Type 2 diabetes
Type 2 diabetes
Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's main source of fuel.
With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. Untreated, type 2 diabetes can be life-threatening.
More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you can manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise don't control your blood sugar, you may need diabetes medications or insulin therapy.
Type 2 diabetes symptoms may develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for:
When to see a doctor
Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. Exactly why this happens is unknown, although excess weight and inactivity seem to be contributing factors.
How insulin works
The role of glucose
In type 2 diabetes, this process works improperly. Instead of moving into your cells, sugar builds up in your bloodstream.
In the much less common type 1 diabetes, the pancreas produces little or no insulin.
Researchers don't fully understand why some people develop type 2 diabetes and others don't. It's clear, however, that certain factors increase the risk, including:
Type 2 diabetes can be easy to ignore, especially in the early stages when you're feeling fine. But diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent these complications.
Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include:
Preparing for your appointment
Your family doctor or primary care physician likely will diagnose your type 2 diabetes, then refer you to a doctor who specializes in hormonal disorders (endocrinologist). Your health care team also may include:
If your blood sugar levels are very high, your doctor may send you to the hospital for treatment.
It's good to prepare for appointments with your health care team. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
What you can do
Preparing a list of questions can help you make the most of your time with your doctor. For type 2 diabetes, some basic questions to ask include:
Don't hesitate to ask any other questions.
What to expect from your doctor
What you can do in the meantime
Tests and diagnosis
In June 2009, an international committee composed of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that type 2 diabetes testing include the:
If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes:
The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test. Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 135/80 millimeters of mercury (mm Hg).
If you're diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — which often require different treatments.
After the diagnosis
The American Diabetes Association has a formula that translates the A1C into what's known as an estimated average glucose (eAG). The eAG more closely correlates with daily blood sugar readings. An A1C of 7 percent translates to an eAG of 154 mg/dL (8.5 mmol/L).
Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication or meal plan.
In addition to the A1C test, the doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important.
Treatments and drugs
Treatment for type 2 diabetes requires a lifelong commitment to:
These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.
Monitoring your blood sugar
Even if you eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to:
You'll also need to eat fewer animal products, refined carbohydrates and sweets.
A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. Remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.
Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.
Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar.
Diabetes medications and insulin therapy
If you can't take metformin, other oral drugs include:
Recently approved drugs given by injection are:
Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you considering many factors, including costs and other aspects of your health. Rosiglitazone (Avandia) has been linked to heart attacks, and its use has been restricted by the FDA.
In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.
Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.
Signs of trouble
Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures.
If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.
If you have signs or symptoms of low blood sugar, eat or drink something that will quickly raise your blood sugar level — fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels are normal. If they're not, treat again and retest in another 15 minutes. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.
Lifestyle and home remedies
Careful management of type 2 diabetes can reduce your risk of serious — even life-threatening — complications. Consider these tips:
Above all, stay positive. Diabetes is a serious disease, but it can be controlled. If you're willing to do your part, you can enjoy an active, healthy life with type 2 diabetes.
Although two naturally occurring substances — chromium and cinnamon — have been shown in some studies to improve insulin sensitivity, other studies have failed to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, neither substance is currently recommended for diabetes control.
Coping and support
Type 2 diabetes is a serious disease, and following your diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile because following your treatment plan can reduce your risk of complications.
Talking to a counselor or therapist may help you cope with the lifestyle changes that come with a type 2 diabetes diagnosis. You may find encouragement and understanding in a type 2 diabetes support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences or helpful information, such as where to find carbohydrate counts for your favorite takeout restaurant. If you're interested, your doctor may be able to recommend a group in your area.
Or, you can visit the American Diabetes Association to check out local activities and support groups for people with type 2 diabetes. The American Diabetes Association also offers online information and online forums where you can chat with others who have diabetes. The phone number is 800-DIABETES (800-342-2383).
Healthy lifestyle choices can help you prevent type 2 diabetes. Even if you have diabetes in your family, diet and exercise can help you prevent the disease. If you've already been diagnosed with diabetes, the same healthy lifestyle choices can help you prevent potentially serious complications. And if you have prediabetes, lifestyle changes can slow or halt the progression from prediabetes to diabetes.
Sometimes medication is an option as well. Metformin (Glucophage, Glumetza, others), an oral diabetes medication, may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.
Last Updated: 2013-01-25
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