Type 2 Diabetes

Overview

Type 2 diabetes is a long-term condition in which the body has difficulty regulating and using sugar (glucose) as a fuel. This results in high levels of sugar in the blood, which can lead to complications in the circulatory, nervous, and immune systems. Type 2 diabetes is primarily caused by two problems: cells in muscle, fat, and the liver becoming resistant to insulin, and the pancreas not producing enough insulin. The disease is more common in older adults, but cases in younger people have increased due to the rise in obesity. There is no cure for type 2 diabetes, but it can be managed through weight loss, a healthy diet, exercise, and medications or insulin therapy if needed. Symptoms may include increased thirst, frequent urination, increased hunger, unintended weight loss, fatigue, blurred vision, slow-healing sores, frequent infections, numbness or tingling in the hands or feet, and areas of darkened skin. If you experience any of these symptoms, it is important to see your healthcare provider.

Understanding the disease

Symptoms

The symptoms of type 2 diabetes may include increased thirst, frequent urination, increased hunger, unintended weight loss, fatigue, blurred vision, slow-healing sores, frequent infections, numbness or tingling in the hands or feet, and areas of darkened skin, usually in the armpits and neck. If you notice any of these symptoms, it is important to see a healthcare provider. Type 2 diabetes is caused by two main problems: cells in muscle, fat, and the liver becoming resistant to insulin, and the pancreas not producing enough insulin or the cells responding poorly to insulin.

Risk Factors

Risk factors for developing type 2 diabetes include being overweight or obese, having a fat distribution where most fat is stored in the abdomen, being inactive, having a family history of type 2 diabetes, belonging to certain races and ethnicities, having low HDL cholesterol levels and high triglycerides, increasing age, having prediabetes, and having conditions like polycystic ovary syndrome or sleep apnea.

Development

Type 2 diabetes develops due to a combination of two main problems: insulin resistance and insufficient insulin production. Insulin resistance occurs when the cells in the muscles, fat, and liver become less responsive to insulin, causing them to take in less glucose. As a result, glucose builds up in the bloodstream, and the pancreas produces more insulin to try to regulate blood sugar levels. Over time, the cells in the pancreas responsible for insulin production can become damaged, leading to insufficient insulin production to maintain healthy blood sugar levels. The exact cause of this process is not fully understood, but being overweight and inactive are key contributing factors.

Assessment and Diagnosis

Triage

You should see a doctor if you notice any symptoms of type 2 diabetes, such as increased thirst, frequent urination, increased hunger, unintended weight loss, fatigue, blurred vision, slow-healing sores, frequent infections, numbness or tingling in the hands or feet, or areas of darkened skin. If you have prediabetes or are at risk of developing type 2 diabetes, it is also important to consult a healthcare provider for proper evaluation and guidance on lifestyle changes to prevent or delay the onset of diabetes.

Diagnosis

Type 2 diabetes is usually diagnosed using the glycated hemoglobin (A1C) test, which indicates your average blood sugar level for the past two to three months. Results are interpreted as follows:

• Below 5.7% is normal.
• 5.7% to 6.4% is diagnosed as prediabetes.
• 6.5% or higher on two separate tests indicates diabetes. If the A1C test isn't available or if you have certain conditions that interfere with an A1C test, your health care provider may use the following tests to diagnose diabetes:
• Random blood sugar test: A level of 200 mg/dL (11.1 mmol/L) or higher, especially with symptoms of diabetes, suggests diabetes.
• Fasting blood sugar test: A blood sample is taken after an overnight fast. Results of 126 mg/dL (7 mmol/L) or higher on two separate tests indicate diabetes.
• Oral glucose tolerance test: This test is taken after fasting and drinking a sugary liquid. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes. Screening is recommended for all adults aged 35 or older and those with risk factors like obesity, family history, or gestational diabetes. Monitoring blood sugar levels is crucial for managing diabetes, and medications like insulin therapy or oral medications may be prescribed if lifestyle changes aren't enough to maintain target blood sugar levels.

Management and Treatment

Complications

Potential complications of type 2 diabetes include chronic kidney disease, end-stage kidney disease, blindness due to eye damage, skin problems, slow healing of cuts and blisters, hearing impairment, obstructive sleep apnea, and an increased risk of dementia. Type 2 diabetes can also lead to nerve damage, foot problems, and amputations.

Prevention

Type 2 diabetes can be prevented through healthy lifestyle choices. By making changes in your diet, increasing physical activity, and maintaining a healthy weight, you can reduce your risk of developing type 2 diabetes. Adopting a lifestyle that includes healthy eating habits, regular exercise, and maintaining a normal body weight can greatly lower your chances of developing the condition.

Treatment

Type 2 diabetes can be managed through lifestyle changes, medications, or a combination of both. The main treatments for type 2 diabetes include:

1. Weight loss and exercise: Losing weight through diet and exercise can help manage blood sugar levels. Regular physical activity, such as 150 minutes or more per week of moderate to vigorous aerobic activity, can improve insulin sensitivity.
2. Healthy eating: Adopting a healthy diet, rich in fiber, and low in fat and calories, can help control blood sugar levels. Focus on whole grains, fruits, and vegetables, and limit intake of processed foods and sugar.
3. Medications: If lifestyle changes aren't enough to control blood sugar levels, diabetes medications or insulin therapy may be recommended. Common diabetes medications include metformin, sulfonylureas, DPP-4 inhibitors, GLP-1 agonists, SGLT2 inhibitors, and insulin.
4. Insulin therapy: In some cases, insulin therapy may be necessary to manage blood sugar levels. This can involve injections or the use of an insulin pump. It is important to consult with a healthcare provider to determine the appropriate treatment plan, as it may vary depending on individual factors and the severity of the condition. Remember to always consult with a healthcare provider for personalized advice and treatment recommendations.

Preparing for medical consultation

To prepare for an appointment for type 2 diabetes, you can:

1. Be aware of any pre-appointment restrictions: Ask your healthcare provider if there are any specific dietary or other restrictions you need to follow before your appointment.
2. Write down symptoms and personal information: Prepare a list of any symptoms you're experiencing, including those that may seem unrelated to diabetes, as well as key personal information, such as major stresses or recent life changes.
3. Make a list of medications: Compile a list of all medications, vitamins, or supplements you're currently taking, including any blood sugar-lowering medications or insulin.
4. Bring a family member or friend: Consider bringing someone along to help you remember information, ask questions, and advocate on your behalf.
5. Be ready to discuss your treatment plan: Be prepared to discuss your understanding of your treatment plan and how confident you feel about following it.
6. Address any challenges in managing diabetes: Be prepared to discuss any difficulties you're experiencing in managing your diabetes, such as dietary changes, physical activity, or medication management.
7. Ask questions: Prepare a list of questions to ask your healthcare provider during the appointment, including questions about follow-up appointments, coordinating treatments, emergency situations, and available resources. Remember to work closely with your healthcare provider and diabetes education specialist to develop a personalized management plan that addresses your individual needs and helps you better coordinate your care.