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What Is Type 2 Diabetes?
Type 2 diabetes can affect all people, regardless of age. Early symptoms of type 2 diabetes may be missed, so those affected may not even know they have the condition. An estimated one out of every three people with type 2 diabetes are not aware they have it. Diabetes interferes with the body's ability to metabolize carbohydrates for energy, leading to high levels of blood sugar. These chronically high blood sugar levels increase a person's risk of developing nerve problems, vision loss, cardiovascular disease, and other conditions.
Warning Sign of Diabetes: Thirst
Although people with type 2 diabetes may not have specific symptoms, an increase in thirst is one symptom that is characteristic of the condition. The increased thirst can accompany other symptoms like frequent urination, feelings of unusual hunger, dry mouth, and weight gain or loss.
Warning Sign of Diabetes: Headaches
Other symptoms that can occur if high blood sugar levels persist are fatigue, blurred vision, and headaches.
Warning Sign of Diabetes: Infections
Often, type 2 diabetes is only identified after its negative health consequences are apparent. Certain infections and sores that take a long time to heal are a warning sign. Other possible signs include frequent yeast infections or urinary tract infections and itchy skin.
Warning Sign of Diabetes: Sexual Dysfunction
Sexual problems can occur as a result of type 2 diabetes. Since diabetes can damage the blood vessels and nerves in the sex organs, decreased sensation can develop, potentially leading to difficulties with orgasm. Vaginal dryness in women and impotence in men are other complications of diabetes. Estimates suggest that between 35% and 70% of men with diabetes will eventually suffer from impotence. Statistics for women show that about one-third of women with diabetes will have some kind of sexual dysfunction.
Risks You Can Prevent
Certain risk factors related to both lifestyle choices and medical conditions can increase your risk of developing type 2 diabetes. These include:
- Cigarette smoking
- Being overweight or obese, especially around the waist
- Lack of exercise
- Consuming a diet that is high in processed meat, fat, sweets, and red meats
- Triglyceride levels over 250 mg/dL
- Low levels of “good” HDL cholesterol (below 35 mg/dL)
Risks You Can’t Prevent
Some risk factors for diabetes can’t be controlled. Hispanics, Native Americans, Asians, and African Americans have a higher than average risk for getting diabetes. Having a family history (parent or sibling) with diabetes increases your risk. Those over 45 have a higher risk of type 2 diabetes than younger people.
Women's Risk Factors
Women who developed gestational diabetes in pregnancy have a higher risk for developing type 2 diabetes later in life. The same goes for women who have babies larger than 9 pounds. The insulin resistance associated with polycystic ovary syndrome also places women with this condition at a higher risk for diabetes.
How Does Insulin Work?
Insulin is a hormone that allows the body to efficiently use glucose as fuel. After carbohydrates are broken down into sugars in the stomach, glucose enters the circulation and stimulates the pancreas to release insulin in the proper amount. Insulin allows the uptake of glucose by body cells for use as energy.
Type 2 Diabetes: Insulin Resistance
In type 2 diabetes, the body's cells cannot take up glucose properly, leading to high levels of glucose in the blood. Insulin resistance means that although the body can produce insulin, the body's cells do not respond properly to the insulin that is made. Over time, the pancreas reduces the amount of insulin that it produces.
How Type 2 Diabetes is Diagnosed
The hemoglobin A1c test measures the amount of glycosylated hemoglobin (hemoglobin bound to glucose) in your blood and provides information about your average blood glucose levels over the previous 2 to 3 months. Hemoglobin A1c levels over 6.5% are suggestive of diabetes. Another diagnostic test is the fasting blood glucose test. If your fasting blood glucose level is over 126, this establishes that diabetes is present. Random blood glucose levels over 200 are also consistent with diabetes.
