Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. It is often managed by engaging in exercise and modifying one's diet. It is rapidly increasing in the developed world, and there is some evidence that this pattern will be followed in much of the rest of the world in coming years. The CDC has characterized the increase as an epidemic.^[1] In addition, whereas this disease used to be seen primarily in adults over age 45, in contrast to Diabetes mellitus type 1, it is now increasingly seen in children and adolescents, an increase thought to be linked to rising rates of obesity in this age group. ^[2] Not to be confused with inulin. ... This article is about the disease that features high blood sugar. ... Structure of the coenzyme adenosine triphosphate, a central intermediate in energy metabolism. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... In epidemiology, an epidemic (from [[Latin language] epi- upon + demos people) is a disease that appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is expected, based on recent experience (the number of new cases in the population during... Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of diabetes mellitus. ...

Unlike Type 1 diabetes, there is little tendency toward ketoacidosis in Type 2 diabetes, though it is not unknown. One effect that can occur is nonketonic hyperglycemia which also quite dangerous, though it must be treated very differently. Complex and multifactorial metabolic changes very often lead to damage and function impairment of many organs, most importantly the cardiovascular system in both types. This leads to substantially increased morbidity and mortality in both Type 1 and Type 2 patients, but the two have quite different origins and treatments despite the similarity in complications. Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of diabetes mellitus. ... It has been suggested that this article or section be merged with Diabetic ketoacidosis. ... This is a complication of type 2 diabetes that results in extremely high glucose levels without the presence of ketones (a by-product of fat that can cause other complications). ... This article is about the biological unit. ... The circulatory system or cardiovascular system is the organ system which circulates blood around the body of most animals. ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the...

In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

Pathophysiology

Insulin resistance means that body cells do not respond appropriately when insulin is present. Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell being used to describe the smallest unit of a living organism Cells in culture, stained for keratin (red) and DNA (green) The cell is the...

Other important contributing factors:

• increased hepatic glucose production (e.g., from glycogen degradation), especially at inappropriate times
• decreased insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects)
• impaired beta-cell function—loss of early phase of insulin release in response to hyperglycemic stimuli
• Cancer survivors who received allogenic Hematopoietic Cell Transplantation (HCT) are 3.65 times more likely to report type 2 diabetes than their siblings. Total body irradiation (TBI) is also associated with a higher risk of developing diabetes.

This is a more complex problem than type 1, but is sometimes easier to treat, especially in the initial years when insulin is often still being produced internally. Type 2 may go unnoticed for years in a patient before diagnosis, since the symptoms are typically milder (no ketoacidosis) and can be sporadic. However, severe complications can result from improperly managed Type 2 diabetes, including renal failure, blindness, wounds that are slow to heal (including surgical incision), and arterial disease, including coronary artery disease. The onset of Type 2 is most common in middle age and later life, though a form of it, called MODY is being much more frequently seen in adolescents. Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... For other uses of Muscles, see Muscles (disambiguation). ... Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... Middle age is the period of life beyond young adulthood but before the onset of old age. ... Paul Kruger in his old age. ... Maturity onset diabetes of the young (MODY) refers to any of several rare hereditary forms of diabetes mellitus due to dominantly inherited defects of insulin secretion. ...

Diabetes mellitus type 2 is presently of unknown etiology (i.e., origin). Diabetes mellitus with a known etiology, such as secondary to other diseases, known gene defects, trauma or surgery, or the effects of drugs, is more appropriately called secondary diabetes mellitus. Examples include diabetes mellitus caused by hemochromatosis, pancreatic insufficiencies, or certain types of medications (e.g. long-term steroid use). 2006 is a common year starting on Sunday of the Gregorian calendar. ... This article is about the medical term. ... Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ... This article is about the chemical family of steroids. ...

About 90–95% of all North American cases of diabetes are type 2^[3], and about 20% of the population over the age of 65 has diabetes mellitus type 2. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons, though these are not known in detail. Diabetes affects over 150 million people worldwide and this number is expected to double by 2025^[3]. There is also a strong inheritable genetic connection in type 2 diabetes: having relatives (especially first degree) with type 2 increases risks of developing type 2 diabetes very substantially. In addition there is also a mutation to the Islet Amyloid Polypeptide gene that results in an earlier onset, more severe, form of diabetes^[4],[5]. About 55 percent of type 2 are obese^[6] —chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue is a (recently identified) source of several chemical signals to other tissues (hormones and cytokines). Other research shows that type 2 diabetes causes obesity.^[7] This article is about the general scientific term. ... Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, is increased to a point where it is associated with certain health conditions or increased mortality. ... Adipose tissue is one of the main types of connective tissue. ... Cytokines are small protein molecules that are the core of communication between immune system cells, and even between immune system cells and cells belonging to other tissue types. ...

