30289629 diabetes mellitus type 2

8/6/2019 30289629 Diabetes Mellitus Type 2

1/29


2/29

DIABETES MELLITUSDIABETES MELLITUSTYPE 2TYPE 2

previously called NONINSULIN-

DEPENDENT DIABETES MELLITUS,

NIDDM, or MATURITY-ONSET DIABETES


3/29

DEFINITIONDEFINITION

yType 2 diabetes mellitus is agroup of disorders characterized

by

hyperglycemia and

associated with microvascular (ie,

retinal, renal, possibly neuropathic),

macrovascular (ie, coronary,peripheral vascular), and

neuropathic (ie, autonomic,

peripheral) complications.


4/29

y the most common form of diabetes

mellitusy over 90-95% of these cases can be

prevented

y it remains for adults the leading cause ofrelated complications such as blindness,

non-traumatic amputations and chronic

kidney failure requiring dialysis.y usually starts in people over age 40 who

are overweight


5/29

y can occur in people who are not

overweight

y Sometimes referred to as "ADULT-

ONSET DIABETES

y has started to appear in childrenbecause of the rise in obesity in

young people

y is slightly more common in olderwomen than men.


6/29

CAUSESCAUSES

y caused by insulin resistance, in whichthe body does not properly use insulin.

y is thought to result from a

combination of genetic factors alongwith lifestyle factors such as obesity,high alcohol intake, and beingsedentary.

y Conditions that damage or destroy thepancreas, such as pancreatitis(inflammation), pancreatic surgery, orcertain industrial chemicals


7/29

y polycystic ovaries are highly

associated with diabetesy certain drugs can also cause

temporary diabetes, including

corticosteroids, beta blockers, andphenytoin.

y Certain genetic and hormonal

disorders are associated with or

increase the risk of diabetes.


8/29

y Deficient insulin production

y

y Hyperglycemia

y

y Inc. concentration of blood glucose

y

y Glucosuria

y

y Excess glucose excreted in uriney

y Excess fluid loss

y

y

Polyuria / Polydipsia (thirst)


9/29

y Insulin deficiency

y

y Impaired metabolism of CHON and

fats

y

y Weight loss

y

y

Decreased storage of caloriesy

y Polyphagia (excessive eating)


10/29

y

The firststage in

type 2

diabetes

is insulinresistance.


11/29

yOver time, the pancreas becomes

unable to produce enough insulinto overcome resistance. In type 2

diabetes, the initial effect of this

stage is usually an abnormal rise

in blood sugar after a meal

(called postprandial hyperglycemia).


12/29


13/29


14/29

RISK FACTORSRISK FACTORS

y Age 45 or older

y Family history of diabetes

y Overweight

y Inactive lifestyle (exercise less than 3 times aweek)

y African-American, Hispanic/Latin American,American Indian and Alaska Native, Asian-

American, or Pacific Islander ethnicityy High blood pressure (140/90 mm Hg or

higher)


15/29

y HDL (good) cholesterol less than 35 mg/dL

or triglyceride level 250 mg/dL or higher

y Have had diabetes during pregnancy (gestational

diabetes) or have given birth to a baby that

weighed more than 9 pounds

y

Polycystic ovary syndrome (metabolic disorderthat affects female reproductive system)

y Acanthosis nigricans (dark, thickened skin

around neck or armpits)

y History of disease of blood vessels to the heart,brain, or legs

y Diabetes test history of impaired fasting glucose

(IFG) or impaired glucose tolerance (IGT)


16/29

SYMPTOMSSYMPTOMS

y Type 2 diabetes usually begins gradually

and progresses slowly. Symptoms in adults

include:

y Excessive thirst (polydipsia)

y Increased urination (polyuria)

y Fatigue

y Blurred vision

y Weight loss


17/29

y In women, vaginal yeast infections

or fungal infections under thebreasts or in the groin

ySevere gum problems

y Itching

yErectile dysfunction in men

yUnusual sensations, such astingling or burning, in the

extremities


18/29

ySymptoms in children are often

different: Most children are obese oroverweight

Increased urination is mild or evenabsent

Many children develop a skin

problem called acanthosis,characterized by velvety, darkcolored patches of skin


19/29

acanthosis


20/29

DIAGNOSISDIAGNOSIS

y A weight that is 20% more than idealbody weight

y Sedentary lifestyle

y High blood pressure (greater than140/90) or unhealthy cholesterol levels --especially for patients with low HDL("good") cholesterol and high triglyceridelevels

y History of heart disease, stroke, orperipheral artery disease


21/29

y A close relative (parent, sibling) with

diabetesy A high-risk ethnic group background

(African-American, Latino, Native

American, Asian American, PacificIslander)

y Having delivered a baby weighing over 9

pounds or having a history of gestational

diabetes (in women)

y Polycystic ovary disease (in women)


22/29


23/29

Managements of DM type 2Managements of DM type 2


24/29

Healthy Eating HabitsHealthy Eating Habits

y CARBOHYDRATES should provide 45 -65% of total daily calories.The type andamount of carbohydrate are both

important.Best choices are vegetables,fruits, beans, and whole grains.Thesefoods are also high in fiber. Patients withdiabetes should monitor their

carbohydrate intake either throughcarbohydrate counting or meal planningexchange lists.


25/29

y FATS should provide 25 - 35% of daily calories.

Monounsaturated (olive, peanut, and canolaoils; avocados; nuts) and omega-3

polyunsaturated (fish, flaxseed oil, and walnuts)

fats are the best types. Limit saturated fat (red

meat, butter) to less than 7% of daily calories.

Choose nonfat or low-fat dairy instead of

whole milk products. Limit trans-fats

(hydrogenated fat found in snack foods, friedfoods, commercially baked goods) to less than

1% of total calories.


26/29

yPROTEIN should provide 12 - 20%

of daily calories, although this mayvary depending on a patientsindividual health requirements.

Patients with kidney disease shouldlimit protein intake to less than 10%of calories.Fish, soy, and poultry are

better protein choices than redmeat.


27/29

Achieve healthy weight and LifestyleAchieve healthy weight and Lifestyle

changeschangesy A reasonable weight is usually defined as a

weight that is achievable and sustainable,

rather than one that is culturally defined

as desirable or ideal.

y Patients should lose weight if their body

mass index (BMI) is 25 - 29 (overweight)

or higher (obese).y aim for a small but consistent weight loss

of - 1 pound per week


28/29

y follow a diet that supplies at least 1,000 -

1,200 kcal/dayfor women and 1,200 - 1,600kcal/dayfor men

y Regular exercise, even of moderate intensity

(such as brisk walking), improves insulinsensitivity and may play a significant role in

preventing type 2 diabetes

y even a modest weight loss of 10 - 15 pounds

can significantly reduce the risk of progressing

to diabetes.


29/29

y Patients should have an exercise goal of 30 -

60 minutes, at least 5 days a week, and followa low-fat, high-fiber diet.

y Quitting smoking is also essential.

y

It is also important to have your doctor checkyour cholesterol and blood pressure levels on

a regular basis.Your doctor should also check

your fasting blood glucose and

microalbuminuria levels every year, and yourhemoglobin A1c and lipids every 6 months

30289629 diabetes mellitus type 2

Documents