Type II Diabetes Mellitus Assignment Sample

Definition of Type II Diabetes Mellitus Assignment

Type II Diabetes Mellitus is the classic, chronic metabolic disorder of high blood sugar results from the occurrence of two predominant dysfunctions that include a failure of the pancreas to adequately produce enough amounts of insulin in the body and resistance of the body toward it. Insulin is a hormone that regulates how glucose, a form of sugar, is moved into cells where it will be used or stored for later. Either the pancreas fails to produce enough insulin or fails to allow the insulin to reach cells that would then fail to increase glucose. Thus resistance caused by this failure forces the pancreas to raise insulin secretion and maintain normoglycemia but the demand becomes so intense that in the long term, it cannot be met by the pancreas forcing it to become chronically hyperglycemic.

Figure 1: Type 2 diabetes

This used to be called adult-onset diabetes, and has increasingly started getting diagnosed in younger age groups due to increasing obese levels. It is the most common type of diabetes especially in older people though it can happen to anyone. Some of the risk factors include a history of family, obesity, sedentary lifestyle, and poor diet. If untreated, Type II diabetes will surely have some serious health complications-cardiovascular, nerve damage, kidney disease, and eye problems. Such treatment may begin with lifestyle and oral medication adjustments, with the final possibility being the initiation of insulin therapy.

Epidemiology

Type II diabetes mellitus is regarded as one of the fast-emerging global issues. The rate of its incidences is increasing rapidly, but in large part because of changing lifestyles, increase in rates of obesity, and also due to an aging population. It was estimated that around 2017 about 462 million people suffered worldwide from type II diabetes, which constituted 6.28% of the population (Ye et al. 2023). It was more prevalent among the elder group with 15% among those aged 50-70 years, and 22% among those 70 years and above. The chronic disease is spreading all over the developed and developing countries portraying alarming trends, especially in the more economically worse off strata.

For Type II diabetes, prevalence using the GBD or “Global Burden of Disease” dataset has been steadily increasing from 1990 to 2017. The average global prevalence rate is estimated at 6059 cases per 100,000 population in 2017 and is projected to rise to 7079 cases per 100,000 in 2030. Growth is increasing more rapidly across all regions among the developed countries, for example, those of Western Europe.

Figure 2: Epidemiology of Type 2 Diabetes

This peaks at about 55 years of age and is spread equally between the genders. Diabetes has indeed emerged as the greatest killer, and a death toll of more than 1 million annually has made it the ninth leading cause of death worldwide (Basith Khan et al. 2020). The burden of diabetes is growing not just quietly but incrementally, while public health measures and clinical interventions should be taken with greater urgency, in light of the increasingly augments burden of diabetes-more dramatically so in low-income countries-to reduce the negative impact that has been inflicted upon the global health systems by the rapidly growing number of patients suffering from Type II diabetes.

Aetiology

T2DM has multiple factors with etiology, representing combined contributions from genetics, environmental as well as lifestyle contributions towards reaching such a condition. Core of T2DM lies in the resistance to insulin, a condition whereby body cells start responding less to insulin. This results in greater pancreatic secretion of insulin because circulating levels of insulin are increased in hopes that normal blood glucose is maintained. At this juncture, though, the secretory capacity of the pancreas is irreversibly lost, leading to ongoing hyperglycemia and the development of full-blown T2DM.

Although genetic susceptibility plays a role in susceptibility, environmental and lifestyle factors are the critical impelling forces behind the epidemic globally. As implied by the pandemic context, dietary habits that are relatively poor in nutrients but rich in energy-dense processed foods, coupled with sedentary lifestyles, have mainly contributed to insulin resistance and obesity, conditions very closely linked with T2DM onset (Galicia-Garcia et al. 2020). Other predisposing factors include intrauterine exposure, especially poor maternal nutrition when pregnant, and increased risk due to early developmental factors. Obesity, especially central or visceral fat, is highly risky for T2DM and causes an increased condition of insulin resistance. Other dangerous conditions include low physical activity, smoking, and excessive alcohol intake. Although T2DM is more common in people older than 45 years, obesity in children and young adults has been on an increase therefore, cases of the young age group have increased. Recommendations to prevent T2DM include healthy eating habits and exercise regularly and maintaining a normal body weight as preventive measures.

Pathophysiology

The interaction between insulin resistance and pancreatic “β-cell dysfunction”, then, sums up the pathophysiology in T2DM. In most cases, the first phase of pathogenesis occurs with the development of insulin resistance. Here, muscle, fat, and even the liver fails to respond appropriately to insulin (Bhatti et al. 2022). Glucose uptake falls, and glucose production by the liver goes up, causing rise in blood sugars.

