Diabetes 1

Type 2 Diabetes

Tim Kirchner

tkirchne@utk.edu

000240729

Nutrition 302

Dr. Zemel

05 March 2009
 Diabetes 2

Type 2 diabetes is a chronic disease that inhibits cells from utilizing glucose from the

blood. Insulin, which is secreted from the pancreas, is either deficient in amount or simply

cannot be utilized. The reason type 2 diabetes is referred to as Adult on-set diabetes is because it

is normally developed in people over 40, however there are cases of younger people who

develop this disease (1). Type 2 diabetes is now accountable for 25 to 30 percent of people

within 10 to 19 years of age (2). This is a very serious disease that deserves attention because 90

percent of people with diabetes have or develop type 2 diabetes and as of now researchers do not

know exactly what causes this chronic illness (1).

It is important to be checked for diabetes because about a third of Americans with

diabetes remain undiagnosed and receive no medical care (2). There are three different

procedures doctors use to screen for diabetes, all of which include measuring the patients plasma

glucose levels (2). There is a random plasma glucose test, oral glucose tolerance test (OGTT),

and a controversial A1C test. The random plasma glucose test uses symptoms of hyperglycemia

and a random plasma glucose level greater or equal to 200 mg/dl as criteria for diagnosis. It does

not account for when the patient consumed their last meal. The OGTT requires a patient to fast

for at least 8 hours and is diagnosed if plasma glucose levels are at or above 126 mg/dl. The

A1C test utilizes a glucose load equivalent to 75 grams anhydrous glucose dissolved in water and

is diagnosed after 2 hours with a plasma glucose level higher than or equal to 200 mg/dl. The

A1C is controversial because during a study it was only sensitive to about 68 percent of

diagnosed patients. Both the A1C and OGTT should be confirmed by taking the test again on a

different day (2). The sooner a patient is diagnosed after developing this disease the better

because people living with the disease may be causing subsequent harm to their body as a result

of untreated type 2 diabetes (1).

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Classification of the disease is the next step after diagnosis so that doctors can

differentiate between the various forms present. Type 2 diabetes has been called adult on-set

diabetes as well as non-insulin dependent diabetes (3). Understanding the etiology, or causation

of a disease, is important so that the disease can be prevented; however, the etiology of type 2

diabetes is unclear. “In the vast majority of patients with type 2 diabetes, no single genetic

defect has been elucidated to explain the etiology of this process; thus, the disease may result

from combined effects of multigenic, heterogeneous, complex, and related causes” (3). With

that being said, there have been many advances in monogenic diabetes and identifying the

problematic genes causing the single cell disorders. Researchers have discovered that beta-cell

genes are the type of monogenic diabetes genes found in most cases. Some examples of beta-

cell dysfunctions in monogenic diabetes are: reduced β-cell number, pancreatic aplasia, reduced

β-cell development, reduced metabolism, reduced glucose sensing, failure to close potassium

channel, endoplasmic reticulum stress, and several others. The ultimate benefit of this research

and discovery is that it has altered treatment.

The best example of pharmacogenetics has been in the treatment of

patients with Permanent Neonatal Diabetes Mellitus (PNDM)

resulting from mutations in…Katp channel. These patients

frequent ketoacidosis and no detectable endogenous insulin

secretion, and therefore insulin injections are the only treatment

option. Insulin treatment is difficult in a young child, and

outstanding glycemic control is rarely achieved. Finding one-third

of patients with PNDM had mutations in the Kir6.2 channel that

reduced channel closure in response to ATP led to the possibility

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of treating these patients with sulfonylureas that close the channel

by an ATP-independent route. It was then possible to replace

insulin injections with high-dose oral sulfonylureas in 90 percent

of patients and also to achieve improved glycemic control without

an increase in hypoglycemia (4).

