- [voiceover] type ii diabetesreceives a lot of attention in the laypress as a public health threat, as it affects about 10%of the global population, and is currently the eighth most common cause of death worldwide.
as such, understanding howto treat type ii diabetes is very important becauseif it's treated properly, one can avoid nearlyall of the complications of type ii diabetes and livea happy and healthy life.
now before we dive intothe specific treatments, let's first discuss theglucose regulation pathway as it will help us to better understand the pharmacokinetics orthe mechanisms of action for the different treatmentsof type ii diabetes. now in the center here isthe blood glucose level, and as blood glucose levels increase, say after eating a meal, thisis sensed by the pancreas, and the beta cells withinthe pancreas secrete insulin
which acts on cells throughout the body to lower the blood glucose level. then as blood glucose levels decrease, this is also sensed by the pancreas, and then the alpha cells secrete glucagon which acts to raise theblood glucose levels. and one of the mechanismsby which it does so is by promoting the conversion of glycogen to glucose in the liver
which is then releasedinto the blood stream. now diabetes mellitusis a group of disorders that's caused by dysfunctionof the insulin pathway resulting in an inability tolower blood glucose levels. and as you can see by this diagram, there are two main steps that must occur for this pathway to work properly. first, insulin must be secreted by the beta cells of the pancreas.
then second, the cells throughout the body must respond to insulinfor it to have an effect. and this glucose regulation pathway can be thought of as similar to that of the temperature regulation in a building. the thermostat isanalogous to the pancreas in that it senses thechanges in temperature and sends different signals accordingly. if the temperatureincreases, then it sends
a signal to the airconditioner to turn on, which then lowers the temperature. conversely, if the temperature decreases, this is also sensed by the thermostat and it sends a signal tothe boiler and radiator to turn on, which thenraises the temperature. now once again, thereare two important steps. the thermostat must sensethe change in temperature and send a signal, which issimilar to the first step
in the insulin pathway, andsecond, the air conditioner must be able to act upon this signal in order to have an effect. so let's go back to our insulin pathway. when we think of the types of diabetes, in general we think of type i diabetes as dysfunction of the first step, and type ii diabetes as occurring due to dysfunction of the second step.
so it would make sense that the treatment of the different types ofdiabetes will be different as their underlyingmechanisms are different. in the treatment of type ii diabetes, some medications are given toincrease insulin secretion, to help overcome the resistance, and others are given to directly decrease the insulin resistance in the second step. so let's now discussthe specific treatments
for type ii diabetes and themechanisms by which they work. and we'll begin withlifestyle modifications. the first lifestyleintervention is that of proper nutrition and weight loss. regardless of one's initial weight, proper nutrition andassociated weight loss improves the body's ability to regulate blood glucose levels. and proper nutrition for type ii diabetes
includes a well-balanced low-calorie and low-carbohydrate diet. admittedly, this can bea very difficult change for many people with type ii diabetes. as it takes a great deal ofdedication and self-control. however, it is extremely important because a proper diet andweight loss have been shown to both increase insulin secretion and decrease insulin resistance.
the other lifestyle modificationis physical activity. independent of weight loss,increased physical activity has been shown to improve glycemic control through reducing insulin resistance. and the benefits of exercisebegin almost immediately, however they can be short lived if physical activity is not maintained. persisting only aboutthree to six days after the cessation of routine exercise.
so the recommendationsfor routine exercise include 30 minutes aday, five days a week, of moderate intensity aerobic activity such as walking, jogging, or biking. and the great thing aboutthese lifestyle modifications is they don't just treat type ii diabetes. a proper diet androutine physical activity will also improve one'scardiovascular function, lipid profile, as well astheir general mental wellbeing.
