Diabetes (Type 2)
Diabetes is disabling, deadly and on the rise. In fact, diabetes is at epidemic proportions in the United States.
There are two main types of diabetes. Type 1 and Type 2. Type 1 diabetes occurs when your body can't make insulin. Type 2 diabetes occurs when the body makes some, but not enough, insulin. It is generally accompanied by an inability to respond normally to insulin. Ninety to 95 percent of people with diabetes have Type 2 diabetes.
A complex relationship between insulin, glucose, your liver and other hormones ensures that your blood sugar stays within set limits. Here's how it works:
- When you eat, your body breaks down carbohydrates from foods into various sugar molecules. One of these is glucose which is absorbed directly into your bloodstream, to be used or stored.
- When you don't eat, your liver (and kidney) produce sugar for fuel.
- Insulin causes glucose to be absorbed into your cells, where it can be used for energy.
- The pancreas produces insulin and regulates how much is released into your body.
- If you don't eat for a long period, the pancreas limits release of insulin.
- After a meal or a snack, the pancreas sends extra insulin into your bloodstream.
- If you have more glucose than your cells need, your body stores the excess in your liver as glycogen until it's needed.
If all goes well, your body maintains "normal" blood sugar levels. If there isn't enough insulin or your body can't use it properly, glucose accumulates in the blood instead of going into cells. When blood glucose levels are chronically too high, you have diabetes.
Over the long term, diabetes can cause serious complications, including amputations, blindness, heart disease, stroke, nerve disease, kidney disease and even premature death. It is the sixth leading cause of death in the United States with some estimates suggesting that diabetes can shorten an individual's life by as much as 15 years.
However, all is not doom and gloom. While there's no cure for Type 2 diabetes, it can be managed and the onset of complications delayed. Better yet, Type 2 diabetes itself can often be prevented when people make good lifestyle choices and make them early enough in their lives. Read on for more information.
- Diabetes is a serious, costly, and increasingly common chronic disease that can cause devastating complications that often result in disability and death.
- A fasting blood sugar over 126 mg/dL or a random blood sugar over 200 mg/dL is diagnostic of diabetes, according to the official American Diabetes Association definition.
- More than 20 million Americans have diabetes today. Every year, one million new cases are diagnosed.
- Type 2 diabetes accounts for 90–95% of all cases.
- Six to seven percent of persons age 45 to 64 years and 10 to 12 percent of those age 65 years and older have diabetes.
- More and more children are being diagnosed with Type 2 diabetes, something unheard of a decade ago.
- People with diabetes have rates of coronary artery disease and stroke that are 2 to 5 times that of non-diabetics.
- Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74.
- More than half the amputations of the feet and legs in the U.S. are due to diabetes.
- Diabetes kills more people each year than AIDS and breast cancer combined.
- Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%.
- For every 1% reduction in results of A1c blood tests, the risk of developing microvascular diabetic complications (eye, kidney, and nerve disease) is reduced by 40%.
- Detecting and treating diabetic eye disease can reduce the development of severe vision loss by an estimated 50% to 60%.
- Comprehensive foot care programs can reduce amputation rates by 45% to 85%.
Ask Your Doctor
This list of questions is a good starting point for discussion with your doctor. However, it is not a comprehensive list.
- What is my target blood glucose level?
- What do you consider an abnormal blood sugar reading?
- How do diet and exercise help my condition?
- Do I need to take medication? If so, can I take pills?
- Do I need insulin, with or instead of pills?
- What are the side effects of the medication/insulin?
- Will I always need medications/insulin?
- What should I do if I forget to take my medication?
- What are the warning signs or symptoms that my blood sugars are too high?
- What are the warning signs or symptoms that my blood sugars are too low?
- What are the long-term complications of diabetes, and how can I avoid them?
- What is the easiest way to monitor my blood sugar?
- How often should I test my blood sugar?
- When is the best time to check my blood sugar?
- How often should I be seeing you to optimize my diabetes management?
- When do I need to call you for emergency help?
- Should I see any specialists?
Key Point 1
Diabetes is an epidemic in the U.S. People at risk need to be screened and diagnosed early.
Diabetes is rising fast in the United States. In the last 15 years, the number of Americans with diagnosed diabetes has more than doubled, reaching 14.6 million in 2005. Plus, medical professionals estimate that as many as 6 to 7 million more people have diabetes and don't know it, and an additional 41 million U.S. adults between the ages of 40 and 74 have pre-diabetes.
