T2DM is a type of metabolic disorder, and insulin resistance usually characterizes the disease. T2DM occurs when the cells of the body resist the normal effect of insulin. Insulin resistance may lead to glucose building up in the blood. Increase in glucose levels in the body makes the pancreas to respond. As a result, it makes extra insulin in order to ensure that the level of sugar in the blood is maintained. If the level of glucose continues to increase, the pancreas will continue to respond until it fails to keep up with the demand for insulin. Once this stage is reached, the pancreas poops out. This increases glucose levels.
T2DM has become a global issue, and the disease has several epidemiological characteristics. Firstly, T2DM is increasing at an alarming rate, especially in developed nations, such as the United States and Japan. It is projected that T2DM will continue to increase steadily in the next two decades with majority of the people affected being aged between 45 and 64 (Wild, Roglic, Green, Sicree, & King, 2004). Secondly, although T2DM is prevalent in old people, T2DM is becoming more common in children and adolescents because of the rising rates of childhood obesity.
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Etiology and Risk Factors
T2DM develops due to genetic and environmental factors. Typically, genetic factors tend to impair insulin secretion. More to this is that it also impairs insulin resistance. Obesity, stress, aging, overeating, and lack of physical exercises are some of the environmental factors that can lead to DM. According to Sanghera & Blackett (2012), “the significantly higher concordance rate between monozygotic twins than dizygotic twins clearly indicates the involvement of genetic.” Additionally, 40 percent of close blood relatives of patients suffering from diabetes may develop the disease as well (Prasad, & Groop, 2015). However, the incident rate of T2DM in the general population is significantly lower (6%) (Prasad & Groop, 2015). Several factors, including sedentary lifestyle, physical inactivity, smoking, and alcohol consumption, are known to be some of the risk factors that can lead to the development of T2DM. The risk of T2DM increases with age, especially after 45 years, but the disease is also increasing among children and adolescents. With regard to gender, diabetes is more prevalent in men than in women (Prasad, & Groop, 2015). The risk of T2DM increases with age, especially after 45 years, but the disease is also increasing among children and adolescents
Pathophysiological Processes
Pathophysiological conditions of T2DM develop as a result of impaired insulin secretion as well as because of insulin resistance (Kahn, Cooper, & Prato, 2015). Once the pancreas is exhausted, it will stop to secreting insulin and this result in a decrease in glucose responsiveness. This may lead to pathophysiological changes in the body. When untreated, it may cause a decrease in pancreas ? cell function (Kahn, Cooper, & Prato, 2015). As the function of pancreatic ? cell continues to deteriorate, a permanent elevation of blood glucose may occur.
With regard to insulin resistance, impairment of insulin can, in turn, affected major organs such as the muscles and liver (Kahn, Cooper, & Prato, 2015). In the early phases after the onset of T2Dm, patients mainly show an increase in postprandial blood glucose. However, as the condition progresses, the pancreas will fail, and this can result in many clinical manifestations and complications if the condition is not addressed timely and adequately
Clinical Manifestations and Complications
Some of the signs and symptoms of T2DM include “weight loss, polyuria, polydipsia, polyphagia, constipation, fatigue, cramps, blurred vision, and candidiasis” (Baynest, 2015). However, patients can have T2DM for five years without showing any signs and symptoms. The signs usually contribute to the diagnosis of T2DM. If the signs and symptoms are not treated, the patient with T2Dm is susceptible to microvascular complications. The individual suffering from T2DM is susceptible to macrovascular disease such as heart disease and coronary artery disease (Baynest, 2015). Other complications that may results if the signs and symptoms of T2DM go untreated include impaired growth, non-alcoholic fatty liver disease, and development, associated autoimmune conditions such as celiac disease and hyperthyroidism, and (Baynest, 2015).
Diagnostics (Lab and Diagnostic Tests)
The identification of a patient with T2DM allows for earlier intervention. A physician usually diagnoses diabetes by testing sugar level in the blood. Most of the laboratory and diagnostic tests require the patient to fast overnight before being tested. Typically, the sugar level in the blood even after fasting ought to range between 70 and 100 mg/dl. Diabetes is diagnosed if blood sugar levels exceed 125 milligrams per decilitre. The primary physician care will then examine the patient and look for obesity, high blood pressure, decreased sensation in the legs, and blisters. There are numerous laboratory tests used to evaluate diabetes. Some of the laboratory tests used include random plasma test, fasting plasma glucose test, and an oral glucose tolerance test (Baynest, 2015).
Random plasma test is one of the simplest tests used to diagnose T2DM. Usually, the patient is required to fast overnight before taking the test. If the blood sugar level exceeds 200 milligrams per decilitre, there are higher chances that the individual has diabetes, but this has to be reconfirmed (Baynest, 2015). With regard to the fasting plasma glucose test, the patient is required to observe fasting for 8 hours before taking the test. The patient ought to be tested twice or more on different days. If the glucose is more than 126 milligram per decilitre, then the individual being diagnosed has diabetes (Baynest, 2015). Oral glucose tolerance tests are used to evaluate the body's response to glucose. Before undergoing the test, the patient is required to observe fasting for 8 hours but nor more than 16 hours. After fasting, the test is conducted to determine the glucose level. Then, the patient is given 75 milligrams of glucose, 100 milligrams for pregnant women (Baynest, 2015). A test is then conducted to determine the glucose levels every 30 minutes or one hour for two or three hours.
Conclusion
Diabetes is becoming a serious global issue. This demands broader involvement of no-specialist physician and government in order to address this global issue. Earlier intervention and continued treatment are key to achieving treatment goals for diabetes.
References
Baynest, H. (2015). Classification, pathophysiology, diagnosis and management of diabetes mellitus. Journal of Diabetes and Metabolism, 6 (5): 1-9.
Kahn, S., Cooper, M., & Prato, S. (2015). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet, 383 (9922): 1068-1083.
Prasad, R., Groop, L (2015). The genetics of type 2 diabetes –pitfalls and possibilities. Genes (Basel), 6 (1): 87-123.
Sanghera, D., & Blackett, P. (2012). Type 2 diabetes genetics: beyond GWAS. The Journal of Diabetes & Metabolism, 3 (198): 6948.
Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004). Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care, 27 (5): 1047-1053.
