Type 2 diabetes

Incidence of diabetes In Finland about 40 000 patients with type 1 diabetes 160 000 type 2 patients (according to National Public Health Institute)

Progression of disease The type 2 diabetes -result of decreased secretion of insulin in beta-cells in pancreas -insulin resistance When there is not enough insulin in the blood, blood glucose levels rise → insufficient insulin for glucose uptake by others cells such as muscle, fat etc.

Progression of disease Insulin resistance -insulin has lost its ability to absorb glucose The disease is for a long time symptomless Symptoms -feeling of thirst, fatigue, increased urination, blurred vision

Long term complications of diabetes Neuropathy (damage to neurons, weakened vision, numbness, tingling, impotence) Nephropathy (renal failure, protein in urine) Foot problems -foot infections and amputations

Oral Medicines 1. Metformin -reduce hepatic glucose production -strengthen insulin’s activity 2. Rosiglitazone and pioglitazone -treat insulin resistance

Oral Medicines 3. Sulphonyurea drugs act by stimulating the pancreas to release more insulin -Chlorpropamide -Glipizide -Glyburide

Oral Medicines 4. Alpha-glucosidase inhibitors -delay the absorption of carbohydrates in the gut by inhibiting alpha-glucoside enzymes -Acarbose -Miglitol 5. Guar gum -a water-soluble fibre -delays the absorption of food -lower cholesterol levels

Insulin

Insulin 6. Insulin -injecting under the skin (subcutaneous fat) Different kinds of insulin preparations -short-acting -long- and very-long acting Insulin medication will be started if dietary changes and oral medicines don’ t work enough to normalize patient blood glucose levels

Lifestyle factors 7. Diet -Most type 2 diabetes patients are overweight -Low fat, low sugar, low salt and plenty of fibre -Losing weight improves insulin activity 8. Exercise -exercise decreases insulin resistance

Lifestyle factors 9. Smoking -nicotine increases insulin resistance 10. Alcohol -induces hypoglycemia by preventing gluconeogenesis (liver produces glucose from non-sugar components) -stimulates excretion of insulin

Unbalanced treatment Hypoglycemia -blood glucose levels have decreased below 3 mmol/l -Insulin, alcohol and oral medicines that intensify body’s sensitivity to insulin can cause this condition -Symptoms -shakiness, dizziness, sweating, irritability, headache, numbness around the mouth, weakness, pale skin and clumsy or jerky movements -in worst case patient can pass out and enter shock -Treatment -drink orange juice or eat sugar immediately if patient is conscious

Unbalanced treatment Diabetic ketoacidosis -a lack of insulin -blood glucose levels have risen and body has started to produce keto acid from fatty acids and amino acids. Symptoms -dry mouth, upset stomach and vomiting, shortness of breath, breath that smells fruity and decreased consciousness -body’s pH has decreased to under 7.3 and -can be treated by giving insulin

Conclusion Treatment for type 2 diabetes -healthy diet -exercise -non-smoking -medicines