Diabetes mellitus type 2 is often associated with obesity, hypertension, elevated cholesterol (combined hyperlipidemia), and with the condition often termed Metabolic syndrome (it is also known as Syndrome X, Reavan's syndrome, or CHAOS). It is also associated with acromegaly, Cushing's syndrome and a number of other endocrinological disorders. Additional factors found to increase risk of type 2 diabetes include aging^[8], high-fat diets^[9] and a less active lifestyle^[10]. For other forms of hypertension, see Hypertension (disambiguation). ... Cholesterol is a sterol (a combination steroid and alcohol). ... In medicine, combined hyperlipidemia (or -aemia) is a commonly occurring form of hypercholesterolemia (elevated cholesterol levels) characterised by increased LDL and triglyceride concentrations, often accompanied by decreased HDL. On lipoprotein electrophoresis (a test now rarely performed) is shows as a hyperlipoproteinemia type IIB. The elevated triglyceride levels (>5 mmol/l... Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ... Acromegaly (from Greek akros high and megas large - extremities enlargement) is a hormonal disorder that results when the pituitary gland produces excess growth hormone (hGH). ... Endocrinology is a branch of medicine dealing with disorders of the endocrine system and its specific secretions called hormones. ...

Diagnosis

The World Health Organization definition of diabetes is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either^[11]:

• fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl)

or

• With a Glucose tolerance test, two hours after the oral dose a plasma glucose ≥ 11.1 mmol/l (200 mg/dl)

A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ...

Screening and prevention

Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes. Although the U.S. Preventive Services Task Force (USPSTF) concluded that "the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose"^[12][13], this was a grade I recommendation when published in 2003. However, the USPSTF does recommend screening for diabetics in adults with hypertension or hyperlipidemia (grade B recommendation).

In 2005, an evidence report by the Agency for Healthcare Research and Quality concluded that "there is evidence that combined diet and exercise, as well as drug therapy (metformin, acarbose), may be effective at preventing progression to DM in IGT subjects".^[14] The Agency for Healthcare Research and Quality (AHRQ), formerly known as the Agency for Health Care Policy and Research (AHCPR), supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services. ...

Accuracy of tests for early detection

If a 2-hour postload glucose level of at least 11.1 mmol/L (≥ 200 mg/dL) is used as the reference standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses current diabetes with^[13]:

• sensitivity about 50%
• specificity greater than 95%

A random capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses current diabetes with^[15]: The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...

• sensitivity = 75%
• specificity = 88%

Glycosylated hemoglobin values that are elevated (over 5%), but not in the diabetic range (not over 7.0%) are predictive of subsequent clinical diabetes in US female health professionals.^[16] In this study, 177 of 1061 patients with glycosylated hemoglobin value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a glycosylated hemoglobin value of 6.0% or more. This equates to a glycosylated hemoglobin value of 6.0% or more having: The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

• sensitivity = 16.7%
• specificity = 98.9%

The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...

Benefit of early detection

Since publication of the USPSTF statement, a randomized controlled trial of prescribing acarbose to patients with "high-risk population of men and women between the ages of 40 and 70 years with a body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters, between 25 and 40. They were eligible for the study if they had IGT according to the World Health Organization criteria, plus impaired fasting glucose (a fasting plasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L) found a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event^[17]. A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... Acarbose is a drug used to treat type 2 diabetes mellitus. ... A graph of body mass index is shown above. ... Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. ... WHO redirects here. ... Impaired fasting glycaemia (IFG) is a pre-diabetic state, associated with insulin resistance and increased risk cardiovascular pathology, although of lesser risk that Impaired glucose tolerance (IGT). ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ...

Other studies have shown that life-style changes^[18] and metformin^[19] can delay the onset of diabetes. Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ...

