Diabetes Type 2

Type 2 diabetes mellitus (T2DM), which is the most common type of diabetes, is a chronic metabolic disorder characterized by high blood sugar levels (hyperglycemia). It was once commonly called adult-onset diabetes. In type 2 diabetes, either the body doesn't produce enough insulin or the cells do not respond normally to the insulin (insulin resistance). This is different from type 1 diabetes, which happens when an autoimmune attack on your pancreas results in a total lack of insulin production.

Insulin is a hormone produced by the pancreas that helps glucose from food enter the body's cells to be used for energy. When insulin doesn't function properly, glucose builds up in the bloodstream instead of being absorbed by cells, leading to high blood sugar levels.

Several factors contribute to the development of type 2 diabetes, including genetics, lifestyle factors (such as poor diet, lack of physical activity, and obesity), and environmental factors. It often develops in adulthood, although it's becoming more common in children and adolescents, particularly due to rising rates of obesity.

Type 2 diabetes can lead to various complications if left untreated or poorly managed, including heart disease, stroke, kidney disease, nerve damage, vision problems, and foot problems. However, with proper management, including lifestyle changes (such as a healthy diet and regular exercise), medication, and monitoring blood sugar levels, many people with type 2 diabetes can effectively manage their condition and prevent complications.

Type 2 diabetes is caused by a combination of genetic, lifestyle, and environmental factors. Here are some key diabetes risk factors that contribute to the development of type 2 diabetes:

• Genetics: Family history plays a significant role in the risk of developing type 2 diabetes. If you have a close relative, such as a parent or sibling, with type 2 diabetes, your risk is higher.
• Obesity and Body Weight: Being overweight or obese is one of the most significant risk factors for type 2 diabetes. Excess body fat, particularly around the abdomen, makes cells more resistant to insulin.
• Insulin Resistance: Insulin resistance occurs when the body's cells don't respond properly to insulin, preventing glucose from entering the cells. This leads to higher levels of glucose in the bloodstream.
• Inactive Lifestyle: Lack of physical activity and a sedentary lifestyle contribute to insulin resistance and obesity, both of which increase the risk of type 2 diabetes.
• Unhealthy Diet: Diets high in refined carbohydrates, sugars, and unhealthy fats can contribute to weight gain, insulin resistance, and ultimately, type 2 diabetes.
• Blood lipid levels: An increased risk is associated with low levels of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — and high levels of triglycerides.
• Age: The risk of type 2 diabetes increases with age, especially after the age of 45. This may be due to factors such as decreased physical activity and muscle mass, as well as hormonal changes.
• Ethnicity: Certain ethnic groups, including African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders, have a higher risk of developing type 2 diabetes compared to Caucasians.
• Gestational Diabetes: Women who develop gestational diabetes during pregnancy are at increased risk of developing type 2 diabetes later in life.
• Medical Conditions: Certain medical conditions, such as polycystic ovary syndrome (PCOS), prediabetes, high blood pressure, and metabolic syndrome, increase the risk of developing type 2 diabetes.
• Medications: Some medications, such as certain antipsychotic drugs and corticosteroids, can increase blood sugar levels and contribute to insulin resistance.

While these factors increase the risk of developing type 2 diabetes, it's important to note that not everyone with these risk factors will develop the condition. Making healthy lifestyle choices, such as maintaining a healthy weight, eating a balanced diet, staying physically active, and managing stress, can significantly reduce the risk of developing type 2 diabetes.

Type 2 diabetes often develops gradually, and some people may not experience noticeable symptoms initially. However, as the condition progresses, symptoms may become more apparent. Common symptoms of type 2 diabetes include:

• Increased Thirst (Polydipsia): Feeling unusually thirsty and needing to drink more fluids than usual.
• Frequent Urination (Polyuria): Needing to urinate more frequently, especially at night.
• Increased Hunger (Polyphagia): Feeling hungry more often, even after eating.
• Unexplained Weight Loss: Despite increased hunger and eating, some people with type 2 diabetes may experience unexplained weight loss. This is more common in cases where the body isn't able to effectively use glucose for energy.
• Fatigue: Feeling tired, even after getting enough rest.
• Blurred Vision: High blood sugar levels can cause fluid to be pulled from the lenses of the eyes, affecting the ability to focus and causing blurred vision.
• Slow Healing of Cuts and Wounds: Type 2 diabetes can impair the body's ability to heal wounds and injuries.
• Frequent Infections: People with type 2 diabetes may be more prone to infections, such as urinary tract infections, skin infections, and yeast infections.
• Tingling or Numbness in Hands and Feet: High blood sugar levels can damage nerves, leading to tingling, numbness, or pain, particularly in the hands and feet (a condition known as peripheral neuropathy).
• Dry Skin: Diabetes can cause dry, itchy skin, particularly on the legs and feet.
• Yeast Infections: Women with type 2 diabetes may experience frequent yeast infections, particularly in the genital area.
• Darkened Skin (Acanthosis Nigricans): Some people with type 2 diabetes may develop darkened patches of skin, particularly in the folds and creases of the body, such as the neck, armpits, and groin.

