Type 2 Diabetes Progression To Insulin

Diabetes Mellitus Type 2

What is Diabetes Mellitus Type 2? Type 2 Diabetes Mellitus is a condition in which the body fails to metabolise glucose (sugar) correctly. This causes levels of sugar in the blood to increase, a state known as hyperglycaemia. When a person does not have diabetes, a gland called the pancreas produces and secretes a hormone called insulin. The hormone is used by the body’s tissues to metabolise glucose. Usually the amount of insulin secreted increases in relation to the amount of carbohydrate (sugar) a person consumes. In people with type 2 diabetes, insulin secretion from the pancreas often decreases. This is referred to as reduced insulin secretion. In addition the body tissues do not respond adequately to the insulin which is produced. Normally the insulin would be used by the body to draw glucose into the cells, where it could be stored as energy which could be used by the body later (e.g. when exercising or any of the other activities which involve energy expenditure). In type 2 diabetes, the glucose is not taken into the cells. This is referred to as insulin resistance. It causes glucose to stay in the blood stream and hyperglycaemia is the result. Type 2 diabetes mellitus was previously called non-insulin dependent diabetes mellitus (NIDDM) and late onset diabetes mellitus. These names are no longer used because they are inaccurate. Insulin is often used in the management of type 2 diabetes. The condition is increasingly diagnosed in young people. Statistics Almost one in 20 Australians, or one million people, were diagnosed with type 2 diabetes mellitus in 2008. The actual proportion of Australians with the condition may be higher as many people are not diagnosed until they develop complications, for example diabetic retinopathy. Of those who have been diagnosed Continue reading >>

Diabetes And Kidney Disease (stages 1-4)

What is diabetes? Diabetes happens when your body does not make enough insulin or cannot use insulin properly. Insulin is a hormone. It controls how much sugar is in your blood. A high level of sugar in your blood can cause problems in many parts of your body, including your heart, kidneys, eyes, and brain. Over time, this can lead to kidney disease and kidney failure. There are two main types of diabetes. Type 1 diabetes generally begins when people are young. In this case, the body does not make enough insulin. Type 2 diabetes is usually found in adults over 40, but is becoming more common in younger people. It is usually associated with being overweight and tends to run in families. In type 2 diabetes, the body makes insulin, but cannot use it well. What is chronic kidney disease (CKD)? Your kidneys are important because they keep the rest of your body in balance. They: Remove waste products from the body Balance the body’s fluids Help keep blood pressure under control Keep bones healthy Help make red blood cells. When you have kidney disease, it means that the kidneys have been damaged. Kidneys can get damaged from a disease like diabetes. Once your kidneys are damaged, they cannot filter your blood nor do other jobs as well as they should. When diabetes is not well controlled, the sugar level in your blood goes up. This is called hyperglycemia. Hyperglycemia (high blood sugar) can cause damage to many parts of your body, especially the kidneys, heart, blood vessels, eyes, feet, nerves. Diabetes can harm the kidneys by causing damage to: Blood vessels inside your kidneys. The filtering units of the kidney are filled with tiny blood vessels. Over time, high sugar levels in the blood can cause these vessels to become narrow and clogged. Without enough blood, the kid Continue reading >>

Type 2 Diabetes

Whether you have type 2 diabetes, are a caregiver or loved one of a person with type 2 diabetes, or just want to learn more, the following page provides an overview of type 2 diabetes. New to type 2 diabetes? Check out “Starting Point: Type 2 Diabetes Basics” below, which answers some of the basic questions about type 2 diabetes: what is type 2 diabetes, what are its symptoms, how is it treated, and many more! Want to learn a bit more? See our “Helpful Links” page below, which provides links to diaTribe articles focused on type 2 diabetes. These pages provide helpful tips for living with type 2 diabetes, drug and device overviews, information about diabetes complications, nutrition and food resources, and some extra pages we hope you’ll find useful! Starting Point: Type 2 Diabetes Basics Who is at risk of developing type 2 diabetes? What is the risk of developing type 2 diabetes if it runs in the family? What is type 2 diabetes and prediabetes? Behind type 2 diabetes is a disease where the body’s cells have trouble responding to insulin – this is called insulin resistance. Insulin is a hormone needed to store the energy found in food into the body’s cells. In prediabetes, insulin resistance starts growing and the beta cells in the pancreas that release insulin will try to make even more insulin to make up for the body’s insensitivity. This can go on for a long time without any symptoms. Over time, though, the beta cells in the pancreas will fatigue and will no longer be able to produce enough insulin – this is called “beta burnout.” Once there is not enough insulin, blood sugars will start to rise above normal. Prediabetes causes people to have higher-than-normal blood sugars (and an increased risk for heart disease and stroke). Left unnoticed or Continue reading >>