Inflammation has even been considered a main cause in the pathogenesis of metabolic

abnormalities particularly targeting therapies for diabetes (5). While research has made

wonderful discoveries it is still hard to pinpoint what the underlying cause of type 2 diabetes is

because it is probably caused by multiple factors.

There is a multitude of reasons and risk factors that may lead to the development of type

2 diabetes. Understanding and recognizing these risks may give people their best chance to

avoid or receive the best care for this disease. Some major risk factors include individuals who

are overweight or obese, hereditary and genetic causes, and pregnant women (1). Overweight

and obese individuals generally are associated with a sedentary lifestyle where they receive little

physical exercise. Participating in regular physical activity directly improves insulin sensitivity

which will delay or even prevent development of type 2 diabetes in those at risk. For patients

diagnosed with type 2 diabetes regular exercise will allow them to reduce insulin dosage or even

the need for it along with several other cardio vascular benefits (3). Another group at risk is

family members in an individual’s direct family who have developed the disease. This disease is

hereditary because of certain genetic factors which those factors also explain why Hispanic,

African American, and Native American people are at a higher risk (1). Pregnant women who

develop gestational diabetes are 5 to 10 percent more likely to develop type 2 diabetes. 50

percent of women who do develop type 2 out of gestational usually do so within 10 years. The
 Diabetes 5

baby’s birth weight and need for a first delivery cesarean section are related to development of

the disease (2). Mothers who give birth to a baby weighing more than 9 pounds are at greater

risk (1). Knowing who is at risk and being aware will give a person insight into how to prevent

this disease from occurring; however, if it should develop that person will be better informed on

how to live with type 2 diabetes.

Living with type 2 diabetes will require several lifestyle modifications in a person’s day

to day routine. At first diagnosis it is normal for people to have an overflow of emotions and

anxiety about all the changes in their life. It is important to seek support from family and

friends, but most importantly from health care professionals. One example of a professional

would be a CDE, or Certified Diabetes Educator. These people are specialized in medications,

monitoring, biological changes, complications, and they must stay current on their certification.

Some daily changes will include eating healthy foods, weight control, physical activity, taking

prescribed drugs, testing blood glucose levels, and getting regular checkups (1). When

diagnosed with type 2 diabetes dietary management becomes a huge part in living a healthy life.

Patient education is extremely important so that they may be successful in adjusting their diet.

The guidelines are similar to that of all people such as providing adequate calories to maintain

healthy weight, lowering LDL cholesterol while raising HDL cholesterol, and reduce blood

pressure. One important guideline different is for patients to “balance intake, activity, and

medical therapies to normalize fasting glucose and minimize postprandial excursions” (3).

Although the guidelines are general each meal plan for each patient must be personalized

because nutritional goals are influenced by the heterogeneous nature of the disease. Differences

in insulin secretion capacity, insulin resistance, personal characteristics, and cultural background

are a few factors that must be assessed when prescribing a dietary modification (2). Glycemic
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control is another huge change in the daily life of someone diagnosed with type 2 diabetes.

Glycemic control is so important because of the progressive nature of the disease. As

complications occur patients must adapt to increased intervention of the disease. At first most

patients with type 2 diabetes were participating in either drug therapy or insulin therapy with

most taking the insulin. Now it is becoming the trend for combination therapy with insulin

introduced early to form tight glycemic control (3). Glycemic control is also managed by a

patient’s diet, which was mentioned earlier as a lifestyle change. One study sought to prove that

a low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized

clinical trial in individuals with type 2 diabetes. The study had two groups, one group followed a

diet whose guidelines were set out by the American Diabetes Association (ADA), and the other

group was assigned a low-fat vegan diet. Both groups reduced diabetes medication, lowered

body weight, and lowered LDL cholesterol. However, the vegan diet saw better results with

6.5kg of body weight loss compared to the ADA group of 3.1kg, and LDL cholesterol fell 21.2

percent in the vegan group versus 10.7 percent in the ADA group. Both are exceptionally good

diets for individuals diagnosed with type 2 diabetes, but the vegan diet will show greater results

for most people (6). Lifestyle changes are absolutely necessary for individuals diagnosed with

type 2 diabetes, but with education and research it is manageable.