Diabetes Management: Diet
Keeping good control over blood sugar levels can help reduce the risk of getting complications from diabetes. Your doctor can refer you to a registered dietician or diabetes counselor to help you formulate a healthy eating plan. Many people with type 2 diabetes will need to monitor intake of carbohydrates and reduce calories. Watching total fat and protein consumption is also recommended.
Diabetes Management: Exercise
Regular exercise, including walking, can help people with type 2 diabetes lower their blood glucose levels. Physical activity also reduces body fat, lowers blood pressure, and helps prevent cardiovascular disease. It’s recommended that people with type 2 diabetes get 30 minutes of moderate exercise on most days.
Diabetes Management: Reduce Stress
Stress is particularly worrisome for people with diabetes. Stress not only increases blood pressure, but it can also increase blood glucose levels. Many people with diabetes find that relaxation techniques can help manage their condition. Examples are visualization, meditation, or breathing exercises. Taking advantage of social support networks is also helpful, like talking with a relative or friend, member of the clergy, or counselor.
Diabetes Management: Oral Medications
Oral medication is recommended for people with type 2 diabetes who cannot adequately control their blood sugar with diet and exercise. Many types of oral diabetes medications are available, and these may be used in combination for the best results. Some increase insulin production, others improve the body’s use of insulin, while still others partially block the digestion of starches.
Diabetes Management: Insulin
Some people with type 2 diabetes also take insulin, sometimes in combination with oral medications. Insulin is also used in "beta-cell failure," a condition in which the pancreas no longer produces insulin in response to elevated blood glucose. This can occur in people with type 2 diabetes. If insulin is not produced, insulin treatment is necessary.
There are other non-insulin drugs given in injection form that are used to treat type 2 diabetes. Examples are pramlintide (Symlin), exenatide (Byetta), and liraglutide (Victoza). These drugs stimulate the release of insulin.
Testing Blood Glucose
Your doctor can suggest how often you should test your blood glucose. Testing can give a good idea of the extent to which your diabetes is under control and can tell you if your management plan needs to be altered. Some common times to test blood sugars are upon awakening, before and after meals, before and after exercise or physical activity, and at night.
Long-Term Damage to Arteries
Around two out of every three people with diabetes die of heart disease. Over time, elevated blood sugar levels damage the blood vessels, leading to an increased risk of clots. This increases the risk of heart attack. People with diabetes are also at an increased risk for stroke because of the damage to blood vessels.
Long-Term Damage to Kidneys
The risk for developing chronic kidney disease increases with time in people with diabetes. Diabetes is the most common cause of renal failure, making up about 44% of cases. Keeping your diabetes under control can reduce the risk of kidney failure. Medications are also used to reduce the risk of kidney disease in people with diabetes.
Long-Term Damage to Eyes
Diabetic retinopathy is damage to the tiny blood vessels within the retina of the eye due to high blood sugar levels over time. This can cause progressive and permanent vision loss. Diabetic retinopathy is the most common cause of new blindness in people between 20 and 74. This image shows pools of blood, or hemorrhages, in the retina.
Long-Term Damage Causing Nerve Pain
Tingling, numbness, and a sensation of "pins and needles" are all symptoms of diabetic neuropathy, or nerve damage related to diabetes. This is most common in the hands, feet, fingers, or toes. Controlling diabetes can help prevent this complication.
Long-Term Damage to Feet
Damage to nerves caused by diabetes can make it hard to feel injuries to the feet. At the same time, damage to the blood vessels can reduce circulation in the feet of people with diabetes. Sores that heal poorly and even gangrene are complications of diabetes that can occur in the feet. Amputation may be the result in severe cases.
Type 2 Diabetes Prevention
Type 2 diabetes is preventable in many cases. At the least, it is possible to reduce the incidence of complications of diabetes by eating a healthy diet, getting moderate exercise, and maintaining a healthy weight. It’s also helpful for people at risk to be screened for diabetes and prediabetes, so that management can begin early in the course of the disease. This reduces the risk of long-term problems.
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