Clinical Features: Type 2 Diabetes

The presentation of Type 2 diabetes

 

  • The patient:
    • Usually has a slow-onset of symptoms developing over years/months
      • Many patients are asymptomatic and only found via routine screening/investigation of other conditions
    • Typically older patients (often  >50 y/o)
      • Although is beginning to affect youngsters (see MODY)
    • Related conditions – several conditions are seen more in T2 than T1 DM
      • Metabolic syndrome and obesity
      • NAFLD
      • PCOS

 

  • T2DM usually presents  in one of 4 ways
    1. Most often, these patients will actually be asymptomatic
      • May be picked up on screening or incidental findings 
      • May have non-specific complaints like fatigue/malaise
    2. Hyperglycaemia
      • Often incidental – e.g. if patient has had a urine dip for a suspected UTI this may show glycosuria
    3. HHS
    4. Long-term complications
      • Macrovascular
      • Microvascular
Symptoms of T2DM
  • Hyperglycaemic symptoms
    • Onset is much slower and the symptoms are less marked than in Type 1
      • However, the same symptoms as Type 1 can develop including: 
        • Increased infection risk
        • Osmotic diuresis
        • CNS
        • Weight loss
      • NB hyperglycaemia is often detected in asymptomatic patients with a routine dipstick for other conditions
    • HHS See Separate
      1. Increased blood osmolality
        1. Significant hyperglycaemia symptoms
        2. Coma
      2. This is a rare presentation as the patient has to have been extremely hyperglycaemic

 

  • Long-term complications See separate
    • Macrovascular
      • Angina/MI
      • Stroke
      • PVD – Claudications and diabetic foot ulcers
    • Retinopathy
      • Blurred vision
      • Shows up on opthalmoscopy which may be done for other conditions (e.g. at optician)
    • Neuropathy
      • Symmetric foot pain, tingling, and numbness in all modalities
      • Increased trauma to feet
    • Nephropathy
      • Microalbuminuria – ACR = >30mg/ml

 

  • Note that symptoms of gluconeogenesis are very rare in T2DM