Introduction to Type 2 Diabetes

Introduction Type 2 diabetes is called adult-onset diabetes, which occurs after 35 to 40 years of age, accounting for more than 90% of diabetic patients. In patients with type 2 diabetes, the ability to produce insulin is not completely lost. In some patients, insulin is even excessive, but the effect of insulin is poor. Therefore, insulin in patients is relatively lacking and can be stimulated by certain oral drugs. Insulin secretion. But in the later period there are still some patients who need insulin therapy. Causes 1. Genetic factors Like type 1 diabetes, type 2 diabetes has a more pronounced family history. Some of the genes that cause disease have been identified, and some are still in the research stage. 2. Environmental factors Epidemiological studies have shown that obesity, high-calorie diet, lack of physical activity and age are the most important environmental factors for type 2 diabetes. Hypertension, dyslipidemia and other factors will also increase the risk of illness. 3. Age factors Most type 2 diabetes develops after 30 years of age. In half of newly diagnosed patients with type 2 diabetes, the age at onset is 55 years or older. 4. Ethnic factors Compared with Caucasians and Asians, type 2 diabetes is more likely to occur in Native Americans, African-Americans, and Spanish. 5. Lifestyle intake of high calorie and unreasonable structure (high fat, high protein, low carbohydrate) diet can lead to obesity, with weight gain and lack of physical activity, insulin resistance will progressively worsen, leading to insulin secretion defects And the occurrence of type 2 diabetes. The main causes of type 2 diabetes include obesity, physical activity and stress. Stress includes stress, fatigue, mental stimulation, trauma, surgery, childbirth, other major illnesses, and the use of hormones that raise blood sugar. Due to the above incentives, the patient's insulin secretion capacity and the body's sensitivity to insulin are gradually reduced, and blood sugar is elevated, leading to diabetes. So far, we have not been able to control the genetic factors of the human body. However, we can intervene in environmental factors to reduce the prevalence of type 2 diabetes. Symptoms Some patients with type 2 diabetes are mainly insulin resistant, patients are obese, insulin resistance, insulin sensitivity is decreased, blood insulin is increased to compensate for insulin resistance, but insulin secretion is still relatively insufficient compared with patients with hyperglycemia. . The early symptoms of these patients are not obvious, only mild fatigue, thirst, and large blood vessel and microvascular complications can often occur before the diagnosis is confirmed. Dietary therapy and oral hypoglycemic agents are more effective. Another part of the patients is mainly caused by insulin secretion defects, and it is clinically necessary to supplement exogenous insulin. Diagnostics In July 1997, the American Diabetes Association presented diagnostic criteria for diabetes. 1. There are symptoms of diabetes, and random blood sugar ≥ 11.1mmol / L. Randomized blood glucose refers to blood glucose values at any given time. Typical symptoms of diabetes include polyuria, polydipsia, and weight loss without other causes. 2. Fasting blood glucose ≥ 7.0 mmol / L, fasting state is defined as no calorie intake for at least 8 hours. 3. OGTT 2 hours of blood glucose ≥ 11.1mmol / L. OGTT is still in accordance with the requirements of the WHO. A patient who does not have the symptoms of diabetes and meets one of the above criteria will be diagnosed with diabetes if he or she continues to meet one of the three criteria on the next day. In the new taxonomy, impaired diabetes and impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are hyperglycemic states, which are associated with a normal glycemic state in which glucose regulates normal. The diagnostic criteria for IGT were: 2 hours of blood glucose ≥ 7.8 mmol/L in OGTT, but <11.1 mmol/L, and IFG was fasting blood glucose ≥ 6.1 mmol/L but < 7.0 mmol/L. Diagnostic criteria for ADA diabetes in 2010: 1. Glycated hemoglobin HbA1c ≥ 6.5%. 2. Fasting blood glucose FPG ≥ 7.0mmol / L. Fasting is defined as no calorie intake for at least 8 hours. 3. Blood glucose ≥ 11.1 mmol / L for 2 hours during oral glucose tolerance test. 4. In patients with typical hyperglycemia or hyperglycemia crisis, random blood glucose ≥ 11.1mmol / L. In the absence of clear hyperglycemia, criteria 1 to 3 should be confirmed by repeated tests. Compared with the past, there are two aspects of improvement: increase the glycosylated hemoglobin index; weaken the symptom indicators, more people are included in the category of diabetes, get early diagnosis and treatment. Treatment 1. Oral hypoglycemic agents (1) Biguanides (such as metformin) These drugs have the ability to reduce the liver's glucose output and help muscle cells, fat cells and liver absorb more glucose from the blood, thus lowering blood sugar levels. . (2) Sulfonylureas (such as glimepiride, glibenclamide, gliclazide, and gliclazide) The main role of such oral hypoglycemic agents is to stimulate islets to release more insulin. (3) Thiazolidinediones (such as rosiglitazone and pioglitazone) These drugs can enhance insulin sensitivity and help muscle cells, fat cells and liver absorb more glucose in the blood. However, rosiglitazone may increase the risk of heart disease. (4) Benzoic acid derivatives (such as repaglinide and nateglinide) The mechanism of action of these drugs is similar to that of sulfonylureas, mainly to stimulate the pancreas to produce more insulin to lower blood sugar. (5) α-glucosidase inhibitors (such as acarbose and voglibose) These hypoglycemic agents can inhibit the absorption of sugar by the human digestive tract, the main role is to reduce postprandial blood glucose. 2. If insulin drugs do not control blood sugar well by changing lifestyles and using oral hypoglycemic agents, or if taking other drugs can have adverse effects, your doctor may recommend you to use insulin. At present, insulin cannot be taken orally, and can only be injected subcutaneously using a device such as a syringe or an insulin pen. The onset time and duration of action of different insulin preparations are also different. The patient needs to choose the type of insulin appropriate to his current condition under the guidance of a doctor and establish an appropriate insulin injection time. In order to achieve the best blood sugar control effect, it is sometimes possible to pre-mix a variety of insulins for injection. Usually, the frequency of insulin injection is 1 to 4 times/day. By losing weight and strengthening exercise, some people with type 2 diabetes find themselves no longer need medication. Because they can control their blood sugar through their own insulin secretion and dietary regulation when their body weight reaches the desired range. It is unclear whether it is safe for pregnant women to take oral hypoglycemic drugs. Female patients with type 2 diabetes may need to stop taking oral hypoglycemic agents and inject insulin during pregnancy and lactation.