With type 2 diabetes being one of the most prevalent chronic diseases in the United

States, with rates climbing, research for interventions is absolutely crucial. Modern medical

advances has shed some hope for the future by the means of medicine and introducing

supplements into the diet. “Many of the new oral agents do not cause hypoglycemia when used

alone, making early and more intensive treatment safer” (2). One group of researchers studied

the “Clinical Efficacy of Magnesium Supplementation in Patients with Type 2 Diabetes.” The
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study was based on the effects of magnesium supplementation on 9 patients diagnosed with a

mild case of type 2 diabetes all of which had stable glycemic control. The magnesium

supplementation was derived from water out of a salt lake with a magnesium content of about

7.1 percent. The study found that with magnesium supplementation all of the participants

reduced both diastolic and systolic blood pressure, also insulin resistance was decreased. The

team concluded that supplementation of salt lake water with high magnesium content has shown

to be clinically beneficial in patients with mild type 2 diabetes (7). Another group studied

Konjac supplementation. During a double-blind trial several doctors evaluated effects of konjac

glucomannan for 28 days on blood lipid and blood glucose levels for type 2 diabetic patients who

are hyperlipidemic. After the study the doctors found that the konjac glucomannan reduced

plasma cholesterol by 11.1 percent and blood glucose levels dropped 12.3 percent when

compared to the patients who took the placebo. The study shows that konjac glucomannan does

lower blood cholesterol and blood glucose level in patients with diagnosed type 2 diabetes (8).

The chronic disease of type 2 diabetes has become one of the most common diseases

found in the general public. This disease impacts people’s lives and forces them to deviate from

their everyday routines. Doctors have not found one determining factor for the cause of the

disease and have defaulted on that it must be a combination of factors. Therefore, it is

recommended for all people, especially those in higher risk categories, to participate in regular

screening for the disease. Understanding the groups that are at higher risk and patient teaching

on all drug, nutritional, and lifestyle changes is the best way to reduce the effects or even prevent

this disease from developing. While research continues there is still no cure for this chronic

disease, but with advancements in medicines and progressive knowledge in nutritional

supplementation type 2 diabetes is a manageable disease.

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Works Cited

1. Cave, J. (2000). Type 2 Diabetes; Your Healthy Living Guide. Toronto: Transcontinental

Printing, Inc.

2. Burant, C. F. (2008). Medical Management of Type 2 Diabetes. Alexandria: American

Diabetes Association.

3. Ronald A. Codario, M. (2005). Type 2 Diabetes, Pre-Diabetes, and the Metabolic Syndrome.

Totowa: Humana Press Inc.

4. Mark I. McCarthy, a. A. (2008). Novel Insights Arising From the Definition of Genes for

Monogenic and Type 2 Diabetes. Diabetes , 2889-2898.

5. Cefalu, W. T. (2009). Inflammation, Insulin Resistance, and Type 2 Diabetes: Back to the

Future? Diabetes , 307-308.

6. Neal D. Barnard, M. J.-M. (2006, October 23). Clinical Care/Education/Nutrition. Retrieved

March 3, 2009, from Diabetes Care:

http://care.diabetesjournal.org/cgi/content/abstract/29/8/1777

7. Kuninobu Yokota, M. M. (2004). Clinical Efficacy of Magnesium Supplementation in Patients

with Type 2 Diabetes. Journal of the American College of Nutrition , 506s-509s.

8. Hsiao-Ling Chen, R. P.-H.-S.-P.-C. (2003). Konjac Supplement Alleviated

Hypercholesterolemia and Hyperglycemia in Type 2 Diabetes Subjects-A Randomized

Double Blind Trial. Journal of the American College of Nutrition , 36-42.

Diabetes 9