Type 2 Diabetes

Type 2 diabetes symptoms can be managed by diligently controlling blood sugar levels.

• Type 2 diabetes is a condition in which cells cannot use blood sugar (glucose) efficiently for energy. This happens when the cells become insensitive to insulin and the blood sugar gradually gets too high.
• There are two types of diabetes mellitus, type 1 and type 2. In type 2, the pancreas still makes insulin, but the cells cannot use it very efficiently. In type 1 diabetes, the pancreas cannot make insulin due to auto-immune destruction of the insulin-producing beta cells.
• Type 2 can be caused by:
  • Being overweight
  • Eating a lot of foods or drinks with sugar and simple carbohydrates
  • Artificial sweeteners (sugar free sodas, sugar free foods) intake
  • Lack of activity (sedentary behavior)
  • Lack of exercise
  • Stress and stress hormones
  • Genetics
• Risk factors include:
  • Having family members with diabetes
  • Being overweight
  • Being sedentary including watching more than 2 hours of TV per day
  • Drinking soda
  • Consuming too much sugar and processed food
• The signs and symptoms of this type of diabetes are sometimes subtle. The major symptom is often being overweight. Other symptoms and signs include:
  • Excess thirst
  • Urinating a lot
  • Gaining or losing weight unintentionally
  • Dark skin under armpits, chin, or groin
  • Fatigue
  • Unusual odor to urine
  • Blurry vision
• Often there are no specific symptoms of the condition and it goes undiagnosed until routine blood tests are ordered.
• A blood sugar level more than 125 when fasting or more than 200 randomly is a diagnosis for diabetes.
• Treatment is with diet and lifestyle changes that include eating less sugary foods and fewer foods that are high in simple carbohydrates (sugar, bread, and pasta).
• Sometimes a person will need to take drugs, for example, metformin (Glucophage).
• People with both types of diabetes need to monitor their blood sugar levels often to avoid high (hyperglycemia) and low blood sugar levels (hypoglycemia).
• Complications include heart and kidney disease, neuropathy, sexual and/or urinary problems, foot problems, and eye problems.
• This health condition can be prevented by following a low-glycemic load diet, staying physically active, and getting regular medical screenings.
• The prognosis for a person with this health condition is estimated to be a life expectancy of 10 years less than a person without diabetes. However, good blood sugar control and taking steps to prevent complications are shortening this gap, and people with the condition are living longer than ever before. It can be reversed with diligent attention to changing lifestyle behaviors.

Type 2 diabetes is the most common type of diabetes. It is a chronic condition in which blood glucose (sugar) can no longer be regulated. There are two reasons for this. First, the cells of the body become resistant to insulin (insulin resistant). Insulin works like a key to let glucose (blood sugar) move out of the blood and into the cells where it is used as fuel for energy. When the cells become insulin resistant, moving sugar into the cells requires more and more insulin, and too much sugar stays in the blood. Over time, if the cells require more and more insulin, the pancreas can't make enough insulin to keep up and begins to fail.

This type of diabetes develops gradually, over years, so the signs and symptoms can seem subtle, and you might think it is something you "just have to live with." If you are overweight or obese, this is the major symptom, but not everyone will be overweight. In fact, weight loss can be a symptom.

Other symptoms and signs include:

1. Fatigue
2. Frequent urination
3. Excess thirst
4. Blurry or cloudy vision
5. Wounds that won't heal
6. Tingling or numbness in the feet
7. Erectile dysfunction (ED)
8. Dark skin under the armpits and around the groin

Type 2 diabetes is a condition of blood sugar dysregulation. In general blood sugar is too high, but it also can be too low. This can happen if you take your diabetes medications then skip a meal. Blood sugar also can rise very quickly after a high glycemic index meal, and then fall a few hours later, plummeting into hypoglycemia (low blood sugar). The signs and symptoms of hypoglycemia can include

• Feeling dizzy or light-headed
• Difficulty concentrating or making decisions
• Feeling sweaty or clammy
• Vision changes, like blurring or narrowing of the visual field
• Feeling physically weak
• Feeling sleepy
• Feeling irritable

Hyperglycemia, or high blood sugar, is common in type 2 diabetes. Its signs and symptoms can be either acute (short in duration) or chronic (last over a long period of time).

Acute symptoms include:

• Feeling tired
• Feeling vision is blurry or foggy
• Frequent urination
• Feeling very thirsty

Chronic signs and symptoms can include:

• Darkening skin under armpits, neck, thighs
• Fungal infections on the skin like ringworm or toenail fungus
• Weight gain
• Difficulty with sexual function
• Numbness, tingling, or burning sensations in the feet

Type 2 diabetes can be reversed with diligent attention to changing lifestyle behaviors. Type 2 diabetes is caused by a combination of genetics and unhealthy lifestyle habits.

