Type 2 Diabetes

The most common form of diabetes is type 2 diabetes, formerly called non-insulin dependent diabetes mellitus or "adult onset" diabetes, so-called because it typically develops in adults over age 35, though it can develop at any age. Type 2 diabetes is diagnosed more often in people who are overweight or obese, and who are not physically active.

Type 2 diabetes is an illness in which the body does not process ingested sugars (glucose) properly. In type 2, the body usually produces some insulin, but not enough to allow the glucose into the cells for the body to use as energy. In addition, there can be insulin resistance, where it becomes difficult for the body to use the insulin produced.

Type 2 diabetes is seen both in men and in women, though men have a slightly higher incidence of developing the disease. It can also be diagnosed in children, even though typically it is seen in adults.

Several factors can cause type 2 diabetes, such as insulin resistance, heredity, being obese or overweight, lack of physical activity, abnormal glucose production by the liver, metabolic syndrome, problems with cell signaling, and beta cell dysfunction.

• Insulin resistance is a condition where the body still produces insulin but is unable to use it properly. It is more commonly seen in people who are overweight or obese, and lead a sedentary lifestyle. This leads to a buildup of glucose (sugar) in the blood, which can result in prediabetes or diabetes.
• Certain genes that affect insulin production rather than insulin resistance are a risk factor for developing type 2 diabetes. Family history of diabetes is a risk factor, and people of certain races or ethnicities are at higher risk, including African Americans, Hispanics/Latinos, Native Americans, some Asians, and Native Hawaiians or other Pacific Islanders.
• Obesity and lack of physical activity can cause type 2 diabetes, especially excess abdominal fat.
• Abnormal glucose production by the liver can also lead to high blood glucose levels.
• Metabolic syndrome is a serious health condition that includes a group of risk factors such as higher than normal blood glucose levels, excess abdominal fat and increased waist size ("apple" shape), high blood pressure, and high cholesterol and triglycerides. Metabolic syndrome can also increase risk for heart disease and stroke.
• Cell signaling – how cells communicate to regulate body processes – may not work properly and can set off a chain reaction that leads to diabetes.
• Insulin-producing beta cells in the pancreas may be damaged and this dysfunction can cause insufficient or abnormal insulin release. Glucose toxicity is when beta cells are damaged by high blood glucose.

Type 2 diabetes may have no symptoms. Symptoms of type 2 diabetes are similar in men, in women, and in children.

Common symptoms and signs of type 2 diabetes include:

• Frequent urination
• Extreme thirst or hunger
• Extreme fatigue
• Blurred vision
• Slow wound healing
• Tingling, pain, or numbness in the extremities
• Weight changes (gain or loss)
• Recurrent yeast infections

Type 2 diabetes (formerly called adult-onset or non-insulin-dependent diabetes) is the most common form of diabetes, affecting 90% or more of those with the disease. In type 2 diabetes, the body produces insulin but is unable to use it properly (a condition called insulin resistance). Initially, the pancreas compensates by making more insulin but as the disease progresses the insulin produced by the pancreas is no longer enough (a condition called insulin deficiency). Type 2 diabetes is preventable with a healthy lifestyle that includes a balanced diet, maintaining a healthy weight, and getting regular exercise.

In type 2 diabetes there may be no symptoms and the disease is typically diagnosed in adults, though children can have the illness. Those with type 2 diabetes do not experience episodes of low blood sugar levels (hypoglycemia), unless they are taking insulin or other anti-diabetic medications.

Type 1 diabetes (formerly called juvenile-onset or insulin-dependent diabetes) is an autoimmune disorder, in which the body's immune system attacks and destroys the cells that make insulin (beta cells).

In type 1 diabetes symptoms can be serious, and start in childhood or in younger adults. Low blood sugar episodes (hypoglycemia) occur frequently. Type 1 diabetes cannot be prevented.

There is no single test to diagnose type 2 diabetes. There are several tests that are done, and most of them will need to be repeated to make a conclusive diagnosis. Tests for diabetes include:

• A1C: This measures average blood glucose levels over 2-3 months.
• A1C of 6.5% or higher is the threshold for diabetes diagnosis.
• Fasting Plasma Glucose (FPG): checks fasting blood glucose levels – no food or drink for 8 hours before testing.
• A Fasting Plasma Glucose (FPG) of 126 mg/dL or more is a sign of diabetes.
• Oral Glucose Tolerance Test (OGTT): a 2-hour test that checks blood glucose levels before and 2 hours after you drink a sweet liquid.
• Blood glucose of 200 mg/dL or higher is a diagnosis of diabetes.
• Random (Casual) Plasma Glucose Test: random testing any time you have diabetes symptoms.
• Diabetes is diagnosed at a blood glucose level of 200 mg/dL or higher.

