Type 2 Diabetes

Type 2 diabetes is a chronic metabolic disorder characterized by high blood sugar (glucose) levels. It occurs when the body becomes resistant to insulin (a hormone that helps glucose enter cells) or when the pancreas doesn't produce enough insulin. This leads to glucose building up in the blood instead of being used for energy.

Type 2 diabetes is the most common form of diabetes, accounting for about 90-95% of all cases. It typically develops in adults but is increasingly seen in children and adolescents, often related to rising obesity rates. With proper management, people with type 2 diabetes can live healthy, active lives.

Type 2 diabetes symptoms may develop slowly and can be mild initially:

• Increased thirst: Feeling very thirsty
• Frequent urination: Needing to urinate more often, especially at night
• Increased hunger: Feeling hungry even after eating
• Fatigue: Feeling tired and weak
• Blurred vision: Difficulty focusing
• Slow-healing sores: Cuts and bruises heal slowly
• Frequent infections: Especially skin, gum, or bladder infections
• Tingling or numbness: In hands or feet
• Unexplained weight loss: Despite eating normally

Some people have no symptoms initially, which is why regular screening is important, especially for those at risk.

Seek emergency medical care if you experience:

• Very high blood sugar (above 250 mg/dL or 13.9 mmol/L) with symptoms
• Signs of diabetic ketoacidosis (nausea, vomiting, fruity breath, confusion)
• Signs of hyperosmolar hyperglycemic state (extreme thirst, dry mouth, confusion)
• Severe hypoglycemia (low blood sugar) that doesn't respond to treatment

Effective diabetes management involves:

1. Blood Sugar Monitoring:

   • Check blood sugar as recommended by your doctor
   • Keep a log of readings
   • Learn to recognize patterns

2. Healthy Eating:

   • Follow a balanced meal plan
   • Control portion sizes
   • Choose whole grains, lean proteins, vegetables
   • Limit sugary foods and drinks
   • Consider working with a dietitian

3. Regular Physical Activity:

   • Aim for at least 150 minutes per week
   • Include both aerobic and strength training
   • Check blood sugar before and after exercise
   • Stay hydrated

4. Medication Adherence:

   • Take medications as prescribed
   • Understand how medications work
   • Know potential side effects
   • Never skip doses

5. Foot Care:

   • Check feet daily for cuts, blisters, or sores
   • Keep feet clean and dry
   • Wear comfortable, well-fitting shoes
   • See a podiatrist regularly

6. Stress Management:

   • Stress can raise blood sugar
   • Practice relaxation techniques
   • Get adequate sleep

• Blood sugar above 250 mg/dL with severe symptoms
• Signs of diabetic ketoacidosis
• Severe hypoglycemia unresponsive to treatment
• Loss of consciousness

• Blood sugar consistently above target range
• Frequent high or low blood sugar episodes
• Symptoms of complications (vision changes, foot problems)
• Need to adjust medications
• Planning pregnancy
• Illness affecting blood sugar control

• Blood sugar well-controlled
• Following treatment plan
• Regular monitoring shows good results
• No concerning symptoms

Diagnosing type 2 diabetes involves:

1. Blood Tests:

   • Fasting Blood Glucose: After 8 hours of fasting
   • HbA1c: Average blood sugar over 2-3 months
   • Oral Glucose Tolerance Test: Measures response to glucose
   • Random Blood Glucose: At any time of day

2. Diagnostic Criteria:

   • Fasting glucose ≥126 mg/dL (7.0 mmol/L)
   • HbA1c ≥6.5% (48 mmol/mol)
   • Random glucose ≥200 mg/dL (11.1 mmol/L) with symptoms
   • OGTT 2-hour glucose ≥200 mg/dL

3. Additional Tests:

   • Cholesterol and triglyceride levels
   • Kidney function tests
   • Eye examination
   • Foot examination

Type 2 diabetes treatment is individualized and may include:

1. Lifestyle Modifications (first-line):

   • Healthy diet
   • Regular exercise
   • Weight loss (if overweight)
   • Smoking cessation

2. Oral Medications:

   • Metformin (usually first choice)
   • Sulfonylureas
   • DPP-4 inhibitors
   • SGLT2 inhibitors
   • GLP-1 receptor agonists

3. Injectable Medications:

   • Insulin (various types)
   • GLP-1 receptor agonists

4. Monitoring:

   • Regular blood sugar checks
   • HbA1c every 3-6 months
   • Blood pressure monitoring
   • Cholesterol monitoring

Treatment goals (individualized):

• HbA1c: Usually <7% (53 mmol/mol), may be higher for older adults
• Fasting glucose: 80-130 mg/dL (4.4-7.2 mmol/L)
• Blood pressure: <130/80 mmHg
• LDL cholesterol: <100 mg/dL (2.6 mmol/L)

Prevent or delay type 2 diabetes by:

• Maintain Healthy Weight: BMI between 18.5-24.9
• Eat a Balanced Diet:
  • Whole grains, fruits, vegetables
  • Lean proteins
  • Limit processed foods and sugar
• Exercise Regularly: At least 150 minutes per week
• Limit Alcohol: Moderate consumption
• Don't Smoke: Smoking increases diabetes risk
• Manage Stress: Chronic stress affects blood sugar
• Get Regular Check-ups: Especially if at risk
• Know Your Risk Factors:
  • Family history
  • Overweight or obesity
  • Age over 45
  • Physical inactivity
  • Prediabetes

In normal metabolism:

1. Food is broken down into glucose
2. Glucose enters the bloodstream
3. Pancreas releases insulin
4. Insulin helps glucose enter cells for energy

In type 2 diabetes:

1. Cells become resistant to insulin
2. Pancreas tries to produce more insulin
3. Eventually, pancreas can't keep up
4. Glucose builds up in blood instead of entering cells

This leads to:

• High blood sugar (hyperglycemia)
• Cells not getting enough energy
• Long-term damage to blood vessels and organs

Complications can affect:

• Heart and blood vessels
• Kidneys
• Eyes
• Nerves
• Feet

• May have other health conditions
• Treatment goals may be less strict
• Higher risk of hypoglycemia
• May need simplified medication regimens
• Regular screening for complications

• Increasingly common in youth
• Often related to obesity
• Requires specialized pediatric care
• Family involvement is crucial
• Focus on healthy lifestyle habits

• Gestational diabetes screening is important
• Well-controlled diabetes is crucial for baby's health
• May need to adjust medications
• Close monitoring throughout pregnancy
• Higher risk of complications if uncontrolled

While diabetes can't be "cured," some people can achieve remission through significant weight loss, especially early in the disease. Blood sugar may normalize, but the underlying tendency remains.

No, but you should limit added sugars and refined carbohydrates. Natural sugars in fruits and vegetables are fine in moderation as part of a balanced diet.

Not everyone with type 2 diabetes needs insulin. Many people manage with lifestyle changes and oral medications. Insulin may be needed if other treatments aren't effective.

This depends on your treatment plan. Some people check multiple times daily, others less frequently. Your doctor will recommend based on your specific situation.

Yes, in moderation and as part of a balanced meal plan. Work with a dietitian to learn how to incorporate your favorite foods while managing blood sugar.