In this scenario, the pancreatic β-cells start producing more insulin than initially intended to neutralize the normal glucose concentrations that accompany the onset of insulin resistance. Hyperglycemia is sustained because of the chronic metabolic requirements and the loss in β-cell function. It is the gradual “β-cell dysfunction” that eventually results in an inability to secrete enough insulin, and it causes increased hyperglycemia followed by T2DM.

Figure 3: Pathophysiology of type 2 diabetes mellitus (T2DM)

This is an important step in the pathogenesis of insulin resistance, more importantly in the setting of visceral obesity. In the state of obesity, FFA and proinflammatory cytokines like TNF-α and IL-6 secreted by the adipose tissue interfere with the insulin signaling pathways and bring about systemic inflammation (Valaiyapathi et al. 2020). However all the above, imbalances in adipokines, which have fewer numbers of adiponectin producers, also lead to insulin resistance. Other pathogenic factors of T2DM include problems in incretin biology, leading to low GLP-1 levels, thereby resulting in hyperglucagonemia, renal glucose reabsorption, amongst many others. All these kinds of abnormalities in metabolic states sum up to contribute towards the chronic perpetuation of hyperglycemia brought about by the process of T2DM and all its complications.

Clinical signs and symptoms

Most of the time clinical signs and symptoms of T2DM develop slowly and there can be many years of life a person may live undiagnosed with the disorder. The inappropriate management of insulin and hyperglycemia are symptomatically characterized by it. Increased thirst (“polydipsia”) and increased “urination (polyuria)” are usually common symptoms-the body is trying to purge itself of the extra sugar. Increased hunger or appetite or polyphagia is another common symptom due to lack of enough glucose within the cells to power them (Wagner et al. 2021). Most patients describe that they have been feeling weak or tired all the time because their body's energy levels have been at baseline despite taking in food.

Figure 4: Clinical signs and symptoms

It will cause unexplained weight loss most notably at the beginning of the disease as both fat and muscle are catabolized to feed the body. High blood sugar will cause the lenses inside the eyes to be damaged thus distorting vision (Bellary et al. 2021). Poor healing for ulcers and recurrent infections, for example urinary tract infection or skin infection, are also highly common, due to the effect of excess glucose on disabling the ability of the body to heal and combat the infection. Other symptoms include numbness or tingling in hands and feet brought about by diabetic neuropathy. Other signs include darkened patches of skin, acanthosis nigricans, usually showing up in such regions as armpits or the neck. Pregnant women with an assigned sex of female may also experience recurrent yeast infections of the vagina or urinary tract infections (Faselis et al. 2020). All of these symptoms require a clinical assessment to obtain an appropriate diagnosis and treatment for T2DM.

Differential diagnosis

For differential diagnosis of T2DM, tests with blood tests would yield the level of blood glucose, thus differentiating it from other types of diabetes such as type 1 diabetes T1DM or latent autoimmune diabetes in adults LADA.

• Fasting Plasma Glucose Test: It can be given after eight hours of overnight fasting. In the test, a level of blood sugar above 126 mg/dL diagnosed diabetes (Magkos et al. 2020). This is the first tester test used in diagnosing somebody of having the condition.
• Random Plasma Glucose Test: The level of blood sugar also could be tested at any time without doing any fasting. The random glucose level of blood could be confirmed if the individual is experiencing the diabetic symptoms and the blood glucose level is 200 mg/dL or greater than this value
• A1C Test: This is a test for mean blood glucose over the last 2 to 3 months. More than 6.5% A1C is consistent with diabetes and thus useful in diagnosis and at followup during diabetes management.

Autoantibody blood testing may be ordered to distinguish between T2DM and T1DM or LADA. It is a test for autoantibodies to autoimmune diabetes, including GAD65 antibodies. In contrast, T1DM autoantibodies are usually positive in T1DM and negative in T2DM (Perkovic et al. 2024). Testing for C-peptide can also be helpful when determining the strength of insulin production, which may imply T1DM if it is low.

Taken together, these tests along with clinical signs make an accurate diagnosis of T2DM and distinguish it from other types of diabetes.

Investigations

Type 2 Diabetes Mellitus can be diagnosed and followed up through a few key investigations. The test for glycated hemoglobin A1C is the gold standard. This test will essentially indicate average blood sugar levels in the two-to-three month period, and values below "5.7%" are normal, “5.7-6.4% prediabetes”, and “6.5%” or more proves the patient suffers from diabetes on two separate occasions (Sarwar et al. 2020).Other tests can be administered if it is impossible to run the "A1C" test due to some medical condition. Some of these tests include random blood sugar tests, which diagnose diabetes when the level is 200 mg/dL and above regardless of food, more especially in the presence of classic symptoms such as frequent urination and thirst.

In the fasting blood sugar tests are primarily given after overnight fasting which means that these entire processes are primarily considered the actual values (Ergasheva 2024). The below value is “100 mg/dL”, the normal value is “100-125 mg/dL”, the “prediabetes is 126 mg/dL” or sometimes these are also known as the higher level diabetes as well. Not only these there are also another type of diabetes that is shown is oral glucose tolerance test (OGTT) and these issues are primarily faced by pregnant women. 

