Type 2 Diabetes
Type 2 Diabetes
Type 2 diabetes, also known as type 2 diabetes mellitus or adult-onset diabetes, is a common chronic, potentially life-threatening disease in which there is too much sugar circulating in the bloodstream. Eventually, high blood sugar levels can lead to circulatory, nervous and immune system disorders. Someone with type 2 diabetes either does not produce the amount of insulin needed to regulate glucose levels in the body or is resistant to the effects of insulin.
There are more than 3 million cases of type 2 diabetes diagnosed in the United States each year. Although type 2 diabetes can appear at any age, it usually occurs in adulthood. However, since more children are obese than in years past, type 2 diabetes is on the rise in younger people.
There is no cure for type 2 diabetes, but you can control it by managing blood sugar levels with diet, exercise, and medication if needed.
Type 2 Diabetes Risk Factors
Although researchers have not yet determined the exact cause of type 2 diabetes, several factors may put you at a higher risk for developing it. The most significant risk factor is being overweight, especially if your body stores fat mainly in your abdomen. The second most significant contributing factor is leading a sedentary lifestyle. Additional risk factors include:
Those with type 2 diabetes may have inherited a gene (passed from parents to children) that puts them at a greater risk of getting it.
Race and ethnicity
Those most likely to develop type 2 diabetes include Black, Hispanic, Native American, Asian, and Pacific Islander.
Having low levels of high-density lipoprotein (HDL) cholesterol (the good kind) and high triglyceride levels puts you at a greater risk.
People usually develop type 2 diabetes after age 45.
Pregnancy and gestational diabetes
If you are pregnant and have or had gestational diabetes, you are at a greater risk.
If you have been diagnosed with pre-diabetes, you are at a greater risk.
Areas of darkened skin
For those who have darkened skin areas in the armpits and on the neck, this indicates you may have insulin resistance, thus putting you at a greater risk.
Polycystic ovary syndrome
Women with polycystic ovary syndrome have an increased risk of developing type 2 diabetes.
Metformin is an oral medication your doctor may prescribe to reduce the risk of developing type 2 diabetes for people with prediabetes. Doctors often prescribe Metformin to older adults who are obese and unable to lower blood sugar levels with lifestyle changes.
Type 2 Diabetes Compications
The effects of type 2 diabetes are dangerous if left uncontrolled. Therefore, you must start treating your condition as soon as possible to avoid complications. Unfortunately, type 2 diabetes often goes undiagnosed for years. Untreated type 2 diabetes can cause:
Heart disease is one of the most significant complications of type 2 diabetes. According to the American Diabetes Association, about 5.7 million people each year live with undiagnosed diabetes, and about 75 percent of people with diabetes die of heart disease.
Having excessive amounts of blood sugar increases your risk of suffering from a stroke.
Kidney Failure (Nephropathy)
Type 2 diabetes damages the kidneys and results in a decrease in the kidney filtration function. Type 2 diabetes is responsible for most cases of kidney failure in the United States.
Nerve Damage (Neuropathy)
There are several types of neuropathies and associated complications due to type 2 diabetes, including:
- Peripheral neuropathy – Most commonly, excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs, causing tingling, numbness, burning, or pain that usually begins at the tips of the toes and gradually spreads upward along the body.
- Gastroparesis – You may develop stomach problems causing nausea, vomiting, diarrhea, or constipation.
Type 2 diabetes can cause nerve and vascular damage, leading to poor circulation to the extremities, especially the feet, causing wounds to heal slowly or not at all. It is not unusual to develop an infection in an unhealed wound. Unfortunately, with type 2 diabetes, you may not realize you have a problem because you can cause lose all sense of feeling in the affected limbs. If wounds are left untreated, the infection can spread, becoming ulcerated, sometimes necessitating the amputation of a toe, a foot, or the entire leg. You must inspect your extremities, especially your feet, daily.
When someone has diabetic ketoacidosis, their body uses fat instead of sugar as an energy source. Ketones build up in the body and the bloodstream, and in high doses, ketones can be poisonous. Although it is a serious condition, diabetic ketoacidosis rarely occurs in people who have type 2 diabetes. There is often an inciting illness such as pneumonia or infection, contributing to a person developing diabetic ketoacidosis.
Retinal Damage (Retinopathy)
Type 2 diabetes causes damage to the blood vessels in the retina of your eye. This damage is progressive and can lead to blindness. You may not immediately notice the vision changes, but over time, eyesight deteriorates. When you manage your type 2 diabetes, you can reduce the chance of blindness by about 95%.
Type 2 diabetes can cause blocked blood vessels and nerve damage due to high blood sugar. Men with undiagnosed or poorly managed type 2 diabetes can experience erectile dysfunction as a result.
