from the destruction of the glucose-responsive, insulin-secreting β‎ cells of the pancreatic islets. Its principal clinical features reflect significant insulin deficiency. In general, the β‎ cell damage is immune mediated and other clinical features occur related to other autoimmune processes. Although typically considered to have a short prodrome, in research studies biochemical evidence of impaired glucose metabolism has been detected years before diagnosis, in the form of mild elevation of blood glucose. It is likely that the clinical symptoms only manifest when 90% or more of the β‎ cells are lost. The effects of insulin deficiency are enhanced at times of insulin resistance, which explains the apparent link between clinical onset of type 1 diabetes and acute stress, such as an intercurrent infection or other illness, or physiological changes in insulin resistance, such as during puberty. The rate of β‎ cell loss is highly variable. It is probable that type 1 diabetes presenting in prepubertal childhood may reflect a more aggressive destructive process, while, at the other extreme, type 1 diabetes may present in adult life with a slow evolution to an absolute need for insulin replacement. The latter is called ‘latent adult onset diabetes’ (LADA), and confounds the clinical definition of type 1 diabetes—often used in recruiting type 1 patients to trials—of requirement for insulin replacement within a year of diagnosis. The diagnosis of type 1A diabetes, i.e. type 1 diabetes of proven autoimmune pathogenesis, may be made by finding evidence of the autoimmune process against β‎ cell antigens, with the presence of anti-islet cell antibodies—or, more accurately, anti-glutamic acid decarboxy Continue reading >>

Introduction To Diabetes

Introduction To Diabetes

Diabetes is a chronic state of hyperglycaemia caused by a lack of or diminished effectiveness of endogenous insulin. Over time it can cause specific tissue damage, particularly to the retina, kidney, nerves and arteries. The term diabetes mellitus literally means ‘passage of a large amount of sweet urine’ In the past the definitions IDDDM and NIDDDM were used for type 1 and type 2 diabetes respectively. However, this is not necessarily true in descriptive terms, as not all type 1 sufferers require insulin, and not all type 2 sufferers do not require insulin (many in the later stages of the disease do). More than 90% of diabetic patients have type 2 diabetes. Less than 10% have type 1. Diabetes affects 2% of the British population, i.e. over 1 million people, and takes up 5-10% of the health budget. The prevalence is increasing rapidly in Western World More than 90% of diabetic patients have type 2 diabetes; less than 10% have type 1. Pancreatectomy – in cases where greater than 90% of the pancreas has been removed Drug induced – steroids and thiazides Others – e.g. congential condition that may cause insulin receptor antibodies, glycogen storage diseases Clinical presentation Acute presentation – typically in those with type 1 diabetes, but not always Polyuria Thirst Weight loss Ketonuria which may progress to ketoacidosis Subacute presentation – in type 2 diabetes, same as above but also with the following: Lack of energy Blurred vision Such cases may also present with complications such as… Fasting glucose > 7 mmol/L and a glucose tolerance test OR random glucose > 11mmol/L (usually on 2 separate occasions) Type 1 diabetes: Insulin and dietary modification Type 2 diabetes: Lifestyle modification (>>+ metformin >>+ further drugs>> + insulin) Weight – Continue reading >>

Pathophysiology And Clinical Presentation

Pathophysiology And Clinical Presentation

Pathophysiology: Type 1 Diabetes Mellitus is a syndrome characterized by hyperglycemia and insulin deficiency resulting from the loss of beta cells in pancreatic islets (Mapes & Faulds, 2014). Nonimmune (type 1B diabetes), occurs secondary to other diseases and is much less common than autoimmune (type 1A). The destruction of beta cells in Type 1A diabetes results from the interaction of both genetic and environmental factors. Although the genetic susceptibility is not well understood, type 1 diabetes is most strongly associated with major histocompatibility complex (MHC), specifically histocompatibility leukocyte antigen (HLA) class II alleles (HLA-DQ and HLA-DR) (McCance & Heuther, 2014). Type 1 diabetes is less hereditary than type 2 but 7-13% of patients also have a first degree relative with type 1 diabetes (Mapes & Faulds, 2014). Environmental factors include viral infections (especially enteroviruses), exposure to infectious microorganisms (such as Helicobacter pylori), exposure to cow’s milk proteins and a lack of vitamin D (McCance & Heuther, 2014). The destruction of insulin-producing beta cells in the pancreas starts with the formation of autoantigens. These autoantigens are ingested by antigen-presenting cells which activate T helper 1 (Th1) and T helper 2 (Th2) lmphocytes. Activated Th1 lymphocytes secrete interluekin-2 (IL-2) and interferon. IL-2 activates autoantigen-specific T cytotoxic lymphocytes which destroy islet cells through the secretion of toxic perforins and granzymes. Interferon activates macrophages and stimulates the release of inflammatory cytokines (including IL-1 and tumor necrosis factor [TNF]) which further destroy beta cells (McCance & Heuther, 2014). Activated Th2 lymphocytes produce IL-4 which stimulates B lymphocytes to proliferat Continue reading >>

Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults

Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults

INTRODUCTION The term diabetes mellitus describes several diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia. It is associated with a relative or absolute impairment in insulin secretion, along with varying degrees of peripheral resistance to the action of insulin. Every few years, the diabetes community reevaluates the current recommendations for the classification, diagnosis, and screening of diabetes, reflecting new information from research and clinical practice. The American Diabetes Association (ADA) issued diagnostic criteria for diabetes mellitus in 1997, with follow-up in 2003 and 2010 [1-3]. The diagnosis is based on one of four abnormalities: glycated hemoglobin (A1C), fasting plasma glucose (FPG), random elevated glucose with symptoms, or abnormal oral glucose tolerance test (OGTT) (table 1). Patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are referred to as having increased risk for diabetes or prediabetes. (See 'Diagnostic criteria' below.) Screening for and prevention of diabetes is reviewed elsewhere. The etiologic classification of diabetes mellitus is also discussed separately. (See "Screening for type 2 diabetes mellitus" and "Prevention of type 2 diabetes mellitus" and "Prevention of type 1 diabetes mellitus" and "Classification of diabetes mellitus and genetic diabetic syndromes".) CLINICAL PRESENTATION Type 2 diabetes is by far the most common type of diabetes in adults (>90 percent) and is characterized by hyperglycemia and variable degrees of insulin deficiency and resistance. The majority of patients are asymptomatic, and hyperglycemia is noted on routine laboratory evaluation, prompting further testing. The frequency of symptomatic diabetes has been decreasing in parallel wi Continue reading >>

Diabetes Mellitus Signs And Symptoms

Diabetes Mellitus Signs And Symptoms

There are three main types of diabetes: Type 1 Diabetes: About 5 to 10 percent of those with diabetes have type 1 diabetes. It's an autoimmune disease, meaning the body's own immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Patients with type 1 diabetes have very little or no insulin, and must take insulin everyday. Although the condition can appear at any age, typically it's diagnosed in children and young adults, which is why it was previously called juvenile diabetes. Type 2 Diabetes: Accounting for 90 to 95 percent of those with diabetes, type 2 is the most common form. Usually, it's diagnosed in adults over age 40 and 80 percent of those with type 2 diabetes are overweight. Because of the increase in obesity, type 2 diabetes is being diagnosed at younger ages, including in children. Initially in type 2 diabetes, insulin is produced, but the insulin doesn't function properly, leading to a condition called insulin resistance. Eventually, most people with type 2 diabetes suffer from decreased insulin production. Gestational Diabetes: Gestational diabetes develops during pregnancy. It occurs more often in African Americans, Native Americans, Latinos and people with a family history of diabetes. Typically, it disappears after delivery, although the condition is associated with an increased risk of developing diabetes later in life. If you think that you have diabetes, visit your doctor immediately for a definite diagnosis. Common symptoms include the following: Frequent urination Excessive thirst Unexplained weight loss Extreme hunger Sudden vision changes Tingling or numbness in the hands or feet Feeling very tired much of the time Very dry skin Sores that are slow to heal More infections than usual Some people may experience o Continue reading >>

