Type 2 diabetes mellitus occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body’s tissues become resistant to normal or even high levels of insulin. Insulin resistance means that even if there is enough insulin in the body, the insulin doesn’t work as well, which in essence is like not having enough insulin. This causes high blood glucose (sugar) levels, which can lead to a number of complications if untreated.
Type 2 diabetes is a chronic medical condition that requires regular monitoring and treatment. Treatment includes lifestyle adjustments, self-care measures, and usually medications. Fortunately, these treatments can control blood sugar levels in the near-normal range and minimize the risk of developing diabetes-related complications. Ninety percent of diabetics have type 2 diabetes.
THE IMPACT OF TYPE 2 DIABETES
Being diagnosed with type 2 diabetes can be a frightening and overwhelming experience, and it is common to have questions about why it developed, what it means for long-term health, and how it will affect everyday life. It is important to try educate yourself as soon as possible. There is a great deal you can do as a patient to affect your diabetes. The sooner you accept it, and care for it, the sooner it will become a part of your normal life.
In order to educate yourself, you should talk to your doctor or nurse about resources that are available for medical as well as psychological support. This may include group classes, meetings with a nutritionist, social worker, or nurse educator, and other educational resources such as books, websites, or magazines.
Despite the risks associated with type 2 diabetes, most people can lead their normal active lives. Today given all the wonderful new medications and tools at our disposal, you can live a good life with diabetes, as long as you take care of yourself.
CAUSES OF TYPE 2 DIABETES
We are only now beginning to understand what causes type 2 diabetes. It is probably caused by a complex interaction of predisposing genetic factors and environmental influences.
Genetic causes: Many people with type 2 diabetes have a family member with either type 2 diabetes or medical problems associated with diabetes, such as high cholesterol levels, high blood pressure, or obesity.
The lifetime risk of developing type 2 diabetes is five to ten times higher in first-degree relatives (sister, brother, son, daughter) of a person with diabetes compared to a person with no family history of diabetes.
Certain ethnic groups are at much higher risk of developing type 2 diabetes. These include people of Hispanic, African, and Asian descent.
Environmental conditions: Environmental factors such as what you eat, how much weight you gain, and how active you are have a strong influence on the risk of developing type 2 diabetes.
Pregnancy: About 3 to 5 percent of pregnant women develop gestational diabetes. This type of diabetes is similar to type 2 diabetes, but generally resolves after a woman delivers her baby. Women who have gestational diabetes are at increased risk for developing type 2 diabetes later in life.
DIAGNOSIS OF TYPE 2 DIABETES
The diagnosis of diabetes is based upon your symptoms and the results of blood tests.
Symptoms: Many patients have no symptoms at all, and are diagnosed by chance after a blood test. Others have symptoms of hyperglycemia (high sugars) which include frequent urination, feeling thirsty and hungry, and blurry vision (which improves after diagnosis and treatment for the high sugars).
Laboratory tests: Several blood tests are used to measure blood glucose (also called blood sugar) levels, the primary test for diagnosing diabetes.
- Random blood sugar test — For a random blood sugar test, you can have blood drawn at any time throughout the day, regardless of when you last ate
- Fasting blood sugar test — A fasting blood sugar is a blood test done after not eating or drinking for 8 to 12 hours (usually overnight).
- Hemoglobin A1c test (HbA1c) — This test measures the average blood sugar level during the past two to three months. Normal values for HbA1c are 4 to 6 percent. The HbA1c test can be done at any time of day (before or after eating).
- Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is a test that involves drinking a specially formulated glucose solution (usually orange or cola flavored). Your blood sugar level is tested before you drink the solution, and then one and two hours after drinking it.
Criteria for diagnosis
The following criteria are used to classify your blood sugar levels as normal, pre-diabetes, or diabetes.
Normal - Fasting (first sugar of the morning) blood sugar less than 100 mg/dL (5.55 mmol/L).
Pre-diabetes – At least 50 percent of people with impaired glucose tolerance eventually develop type 2 diabetes, and there is an increased risk of heart disease even if diabetes does not develop. Impaired glucose tolerance is very common; about 11 percent of all people between the ages of 20 and 74 years have impaired glucose tolerance.
- Impaired fasting glucose is defined as a fasting blood sugar level between 100 and 125 mg/dL (5.6 to 6.9 mmol/L).
- Impaired glucose tolerance is defined as a blood sugar level of 140 to 199 mg/dL two hours after an oral glucose tolerance test.
Diabetes mellitus — A person is considered to be diabetic if he or she has one or more of the following:
- Symptoms of diabetes and a random blood sugar of 200 mg/dL (11.1 mmol/L) or higher
- A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher
- A blood sugar of 200 mg/dL (11.1 mmol/L) or higher two hours after a 75 gram oral glucose tolerance test.
- A HbA1c of 6.5 percent or higher
All of these blood tests must be repeated to confirm that the results remain abnormally high.
TREATMENT of TYPE 2 DIABETES
TYPE 2 DIABETES COMPLICATIONS
Complications of type 2 diabetes can be related to the disease itself or to the treatments used to manage diabetes. SEE COMPLICATIONS OF DIABETES.
PREGNANCY AND DIABETES
Women with type 2 diabetes are usually able to become pregnant and have a healthy baby. Read more on gestational diabetes. READ MORE ON GETTING PREGNANT WITH DIABETES.