What is Type 2 Diabetes?
Diabetes mellitus, often known simply as diabetes, is a long-term health condition where there’s too much sugar in the blood. This can happen because the body either doesn’t produce enough insulin, resists the effects of insulin, or both. The International Diabetes Federation estimates there were around 415 million adults aged between 20 and 79 with diabetes in 2015. This number is predicted to surge by another 200 million by 2040, making diabetes an increasing global health concern.
Chronic high blood sugar, together with other metabolic issues seen in people with diabetes, can harm different organs over time, leading to serious and potentially lethal health problems. Particular concerns are microvascular problems such as damage to the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy), and macrovascular issues increasing the risk of heart disease by 2 to 4 times. This piece will cover the causes, diagnosis, symptoms, and principles of managing diabetes.
What Causes Type 2 Diabetes?
Diabetes is a health condition known for high sugar levels in the blood and is generally divided into three main types: type 1, type 2, and gestational diabetes. However, there are also a few other minor types, such as monogenic diabetes and secondary diabetes.
Type 1 diabetes represents 5% to 10% of all cases of diabetes. This form of diabetes occurs when the body’s immune system destroys the cells in the pancreas that make insulin, a hormone needed to control blood sugar levels. While the exact cause of this autoimmune response isn’t entirely understood, theories suggest a mix of genetic predisposition and environmental elements like viral infection or certain diet habits could play a part. Type 1 diabetes is most often found in children and teenagers, but can appear at any age.
Type 2 diabetes, on the other hand, is significantly more common, accounting for nearly 90% of all diabetes cases. In type 2 diabetes, the body becomes resistant to insulin, meaning it doesn’t respond to the hormone as it should. Initially, the body compensates by producing more insulin, but over time, production decreases, causing blood sugar levels to rise. Although it’s often seen in adults over 45, due to a rise in obesity and physical inactivity, type 2 diabetes is also becoming more prevalent in children, teenagers and young adults.
Gestational diabetes is a type of diabetes that is first diagnosed during pregnancy. It normally appears during the second or third trimester and complicates about 7% of all pregnancies, per the American Diabetes Association. Women diagnosed with gestational diabetes and their children stand a higher chance of developing type 2 diabetes in the future. Potential complications include high blood pressure, excessive amniotic fluid, as well as the need for medical interventions for mother and baby. Risk factors include older age, obesity, a history of birth defects or stillbirth in previous pregnancies, or having a family history of diabetes.
Monogenic diabetes is caused by a single genetic mutation and includes conditions like neonatal diabetes and maturity-onset diabetes of the young. Around 1 to 5% of all diabetes cases are of this type. The latter often appears before the age of 25 and tends to run in families.
Secondary diabetes, as the name suggests, isn’t a primary condition. Instead, it’s a consequence of other health conditions that affect the pancreas or hormonal balances, or the use of certain drugs.
Risk Factors and Frequency for Type 2 Diabetes
Diabetes is a global issue that’s becoming more common due to changes in lifestyle and increasing rates of obesity. The number of people with diabetes was 425 million globally in 2017. According to the International Diabetes Federation, in 2015, roughly 10% of Americans had diabetes, and about 7 million of these cases weren’t diagnosed. Diabetes also becomes more common as people age, with about 25% of people over 65 having the condition.
- Diabetes is becoming more common due to changes in our lifestyles and increasing obesity.
- In 2017, there were 425 million people with diabetes globally.
- In 2015, about 10% of Americans had diabetes, according to the International Diabetes Federation.
- About 7 million of these cases weren’t diagnosed.
- Diabetes is more common in older age groups, with about 25% of people over 65 having the condition.
Signs and Symptoms of Type 2 Diabetes
People with diabetes often show symptoms such as experiencing increased thirst, having to urinate more frequently, feeling low on energy or constantly tired, being prone to bacterial and fungal infections, and finding that wounds take longer than normal to heal. Some may also notice sensations of numbness or tingling in their hands or feet, or have issues with blurred vision.
These individuals may have slightly high blood sugar levels, which can escalate to dangerously high levels or even lead to a condition called ketoacidosis when under physical or emotional stress. Notably, around 30% of Type 1 diabetes sufferers can initially present with a diabetic ketoacidosis coma.
When examining a patient with diabetes, it’s important to take note of their height, weight, and Body Mass Index (BMI). An eye specialist should screen these patients to rule out potential issues with the retina in the eye, which is a condition known as retinopathy. It’s also necessary to check their pulses to look for signs of peripheral arterial disease. Furthermore, the doctor needs to conduct a physical examination and take the patient’s history to ascertain there’s no peripheral neuropathy, a nerve disorder that often affects the hands and feet.