Type 2 Diabetes Mellitusclinical Presentation

Type 2 Diabetes Mellitusclinical Presentation

Type 2 Diabetes MellitusClinical Presentation Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... The diagnosis of diabetes mellitus is readily entertained when a patient presents with classic symptoms (ie, polyuria, polydipsia, polyphagia, weight loss). Other symptoms that may suggest hyperglycemia include blurred vision, lower extremity paresthesias, or yeast infections, particularly balanitis in men. However, many patients with type 2 diabetes are asymptomatic, and their disease remains undiagnosed for many years. In older studies, the typical patient with type 2 diabetes had diabetes for at least 4-7 years at the time of diagnosis. [ 98 ] Among patients with type 2 diabetes in the United Kingdom Prospective Diabetes Study, 25% had retinopathy; 9%, neuropathy; and 8%, nephropathy at the time of diagnosis. (For more information, see Diabetic Neuropathy .) In patients with known type 2 diabetes, inquire about the duration of the patient's diabetes and about the care the patient is currently receiving for the disease. The duration of diabetes is significant because the chronic complications of diabetes are related to the length of time the patient has had the disease. A focused diabetes history should also include the following questions: Is the patient's diabetes generally well controlled (with near-normal blood glucose levels) - Patients with poorly controlled blood glucose levels heal more slowly and are at increased risk for infection and other complications Does the patient have severe hypoglycemic reactions - If the patient has episodes of severe hypoglycemia and therefore is at risk of losing consciousness, this possibility must be addressed, especially if the patient drives or has significant underlying neuropathy or cardiovascul Continue reading >>

Type 2 Diabetes Mellitus: Etiology, Pathogenesis And Clinical Manifestations

Type 2 Diabetes Mellitus: Etiology, Pathogenesis And Clinical Manifestations

Type 2 Diabetes Mellitus: Etiology, Pathogenesis and Clinical Manifestations Type 2 diabetes mellitus affects about 3% of the population or 100 million people worldwide. The prevalence is higher in Europe and the USA, affecting 57% of the population and is increasing. Many cases (30% or more) are undiagnosed. Although common, its pathogenesis remains unclear. There are many reasons for this. Perhaps the most important is the heterogeneity of type 2 diabetes due in part to a variable interplay between genetic and environmental factors. Although the diagnosis rests on documentation of hyperglycemia it is important to appreciate that other metabolic abnormalities, for example disturbances of lipid metabolism, are also present and may precede the emergence of hyperglycemia (see Chapter VI.11). As depicted in Figure 1, overt hyperglycemia and the syndrome of type 2 diabetes is due to a variable combination of insulin resistance affecting the liver and peripheral insulin target tissues and of impaired insulin secretion. Since insulin resistance and abnormalities of insulin secretion may be associated with other pathologies, for example liver disease, renal disease, glucocorticoid, growth hormone or thyroid hormone excess, diabetes may be secondary to these conditions (see Chapter V.5). Insulin ResistanceInsulin SecretionInsulin ReceptorPostprandial HyperglycemiaImpaired Insulin Secretion These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access. Unable to display preview. Download preview PDF. Froguel P, Velho G. Genetic determinants of type 2 diabetes. Recent Prog Horm Res 56: 91105, 2001. PubMed CrossRef Googl Continue reading >>

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss.[3] Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[4][5] Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).[3] Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly.[1] Treatment involves exercise and dietary changes.[1] If blood sugar levels are not adequately lowered, the medication metformin is typically recommended.[7][14] Many people may eventually also require insulin injections.[9] In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills.[15] Bariatri Continue reading >>

Clinical Presentation Of Type 2 Diabetes Mellitus

Clinical Presentation Of Type 2 Diabetes Mellitus

Clinical Presentation of Type 2 Diabetes Mellitus Clinical Presentation of Type 2 Diabetes Mellitus The risk factors for the development of both prediabetes and type 2 diabetes mellitus (T2DM) are as follows:1 Being overweight or obese (BMI >25 kg/m2) Nonwhite ancestry (Asian, African American, Hispanic, Native American, or Pacific Islander) Increased levels of triglycerides (>250 mg/dL), low concentrations of high-density lipoprotein cholesterol (HDL-C Previously identified impaired glucose tolerance, impaired fasting glucose, and/or metabolic syndrome Polycystic ovary syndrome (PCOS), acanthosis nigricans, or nonalcoholic fatty liver disease (NAFLD) Delivery of a baby weighing more than 4 kg (9 lbs) Antipsychotic therapy for schizophrenia and/or severe bipolar disease Antipsychotic therapy for schizophrenia and/or severe bipolar disease Sleep disorders in the presence of glucose intolerance (A1C >5.7%, IGT, or IFG on previous testing), including OSA, chronic sleep deprivation, and night-shift occupation The American Diabetes Association (ADA) recommendations are similar: they suggest screening obese adults (aged 18 years) who have one or more diabetes risk factors, as well as screening everyone aged 45 years at least every 3 years. Negative screening tests should be repeated every 3 years, according to the ADA.2 Type 2 diabetes is typically identified in persons older than 30 years who are overweight or obese and/or have a positive family history but do not have autoantibodies characteristic of type 1 diabetes (T1D) . Most people with T2D have evidence of insulin resistance (such as high triglycerides or low HDL-C).1 T2D likely develops as a result of polygenic defects that predispose affected individuals to the disease. Environmental factors such as a sedentary life Continue reading >>