Diabetes Mellitus

Diabetes mellitus (DM) describes a group a metabolic diseases that are characterized by chronic hyperglycemia (elevated blood glucose levels). The two most common forms are type 1 and type 2 diabetes mellitus. Type 1 is the result of an autoimmune response that triggers the destruction of insulin-producing β cells in the pancreas and results in an absolute insulin deficiency. Type 2, which is much more common, has a strong genetic component as well as a significant association with obesity and sedentary lifestyles. Type 2 diabetes is characterized by insulin resistance (insufficient response of peripheral cells to insulin) and pancreatic β cell dysfunction (impaired insulin secretion), resulting in relative insulin deficiency. This form of diabetes usually remains clinically inapparent for many years. However, abnormal metabolism (prediabetic state or impaired glucose intolerance), which is associated with chronic hyperglycemia, causes microvascular and macrovascular changes that eventually result in cardiovascular, renal, retinal, and neurological complications. In addition, type 2 diabetic patients often present with other conditions (e.g. hypertension, dyslipidemia, obesity) that increase the risk of cardiovascular disease (e.g., myocardial infarction). Renal insufficiency is primarily responsible for the reduced life expectancy of patients with DM. Due to the chronic, progressive nature of type 1 and type 2 diabetes mellitus, a comprehensive treatment approach is necessary. The primary treatment goals for type 2 diabetes are the normalization of glucose metabolism and the management of risk factors (e.g., arterial hypertension). In theory, weight normalization, physical activity, and a balanced diet should be sufficient to prevent the manifestation of diabetes in Continue reading >>

Cocoa Compound Could 'delay Or Prevent' Type 2 Diabetes

Cocoa compound could 'delay or prevent' type 2 diabetes Cocoa powder antioxidants may help slow diabetes' progression. With diabetes reaching epidemic proportions, the search is on for innovative ways to reduce the burden. Breaking research finds hope in the most surprising of places- chocolate. Today, there are an estimated 29 million Americans living with diabetes , with the vast majority of cases beingtype 2 diabetes. Globally, by 2035, there could be 592 million people with diabetes. This is no small problem. Beyond those Americans who already have a diabetes diagnosis, a further 86 million adults - more than 1 in 3 Americans - have prediabetes, a precursor to the disease. Without intervention (diet and exercise), diabetes is likely to be the next step for these individuals, often within 5 years. Diabetes is costly in human terms, of course, but it is also a huge financial drain; in 2012, diabetes and itscomplications accounted for $245 billion in total medical costs and lost work and wages, up from $174 billion just 5 years earlier.The statistics are overwhelming. Although type 2 diabetes is largely preventablethrough lifestyle choices, at this point in time, more needs to be done to stemthe flow and turn the tide. Finding potential medical interventions for people at risk of developing type 2 diabetes is more pressing than ever. Research, recently published in The Journal of Nutritional Biochemistry , investigates whether a compound found in cocoa could be useful in the fight. At the root of diabetes is the hormone insulin , which is produced, stored, and released by beta cells in the pancreas. Insulin is responsiblefor controlling and regulating levels of sugar in the blood; it ensures that blood sugar levels never gets so high that theydamage blood vessels and Continue reading >>

Type 2 Diabetes Faqs

Common questions about type 2 diabetes: How do you treat type 2 diabetes? When you have type 2 diabetes, you first need to eat a healthy diet, stay physically active and lose any extra weight. If these lifestyle changes cannot control your blood sugar, you also may need to take pills and other injected medication, including insulin. Eating a healthy diet, being physically active, and losing any extra weight is the first line of therapy. “Diet and exercise“ is the foundation of all diabetes management because it makes your body’s cells respond better to insulin (in other words, it decreases insulin resistance) and lowers blood sugar levels. If you cannot normalize or control the blood sugars with diet, weight loss and exercise, the next treatment phase is taking medicine either orally or by injection. Diabetes pills work in different ways – some lower insulin resistance, others slow the digestion of food or increase insulin levels in the blood stream. The non-insulin injected medications for type 2 diabetes have a complicated action but basically lower blood glucose after eating. Insulin therapy simply increases insulin in the circulation. Don’t be surprised if you have to use multiple medications to control the blood sugar. Multiple medications, also known as combination therapy is common in the treatment of diabetes! If one medication is not enough, you medical provider may give you two or three or more different types of pills. Insulin or other injected medications also may be prescribed. Or, depending on your medical condition, you may be treated only with insulin or injected medication therapy. Many people with type 2 diabetes have elevated blood fats (high triglycerides and cholesterol) and blood pressure, so you may be given medications for these problem Continue reading >>

Insulin Initiation In Type 2 Diabetes – Why, When And How?