Testing for Type 2 Diabetes
Doctors recommend annual health checks for people above 40 years of age. If you have risk factors for diabetes, you might need to get checked more frequently. These risk factors include certain ethnic backgrounds (Native American, African American, Hispanics, or Asian American, Pacific Islander), being overweight, having a close family member with diabetes, past heart disease or high blood pressure, low HDL-cholesterol or high triglycerides, polycystic ovarian syndrome in women, and lack of physical activity. Some skin conditions, like Acanthosis nigricans, can also indicate insulin resistance, a contributory factor for diabetes.
Women who have had gestational diabetes (diabetes during pregnancy) should be tested at least every three years for the rest of their lives. For everyone else, testing should start at age 45 and be carried out at least every three years if the results are normal. The same checks are used to screen for and diagnose diabetes, and can also find out if someone has prediabetes, a condition that can lead to diabetes.
Your doctor can diagnose diabetes using either the hemoglobin A1C criteria or your blood sugar levels (either fasting or after consuming glucose). For the fasting test, blood is drawn after an overnight fast. A reading of more than 126 mg/dL is consistent with diabetes. In the oral glucose tolerance test, your blood sugar level is tested before and 2 hours after you drink 75 gm of glucose. Diabetes is confirmed if the result is more than 200 mg/dL. For the A1C test, a reading of over 6.5% indicates diabetes. The A1C test provides an average of your blood sugar levels over two or three months, but there are some issues, like its lower sensitivity and the effect of conditions like sickle cell disease, pregnancy, and blood loss, on its result.
Testing should be repeated at a later time if you are not experiencing symptoms to confirm a diabetes diagnosis. If you have classic symptoms of high blood sugar like excessive thirst, hunger, and urination, and your blood sugar level is over 200 mg/dL, diabetes can be diagnosed. All three tests FPG, 2-hour PG during 75-g GTT, and Hb A1C are appropriate for diagnosing diabetes. But the results from these tests may not match.
Women who weren’t previously known to have diabetes should get tested for gestational diabetes between 24 to 28 weeks of pregnancy. The testing methods recommended by the American Diabetes Association and the American College of Obstetrics and Gynecology include a one-step and two-step approach. A one-step test involves having your blood drawn before and 1 and 2 hours after drinking 75 gm of glucose. In the two-step test, you have a glucose challenge test first, and if your sugar levels are high, you will have an overnight fasting test with a larger amount of glucose. The results from these tests can confirm a diagnosis of gestational diabetes.
Treatment Options for Type 2 Diabetes
For both type 1 and type 2 diabetes, the most important part of treatment is maintaining a healthy diet and exercising regularly. It’s best to eat a diet low in saturated fats, refined carbs, and high fructose corn syrup, while eating foods high in fiber and monounsaturated fats. Regular aerobic exercise, at least 90 to 150 minutes per week, can also help manage diabetes. For patients with type 2 diabetes who are overweight, the primary goal is to lose weight.
If maintaining a healthy diet and regular exercise are not enough to manage blood sugar levels, medication may be necessary. Metformin is usually the first choice. If metformin isn’t effective, other possible treatments include oral sulfonylureas, DPP-4 inhibitors, GLP-I receptor agonists, SGLT2 inhibitors, pioglitazone, alpha-glucosidase inhibitors, and insulin. In particular, studies have shown that SGLT2 inhibitors like empagliflozin (EMPA) and GLP-1 receptor agonists like liraglutide can significantly decrease risks related to heart disease and death. Individuals with heart disease might consider adding these medications to their treatment regimen. As for type 1 diabetes, the most common treatment is a regimen of basal-bolus insulin, although insulin pump therapy is also a reasonable option.
All treatment approaches should take into account the risk of low blood sugar (hypoglycemia), which can lead to higher mortality. Medications like DPP-4 inhibitors, SGLT-2 inhibitors, GLP-I receptor agonists, and pioglitazone with metformin are preferred because they do not typically cause hypoglycemia. Another benefit of SGLT-2 inhibitors and GLP-I receptor agonists is that they can help reduce body weight, blood pressure, and albuminuria (a condition whereby the protein albumin is abnormally present in the urine).
The goal is to reduce microscopic damage to the body’s tissues and organs (microvascular complications). Ideally, your Hb A1C measurement, a long-term gauge of blood sugar control, should be less than 7%, and your blood pressure should be less than 130/85 mmHg. Eye exams and regular urine tests for albumin, a protein that can indicate kidney damage, are also essential.
