Filed under: Diabetes
Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's main source of fuel.
With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. Untreated, type 2 diabetes can be life-threatening.
There's no cure for type 2 diabetes, but you can manage — or even prevent — the condition. Start by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to control your type 2 diabetes, you may need diabetes medications or insulin therapy to manage your blood sugar.
Type 2 diabetes symptoms may develop very slowly. In fact, you can have type 2 diabetes for years and not even know it. Look for:
When to see a doctor
See your doctor if you're concerned about diabetes or if you notice any type 2 diabetes symptoms.
Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. Exactly why this happens is unknown, although excess weight and inactivity seem to be contributing factors.
Insulin is a hormone that comes from the pancreas, a gland situated just behind and below the stomach. When you eat, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.
Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. After intestinal digestion and absorption, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.
The liver acts as a glucose storage and manufacturing center. When your insulin levels are low — when you haven't eaten in a while, for example — the liver metabolizes stored glycogen into glucose to keep your glucose level within a normal range.
In type 2 diabetes, this process works improperly. Instead of moving into your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin.
In type 1 diabetes, which is much less common, the pancreas produces little or no insulin.
Researchers don't fully understand why some people develop type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:
Type 2 diabetes can be easy to ignore, especially in the early stages when you're feeling fine. But diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent these complications.
Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include:
It probably will be your family doctor or primary care physician who makes the initial diagnosis of type 2 diabetes. You'll likely then be referred to a doctor who specializes in hormonal disorders (endocrinologist). Your health care team also may include a dietitian, a certified diabetes educator, a foot doctor (podiatrist) and a doctor who specializes in eye care (ophthalmologist). If your blood sugar levels are very high, your doctor may send you to the hospital for treatment.
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for any appointments you have with your health care team. Here's some information to help you get ready for your appointment, and what you can expect from your doctor.
What you can do
Preparing a list of questions can help you make the most of your time with your doctor. Other members of your health care team, such as a certified diabetes educator, may be the best person to answer some of your questions. For type 2 diabetes, some basic questions to ask include:
Don't hesitate to ask any other questions that occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
What you can do in the meantime
If your blood sugar isn't well controlled, or if you're not sure about what to do in a certain situation, don't hesitate to contact your doctor or diabetes educator for guidance.
In June 2009, an international committee composed of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that type 2 diabetes testing include the:
If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:
The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test. Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 135/80 millimeters of mercury (mm Hg).
If you're diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — which often require different treatment strategies because in type 1 diabetes, the pancreas no longer makes insulin.
After the diagnosis
A1C levels need to be checked between two and four times a year. Your target A1C goal may vary depending on your age and various other factors. However, for most people, the American Diabetes Association recommends an A1C level below 7 percent. Ask your doctor what your A1C target is.
The American Diabetes Association has a formula that translates the A1C into what's known as an estimated average glucose (eAG). The eAG more closely correlates with daily blood sugar readings. An A1C of 7 percent translates to an eAG of 154 mg/dL (8.5 mmol/L).
Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication or meal plan.
In addition to the A1C test, the doctor will also take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will assess your blood pressure. Regular eye and foot exams also are important.
Treatment for type 2 diabetes requires a lifelong commitment to:
These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.
If managing your diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your blood sugar level as close to normal as possible.
Monitoring your blood sugar
Depending on your treatment plan, you may check and record your blood sugar level once a day or several times a week. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
Even if you eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to:
Contrary to popular perception, there's no diabetes diet. You won't be restricted to a lifetime of boring, bland foods. Instead, you'll need plenty of:
These foods are high in nutrition and low in fat and calories. You'll also need to eat fewer animal products and sweets.
Counting carbohydrates in your food is another thing you'll need to incorporate into meal planning. A registered dietitian can help you learn to count carbohydrates and put together a meal plan that fits your health goals, food preferences and lifestyle. Once you've covered the basics, remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.
Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.
Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually.
Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar or insulin.
Diabetes medications and insulin therapy
Some people who have type 2 diabetes can manage their blood sugar with diet and exercise alone, but many need diabetes medications or insulin therapy. Some studies indicate that early intervention with medication, even before the A1C is significantly elevated, may improve control of blood sugar levels over time. The decision about which medications are best depends on many factors, including your blood sugar level and the presence of any other health problems. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.
Diabetes medications. Often, people who are newly diagnosed will be prescribed metformin (Glucophage, Glumetza, others), a diabetes medication that lowers glucose production in the liver. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active.
