Pathophysiology of Type II Diabetes Mellitus

The pathophysiology of type 2 diabetes mellitus is characterized by peripheral insulin

resistance, impaired regulation of hepatic glucose production, and declining β-cell function,
eventually leading to β -cell failure II Diabetes Mellitus.
Diabetes mellitus type 2 risk factors Combinations of
1. Genetic
2. Environmental
3. Metabolic risk factors lead to type 2 diabetes mellitus
The most vulnerable individuals are older, fat, and inactive, and they have a family
history of diabetes mellitus. Minorities are also more likely to be at risk. Currently, type 2
diabetes mellitus prevention and retardation strategies focus on altering environmental risk
factors, such as lowering obesity rates and encouraging physical exercise. To reduce both
microvascular and macrovascular consequences, screening, early identification, and treatment in
high-risk populations will be encouraged. Children of women who previously had gestational
diabetes are more likely to develop type 2 diabetes mellitus. A person is more likely to acquire
type 2 diabetes and poor glucose tolerance if they have insulin resistance. Many of the same risk
factors that are present in type 2 diabetics are also present in people with insulin resistance.
These include polycystic ovarian syndrome, hypertension, prothrombic condition,
hyperuricemia, glucose intolerance, hyperinsulinemia, and atherogenic dyslipidemia,
contemporary interventions.
Madam Suba is 52 years old woman whose height is about 167 cm and weight is about
105 Kg. It seems that the woman is an overweight patient. Further, it was observed, her blood
glucose level was 22.9 mmol/L [Normal: 3.9‐6.1 mmol/L] and HbA1c: 11% [normal <6.5%].
Based on the above symptoms, it could be seen that Madam Suba is a vulnerable woman to
diabetes mellitus type 2.
Due to the present situation of Madam Suba, she

Pathogenesis of Type II Diabetes Mellitus

Numerous distinct pathophysiologic abnormalities have been associated with type 2 diabetes
mellitus (T2DM). It is well established that decreased peripheral glucose uptake (mainly muscle)
combined with augmented endogenous glucose production are characteristic features of insulin
resistance. Increased lipolysis, elevated free fatty acid levels, and accumulation of intermediary
lipid metabolites further increase glucose output, reduce peripheral glucose utilization, and
impair beta-cell function. Adipocyte insulin resistance and inflammation have been identified as
important contributors to the development of T2DM. The presence of non-alcoholic fatty liver
disease [NAFLD] is now considered an integral part of the insulin-resistant state. The traditional
concepts of “glucotoxicity” and lipotoxicity, which cover the process of beta cell deterioration in
response to chronic elevations of glucose and lipids, have been expanded to encompass all
nutrients [‘Nutri-toxicity”]. The delayed transport of insulin across the microvascular system is
also partially responsible for the development of tissue insulin resistance. Compensatory insulin
secretion by the pancreatic beta cells may initially maintain normal plasma glucose levels, but
beta cell function is already abnormal at this stage, and progressively worsens over time.
Concomitantly, there is the inappropriate release of glucagon from the pancreatic alpha-cells,
particularly in the post-prandial period. It has been postulated that both impaired insulin and excessive
glucagon secretion in T2DM are secondary to an “incretin defect”, defined primarily as inadequate
release or response to the gastrointestinal incretin hormones upon meal ingestion. To a certain extent,
the gut microbiome appears to play a role in the hormonal and metabolic disturbances seen in T2DM.
Moreover, hypothalamic insulin resistance (central nervous system) also impairs the ability to circulate
insulin to suppress glucose production, and renal tubular glucose reabsorption capacity may be
enhanced, despite hyperglycemia. These pathophysiologic abnormalities should be considered for the
treatment of hyperglycemia in patients with T2DM. For complete coverage of all related areas of
Endocrinology,

What are the chronic complications of type 2 diabetes mellitus?

Heart disease

Vision loss

Oral Health

Kidney disease

Neuropathy

Skin conditions

Lifestyle changes can help prevent the onset of type 2 diabetes, the most common form of the disease.
Prevention is especially important if you're currently at an increased risk of type 2 diabetes because of
excess weight or obesity, high cholesterol, or a family history of diabetes.

She has been diagnosed with prediabetes — high blood sugar that doesn't reach the threshold of a
diabetes diagnosis — lifestyle changes can prevent or delay the onset of the disease.

Making a few changes in her lifestyle now may help her avoid the serious health complications of
diabetes in the future, such as nerve, kidney, and heart damage. It's never too late to start.

1. Lose extra weight

Losing weight reduces the risk of diabetes. People in one large study reduced their risk of developing
diabetes by almost 60% after losing approximately 7% of their body weight with changes in exercise and
diet.

2. Be more physically active

There are many benefits to regular physical activity. Exercise can help her: ose weight

Lower your blood sugar

Boost your sensitivity to insulin — which helps keep her blood sugar within a normal range

Goals for most adults to promote weight loss and maintain a healthy weight include:

Aerobic exercise. Aim for 30 minutes or more of moderate to vigorous aerobic exercise — such as brisk
walking, swimming, biking or, running — on most days for a total of at least 150 minutes a week.

Resistance exercise. Resistance exercise — at least 2 to 3 times a week — increases your strength,
balance, and ability to maintain an active life. Resistance training includes weightlifting, yoga and
calisthenics.

