Diabetes Mellitus Type II

Diabetes is occurring much more often currently in the US especially in the State of Texas. A few years ago the State of Texas had 7 of the top 10 Fattest Cities as its designation, not a desirable statistic. Along with this trend in overweight and obesity comes the inevitable difficulty of the pancreas to keep up with the demand along with the body’s tendency to become more resistant to the effect of insulin. With this situation, the cells of your body become less responsive to the insulin that your body does produce.  So you produce less insulin and you then respond less to that insulin produced. So the glucose or sugar does not go into the cells as easily to feed them and then the sugar stays in the bloodstream resulting in high blood sugar. We do not know exactly why the body cells become resistant to insulin, many different theories are being proposed currently.

Diabetes is a condition or disease state where the body produces no insulin at all, type I diabetes or where the body produces insulin, but not enough for the demands of the body, or the body is resistant to the insulin that is produced. Both situations result in the same thing, minimal glucose is uptaken by the cells and tissues (muscle, brain, kidney, all tissues etc).  The remainder of this discussion will be limited to Type II Diabetes Mellitus which I treat, versus Type I which is better handled by an internest or endocrinologist.

Symptoms of Diabetes Type II

  • Hyperglycemic symptoms (high blood sugar)
    Symptoms are drowsiness, dry skin, polyphagia (excess hunger), polydipsia (excess thirst), polyuria (excess urination), nausea (D.C. Maldonado, 2005).
  • Hypoglycemic symptoms (low blood sugar)
    Symptoms are tremors, anxiety, weakness, headache, rapid heart rate, dizziness, fatigue, blurry vision, sweating, hunger and irritability. 
    (D.C. Maldonado, 2005)

Risk factors for Diabetes Type II

The risk factors for DM II are family history of diabetes in other family members that are a 1st degree relatives, obesity or a BMI of 30.00 or greater, ethnicity of African American, Mexican American or Latino, Native American, Asian American, or Pacific Islander, history of gestational diabetes (DM II when pregnant), or history of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (R. Webster, 2012).

The current criteria for diagnosing Type II DM

  • Hgb A1C of greater than 6.5% on 2 or more occasions (HgbA1C between 5.7% - 6.4% is considered pre-diabetes.
  • Symptoms of diabetes plus a random plasma glucose of greater than 200mg/dl or a fasting plasma glucose of 126 mg/dl on 2 occasions.
  • 2 hour plasma glucose greater than 200 mg/dl during a oral glucose tolerance test (GTT) with a 75 gram glucose load.
    (R.L. Webster, 2012)

The complications of DM II

This disease as many other conditions and diseases in the body may go undetected for years. This reason is a strong clue to my statement to a multitude of patients that symptoms are not always a good indicator of a problem. Many conditions are hidden and give no recognizable warning signs to the untrained eye.  The fact that it may go unrecognized for a long time, results many times in damage already to the body prior to diagnosis.

Diabetes if not treated properly can result in damages to the vascular system whether it be large or small blood vessels, both are bad, all tissues need a constant supply of blood. DM II can result in damages in the nerves of the body resulting in chronic pain and/or loss of function. These neuropathies can be pain in an arm of leg or loss of function of the nerves to the stomach or intestines as an example, resulting in slowed or no function of that area of the organ. The retina of the eye or other structures may be damaged resulting in lack of vision or damaged vision. The kidneys may become less functional or become damaged to the point that one needs dialysis. The body may become ulcerated resulting in sores that don’t heal properly and occasionally resulting in gangrene and amputation (R.L. Webster, 2012).

Treatment of Diabetes Type II

  1. Exercise
  2. Weight loss
  3. Proper diet
  4. Oral anti-diabetic medications
  5. Injection based anti-diabetic medications
  6. Insulins
  7. Follow up visits for monitoring blood tests
  8. Home self blood glucose monitoring

If you or a family member, coworker or friend have any questions about management of diabetes type II or have questions about the condition, call my office and make an appointment and we can sit down and discuss your case and do the necessary blood tests and if needed, prescribe the medications to treat your condition. Diabetes is not a condition to put off, one must know his or her status.

  1. The 5 Minute Clinical Consult 2012, pp 386-387, R.L. Webster, 2012
  2. SOAP for Family Medicine 2005, pp 26-27, D.C. Maldonado, C. Zuniga, P.S. Uzelac, 2005