It's important to note that not everyone with type 2 diabetes will experience all of these symptoms, and some individuals may not have any noticeable symptoms at all, especially in the early stages of the disease. If you experience any of these symptoms, particularly if they persist or worsen over time, it's important to see a healthcare professional for evaluation and testing. Early diagnosis and management of type 2 diabetes are essential for preventing complications and maintaining overall health.

physical examination, and laboratory tests. Here's an overview of the diagnostic process:

• Medical History and Physical Examination: Your healthcare provider will ask about your symptoms, medical history, family history of diabetes, and any risk factors you may have, such as obesity or a sedentary lifestyle. During the physical exam, your healthcare provider may check your weight, blood pressure, and examine your abdomen for signs of excess fat.
• Fasting Plasma Glucose Test: This is the most common test used to diagnose type 2 diabetes. You will be asked to fast overnight (usually for at least 8 hours), and then a blood sample will be taken to measure your fasting blood glucose level. A blood glucose level of 126 milligrams per deciliter (mg/dL) or higher on two separate tests confirms a diagnosis of diabetes.
• Oral Glucose Tolerance Test (OGTT): In some cases, your healthcare provider may recommend an OGTT to confirm the diagnosis. For this test, you'll fast overnight, and then you'll drink a sugary solution. Blood samples will be taken at intervals over the next few hours to measure how your body processes glucose. A blood glucose level of 200 mg/dL or higher two hours after drinking the solution indicates diabetes.
• Random Plasma Glucose Test: If you have symptoms of diabetes and a casual plasma glucose test (taken at any time of day, regardless of when you last ate) shows a blood glucose level of 200 mg/dL or higher, along with symptoms of diabetes, this may indicate diabetes.
• Glycated Hemoglobin (A1C) Test: This blood test measures your average blood sugar level over the past two to three months. An A1C level of 6.5% or higher is indicative of diabetes.
• Additional Tests: In some cases, your healthcare provider may order additional tests to assess complications related to diabetes or to rule out other conditions that may be causing your symptoms.

Once diagnosed, it's essential to work with your healthcare team to develop a comprehensive treatment plan, which may include lifestyle modifications (such as diet and exercise), medication, and regular monitoring of blood sugar levels. Early diagnosis and management of type 2 diabetes are crucial for preventing complications and maintaining overall health.

The treatment of type 2 diabetes typically involves a combination of lifestyle changes, medication, and regular monitoring to help manage blood sugar levels and prevent complications. Here are the key components of treatment:

• Lifestyle Modifications:

  • Healthy Eating: Adopting a balanced diet that focuses on healthy foods such as whole grains, fruits, vegetables, lean proteins, and healthy fats can help manage blood sugar levels. Limiting the intake of refined carbohydrates, sugars, and unhealthy fats is essential.

  • Regular Physical Activity: Engaging in regular exercise, such as brisk walking, cycling, or swimming, helps improve insulin sensitivity and lower blood sugar levels. Aim for at least 150 minutes of moderate-intensity aerobic activity per week, along with muscle-strengthening exercises on two or more days per week.
  • Weight Management: Achieving and maintaining a healthy weight through diet and exercise is crucial for managing type 2 diabetes, as excess weight can contribute to insulin resistance.

• Medications

  • Oral Medications: Various oral medications are available to help lower blood sugar levels by improving insulin sensitivity, reducing glucose production by the liver, or increasing insulin production by the pancreas. Examples include metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists.

