Type II Diabetes Mellitus by Lacey Stewart

According to the Center for Disease Control and Prevention 2010 fact sheet, 8.3 % of Americans have diabetes, and an alarming 1.9 million were diagnosed in 2010 alone. Close to 18.8 million people have been diagnosed and 7 million have gone undiagnosed in the United States (“U.S. Department” 2011). The prevalence of the disease is rising at an alarming rate due to many factors such as an increase of obesity in children and adults. People are also living longer with diabetes due to better management of the disease and new tests to detect diabetes (“U.S. Department” 2011). Diabetes has now become the seventh leading cause of death, costing Americans $174 billion a year (“U.S. Department” 2011). It has become an expensive epidemic that can be drastically reduced by taking simple precautions.


Diabetes occurs when the body is no longer able to absorb the amount of glucose in the bloodstream due to lack of insulin or due to the body becoming resistant to insulin. The normal range of insulin in the bloodstream is 70-110mg/dL; when this level rises in the pancreas the islets of Langerhans produce cells called beta cells which produce insulin. The insulin then converts glucose in the blood into forms of energy and is then stored as glycogen in the liver and muscle cells to be used by the body at a later time. Glucose is what the body’s cells use for energy or food. Insulin allows the body’s cells to absorb this glucose. Without the glucose, the cells will starve and then start breaking down surrounding muscle and fat tissue. This breakdown of tissues can cause many chronic medical problems. When the body is not producing insulin or becomes resistant to the insulin, there becomes an abundance of glucose in the bloodstream. This excess of glucose can become so high that it can overwhelm the reabsorption capabilities of the kidneys, which is called hyperglycemia.

Diabetes can take three different forms: Type I diabetes (also called Insulin-dependent diabetes), Type II (non-insulin-dependent) diabetes, and Gestational diabetes. Type I diabetes affects 10 percent of people with diabetes and is generally onset rapidly in childhood. It is an auto-immune disease, where the body’s beta cells are destroyed and produce little or no insulin. This type of diabetes requires daily injections of insulin to regulate glucose levels in the blood. Gestational diabetes occurs during pregnancy when the body is unable to control glucose levels and they become too high. Gestational diabetes usually appears late in pregnancy and right after birth, and usually disappears shortly after birth. Women who develop gestational diabetes and their children are at a higher risk of developing type II diabetes and 50 % of these women develop type II diabetes within five to ten years after giving birth. Giving birth to a child weighing over nine pounds also places a woman at a higher risk of developing type II diabetes later in life (“Types Of” 2011).

Eighty to ninety percent of diabetes cases in the United States are cases of Type II diabetes (Hall 2011). Non-insulin-dependent diabetes or Type II occurs when the body becomes resistant to insulin. The insulin is unable to allow glucose to be absorbed into muscle and liver cells and there becomes an abundance of glucose in the blood. The islet cells in the pancreas will then produce more insulin and, when the body is still not able to absorb the glucose, the islet cells will not be able to keep producing large amounts of insulin and will start to not function properly. The islet cells will essentially wear themselves out no longer producing the needed amount of insulin the body needs to function properly. The onset of type II diabetes is gradual and can go undetected for years. The cause of the body to become insulin resistant is unknown.

Diabetes type II can cause many complications with other major organs of the body if not maintained correctly. Cardiovascular disease and the risk of stroke are increased two to four times in people with diabetes (Hall 2011). High blood sugar can also cause diabetic retinopathy which destroys the blood vessels in the back of the eye and can eventually lead to blindness. Glaucoma and cataracts can also form on the lens of the eye. (“Risk Factors” 2011) Blood vessels in the legs can be damaged due to too much glucose in the bloodstream which can cause numbness and tingling and can eventually lead to loss of feeling in the extremities; this nerve damage can also cause men to develop erectile dysfunction. Severe nerve damage can cause poor blood flow to the feet and lead to slow healing of cuts and wounds and severe infection and could eventually lead to amputation of lower limbs. This nerve damage caused by diabetes is called diabetic neuropathy. One of the most common complications from diabetes is nephropathy or kidney damage. This is caused by high levels of glucose which destroy the blood vessels in the kidneys called nephrons. Nephrons filter waste from your blood and become thickened and scarred over time. The kidneys will begin to leak a protein called albumin and pass the protein into the urine. Your doctor can detect this protein during a urine test to determine whether or not you have diabetes. Long-term damage to your kidneys can lead to kidney failure and the need for either kidney dialysis (where your blood is run through a machine and waste is filtered out) or kidney transplant.