Blood Pressure & Cholesterol
Those with type 2 diabetes often have high blood pressure and high cholesterol.
Skin and Mouth Problems
Type 2 diabetes may leave you more susceptible to skin and mouth infections, including bacterial and fungal infections. Gum disease and dry mouth also are common.
High blood sugar levels may increase the risk of stillbirth, miscarriage, and congenital abnormalities. Type 2 diabetes may also increase the mother’s risk of diabetic eye problems (retinopathy), diabetic ketoacidosis, pregnancy-induced high blood pressure, and preeclampsia.
Keeping your blood sugar levels under control will significantly reduce many complications.
Type 2 Diabetes Symptoms
Symptoms of type 2 diabetes usually develop over several years. The symptoms can be so mild you may not even notice them. Often, people do not find out they have the disease until they are diagnosed with diabetes-related medical problems, such as heart disease. Signs of type 2 diabetes include:
- Blurry vision
- Increased thirst
- Increased appetite
- Frequent infections
- Unexplained weight loss
- Slow healing cuts or wounds
- More frequent need to urinate
- Sudden unintended weight loss
- Numbness or tingling in the hands or feet
- Itching and rash around the genitals or other skin folds
- Areas of darkened skin, usually in the armpits and neck
Type 2 Diabetes Diagnosis
Since most people don’t show any signs of type 2 diabetes for years after onset, the American Diabetes Association recommends routine screening in adults aged 45 or older. The following groups of people younger than 45 should also be screened regularly if they:
- Have experienced gestational diabetes
- Have been diagnosed with prediabetes
- Are overweight, obese, and have one or more risk factors
- Are overweight or obese children with a family history of type 2 diabetes or other risk factors
Diagnosing type 2 diabetes begins with a physical examination. Your doctor will ask questions about your medical history and your family’s medical history. Your doctor will order blood tests if they suspect type 2 diabetes. Diagnostic blood tests to measure the glucose level in the body include:
Glycated hemoglobin (A1C) test
The A1C test indicates your average blood sugar level for the past two to three months by measuring the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin)
The A1C test is the most common one used to diagnose type 2 diabetes. However, certain conditions, like pregnancy, or an uncommon form of hemoglobin (hemoglobin variant), can make the A1C test inaccurate. If you have any medical condition that might distort the results of the A1C test, or if the A1C test is not available, your doctor may use one of these tests:
Fasting blood sugar (FBS) test
Blood is sampled after fasting overnight. Your doctor may repeat the FBS test to confirm the results.
Random blood sugar test
The phlebotomist will sample your blood at a nonfasting time. The doctor may repeat the random blood sugar test to verify high blood sugar.
Oral glucose tolerance test (OGTT)
The phlebotomist will sample your blood two hours after drinking a glucose solution. The OGTT is the least commonly performed blood test in non-pregnant individuals but is an excellent choice for pregnant patients.
A urine test can detect how much excess glucose is being excreted, which is a good indicator in diagnosing type 2 diabetes.
If you are diagnosed with diabetes, your doctor may order additional tests to verify type 1 versus type 2 diabetes because the two conditions sometimes require different treatments.
Type 2 Diabetes Treatments
You can often manage type 2 diabetes with diet and exercise, but medications are available if diet and exercise alone cannot control your diabetes. Your doctor may refer you to an endocrinologist to help create a treatment plan.
You will primarily manage your diabetes with assistance from your medical team, so it is crucial to educate yourself. You can help control your diabetes by combining a healthy diet, physical activity, and medication. You will use a small device called a blood glucose meter to monitor your blood sugar levels several times a day. Another option is a continuous glucose monitor. The continuous glucose monitor samples your interstitial fluid every few minutes from a sensor wire under your skin. The continuous glucose monitor can even send your readings to your cell phone, and you can receive alerts when your levels are too high or too low.
You will need regular appointments so your doctor can monitor your A1C levels. When you have type 2 diabetes, it is vital to control your blood pressure and cholesterol levels. Your doctor should also monitor labs for thyroid, kidney, and liver functions and may take a urine sample to check these functions at your appointments. The doctor will also check the sites where you test your blood sugar and deliver insulin to avoid infections.
There is not a specific diabetes diet that will work for all individuals. You may want to work with a nutritionist to help you understand your dietary needs and create a meal plan to control your type 2 diabetes. Your nutritionist will probably recommend that you eat primarily low-fat, high-fiber foods like fruits, vegetables, and whole grains while eating fewer refined carbohydrates and animal products, especially red meat and poultry skin. You should also avoid foods with high sugar or fat content. Additionally, it may help you keep your blood sugar level stable if you eat smaller portions more often throughout the day. For example, six small meals a day might help you control your blood sugar levels better than three large meals a day.
