Type 2 diabetes

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Type 2 diabetes has traditionally been known as late-onset diabetes, and it is the great scourge of the Western or supposedly developed world. The main difference between Type 1 diabetes and Type 2 diabetes is that Type 2 patients - at least initially - have "normal" insulin in their blood streams, though their body doesn't know how to use it (they are said to be insulin-resistant). Another important difference is that Type 2 diabetic patients are much less prone to ketoacidosis, though they are not totally exempt from it.

Because Type 2 diabetics are initially different from Type 1 diabetics (i.e., they have insulin initially), they are treated differently. Since their cells are insulin-resistant, one way of treating it is by inducing increased insulin production. As the days turn into months, and the months into years, the β-cells of the pancreas stop producing insulin, though the reason for this is not clear. Once the &beta-cells have stopped producing insulin, they might as well be Type 1 diabetics.

In general, diabetic patients have high serum glucose, which leads (by mass action) to increased glycosylated hemoglobin (HbA1c) and sorbitol.

Being overweight is one of the key risk factors for Type 2 diabetes, since it increases insulin resistance. Therefore, at least initially, Type 2 diabetes can be easily treated with exercise and weight loss. Sadly, this is the one treatment patients do not want, instead preferring a magic pill or silver bullet. So, physicians do what they gotta do, but should always understand that the best treatment of Type 2 diabetes before the patient becomes insulin-dependent (i.e., Type 1 diabetes).

Since Type 2 diabetics are frequently not completely resistant to insulin, increasing insulin production (i.e., inducing hyperinsulinemia) may suffice. One of the drugs involved in this is sulfonylurea, which stimulates the pancreas to produce more insulin. This is univerally considered a bad idea, but is still widely used. Another drug used for Type 2 diabetics is metformin (generic name), which improves the use of glucose.

Exam factoids:

  • One of the differences between Type 1 and Type 2 diabetes is that only type 1 gets ketotic
  • Type 2 diabetes has lots of serum insulin - they are insulin resistant
  • 6.5% of hemoglobin should be glycosylated. When sugars are high, more hemoglobin becomes glycosylated.
  • Sulfonyl urea increases serum insulin by encouraging the pancreas



  • Intermediary metabolism, from a 2 DM viewpoint
  • High blood glucose leading by mass action to increased glycosylated hemoglobin HbA1c and sorbitol
  • The fact that the greatest concern in type 2 DM is not acute care, but management of the multi-organ system failure that results from molecular issues such as high blood sugar and hyperinsulinemia
  • The fact that type 2 DM patients are much less prone to ketoacidosis
  • The fact that there are typically classic differences in the initial presentation of type 2 vs type 1 DM patients
  • The fact that type 2 patients are treated differently (from type 1) early in their course
  • The importance of lifestyle issues and patient education in DM management
  • Some basic groups of drugs used in management of type 2 DM