All this translates to a lifetime risk for diabetes of 1 in 3 (for people born in the U.S. in 2000). Lifetime risk is even higher for Hispanic females at 1 in 2 and African Americans and Hispanics overall at 2 in 5. That means, in general, that an individual born in 2000 will have at least a 33 percent chance of developing diabetes unless circumstances change.
While there are two types of diabetes, the most common is referred to as Type 2 – 90 to 95 percent of the people with diabetes have this type.
Diabetes is easy to diagnose at an early stage and the tests are inexpensive. In fact, blood tests can identify pre-diabetes. When pre-diabetes is detected, steps can be taken to help you avoid or at least postpone getting diabetes.
- Often, people with Type 2 diabetes have few or no symptoms, especially in the early stages. Symptoms usually develop slowly and may go unnoticed for months or even years.
- Some individuals who suspect they may have diabetes or are in danger for getting diabetes don't want their fears confirmed.
- Historically, only people who doctors suspected might have diabetes were screened, usually those who reported symptoms or those at high risk. Today, work is being done to gain consensus that all adults undergo a blood test for diabetes by age 45 and have additional tests every three years thereafter.
Why get screened?
Regular medical check-ups will help you identify the condition early and get proper treatment. By the time symptoms appear, you may already be developing complications affecting nearly every major organ in your body. If your doctor identifies pre-diabetes, you can still avoid getting diabetes. If he or she detects diabetes early, you can prevent or delay the onset of complications.
Who should be screened?
While the risk of developing Type 2 diabetes increases with age, people can develop it at any age, even during childhood. Many healthcare providers recommend universal screening for adults at age 45. Earlier screening is recommended for those with additional factors that put them at high risk. They include:
- Symptoms such as:
Fatigue Excessive thirst Frequent need to urinate Unexplained weight fluctuations Extreme hunger Tingling/numbness in hands or feet Very dry or itchy skin Red, swollen tender gums Sudden blurred vision or floating spots
in your vision
Slow healing sores or frequent infections Foamy looking urine
- A family history of diabetes.
- Obesity, especially if extra weight is distributed around your abdomen.
- Race/ethnicity. African Americans, Hispanic Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for Type 2 diabetes.
- Physical inactivity.
- Delivering a baby weighing more than 9 pounds.
- Certain medical conditions such as:
High blood pressure Elevated cholesterol Elevated triglycerides Coronary artery disease Past gestational diabetes Polycystic ovary syndrome Fatty liver Chronic pancreatitis
- Use of certain medications including some chemotherapy agents, antipsychotics and mood stabilizers.
The more risk factors you have, the more likely you will get Type 2 diabetes.
Don't wait. If you suspect you have diabetes or have one or more risk factors, talk to your doctor. The earlier you know, the more control you will have.
Key Point 2
The goal of diabetes treatment is to get your blood sugar normal and keep it there. The solution is not the same for everyone. You have to do whatever it takes to control it.
Your first step after being diagnosed with diabetes is to come to terms with the inevitable life changes you'll have to make. It's natural to go through emotional reactions like denial, anger and depression, but ultimately you'll need to embrace a treatment regimen. When you do, you'll probably feel better and have more energy and you'll reduce the effect of diabetes-related complications.
The first thing most people think about when they hear "diabetes" is insulin shots. While people with Type 1 diabetes don't make insulin and need regular insulin injections, that's not the treatment option needed for most Type 2 diabetes patients whose bodies do make insulin. Common treatments include:
- Lifestyle modification
- Taking oral diabetes medicines
The key is to take responsibility for the day-to-day management of your blood glucose levels. You should:
- Learn all you can about Type 2 diabetes
- Monitor your glucose levels by testing and keeping a log of your numbers
- Schedule regular checkups with your doctor
- Buy and wear a "medic alert" bracelet
- Do your best to stay positive
Self testing is important because it tells you if you're keeping your glucose levels in the correct range. It also helps you learn what makes your blood sugar levels rise and fall so your doctor can fine tune your treatment program. Your doctor will periodically do a blood test called Hemoglobin A1C, which measures your average blood sugar levels over time.
Studies have shown the best way to treat pre-diabetes is through lifestyle change. Lifestyle change is also a major component of treating diabetes. This includes cutting calories, making healthy food choices, and exercising regularly. Your doctor may start by focusing on these aspects of treatment.