  • Injectable Medications: In some cases, injectable medications, such as insulin or GLP-1 receptor agonists, may be prescribed to help lower blood sugar levels.
  • Insulin Therapy: People with type 2 diabetes may eventually have to take insulin if oral medications are not sufficient to control blood sugar levels.
• Blood Sugar Monitoring: Regular monitoring of blood sugar levels helps track how well treatment is working and allows for adjustments in medication, diet, and exercise as needed. Your healthcare provider will advise you on how often to check your blood sugar levels and what target ranges to aim for.
• Management of Other Health Conditions: People with type 2 diabetes are at increased risk of developing other health conditions, such as high blood pressure, high cholesterol, and cardiovascular disease. Managing these conditions through medication, lifestyle changes, and regular medical check-ups is important for overall health and reducing the risk of complications.
• Education and Support: Education about diabetes management, including meal planning, medication management, blood sugar monitoring, and the recognition of signs and symptoms of high or low blood sugar, is essential. Diabetes education programs and support groups can provide valuable information, resources, and encouragement for managing the condition effectively.
• Regular Follow-Up Care: Regular follow-up visits with healthcare providers, including primary care physicians, endocrinologists, and diabetes educators, are important for ongoing monitoring of diabetes control, adjustment of treatment plans as needed, and addressing any concerns or complications that may arise.

Treatment for type 2 diabetes is individualized based on factors such as age, overall health, duration of diabetes, presence of complications, and personal preferences. Working closely with a healthcare team to develop and implement a comprehensive diabetes care plan is key to successfully managing type 2 diabetes and reducing your risk of long-term complications.

Type 2 diabetes can lead to various complications that affect different organs and systems in the body. These complications can develop over time if blood sugar levels are not well-managed. Some of the common complications of diabetes include:

• Cardiovascular Disease: People with type 2 diabetes are at increased risk of developing heart disease, including coronary artery disease, heart attack, and stroke. High blood sugar levels can damage blood vessels and lead to the buildup of plaque, narrowing the arteries and restricting blood flow to the heart and brain.
• Nerve Damage (Neuropathy): Elevated blood sugar levels can damage the nerves throughout the body, leading to neuropathy. Symptoms may include numbness, tingling, burning sensations, or pain, typically affecting the hands and feet. Neuropathy can also lead to problems with digestion, sexual function, and bladder control.
• Diabetic Ketoacidosis (DKA): This serious and sometimes life-threatening condition occurs when there’s not enough insulin in your body to let the glucose into the cells, it starts to break down fat instead of sugar. Symptoms of DKA can include nausea, vomiting, stomach pain, fast breathing, and in severe cases, unconsciousness. DKA happens more often in people with type 1 diabetes, but it can sometimes if you have type 2 diabetes.
• Kidney Damage (Nephropathy): Diabetes is a leading cause of kidney failure. High blood sugar levels can damage the small blood vessels in the kidneys, impairing their ability to filter waste products from the blood. Over time, this can lead to kidney disease and eventual kidney failure, requiring dialysis or kidney transplantation.
• Eye Damage (Retinopathy): Diabetes can damage the blood vessels in the retina, the light-sensitive tissue at the back of the eye, leading to diabetic retinopathy. This condition can cause vision problems, including blurry vision, floaters, or even blindness if left untreated.
• Foot Complications: Diabetes can lead to poor circulation and nerve damage in the feet, increasing the risk of foot problems. These may include ulcers, infections, and poor wound healing, which can lead to serious complications and even amputation if not properly managed.
• Skin Conditions: People with type 2 diabetes are more prone to various skin problems, including bacterial and fungal infections, itching, and dry skin. High blood sugar levels can also contribute to slow wound healing and skin conditions such as acanthosis nigricans (dark, velvety patches of skin).
• Gum Disease (Periodontal Disease): Diabetes increases the risk of gum disease, which can lead to inflammation, bleeding gums, tooth loss, and other oral health problems.
• Hearing Loss: Studies have shown that people with diabetes are at increased risk of developing hearing loss compared to those without diabetes.
• Mental Health Disorders: Diabetes is associated with an increased risk of mental health disorders, including depression and anxiety, which can negatively impact quality of life and diabetes management.
• Increased Risk of Infections: Diabetes can weaken the immune system, making individuals more susceptible to infections, such as urinary tract infections, skin infections, and respiratory infections.

You need to work closely with your healthcare team to monitor and manage your condition effectively, which can help reduce the risk of complications and improve overall health outcomes. This typically involves maintaining healthy blood sugar levels, adopting a healthy lifestyle, taking prescribed medications as directed, and attending regular medical check-ups. Early detection and treatment of complications are also crucial for preventing further damage and improving outcomes.

Resources

• Understanding Type 2 Diabetes. American Diabetes Association. https://diabetes.org/about-diabetes/type-2. Accessed Mar. 24, 2024.

• Type 2 Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes. Accessed Mar. 25, 2024.
• Type 2 Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/type2.html. Accessed Mar. 24, 2024.
• Type 2 Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK513253/. Accessed Mar. 25, 2024.