Type 2 diabetes is characterized by high blood glucose levels due to the body becoming resistant to insulin or not producing enough insulin. It accounts for 90% of diabetes cases and risk factors include family history, obesity, poor diet, and lack of exercise. Symptoms may include increased thirst, hunger, fatigue, and blurred vision. Untreated diabetes can lead to serious complications affecting the eyes, kidneys, heart, nerves, and feet. Treatment involves lifestyle changes like diet and exercise as well as medications to lower blood glucose levels such as metformin, glipizide, and insulin injections if needed.

1. HUC103 Introduction To Pharmacology
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Type 2 Diabetes
Introduction
Diabetes mellitus, a highly complex metabolic disorder is characterised by high levels of
glucose in the blood, which may further leads to damaging organs like eyes, herat, nerves
and kidneys. Diabetes is primarily of two types – type 1 and type 2. T2DM also know as
adult diabetes or non-insulin-dependent diabetes mellitus (NIDDM) affects the blood sugar
levels of the human body. It accounts for approximate 90% of diabetes cases and develops
when there is insufficient insulin secretion by pancreatic islet beta-cells or due to cell
insulin resistance or due to an in-sufficient insulin secretory response.
Insulin, a hormone plays vital role in carbohydrate metabolism and helps in the
transportation of the sugar from the blood stream to the body's cells for use as energy.
However, if the sufficient insulin is not synthesized or body becomes insulin resistance, the
sugar starts accumulating in the blood stream thereby resulting in high blood sugar/glucose
levels or hyperglycemia. This increase in blood sugar levels can wreak havoc on your body,
affecting multiple systems such as the circulatory system, endocrine system, nervous
system, excretory system and ocular system.
In a healthy body, the pancreas releases a hormone named insulin which assists in
converting blood glucose into energy that is fed to our cells and/or stored in our muscles,
fat tissue, and liver for later use. After any meal, the blood sugar level increases which
causes the pancreas to release insulin into our blood system. Insulin interacts with the cells,
causing them to open and consume the sugar. When the sugar is consumed by the cells, it is
converted into glucose for energy or stored for later use.
Because of insulin deficiency and/or resistance, someone with T2DM body is unable to use
or store glucose for energy, the glucose remains in the bloodstream and result in
hyperglycemia. Increased thirst, increased urination, loss of vision, and poor wound healing
are among the most frequently occurring symptoms of hyperglycemia. Over time, untreated
or poorly controlled hyperglycemia will cause nerve, organ and damage to blood vessels. In
fact, people with poorly controlled hyperglycemia are more likely to develop heart disease,

2. renal failure, loss of vision, and lower limb amputations.
Epidemiologic Data
Globally, the T2DM prevalence vary greatly by ethnic background and geographical area.
The Hispanics, Japanese and Native Americans demonstrate high risk of diabetes. Moreover,
compared to white populations (America and UK), the Asians and black population have a
higher incidence rate (Galicia-Garcia et al., 2020).
According to the reports by CDCP (Centers for Disease-Control-and-Prevention) about 29.2
million people in the US were diabetics in the year 2014. Among these, 21 million were
diagnosed and included both men and women in the age group above 20 yrs. However,
8.1million were not diagnosed (Centers for Disease Control, 2014). Also, 95% were
diagnosed with T2DM. It is accepted that by 2050, the prevalence will elevate to about 25-
28 percent, with a devastating 33 percent increase in mortality, if issue remained unsolved
(Centers for Disease Control, 2014).
Fig 1: Registered diabetic patient in England from 2008/09 - 2017/18 (Statista, n.d.)
Awareness And Management Of T2dm
Recommendations and clinical practise guidelines are critical to improving population
health. The need for effective practise strategies has been emphasised as the prevalence of
T2DM continues to rise in the United States and around the world. According to the
American Diabetes Association (ADA), individualised diabetes care should guide clinical
practise in order to achieve the best results. The ADA highlights three themes that
policymakers, advocates, and clinicians have to keep in mind. These include patient-
centeredness, diabetes across the lifespan, and diabetes patient advocacy (ADA, 2016).
Multidisciplinary collaborative teams are best suited to caring for patients with chronic
conditions such as diabetes while also facilitating patient self-management (ADA, 2016).
Using explicit goal setting strategies with patients, appropriate and timely intensification of
pharmacological therapy and lifestyle would be prioritised. In addition, it is important
to identify and address numeracy, language, and cultural barriers to care, while
incorporating clinical information tools and evidence-based guidelines into care processes.
All of these strategies have been shown to improve behaviour among care providers and
management teams while also lowering blood pressure, A1C, and LDL cholesterol. Diabetes
management is based on education, and it is critical to educate the patient on diabetes self-
management and support their efforts to change behaviour. National and international
diabetes self-management education standards call for integrated approaches that include
clinical skills and content, behavioural strategies such as problem-solving and goal setting,
and engagement of psychosocial concerns (Day, 2018). Educate the patient on the disease

