Type 2 Diabetes

Most people with diabetes have type 2 diabetes. If you have type 2, you might have one or both of the following problems:

• Your cells don’t use insulin properly. This is called insulin resistance.
• Your pancreas doesn’t produce enough insulin. This is called insulin deficiency.

Often when type 2 diabetes is first diagnosed, the problem is insulin resistance. But as the disease progresses, the pancreas may also produce less insulin. Unlike type 1 diabetes, type 2 usually comes on gradually.

Type 2 diabetes is treated with a combination of diet, exercise, and oral medications (pills). In some cases, injections of insulin or other medications are needed to help control blood glucose levels. Uncontrolled diabetes can result in catastrophic health problems including heart disease, stroke, blindness, kidney disease, nervous system disease, amputations, dental disease, and pregnancy complications.

In people with diabetes, high blood glucose can cause two problems — both of which can result in foot problems. You may have one or both of these:

• Nerve damage (neuropathy). Nerve damage from high blood glucose usually begins in the hands and feet. It can cause painful symptoms — tingling, aching, or throbbing — but it can also reduce sensation. If you can’t really feel cold, heat, or pain in your feet, it’s easy to ignore an injury or infection. And unfortunately, in people with diabetes, even a small blister or stubbed toe can become serious.
• Poor circulation. High blood glucose can damage your blood vessels and reduce blood flow to your feet. This means that injuries take longer to heal. Over time, poor circulation in your feet can even change the shape of your feet and toes. This can cause problems with the way you walk.

If you are experiencing symptoms of diabetes, talk to your primary care provider.

No one knows exactly why type 2 diabetes develops in some people. But several factors have been shown to increase your risk of developing type 2 diabetes. For example, scientists have shown that type 2 is more likely to occur in people who:

• Are overweight. Being overweight doesn’t cause diabetes, but it may trigger it in some people. Having too much body fat promotes insulin resistance. And if you tend to carry your extra weight around your waistline — if you have an “apple-shaped” body — you have a higher risk than people who carry their excess weight on their hips and thighs.
• Are 45 or older. Type 2 is most common in older adults. But the disease is seen in more and more children every year. This is probably because more children today are inactive and obese.
• Are physically inactive. Inactivity promotes obesity and insulin resistance.
• Have a parent or sibling with diabetes. Type 2 diabetes often runs in families. In fact, the genetic link for type 2 is much stronger than it is for type 1 diabetes.
• Are African American, American Indian/Alaskan Native, Hispanic American, or Pacific Islander. Because the tendency to develop type 2 may be inherited, your ethnic background is also a factor. People in the groups listed above are at higher risk.
• Have abnormal cholesterol levels. For example, you may have high triglycerides, high LDL cholesterol (“bad cholesterol”), or low HDL cholesterol (“good cholesterol”) levels.
• Have had gestational diabetes, or have given birth to a baby who weighed more than 9 pounds at birth. Although gestational diabetes usually goes away when your baby is born, once you’ve had it, you’re at risk for developing type 2 diabetes later in life.
• Have high blood pressure. High blood pressure and diabetes often occur together and are a dangerous combination for your heart and blood vessels.

To confirm a type 2 diabetes diagnosis, your doctor will ask about your symptoms and family history, as well as perform a few tests. To diagnose and monitor diabetes, healthcare providers test your plasma glucose levels. In the United States, plasma or whole blood glucose are measured in milligrams per deciliter, or mg/dL.

• HbA1C test.This test can be done any time during the day, whether or not you’ve eaten recently. It requires a small blood sample that’s then analyzed. The HbA1c test is used to monitor diabetes as well as to diagnose it. This test is unique in that it evaluates blood glucose levels over several months.
• Fasting plasma glucose (FPG) test. For the FPG test, you first need to fast (not eat or drink anything except water) for at least 8 hours. Then, a sample of your blood is drawn and analyzed at your healthcare provider’s office.
• Other blood tests. Your doctor may ask for additional blood samples to test for ketones in your urine.

Right now, there is no cure for diabetes. You have a chronic (lifelong) illness that you need to continually monitor and manage.

The good news? Diabetes is highly controllable, and you can have a long and healthy life in spite of your disease. Thanks to medical research, today we know a lot about what you can do to take care of yourself. Learning about and doing these things can be a challenge, but it will yield a big reward: your good health.

