Diabetes mellitus type 2 (patient information)
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What is diabetes mellitus type 2?
Diabetes is a disease in which blood glucose levels are above normal. Type 2 diabetes, also known as adult-onset diabetes, is the most common form of diabetes, accounting for 90-95% of all diagnosed cases of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:
- Right away, your cells may be starved for energy.
- Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.
How do I know if I have diabetes mellitus type 2? What are its symptoms?
Pre-Diabetes
Before people develop type 2 diabetes, they almost always have "pre-diabetes" -- blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 57 million people in the United States who have pre-diabetes. About 11 percent of people with pre-diabetes in the Diabetes Prevention Program standard or control group developed type 2 diabetes each year during the average 3 years of follow-up. Other studies show that many people with pre-diabetes develop type 2 diabetes in 10 years. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.
Symptoms
People with diabetes may exhibit some or none of the following symptoms:
- Frequent urination
- Excessive thirst
- Unexplained weight loss
- Extreme hunger
- Sudden vision changes
- Tingling or numbness in hands or feet
- Feeling very tired much of the time
- Very dry skin
- Sores that are slow to heal
- More infections than usual
Who is at risk for diabetes mellitus type 2?
Risk factors for type 2 diabetes include:
- Older age
- Obesity
- Family history of diabetes
- Prior history of gestational diabetes (type of diabetes that only pregnant women get)
- nearly 40% of women with a history of gestational diabetes developed diabetes in the future
- Impaired glucose tolerance
- Physical inactivity
- Race/ethnicity
African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.
Are you at risk for diabetes mellitus type 2? Take the American Diabetes Association Risk Test!
Diagnosis
There are two different tests your doctor can use to determine whether you have pre-diabetes: the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT). The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have pre-diabetes or diabetes. If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).
FPG OGTT
Treatment
The main goal of treatment is to get your blood glucose (sugar) levels under control in order to increase your chances of a complication-free life. People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.
Healthy Living
Healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high. Blood glucose monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any one time. Keeping a log of your results is vital. When you bring this record to your health care provider, you have a good picture of your body's response to your diabetes care plan. Blood glucose checks let you see what works and what doesn't. This allows you and your doctor, dietitian, or nurse educator to make needed changes. How do blood checks work? You stick your finger with a special needle, called a lancet, to get a drop of blood. With some meters, you can also use your forearm, thigh or fleshy part of your hand. There are spring-loaded lancing devices that make sticking yourself less painful. Before using the lancing device, wash your hands or site you chose with soap and water. If you use your fingertip, stick the side of your fingertip by your fingernail to avoid having sore spots on the frequently used part of your finger. Blood glucose meters are small computerized machines that "read" your blood glucose. In all types of meters, your blood glucose level shows up as a number on a screen (like that on your pocket calculator). Be sure your doctor or nurse educator shows you the correct way to use your meter. With all the advances in blood glucose meters, use of a meter is better than visual checking. In addition, you may need to check your urine for ketones once in a while. Ketones in the urine is a sign that your body is using fat for energy instead of using glucose because not enough insulin is available to use glucose for energy. Ketones in the urine is more common in type 1 diabetes however.
Insulin
Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy. Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood. There are many different insulins for many different situations and lifestyles and there are more than 20 types of insulin sold in the United States. These insulins differ in how they are made, how they work in the body, and price.
Diabetes Pills
The first treatment for type 2 diabetes is often meal planning for blood glucose (sugar) control, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels. All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels. Diabetes pills don't work for everyone. These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels. Your chances of diabetes pills working are low if you have had diabetes for more than 10 years or already take more than 20 units of insulin each day. On the other hand, your chances are good if you developed diabetes recently or have needed little or no insulin to keep your blood glucose levels near normal. Diabetes pills sometimes stop working after a few months or years. Even if diabetes pills do bring your blood glucose levels near the normal range, you may still need to take insulin if you have a severe infection or need surgery. Pills may not be able to control blood glucose levels during these stressful times when blood glucose levels shoot up. Also, if you plan to become pregnant, you will need to control your diabetes with diet and exercise or with insulin. It is not safe for pregnant women to take oral diabetes medications.
Combination Therapy
Because diabetes pills seem to help the body use insulin better, some people take them along with insulin shots. The idea behind this "combination" therapy is to try to help insulin work better.
Other
In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management. Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke. Managing diabetes is more than keeping blood glucose levels under control—it is also important to manage blood pressure and cholesterol levels through healthy eating, physical activity, and the use of medications, if needed. By doing so, those with diabetes can lower their risk. Aspirin therapy, if recommended by a person’s health care team, and smoking cessation can also help lower risk.