If you have type 1 or type 2 diabetes, managing your cholesterol levels is key. Usually, an LDL-C level (a measure of “bad” cholesterol) less than 100 mg/dl is the goal if you don’t have any heart disease. If you do have heart disease, your aim should be less than 70 mg/dl. Statins are generally the medication options of choice to control cholesterol and reduce heart-related events and risk of death, with other drugs like ezetimibe and PCSK9 inhibitors considered if necessary and if you’re not meeting your cholesterol goals.
For more information on the complications and therapies for both type 1 and type 2 diabetes, take a look at other related articles. This is just a basic rundown of the treatment principles you need to know.
What else can Type 2 Diabetes be?
When a doctor is trying to diagnose diabetes, they have to consider a range of conditions that present similar signs and symptoms. These may include:
- Side effects from certain medications such as corticosteroids, neuroleptics, or pentamidine.
- Genetic issues that affect how the cells in the pancreas function or how insulin works in the body.
- Metabolic syndrome, sometimes known as ‘syndrome X’.
- Bacterial or viral infections.
- Endocrine diseases like acromegaly, Cushing’s disease, pheochromocytoma, and hypothyroidism.
- Health issues caused by an overload of iron in the body (hemochromatosis).
- Conditions affecting the pancreas, such as pancreatitis or cystic fibrosis.
It’s crucial for the doctor to review these possibilities since they could confuse the diagnosis of diabetes.
What to expect with Type 2 Diabetes
Diabetes is known to increase the risk of severe heart disease related to the hardening and narrowing of arteries, also known as atherosclerotic cardiovascular disease (ASCVD). Controlling blood pressure, using statins (cholesterol-lowering drugs), maintaining a regular exercise routine, and quitting smoking can significantly help reduce this risk. Overall, people with type 2 diabetes have about a 15% higher rate of mortality, but this number can vary quite a bit.
In the United States, around 4.4% of adults with diabetes face a serious risk to their vision due to diabetic retinopathy, a condition that damages the blood vessels in the retina. About 1% have end-stage kidney disease, a serious condition that can require dialysis or a kidney transplant.
Fortunately, today’s medical treatments are quite effective at managing the vascular complications often seen in diabetes patients. This includes drugs to control high blood sugar and lower ‘bad’ LDL cholesterol, medication to manage high blood pressure, and the use of aspirin for people who’ve already had a heart attack or stroke. These therapies have significantly reduced both the occurrence and severity of complications, as well as the number of deaths.
Possible Complications When Diagnosed with Type 2 Diabetes
If you have uncontrolled diabetes, it means your blood sugar levels are too high and this can lead to a number of health issues. Diabetes is a major cause of heart disease, blindness, kidney failure, and lower limb amputation. There are both immediate and long-term problems connected with the condition.
Immediate dangers can include sudden drops in blood sugar levels, conditions called diabetic ketoacidosis and hyperglycemic hyperosmolar state, and falling into a diabetic coma due to extreme high blood sugar levels.
On the other hand, long-term complications could involve small blood vessels which can affect the kidneys, nerves and eyes. Larger blood vessels could also be affected, leading to heart disease, blockages in the blood vessels of the limbs, and brain disease. It’s projected that, unfortunately, every year between 1.4 to 4.7% of middle-aged people with diabetes may experience a heart-related event.
Common complications of uncontrolled diabetes
- Heart disease
- Blindness
- Kidney failure
- Lower limb amputation
- Blood sugar level drop
- Diabetic ketoacidosis
- Hyperglycemic hyperosmolar state
- Diabetic coma
- Problems with small blood vessels (affecting kidneys, nerves, eyes)
- Problems with large blood vessels (leading to heart disease, limb blood vessel blockages, brain disease)
Preventing Type 2 Diabetes
It’s important for patients to understand the significance of managing their blood sugar levels in order to steer clear of complications related with diabetes. A major focus should be placed on lifestyle changes, which include controlling their diet and incorporating physical exercise into their routine. Regular self-monitoring of blood glucose levels is a crucial activity that enables patients to play an active role in managing their own diabetes. Regular checks of glucose, glycated hemoglobin, and lipid levels are also necessary.
Doctors and nurses should help patients to recognize symptoms of low blood sugar, such as a rapid heartbeat, sweating, or confusion, and should teach them the proper response, which is to consume 15 to 20 grams of carbs.
Patients should also be encouraged to stop smoking, and the importance of regular eye exams and good foot care should be emphasized in order to avoid any side-effects.