in addition to lifestyle modifications, there are many different medications available to treat type ii diabetes, however it can be confusingto keep them all straight. instead of discussingeach of the medications individually, let's classifythe different medications into groups based ontheir mechanism of action and how it relates to ourdiagram of glucose regulation. and we'll start witha group of medications
known as the biguanides, and i know i just saidwe won't be discussing the individual medications,however there is one exception, and that is with metformin. and this is because metformin is by far the most common biguanideprescribed for type ii diabetes. and it's also the first linemedication for the disease. now, metformin has threemechanisms of action that improve glucose regulation.
most importantly, metformindirectly increases the peripheral insulin sensitivity. it also acts by decreasing the action of glucagon in the liver. so instead of just augmentingthe insulin pathway, metformin also inhibits theopposing glucagon pathway. then lastly, although notshown in this diagram, metformin reduces intestinalabsorption of glucose which then decreases the amount of glucose
available to enter the blood stream. and fortunately, metforminis also very effective. on average, metformin can reduce someone's hemoglobin a1c by about1%, however it is important to note that individualswith liver failure can not take metforminand a small percentage of individuals who take the medication will need to stop taking it due to an adverse side effectknown as lactic acidosis.
the next group of medications have a somewhat difficult name. they are the thiazolididionesor tzds for short. similar to metformin,tzds also work to increase type ii diabetes byacting on the second step to increase insulin sensitivity, however the means by whichthey do so is different. tzds activate a receptor known as the peroxisome proliferator-activatedreceptor gamma
or ppar gamma for short. and ppar gamma is a transcription factor for multiple genes thatincrease insulin sensitivity in adipose, muscle, and liver cells. as such, by activating ppar gamma, tzds indirectly increaseinsulin sensitivity. now the next group ofmedication is the sulfonylureas which are another common groupof anti-diabetic medication. sulfonylureas inhibitthe potassium channels
on the beta cells within the pancreas and by inhibiting these channels, potassium builds up within the cell and this depolarizes the cell membrane which opens voltagegated calcium channels. this causes an influx ofcalcium into the beta cells which triggers the release ofinsulin into the blood stream. so instead of decreasinginsulin resistance, sulfonylureas treat type ii diabetes by
overcoming the insulin resistance through increased insulin secretion. the last two groups of typeii diabetes medications act upon the incretin pathway, and are therefore known as incretins. and they are the glucagon-like peptide one or glp-1 agonists and thedipeptidyl peptidase four or dpp-4 antagonists. incretins such as glp-1are hormones that have
two synergistic effects that result in the lowering of blood glucose levels. first, they directly stimulatethe release of insulin from the beta cells in the pancreas. and second, they inhibitthe release of glucagon. dpp-4, on the other hand, is an enzyme that inhibits the action of glp-1. therefore glp-1 agonists can be given to directly stimulatethis incretin pathway
to augment the insulin pathway and treat type ii diabetes. similarly, dpp-4 inhibitors can be given to indirectly augment the insulin pathway by inhibiting the inhibitionof the incretin pathway. so it's important to knowthat any of the treatments for type ii diabetes thatact upon this first step in the insulin pathway, and therefore increase insulin secretion, will therefore
also carry a risk of inducing hypoglycemia or low blood sugar levels. and the treatments that act upon this step and carry this risk includelifestyle modifications, sulfonylureas, and the incretins. and one way to decrease this risk is to take the medications with a meal. now this is just an overview of the pharmacokinetics ofthe different interventions
used to treat type ii diabetes and this is helpful for understanding how we can use medications to reverse and treat the underlyingmechanisms that cause the disease, however just understanding the mechanisms does not convey a very practical approach to treating this disease. for most individuals,treating type ii diabetes requires a combination oflifestyle modifications,
Nursing Diagnosis For Diabetes Mellitus,
potentially multiple medications, and routine care by aprimary care provider to achieve a happy and healthy life free of the complicationsof type ii diabetes.
Since you now understand how to control your condition, you are far better able to have the correct alternatives and alterations in your lifetime. Understand that these tips are only appropriate if you utilize as the majority of them as possible, and therefore you must start right now to see fast effects.
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