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Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2 or non-insulin dependent diabetes is more commonly noticed. This is caused due to insufficient production of insulin by the pancreas or when the body is unable to regulate the amount of glucose in the blood. Complications of type 2 diabetes include coronary heart disease, renal failure, diabetic neuropathy and failing eyesight. Diabetes Type 2 is also referred to as late-onset diabetes.


Diabetes Mellitus Type 2 develops when the patient's body becomes insulin-resistant. Symptoms of Type 2 diabetes include blurred vision, weight loss and excessive thirst and fatigue. Yeast infection and fungal infections are common. Weight reduction can go a long way in maintaining blood sugar levels. Smoking and excessive alcohol consumption increase the risk of developing type 2 diabetes. Sedentary lifestyle and obesity also increase a person's chances of diabetes type 2. Often this type of diabetes is hereditary. Persons with excessive abdominal fat are more prone to developing diabetes type 2. Hypertension and high blood cholesterol increases a person's risk of diabetes mellitus type 2.


Blood tests for glucose tolerance help in detecting diabetes mellitus type 2. In some cases, patients suffering from diabetes mellitus type 2 are able to control their condition with diet and exercise. Follow a diet that is low in saturated fat, salt and sugar. Instead opt for high fiber vegetables and fruits. Antidiabetic medications (sulphonylureas) are prescribed for diabetic patients to increase the production of insulin and improve its efficiency. These include glibenclamide and glipizide. Insulin injections are resorted to when all these measures fail to reduce blood sugar levels.

Zieve's Syndrome

A syndrome that is characterized by acute metabolic condition that can occur during prolonged alcohol abuse. It was described initially in 1958 by Dr Leslie Zieve for patients with a combination of alcoholic liver disease Hemolytic Anemia and Hypertriglyceridemia. Zieve's syndrome exhibits liver and blood abnormalities caused by heavy alcohol consumption.


This is a condition associated with chronic alcoholism, frequently encountered in hospitalized alcoholics who have suddenly stopped alcohol. The underlying cause is liver delipidization and hemolytic anemia. This is distinct from alcoholic hepatitis which may be present simultaneously or develop later. The syndrome is defined by excessive blood lipoprotein, jaundice and abdominal pain.


Symptoms

Most common symptoms due to long-term history of chronic alcoholism include:

Nausea
Vomiting after heavy drinking
Anorexia
Abdominal pain
Hepatomegaly, enlarged spleen, late cirrhosis
Skin and yellow sclera
Hemolytic Anemia, Hemoglobinuria (hemoglobin is excreted in urine) and Hemosiderin (insoluble form of storage iron complex) in urine.
Hepatic dysfunction, Jaundice, Hyperlipidemia and reversible hemolytic anemia after alcohol abuse are prominent symptoms.


Causes of Zieve's Syndrome

Zieve's syndrome is caused by alcoholism due to liver cell damage and various degrees of cholestasis thus causing cancer. Fatty liver production of free fatty acids into blood stream, increased triglycerides that causes hyperlipidemia and increased cholesterol and phospholipid deposition, and damaged red blood cells which become hard and brittle and blocked by splenic sinusoids. In addition, alcoholism induced pancreatitis and vitamin E deficiency is associated with hemolysis.


Diagnosis of Zieve's Syndrome

The diagnosis is based from objective information about alcoholism, and blood test for the abnormalities. It is based on history and the triple disease – jaundice, hemolytic anemia and hyperlipidaemia. For jaundice, moderate and direct bilirubin test is done. Hemolytic anemia is visible in hemoglobinuria and hemosiderin urine. There could be drop in hemoglobin, reticulocytes, bone marrow erythroblastic hyperplasia, and increased erythrocyte fragility and shortened life of red blood cells.

Hyperlipidemia is detected by increase in cholesterol, triglycerides and phospholipids. Diagnostic tests include hemoglobin, bone marrow examination, blood lipids including cholesterol, phospholipids, triglycerides, serum bilirubin, alkaline phosphatase, and liver function test and liver biopsy. Ultrasonography is done to reveal the syndrome. There could be rapid serum level rise after alcohol withdrawal in patients with denial of drinking.


Treatment

Temperance for two to three weeks is essential for symptoms to disappear. A diet high in sugar-protein, vitamins and hepatoprotective drug is necessary. In addition to jaundice, treatment for high blood cholesterol and hemolytic anemia are essential. Basic therapy includes bed rest, adequate food intake, hydration and vitamin supplementation. The patient usually recovers from the symptoms very quickly, but the disease can recur if alcohol abuse persists.


Diabetes Mellitus Type 2

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