Type 2 diabetes is a progressive disease and, despite recent progress in the treatment of diabetes, the glycemic control usually deteriorates gradually and insulin therapy is needed. When insulin therapy should be started and which are the appropriate insulin therapy strategies, still represent subjects of debates. Insulin represents a therapeutic option in type 2 diabetes due to the existence of early β-cell dysfunction and significant reduction of β-cell mass in natural history of type 2 diabetes. The current guidelines recommend insulin in double therapy in association with metformin or in combination with metformin and other noninsulin agent. Initiation of insulin therapy is recommended in patients with newly diagnosed type 2 diabetes and symptomatic and/or presenting important hyperglycemia or elevated HbA1c. Initiation of insulin therapy in type 2 diabetes should take into consideration the pathophysiology of type 2 diabetes, the effects and the potential risks of insulin therapy, the guidelines recommendations and the barriers to insulin use. Literatures of only English language were analyzed from NCBI database. Guidelines were accessed electronically from organisations, i.e. American Diabetes Associations, American Association of Clinical Endocrinologists and American College of Endocrinology, European Association for the Study of Diabetes, International Diabetes Federation. Continue reading >>

Is Retinopathy & Progression To Insulin Inevitable For Type 2 Diabetics?

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Is retinopathy & progression to Insulin inevitable for Type 2 diabetics? I receive the "Type 2 and you" newsletter from The Independent Diabetes Trust. Today, the September, issue 24, landed on my doormat. Having just read it, I am distressed & disturbed by what has been written. And I quote: "On average, people with Type 2 diabetes will need to start taking insulin seven years after diagnosis." I had NO idea that this is my future with this damn disease. It's frightening. The article on Diabetic Retinopathy States "After 20 years of Diabetes, nearly all patients with Type 1 diabetes and >60% of patients with Type 2 diabetes will have some degree of retinopathy." Again, this frightens & saddens me. Of course, I know about diabetic complications. I made it my business to educate & inform myself, via this forum and other resources, when I was diagnosed earlier this year. Am I really so naive not to be aware of this prognosis. I'm angry! Rightly or wrongly so. The Independent Diabetes Trust is a competent, trustworthy & reliable organisation with a good reputation, who educate and support those with this disease. I've no reason not to believe their statistics. I'm gutted to be honest. All advice, views, personal experience & opinions will be gratefully received. Oh, and here's a link to the newsletter. Dunno about you, but I don't consider myself "average", and I have no intention of willingly becoming one of their averages. I receive the "Type 2 and you" newsletter from The Independent Diabetes Trust. Today, the September, issue 24, landed on my doormat. Having just read it, I am distressed & disturbed by what has been written. And I quote: "On average, Continue reading >>

Defining And Characterizing The Progression Of Type 2 Diabetes

Type 2 diabetes is a progressive disease in which the risks of myocardial infarction, stroke, microvascular events, and mortality are all strongly associated with hyperglycemia (1). The disease course is primarily characterized by a decline in β-cell function and worsening of insulin resistance. The process is manifested clinically by deteriorations in multiple parameters, including A1C, fasting plasma glucose (FPG), and postprandial glucose levels. In this review, we will evaluate our current understanding of the role played by deteriorating β-cell function and other abnormalities linked with the progression of type 2 diabetes. An improved understanding of these abnormalities may provide the scientific groundwork for novel therapies that may help achieve and maintain good glycemic control. CHARACTERISTICS OF DISEASE PROGRESSION Progression from pre-diabetes to overt diabetes Because glucose is a continuous variable, the use of thresholds to make a diagnosis is somewhat arbitrary. The term “pre-diabetes” has become well established and implies a risk of progression to overt diabetes. However, although such progression is well studied in prevention trials, little is known about the rate of progression and the characteristics of such progression in the population at large. Table 1 summarizes some of the factors associated with such progression. Nichols et al. (2) studied the progression of pre-diabetes to overt disease and observed that 8.1% of subjects whose initial abnormal fasting glucose was 100–109 mg/dl and 24.3% of subjects whose initial abnormal fasting glucose was 110–125 mg/dl developed diabetes over an average of 29.0 months (1.34 and 5.56% per year, respectively). A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycer Continue reading >>

Progression Of Type 2 Diabetes And Insulin Initiation.

