The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands.
At least 90% of patients with diabetes have type 2 diabetes.
Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non–insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes need to use insulin.
Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral medications. More than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illnessAlthough chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are diabetes and high blood pressure.
Type 1 and type 2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease in the United States. Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli.
Anemia is common in people with kidney disease. Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys, however, often don't make enough EPO. As a result, the bone marrow makes fewer red blood cells. Other common causes of anemia include loss of blood from hemodialysis and low levels of iron and folic acid. These nutrients from food help young red blood cells make hemoglobin (Hgb), their main oxygen-carrying protein.
In patients with type 2 diabetes, a decrease in hemoglobin (Hb) is insidious and occurs predominantly in older people with chronic kidney disease and damaged large blood vessels, research suggests.
"The early identification of anemia may be achieved by annual or biannual screening in these high-risk groups," Dr. Merlin C. Thomas from the Baker Medical Research Institute in Melbourne, Australia, told Reuters Health.
Anemia occurs when there is a drop in the blood's ability to carry oxygen, because of a deficiency in red blood cells or their oxygen-carrying component, hemoglobin. A lack of iron in the diet or blood loss, perhaps from internal bleeding or diseased blood vessels, are two potential causes of anemia.If your blood is low in red blood cells, you have anemia. Red blood cells carry oxygen (O2) to tissues and organs throughout your body and enable them to use the energy from food. Without oxygen, these tissues and organs—particularly the heart and brain—may not do their jobs as well as they should. For this reason, if you have anemia, you may tire easily and look pale. Anemia may also contribute to heart problems.
"Anemia is now recognized as another problem in patients with diabetes, which develops earlier and is more severe in patients with diabetic kidney disease," Thomas said.
In a 5-year prospective study of roughly 500 type 2 diabetics, Thomas and colleagues found that 12 percent had anemia at baseline and an additional 13 percent developed anemia during follow-up.
Overall, Hb levels fell by -0.07 grams per deciliter per year. This suggests that anemia is "the endpoint of a process that begins more than 10 years previously, with the initiation of microvascular (small blood vessel) damage," Thomas and colleagues write in the American Journal of Kidney Diseases.
In patients with small blood vessel disease, decreasing Hb levels tracked with decreasing renal function. The rate of Hb decline was fastest in patients with established and progressive renal injury and large blood vessel or "macrovascular" disease at baseline.
"These data," Thomas concludes, "are important for developing a rational response to prevention and early management of anemia in individuals with diabetes."
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