Diabetes Mellitus (Type II)
Non-insulin Dependent Diabetes Mellitus, NIDDM, Adult Onset Diabetes Mellitus (AODM)
What is Type II diabetes?
Type II diabetes mellitus or NIDDM is an endocrine abnormality caused by insulin resistance or insufficient levels of insulin. Insulin is necessary for the transportation of glucose from the blood to the cells and tissues of the body.
Diabetes mellitus, of both types I and II, is the most common endocrine disorder and a serious disease of adults. NIDDM usually has a gradual onset of symptoms and is more commonly diagnosed in adulthood, usually after the age of 40. Ninety percent of all diabetic cases fall into this category. Obesity is a major factor leading to this condition, although it is not clearly understood why.
How is it diagnosed?
Type II Diabetes signs and symptoms
- Excess thirst.
- Increased appetite.
- Frequent urination.
- Decreased resistance to infection, especially urinarytract infections and yeast infections of the skin, mouth or vagina.
History: Individuals may report increased urination (polyuria) and excessive thirst. There is increased fluid and food consumption (polydipsia and polyphagia). The individual may complain of frequent skin infections that are slow to heal, itching, blurred vision, tingling, numbness and pain in the arms and legs. There may be a feeling of general fatigue and drowsiness. Women may experience chronic vaginal infections (vaginitis). There may be a family history of diabetes.
Physical exam: High blood pressure is present in half the cases and obesity is a common finding. Some of the physical signs of diabetes are evident after a number of years. The feet and lower legs are examined carefully for signs of ulceration and gangrene. Diabetes affects the peripheral nerves (diabetic neuropathy) with decreased sensation to pain. There may be diminished pulses in the feet. An eye exam will reveal changes in the blood vessels, bleeding, and yellow or white patches in the retina (diabetic retinopathy), all characteristics of diabetes.
Tests: Urine dipstick tests and regular urinalysis measure the amount of sugar in the urine (glycosuria-always an abnormal finding). A chemistry profile can measure the serum creatinine to determine kidney function. Common tests for NIDDM are measurements of sugar in the blood with normal eating (non-fasting blood glucose level) or after abstaining from food or fluids for twelve hours (fasting blood glucose level). The oral glucose tolerance test is frequently used to help confirm the diagnosis of diabetes. This test measures the glucose in the blood and urine for several hours after drinking a set amount of glucose. Diabetics show an abnormal rise in the blood sugar (hyperglycemia) and the appearance of glucose in the urine (glycosuria).
How is Type II diabetes treated?
Diet and exercise are the best treatment and preventive measures for those with diabetes or a family history of the disease. Individual education in weight control through diet and exercise can be a very effective combination in controlling NIDDM. Stress reduction techniques also assist in controlling NIDDM. Self-care education should include daily inspection of feet and lower extremities, daily cleansing, moisturizing, nail trimming, footwear for protection against injury and early intervention for any injuries to the lower legs and feet (including small scratches).
If diet, exercise and stress reduction aren't effective in controlling the blood sugar, the physician may need to prescribe medication to lower the blood sugar (oral hypoglycemics). Treatment includes monitoring of blood glucose levels at regular intervals by the physician and daily by the individual with a home-monitoring machine. The individual should be educated on the symptoms of and early response to hypoglycemia. The individual should have regular physical and eye exams.
Oral medicines to reduce blood sugar (hypoglycemics) may be prescribed. These are not always necessary. They can often be discontinued when body weight becomes normal.
Xenical (Orlistat), Actos (Pioglitazone), Avandia (Rosiglitazone)
What might complicate it?
Complications of NIDDM include hypoglycemia, infection, diabetic retinopathy, cataracts, diabetic neuropathy, atherosclerosis, heart attack, stroke, or kidney failure. Diabetic coma and ketoacidosis, seen in Type I diabetes, are rare in this disease.
Exercise and weight loss seem to make the body more sensitive to the action of insulin and helps control the blood glucose levels. With good control of the blood glucose and compliance with self-care, the outcome is good. Presence of complications will impact outcome.
Differential diagnosis may be Type I diabetes. Gestational diabetes seen during pregnancy may be the first sign of developing NIDDM. Diseases of the endocrine system or pancreas and reactions to certain drugs can have the same symptoms of diabetes.
Notify your physician if
- You or a family member has symptoms of diabetes mellitus.
- The following occur during treatment:
- Inability to think clearly, weakness, sweating, paleness, rapid heartbeat, seizures, coma (may indicate hypoglycemia). Seek medical help immediately!
- Numbness, tingling or pain in the feet or hands.
- Infection that does not improve in 3 days.
- Chest pain.
- Worsening of original symptoms, despite adherence to treatment.
Last updated 23 December 2011