Type 2 Diabetes

What is type 2 diabetes?

Type 2 diabetes is a metabolic disorder resulting from the body's inability to make enough, or to properly use, insulin. It used to be called non-insulin-dependent diabetes mellitus (NIDDM).

Without adequate production or utilization of insulin, the body cannot move blood sugar into the cells. It is a chronic disease that has no known cure. It is the most common type of diabetes.

What is prediabetes?

Type 2 diabetes is commonly preceded by prediabetes. In prediabetes, blood glucose levels are higher than normal but not high enough to be defined as diabetes. However, many people with prediabetes develop type 2 diabetes within 10 years, states the National Institute of Diabetes and Digestive and Kidney Diseases. Prediabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes.

Prediabetes affects 79 million people age 20 or older in the U.S., according to the American Diabetes Association (ADA).

What causes type 2 diabetes?

The exact cause of type 2 diabetes is unknown. However, there does appear to be a genetic factor which causes it to run in families. And, although a person can inherit a tendency to develop type 2 diabetes, it usually takes another factor, such as obesity, to bring on the disease.

Prevention or delay of onset of type 2 diabetes

Type 2 diabetes may be prevented or delayed by following a program to eliminate or reduce risk factors - particularly losing weight and increasing exercise. Information gathered by the Diabetes Prevention Program, sponsored by the National Institutes of Health and the ADA, continues to study this possibility.

What are the symptoms of type 2 diabetes?

The following are the most common symptoms of type 2 diabetes. However, each individual may experience symptoms differently. Symptoms may include:

• Frequent infections that are not easily healed

• High levels of sugar in the blood when tested

• High levels of sugar in the urine when tested

• Unusual thirst

• Frequent urination

• Extreme hunger but loss of weight

• Blurred vision

• Nausea and vomiting

• Extreme weakness and fatigue

• Irritability and mood changes

• Dry, itchy skin

• Tingling or loss of feeling in the hands or feet

Some people who have type 2 diabetes exhibit no symptoms. Symptoms may be mild and almost unnoticeable, or easy to confuse with signs of aging. Half of all Americans who have diabetes do not know it.

The symptoms of type 2 diabetes may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What are the risk factors for type 2 diabetes?

Risk factors for type 2 diabetes include the following:

• Age. People age 45 or older are at higher risk for diabetes.

• Family history of diabetes

• Being overweight

• Not exercising regularly

• Race and ethnicity. Being a member of certain racial and ethnic groups, such as African-Americans, Hispanic Americans, and American Indians increases the risk for type 2 diabetes.

• Pregnancy

• History of gestational diabetes, or giving birth to a baby who weighed more than 9 pounds

• A low level HDL (high-density lipoprotein - the "good cholesterol")

• A high triglyceride level

Treatment for type 2 diabetes

Specific treatment for type 2 diabetes will be determined by your physician based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

The goal of treatment is to keep blood sugar levels as close to normal as possible.

Emphasis is on control of blood sugar (glucose) by monitoring the levels, regular physical activity, meal planning, and routine health care. Treatment of diabetes is an ongoing process of management and education that includes not only the person with diabetes, but also health care professionals and family members.

Often, type 2 diabetes can be controlled through losing weight, improved nutrition, and exercise alone. However, in some cases, these measures are not enough and either oral or injected medications and/or insulin must be used. Treatment often includes:

• Proper diet

• Weight control

• An appropriate exercise program

• Regular foot inspections

• Oral medications, other medications, and/or insulin replacement therapy, as directed by your physician. There are various types of medications that may be used to treat type 2 diabetes when lifestyle changes such as diet, exercise, and weight loss are not effective. Oral medications of several different types are available, with each type working in a different manner to lower blood sugar. One medication may be combined with another one to improve blood sugar control. When oral medications are no longer effective, insulin may be required. New medications for treating diabetes are in development. GLP-1 agonists are one of the new types of medications. GLP-1 agonists work by stimulating insulin production by the pancreas, slowing the emptying of food from the stomach, and inhibiting the production of glucagon in the pancreas (glucagon is a hormone produced by the pancreas that stimulates release of glucose by the liver). Byetta®, a GLP-1 agonist approved by the FDA in 2005, is given by injection.

• Regular monitoring of the hemoglobin A1c levels. The hemoglobin A1c test (also called HbA1c test) shows the average amount of sugar in the blood over the last three months. The result will indicate if the blood sugar level is under control. The frequency of HbA1c testing will be determined by your physician. It is recommended that testing occur at least twice a year if the blood sugar level is in the target range and stable, and more frequently if the blood sugar level is unstable.

Untreated or inappropriately-treated diabetes can cause problems with the kidneys, legs, feet, eyes, heart, nerves, and blood flow, which could lead to kidney failure, gangrene, amputation, blindness, or stroke. For these reasons, it is important to follow a strict treatment plan.

Advances in diabetes research have led to improved methods of managing diabetes and treating its complications. However, scientists continue to explore the causes of diabetes and ways to prevent and treat the disorder. Other methods of administering insulin through inhalers and pills are currently being studied. Scientists are investigating gene involvement in type 1 and type 2 diabetes and some genetic markers for type 1 diabetes have been identified. Pancreas transplants are also being performed.