I. CASE DESCRIPTION
A 29 year old male who works at your clinic believes he has diabetes mellitus. His father and paternal
grandfather both developed this disease late in life. He has polyuria, polydypsia and polyphagia
accompanied by weakness, weight loss and blurry vision. You test his urine and find 3+ glycosuria; blood
glucose is 450 mg/dL. The patient does not want to take insulin and hopes that pills will be enough. On
the other hand, he has heard that oral hypoglycemics can be bad for you.
II. DIABETES MELLITUS TYPE II
1. is characterized by insulin resistance and relative insulin deficiency
2. is associated with both hereditary and environmental factors
Æ40-50% increase in risk for individual with affected first degree relatives
Æ significant association with obesity
3. if uncontrolled, may lead to such pathologies as diabetic retinopathy, autonomic neuropathy and
nephropathy
III. NON-PHARMACOLOGIC INTERVENTIONS
1. Diet changes: Low calorie diet can reduce fasting glucose and increase insulin sensitivity in five days
(hypothesized due to hepatic glycogenolysis).
a) not effective over long term (three years in the United Kingdom Prospective Diabetes Study)
2. Exercise: Besides weight loss, produces increased insulin sensitivity and delays onset of overt
diabetes.
IV. TREATMENT STRATEGIES WITH ORAL HYPOGLYCEMICS
[Diagram removed for copyright reasons.]
Inzucchi. (
2002) JAMA 287 (3): 360-372.
A. Monitoring efficacy
1. Blood glucose concentrations
a) measure mean blood glucose concentrations before meals and bedtime; mid
morning and mid afternoon
b) keep track of fluctuations over the day
c) monitor day-to-day variations in mean glucose level
2. HbA1c
a) average measurement indicates mean glucose level over the previous 6 to 8
weeks. Target is 7.0%
b) potential for false values: falsely high if RBC turnover is lower than normal
(eg., iron deficiency anemia) or low if turnover higher than normal (eg.,
hemolysis)
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