Diabetes Mellitus Type-II is a lifelong disease where the body does not properly use insulin to regulate blood sugar levels. Over time, high blood sugar can damage organs like the heart, kidneys, eyes, and nerves. Type-2 diabetes is usually caused by a combination of genetic and lifestyle factors like weight and diet. It is diagnosed through blood tests measuring glycated hemoglobin and fasting plasma glucose levels. Treatment involves medications, lifestyle changes like diet and exercise, and possibly surgery, to manage blood sugar and prevent complications.

1. Diabetes Mellitus Type-II

2. Introduction:
 Diabetes is a life-long disease that affects the way your body handles glucose, a
kind of sugar, in your blood.
 Your pancreas makes a hormone called insulin. It's what lets your cells turn glucose
from the food you eat into energy. People with type 2 diabetes make insulin, but
their cells don't use it as well as they should. Doctors call this insulin resistance.
 At first, the pancreas makes more insulin to try to get glucose into the cells. But
eventually it can't keep up, and the sugar builds up in your blood instead.

3. Usually a combination of things cause type 2 diabetes, including
 Genes
 Extra weight
 Metabolic syndrome

4. Signs And Symptoms:
The symptoms of type 2 diabetes can be so mild you don't notice them. In fact, about 8
million people who have it don't know it.
 Classic symptoms: Polyuria, polydipsia, polyphagia, and weight loss
 Being very thirsty
 Peeing a lot
 Blurry vision
 Being irritable
 Tingling or numbness in your hands or feet
 Feeling worn out
 Wounds that don't heal
 Yeast infections that keep coming back

5. Long Term Effects:
Over time, high blood sugar can damage and cause problems with your:
 Heart and blood vessels
 Kidneys
 Eyes
 Nerves, which can lead to trouble with digestion, the feeling in your feet, and your
sexual response
 Wound healing
 Pregnancy

6. Diagnosis:
Your doctor can test your blood for signs of diabetes. Usually doctors will test you on
two different days to confirm the diagnosis. But if your blood glucose is very high or
you have a lot of symptoms, one test may be all you need.
Diagnostic criteria by the American Diabetes Association (ADA) include the following:
 Glycated hemoglobin (A1C) test.
 Fasting plasma glucose (FPG)
 Oral glucose tolerance test (OGTT)
 Random blood sugar test.

7. Glycated hemoglobin (A1C) test:
 It's like an average of your blood glucose over the past 2 or 3 months.
 A hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic
criterion or an optional criteria.
 A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a
high risk of developing diabetes.
 Normal levels are below 5.7 percent.

8. Fasting plasma glucose:
(FPG)
 This measures your blood sugar on an empty stomach. You won't be able to eat or
drink anything except water for 8 hours before the test.
 A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal.
 A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is
considered prediabetes.
 A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher on two
separate tests, you have diabetes.

9. Oral glucose tolerance test:
(OGTT)
 For this test, you fast overnight, and the fasting blood sugar level is measured.
Then you drink a sugary liquid, and blood sugar levels are tested periodically for
the next two hours.
 A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal.
 A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates
prediabetes.
 A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate
diabetes.

10. Random blood sugar test:
 A blood sample will be taken at a random time. Regardless of when you last ate.
 A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with
classic symptoms of hyperglycemia or hyperglycemic such as frequent urination
and extreme thirst

11. Treatment
Medication therapy Lifestyle modification

12. Medications:
Agents used in diabetic therapy include the following:
 Biguanides:
It works by improving the sensitivity of your body tissues to insulin so that your body uses
insulin more effectively. Metformin also lowers glucose production in the liver.
Examples are Metformin (Glucophage, Glumetza, others).
 Sulfonylureas:
These medications help your body secrete more insulin.
Examples of medications in this class include glyburide (DiaBeta, Glynase), glipizide
(Glucotrol) and glimepiride (Amaryl).
 Meglitinide derivatives:
These medications work like sulfonylureas by stimulating the pancreas to secrete more
insulin.
Examples include repaglinide (Prandin) and nateglinide (Starlix).

13.  Alpha-glucosidase inhibitors:
They slow the digestion of food with complex carbohydrates. This keeps your blood
from shooting up after you eat.
Examples include Acarbose (Precose) and Miglitol (Glyset)
 Thiazolidinediones (TZDs):
These help insulin work better. They lower insulin resistance from your cells so your
pancreas doesn't have to work as hard.
Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones.
 Glucagonlike peptide–1 (GLP-1) agonists:
These medications slow digestion and help lower blood sugar levels, though not as
as sulfonylureas.
Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists.

14.  Dipeptidyl peptidase IV (DPP-4) Inhibitors:
These medications help reduce blood sugar levels, but tend to have a modest effect. They
don't cause weight gain.
Examples of these medications are sitagliptin (Januvia), saxagliptin (Onglyza) and
(Tradjenta).
 Selective sodium-glucose transporter-2 (SGLT-2) inhibitors:
They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the
sugar is excreted in the urine.
Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga).
 Amylinomimetics:
These agents mimic endogenous amylin effects by delaying gastric emptying, decreasing
postprandial glucagon release, and modulating appetite.
Example of amylinomimetics is Pramlintide

15.  Bile acid sequestrants:
Colesevelam is FDA approved as an adjunctive therapy to improve glycemic control in adults
type 2 diabetes mellitus.
Examples includes Colesevelam
 Dopamine agonists:
Acts on circadian neuronal activities within the hypothalamus to reset the abnormally elevated
hypothalamic drive for increased plasma glucose, triglyceride, and free fatty acid levels in fasting
and postprandial states in patients with insulin resistance.
Examples include bromocriptine

16.  Insulin: Because normal digestion interferes with insulin taken by mouth, insulin must be injected.
Often, people with type 2 diabetes start insulin use with one long-acting shot at night.
There are many types of insulin, and they each work in a different way. Options include:
Rapid acting insulins:
 Insulin glulisine (Apidra)
 Insulin lispro (Humalog)
 Insulin aspart (Novolog)
 Insulin inhaled (Afrezza)
Short acting insulins:
 Regular insulin (Humulin R, Novolin R)
Long acting insulins:
 Insulin glargine (Lantus)
 Insulin detemir (Levemir)
 Insulin degludec (Tresiba)
Intermediate acting insulins:
 Insulin isophane (Humulin N, Novolin N)

17.  These drugs allow for the use of combination oral therapy, often with improvement
in glycemic control that was previously beyond the reach of medical therapy.

18. Bariatric surgery
If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you
may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels
return to normal in 55 to 95 percent of people with diabetes, depending on the
procedure performed. Surgeries that bypass a portion of the small intestine have more
of an effect on blood sugar levels than do other weight-loss surgeries

20. Lifestyle modifications:
Healthy eating:
Contrary to popular perception, there's no specific diabetes diet. However, it's important to
center your diet on these high-fiber, low-fat foods:
 Fruits
 Vegetables
 Whole grains
You'll also need to eat fewer animal products, refined carbohydrates and sweets.
Physical activity:
Everyone needs regular aerobic exercise. Choose activities you enjoy, such as walking,
swimming and biking.. Aim for at least 30 minutes of aerobic exercise five days of the week.
Monitoring your blood sugar:
Careful monitoring is the only way to make sure that your blood sugar level remains within
your target range.

21. Problems that require immediate care:
Because so many factors can affect your blood sugar, problems sometimes arise that
require immediate care, such as:
 High blood sugar (hyperglycemia)
 Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS).
 Increased ketones in your urine (diabetic ketoacidosis).
 Low blood sugar (hypoglycemia)

22. HbA1c and FPG test reports: