What is Type 2 Diabetes Mellitus or Non-Insulin Dependent Diabetes Mellitus (NIDDM), Know the Risk factors
In my work as an ITU nurse, I cannot fail to notice the increasing number of people admitted to hospital with a primary or secondary condition of type 2 diabetes mellitus.
Type 2 diabetes mellitus is a lifelong condition also known as adult-onset or non-insulin dependent diabetes mellitus (NIDDM)
Diabetes is a chronic disorder that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin produced.
The condition is characterized by a higher than normal blood glucose level (sugar) with disturbances of carbohydrate, fat and protein metabolism.
The effects of diabetes mellitus include long-term damage, dysfunction, and failure of various organs (WHO 1999).
There are two types of diabetes, type 1 diabetes and type 2 diabetes, for this article we will look at type 2 diabetes.
Type 2 diabetes occurs when the body makes some insulin, but not quite enough, or when the insulin it makes, does not work effectively; this is known as insulin resistance.
Insulin is a hormone that regulates the movement of sugar into the cells. The hormone acts rather like a key that unlocks the cells. When there is insufficient insulin, or when the insulin produced fails to work correctly; the cells are only partially unlocked or not at all, resulting in a build-up of glucose in the bloodstream.
Some of the foods we eat are broken down into sugar in the gut. The main sugar is known as glucose, which enters the bloodstream through the wall of the gut. In a healthy body, the glucose level is neither too high nor too low and is maintained by the hormone insulin that rises as the glucose levels increase after a meal. Insulin work on the cells allowing them to take in glucose from the blood stream.
Some of the glucose are used by the cells for energy, and some are converted to glycogen or fat and stored to be used later when the glucose level falls between meals. The insulin level also falls and some glycogen or fat is converted back into glucose and released into the bloodstream
Type 2 diabetes occurs mostly in people over the age of 40 but can develop at any age. Until recently, type 2 diabetes was only seen in adults, but now rather unsettlingly, the condition is also occurring in children.
In the UK, the incident of type 2 diabetes is increasing, not only is it common in people who are overweight but it is also familial. The condition is about five times more common in South Asian and people of African-Caribbean descent.
There are an estimated 750,000 people in the UK with undiagnosed type 2 diabetes, and the numbers are continuing to rise.
Type 2 Diabetes, Causes, and Risk Factors
- Having a parent, brother, sister or child with type 2 diabetes
- Of African-Caribbean or South-Asian origin
- Overweight or obese
- A waist measuring greater than 80cm in women and 94cm in me.
- An impaired glucose tolerance ( a higher than normal blood glucose level, but not sufficiently high to be diabetes)
- A diagnosis of diabetes or impaired glucose tolerance when pregnant
- Over 40 years of age. (The risk increases with age)
- Have high blood pressure, or have had a heart attack or stroke
- Don’t take regular exercise
- Women with polycystic ovary syndrome and are overweight
According to the World Health Organization (WHO), 346 million people worldwide have diabetes; projected deaths from diabetes will double between 2005 and 2030.
Type 2 diabetes accounts for 90% of people with diabetes around the world and is mostly due to obesity, a lack of physical activity, unhealthy diet, sedentary lifestyle, stress, and urbanization. Excess body fat is associated with 64% of cases of diabetes in men and 77% of women.
Some contributing factors relating to diet include the consumption of sugary drinks and foods, high-fat diet that can lead to a high cholesterol level and the consumption of large quantity of white rice.
Symptoms of Type 2 diabetes
The symptoms of type 2 diabetes may be similar to type 1 diabetes but are often less marked, because of this; the condition may take several years from the onset before it is diagnosed allowing complications to set in.
Some people have no noticeable symptoms of diabetes. Therefore, those in the high-risk group should consult their GP or healthcare providers as a matter of urgency for a blood fasting glucose test, (FBG) or an HbA1C, which look at the fasting blood glucose for the past 2 to 3 months. A glucose tolerance test (GTT) can also diagnose the condition.
Facts about Diabetes;
Poorly control blood glucose level can result in a hyperglycaemic or hypoglycaemic state that can cause drowsiness and potentially unconsciousness that requires hospital admission.
When the blood glucose level is uncontrolled for long periods, the risk of complications increases as follows:
- · The risk of heart disease and stroke increases in people with diabetes. 50% of people with diabetes die from cardiovascular disease, mainly heart disease, and stroke.
- · Blindness, after 15 years of diabetes, approximately 2% of people become blind and about 10% develop severe visual impairment due to Diabetic Retinopathy
- · Reduced peripheral circulation and nerve damage increases the risk of foot and leg ulcers potentially leading to limb amputation
- · Diabetes is one of the leading causes of Kidney failure, 10-20% of people with this condition die of kidney failure
- · Diabetic neuropathy is damage to the nerve, caused by diabetes; diabetic neuropathy affects up to 50 % of people with diabetes. Some symptoms of diabetic neuropathy are; tingling, numbness, pain, or weakness in the feet and hands
- · The risk of death among people with diabetes is at least twice as high in similar groups without diabetes.
The symptoms of type 2 diabetes include:
- Passing more urine than usual, more frequently (polyuria)
- Feeling consistently thirsty (polydipsia)
- Increased hunger (polyphagia)
- Excessive tiredness
- Weight loss
- Blurred vision
- Itchy skin around the genital area
- Frequent infections such as thrush
- Cuts and wounds heal slowly
Diabetes Test: The majority of people with diabetes have been diagnosed on admission to hospital for unrelated conditions, by routine urine testing.
A urine test is simple to do, using a dipstick, this will indicate whether glucose is present in the urine, the test can also show levels of protein and ketones.
Fasting blood glucose involves taking a sample of blood from the arm after overnight fasting. A glycosylated hemoglobin (HbA1C) test may also be performed; this is a protein that is produced when there is a high glucose level over an extended period.
Glucose tolerance test may be required if the fasting blood glucose test is borderline. This test measures how the blood glucose level changes over time after drinking a sugary drink, fasting overnight is also necessary for this test.
Universal screening for diabetes apparently has not been recommended by the appropriate organizations because there is no evidence that such a program would improve outcomes. In the USA screening is recommended in some cases, and the WHO recommends testing those groups at high risk.
The WHO define diabetes as a single raised glucose reading with symptoms, otherwise raised values on two occasions of either fasting plasma glucose >7.0 mmol/l (126mg/dl) or a glucose tolerance test, two hours after the oral dose of a plasma glucose >11.1mmol/l (200mg/dl).
There isn’t a cure for type 2 diabetes, but the condition can be controlled. In some cases all that is required is some lifestyle changes, others may need to monitor the condition with medication or with insulin injection.
It is imperative that people with type 2 diabetes understand their condition and the potential complications that can arise as a result of poor management.
They need to be aware of conditions such as urinary tract infection, dehydration, flu-like symptoms that can cause the glucose levels to become unstable, resulting in hospital admission and sometimes death.
Blood glucose levels must be regularly monitored. Glucometers can be bought at most chemists. If in doubt contact you GP or health care provider for advice. When a person is diagnosed with type 2 diabetes, relevant information will be provided.