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ype 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. This long-term (chronic) condition results in too much sugar circulating in the bloodstream. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems.

In type 2 diabetes, there are primarily two interrelated problems at work. Your pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into your cells — and cells respond poorly to insulin and take in less sugar.

Type 2 diabetes used to be known as adult-onset diabetes, but both type 1 and type 2 diabetes can begin during childhood and adulthood. Type 2 is more common in older adults, but the increase in the number of children with obesity has led to more cases of type 2 diabetes in younger people.

There’s no cure for type 2 diabetes, but losing weight, eating well and exercising can help you manage the disease. If diet and exercise aren’t enough to manage your blood sugar, you may also need diabetes medications or insulin therapy.

Symptoms

Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can be living with type 2 diabetes for years and not know it. When signs and symptoms are present, they may include:

  • Increased thirst
  • Frequent urination
  • Increased hunger
  • Unintended weight loss
  • Fatigue
  • Blurred vision
  • Slow-healing sores
  • Frequent infections
  • Numbness or tingling in the hands or feet
  • Areas of darkened skin, usually in the armpits and neck

When to see a doctor

Causes

Type 2 diabetes is primarily the result of two interrelated problems:

  • Cells in muscle, fat and the liver become resistant to insulin. Because these cells don’t interact in a normal way with insulin, they don’t take in enough sugar.
  • The pancreas is unable to produce enough insulin to manage blood sugar levels.

Exactly why this happens is unknown, but being overweight and inactive are key contributing factors.

How insulin works

Insulin is a hormone that comes from the gland situated behind and below the stomach (pancreas). Insulin regulates how the body uses sugar in the following ways:

  • Sugar in the bloodstream triggers the pancreas to secrete insulin.
  • Insulin circulates in the bloodstream, enabling sugar to enter your cells.
  • The amount of sugar in your bloodstream drops.
  • In response to this drop, the pancreas releases less insulin.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues. The use and regulation of glucose includes the following:

  • Glucose comes from two major sources: food and your liver.
  • Glucose is absorbed into the bloodstream, where it enters cells with the help of insulin.
  • Your liver stores and makes glucose.
  • When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

In type 2 diabetes, this process doesn’t work well. Instead of moving into your cells, sugar builds up in your bloodstream. As blood sugar levels increase, the insulin-producing beta cells in the pancreas release more insulin. Eventually these cells become impaired and can’t make enough insulin to meet the body’s demands.

In the less common type 1 diabetes, the immune system mistakenly destroys the beta cells, leaving the body with little to no insulin.

Risk factors

Factors that may increase your risk of type 2 diabetes include:

  • Weight. Being overweight or obese is a main risk.
  • Fat distribution. Storing fat mainly in your abdomen — rather than your hips and thighs — indicates a greater risk. Your risk of type 2 diabetes rises if you’re a man with a waist circumference above 40 inches (101.6 centimeters) or a woman with a measurement above 35 inches (88.9 centimeters).
  • Inactivity. The less active you are, the greater your risk. Physical activity helps 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.
  • Race and ethnicity. Although it’s unclear why, people of certain races and ethnicities — including Black, Hispanic, Native American and Asian people, and Pacific Islanders — are more likely to develop type 2 diabetes than white people are.
  • 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 as you get older, especially after age 45.
  • 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.
  • Pregnancy-related risks. Your risk of developing type 2 diabetes increases if you developed gestational diabetes when you were pregnant or if you gave birth to a baby weighing more than 9 pounds (4 kilograms).
  • Polycystic ovary syndrome. Having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes
  • Areas of darkened skin, usually in the armpits and neck. This condition often indicates insulin resistance.

Complications

Type 2 diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Also, factors that increase the risk of diabetes are risk factors for other serious chronic diseases. Managing diabetes and controlling your blood sugar can lower your risk for these complications or coexisting conditions (comorbidities).

Potential complications of diabetes and frequent comorbidities include:

  • Heart and blood vessel disease. Diabetes is associated with an increased risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).
  • Nerve damage (neuropathy) in limbs. High blood sugar over time can damage or destroy nerves, resulting in tingling, numbness, burning, pain or eventual loss of feeling that usually begins at the tips of the toes or fingers and gradually spreads upward.
  • Other nerve damage. Damage to nerves of the heart can contribute to irregular heart rhythms. Nerve damage in the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. For men, nerve damage may cause erectile dysfunction.
  • Kidney disease. Diabetes may lead to chronic kidney disease or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
  • Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness.
  • Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
  • Slow healing. 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.
  • Sleep apnea. Obstructive sleep apnea is common in people living with type 2 diabetes. Obesity may be the main contributing factor to both conditions. It’s not clear whether treating sleep apnea improves blood sugar control.
  • Dementia. Type 2 diabetes seems to increase the risk of Alzheimer’s disease and other disorders that cause dementia. Poor control of blood sugar levels is linked to more-rapid decline in memory and other thinking skills. 

Prevention

Healthy lifestyle choices can help prevent type 2 diabetes, and that’s true even if you have biological relatives living with diabetes. If you’ve received a diagnosis of prediabetes, lifestyle changes may slow or stop the progression to diabetes.

A healthy lifestyle includes:

  • Eating healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains.
  • Getting active. Aim for 150 or more minutes a week of moderate to vigorous aerobic activity, such as a brisk walk, bicycling, running or swimming.
  • Losing weight. Losing a modest amount of weight and keeping it off can delay the progression from prediabetes to type 2 diabetes. If you have prediabetes, losing 7% to 10% of your body weight can reduce the risk of diabetes.
  • Avoiding inactivity for long periods. Sitting still for long periods can increase your risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes.