There are many risk factors associated with developing type II diabetes including race, inactivity, age, family history, fat distribution, and the most prevalent being obesity. Hypertension also plays an important role in diabetes. Sixty-seven percent of diabetes patients over the age of twenty had high blood pressure over 140/90 mmHg over a three-year study between 2005-2008 (“U.S. Department” 2011). African Americans, Hispanics, and American Indians are at a higher risk for developing type II diabetes than their Caucasian counterparts and an increase of age also plays a significant role (“Risk Factors” 2011). People with a family history of type II diabetes have a higher risk of developing the disease and the less active you are the higher your risk is also. The biggest risk for developing type II diabetes by far is obesity.

Obesity affects almost one-third of the population. (Pradhan 2007) The more adipose or fat tissue a person has, the less sensitive their body becomes to insulin and the greater the risk for developing Type II diabetes (“Critical Link” 2009). The most common screening for diabetes is measuring the percentage of body fat a person has. This screening is referred to as measuring a person’s Body Mass Index. When determining one’s BMI, one’s weight in Kilograms is divided by their height in meters squared. A BMI of 18.5 to 24.9 is considered normal, a BMI of 25 to 29.9 is considered overweight and a BMI of greater than 30 is considered obese. According to the Centers for Disease Control and Prevention, when a woman’s body mass index is 30 or above, she is at risk of developing type II diabetes 28 times more than if her body mass index fell within the normal ranges (Barnes 2011). Monash University linked obesity to type II diabetes in 2009 during a study on a protein called pigment epithelium-derived factor (PEDF) released from fat cells (“Critical Link” 2009).

According to the study, liver and muscle cells become desensitized to insulin due to the release of PEDF into the bloodstream and cause the pancreas to continue producing more insulin to make up for the cells not absorbing the glucose (“Critical Link” 2009). The pancreas wears itself out and the body becomes insulin resistant and type II diabetes occurs. Monash University concluded that these studies proved that the PEDF protein caused type II diabetes, but that blocking the protein could also cause the body to again become insulin-sensitive (“Critical Link”2009). The fewer content of fat a person acquires the smaller amount of pigment epithelium-derived factor that is released into the bloodstream and the less damage it can do to the body.

Diabetes can be controlled in many different ways depending on the patient. Some patients require daily injections of insulin and some only require different types of diabetic pills such as alpha-glucosidase inhibitors and metformin, combined with a controlled diet and physical activity to help control glucose levels. Monitoring of glucose levels through home blood glucose monitors is the best way to track sugar levels. Checking levels several times a day usually before each meal and before bed, keeping a record of these levels, and adjusting amounts of medicines and dietary intake can greatly reduce complications.

The key to preventing Diabetes type II is to reduce caloric intake, especially sugar, and carbohydrates, modify your diet to include more polyunsaturated fats and high-fiber foods, and increase physical activity to at least 30 minutes a day. Losing as little as five to seven percent of body fat can also greatly reduce a person’s Body Mass Index and reduce complications from type II diabetes. Taking steps to better your physical health, checking your blood sugar regularly, and managing your medication can lead to a long prosperous life with type II diabetes.
References

Barnes, Ann Smith, MD, MPH. (2011). The epidemic of obesity and diabetes, Texas Heart
Institute Journal, 38, 142-144.

Critical link obesity and diabetes discovered. (2009, July 8). Retrieved
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https://www.sciencedaily.com/releases/2009/07/090708090917.htm

Hall, Gwen (2011). An introduction to diabetes. Practice Nurse, 41, 18-45.
https://www.cinhal.com/cgi-bin/refsvc?jid=1149&accno=2011064657

Pradhan, Aruna, MD, MPH. (2007). Obesity, metabolic syndrome, and type 2 diabetes:
Inflammatory basis of glucose metabolic disorders. Nutrition Reviews, 65, 152-155.

Risk Factors. (2011, May 24). Retrieved November 15, 2011, from Mayo Clinic:
https://www.mayoclinic.com/health/type-2-diabetes/DSECTION=%2Dfactors

Types of diabetes- International diabetes federation. (2011). Retrieved November 15, 2011,
From International Diabetes Federation: https://www.idf.org/types-diabetes

U. S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011).
2011 National diabetes fact sheet. Retrieved from https://www.cdc.gov/diabetes/pubs/estimates11.htm