Type 2 Diabetes occurs when the body is unable to produce enough insulin to keep blood sugar at a healthy level and/or when the cells of the body are no longer responsive to the insulin that is being produced. Like Type 1 diabetes, the exact cause is unknown, but thought result from a combination of genetic predisposition and lifestyle factors. Lifestyle factors such as weight, food choices, substance use, physical activity level, and environment. Accounts for greater than 90% of diabetes cases. Type 2 used to be associated with older patients, but due to western lifestyles and increasing obesity rates in all ages is now becoming an epidemic in the youth as well. Progression of Type 2 Diabetes: Early in this disease the pancreas is able to overcome the bodies cellular resistance to insulin and maintain normal blood sugar levels by producing extra amounts of insulin (hyperinsulinemia). Over time the beta cells of the pancreas become fatigued and are unable to keep up with the insulin demand, which results in impaired (decreased) insulin production. This leads to chronically elevated blood sugar levels and the diagnosis of diabetes. Pre Diabetes- the beta cells are fatigued and there is an impairment in the secretion of insulin.

Elevated blood sugar over time can lead to a complication that affects many systems of the body from the heart to the eyes. One way to think of this is to think of how sugar mixes with water. When sugar is added to water, the result is a thicker substance that tends to be sticky. When blood sugar levels remain high for extended periods of time, the blood becomes thicker and harder to pump or flow through the vessels. This causes distress on the heart and body. When blood sugars remain high, there also tends to be more of a congregation of blood fats which can lead to thinks like heart attack and stroke. Types of Diabetes Complications Include: Cardiovascular Complications Dermatological Complications Eye Complications Kidney Complications Nerve Complications Peripheral Vascular Complications

Patients with diabetes have a higher risk of developing heart disease than non-diabetic patients. According the the American Heart Association diabetic patients are 3x more likely to develop heart disease then non-diabetic and nearly 60-68% of patients with diabetes will die from heart disease. In addition, diabetic patients develop coronary artery disease (a condition that affects the blood vessels the supply the heart with blood) at a younger age than those without diabetes. The reason for this is because people with diabetes not only have higher blood sugar, but often have other conditions that increase risk for heart disease such as elevated blood pressure, high cholesterol, and being overweight. Proper blood pressure, blood sugar, and cholesterol management along with a healthy lifestyle can can help reduce risk. Risk factors for developing heart disease in patients with Diabetes: men >50 years women >60 years family HX CVD hypertension (blood pressure >130/80) smoking high cholesterol albuminuria (protein in the urine)

Acanthosis nigricanis: A darkening and thickening in the folds of the skin; typically found on neck, armpit, groin. Described as brown velvety feeling patches Benign condition Mostly found on overweight patients May be reduced by weight loss and glucose control Onychomyosis: Fungal infection of the nails Thickening, flaking, splitting of the nails Yellowing of the nails Require antifungal treatment for 12 weeks or longer Diabetic Foot Ulcer: Breakdown of skin due to decreased blood perfusion Superficial wound that may extend down to the bone Most common reason for hospitalization among diabetic patients Is the leading cause of non traumatic foot amputation Prevention is key Smoking, high blood sugar, high blood pressure, and high cholesterol increases risk Diabetic Dermopathy: Are spots on the skin due to changes in small blood vessels cause leakage of blood products into surrounding tissue Most often found on the shins, which is why they are sometimes called shin spots Associated with standing for long periods of time and blood poor glucose control Typically heal/ improve on their own with good  blood glucose control

Diabetic Retinopathy is damage to the blood vessels of the retina due to chronic elevation in blood sugar. It is very important diabetic patients have yearly eye exams due to increased risk for vision impairments. Symptoms: Early in this disease patients may not experience any symptoms, but over time the following can occur Decreased vision blurry vision Floaters (specks or squiggles that enter your line of vision) Distorted vision Dulling of color Prevention: Yearly eye exams Keep blood sugar under control: There is a 30% reduction in risk per 1% of A1c decreased Blood pressure control: <130/80 Complications: Complications associated with diabetic retinopathy: Blindness Glaucoma Retinal Detachment