Limited inactivity. Breaking up long bouts of inactivity, such as sitting at the computer, can help
control blood sugar levels. Take a few minutes to stand, walk around or do some light activity every 30
minutes.

3. Eat healthy plant foods

Plants provide vitamins, minerals and carbohydrates in your diet. Carbohydrates include sugars and
starches — the energy sources for your body — and fiber. Dietary fiber, also known as roughage or bulk,
is the part of plant foods your body can't digest or absorb.

Fiber-rich foods promote weight loss and lower the risk of diabetes. Eat a variety of healthy, fiber-rich
foods, which include:

Fruits, such as tomatoes, peppers and fruit from trees

No starchy vegetables, such as leafy greens, broccoli and cauliflower

Legumes, such as beans, chickpeas and lentils

Whole grains, such as whole-wheat pasta and bread, whole-grain rice, whole oats, and quinoa

The benefits of fiber include:

Slowing the absorption of sugars and lowering blood sugar levels

Interfering with the absorption of dietary fat and cholesterol

Managing other risk factors that affect heart health, such as blood pressure and inflammation

Helping you eat less because fiber-rich foods are more filling and energy energy-rich foods that are "bad
carbohydrates" — high in sugar with little fiber or nutrients: white bread and pastries, pasta from white
flour, fruit juices, and processed foods with sugar or high- fructose corn syrup.
Differences between Type I Diabetes Mellitus and Type II Diabetes Mellitus.

Type 1 and type 2 diabetes may have similar names, but they’re different diseases with unique causes.

Causes of type 1 diabetes

The body’s immune system is responsible for fighting off foreign invaders, such as harmful viruses and
bacteria.

Type 1 diabetes is believed to be caused by a rusted Source an autoimmune reaction. In people with
type 1 diabetes, the immune system mistakes the body’s own healthy cells for foreign invaders.

The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these
beta cells are destroyed, the body is unable to produce insulin.

Researchers don’t know why the immune system sometimes attacks the body’s own cells. It may have
something to do with genetic and environmental factors, such as exposure to viruses.

Research into autoimmune diseases is ongoing. Diet and lifestyle habits do not cause type 1 diabetes.

Causes of type 2 diabetes

People with type 2 diabetes have insulin resistance. The body still produces insulin, but it’s unable to use
it effectively.

Researchers aren’t sure why some people become insulin resistant and others don’t, but several lifestyle
factors may contribute, including being inactive and carrying excess weight.

Other genetic and environmental factors may also play a role. When you develop type 2 diabetes, your
pancreas will try to compensate by producing more insulin. Because your body is unable to effectively
use insulin, glucose accumulates in your bloodstream.
What is High Blood Sugar?

Elevated blood sugar levels are known as hyperglycemia. Blood sugar levels are measured using a small
sample of blood (typically pricked from the finger) that is tested in a lab. Blood sugar can also be tested
using home devices such as a handheld glucometer. Levels that indicate hyperglycemia are indicative of
prediabetes and both type 1 and type 2 diabetes.

Normal ranges of blood sugar will vary depending on the test being done. In general, a normal fasting
(testing done early in the morning before breakfast is eaten) glucose level will be between 70-100
mg/dL. After a meal, these levels are expected to rise slightly around 1 to 2 hours after the beginning of
a meal but should be less than 180 ml/dL.
Maintaining healthy blood sugar levels is important not only for metabolic health but for heart health
too. Over time, high blood sugar can damage blood vessels and the nerves that control your heart.
People with diabetes are also more likely to have other conditions that raise the risk for heart disease:

High blood pressure increases the force of blood through your arteries and can damage artery walls.
Having both high blood pressure and diabetes can greatly increase your risk for heart disease.

Too much LDL (“bad”) cholesterol in your bloodstream can form plaque on damaged artery walls.

Causes of High Blood Sugar

The leading causes of high blood sugar or hyperglycemia include:

♦ Diet: Glucose comes from food, so what you are eating causes high blood sugar. Carbohydrates are
the most common culprit as they are broken down into glucose very quickly in the body. High-sugar
foods, high-fat foods, and processed foods also cause blood glucose spikes and should be replaced with
healthier options.

♦ Stress: When you are stressed, more stress hormones and chemicals are released, which drives blood
sugar levels up too. If the stress is only temporary, this is not a serious issue, but if you experience
chronic stress or an anxiety disorder, you may experience high blood sugar levels more often.

♦ Metabolic Syndrome: These are a collection of conditions that occur at the same time and increase
your risk for type 2 diabetes. High blood pressures, excess fat around the waist, and high cholesterol or
triglycerides are examples of these conditions. When these occur in the body together, your risk for
diabetes increases as does your blood sugar and the risk for potential complications.

♦ Physical Inactivity: A lack of physical activity contributes to elevated blood sugar. When you are
physically active each day, insulin works more efficiently, and your blood sugar can be maintained.

♦ Obesity: This is commonly associated with diabetes as a result of eating too many processed and high-
sugar foods. Your risk for diabetes increases if you are overweight, so maintaining a healthy weight is
important in preventing high blood sugar. You can also promote healthier blood glucose levels by losing
weight.
www.breathewellbeing.in/blog/main-difference-between-type-1-and-type-2-
www.medicinenet.com/pathogenesis_of_types_i_and_ii_diabetes_mellitus/articl