Clinical Presentation Of Type 2 Diabetes Mellitus In Children And Adolescents

Clinical Presentation Of Type 2 Diabetes Mellitus In Children And Adolescents

International Journal of Obesity volume 29, pages S105S110 (2005) | Download Citation Recent reports indicate an increasing prevalence of type 2 diabetes mellitus (TD2M) in children and adolescents around the world in all ethnicities, possibly due to increasing prevalence of obesity. Therefore, it is essential that clinicians are aware of the clinical features of T2DM in these age groups. All published cases of T2DM in children and adolescents were evaluated and the different clinical presentations of T2DM in minorities and Caucasian described. Manifestation of T2DM is usually at mid-to-late puberty with few symptoms such as mild-polyuria or polydipsia. Most of the children and adolescents are extremely obese. The great majority of children and adolescents with T2DM have relatives with T2DM, and show other clinical features of the insulin resistance syndrome such as hypertension, dyslipidemia, polycystic ovarian syndrome (PCOS) or acanthosis nigricans. One-third of the minority children with T2DM and the majority of the Caucasian children with T2DM were detected by screening in the absence of symptoms. It is becoming increasingly clear that overweight children above the age of 10 y with (1) clinical signs of insulin resistance (acanthosis nigricans, dyslipidemia, hypertension, PCOS), or (2) relatives with T2DM, or (3) of particular ethnic populations (Asian, Indians, Africa-Americans, Hispanics), or (4) extremely obese children should be screened for T2DM. Type 2 diabetes mellitus (T2DM) is a serious and costly disease associated with excess morbidity and mortality. It is a complex metabolic disorder of heterogeneous etiology with social, behavioral, and environmental risk factors unmasking the effects of genetic susceptibility. T2DM develops, when insulin resistance i Continue reading >>

Clinical Presentation And Treatment Of Type 2 Diabetes In Children.

Clinical Presentation And Treatment Of Type 2 Diabetes In Children.

1. Pediatr Diabetes. 2007 Dec;8 Suppl 9:16-27. doi:10.1111/j.1399-5448.2007.00330.x. Clinical presentation and treatment of type 2 diabetes in children. (1)Pediatric Endocrinology and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. Type 2 diabetes mellitus (T2DM) has dramatically increased throughout the worldin many ethnic groups and among people with diverse social and economicbackgrounds. This increase has also affected the young such that over the pastdecade, the increase in the number of children and youth with T2DM has beenlabeled an 'epidemic'. Before the 1990s, it was rare for most pediatric centersto have significant numbers of patients with T2DM. However, by 1994, T2DMpatients represented up to 16% of new cases of diabetes in children in urbanareas and by 1999, depending on geographic location, the range of percentage ofnew cases because of T2DM was 8-45% and disproportionately represented amongminority populations. Although the diagnosis was initially regarded withskepticism, T2DM is now a serious diagnostic consideration in all young peoplewho present with signs and symptoms of diabetes in the USA. Continue reading >>

Articles Ontype 2 Diabetes

Articles Ontype 2 Diabetes

Diabetes is a life-long disease that affects the way your body handles glucose, a kind of sugar, in your blood. Most people with the condition have type 2. There are about 27 million people in the U.S. with it. Another 86 million have prediabetes: Their blood glucose is not normal, but not high enough to be diabetes yet. Your pancreas makes a hormone called insulin. It's what lets your cells turn glucose from the food you eat into energy. People with type 2 diabetes make insulin, but their cells don't use it as well as they should. Doctors call this insulin resistance. At first, the pancreas makes more insulin to try to get glucose into the cells. But eventually it can't keep up, and the sugar builds up in your blood instead. Usually a combination of things cause type 2 diabetes, including: Genes. Scientists have found different bits of DNA that affect how your body makes insulin. Extra weight. Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around the middle. Now type 2 diabetes affects kids and teens as well as adults, mainly because of childhood obesity. Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides. Too much glucose from your liver. When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and usually the liver will slow down and store its glucose for later. But some people's livers don't. They keep cranking out sugar. Bad communication between cells. Sometimes cells send the wrong signals or don't pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reac Continue reading >>

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