Progression of Type 2 Diabetes

In a patient with Type 2 diabetes, insulin loses its ability to inhibit glucose production, and beta cells are exposed to elevated blood glucose levels. This constant exposure to insulin leaves the beta cells unable to respond to hyperglycemia.

Peripheral insulin resistance occurs when the number of available insulin receptors in muscle and fat cells decreases. This results in higher blood glucose levels, progressively increasing the person’s requirement for insulin secretion. To reseverse the process, the person can lose weight, and to reduce blood glucose levels, she can take oral antidiabetic drugs. If these drugs, in conjunction with weight loss, don’t work effectively, the person may need insulin. She also may need insulin when she’s acutely ill or under stress.

Although the person has high blood glucose levels, she still produces enough insulin to pre vent DKA. However, she may lose fluids and electrolytes-losses that can lead to HHNK syndrome.

People with Type 2 diabetes may experience the same long-term complications as those with Type 1 diabetes. However, they’re particularly at risk for heart disease-the most common cause of death among patients with Type 2 diabetes. The hyperinsulinemia associated with Type 2 diabetes may be an important risk factor in the develop­ment of hypertension, abnormal lipid levels, and atherosclerosis.

Syndrome X is the combination of insulin resistance, hypertension, low high-density lipoprotein cholesterol levels, and increased very-low­density lipoprotein cholesterol levels. By the time most patients are diagnosed with Type 2 diabetes, they’ve had syndrome X for many years. The combined abnormalities of this syndrome increase the chances of angina, myocardial infarction, cerebrovascular accident, and peripheral vascular disease in patients with Type 2 diabetes.