When metformin is not enough to control your glucose level, other oral or injected medications can be added to treat type 2 diabetes. Medications lower glucose in different ways. Some diabetes medications stimulate your pancreas to produce and release more insulin. They include glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase) and glimepiride (Amaryl). Still others block the action of enzymes that break down carbohydrates or make your tissues more sensitive to insulin such as pioglitazone (Actos).
If you can't take metformin, other oral drugs include sitagliptin (Januvia), saxagliptin (Onglyza), repaglinide (Prandin) and nateglinide (Starlix). Exenatide (Byetta) and liraglutide (Victoza) are newly approved drugs given by injection.
Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you considering many factors, including costs and other aspects of your health. Rosiglitazone (Avandia) has been linked to heart attacks, and its use has been restricted by the FDA. A recent study indicated that more expensive drugs are not more effective in preventing heart attach and stroke than less expensive ones in people who have both diabetes and heart disease.
In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.
Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. Because normal digestion interferes with insulin taken by mouth, insulin must be injected.
Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks like an ink pen, except the cartridge is filled with insulin.
An insulin pump also may be an option. The pump is a device about the size of a cell phone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. A tubeless pump that uses disposable pods to hold the insulin and a wireless device to tell the pump what to do also is available. A small catheter from the pod is automatically inserted under the skin, and the pod can be worn on the abdomen, lower back, thighs or upper arms. Whichever insulin pump you use, it can be programmed to dispense specific amounts of insulin automatically. It can also be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.
Types of insulin are many and include rapid-acting insulin, long-acting insulin and intermediate options. Examples include insulin lispro (Humalog), insulin aspart (NovoLog), insulin glargine (Lantus) and insulin detemir (Levemir).
Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.
If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries. However, the surgery is expensive and there are risks involved, including a slight risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis.
Women with type 2 diabetes will likely need to alter their treatment during pregnancy. Although there's no evidence that metformin is harmful to a growing fetus, studies haven't been done to definitively establish its safety in pregnancy. So, during pregnancy, you'll be switched to insulin therapy. Also, many blood pressure and cholesterol-lowering medications can't be used during pregnancy. If you have signs of diabetic retinopathy, it may worsen during pregnancy. Visit your ophthalmologist during the first trimester of your pregnancy and at one year postpartum.
Signs of trouble
Because so many factors can affect your blood sugar, problems sometimes arise. These conditions require immediate care, because if left untreated, seizures and loss of consciousness (coma) can occur.
Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar. Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're on insulin therapy. Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures.
If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.
If you have signs or symptoms of low blood sugar, eat or drink something that will quickly raise your blood sugar level — fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels are normal. If they're not, treat again and retest in another 15 minutes. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.
Careful management of type 2 diabetes can reduce your risk of serious — even life-threatening — complications. Consider these tips:
Above all, stay positive. Diabetes is a serious disease, but it can be controlled. If you're willing to do your part, you can enjoy an active, healthy life with type 2 diabetes.
Although two naturally occurring substances — chromium and cinnamon — have been shown in some studies to improve insulin sensitivity, other studies have failed to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, neither substance is currently recommended for diabetes control.
Type 2 diabetes is a serious disease, and following your diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile because following your treatment plan can reduce your risk of complications.
Talking to a counselor or therapist may help you cope with the lifestyle changes that come with a type 2 diabetes diagnosis. You may find encouragement and understanding in a type 2 diabetes support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences or helpful information, such as where to find carbohydrate counts for your favorite takeout restaurant. If you're interested, your doctor may be able to recommend a group in your area.
Or, you can visit the American Diabetes Association to check out local activities and support groups for people with type 2 diabetes. The American Diabetes Association also offers online information and online forums where you can chat with others who have diabetes. The phone number is 800-DIABETES (800-342-2383).
Healthy lifestyle choices can help you prevent type 2 diabetes. Even if diabetes runs in your family, diet and exercise can help you prevent the disease. If you've already been diagnosed with diabetes, the same healthy lifestyle choices can help you prevent potentially serious complications. And if you have prediabetes, lifestyle changes can slow or halt the progression from prediabetes to diabetes.
There's some evidence that coffee and, possibly, tea drinking may decrease your risk of developing type 2 diabetes, but more research is needed.
Sometimes medication is an option as well. Metformin (Glucophage), an oral diabetes medication, may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.
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