Type 2 Diabetes Mellitus Without Complications:
This can bring about issues with your heart rate, blood pressure, digestive system, bladder, sex organs, sweat glands, and eyes. Diabetic retinopathy, or eye disease, can cause vision loss and blindness. High blood glucose levels can damage your retina, leading to conditions such as cataracts and glaucoma and damage to the retina’s blood vessels, potentially leading get redirected here to blindness. A person may also take diabetes medications or insulin to manage their blood glucose levels and reduce their risk of complications. At present, some clinical evidence for acupuncture improving type 2 diabetes related complications mainly focuses on diabetic peripheral neuropathy [147,148,149,150,151] and diabetic gastroparesis [152, 153].
Patients are typically treated with a second-generation sulfonylurea starting at a low dose. If the patient has not achieved glycemic goal after four weeks of therapy at a maximal sulfonylurea dose, sulfonylurea therapy should be considered inadequate. However, metformin has negative side effects and may not be tolerated by some patients. Initiate Metformin, along with lifestyle modifications, as first line pharmacologic agent for type 2 diabetes. Please place a referral to diabetes education if you are wish to order an insulin pump or CGM for your patient.
Diagnosis is made by (1) an A1c =6.5%, (2) a fasting glucose =126 mg/dL, (3) a 2h post 75 gm glucose load glucose of =200 mg/dL, or (4) a random glucose =200 mg/dL with symptoms, confirmed by a repeat or second test. An abbreviated differential diagnosis of diabetes is shown in Table 2. It is important to recognize diabetes types due to insulin deficiency as the pathophysiology directs treatment recommendations. An A1c of =6.5%, confirmed by second test, is diagnostic of diabetes.
Most insurance plans, including Medicare, cover therapeutic footwear for patients with diabetic neuropathy or deformity. For others with less deformity, athletic shoes with sufficient room for the toes and forefoot and cushioned socks are appropriate. All patients require education regarding optimal foot and nail care, which includes daily inspection and appropriately fitting shoes. To minimize the risk of trauma, patients should be counseled to avoid walking barefoot and those with neuropathy should avoid high-impact exercise and the use of hot water. Other antihypertensives (including beta-blockers and non-dihydropyridine classes of calcium-channel blockers (NDCCB) can reduce the level of albuminuria, but no antihyptertensive studies to date have demonstrated a reduction in the rate of fall of GFR. Some members of the dihydropyridine class of calcium channel blockers (eg, nifedipine, felodipine) may increase urinary albumin excretion, and should be avoided in patients with microalbuminuria.
Healthy blood sugar (glucose) levels are 70 to 99 milligrams per deciliter (mg/dL). If you have undiagnosed Type 2 diabetes, your levels are typically 126 mg/dL or higher. People with type 2 diabetes can typically manage the condition with lifestyle changes and medications. However, some people will require insulin treatment if their diabetes does not respond to look at this these medications. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), people with diabetes commonly develop heart disease at younger ages than people without diabetes. To evaluate the micromechanical properties of the femoral neck trabecular bone, we utilized a Vickers microhardness tester (HMV-G version, Schimadzu, Japan).
Any infection that develops tends to be more severe and takes longer to resolve in people with diabetes. For further information regarding care of patients with chronic kidney disease, see the UMHS clinical guideline on Chronic Kidney Disease. Regardless of initial agent, most patients with type 2 diabetes will require multiple agents in order to achieve their blood pressure goal. Indeed, many patients will not achieve their goal even with the use of 3 or 4 agents. Further evaluation for secondary causes of hypertension should be considered in these patients. The majority of patients with diabetes and HTN have essential hypertension.
Check electrolytes and kidney function before and again 8 weeks after initiation of SGLT2 inhibitors. If adequate glycemia cannot be achieved, metformin is the first-line therapy. Following metformin, many other therapies such as oral sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors. Glucagon-like peptide-1 (GLP-I) receptor agonists, Sodium-glucose see co-transporter-2 (SGLT2) inhibitors, pioglitazone, especially if the patient has fatty liver disease, alpha-glucosidase inhibitors, and insulin, are available. Recent studies have shown that the SGLT2 inhibitor, empagliflozin (EMPA), and the GLP-1 receptor agonist, liraglutide, reduce significant cardiovascular (CV) events and mortality.
For DBP, a target of =90 and likely =80 mmHg provides marked benefits. The addition of basal insulin including NPH, or one of the long-acting insulins, to oral medications is a common approach especially for those who have had diabetes for a longer duration of time. Once daily glargine therapy has become increasingly popular due to its convenience, lack of an insulin peak, and 24-hour duration of action. However, because long-acting insulin effects on glycemia are relatively constant throughout the day, this approach may make it difficult to address both nocturnal hypoglycemia and inadequately controlled post-prandial hyperglycemia simultaneously.
Low-dose thiazide diuretics (eg, 12.5 to 25 mg of hydrochlorothiazide or mg chlorthalidone) do not appear to have clinically important adverse effects, and have been proven to reduce mortality in patients with diabetes. The choice of first-line antihypertensive drugs for patients with diabetes is controversial and not entirely based on the available literature. That result held across all subgroups, including patients with diabetes. The ADA guidelines recommends Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs) as first-line therapy for hypertension in patients with established coronary artery disease and diabetes (HOPE trial). Hypoglycemia is linked with increased risk of mortality thus outweighing the potential benefits on microvascular complications in some patients.
Patients who have been diagnosed with retinopathy should be screened at least annually, and many will require much more frequent examination depending on the degree of retinal abnormality. Patients have a low risk of developing retinopathy that will require treatment over the short term if they have no retinopathy on a baseline retinal exam by an expert and have both reasonable glucose and blood pressure control. These patients can be screened less frequently, at 2 year intervals.
In people with insulin resistance, the pancreas “sees” the blood glucose level rising. The pancreas responds by making extra insulin to maintain a normal blood sugar. ACE inhibitors and ARBs reduce progression of established diabetic renal disease and reduce cardiovascular mortality (HOPE trial). Thus, ACE inhibitors or ARBs are recommended as first-line therapy in patient with albuminuria (urine albumin-to-creatinine ratio [UACR] =30 mg/g). An important note is that the combination of ACE inhibitors and ARBs should be avoided.
At this stage, your diabetes has led to vascular (blood vessel) problems. You may have damage to vessels in your eyes (retinopathy), kidneys (nephropathy), and certain nerves (neuropathy). You might also develop heart disease, stroke, or circulation issues. If a person follows these steps, they can reduce their risk of developing certain complications, including heart disease, nerve damage, and mouth problems. With prediabetes, the risk of conversion to diabetes increases, but this can be reduced by active intervention [7,8,9,10,11]. Myocardial strain, which represents the percent change in myocardial length from a relaxed to a contractile state, may be evaluated using echocardiography or cardiovascular magnetic resonance (CMR) imaging.