1. J Natl Med Assoc. 2011 Mar;103(3):241-6. Progression of type 2 diabetes and insulin initiation. (1)Beth Israel Deaconess Medical Center-West Campus, 110 Francis St, Ste 2F, Boston, MA 02215, USA. [email protected] The prevalence of type 2 diabetes is significantly greater among AfricanAmericans compared to some other ethnic groups. The reasons for this increasedincidence are due at least in part to the increased frequency of obesity,especially among African American women. The onset of hyperglycemia, after manyyears of insulin resistance, is due to beta cell dysfunction that slowlyprogresses to beta cell failure, necessitating insulin replacement. The timelyinitiation of insulin therapy is a critical clinical decision for treatingphysicians managing patients, especially when the patient is hesitant to begininsulin therapy. The availability of various insulin formulations gives theopportunity to tailor insulin therapy based on a patient's personal insulinrequirements and lifestyle. Specific issues related to insulin therapy such aspatient preferences, quality of life, barriers to the addition of insulin to the treatment regimen, and the effectiveness of insulin therapy are illustrated usinga case study. Continue reading >>

Retinopathy Progression And Sudden Lowering Of Hba1c , Etc

Generally retinopathy progresses according to the parameters below. There are very few exceptions. Once background retinopathy develops, unless diabetic control is improved as below, the retinopathy will deteriorate, laser will be needed, and even with laser sight may be affected. glucose level/HbA1c, linear relationship with retinopathy progression blood pressure, linear relationship lipid level, probably a near linear relationship smoking, probable linear relationship (some work suggests 20 cigarettes a day triples/quadruples retinopathy, others less so) pregnancy may cause a rapid deterioration sudden improvement (lowering to normal) of glucose levels in a person whose diabetes has been poorly controlled for sometime see and here . Certain clinical situations are recognised: Some people never seem to develop retinopathy: a suggestion has been made that these patients have ultra-low blood pressures, and this is what protects them. There are genes controlling retinopathy progression, and these may act through blood pressure effects. Retinopathy may run in families; there is certainly a genetic contribution All of a sudden a patient's retinopathy may start to get much worse: this may be because of a relatively sudden rise in blood pressure, which is quite common. Sometimes this seems to occur as renal function decreases. Some people's retinopathy never seems to get worse. I am not convinced this situation exists, but if it does it could be explained: a person whose diabetes was reasonably, but not well, controlled, perhaps an HbA1c of 8% with a low blood pressure, develops retinopathy, but then starts to control their diabetes and blood pressure really well, achieving an HbA1c of 7%, then the retinopathy does not progress. When a patient with poorly controlled type 2 di Continue reading >>

Symptoms At Diagnosis May Predict Progression Of Type 2 Diabetes

Researchers followed patients who were newly diagnosed with type 2 diabetes for 18 months to classify their disease progression based on 20 baseline symptoms. With Caroline A. Brorsson, PhD, and Michael Gonzalez-Campoy, MD, PhD Three major subgroups of newly diagnosed patients with type 2 diabetes (T2D) experienced different rates of disease progression over 18 months,1 according to data presented at the 53rd annual meeting of the European Association for the Study of Diabetes in Lisbon, Portugal. The research was part of the Diabetes Research on Patient Stratification project (DIRECT) within the European Union Framework 7 Innovative Medicines Initiative. Patients with type 2 diabetes are likely to present with varying degrees of insulin resistance and beta cell failure.1 Understanding the heterogeneity of a T2D presentation may lead to more effective treatment strategies for these patients. An underlying difference in pathophysiology may be indicative of a patient’s responsiveness to a prescribed treatment and have an anticipated effect on disease progression.1 Evaluating Differences in Diabetes Progression Caroline Brorsson, PhD, a postdoctoral researcher at the Technical University of Denmark and colleagues used the detailed clinical phenotyping from the Diabetes Remission Clinical Trial (DIRECT) to identify and cluster subgroups of patients who were newly diagnosed with T2D.1,2 In the DIRECT study, detailed metabolic data were collected on patients newly diagnosed with either prediabetes or type 2 diabetes.2 “Using a very detailed clinical phenotyping methodology, we wanted to systematically capture disease heterogeneity in newly diagnosed diabetes patients using a data-driven approach to be able to investigate the effect of different patient subgroups on diseas Continue reading >>

