Type 2 Diabetes Mellitus

Content provided by the Faculty of the Harvard Medical School

Filed Under: Take Charge of our Diabetes

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Type 2 diabetes is a chronic disease$ "t is characteri%ed by high levels of sugar in the blood$ Type 2 diabetes is also called type 2 diabetes &ellitus' adult(onset diabetes' non(insulin(dependent diabetes' or )ust diabetes$ Type 2 diabetes affects the *ay the body processes and uses carbohydrates' fats and proteins$ During digestion' food is broken do*n into its basic co&ponents$ The liver processes these nutrients into one type of sugar+glucose$ ,lucose is the &ost basic fuel for the body$ ,lucose enters your body-s cells *ith the help of insulin$ "nsulin is a hor&one produced by the pancreas$ !ithout insulin' glucose cannot pass through the cell *all$ Type 2 diabetes occurs *hen your body-s cells do not react efficiently to insulin$ This condition is called insulin resistance$ "n people *ith insulin resistance' the pancreas first &akes e.tra insulin to &aintain a nor&al blood sugar$ /ver ti&e' the body-s insulin resistance gets *orse$ The pancreas cannot keep up *ith the de&and for &ore and &ore insulin$ 0s a result' blood glucose levels rise$ Type 2 diabetes runs in fa&ilies$ "t &ost often affects people *ho are older than 12$ 3ut type 2 diabetes is no* being seen in &ore and &ore young people$ /besity greatly increases the risk of diabetes$

Sy&pto&s
The sy&pto&s of diabetes are related to high blood glucose levels$ They include: 4.cessive urination' thirst and hunger !eight loss "ncreased susceptibility to infections' especially yeast or fungal infections 4.tre&ely high blood sugar levels can lead to a dangerous co&plication called hyperos&olar syndro&e$ This is a life(threatening for& of dehydration$ "n so&e cases' hyperos&olar syndro&e is the first sign that a person has type 2 diabetes$ "t causes confused thinking' *eakness' nausea and even sei%ure and co&a$ 5eople *ith type 2 diabetes take &edications to reduce blood sugar$ 3ut these &edications &ay cause sugar levels to drop belo* nor&al$ 6o* blood sugar is called hypoglyce&ia$ Sy&pto&s of hypoglyce&ia include: S*eating Tre&bling Di%%iness Hunger Confusion Sei%ures and loss of consciousness 7if hypoglyce&ia is not recogni%ed and corrected8 ou can correct hypoglyce&ia by eating or drinking so&ething *ith carbohydrates$ This raises your blood sugar level$ Type 2 diabetes affects all parts of the body$ "t can cause serious' potentially life(threatening co&plications$ These include:

Atherosclerosis + 0therosclerosis is fat buildup in the artery *alls$ This can i&pair blood flo* to the all the organs$ The heart' brain and legs are &ost often affected$ Retinopathy + Tiny blood vessels at the back of the eye beco&e da&aged by high blood sugar$ Caught early' retinopathy da&age can be &ini&i%ed by tightly controlling blood sugar and using laser therapy$ Untreated retinopathy can lead to blindness$ Neuropathy + This is nerve da&age$ The &ost co&&on type is peripheral neuropathy$ The

nerves to the legs are da&aged first' causing pain and nu&bness in the feet$ This can advance to cause sy&pto&s in the legs and hands$ Da&age to the nerves that control digestion' se.ual function and urination can also occur$ Foot problems + Sores and blisters on the feet occur for t*o reasons: "f peripheral neuropathy causes nu&bness' the person *ill not feel irritation in the foot$ The skin can break do*n and for& an ulcer$ 3lood circulation can be poor' leading to slo* healing$ 6eft untreated' a si&ple sore can beco&e infected and very large$ Nephropathy + Da&age to the kidneys$ This is &ore likely if blood sugars re&ain elevated and high blood pressure is not treated aggressively$

