Diabetes Type 2

Causes

The causes of type 2 diabetes are unclear. Diabetes seems to run in families in most cases. However, age, diet, obesity and a lack of exercise also play a role. The rising number of type 2 diabetes cases seems to correlate with the increasing number of overweight and obese Americans. About six out of every 10 Americans are overweight or obese.

Symptoms

In children, teenagers and young adults, symptoms of type 2 diabetes tend to develop abruptly over days or within weeks. In overweight adults older than 40, diabetes tends to develop more gradually over several years. Often diabetes goes undiagnosed because many of its symptoms seem harmless. Finding and treating diabetes early can help reduce the chance of complications.

Some diabetes symptoms include:

  • Increased fatigue.
  • Extreme hunger.
  • Excessive thirst.
  • Frequent urination (especially needing to get up during the night).
  • Blurred vision.
  • Irritability.
  • Weight loss.
  • Frequent infections (especially urinary tract infections, boils, and fungal infections).
  • Erectile dysfunction (impotence).
  • Slow healing of cuts and sores.

Because of the nature of these symptoms, diabetes might not be discovered until you see a doctor about another health problem that could be caused by the undiagnosed diabetes.

Symptoms suggesting low blood sugar

  • Night sweats.
  • Nightmares.
  • Headache.
  • Sweaty rapid pulse.
  • Feeling nervous or jittery or confused.

If your blood sugars are recording low and you do NOT have these symptoms, you may be unaware of hypoglycemia. Hypoglycemia happens from time to time to everyone who has diabetes.

THIS COULD BE SERIOUS.

If you are worried about this, you should:

  • Carry something sweet with you at all times.
  • Check your finger-stick sugar levels at least four times per day.

Risk Factors

  • Obesity. Most people with type 2 diabetes are obese, weighing at least 20 percent more than what is recommended for their height or having a BMI (body mass index) of 30 or greater. Insulin resistance increases when weight is excessive.
  • Heredity. Type 2 diabetes can run in families.
  • Age. The risk for developing type 2 diabetes increases with age. Half of all new cases of type 2 diabetes occur in people 55 or older.
  • Race. Compared with Caucasians and Asians, type 2 diabetes is more common among Native Americans, African-Americans and Hispanics.
  • Sedentary lifestyle. Insulin resistance increases with lack of exercise.
  • Women who have had gestational diabetes. Women who develop gestational diabetes during pregnancy have an increased risk of getting type 2 diabetes later on in life. Women who give birth to babies weighing 9 pounds or more at birth also have an increased risk of developing type 2 diabetes.
  • Certain medications. The use of certain drugs, including diuretics and steroids, may contribute to the development of type 2 diabetes.

Prevention

While family history of type 2 diabetes is one of the strongest risk factors, this genetic link generally matters more in people living an unhealthy lifestyle. Many Americans eat too much fat and not enough carbohydrates and fiber, weigh too much and don’t exercise enough. Type 2 diabetes is more common in people with these habits, especially if they have a family history of diabetes.

If you develop pre-diabetes, you may have a chance to prevent or slow the progression of diabetes type 2 by changing your habits. Pre-diabetes is a condition that starts before type 2 diabetes. This means blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. At least 20 million Americans ages 40 to 74 have pre-diabetes. For many people with pre-diabetes, lifestyle changes can return elevated blood glucose levels to the normal range.

  • Eat a diet rich in fruits and vegetables along with whole grains, beans and low-fat dairy products. Red meat should be eaten sparingly. Lean meats such as chicken and turkey are preferable. Sweets should be eaten occasionally.
  • Exercise at least 30 minutes a day for most days of the week. Take a stroll in your neighborhood or take the stairs. Every bit of movement counts.
  • Maintain a healthy weight, and lose weight if you need to. Any reduction in body weight can reduce your chances for diabetes.
  • Talk to your doctor about diabetes, particularly if you have risk factors.

Diagnosed by Test

Common tests used for monitoring diabetes.

To help diagnose pre-diabetes or diabetes, your doctor has two different tests to use: the fasting plasma glucose test or the oral glucose tolerance test. Your blood glucose levels after these tests determine if your metabolism is normal, or whether you have pre-diabetes or diabetes.

Routine monitoring by your doctor when you have diabetes:

Name of Test How Often It Should Be Ordered
Recent blood sugar level Every visit
Hemoglobin A1C level If in desirable range, two times a year. If outside desirable range, four times a year.
Blood fat (lipid) panel Once a year
Blood electrolyte level Not routine: Test only if there is reason for concern.
Blood creatinine level Once a year
Urine test for protein Once a year
Thyroid tests Once a year
Electrocardiogram (EKG) Once (if you are over 35)

Note:

You should also have your eyes examined by a specialist every year. Your blood pressure, weight and feet should be examined at every visit.

