Treatment of Type II Diabetes Mellitus: Past and Present

Brittany Rouse, Clark Simcoe, Ian Lind & Fern DeMello

Introduction

Results

Diabetes Mellitus Type II is a disease of the pancreas

and peripheral tissues culminating in the inability to
effectively process blood glucose. The main affected
tissues are muscle, liver, and adipose.

Hyperglycemia

The ability of these tissues to sense and respond to

insulin is greatly diminished and results in insulin
resistance. Pancreatic beta-cell malfunction and
insulin resistance are the hallmarks of Type II
diabetes.

Pancreas increases insulin production to

compensate until it can no longer produce enough
to control blood glucose concentration .

Hepatic gluconeogenesis and glycogenolysis are

stimulated while glucose and triglyceride uptake is
simultaneously diminished, which contribute to the
characteristic hyperglycemia and dyslipidemia.
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Methods

1. How are primary metabolic processes altered?

2. How has the nutritional relationship to Type II
Diabetes changed and what led to those changes?
3. What are the current nutritional, pharmacological
and alternative treatment options?
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Results
Metabolic Changes

Blood glucose levels are high due to lack of

uptake caused by insulin resistance.

Results in decreased glucose uptake and increased

hepatic glucose production (glycogenolysis and
gluconeogenesis).
Dyslipidemia
Associated with increase in VLDL.
Increase in FFAs and glucose levels increase
VLDL from the liver.
Increase in liver TGs inhibits ApoB degradation
and increases VLDL assembly and secretion.
Decrease in LPL decreases TG clearance and
leads to atherogenic profile.
Treatment
Historical Treatment

Results

Results

Treatment

Alternative Treatment Therapies

Hypoglycemic Herbs and Tissue Effect

Present - Medical Nutrition Therapy

Supports healthful eating patterns, emphasizing a
variety of nutrient dense foods to address:
Glycemic control
o Carbohydrate intake
Blood pressure management
Lipid control
o Dietary fat intake
Weight management
Evidence suggests there is not an ideal percentage of
calories from carbohydrate, protein, and fat for all
people with diabetes.

Weight loss for overweight diabetics has been shown

to provide clinical benefits including:
Improved glycemia
Improved blood pressure
Improved lipid markers.

Medications
1st Line:
Metformin
Sulfonylureas
2nd Line:
Sulfonylureas
TZDS, DPP-4 inhibitors, GLP-1 Agonists, SGLT-2
Inhibitors, Alpha-Glucosidase inhibitors
3rd Line:
Insulin injections and/or 3rd Oral Agent

RESEARCH POSTER PRESENTATION DESIGN 2012

www.PosterPresentations.com

Simplified Approach to Type II Diabetes Management

Weight Loss

Diabetic Cookery, 1917

Figure 1: Specific metabolic changes of major tissues effected by insulin resistance.

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(Evert AB, Boucher JL, Cypress M, et al. Diabetes Care 2013)

(Evert AB, Boucher JL, Cypress M, et al. Diabetes Care 2013)

Figure 2: Historical Context of Diabetic Treatment and Nutrition (Oppenheimer

1917)

Figure 3: Action sites of herbs in diabetes treatment. The efficacy of

hypoglycemic herbs has been mediated by increasing insulin secretion,
enhancing glucose uptake, inhibiting glucose absorption from intestine, and
inhibiting glucose production from hepatocytes. (Hui H, Tang G, Go VLW.
2009)

Figure 4: Contributing factors and therapies that improve outcomes of Type II

Diabetes. (Elrich D, Slawson D, Shaughnessey A. 2014)

Conclusions
Historical shift from concern about carbohydrate
consumption to concern about fat consumption.
Once T2D is diagnosed as poorly controlled,
metabolic changes are difficult to reverse.
Though they are the common treatment, drugs
will not provide the long term benefits that
lifestyle changes will.
With proper treatment, quality of life can be
maintained and the symptoms and side effects
can be mitigated.