Type 2 diabetes is gradual in onset. Early stages of insulin resistance cause a silent rise in insulin levels, as the pancreas tries to override the problem of fuel not entering the cells. This is followed by glucose intolerance in the later stages as the pancreas tires out from over-activity, and this will be seen in elevated blood sugars. This type of diabetes is very highly associated with heart disease. It is therefore essential to include checks for early heart disease:
- common carotid ultrasound to measure arterial thickening (IMT),
- exercise ECG and/or echocardiogram to measure heart function,
- blood test to measure cholesterol and other risk factors, and
- peripheral vascular doppler where necessary, to assess circulation to the legs.
Insulin resistance is believed to be caused by an excess of fat in the abdominal area. Obesity is therefore a risk factor for Type 2 diabetes. Treatment is aimed at decreasing the insulin resistance, thereby increasing insulin sensitivity so that the insulin that is produced can better enter the cell, bringing fuel with it. This can be achieved through weight loss, exercise and drugs known as insulin sensitizers, such as metformin and the glitazones.
Because onset is so gradual and symptoms may not be obvious, it is estimated that only 30% of patients with Type 2 diabetes or impaired glucose tolerance have been diagnosed.
Management of Type 2 Diabetes
Patients with Type 2 diabetes initially have to make changes to their lifestyle and diet. When diet and exercise with or without an insulin sensitizing drug such as metformin or a "glitazone" are used to control the blood glucose and normalise insulin resistance. Some of the newer drugs such as metiglinides may also be prescribed. Insulin production in the pancreas generally slows over time and treatment with insulin may eventually become necessary.
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