Type 2 Diabetes Information
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About Type 2 Diabetes
Many people with type 2 diabetes don't show any symptoms of having the disease prior to being diagnosed with it. In fact, more than 7 million people in the United States have type 2 diabetes and don't yet know it, according to the U.S. Centers for Disease Control and Prevention's National Diabetes Fact Sheet (cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf).
However, some people do experience one or more of these so-called "classic" diabetes symptoms, including:
- increased thirst
- increased hunger
- weight loss
- blurred vision
- frequent urination
- frequent infections and/or slow-healing cuts or sores
If you experience any of these symptoms, schedule an appointment with your health care provider and ask about having an A1C blood test or fasting or random blood glucose test done.
The Cause of Type 2 Diabetes
Type 2 diabetes is a progressive disease and is diagnosed when an individual's glucose level (also called blood sugar) is consistently above normal.
Glucose from digested food is the main source of energy for the body's cells. When glucose enters the bloodstream, the pancreas releases insulin to help cells use glucose for energy.
In people with type 2 diabetes, two problems occur. First, the body has slowly become insulin-resistant. This means that the cells are not able to efficiently and effectively use the insulin that the pancreas makes. Second, the pancreas is not producing enough insulin to keep blood glucose levels normal, called relative insulin deficiency. When this happens, several problems occur:
- Glucose continues to flow through the bloodstream but cannot be used by the cells.
- Over time, glucose levels increase while the cells don't get the energy they need.
- Left untreated over the short term, the signs and symptoms of diabetes set in. Over the long term, high blood glucose for years can lead to complications such as nerve problems, heart and blood vessel disease, eye damage, and kidney disease.
What's Happening Inside the Body
1. After you eat, food is broken down into glucose that the body can use for energy and repair.
2. Glucose (shown here as purple hexagons) enters the bloodstream.
3. Beta cells of the pancreas are no longer able to make enough insulin (shown here as yellow dots) to control blood glucose. Plus, the body's cells are insulin-resistant and no longer able to use this insulin as effectively as normal. This is a progressive condition that starts even before a person develops prediabetes.
4. Without enough insulin or insulin that can be used by the body effectively, glucose is not able to enter the cells for energy.
Risk Factors for Type 2 Diabetes
There are several risk factors for type 2 diabetes, including:
- Weight: People who are overweight -- particularly those who tend to carry extra weight around their middle (abdomen) -- have an increased risk.
- Family History: Having a parent or sibling with type 2 diabetes increases the chances of developing the disease.
- Race: For reasons that aren't completely understood, African-Americans, Hispanics, Asian-Americans, and Native Americans have a higher risk.
- Age: People older than 45 tend to have a higher risk of developing type 2 diabetes, but younger adults -- including children -- are also developing the disease.
- Sedentary Lifestyle: Individuals who are inactive (exercise less than three times per week) have a higher risk.
- Gestational Diabetes: Women who had diabetes while pregnant (gestational diabetes) or delivered one or more babies weighing more than 9 pounds are at an increased risk.
- Prediabetes: Men and women who have prediabetes -- a condition with elevated glucose levels that are higher than normal but not high enough to be called diabetes -- are at a higher risk.
How Type 2 Diabetes Is Diagnosed
As of 2010, the American Diabetes Association, in its Standards of Medical Care for Diabetes, recommends the hemoglobin A1C (abbreviated simply as A1C) blood test to determine the diagnosis of pre-diabetes or diabetes. Internationally this is becoming the preferred test rather than a blood glucose check, which only shows a blood glucose result at one point in time. The A1C test is able to detect the ups and downs of blood glucose over the last two to three months. It's also more convenient because fasting isn't required.
Normal: 5.6% or less
Prediabetes: 5.7% up to 6.4%
Diabetes: 6.5% or greater
Blood glucose results can also be used to diagnose diabetes. These are the ADA criteria for normal, prediabetes, and diabetes (both type 1 and type 2):
Less than 100 mg/dl
Equal to or greater than 100 mg/dl and less than 126 mg/dl
Equal to or greater than 126 mg/dl. A second test is required for confirmation.
After eating/ random
Less than 140 mg/dl
Equal to or greater than 140 mg/dl and less than 200 mg/dl
Equal to or greater than 200 mg/dl.
*If one result does not clear indicate prediabetes or diabetes, a second blood glucose measure should be done.
How to Manage Type 2 Diabetes
With good blood sugar control, along with good cholesterol and blood pressure control, people with type 2 diabetes can live a long and healthy life. Studies show that good control over the years is essential to reduce the risk of complications. While treatment varies from person to person, there are typically several steps.
1. Medications: Today the ADA and other organizations recommend that as soon as most people are diagnosed with diabetes, they should begin taking a blood glucose-lowering medication. The medication that's most commonly prescribed is metformin, which is available as a generic medicine. Over time, most people need to increase, add, and/or change their blood glucose-lowering medicines because of the progression of type 2 diabetes. After having type 2 diabetes for 10 years, it's very common to need insulin to control blood glucose levels.