If diet, exercise and maintaining a healthy weight aren't enough to control your diabetes, you may need oral medication. These medications can lower blood sugar by:
- Causing the body to release more insulin into the blood stream, or
- Helping the body to use its own insulin more effectively
There are several types of oral diabetes medications. Sometimes combinations of them are used.
|Type of Medication||What it Does||Common Brand Names|
|Sulfonylureas (glipizide, glyburide, glimenpiride)||Helps your body make more insulin||Dymelor, Diabinese, Glucotrol, DiaBeta, Glynase, Micronase, Amaryl|
|Meglitinides||Helps your body make more insulin||Starlix, Prandin|
|Thiazolidinediones (rosiglitazone, pioglitazone hydrochloride)||Helps your body use insulin better||Actos, Avandia|
|Alpha-glucosidase inhibitors (acarbose, miglitol)||Helps your body absorb sugar more slowly to keep your blood sugar lower||Precose, Glyset|
|Metformin||Helps your body use insulin better and make less sugar. Also reduces the amount of sugar your body absorbs from food||Glucophage|
|Drugs combined with Metformin||Glucovance, Metaglip, Avandamet|
Oral medications don't work for everyone. If a combination of lifestyle improvements and these medications don't bring your blood sugar down enough, your doctor may need to add insulin to your treatment plan.
Diabetes-related complications are less common and less severe in people who have well-controlled blood sugar levels. Good control means getting as close to a normal (non-diabetic) blood glucose level as you can.
Key Point 3
Tight control of diabetes can significantly delay the onset of complications by decades.
Because it's possible to have high blood glucose levels and feel no symptoms, diabetes is often called a silent disease. But, even though it may be silent, it's always serious, with potential for dangerous short- and long-term effects if it isn't properly controlled.
Serious short-term complications from uncontrolled blood glucose levels can be fatal.
- Very high blood sugar. Blood sugar can become so high that it actually becomes thick and syrupy. Symptoms include excessive thirst, increased urination, weakness, leg cramps, confusion, convulsions and coma.
- Very low blood sugar. This is most common in people taking insulin, but people taking oral medications that enhance the release of insulin are also at risk. Symptoms include slurred speech, drowsiness, confusion and coma.
- Diabetic ketoacidosis. When blood glucose levels are persistently high, your cells become starved for energy and your body begins to break down fat. This produces toxic acids (ketones). Left untreated, it can lead to coma and even death.
The long term complications of diabetes are equally dangerous. The good news is that numerous studies very clearly show that when people with diabetes keep their blood glucose levels close to the normal, non-diabetic range the long term complications of diabetes can be significantly delayed. According to a study described in the February, 2003 issue of The New England Journal of Medicine, the most serious complications of Type 2 diabetes can be reduced up to 50%.
Because diabetes can damage nerves, blood vessels and organs found everywhere in your body, the long-term complications from uncontrolled blood glucose levels are many.
- Heart disease and stroke are two to four times more common in those with diabetes.
- Diabetics with poor blood sugar control and high blood pressure are at greatest risk of severe kidney disease, including kidney failure.
- Diabetes can cause a variety of eye problems and may lead to blindness.
- Diabetes can damage the sensory nerves in your legs and sometimes your arms. This becomes most dangerous when, in addition to nerve damage, blood flow is poor. Gangrene can develop, requiring amputation.
- Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation.
- High blood sugar impairs your immune system and increases your risk of infections.
The signs and symptoms of long term complications develop slowly and by the time they're evident you may have already sustained a great deal of damage. But, by taking the right steps, and taking them early, you can make a big difference in your prognosis.
- Step 1. Set ambitious treatment goals and stick to them.
- Step 2. Optimize your overall health including weight, blood pressure, cholesterol levels and blood glucose levels. If you smoke, stop.
- Step 3. Talk to your primary care physician about specialists who should be on your health care team. For instance, if you're at high risk for heart disease, consider annual checkups with a cardiologist. Make sure you get annual eye exams – timely treatment and appropriate follow-up eye care can reduce the risk of blindness by 90 percent.
It's all about looking ahead and making a decision. It's tempting to ignore the specter of future complications and continue to live your life exactly as you did before. That choice virtually guarantees some pretty grim consequences. Or, you can take the disease seriously and choose to make changes. When you do, you can look forward to a longer and more productive life, even with diabetes.
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