Signs and Symptoms

Signs and symptoms of type II DM often develop slowly. You can live with type II DM for years and not know it. When signs and symptoms are present, they include:

• Increased thirst
• Frequent urination
• Increased hunger
• Unintended weight loss
• Fatigue
• Blurred vision
• Slow-healing sores
• Frequent infections
• Numbness or tingling in hands or feet
• Areas of darkened skin, usually in the armpits & neck

Causes

Type II DM is primarily the result of two interrelated problems:

• • Cells in muscle, fat, and the liver become resilient to insulin.
  • Because these cells don’t interact in a normal way with insulin, they don’t take in enough sugar.
  • The pancreas is unable to produce enough insulin to manage blood sugar levels.
    

How Insulin Works

Insulin is a hormone that comes from the pancreas and regulates how the body uses sugar in the following ways:

• Sugar in the bloodstream triggers the pancreas to secrete insulin
• Insulin circulates in the bloodstream, enabling sugar to enter the cells
• The amount of sugar in the bloodstream drops
• In response to this drop, the pancreas releases less insulin

Insulin Mixtures

For convenience, there are premixed rapid- and intermediate-acting insulin. The insulin will start to work as quickly as the fastest-acting insulin in the combination. It will peak when each type of insulin typically peaks, and it will last as long as the longest-acting insulin.

Examples include:

• 30% regular and 70% NPH (Humulin 30/70, Novolin ge 30/70)
• 50% lispro and 50% lispro protamine (Humalog Mix 50)
• 25% lispro and 75% lispro protamine (Humalog Mix 25)
• 30% aspart and 70% aspart protamine (NovoMix 30)

The Role of Glucose

Glucose – a sugar – is a main source of energy for the cells that make up muscles and other tissue. The use and regulation of glucose includes the following:

• Glucose comes from 2 major sources:  food and the liver
• Glucose is absorbed into the bloodstream, where it enters cells with the help of insulin
• The liver stores and makes glucose
• When glucose levels are low, the liver breaks down stored glycogen into glucose

In type II DM, this process does not work well. Sugar does not enter the cells, builds up in bloodstream. The beta cells in the pancreas release more insulin. Eventually these cells become impaired.

In type I DM, the immune system mistakenly destroys the beta cells, leaving the body with little to no insulin.

Risk Factors

Weight – being overweight or obese is a main risk

Fat distribution – storing fat mainly in the abdomen (men waist >40 inches, women waist >35 inches)

Inactivity – physical activity keeps weight done, and uses up glucose as energy, makes cells more sensitive to insulin

Family history – increases if parent or sibling has type II DM

Race and ethnicity – Black, Hispanic, Indigenous, Asian, Pacific Islanders

Blood lipid levels – increased risk associated with love levels of HDL cholesterol and high levels of triglycerides

Age – increases with age, especially after age 45

Prediabetes – blood sugars higher than normal, but not high enough to be classified as diabetes, if left untreated often progresses to type II DM

Pregnancy-related risks – increases if you develop gestational diabetes or if you give birth to a baby weighing > 9 pounds

Polycystic ovary syndrome – common condition characterized by irregular menstrual periods, excess hair growth and obesity-increases the risk of diabetes

Complications and Frequent Comorbidities

Heart and blood vessel disease – increase risk of heart disease, stroke, hypertension, and atherosclerosis

Neuropathy in limbs – overtime nerves are destroyed, resulting in tingling, numbness, burning pain or eventual loss of feeling. Begins at tips of toes or fingers and gradually spreads

Other nerve damage – damage to heart nerves can contribute to irregular heart rhythms. Digestive nerve damage may lead to nausea, vomiting, diarrhea or constipation. Men, erectile dysfunction.

Kidney disease – may lead to irreversible end-stage kidney disease

Eye damage – cataracts and glaucoma, may damage the blood vessels in the retina

Skin conditions – more susceptible to bacterial and fungal infections

Slow healing – cuts and blisters can become seriously infected, severe damage might require amputation

Hearing impairment

Sleep apnea – obstructive sleep apnea is common, obesity may be the main contributing factor. Not clear if treating sleep apnea improves blood sugar control

Dementia – seems to increase risk of Alzheimer’s disease and other dementia disorders. Poor blood sugar control linked to more-rapid decline in memory and thinking skills

Prevention

• Monitor and/or lower blood pressure and cholesterol
• 30 minutes of activity per day five days per week helps lower risk of developing type II diabetes by 58%
• Eat a healthy diet, including less fats, more fiber, whole grains, veggies, fruits, lean meats
• Manage weight and BMI