Diagnosis
Diabetes is diagnosed by testing the blood for sugar levels$ 3lood is tested in the &orning after you have fasted overnight$ Typically' the body keeps blood sugar levels bet*een 92 and :22 &illigra&s per deciliter 7&g;d68' even after fasting$ "f a blood sugar level after fasting is greater than :2< &g;d6' diabetes is diagnosed$ our doctor *ill e.a&ine you to look for signs of diabetes co&plications$ These include: /besity' especially abdo&inal obesity$ High blood pressure Deposits of blood' or puffy yello* spots in the retina of your eyes Decreased sensation in the legs !eak pulses in the feet 0bnor&al pulses in the abdo&en 3listers' ulcers or infections of the feet 6aboratory tests are also used routinely to evaluate diabetes$ These include: Fasting glucose$ 0 test of your blood sugar level after you have not eaten for several hours$ Hemoglobin A1C (HbA1c). "ndicates ho* close to average your blood glucose has been during the previous t*o &onths$ Blood creatinine and urine microalbumin. Tests for evidence of kidney disease$ Lipid pro ile. Measures levels of triglycerides and total' HD6' and 6D6 cholesterol$ This evaluates the risk of atherosclerosis$

Expected Duration
Diabetes is a lifelong illness. Aging and episodic illness can cause the body's insulin resistance to increase. As a result, additional treatment typically is required over time.

Prevention

You can help to prevent type diabetes by! "aintaining your ideal body #eight. $his is especially true if you have a family history of diabetes. Eating a healthy diet and getting regular exercise. $hese delay the onset of diabetes in people #ho are in the early stages of insulin resistance. $a%ing medication. $he medication metformin &'lucophage( offers some additional protection for people #ith pre)diabetes. Pre)diabetes is defined as blood glucose levels bet#een *++ and * , mg-d.. /f you already have type diabetes, you can still delay or prevent complications! 0eep tight control of your blood sugar. $his reduces the ris% of most complications. .o#er your ris% of heart)related complications by! $a%ing a daily aspirin. Aggressively managing other ris% factors for atherosclerosis, such as! 1igh blood pressure 1igh cholesterol and triglycerides 2igarette smo%ing 3besity 4isit an eye doctor and a foot specialist every year to reduce eye and foot complications.

$reatment
/n most cases, type diabetes treatment begins #ith #eight reduction through diet and exercise. A healthy diet for a person #ith diabetes is! .o# in cholesterol .o# in total calories 5utritionally balanced #ith abundant amounts of! 6hole)grain foods "onounsaturated oils 7ruits and vegetables A daily multivitamin is recommended for most people #ith diabetes. $ype diabetes can be controlled #ith medications8pills or in9ections. "edicines for type diabetes #or% in many different #ays. $hey include medications that! /mprove insulin resistance in the muscles and liver. /ncrease the amount of insulin made and released by the pancreas. 2ause a burst of insulin release #ith each meal. Delay the absorption of sugars from the intestine. :lo# your digestion. ;educe your appetite for large meals. Add to your o#n insulin supply. $his is given as an insulin in9ection. 6ith enough insulin, you can adequately process glucose despite having insulin resistance. Decrease the conversion of fat to glucose and improve insulin resistance. $hese medications are called thia<olidinediones. 3ne medication in this group has recently been

lin%ed to heart disease. As a result, drugs from this group are not recommended as a first choice in treatment. About one of three people #ith type diabetes use in9ectable insulin regularly. /nsulin often is used in small doses before bed. $his helps prevent the liver from producing and releasing glucose during sleep. /n advanced type diabetes, or for people #ho #ant to tightly control glucose levels, insulin may be needed more than once per day and in higher doses. $reatment plans that include both very long)acting insulin and very short)acting insulin are frequently the most successful for controlling blood sugar. Doses of very short)acting insulin can be ad9usted to accommodate inconsistent eating patterns. "edications used to treat type diabetes can have side effects. $hese vary by medication. :ide effects may include! .o# blood sugar levels &hypoglycemia( 6eight gain 5ausea Diarrhea .ife)threatening buildup of lactic acid in the blood &in people #ith %idney failure( .eg s#elling 6orsening of heart failure .iver inflammation /ncreased ris% of heart attac% &#ith one of the thia<olidinediones medicines( Excessive gas and bloating Although diabetes treatments, li%e all treatments, can cause side)effects, the benefits generally greatly out#eigh the ris%s. "edicines are also available to reduce the ris% or to slo# the onset of complications. $hese include medications that! :lo# the #orsening of %idney disease. .o#er cholesterol. All diabetics should consider ta%ing medication to lo#er their cholesterol. .o#er blood pressure. Diabetics should use medication to control high blood pressure if it can't be improved by lifestyle changes. Protect against heart attac%s. "ost people #ith diabetes benefit from a daily aspirin.