Doctors now set three main goals for diabetes treatment, including control of blood glucose, blood pressure, and cholesterol.

• Controlling your blood glucose. Your doctor will give you a target range for your blood glucose levels. Your aim is to keep your blood glucose within these ranges most of the time by following your treatment plan every day.
• Controlling your blood pressure. The usual target for people with diabetes is 140/90 mm Hg or less. But if you have kidney disease, your doctor may give you a lower target.
• Controlling your cholesterol. Depending on your sex and other factors, your doctor will set targets for various types of fat and cholesterol in your bloodstream.

Type 2 diabetes is treated with a combination of diet, exercise, and oral medications (pills). In some cases, injections of insulin or other medications are needed to help control blood glucose levels. If you need to take insulin, you’ll take it in one of the following ways:

• Injection. Most people take insulin in daily injection shots. In this case, you’ll inject the insulin yourself, into the fatty part of your stomach, thigh, arm, or hip. You’ll need to take a shot two or more times a day, depending on your condition, lifestyle, body type, and other factors.
• Insulin pump. An insulin pump delivers insulin directly into your body through a thin tube (catheter) placed under your skin. You “wear” the pump all the time. It can be carried in your pocket or on your waistband — wherever it’s most comfortable for you. The pump is programmed like a computer to deliver a little insulin throughout the day. At mealtimes (or when your blood glucose is high), you can set it to deliver extra insulin.
• Inhaled insulin. Inhaled insulin is a new treatment for adults with type 1 or type 2 diabetes. It is usually taken at mealtime. The insulin comes in a powder form and is breathed into the lungs. People with asthma shouldn't use inhaled insulin.

Common medications prescribed for individuals with diabetes also include the following:

• Ace inhibitors
• ARBS (angiotensin II receptor antagonists)
• Aspirin
• Beta blockers
• Diuretics
• Statins
• Corticosteroids

More and more American children, adolescents, and adults are being diagnosed with type 2 diabetes. The increase is so rapid, many experts now call type 2 an emerging childhood epidemic. To protect you and your kids from getting type 2, your whole family can do these things:

• Stay at a healthy weight. Being overweight is one of the biggest risk factors for type 2 — but studies show that parents often don’t recognize their child’s weight problems. Ask your child’s healthcare provider what a healthy weight is for your child. Then, help your children reach their targets by encouraging them to be active and by cutting calories in meals and snacks.
• Be active every day. Physical activity will help your children keep a healthy weight and a positive attitude. So look for ways to keep you and your kids moving. Have them walk or bike to school. Limit TV time. Sign them up for sports or a fitness class. And exercise with them every day — it’s a great way to stay close and get fit.
• Eat healthy foods. Build a better diet with a few small changes. Eat more fruits and vegetables. Choose whole grain foods. Drink water throughout the day, not sodas or sports drinks. Limit sweets, processed snacks, and fatty foods.

• Diabetes Care Handbook

Sometimes — but not always — symptoms are the first clue that a person has diabetes. These common symptoms may be caused by high blood glucose levels, and may go away once blood glucose is controlled. Symptoms include:

• Fatigue. It makes sense that untreated diabetes makes you feel tired and weak. Your body is having trouble getting energy from glucose.
• Intense thirst and frequent urination. When you have high blood glucose, your body loses more fluid than normal. To replenish these fluids, you drink more and more. You urinate more as well.
• Unusual hunger. Many people report that they’re hungry all the time. That’s because even though they may have plenty of glucose in their bloodstream, their cells are starving for energy. In response, their bodies prompt them to eat more.
• Unexplained weight loss. Some people find that they’re losing weight, even though they may be eating and drinking more than usual. As glucose builds up in your blood, it spills into your urine. Glucose in your urine is a significant drain of calories.
• Numbness or tingling in your hands and feet. This is a result of nerve damage caused by high blood glucose. Unless the damage is severe, these sensations may slowly go away when your blood glucose returns to normal.
• Blurred vision. When your blood glucose is high for days in a row, the lenses of your eyes tend to swell. This makes it harder to focus and harder for you to see clearly.
• Frequent infections, or cuts and sores that are slow to heal. High blood glucose can increase your risk for infections for two reasons: – The bacteria and fungi that cause infection thrive in a high-glucose environment. (And if you’ve got untreated diabetes, your whole body is probably a high-glucose environment.) – Your immune system — which is responsible for fighting infection — doesn’t work as well when you have high blood glucose.