السكري النوع الثاني

Definition

Type 2 diabetes is the commonest form, combining insulin resistance with gradually declining secretion.

Risk factors

Obesity especially central, inactivity, family history, previous gestational diabetes and age.

Symptoms

Often gradual or absent: thirst, frequent urination, fatigue, slow wound healing and recurrent infections.

Diagnosis

HbA1c 6.5% or more, fasting glucose 126 or more, or 200 two hours into a glucose tolerance test.

Complications

• Microvascular: retinopathy, nephropathy, neuropathy
• Macrovascular: heart attack, stroke, peripheral arterial disease
• Hyperosmolar hyperglycaemic state (HHS): very high glucose and severe dehydration without marked acidosis

Treatment

• Lifestyle and weight loss are the foundation
• Metformin usually first line
• SGLT2 inhibitors and GLP-1 agonists protect the heart and kidneys
• Other drugs or insulin as needed

Nursing care

• Daily foot checks and proper footwear
• Teach diet, activity and medication
• Annual eye, kidney and foot screening

Exam point

Metformin is held before iodinated contrast when kidney function is impaired.