Physical activity plays a vital role in helping you control your type 2 diabetes. Choose activities you enjoy, such as walking, jogging, swimming, riding a bike, or tennis, and make them part of your daily routine. Try to get at least 30 minutes a day or 150 minutes of aerobic exercise a week, with no more than two days without exercise because physical activity helps lower blood sugar levels. If it is too difficult to do 30 minutes of activity at once, it is okay to break it up into 10-minute chunks. Besides aerobic exercise, you should add strength training for 20 to 30 minutes two or three times a week, and flexibility training, especially before working out to warm up and after working out to cool down. You should aim to have a good balance of all three. Your long-term health depends on activity, so as tough as it may be to find the time or to motivate yourself, stay active. Additionally, try to avoid inactivity for long periods. For example, when you are sitting at the computer, it is recommended that you take a few minutes every 30 minutes to stand up, walk around, or do some light activities.
Medications cannot cure type 2 diabetes, but they can help you control your blood sugar levels. Different drugs work in different ways. Metformin is usually the first medication doctors prescribe. It works by lowering glucose production in the liver and improving your body’s sensitivity to insulin so that your body uses insulin more effectively. Sulfonylureas and Glinides help your body secrete more insulin, but Glinides act more quickly than Sulfonylureas, and the duration of their effectiveness is shorter. DPP-4 inhibitors and GLP-1 receptor agonists help reduce blood sugar levels, but DPP-4 inhibitors tend to be somewhat less effective. GLP-1 receptor agonists are often associated with weight loss, and some reduce heart attack and stroke risk. Thiazolidinediones make the body’s cells more sensitive to insulin, and SGLT2 inhibitors prevent the return of glucose to the bloodstream, so glucose is excreted in the urine. SGLT2-I drugs may reduce the risk of heart attack and stroke in people with a high risk of those conditions.
Other medications your doctor might prescribe in addition to diabetes medications include cholesterol and blood pressure medicines, as well as low-dose aspirin, to help prevent heart and blood vessel disease.
Sometimes, people with type 2 diabetes need to take insulin. There are four types of insulin including:
- Long-acting insulin
- Rapid-acting insulin
- Regular (Short-acting) insulin
- NPH insulin (Intermediate-acting)
You cannot take insulin orally because stomach enzymes break down insulin voiding its effectiveness. The amount and frequency of insulin depend on your daily blood glucose and the A1C levels. Insulin must be taken by injection, inhalation, or with an insulin pump.
- Injection – You can use a syringe or an insulin pen to inject insulin under your skin. Insulin pens are available in disposable or refillable varieties. If you choose injections, you will likely need a mixture of insulin types (see above) to use throughout the day and night. A regimen incorporating three or more insulin injections a day, with various insulin types, improves blood sugar levels. This type of regimen mimics the natural pattern of insulin production.
- Insulin pump – An insulin pump is a small programmable device worn outside the body. The pump is small enough to fit within the palm of your hand. The insulin pump delivers insulin according to the programmed settings or in response to glucose levels when paired with a continuous glucose monitor. Research indicates that an insulin pump may be more effective at controlling blood sugar levels than injections, but many people achieve good blood sugar levels with injections, too.
Because weight loss surgery changes your digestive system’s shape and function, it might help you manage your type 2 diabetes and other conditions related to obesity. Diet, exercise, and mental health care go hand-in-hand with weight loss surgery. Weight loss surgery requires a lifelong commitment to permanent lifestyle changes.
Treatment during pregnancy
Women may need to change their treatment plan when pregnant. Insulin is often recommended rather than non-insulin medications during pregnancy. Pregnant women should visit an ophthalmologist for an eye exam during each trimester of pregnancy due to an increased risk of developing retinopathy during pregnancy.
Caring for yourself after being diagnosed with type 2 diabetes
After being diagnosed with type 2 diabetes, you will be responsible for monitoring your health to avoid complications. Besides testing your blood sugar and keeping a record of the results, you will also need to:
Get plenty of sleep
Manage your stress
Take your medications as prescribed
Stick to your diet and exercise plan
Purchase and adequately store diabetes supplies
Check your feet, skin, and eyes to catch problems early
Recognize signs of high or low blood sugar and know what to do about it
Type 2 Diabetes Specialists
Laurie Kane, MD
12555 West Jefferson Blvd., Suite 301, Los Angeles, CA 90066
Rose Lin, MD
1831 Wilshire Blvd., Suite A, Santa Monica, CA 90403
Sarah Rettinger, MD
1831 Wilshire Blvd., Suite A, Santa Monica, CA 90403