Type II Diabetes

1. Caused by insulin resistance (RECALL: acanthosis nigricans is associated with insulin

resistance so its probably associated with Type II DM)
a. Muscle, adipose tissue, and liver become resistant to insulin!
i. Leads to hyperglycemia
1. INITIALLY: pancreas will respond by increasing the insulin
production but it will eventually fail, leading to the low levels of
insulin
2. NOTE: therefore (from above), in type II, the insulin levels can be
HIGH or LOW depending on the stage of the disease
b. Most common form of diabetes
c. Most common in adults
i. Prevalence is rising!
ii. Becoming more common in kids
2. Risk factors:
a. Obesity
i. Central or abdominal obesity has greatest risk (apple shape)
ii. Weight loss improves glucose levels, so try to get patients to lose weight
b. Family history
i. Strong genetic component for type II!
1. Patients with first degree relatives with T2DM have a 2-3x
increased risk for developing it!
c. Certain ethnic groups are at greater risk
d. Certain medications such as some antipsychotics
3. Symptoms:
a. Many patients may initially have no symptoms!
i. Period of time where patients are asymptomatic
b. When they do have symptoms:
i. Polyuria
1. Increased frequency and increase in volume (which can lead to
dehydration)
a. Note: the increase in urine volume is due to the very high
glucose levels. Normally, our kidneys reabsorb glucose into
our body, but in Type II, the glucose levels are so high that
our kidneys cannot reabsorb all the glucose and they will
excrete it. Therefore, glucose enters in the urine and
water follows it = increased urine production
ii. Polydipsia
1. Due to increased in urine loss leading to patient feeling
dehydrated and wanting to drink more
iii. Polyphagia
1. Due to insulin resistance our cells essentially feeling more hungry
iv. Fatigue
1. Vague but can occur!
 v. Weight loss - RARE
1. JJ medicine???
vi. Vision changes
1. Blurry vision
a. Due to the osmosis from increased glucose levels
(increased water diffusion into the lens of the eyes)
2. Vision loss - Diabetic retinopathy
a. In uncontrolled diabetics
b. Very important to recognize
3. Increased infections
a. Candida vaginitis
b. Chronic skin infections
4. Delayed wound healing
4. Associated conditions that may develop (besides stroke, retinopathy, etc.):
a. Gastroparesis!!
i. “stomach paralysis” associated with long standing diabetic neuropathy, it
can cause neurons closer to the trunk like the VAGUS NERVE
(responsible for functioning of the stomach) to develop paralysis.
ii. Can cause symptoms of N/A
iii. Nerves in feet will be affected first, then later in their disease progression
they will have issues with vagus nerve damage
5. Histology:
a. Biopsy will show amyloid in pancreatic islets
6. Complications of T2DM: Hyperglycemic Hyperosmolar Syndrome (HHS):
a. Life threatening complication
b. More common in type 2 (DKA more common in type 1)
c. Very high glucose level that can be in greater than 1000!
i. Causes marked diuresis (peeing out a lot, REMEMBER WATER FOLLOWS
GLUCOSE!) which leads to severe dehydration
d. Different from DKA:
i. NO KETONES present (because there is some insulin still present in type
II! Therefore, there’s enough insulin around to prevent the formation of
ketones
ii. NO ACIDOSIS
1. Because there is no ketones!
iii. Very high serum osmolarity which can lead to CNS dysfunction (which is
more specific to HHS than DKA)
7. Symptoms, findings and treatment of HHS:
a. Symptoms:
i. Polyuria, polydypsia
ii. Dehydration
iii. Mental status changes
1. Confusion
2. Coma
b. Treatment:
i. Similar to DKA, administer insulin and IV fluids