3. process, nutritional plans, treatment options, exercise plans, blood glucose monitoring,
knowledge of the prescribed medication, individual health promotion strategies, and
psychosocial issues based on the needs assessment. Guidelines recommend hypocaloric
diets for obese or overweight people in order to achieve clinically significant weight loss
and maintain normal body weight (Day, 2018). ADA (2016)
Type 2 Diabetes Treatment
Metformin is the most commonly prescribed oral medication for people with type 2
diabetes. Metformin works in the body by restoring the body's proper response to the
insulin it naturally produces. It is also known to reduce the amount of sugar produced by
the liver and absorbed by the stomach and intestines. One cause of high blood sugar levels is
that the cells of the body have become resistant to the insulin produced by the pancreas.
Metformin aids in the re-establishment of communication between insulin and the body's
cells. Once the treatment begins, the insulin will naturally remove the sugar/glucose from
the bloodstream and feed/store it in the cells of the body, preventing hyperglycemia.
Glipizide is another type of oral medication used to treat type 2 diabetes. Glipizide works by
instructing the pancreas to produce more insulin when it is unable to do so on its own.
Some people develop type 2 diabetes because their bodies do not produce enough insulin,
but glipizide eliminates this problem. Once the pancreas resumes normal insulin
production, blood sugar levels will return to normal, and sugar/glucose will be removed
from the bloodstream at the normal rate.
Insulin injections are another type of treatment for type 2 diabetes. Insulin injections are
used to supplement insulin levels in the body when the body's insulin production is low or
non-existent. Insulin injections assist in maintaining the body's insulin levels in
homeostasis, thereby keeping blood sugar levels at a safe normal level. Individuals may be
prescribed one or more of the following types of insulin, depending on the severity of their
body's insulin production levels: rapid acting, short-acting, intermediate-acting and long
acting. The peak effective levels of these various insulins differ. If a person has extremely
high blood sugar levels, especially after meals, they may be prescribed a rapid-acting
insulin, which lowers blood sugar levels faster than the other three insulins. Other people
who can produce their own insulin but at a slower rate than normal may be prescribed an
intermediate to long-lasting insulin that works throughout the day. Once an insulin
treatment regimen is initiated, it must be closely and routinely monitored with blood sugar
readings throughout the day. Blood sugar readings will tell you how effective your
treatment plan is. When insulin is introduced into the body, it removes sugar/glucose from
the bloodstream, restoring blood sugar levels to normal. However, if too much insulin is
introduced into the body, it can remove too much sugar/glucose from the body, resulting in
hypoglycemia and, in the worst-case scenario, hypoglycemic shock.
Signs/Symptoms Of Type 2 Diabetes

4. Diabetes has become a growing epidemic. T2DM can strike anyone at any time, but there
are some people who are more likely to develop the disease. Overweight or obesity is
frequently regarded as a precursor to pre-diabetes, which is frequently regarded as a
precursor to T2DM. The transition from being overweight or obese to having T2DM can
take many years. However, T2DM can occur in non-obese adults, children and adolescents
also. Evidence suggests that there is most likely an inheritance factor in the development of
T2DM, but the precise genetic concern associated with T2DM have yet to be determined.
Non-alcoholic fatty liver disease (NAFLD), particularly non-alcoholic steatohepatitis
(NASH), is another significant risk factor. NAFLD is defined as excessive fat storage in the
liver in people who drink alcohol infrequently.
The signs of the T2DM can be very mild to severe. Some of the important symptoms are
listed below:
Extremely thirsty
Blurry vision due to excessive peeing
Being irritable
Numbness or tingling in your hands or feet
Tiredness/a sense of exhaustion
Non-healing wounds
Yeast infections that keep reappearing
Feeling peckish
Weight loss without exertion
Prone to various infections
Causes Or Risks Of Type 2 Diabetes
People withT2DM produce insulin, but their cells do not utilise it as effectively. Initially
the pancreas produces more insulin in an attempt to get glucose in to the cells. But it can't
even keep up forever, and the glucose helps build up in the bloodstream rather. T2DM is
usually caused by a combination of factors as given below
Genes - According to studies DNA can influence the production of insulin in the body.
Weight - Weight gain can lead to insulin resistance, particularly if extra weight all over your
abdomen.
Metabolic syndrome - Insulin resistance is linked to number of conditions, including high
blood sugar, extra fat around the waist, hypertension, and high lipid profile.
Excess glucose from liver - On consuming diet the blood sugar increases, the liver slows
down and start storing glucose for later use. However, sometimes the liver do not store
resulting in conti nue to produce sugar.

5. Broken beta cells - When the cells that produce insulin send out the incorrect amount of
insulin at the incorrect time, your blood sugar levels are thrown off. High blood sugar levels
can also harm these cells.
Of the various risk factors for T2MD, including a family history of diabetes, inactiveness and
age, obese is the major concern. This is due to the reason that the cells become more insulin
resistance if more fat tissue is there throughout the body especially the abdomen.
Inactivity is another risk factor. This is due to the reason that if the glucose so converted to
energy is not been utilized by the body will result in its conversion to fat and thereby the
person gain weight. A person with family history of T2DM has more chances of acquiring
T2DM.. The risk of T2DM increases with increase in age as the older people perform less
physical activity and thereby gain weight.
Fig 2: Complications of T2DM
If the T2DM remained uncoltrolled can lead to severe complications as shown in the fig.
2. The complications can be either long term complications like diabetic retinopathy,
nephropathy, diabetic neuropathy and macrovascular problems or can be short-term
complications which include hypoglycemia and hyperosmolar hyperglycemic nonketotic
syndrome.
References
American Diabetes Association. (2016). 1. Strategies for improving care. Diabetes care,
39(Supplement 1), S6-S12.
Centers for Disease Control. (2014). National diabetes statistics report 2014. Retrieved from
https://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
Day, C. (2018). Reflections from IDF 2017. British Journal of Diabetes, 18(1), 36-37.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B.,
Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International
journal of molecular sciences, 21(17), 6275.
https://doi.org/10.3390/ijms21176275