For people with prediabetes, metformin (Fortamet, Glumetza, others), an oral diabetes medication, may be prescribed to reduce the risk of type 2 diabetes. This is usually prescribed for older adults who are obese and unable to lower blood sugar levels with lifestyle changes.

Diabetes prevention: 5 tips for taking control

Changing your lifestyle could be a big step toward diabetes prevention — and it’s never too late to start. Consider these tips.By Mayo Clinic Staff

Lifestyle changes can help prevent the onset of type 2 diabetes, the most common form of the disease. Prevention is especially important if you’re currently at an increased risk of type 2 diabetes because of excess weight or obesity, high cholesterol, or a family history of diabetes.

If you have been diagnosed with prediabetes — high blood sugar that doesn’t reach the threshold of a diabetes diagnosis — lifestyle changes can prevent or delay the onset of disease.

Making a few changes in your lifestyle now may help you avoid the serious health complications of diabetes in the future, such as nerve, kidney and heart damage. It’s never too late to start.

1. Lose extra weight

Losing weight reduces the risk of diabetes. People in one large study reduced their risk of developing diabetes by almost 60% after losing approximately 7% of their body weight with changes in exercise and diet.

The American Diabetes Association recommends that people with prediabetes lose at least 7% to 10% of their body weight to prevent disease progression. More weight loss will translate into even greater benefits.

Set a weight-loss goal based on your current body weight. Talk to your doctor about reasonable short-term goals and expectations, such as a losing 1 to 2 pounds a week.

2. Be more physically active

There are many benefits to regular physical activity. Exercise can help you:

  • Lose weight
  • Lower your blood sugar
  • Boost your sensitivity to insulin — which helps keep your blood sugar within a normal range

Goals for most adults to promote weight loss and maintain a healthy weight include:

  • Aerobic exercise. Aim for 30 minutes or more of moderate to vigorous aerobic exercise — such as brisk walking, swimming, biking or running — on most days for a total of at least 150 minutes a week.
  • Resistance exercise. Resistance exercise — at least 2 to 3 times a week — increases your strength, balance and ability to maintain an active life. Resistance training includes weightlifting, yoga and calisthenics.
  • Limited inactivity. Breaking up long bouts of inactivity, such as sitting at the computer, can help control blood sugar levels. Take a few minutes to stand, walk around or do some light activity every 30 minutes.

3. Eat healthy plant foods

Plants provide vitamins, minerals and carbohydrates in your diet. Carbohydrates include sugars and starches — the energy sources for your body — and fiber. Dietary fiber, also known as roughage or bulk, is the part of plant foods your body can’t digest or absorb.

Fiber-rich foods promote weight loss and lower the risk of diabetes. Eat a variety of healthy, fiber-rich foods, which include:

  • Fruits, such as tomatoes, peppers and fruit from trees
  • Nonstarchy vegetables, such as leafy greens, broccoli and cauliflower
  • Legumes, such as beans, chickpeas and lentils
  • Whole grains, such as whole-wheat pasta and bread, whole-grain rice, whole oats, and quinoa

The benefits of fiber include:

  • Slowing the absorption of sugars and lowering blood sugar levels
  • Interfering with the absorption of dietary fat and cholesterol
  • Managing other risk factors that affect heart health, such as blood pressure and inflammation
  • Helping you eat less because fiber-rich foods are more filling and energy rich

Avoid foods that are “bad carbohydrates” — high in sugar with little fiber or nutrients: white bread and pastries, pasta from white flour, fruit juices, and processed foods with sugar or high-fructose corn syrup.

4. Eat healthy fats

Fatty foods are high in calories and should be eaten in moderation. To help lose and manage weight, your diet should include a variety of foods with unsaturated fats, sometimes called “good fats.”

Unsaturated fats — both monounsaturated and polyunsaturated fats — promote healthy blood cholesterol levels and good heart and vascular health. Sources of good fats include:

  • Olive, sunflower, safflower, cottonseed and canola oils
  • Nuts and seeds, such as almonds, peanuts, flaxseed and pumpkin seeds
  • Fatty fish, such as salmon, mackerel, sardines, tuna and cod

Saturated fats, the “bad fats,” are found in dairy products and meats. These should be a small part of your diet. You can limit saturated fats by eating low-fat dairy products and lean chicken and pork.

5. Skip fad diets and make healthier choices

Many fad diets — such as the glycemic index, paleo or keto diets — may help you lose weight. There is little research, however, about the long-term benefits of these diets or their benefit in preventing diabetes.

Your dietary goal should be to lose weight and then maintain a healthier weight moving forward. Healthy dietary decisions, therefore, need to include a strategy that you can maintain as a lifelong habit. Making healthy decisions that reflect some of your own preferences for food and traditions may be beneficial for you over time.

One simple strategy to help you make good food choices and eat appropriate portions sizes is to divide up your plate. These three divisions on your plate promote healthy eating:

  • One-half: fruit and nonstarchy vegetables
  • One-quarter: whole grains
  • One-quarter: protein-rich foods, such as legumes, fish or lean meats

When to see your doctor

The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes for all adults age 45 or older and for the following groups:

  • People younger than 45 who are overweight or obese and have one or more risk factors associated with diabetes
  • Women who have had gestational diabetes
  • People who have been diagnosed with prediabetes
  • Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors

Share your concerns about diabetes prevention with your doctor. He or she will appreciate your efforts to prevent diabetes and may offer additional suggestions based on your medical history or other factors.

http://www.eastcoastfamilyclinic.com/home-1/patient-information/diabetes

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