Treatment

Diabetes mellitus type 2 is a chronic, progressive disease that has no clearly established cure. There are two main goals of treatment of the disease:

1. reduction of mortality and concomitant morbidity (from assorted diabetic complications)
2. preservation of quality of life

The first goal can be achieved through close glycemic control (i.e., blood glucose levels); the reduction effect in diabetic complications has been well demonstrated in several large clinical trials and is well established beyond controversy. The second goal is often addressed (in developed countries) by support and care from teams of diabetic health workers (physician, PA, nurse, dietitian or a certified diabetic educator). Endocrinologists, family practitioners, and general internists are the types of physicians most likely to treat people with diabetes. Knowledgeable patient participation is vital and so patient education is a crucial aspect of this effort. In health care, including medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a process in which a medicine or other medical treatment is tested for its safety and effectiveness, often in comparison to existing treatments. ...

Type 2 is initially treated by adjustment in diet and exercise, and by weight loss, especially in obese patients. The amount of weight loss which improves the clinical picture is sometimes modest (2-5 kg or 4.4-11 lb); this is almost certainly due to currently poorly understood aspects of fat tissue activity, for instance chemical signaling (especially in visceral fat tissue in and around abdominal organs). In many cases, such initial efforts can substantially restore insulin sensitivity. Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ...

Treatment goals

Treatment goals for diabetic patients are related to effective control of blood glucose, blood pressure and lipids to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies. In medicine, blood sugar is glucose in the blood. ... A sphygmomanometer, a device used for measuring arterial pressure. ... Some common lipids. ... Clinical practice guidelines are collections of practical information for use by doctors and other medical professionals. ...

The targets are:

• Hb_A1c of 6.0%^[20] to 7.0%^[21]

• Preprandial blood glucose: 4.0 to 6.0 mmol/L^[22]

• 2-hour postprandial blood glucose: 5.0 to 8.0 mmol/L^[22]

Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ... Look up Postprandial in Wiktionary, the free dictionary. ...

Self monitoring of blood glucose

Main article: Blood glucose monitoring

Self-monitoring of blood glucose may not improve outcomes in some cases, that is among "reasonably well controlled non-insulin treated patients with type 2 diabetes".^[23] Nevertheless, it is strongly recommended for patients in whom it can assist in maintaining proper glycemic control, and is well worth the (sometimes considerable) if it does. Blood glucose testing, showing the size of blood drop required by modern meters. ...

Dietary management

Main article: Diabetic diet

Modifying the diet is known to help control glucose (or glucose equivalnet, eg starch) intake, and in consequence, blood glucose levels. Additionally, weight loss is often recommended in persons suffering from type 2 diabetes for the reasons discussed above. The diet recommended for people who suffer from diabetes mellitus is one that is high in dietary fibre, especially soluble fibre, but low in fat (especially saturated fat) and sugar. ...

Exercise

In September 2007, a joint randomized controlled trial by the University of Calgary and the University of Ottawa found that "Either aerobic or resistance training alone improves glycemic control in type 2 diabetes, but the improvements are greatest with combined aerobic and resistance training than either alone."^[24][25] The combined program reduced the HbA1c by 0.5 percentage point. Other studies have established that the amount of exercise needed is not excessive, but must be consistent and continuing. Examples might include a brisk 45 minute walk every other day. A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... Arch marking south entrance to campus during the winter. ... For the university in Ottawa, Kansas, see Ottawa University. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

Antidiabetic drugs

There are several drugs available for type 2 diabetics -- most are unsuitable or even dangerous for use by type 1 diabetics. They fall into several classes and are not equivalent, nor can they be simple substituted one for another. All are prescription drugs for good reason.

Metformin 500mg tablets

Main article: anti-diabetic drug

The most important drug now in use for Type 2 Diabetes is the Biguanide metformin which works primarily by reducing liver release of blood glucose from glycogen stores as well as provoking some increase in cellular uptake of glucose in body tissues. Both historically, and currently, commonly used are the Sulfonylurea group, of which several members (including glibenclamide and gliclazide) are widely used; these increase glucose stimulated insulin secretion by the pancreas. Image File history File links Metadata Size of this preview: 790 × 600 pixelsFull resolution (1874 × 1423 pixel, file size: 818 KB, MIME type: image/jpeg) These tablets were prescribed on the National Health Service for my use as a type 2 diabetic. ... Image File history File links Metadata Size of this preview: 790 × 600 pixelsFull resolution (1874 × 1423 pixel, file size: 818 KB, MIME type: image/jpeg) These tablets were prescribed on the National Health Service for my use as a type 2 diabetic. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... Biguanides (ATC A10 BA) form a class of oral hypoglycemic drugs used for diabetes mellitus treatment. ... Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ... Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ... Glibenclamide is a class of drug known as sulphonylureas. ... Gliclazide is an oral hypoglycemic (anti-diabetic drug) and is classified as a sulfonylurea. ... A secretagogue is a substance which causes another substance to be secreted. ...