Type 2 Diabetes Mellitus In Childhood: Obesity And Insulin Resistance

As rates of childhood obesity climb, type 2 diabetes mellitus has increasingly been diagnosed in children and adolescents, with the highest incidence occurring among youth from racial and ethnic minority backgrounds. The serious complications associated with type 2 diabetes mellitus make it essential for physicians to be aware of risk factors and screening guidelines, allowing for earlier patient diagnosis and treatment. It is also important for physicians to be aware of the treatment options available, including weight control through diet and exercise as well as common pharmacotherapeutic options. According to the SEARCH for Diabetes in Youth Study Group,8 incidence rates among American Indians aged 15 to 19 years is 49.4%, compared to 5.6% in non-Hispanic whites of the same age group. Among youth in the United States, Pima Indian adolescents have the highest reported prevalence of type 2 diabetes mellitus. For Pima Indian children aged 5 to 9 years, the incidence rate is less than 0.5%; for children and adolescents aged 10 to 14 years, 1.5% to 3%; and for adolescents and young adults aged 15 to 19 years, 4% to 5%.7 Neel9 postulated that, when humans were hunter-gatherers and did not know when the next meal was expected, some individuals developed “thrifty genes.” These genes caused the body to become insulin resistant by interfering with mechanisms that allowed blood glucose to be transported into cells where it would be phosphorylated and used for energy. Consequently, the pancreas had to make more insulin. The excess insulin allowed cells to store fat for use during times of relative famine, leading to a much higher survival rate.9-11 These genes may include uncoupling proteins, PPAR-γ and PPAR-α, CALPAIN 10, and adrenergic receptor polymorphisms.12-14 Athero Continue reading >>

Diabetes Update: The Untold Story Of Disease Progression

CE credit is no longer available for this article. Originally posted March 2001 Pick up the paper. Turn on the radio. Diabetes is rapidly becoming a national epidemic. An estimated 18 million Americans have diabetes—and that number is growing, particularly among children. Certain ethnic groups, such as African-Americans, Hispanics, and Native Americans, have the highest incidence. Among those groups, one in four over the age of 45 will most likely develop diabetes. The Centers for Disease Control and Prevention (CDC) reports that between 1990 and 1998, the incidence of diabetes rose by 70% among people ages 30 - 39; by 40% among those 40 - 49; and by 31% among those 50 - 59. What may be even more disturbing is the percentage of people who don't even know that they have diabetes: About 33% of the population with Type 1 diabetes and up to 55% of people with Type 2 go undiagnosed. Many patients are hyperglycemic for up to six years before finding out they have diabetes. The toll diabetes takes is staggering. It is the leading cause of new cases of adult blindness, end-stage renal disease, and nontraumatic lower extremity amputations. And patients with diabetes have an incidence of cardiovascular morbidity and mortality four times that of non-diabetics. In fact, 65% of patients with Type 2 diabetes will die of a cardiovascular complication. The cost is enormous: $138 billion annually. The average per capita medical expenditure is $10,000 per diabetic patient, vs. $2,700 for the non-diabetic individual. The good news is that complications of diabetes can be limited and its progression slowed with strict control of blood sugar and new treatment protocols. New drugs provide more therapeutic options. Insulin sensitizers, insulin secretagogues, medications that alter the diges Continue reading >>

Double Diabetes: Dealing With Insulin Resistance In Type 1 Diabetes

Recently, Glu published a Call to Action to the Centers for Disease Control and Prevention (CDC), in response to their recent report highlighting a significant reduction in newly diagnosed cases of diabetes. Although it appeared to represent significant progress in reducing the global obesity epidemic, the report was soon regarded as problematic, largely due to the lack of distinction between type 1 diabetes (T1D) and type 2 diabetes (T2D) within their data set. Many from the diabetes community weighed in on the importance of separating T1D and T2D in media reports—highlighting differences in origin, treatment, and challenges. Most of us would agree that this dialogue was long overdue. After all, T1D and T2D are two separate diseases—right? Well, that’s where things get complicated. While there remains a great deal of confusion around the differences between T1D and T2D, there is a unique set of individuals dealing with a third option—a condition known as double diabetes. What Is Double Diabetes? The term “double diabetes” was first introduced in 1991, when a research study1 showed that participants with T1D who had a family history of T2D were more likely to be overweight and have difficulty achieving optimal glycemic control. Since this study was published, researchers have conducted numerous epidemiological studies on this topic. As the name suggests, double diabetes is a condition characterized by features of both T1D and T2D2. It can exist in many forms, such as a person living with T1D who develops insulin resistance or a person with T2D who has autoantibodies to their pancreatic β-cells. Given the interests of the Glu community, we will focus on the first example, in which a person with T1D has insulin resistance. How Common Is Double Diabetes? The p Continue reading >>