• Some ethnic groups have a higher inherited incidence of it. African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders are all at increased risk.
• Other causes include unhealthy lifestyle habits, for example, if you:
  • Eat too much sugar and carbohydrates
  • Eat or drink foods with artificial sweeteners
  • Don't get enough exercise
  • Are under chronic, high stress

• If you have type 2, you can lower high blood sugar levels with diet, exercise, and oral drugs that either make the body more sensitive to insulin or help the pancreas release more insulin.
• In type 1 diabetes, the pancreas cannot make any insulin, and people have to depend on insulin injections to lower blood sugar.
• Over time, people with type 2 also can require insulin. This happens when the pancreas "wears out."

Risk factors for type 2 diabetes are:

• Age (being over age 45)
• A family history of diabetes
• Being of a race or ethnic group with a genetic predisposition for this type of diabetes
• Being overweight
• Having had prediabetes or gestational diabetes
• Having other metabolic syndrome conditions such as high blood pressure, low HDL or "good" cholesterol, or high triglycerides

What lifestyle factors affect my chances of getting this type of diabetes?

Lifestyle habits can contribute to a person developing the disease, for example:

• If you are overweight or obese
• If you are sedentary (you don't exercise and are not physically active)
• If you watch more than 2 hours of TV per day
• If you drink artificially sweetened or sugar sweetened products. These products increase your risk by 26%-67%.
• Economic stress. People who live in the lowest-income circumstances have 2 1/2 times greater risk of developing the disease.

Yes, there is a blood test to diagnose this disease. The blood is tested for glucose, and if it is greater than 125 fasting, or more than 200 when randomly tested, the diagnosis is diabetes. If the fasting blood sugar is between 100-125, the person has a diagnosis of prediabetes.

Tests also can measure average blood sugar over time. A hemoglobin A1c (HbA1c) test greater than 6.5% indicates the diagnosis of the disease. Prediabetes is diagnosed with an HbA1c of 5.7% - 6.4%.

Treatment for this type of diabetes can include:

• Diabetic eating plan
• Exercise
• Weight loss
• Oral drugs
• Injectable drugs
• Treating other problems like stress or sleep apnea
• Dietary supplements

Not all people with diabetes need drug therapy. A healthy eating plan and exercise alone can be enough if the person makes significant lifestyle changes. Other signs, symptoms, and complications also may need treatment. For example, nutritional deficiencies should be corrected, heart or kidney disease may need to be treated, and vision must be checked for eye problems like diabetic retinopathy.

If you have this type of diabetes, the foods you eat should have a low-glycemic load (index) -- foods higher in fiber, protein, or fats -- like vegetables and good quality protein such as fish, chicken, beans, and lentils. From that base, add other types of nutritious foods like fruit, whole grains, low-fat dairy products, and nuts.

Avoid foods with a high glycemic index (foods that raise blood sugar too quickly) such as processed foods, and foods high in carbohydrates, sugars, or animal fat. Examples of foods to avoid include:

• Desserts
• Sweets
• Pastries
• Breads
• Chips
• Crackers
• Pasta

A good rule of thumb is to avoid white foods (except for cauliflower!).

Exercise is very important if you have this health condition. Exercise makes cells more insulin sensitive, pulling glucose out of the blood. This brings down blood sugar, and more importantly, gives you better energy because the glucose is being transferred to the cells. Any type of exercise will do this, but you gain extra benefit when the activity helps build muscle, such as weight training or using resistance bands. The benefits of exercise on blood sugar last about 48-72 hours, so it is important for you to be physically active almost every day.

There are different types of diabetes drugs. They work in different ways to either stop the liver from making glucose, make the pancreas release more insulin, or block glucose from being absorbed. Insulin replaces the natural insulin when the pancreas can't make it any longer.

Metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet)

Metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet) belongs to a class of drugs called biguanides. Metformin is first-line therapy for most type 2 diabetics. It works to stop the liver from making excess glucose, and has a low risk of hypoglycemia. Hypoglycemia, or very low blood sugar can cause symptoms such as sweating, nervousness, heart palpitations, weakness, intense hunger, trembling, and problems speaking. Many patients lose some weight taking metformin, which is also helpful for blood sugar control.

Sulfonureas and meglitinides

Sulfonureas and meglitinides are classes of drugs also prescribed for treatment. These drugs cause the pancreas to release more insulin. Since the pancreas can only work so hard, these drugs have a limited duration of usefulness.