Newer drug classes include:

• Thiazolidinediones (TZDs) (rosiglitazone, pioglitazone, and troglitazone) (withdrawn from the US market) which increase tissue insulin response
• α-glucosidase inhibitors (acarbose and miglitol) which interfere with absorption of some nutrients
• Meglitinides which stimulate insulin release (nateglinide, repaglinide, and their analogs) quickly; they can be taken with food, unlike the sulfonylureas
• Peptide analogs which work in a variety of ways:
  • Incretin mimetics which increase insulin output from the beta cells among other effects. These includes the Glucagon-like peptide (GLP) analog exenatide
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors increase Incretin levels (sitagliptin) by decreasing their deactivation rates
  • Amylin agonist analog, which slows gastric emptying and suppresses glucagon (pramlintide)

The medication class of thiazolidinedione was introduced in the late 1990s as an adjunctive therapy for diabetes mellitus (type II) and related diseases. ... The medication class of thiazolidinedione was introduced in the late 1990s as an adjunctive therapy for diabetes mellitus (type II) and related diseases. ... Rosiglitazone is an anti-diabetic drug from the thiazolidinedione class. ... Pioglitazone is a prescription drug of the class thiazolidinedione with hypoglycemic (antihyperglycemic, antidiabetic) action. ... Troglitazone (Rezulin®, Resulin® or Romozin®) is a member of the drug class of the thiazolidinediones. ... Alpha-glucosidase inhibitors are oral anti-diabetic drugs used for diabetes mellitus type 2 that work by preventing the digestion of carbohydrates (such as starch). ... Acarbose is a drug used to treat type 2 diabetes mellitus. ... Miglitol is an oral anti-diabetic drug that is classified as a alpha-glucosidase inhibitor. ... This article belongs in one or more categories. ... Nateglinide (Starlix®) is a drug for the treatment of type II diabetes. ... Repaglinide (Prandin® in the US, GlucoNorm® in Canada, NovoNorm® elsewhere) is a for the treatment of type II diabetes. ... Exenatide (also Exendin-4, marketed as Byetta) is the first of a new class of medications approved for the treatment of type 2 diabetes. ... Dipeptidyl peptidase 4 inhibitors, also DPP-4 inhibitors, are a new class of oral hypoglycemics. ... Incretins are a type of gastrointestinal hormone that cause an increase in the amount of insulin released from the beta cells of the islets of Langerhans after eating, even before blood glucose levels become elevated. ... Sitagliptin, previously identified as MK-0431, is a new oral hypoglycemic (anti-diabetic drug) of the new dipeptidyl peptidase-4 (DPP-4) inhibitor class of drugs. ... Pramlintide acetate (Symlin) is a relatively new adjunct treatment for diabetes (both Type 1 and 2). ...

Oral drugs

A systematic review of randomized controlled trials found that metformin and second-generation sulfonylureas are the preferred choices for most with type 2.^[26] Failure of response after a time is not unknown with most of these agents: the initial choice of anti-diabetic drug has been compared in a randomized controlled trial which found "cumulative incidence of monotherapy failure at 5 years of 15% with rosiglitazone, 21% with metformin, and 34% with glyburide".^[27] Of these, rosiglitazone users showed more weight gain and edema than did non-users.^[27] Rosiglitazone may increase risk of death from cardiovascular causes.^[28] Pioglitazone and rosiglitazone may also increase the risk of fractures.^[29][30] Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...

For patients who also have heart failure, metformin may be the best available drug.^[31] Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ...

Insulin preparations

If antidiabetic drugs fail (or stop helping), insulin therapy may be necessary – usually in addition to oral medication therapy – to maintain normal glucose levels. An anti-diabetic drug is used to treat diabetes mellitus. ... Not to be confused with inulin. ...