Common medications include:
- Metformin, which helps keep the liver from generating extra glucose and also helps the muscles use more glucose. (Generic: metformin; brand names: Glucophage, Glucophage XR, Glumetza, Fortamet XR, Riomet Liquid)
- Sulfonylureas, which stimulate the pancreas to produce more insulin. (Generics: glimepiride, glipizide, glyburide; brand names: Glyanse PresTabs, Diabeta, Micronase, Glucotorol, Amaryl)
- Dipeptidyl peptidase 4 (DPP-4) inhibitors , which help the body use its dwindling supply of the gut hormone incretin by inhibiting the breakdown of the enzymes that slow the stomach's emptying. This also slows the rise of blood sugar after you eat, delays the release of glucose into the bloodstream, promotes fullness, and prevents the release of glucagon (the hormone that releases glucose into the bloodstream) from the pancreas. (Brand names [generics]: Januvia [sitagliptin], Onglyza [saxagliptin], Tradjenta [linagliptin])
- GLP-1 analogs, which act like the gut hormone incretin to slow the rise of blood glucose after you eat, delay the release of glucose into the bloodstream, promote fullness, and prevent the release of glucagon (the hormone that releases glucose into the bloodstream) from the pancreas. These injectable medicines have a more significant effect than DPP-4s. (Brand names [generics]: Byetta [exenatide, taken twice a day], Bydureon [exenatide, once a week], Victoza [liraglutide, once a day])
- Meglitinide, which stimulate the pancreas to produce more insulin but are fast-acting. (Brand names [generics]: Prandin [replaglinide], Starlix [nateglinide])
- Alpha Glucosidase Inhibitors, which prevent the digestive system from absorbing glucose. (Brand names [generics]: Precose [acarbose], Glyset [miglitol])
- Insulin, which helps the cells use glucose. There are several types of insulin, from rapid-acting to long-acting. Insulin can be taken with a syringe, pen, or pump.
Be aware that new blood glucose-lowering medications are approved by the U.S. Food and Drug Administration from time to time. These medicines may be a new drug in an existing category or may represent a new category of medications.
2. Healthful Meal Plan: Making healthy food choices and eating nutritious meals is necessary to maintain good control of glucose, along with cholesterol and blood pressure. To manage diabetes and prevent complications, a healthful eating plan should be rich in dietary fiber, whole grains, fresh fruits, low-fat dairy, and vegetables, plus it should be low in saturated and trans fats. Speak with a registered dietitian to help set goals to slowly change unhealthy eating habits.
Maintaining a Healthy Weight
3. Weight Loss: Some people, particularly in the first few years of having type 2 diabetes, can improve their diabetes control by losing about 5-7 percent of their starting body weight. In addition, weight loss -- particularly around the abdomen -- can improve the body's response to insulin. This is known as improved insulin sensitivity. Maintaining a healthy weight may also help reduce the risk of diabetes-related complications, such as heart disease and high blood pressure.
Being Physically Active
4. Physical Activity: Exercise can help reduce blood sugar levels, improve insulin resistance, improve cholesterol, and decrease high blood pressure. In addition, moving more can help achieve and maintain a healthy weight.
Tracking Blood Glucose Levels
5. Monitoring Your Progress: Keeping track of glucose levels by checking your blood sugar with a glucose monitor can help you learn about the ups (high blood sugar, or hyperglycemia) and downs (low blood sugar, or hypoglycemia) of your blood glucose and how well your medications, activity level, and food choices are working to control blood sugar levels.
Preventing Type 2 Diabetes
Type 2 diabetes is a progressive disease. By the time type 2 is diagnosed, people have lost half or more of their ability to supply the body with a sufficient amount of their own insulin. They also have significant insulin resistance. If you are at risk or have been told you have prediabetes, take action now. There are steps you can take to help prevent or delay the onset of type 2 diabetes, including:
Achieve and maintain a healthy weight: Talk with your health care provider about reaching a healthy weight for you. Studies have shown that losing 5-7 percent of your body weight (a 10- to 14-pound weight loss for a 200-pound person) can prevent or delay prediabetes from progressing to type 2.
Know your risk for prediabetes: Talk with your health care provider about how frequently you should be checked for type 2 diabetes. Mention any diabetes symptoms you may be experiencing.
Become more physically active: Increasing your activity level improves your body's sensitivity to the insulin you make. It also helps control blood sugar and helps with weight control.
Eat healthfully: To maintain a healthy weight, enjoy nutritious food choices. That means fruits and vegetables, whole grains, low-fat dairy foods, lean protein, and plenty of dietary fiber. Limit the amount of foods and beverages with added sugars and lots of fat. Those foods will be high in calories.