Type 2 Diabetes Mellitus

What Is It?

Published: December, 2018

Type 2 diabetes is a chronic disease. It is characterized by high levels of sugar in the blood. Type 2
diabetes is also called type 2 diabetes mellitus and adult-onset diabetes. That's because it used to
start almost always in middle- and late-adulthood. However, more and more children and teens are
developing this condition. Type 2 diabetes is much more common than type 1 diabetes, and is really
a different disease. But it shares with type 1 diabetes high blood sugar levels, and the complications
of high blood sugar.

During digestion, food is broken down into basic components. Carbohydrates are broken down into
simple sugars, primarily glucose. Glucose is a critically important source of energy for the body's
cells. To provide energy to the cells, glucose needs to leave the blood and get inside the cells.

Insulin traveling in the blood signals the cells to take up glucose. Insulin is a hormone produced by
the pancreas. The pancreas is an organ in the abdomen. When levels of glucose in the blood rise (for
example, after a meal), the pancreas produces more insulin.

Type 2 diabetes occurs when your body's cells resist the normal effect of insulin, which is to drive
glucose in the blood into the inside of the cells. This condition is called insulin resistance. As a result,
glucose starts to build up in the blood.

In people with insulin resistance, the pancreas "sees" the blood glucose level rising. The pancreas
responds by making extra insulin to maintain a normal blood sugar. Over time, the body's insulin
resistance gets worse. In response the pancreas makes more and more insulin. Finally, the pancreas
gets "exhausted". It cannot keep up with the demand for more and more insulin. It poops out. As a
result, blood glucose levels start to rise.

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Type 2 diabetes runs in families. Obesity greatly increases the risk of diabetes.

Symptoms

The symptoms of diabetes are related to high blood glucose levels. They include:

Excessive urination, thirst and hunger

Weight loss

Increased susceptibility to infections, especially yeast or fungal infections

Extremely high blood sugar levels also can lead to a dangerous complication called hyperosmolar
syndrome. This is a life-threatening form of dehydration. In some cases, hyperosmolar syndrome is
the first sign that a person has type 2 diabetes. It causes confused thinking, weakness, nausea and
even seizure and coma.

The treatment of type 2 diabetes also can produce symptoms. Too much glucose-lowering medicine,
relative to dietary intake, can lead to the complication of low blood sugar (called hypoglycemia).
Symptoms of hypoglycemia include:

 Sweating

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  Trembling
 Dizziness
 Hunger
 Confusion
 Seizures and loss of consciousness (if hypoglycemia is not recognized and corrected)
You can correct hypoglycemia by eating or drinking something that has carbohydrates. This raises
your blood sugar level.

Type 2 diabetes affects all parts of the body. It can cause serious, potentially life-threatening
complications. These include:

 Atherosclerosis — Atherosclerosis is fat buildup in the artery walls. This can impair blood
flow to the all the organs. The heart, brain and legs are most often affected.
 Retinopathy — Tiny blood vessels in the retina (the back of the eye that sees light) can
become damaged by high blood sugar. The damage can block blood flow to the retina, and
can lead to bleeding into the retina. Both damage the ability of the retina to see light. Caught
early, retinopathy damage can be minimized by tightly controlling blood sugar and using laser
therapy. Untreated retinopathy can lead to blindness.
 Neuropathy — This is nerve damage. The most common type is peripheral neuropathy. The
nerves to the legs are damaged first, causing pain and numbness in the feet. This can
advance to cause symptoms in the legs and hands. Damage to the nerves that control
digestion, sexual function and urination can also occur.
 Foot problems — Sores and blisters on the feet occur for two reasons:
o If peripheral neuropathy causes numbness, the person may not feel irritation in the foot.
The skin can break down, form an ulcer, and the ulcer can get infected.
o Blood circulation can be poor, leading to slow healing. Left untreated, a simple sore can
become infected and very large. If medical treatment cannot heal the sore, an
amputation may be required.
 Nephropathy — Damage to the kidneys. This is more likely if blood sugars remain elevated
and high blood pressure is not treated aggressively.