Other Tests

Glucose monitoring

All people with type 2 diabetes need to monitor their blood glucose levels, since the single most important factor in managing the disease is achieving tight glucose control.

Most people with type 2 diabetes monitor their blood glucose levels at home. Home glucose monitoring involves taking a small sample of blood from the fingertip, placing it on a special strip, and waiting for a machine to read the glucose levels. This can be as quick as five seconds. There are other meters available that are less painful.

Keep a log for results. This will help your doctor know if your treatment plan is working.

Urine checks

Urine checks for sugar are not as accurate as blood glucose checks, which are preferred by doctors. But doing a urine test for ketones is another matter. This can help determine if your diabetes is out of control. You can find moderate or large amounts of ketones in urine when your body is burning fat instead of glucose for fuel. This happens when there is too little insulin at work.

Moderate or large amounts of ketones are a danger sign. They upset the chemical balance of your blood and can poison your body. Call your doctor immediately if there are ketones in your urine.

Treatment Plan

Good glucose control is the cornerstone to your treatment plan. Most aspects such as measuring your sugar levels, taking diabetes pills or insulin shots, exercising, losing weight, and planning meals are to help you reach your target sugar level.

Medical Examination

Diabetes is not broken into different levels of severity, although the condition called pre-diabetes sets the stage for the disease to develop.

Doctors look for how well you are controlling your disease. The most important ways to reduce your risk of developing complications associated with diabetes are to maintain tight blood glucose control and have regular checkups. Poorly controlled diabetes could lead to complications, including:

  • Cardiovascular and cerebrovascular disorders. Two-thirds of people with diabetes die of heart or blood vessel disease. Those with diabetes are five times more likely than those without to have a stroke.
  • Eye disorders. The most serious is a condition called diabetic retinopathy, which is caused by damage to the blood vessels that nourish the nerves within the retina. People with diabetes also are at higher risk for cataracts (clouding of the lens of the eye) and glaucoma (caused by an increase in fluid pressure within the eye that damages the optic nerve).
  • Nervous system disorders. Diabetic neuropathy can cause a pins and needles sensation in hands and legs or a loss of pain sensation in the extremities, which can contribute to foot problems. Neuropathy also can affect the bladder, bowel and stomach along with causing sexual dysfunction in men.
  • Foot ulcers. Diabetic foot ulcers are open foot sores that lead to thousands of amputations each year in people with diabetes.
  • Kidney disorders. Kidney damage called nephropathy occurs more commonly with diabetes and may cause end-stage renal disease.
  • Infection. People with diabetes have an increased risk of developing many types of infections.

Treatment goals

Measure How Often To Be Checked Goal
Blood Sugar Levels Each Visit *Before Meals:

  • 110 mg/dL or lower

*After Meals:

  • 140 mg/dL or lower
Hemoglobin A1C 2 to 4 Times a Year *6.5 percent or lower
Blood Pressure Levels Each Visit Below 130/80
Weight Levels Each Visit As Close To Ideal Weight As Possible
Lipid Levels Once A Year Low Density Lipoprotein Should Be Below 100 mg/dL
Urine Protein Level Once A Year Appropriate Treatment If Present
Eye (Retinal) Examination Once A Year Appropriate Treatment Given

*These numbers are ideal. These goals may change with an assessment by your doctor and diabetes team.

If your treatment is stable

Measure Frequency of Visit
If your diabetes is severe or complicated and you are on insulin shots. Once A Month
If your diabetes is severe or complicated and you are taking tablets only. Every 6-12 Weeks
If your diabetes is not severe or complicated. Every 3 Months

If your treatment is just starting or has been changed*

Measure Frequency of Visit
If you are on diet alone. Every 2 months
If you are on tablets only. Every 1-2 months
If you are injecting more than 2 shots of insulin a day. Every 2 weeks

*NOTE:

In addition, weekly phone contact may be necessary. Contact may be required more often, especially when changing insulin doses.

Medications

Medication Safety Tips

When you are prescribed new medicines, make sure you understand the following things:

  • What is the medicine for?
  • How should I take it and for how long?
  • What should I do if I forget a dose?
  • What side effects can this medicine cause?
  • Is this medicine safe to take with the other medicines and supplements that I am presently taking?
  • What other safety measures should I follow while using this medicine?
  • What storage conditions are required for this medicine?
  • Ask for written information about the new medicine.

