Discuss the clinical and pathologic findings associated with non-insulin dependent (type II) diabetes mellitus. (<250 words)

Type II diabetes mellitus is more frequent than type I and is most often seen in adults over the age of 30. About 80% of affected persons are obese. There is a genetic predisposition to type II diabetes in families. The patients may manifest with polyuria and polydipsia. If untreated, they may develop a hyperosmolar coma, with markedly elevated serum glucose, because of unchecked glucosuria. They usually have normal to increased levels of insulin, and the problem is a relative lack of insulin from a defect in release of insulin from islet beta cells, or there is an insulin resistance because insulin receptors are lacking or defective in fat and muscle cells. Thus, ketoacidosis is uncommon. Increased glucose levels in blood lead to glycosylation of a variety of cells and tissues, and can provide a measure of diabetic control through measurement of hemoglobin A1c.

Pathologic changes include atherosclerosis which can result in coronary artery disease with myocardial infarction, a common mode of death in diabetics. LDL cholesterol is often increased as well. Atherosclerosis can also lead to stroke and to renal failure, as well as peripheral vascular disease with gangrene. Renal failure can also be produced from nephropathy consisting of nodular glomerulosclerosis, necrotizing papillitis, or pyelonephritis. They can also develop retinopathy, cataracts, and neuropathy from sorbitol accumulation. Diabetics are more prone to infections.