Diagnosis

Diabetes is diagnosed by testing the blood for sugar levels. Blood is tested in the morning after you
have fasted overnight.

Typically, the body keeps blood sugar levels between 70 and 100 milligrams per deciliter (mg/dL),
even after fasting. If a blood sugar level after fasting is greater than 125 mg/dL, diabetes is
diagnosed.

Your doctor will examine you to look for:

 Obesity, especially abdominal obesity—a condition that greatly raises a person's risk for type 2
diabetes.
 High blood pressure—a condition often present in people with type 2 diabetes, that together
with diabetes greatly increases the risk of heart disease and strokes.
 Deposits of blood, or puffy yellow spots in the retina of your eyes—complications of both
diabetes and high blood pressure, that increase the risk of blindness
 Decreased sensation in the legs—which can cause a person with diabetes to fail to notice
developing foot sores, particularly sores on the underside of the feet
 Weak pulses in the feet—a condition that can slow or prevent the healing of foot sores, and
possibly lead to amputation
 Blisters, ulcers or infections of the feet
Laboratory tests are also used routinely to evaluate diabetes. These include:

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  Fasting plasma glucose (FPG) test. Blood is taken in the morning after fasting overnight.
Normally, blood sugar levels remain between 70 and 100 milligrams per deciliter (mg/dL).
Diabetes is diagnosed if a fasting blood sugar level is 126 mg/dL or higher.
 Oral glucose tolerance test (OGTT). Blood sugar is measured two hours after drinking 75
grams of glucose. Diabetes is diagnosed if the 2-hour blood sugar level is 200 mg/dL or higher.
 Random blood glucose test. A blood sugar of 200 mg/dL or greater at any time of day
combined with symptoms of diabetes is sufficient to make the diagnosis.
 Hemoglobin A1C (glycohemoglobin). This test measures the average glucose level over the
prior two to three months. Diabetes is diagnosed if the hemoglobin A1C level is 6.5% percent
or higher.
 Blood creatinine and urine microalbumin. Tests for evidence of kidney disease.
 Lipid profile. Measures levels of triglycerides and total, HDL, and LDL cholesterol. This
evaluates the risk of atherosclerosis. People with diabetes who also have high levels of total
cholesterol or LDL cholesterol are at greatly increased risk for heart disease and strokes.

Expected Duration

Diabetes is a lifelong illness. However, people with type 2 diabetes can sometimes restore their blood
sugar levels to normal just by eating a healthy diet, regularly exercising, and losing weight.

Aging and episodic illness can cause the body's insulin resistance to increase. As a result, additional
treatment typically is required over time.

Prevention

If a close relative—particularly, a parent or sibling—has type 2 diabetes, or if your blood glucose test
shows "pre-diabetes"—defined as blood glucose levels between 100 and 125 mg/dL—you are at
increased risk for developing type 2 diabetes. You can help to prevent type 2 diabetes by:

 Maintaining your ideal body weight.

 Exercising regularly—like a brisk walk of 1-2 miles in 30 minutes—at least five times a week,
even if that does not result in you achieving an ideal weight. That's because regular exercise
reduces insulin resistance, even if you don't lose weight.
 Eating a healthy diet.
 Taking medication. The medication metformin (Glucophage) offers some additional protection
for people with pre-diabetes.
If you already have type 2 diabetes, you can still delay or prevent complications:

 Keep tight control of your blood sugar. This reduces the risk of most complications.
 Lower your risk of heart-related complications by:
o Taking a daily aspirin—particularly if you already have some signs of heart disease.
o Aggressively managing other risk factors for atherosclerosis, such as:
 High blood pressure
 High cholesterol and triglycerides
 Cigarette smoking
 Obesity
 Visit an eye doctor and a foot specialist every year to reduce eye and foot complications.