Treatment for type 2 diabetes includes a healthy balanced diet, meal planning, weight loss or maintaining a healthy weight, and exercise. Not everyone with type 2 diabetes will need medication, but in some cases oral diabetes medications and/or insulin may be prescribed to maintain healthy blood glucose levels.

Several classes of anti-diabetic drugs are prescribed to lower blood sugar (glucose) levels. Because they work in different ways, it is common for different drugs to be used in combination.

• Sulfonylureas work by increasing the insulin released by the pancreas. Examples: chlorpropamide (Diabinese), glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), glimepiride (Amaryl).
• Biguanides work to lower blood glucose levels. Examples: metformin (Glucophage)
• Meglitinides stimulate the release of insulin. Examples: repaglinide (Prandin), nateglinide (Starlix).
• Thiazolidinediones help your body use insulin better and also reduce glucose production in the liver. Examples: rosiglitazone (Avandia), pioglitazone (ACTOS).
• DPP-4 inhibitors work by helping a compound called GLP-1 stay active in the body longer, which can help lower blood glucose levels. Examples: sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina)
• SGLT2 Inhibitors block the reabsorption of glucose in the kidneys, causing it to be released in urine and lower blood glucose levels. Examples: canagliflozin (Invokana), dapagliflozin (Farxiga)
• Bile Acid Sequestrants are cholesterol-lowering medications that can also work to lower blood glucose in patients with diabetes. Examples: colesevelam (Welchol).

It may not be possible to cure type 2 diabetes, but it may be possible to reverse the disease, or put it in remission, with a healthy diet and exercise. Losing just 5% to 10% of body weight and exercising 150 minutes per week can help some people get off medications. However, the diet and lifestyle changes must be maintained in order to keep the symptoms of the disease from progressing.

The diet for type 2 diabetes is similar to that for heart disease. It includes lots of fruits, vegetables, whole grains, beans and legumes, poultry, fish, and non-fat dairy. Avoid processed, sugary, and fatty foods. Monitor portion sizes so you don't overeat.

Meal planning can help you maintain your diet. People with type 2 diabetes need to manage blood sugar levels and make sure their diet accommodates any insulin or oral medications they take.

Some meal planning tools the American Diabetes Association recommends include:

• The plate method: Fill your plate with larger portions of non-starchy veggies and smaller portions of starchy foods and protein.
• Carbohydrate (or carb) counting: Work with your doctor to find the right amount of carbs and set a limit for the maximum amount of carbohydrates for each meal, taking into account physical activity and any medications you take.
• Glycemic index (GI): GI measures how carbohydrate-containing foods can raise blood glucose. Choose foods with low to medium GI.

Consult a nutritionist who specializes in diets for diabetic patients for more specific guidance on what to eat and what to avoid.

If you are at risk for type 2 diabetes, you can take steps to prevent developing the disease. They key lies in a healthy diet, maintaining a healthy weight, and exercise. If you have been diagnosed with prediabetes, it does not automatically mean you will develop diabetes, and diet and lifestyle changes can help prevent it.

Eat a diet full of fruits, vegetables, whole grains, beans and legumes, poultry, fish, and non-fat dairy. Avoid processed, sugary, and fatty foods. Monitor portion sizes so you don't overeat.

Incorporate about 150 minutes of exercise weekly (that translates to 30 minutes, 5 days a week).

Lose weight. Losing just 15 pounds can lower your risk of developing type 2 diabetes by 58% over 3 years. If you're over 60, 15 pounds can mean 71% reduced risk.

In those at risk, taking the medication metformin may also reduce the risk of developing type 2 diabetes.

It is important to get type 2 diabetes under control because it can lead to many serious health complications.

The most serious complications of type 2 diabetes include heart disease, stroke, high blood pressure, kidney disease, diabetic retinopathy (which can lead to blindness), and Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). Other complications include nerve damage (neuropathy), diabetic ketoacidosis, gastroparesis, skin infection, glaucoma, and cataracts.