A fasting period is asked of the individual; then he/she drinks a sugary beverage and after two hours the blood sugar levels are ascertained. Normal value is less than “140 mg/dL”. For the range “140-199 mg/dL”, prediabetes is indicated (Thomas et al. 2021). These come between “200 mg/Dl” or more diabetes is indicated. All adults aged 35 years or older should be screened for T2DM all obese adults; and those with a strong family history of diabetes. Assessments of A1C levels are necessary for diagnosis, to guide management, and to assess the adequacy of its plan of treatment.

Orthodox medicines 

These behavioral treatments and medications are used also to treat “type 2 diabetes mellitus”. The management of such patients mainly focus on preventing complications of diabetes, maintaining blood glucose levels and improving the quality of life. The most used first-line drug is Metformin lowers hepatic glucose output and improves insulin sensitivity. It is typically marketed in tablets, and the majority of the patients likewise are well tolerant of it (Demir et al. 2021). However these come from Metformin there are several other drugs administered orally that interfere with the kingdom at various stages. These drugs include “Sulfonylureas”, which stimulate the pancreas to increase insulin release, and “DPP-4 inhibitors”, which enhance the action of incretins: substances that bring about the secretion of insulin. Others are the “SGLT-2 inhibitors” which reduce blood sugar by promoting urinary glucose output.

Figure 5: Pharmacotherapy of Type 2 Diabetes Mellitus

The insufficient and result in the patient with “insulin therapy” or injective drugs, such as “GLP-1 receptor agonists” which promotes the release of insulin, slow gastric emptying and reduce eater appetite for the management of high glucose level and obesity (Hiersch et al. 2021). The treatment based on the patient's preferences include constant checkups of the two key parameters, “blood glucose” as well as A1C that in turn inform the changes.

Natural medicines (diet, herbal, supplements etc.)

The practices of natural medicine and other weird treatments can be able to support the common treatments that are used in the traditional state for type 2 diabetes since it can regulate the degree of the blood sugar, insulin tolerance, and overall health condition (Ahuja et al. 2021). In the time of using the proper recommendation all the doctor is to ensure that they are given safe and effective aspects.

Apple Cider Vinegar

This is one of the most effective products for consumption because this can make a higher insulin level which is more sensitive and this could help to secure the level of blood sugar variability that comes from after having meals (Jagannathan et al. 2020). The entire dose of apple cider vinegar is primarily diluted with the actual preparation with the water and drink that water before their meal.

• Fiber and Barley: These are some food items in which quantification has been done for slowing down sugar digestion include: ; barley, legumes, and vegetables. These control blood sugar.
• Chromium : This particular food item plays an effective role in the activation of their hormone which is primarily known as insulin and this area plays a function of “metabolizing glucose” (Dritsas et al. 2022).
• Zinc: They also discovered that “H19” plays an important role in the synthesis and secretion of zinc (Liu et al. 2021). It has been proven that the patient with diabetes is suffering from “hypozincemia” and it has been said that zinc enhances glycemic control.

Prognosis and complications

Diabetes mellitus type 2 is a lifelong disease which if not well controlled has severe long-term complications.

• Chronic hyperglycemia:In the dysfunction of many organs and systems in the body because of diabetic complications. One of its most serious “comorbidity” is “cardiovascular disease”, mainly heart attack and stroke, to the way that diabetes affects the blood vessels. “Kidney damage” is another complication or diabetic nephropathy is the damage of kidney filters and resulting kidney failure, requiring dialysis or transplantation.
• Neuropathy: This is frequent, peripheral to the nerves, particularly in extremities; it presents with pain, tingling or numbness and may lead to injury to the feet and development of ulcers or need for amputation.
• EYE complication : These are focused on some diseases, for example diabetic retinopathy, which cause blindness if not treated. Diabetes also increases “gum disease” and other Oral diseases, as well as some types of cancer (Utzschneider et al. 2021). On the other hand, diabetes can impair sexual activities resulting in erection problems in male that are called “erectile dysfunction” and sexual dysfunction in females. The immunity system of the diabetic is low and wounds or cuts may take longer time to heal. These complications can nevertheless be prevented by careful control in diet and exercise, adherence to medical appointments particularly in monitoring of blood sugar levels.

Reference List

Journal

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• Basith Khan, M. A., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Kaabi, J. A. (2020). Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends. Journal of Epidemiology and Global Health, 10(1), 107-111.
• Bellary, S., Kyrou, I., Brown, J.E. and Bailey, C.J., (2021). Type 2 diabetes mellitus in older adults: clinical considerations and management. Nature Reviews Endocrinology, 17(9), pp.534-548.
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