Treatment

Diet and Exercise

In most cases, type 2 diabetes treatment begins with weight reduction through diet and exercise. A
healthy diet for a person with diabetes is:

 Low in saturated fats and cholesterol

 Without any trans fats
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  Low in total calories
 Nutritionally balanced with abundant amounts of:
o Whole-grain foods
o Monounsaturated oils
o Fruits and vegetables
A daily multivitamin is recommended for most people with diabetes.

For some people, type 2 diabetes can be controlled just with diet and exercise. Even if medications
are required, diet and exercise remain important for controlling diabetes.

Medications: Pills

These medications work in many different ways. They include medications that:

 Reduce insulin resistance in the muscles and liver.

 Increase the amount of insulin made and released by the pancreas.
 Cause a burst of insulin release with each meal.
 Delay the absorption of sugars from the intestine.
 Slow your digestion.
 Reduce your appetite for large meals.
 Decrease the conversion of fat to glucose.
 Increase the amount of sugar that flows out of the kidneys into urine.

Insulins

Because type 2 diabetes develops when the pancreas cannot make enough insulin to overcome
insulin resistance, about one of three people with this disease take some form of insulin injection.

In advanced type 2 diabetes, or for people who want to tightly control glucose levels, insulin may be
needed more than once per day and in higher doses.

Treatment plans that include both very long-acting insulin and very short-acting insulin are frequently
the most successful for controlling blood sugar. Very short-acting insulin is used with meals, to help
control the spike in blood sugar levels that occur with a meal. If a person does not eat on a regular
schedule, very short-acting insulin can be particularly helpful.

Treatment Side Effects

Medications used to treat type 2 diabetes can have side effects. These vary by medication. Side
effects may include:

 Low blood sugar levels (hypoglycemia)

 Weight gain
 Nausea
 Diarrhea
 Leg swelling
 Worsening of heart failure
 Liver inflammation
 Excessive gas and bloating
 Frequent urination
In general, the benefits of treatment outweigh the risks. People with type 2 diabetes who have other
medical problems such as advanced kidney disease need to avoid some of the pills and non-insulin
injections.

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In addition to medicines that help control the level of blood sugar, people with type 2 diabetes often
take other medicines that reduce the risk or to slow the onset of the complications of diabetes. These
include medications that:

 Slow the worsening of kidney disease—particularly drugs called angiotensin-converting

enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).
 Lower cholesterol. All diabetics should consider taking medication to lower their cholesterol,
usually one of the statin medications.
 Lower blood pressure. Diabetics should use medication to control high blood pressure if it can't
be improved by lifestyle changes.
 Protect against heart attacks. Most people with diabetes benefit from daily low-dose aspirin.

When To Call a Professional

If you have diabetes, see your doctor regularly.

People with high blood sugar levels have a higher risk of dehydration. Contact your doctor
immediately if you develop vomiting or diarrhea and are not able to drink enough fluids.

Monitor your blood sugar as advised by your health care team. Report any significant deviations in
blood sugar levels.

Prognosis

Your treatment plan is likely to require adjustment over time. Insulin resistance increases with age.
And the insulin-producing cells in the pancreas may wear out as the pancreas tries to keep up with
the body's extra insulin needs.

After the first few years, the majority of people with type 2 diabetes require more than one medicine to
keep their blood sugar controlled.

The prognosis in people with type 2 diabetes varies. It depends on how well an individual modifies his
or her risk of complications. Heart attack, stroke and kidney disease can result in premature death.
Disability due to blindness, amputation, heart disease, stroke and nerve damage may occur. Some
people with type 2 diabetes become dependent on dialysis treatments or require a kidney transplant
because of kidney failure.

Additional Info

American Diabetes Association

http://www.diabetes.org/

American Dietetic Association

http://www.eatright.org/

National Diabetes Information Clearinghouse

http://diabetes.niddk.nih.gov/

National Institute of Diabetes & Digestive & Kidney Disorders

http://www.niddk.nih.gov/

Weight-Control Information Network

http://www.niddk.nih.gov/health/nutrit/win.htm

health.harvard.edu/a_to_z/type-2-diabetes-mellitus-a-to-z