Typical total daily dosage of insulin is 0.6 U/kg.^[32] More complicated estimations to guide initial dosage of insulin are:^[33]

• For men, [(fasting plasma glucose [mmol/liter]–5)x2] x (weight [kg]÷(14.3xheight [m])–height [m])
• For women, [(fasting plasma glucose [mmol/liter]–5)x2] x (weight [kg]÷(13.2xheight [m])–height [m])

The initial insulin regimen can be chosen based on the patient's blood glucose profile.^[34] Initially, adding nightly insulin to patients failing oral medications may be best.^[35] Nightly insulin combines better with metformin that with sulfonylureas.^[32] The initial dose of nightly insulin (measured in IU/d) should be equal to the fasting blood glucose level (measured in mmol/L). If the fasting glucose is reported in mg/dl, multiply by 0.05551 to convert to mmol/L.^[36] Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ... Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ...

When nightly insulin is insufficient, choices include:

• Premixed insulin with a fixed ratio of short and intermediate acting insulin; this tends to be more effective than long acting insulin, but is associated with more hypoglycemia.^[37][38][39]. Initial total daily dosage of biphasic insulin can be 10 units if the fasting plasma glucose values are less than 180 mg/dl or 12 units when the fasting plasma glucose is above 180 mg/dl".^[38] A guide to titrating fixed ratio insulin is available (http://www.annals.org/cgi/content/full/145/2/125/T4).^[34]

• Long acting insulins such as insulin glargine and insulin detemir. A meta-analysis of randomized controlled trials by the Cochrane Collaboration found "only a minor clinical benefit of treatment with long-acting insulin analogues for patients with diabetes mellitus type 2".^[40] More recently, a randomized controlled trial found that although long acting insulins were less effective, they were associated with less hypoglycemia.^[37]

Insulin glargine, sold under the name Lantus, is a long-acting basal insulin analogue, usually given once or twice daily to help control the blood sugar level of those with diabetes. ... Novo Nordisk created insulin detemir and markets it under the trade name Levemir® as a long-lasting insulin analogue for maintaining the basal level of insulin. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...

Alternative medicines

Carnitine has been shown to increase insulin sensitivity and glucose storage in humans. ^[41]. It is important to note that this was with a constant blood infusion, not an oral dose, and that the clinical significance of this result is unclear. This article or section contains information that has not been verified and thus might not be reliable. ...

Taurine has also shown significant improvement in insulin sensitivity and hyperlipidemia in rats.^[42] Taurine, or 2-aminoethanesulfonic acid, is an organic acid. ... Insulin sensitivity is the opposite of insulin resistance. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ...

Neither of these have shown permanent positive effects, nor a complete restoration to pre-diabetes conditions, only improvement. Their clinical importance in humans remains unclear.

Antihypertensive agents

Main article: Antihypertensive

The goal blood pressure is 130/80 which is lower than in non-diabetic patients.^[43] Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). ...

ACE inhibitors

The HOPE study suggests that diabetics should be treated with ACE inhibitors (specifically ramipril 10 mg/d) if they have one of the following ^[44]: ACE inhibitors, or inhibitors of Angiotensin_Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ... Ramipril (marketed as Tritace or Altace) is an angiotensin-converting enzyme (ACE) inhibitor, used to treat hypertension and congestive heart failure. ...

• hypertension
• hypercholesterolemia or reduced low high-density lipoprotein cholesterol levels
• cigarette smoking
• microalbuminuria

After treatment with ramipril for 5 years the number needed to treat was 50 patients to prevent one cardiovascular death. Other ACE inhibitors may not be as effective.^[45] For other forms of hypertension, see Hypertension (disambiguation). ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... Microalbuminuria - the measurement of small amounts of albumin in the urine that cannot be detected by urine dipstick methods. ... Ramipril (marketed as Tritace or Altace) is an angiotensin-converting enzyme (ACE) inhibitor, used to treat hypertension and congestive heart failure. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... ACE inhibitors, or inhibitors of Angiotensin_Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ...

Hypolipidemic agents

Main article: Hypercholesterolemia#Diabetic_patients

Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ...

Footnotes

NIH can refer to: National Institutes of Health Norwegian School of Sports Sciences: (Norges idrettshøgskole - NIH) Not Invented Here This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 70th day of the year (71st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 149th day of the year (150th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 329th day of the year (330th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 271st day of the year (272nd in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 141st day of the year (142nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 141st day of the year (142nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 141st day of the year (142nd in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• Diabetes UK - Largest organisation in the UK working for people with diabetes
• American Diabetes Association
• National Diabetes Information Clearinghouse
• Diabetes Section of The Hormone Foundation
• Diabetes Health Institute