Types of Medicine

While some people with type 2 diabetes can control their disease with diet and exercise, most need medication. Treatment can include medications taken by mouth, insulin injections or both. Most oral medications increase insulin production, decrease glucose production or help the body use its own insulin better.

Sulfonylureas

Sulfonylureas stimulate the beta cells of the pancreas to release insulin. Sulfonylurea drugs have been around since the 1950s, with chlorpropamide as the only first-generation sulfonylurea still used. All these medications work similarly on blood glucose levels, yet they differ in what side effects they produce, how often they are taken and how they interact with other drugs.

Meglitinides

Meglitinides also stimulate the beta cells to release insulin. Because sulfonylureas and meglitinides stimulate the release of insulin, you might develop hypoglycemia, or low blood glucose levels.

Biguanides

Biguanides lower blood glucose levels by decreasing how much glucose the liver makes. These medications help lower blood glucose levels by making muscles more sensitive to insulin, allowing glucose to be absorbed. A side effect may be diarrhea.

Thiazolidinediones

These medications help insulin work better in the muscle and fat and also reduce glucose production in the liver. Thiazolidinediones can have a rare but serious effect on the liver. You should have regular blood tests to check your liver.

Alpha-glucosidase inhibitors

These drugs help lower blood glucose levels by blocking the digestion of starches, such as bread, potatoes and pasta, in the intestine. These medications can also slow the breakdown of some sugars consumed in the diet. Alpha-glucosidase inhibitors slow the rise in blood glucose levels after you eat. Side effects may include gas and diarrhea.

Insulin

Many people with diabetes take insulin to control blood sugar levels, or glucose. This medication cannot be taken by mouth because it would be destroyed by digestion. Many people get insulin shots. Other methods include insulin pens, insulin jet injectors and insulin pumps. Some insulin medications are fast-acting, only taking five to 15 minutes to start working and finishes in three to four hours. Longer-acting ones might take as long as four to six hours and may not finish until 48 hours later. More than 20 types of insulin products are available.

Doctor Visit

When to See the Doctor

Because the disease begins slowly, you may not know you have it. About one-half of the people with type 2 diabetes don’t know they have it. Some people dismiss their symptoms.

A condition known as pre-diabetes often precedes diabetes, but can be hard to find because it does not have obvious symptoms other than elevated blood glucose levels. If pre-diabetes is caught, the disease may be reversed or slowed.

If you have a family history and other risk factors, talk to your doctor. Watch out for symptoms such as frequent urination. The sooner diabetes is caught, the less chance you’ll have for complications.

Questions to Ask Your Doctor

You and your doctor should talk about the following items:

Referring to your pre-visit log:

  • How well is your diabetes being controlled? If more than 50 percent of your blood sugar results are outside your target range, your doctor will discuss changes to your treatment plan.
  • How well are you following your diet and exercise recommendations?
  • Whether you should receive in-depth education about diabetes from a group class or a certified nurse educator.
  • Whether you are experiencing low blood sugar levels. If so, ask your doctor to advise treatment.
  • Review of your weight and blood pressure results.
  • Review of your blood sugar results in the office.

Examination of your pulses, including your feet, and checking for dry and peeling skin, calluses and ulcers. Review of general rules for foot care.

You should also discuss:

  • Checking your mouth and gums.
  • Whether you may need laboratory testing and how often.
  • Additional factors that need treatment to prevent further problems.
  • Whether referral to a specialist or admission to a hospital is needed.
  • Treatment goals.

While at your doctor, make sure that you:

  • Understand how and when to take all of your medications.
  • Understand recommendations about your diet and exercise.
  • Know how to check your finger-stick sugar and how often to do it.
  • Have discussed with your doctor whether treatment is needed for any of the conditions that can cause complications.
  • Are referred to an eye specialist (if it is an annual visit).
  • Plans are made to check your blood fat levels and urine protein content.
  • Know the treatment goals for your condition.
  • Get a flu vaccination, if appropriate.

When to See a Specialist

Your diabetes care team may include a primary care doctor, nurses and a dietitian. Your primary care doctor may send you to other specialists to help deal with any complications you may develop.

You will be referred to an endocrinologist (diabetes specialist) when:

  • You haven’t met your target hemoglobin A1C goals in six months.
  • You’ve developed ulcers or infection in your feet that, despite treatment, do not get better quickly or come back.
  • You have severe pain or loss of feelings in your feet.
  • You experience frequent vomiting, diarrhea or low blood pressure with dizziness.
  • You have frequent low blood sugar levels.
  • You are being hospitalized often (whether for high or low blood sugar levels).
  • You have frequent episodes of ketoacidosis.