The sulfonureas include:

• glyburide (DiaBeta)
• glipizide (Glucotrol)
• glimepiride (Amaryl)

The meglitinides include:

• repaglinide (Prandin)
• nateglinide (Starlix)

Canagliflozin (Invokana) and dapagliflozin (Farxiga)

Canagliflozin (Invokana) and dapagliflozin (Farxiga) are oral medications prescribed to treat type 2 diabetics. These drugs belong to the drug class referred to as sodium-glucose co-transporter 2 (SGLT2) inhibitors. These drugs work by stopping the absorption of glucose in the kidneys, enabling some of it to be urinated out.

Other type 2 diabetes medications

There are other oral and injectable drugs for patients with type 2 diabetics such as:

• Thiazolidinediones: pioglitazone (Actos) and rosiglitazone (Avandia)
• acarbose (Precose)
• pramlintide (Symlin)
• Incretin mimetic drugs including exenatide (Byetta), liraglutide (Victoza), long-acting exenatide (Bydureon), dulaglutide (Trulicity), and semaglutide (Ozempic)
• DPP-IV inhibitors such as (sitagliptin [Januvia], saxagliptin [Onglyza], linagliptin [Tradjenta])
• Combination drugs (Glyburide/metformin [Glucovance], rosiglitazone/metformin [Avandamet], glipizide/metformin [Metaglip], pioglitazone/metformin [Actoplusmet], and metformin/sitagliptin [Janumet])

For people who want to avoid drugs, taking an aggressive approach to healthy eating plan and lifestyle change is an option. It isn't easy, but if someone is very committed and motivated, lifestyle changes can be enough to maintain a healthy blood sugar level and to lose weight. Learning about a healthy diabetes diet (a low-glycemic load diet) can be a good place to start.

Insulin is only recommended for individuals with type 2 diabetes when they have not been able to get blood sugars low enough to prevent complications through other means. To avoid insulin, those with this health condition should work very hard to follow a healthy eating plan that includes a lot of vegetables and lean proteins, exercise every day, and keep stress in perspective. They also should take their oral drugs regularly. It can be difficult to follow these recommendations and the help of your doctor, nutritionist, diabetes educator, health coach, or integrative medicine practitioner may be helpful. If you want to avoid taking medicine, work with health professionals who are knowledgeable about lifestyle medicine and can help you understand how to fit the changes into your life.

If you are a diabetic and are pregnant you can have a normal, healthy pregnancy, but you need to take extra steps to avoid gaining excess weight and high blood sugars. Lifestyle habits (eating primarily vegetables and lean protein and exercising every day) will prevent problems during pregnancy. If you are a diabetic and become pregnant, monitor your blood sugar levels often. Talk with your doctor about exploring additional health care professionals, for example, a nutritionist, health coach, or naturopathic doctor about a healthy eating plan. If your blood sugar gets out of control you may:

• Have a large baby
• Get preeclampsia
• Have a premature birth

If blood sugar is not controlled over time, complications can develop. These include:

• Diabetic eye disease
• Heart disease
• Foot problems such as wounds that don't heal, loss of feeling, or pins and needles sensations
• Neuropathy or nerve pain especially in the legs and feet
• Sexual issues such as erectile dysfunction, inability to orgasm or feel full sensation
• Urinary frequency
• Unusual odor to urine

If you have diabetes, you have a higher risk of heart disease and heart attack. Because of this, it is important to control cholesterol and high blood pressure in addition to blood sugar. The good news is that all of these diseases are responsive to healthy lifestyle changes.

A healthy lifestyle can prevent almost all cases of type 2 diabetes. A large research study called the Diabetes Prevention Program, found that people who made intensive lifestyle changes including diet and exercise reduced their risk of developing diabetes by 58%. Those over 60 years old seemed to experience extra benefit; they reduced their risk by 71%. In comparison, people who were given the drug metformin for diabetes prevention only reduced their risk by 31%.

Some research shows that people with type 2 diabetes may die 10 years earlier than those without diabetes. Most people with the disease die of secondary complications of it, for example kidney failure or heart disease. However, with good blood sugar control and healthy lifestyle choices, complications can be prevented.

Adult and pediatric endocrinologists, specialists in treating hormone imbalances and disorders of the endocrine system, are experts in helping patients with diabetes manage their disease. People with the disease also may seek care from a number of primary care providers including family or internal medicine practitioners, naturopathic doctors, or nurse practitioners. When complications arise, these patients often consult other specialists, including neurologists, gastroenterologists, ophthalmologists, acupuncturists, surgeons, and cardiologists. Nutritionists, integrative and functional medicine doctors, and physical activity experts such as personal trainers are also important members of a diabetes treatment team. It is important to interview new health care professionals about their experience, expertise, and credentials to make sure they are well qualified to help you.