Type 2 Diabetes
Glucose comes from the breakdown of food. It is the body's energy source. It can pass from the blood to cells with a hormone called insulin.Without insulin, glucose will build up in the blood. This is called hyperglycemia. At the same time, your body's cells are starved for glucose (energy).
A lack of insulin or a resitance to insulin causes diabetes. In Type 2 diabetes the body is resistant to high levels of insulin. There is plenty of insulin in the body but the cells are unable to use it.
High blood sugar levels over a long period of time can damage vital organs. This can include the kidneys, eyes, and nerves.
Insulin is made in the pancreas.
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Two conditions contribute to hyperglycemia in type 2 diabetes:
- Insulin resistance related to excess body fat
- Body's failure to make an adequate amount of insulin
Factors that increase your chance for type 2 diabetes include:
- Age: 40 or older and younger individuals who are obese and belong to vulnerable ethnic groups
- Low birth weight
- Sex: more common in older women than men
- Obesity or being overweight (especially excess weight in the upper body and abdomen)
- Lack of physical activity
- Family members with type 2 diabetes
- History of gestational diabetes
- History of impaired glucose tolerance
- Race: African American, Hispanic, Native American, Asian American, or Pacific Islander
- Endocrine disorders ( Cushing’s syndrome , hyperthyroidism , acromegaly , polycystic ovary syndrome , pheochromocytoma, glucagonoma)
- Medications ( pentamidine , nicotinic acid, glucocorticoids, thiazide)
- Genetic factors
A study reported that having a high intake of certain foods can put you at risk. This includes food such as red meat, low-fiber bread, eggs, and cheese. * 11
You may not have symptoms for years. Symptoms due to high blood sugar or diabetic complications may include:
- Weight loss
- Increased urination
- Extreme thirst
- Hunger
- Fatigue
- Blurry vision
- Irritability
- Frequent or recurring infections
- Poor wound healing
- Angina
- Painful leg cramps when walking
- Numbness or tingling in the hands or feet
- In women: frequent vaginal yeast infections
- Problems with gums
- Itching
- Impotence
The doctor will ask about your symptoms and medical history. You will also be asked about your family history. A physical exam will be done.
Diagnosis is based on the results of blood tests and other criteria, including:
- Symptoms of diabetes and a random blood test revealing a blood sugar level greater than or equal to 200 mg/dL [11.1 mmol/L]
- Blood sugar tests after you have not eaten for eight or more hours revealing blood sugar levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days
- Glucose tolerance test measuring blood sugar two hours after you consume glucose with a measurement greater than or equal to 200 mg/dL (11.1 mmol/L)
mg/dL=milligrams per deciliter of blood; mmol/L=millimole per liter of blood
Treatment aims to:
- Maintain blood sugar at levels as close to normal as possible
- Preventing or delaying complications (regular medical care is important for this)
- Follow a balanced meal plan. Eat consistent and moderate amounts of food at regular times.
- Do not skip meals.
- Eat plenty of vegetables and fiber .
- Eat limited amounts of fat.
- Eat moderate amounts of protein and low-fat dairy products.
- Carefully limit foods containing sugar .
- Keep a record of your food intake. This will help a dietitian or doctor advise you.
If you are overweight, talk to your doctor about a reasonable weight goal. You and your doctor can develop a safe diet program for you. Weight loss will help your body respond better to insulin.
Group education may help people recently diagnosed with their goals in weight loss. * 8
Physical activity:
- Can make the body become more sensitive to insulin
- Will help you reach and maintain a healthy weight
- Can lower the levels of fat in your blood
- Has been found to improve blood sugar control * 2
Talk to your doctor about any restrictions. Work with your doctor to make an activity plan. Even a brief counseling session may help to increase your activity levels * 9
Diabetes is a risk factor for heart disease. Exercising can help to reduce your risk for heart disease.
Medications taken by mouth may be used to lower blood sugar:
- Drugs that prompt the cells in the pancreas to make more insulin (eg, sulfonylureas [ glyburide , tolazamide] )
- Insulin sensitizers—a class of drugs that help the body better use insulin (eg, rosiglitazone and pioglitazone )
- Starch blockers—a class of drugs (eg, acarbose and miglitol ) that lessen glucose absorption into the bloodstream
- Drugs that reduce the production of glucose by the liver (eg, metformin )
- Amylin analogues (eg, pramlintide )
- Dipeptidyl peptidase IV (DDPP-4) inhibitor (eg, sitagliptin )
- Incretin-mimetic (eg, exenatide )
Some studies showed that the use of certain drugs to reach very low blood glucose level may increase harm. Talk to your doctor about your drug program. * 3,6,7,10
In some cases the body does not make enough insulin. Insulin injections may be needed.
This is needed when blood sugar levels are not kept low enough with lifestyle change and medicine
Checking blood glucose levels during the day can help you stay on track. It will also helps your doctor determine if you treatment is appropriate. Testing is easy with a blood glucose monitor. Keeping track of blood glucose levels is especially important if you take insulin.
The glycosylated hemoglobin or hemoglobin A1c (HbA1c) may also be done at your doctor's office. HbA1c will measure the average blood glucose levels over the previous three months. Doctors advise that most keep their HbA1c levels below 7%. This level can help to avoid diabetic complications.
Regular blood sugar testing may not be needed in patients with type 2 diabetes. It may not be needed for those whose condition is under reasonably good control without insulin. * 4 Talk with your doctor before stopping blood sugar monitoring.
One study focused on people with a specific type 2 diabetes. When given vitamin E they showed a decrease in the rates of heart problems. * 5
If you are diagnosed with type 2 diabetes, follow your doctor's instructions .
Last reviewed February 2009 by David Juan, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
