TYPE 2 DIABETES

Overview & Facts

Type 2 diabetes, previously known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body’s important 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.

More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There’s no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren’t enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy.

Risk factors

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:

Weight. Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to insulin. However, you don’t have to be overweight to develop type 2 diabetes.
Fat distribution. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs.
Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes.
Age. The risk of type 2 diabetes increases as you get older, especially after age 45. That’s probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.
Polycystic ovarian syndrome (PCOS). For women, having polycystic ovarian syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.

Complications

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:

Heart and blood vessel disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure.
Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which often eventually requires dialysis or a kidney transplant.
Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.
Hearing impairment. Hearing problems are more common in people with diabetes.
Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
Alzheimer’s disease. Type 2 diabetes may increase the risk of Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. The exact connection between these two conditions still remains unclear.

Types & Symptoms

Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for:

Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual.
Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger.
Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine.
Fatigue. If your cells are deprived of sugar, you may become tired and irritable.
Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus.
Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections.
Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance.

Diagnosis & Medications

DIAGNOSIS

To diagnose type 2 diabetes, you’ll be given a:

Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent.

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:

Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.
Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate 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 140/90 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 — since the two conditions often require different treatments.

After the diagnosis

A1C levels need to be checked between two and four times a year. Your target A1C goal may vary depending on your age and other factors. However, for most people, the American Diabetes Association recommends an A1C level below 7 percent. Ask your doctor what your A1C target is.

Compared with repeated daily blood sugar tests, the A1C test is a better indicator of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication, meal plan or activity level.

In addition to the A1C test, your 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.

MANAGEMENT

Management of type 2 diabetes includes:

Healthy eating
Regular exercise
Possibly, diabetes medication or insulin therapy
Blood sugar monitoring

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

Healthy eating

Contrary to popular perception, there’s no specific diabetes diet. However, it’s important to center your diet on these high-fiber, low-fat foods:

Fruits
Vegetables
Whole grains

You’ll also need to eat fewer animal products, refined carbohydrates and sweets.

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 index foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.

A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. He or she can also teach you how to monitor your carbohydrate intake and let you know about how many carbohydrates you need to eat with your meals and snacks to keep your blood sugar levels more stable.

Physical activity

Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor’s OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming and biking. What’s most important is making physical activity part of your daily routine.

Aim for at least 30 minutes of aerobic exercise five days of the week. Stretching and strength training exercises are important, too. If you haven’t been active for a while, start slowly and build up gradually.

A combination of exercises — aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week — often helps control blood sugar more effectively than either type of exercise alone.

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.

Monitoring your blood sugar

Depending on your treatment plan, you may need to check and record your blood sugar level every now and then or, if you’re on insulin, multiple times a day. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

Sometimes, blood sugar levels can be unpredictable. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication.

RECOMMENDED MEDICATIONS

Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.

Examples of possible treatments for type 2 diabetes include:

Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively.

Metformin also lowers glucose production in the liver. Metformin may not lower blood sugar enough on its own. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active.

Nausea and diarrhea are possible side effects of metformin. These side effects usually go away as your body gets used to the medicine. If metformin and lifestyles changes aren’t enough to control your blood sugar level, other oral or injected medications can be added.

Sulfonylureas. These medications help your body secrete more insulin. Examples of medications in this class include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain.

Meglitinides. These medications work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they’re faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar, but this risk is lower than with sulfonylureas.

Weight gain is a possibility with this class of medications as well. Examples include repaglinide (Prandin) and nateglinide (Starlix).

Thiazolidinediones. Like metformin, these medications make the body’s tissues more sensitive to insulin. This class of medications has been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and fractures. Because of these risks, these medications generally aren’t a first-choice treatment.

Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones.

DPP-4 inhibitors. These medications help reduce blood sugar levels, but tend to have a modest effect. They don’t cause weight gain. Examples of these medications are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta).

GLP-1 receptor agonists. These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas. Their use is often associated with some weight loss. This class of medications isn’t recommended for use by itself.

Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists. Possible side effects include nausea and an increased risk of pancreatitis.

SGLT2 inhibitors. These are the newest diabetes drugs on the market. They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine.

Examples include canagliflozin (Invokana) and dapagliflozin (Forxiga). Side effects may include yeast infections and urinary tract infections, increased urination and hypotension.

Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was used as a last resort, but today it’s often prescribed sooner because of its benefits.

Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Often, people with type 2 diabetes start insulin use with one long-acting shot at night.

Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks similar to an ink pen, except the cartridge is filled with insulin.

There are many types of insulin, and they each work in a different way. Options include:

Insulin glulisine (Apidra)
Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glargine (Lantus)
Insulin detemir (Levemir)
Insulin isophane (Humulin N, Novolin N)

Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health.

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.

TYPE 2 DIABETES

Overview & Facts

Types & Symptoms

Diagnosis & Medications

Related Articles