1. Diabetes Mellitus Type 2

2. Type 2 diabetes mellitus is a disorder that disrupts the way your body uses glucose (sugar). All the cells in your body need sugar to work normally. Sugar gets into the cells with the help of a horm one called insulin. If there is not enough insulin, or if the body stops responding to insulin, sugar builds up in the blood. This is what happens to people with diabetes mellitus. There are two different types of diabetes mellitus. In type 1 diabetes mellitus, the problem is that the p ancreas (an organ in the abdomen) does not make enough insulin. In type 2 diabetes mellitus, the pancreas does not make enough insulin (the body becomes resistant to normal or even high levels of insulin, or both. This causes high blood glucose (blood sugar) levels, which can cause problems if untreated. In the United States, Canada, and Europe, about 90 percent of all people with diabetes ha ve type 2 diabetes. Type 2 diabetes is a chronic medical condition that requires regular monitoring and treatment throu ghout your life. Treatment includes lifestyle changes, self-care measures, and sometimes medicati ons. Fortunately, these treatments can keep blood sugar levels close to normal and minimize the risk of developing complications. INTRODUCTION

4. Type 2 diabetes mellitus is characterized by hyperglycemia, insulin re sistance, and relative impairment in insulin secretion. Its patho genesis is poorly understood, but is heterogeneous and both genetic f actors affecting insulin release and responsiveness and environme ntal factors, such as obesity, are important.

5. CAUSES OF TYPE 2 DIABETES 1.Genetic causes : Many people with type 2 diabetes have a family member with either type 2 diabet es or other medical problems associated with diabetes, such as high cholesterol levels, high blood pressure, or obesity. The lifetime risk of developing type 2 diabetes is 5 to 10 times higher in first- degre e relatives (sister, brother, son, daughter) of a person with diabetes compared with a p erson with no family history of diabetes. The likelihood of developing type 2 diabetes is greater in certain ethnic groups, such as people of Hispanic, African, and Asian descent. 2.Environmental conditions : Environmental factors such as what you eat and how active you are, combined with genetic causes, affect the risk of developing type 2 diabetes. 3.Pregnancy : A small number (about 3 to 5 percent) of pregnant women develop diabetes during pregnancy, called "gestational diabetes." Gestational diabetes is similar to type 2 dia betes, but usually resolves after the woman delivers her baby. Women who have ge stational diabetes are at increased risk for developing type 2 diabetes later in life.

6. TYPE 2 DIABETES DIAGNOSIS The diagnosis of diabetes is based upon your symptoms and the results of blo od tests Symptoms Before being diagnosed with type 2 diabetes, most people have no s ymptoms at all. In those who do have symptoms, the most common include :  Needing to urinate frequently  Feeling thirsty  Blurred vision

7. Laboratory tests : Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes.  Random blood sugar test : For a random blood sugar test, you can have bloo d drawn at any time throughout the day, regardless of when you last ate. If your bl ood sugar is 200 mg/dL (11.1 mmol/L) or higher and you have symptoms of hi gh blood sugar it is likely that you have diabetes.  Fasting blood sugar test :A fasting blood sugar test is a blood test done after not eating or drinking for 8 to 12 hours (usually overnight). A normal fasting blood su gar level is less than 100 mg/dL (5.55 mmol/L).  Hemoglobin A1C test : The "A1C" blood test measures your average blood su gar level over the past two to three months. Normal values for A1C are 4 to 5.6 perc ent. The A1C test can be done at any time of day (before or after eating).  Oral glucose tolerance test: Oral glucose tolerance testing (OGTT) is a test that in volves drinking a special glucose solution (usually orange or cola flavored). Your blood sugar level is tested before you drink the solution, and then again one and t wo hours after drinking it.

8. Criteria for diagnosis The following criteria are used to classify your blood sugar levels as normal, incre ased risk (blood sugar levels that are higher than normal and indicate a risk of fut ure diabetes), or diabetes. Normal Fasting blood sugar less than 100 mg/dL (5.55 mmol/L). Categories of increased risk  Impaired fasting glucose is defined as a fasting blood sugar level between 100 and 125 mg/dL (5.6 to 6.9 mmol/L).  Impaired glucose tolerance is defined as a blood sugar level of 140 to 19 9 mg/dL two hours after an oral glucose tolerance test.  A1C – persons with 5.7 to 6.4 percent are at highest risk, although there is a co ntinuum of increasing risk across the entire spectrum of subdiabetic A1C levels. At least 50 percent of people with impaired glucose tolerance eventually develop t ype 2 diabetes. Even if they don't develop diabetes, these people are at increase d risk of heart disease. Impaired glucose tolerance is very common; about 11 perc ent of all people between the ages of 20 and 74 have impaired glucose toleran ce.

9. Diabetes mellitus A person is considered to be diabetic if he or she has one or more of the following:  Symptoms of diabetes and a random blood sugar of 200 mg/dl or higher  A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher  A blood sugar of 200 mg/dL (11.1 mmol/L) or higher two hours after an oral gluc ose tolerance test  An A1C of 6.5 percent or higher The blood tests must be repeated on another day to confirm the diagnosis of diab etes.

10. Type 1 versus type 2 diabetes Doctors can usually tell whether a person has type 1 or t ype 2, but there are situations when the diagnosis is diffi cult to determine. In such cases, doctors often run additi onal blood tests

11. complications in diabetes mellitus: Diabetes mellitus is a chronic condition that can lead to complications over time. These complications can include: Coronary heart disease  which can lead to a heart attack A number of measures are important to reduce the risk of cardiovascular (heart a nd blood vessel) disease. ●Quit smoking. ●Manage high blood pressure with lifestyle modifications and/or medication ●Have a blood test to measure cholesterol and triglyceride levels, and modify the diets if needed. Some people will also need a medication to lower their low-den sity lipoprotein (LDL) (“bad cholesterol”) or triglycerides.

12. If medication is needed, a statin drug should be included whenever possible. The statin drugs have been shown to decrease the future risk of heart attacks, strok es, and death in people with diabetes who are over age 40 years, even when ch olesterol levels are normal. The initiation of statins should be based upon cardiovascular risk rather than an LDL cholesterol level. Statins are recommended for anyone with clinical cardiova scular disease or over age 40 years, regardless of baseline lipid levels. For patien ts without clinical cardiovascular disease and under age 40 years, statins can b e added (in addition to lifestyle intervention) if there are multiple cardiovascular dis ease risk factors. The intensity of statin therapy can be adjusted based upon side eff ects, tolerability, and LDL cholesterol levels. The American Diabetes A ssociation (ADA) recommends that people with diabetes have an LDL cholesterol le vel less than 100 mg/dL (2.59 mmol/L) Some studies suggest lowering LDL even fu rther, to 70 to 80 mg/dL(1.81 to 2.07 mmol/L).

13. Cerebrovascular disease  which can lead to stroke Retinopathy (disease of the eye)  which can lead to blindness Nephropathy (disease of the kidney)  which can lead to kidney failure and th e need for dialysis Neuropathy (disease of the nerves)  which can lead to, among other thing s, ulceration of the foot requiring amputation