You will be referred to an ophthalmologist:

  • Routinely every year.
  • If you have any abnormal vision.
  • If your vision is getting worse.

You will be referred to a podiatrist:

  • If the nerves in your feet are damaged.

You May Be Admitted to the Hospital If…

Your doctor may consider admitting you to the hospital if you have a very high blood sugar level and any of the following:

  • A blood test that shows ketones in your blood.
  • A blood test that shows a high acid level.
  • You are dehydrated.
  • You need antibiotics directly into your veins.
  • You have a serious leg infection.
  • There is evidence of active heart problems.

Lifestyle Changes

Controlling your diabetes depends mostly on you and how well you stick to your treatment plan. Lifestyle changes can take time. Don’t lose patience.

  • Do not smoke.
  • Maintain normal blood pressure and blood cholesterol levels.
  • Eat a low-fat diet.
  • Get regular exercise. Exercise improves diabetes control 12 to 18 hours after physical activity.
  • See your diabetes care team regularly.
  • Monitor blood glucose levels.

Exercise

Start slowly, perhaps aiming for 15 minutes of physical activity a day. Develop an exercise program with your diabetes care team. Some people with diabetes may need approval from their doctors before starting an exercise program.

  • Get your weight to as close to ideal as possible.
  • If you are prone to hypoglycemia, exercise with someone for safety.
  • Aerobic activity is best. Ask your doctor what is right for you.
  • Each session should be 30 to 45 minutes long.
  • You can start by keeping a more active routine. Take the stairs, do the laundry, walk to your neighbor’s house instead of driving.

Cholesterol levels and blood pressure

People with diabetes should try to keep their cholesterol low no matter what their levels, according to a study published in the British medical journal The Lancet. Treatment using the cholesterol-lowering medication simvastatin lowered the risk of heart attacks and stroke for people with type 1 and type 2 diabetes by 30 percent, according to the study. About 6,000 people participating in the landmark Heart Protection Study benefited whether their cholesterol levels were high or normal.

Two out of every three adults with diabetes have high blood pressure. Hypertension and diabetes are associated with other problems, such as heart disease and strokes.

Diet

If you are taking oral medications or insulin, the timing of your meals is important. Skipping or delaying meals can lead to hypoglycemia (low blood sugar).

  • Eat at least five servings of fruits and vegetables each day.
  • Make grains, starches, cereals and potatoes the focus.
  • Eat small servings of meat, fish and poultry.
  • Use fats such as oil and butter sparingly.
  • Follow your dietitian’s meal plan.
  • Learn how to read Nutrition Facts labels.

Monitoring blood glucose

Everyone with diabetes should know how to use a blood glucose monitor. You will discuss with your doctor exactly how many times a day to measure your blood glucose. The frequency of home testing depends on the medication you are taking and how well your blood sugar is controlled on a daily basis.

Stress

Watch your stress. Elevated levels of stress hormones can interfere with your treatment plan. Try deep breathing and other relaxation techniques along with following your doctor’s treatment plan.

Everyday Care

  • Only eat sugar-free, low-calorie products.
  • Eat three meals a day and snacks at consistent times. Snacks are less important if you are taking diabetic medications by mouth.
  • Cut down on saturated fat.
  • Eat foods high in fiber.
  • Stop smoking.
  • Don’t drink excessively.
  • Follow the treatment plan closely so that you take all the medications your doctor has given you correctly.
  • Follow the diet and exercise recommendations.
  • Check your finger-stick sugars regularly and record the results on your blood sugar log. Also, check your blood sugars if you have symptoms of hypoglycemia (low blood sugar).
  • Check your feet routinely, but do not treat feet problems without talking with your doctor first.
  • Reduce stress. Studies show stress can affect how well your diabetes is controlled. Practice relaxation techniques such as deep breathing.
  • Before exercising, check your blood sugar levels.

Exercise tips

Check with your doctor before beginning any exercise program.

  • Take the stairs instead of the elevator.
  • Park farther away from store entrances.
  • Get together a group of friends to take a daily walk.
  • Mow the lawn or weed the garden.
  • Sign up for a dance class.
  • Go bowling or visit a museum.

Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases

2. American Diabetes Association

3. National Diabetes Information Clearinghouse

4. U.S. Food and Drug Administration