TYPE 2 DIABETES

What is type 2 diabetes?

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. Healthy blood sugar (glucose) levels are 70 to 99 milligrams per deciliter (mg/dL). If you have undiagnosed Type 2 diabetes (T2D), your levels are typically 126 mg/dL or higher.

T2D happens because pancreas doesn’t make enough hormone called insulin, or body doesn’t use insulin properly, or both. This is different from type 1 diabetes, which happens when an autoimmune attack on pancreas results in a total lack of insulin production. 

What are the causes of T2D?

Several factors can contribute to insulin resistance, including:

• Genetics.
• Excess body fat, especially in your belly and around your organs (visceral fat).
• Physical inactivity.
• Eating highly processed, high-carbohydrate foods and saturated fats frequently.
• Certain medications, like long-term corticosteroid use.
• Hormonal disorders, like hypothyroidism and Cushing`s syndrome. 
• Chronic stress and lack of quality sleep. 

What are the risk factors for T2D?

• Having family history of T2D
• Age older than 45 years
• Being overweight or obese (BMI > 25)
• Are physically active less than 3 times per week
• Black, Hispanic, Native American, Asian American or Pacific Islander
• Had gestational diabetes when pregnant
• Have high blood pressure or high cholesterol 
• Have pre-diabetes
• Have polycystic-ovarian disease 

How common is T2D?

More than 37 million people in the U.S. have diabetes (about 1 in 10 people), and about 90% to 95% of them have T2D. 

Researchers estimate that T2D affects about 6.3% of the world’s population. T2D most commonly affects adults over 45, but people younger than 45 can have it as well, including children. (https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes) 

What are the symptoms of T2D?

Symptoms of type 2 diabetes often come on slowly. In fact, people can live with type 2 diabetes for years and not know it. When there are symptoms, they may include: 

• More urination
• More hunger
• Weight loss 
• Tiredness
• Blurred vision
• Slow healing sores
• Frequent infections
• Numbness or tingling in hands or feet
• Areas of darkened skin, most often in the armpits and neck. (https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199) 

More thirst

How is T2D diagnosed?

• Fasting plasma glucose test: This lab test checks your blood sugar level. You typically need to get this test in the morning after an eight-hour fast (nothing to eat or drink except water). A result of 126 mg/dL or higher means you have diabetes.
• Random plasma glucose test: This lab test also checks your blood sugar, but you can get it at any time without fasting. A result of 200 mg/dL or higher means you have diabetes.
• A1C test: This lab test measures your average blood sugar levels over the past two to three months. A result of 6.5% or higher means you have diabetes. (https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes) 

What is the treatment for T2D?

For both T1DM and T2DM, the cornerstone of therapy is diet and exercise.

• Exercises help with burning calories, lowering sugar levels, weight loss, improves metabolism and reduce stress. 
• Regular blood sugar monitoring to help understand glucose spikes and medication dosage.
• Medication
  • Metformin is the first medicine prescribed for type 2 diabetes. It lowers the amount of glucose the liver makes and helps the body use insulin better. Side effects include B-12 deficiency, nausea, belly pain, bloating and diarrhea. 
  • Sulfonylureas like glipizide and glimepiride help the body make more insulin. Side effects include lower blood sugar and weight gain.
  • Glinides like repaglinide and nateglinide help the pancreas to make more insulin. Side effects include lower blood sugar and weight gain.
  • Thiazolidinediones like pioglitazone and rosiglitazone help the body's tissues take in more insulin. Side effects may include weight gain, broken bones, fluid retention and heart failure.
  • DPP-4 inhibitors like alogliptin (Nesina), sitagliptin (Januvia), saxagliptin and linagliptin (Tradjenta) help lower blood sugar levels. Side effects may include pancreatitis and joint pain. 
  • GLP-1 receptor agonists are injections used to slow digestion and help lower blood sugar levels. Their use is often linked with weight loss. These medicines include dulaglutide (Trulicity) exenatide (Byetta, Bydureon Bcise), liraglutide (Saxenda, Victoza) and semaglutide (Rybelsus, Ozempic, Wegovy). 
  • SGLT2 inhibitors like canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance) block the return of glucose to the bloodstream. Excess glucose then leaves the body in the urine. Side effects may include vaginal yeast infections, urinary tract infections, gangrene, low blood pressure. 
• People with T2D are given Insulin if other treatments have failed. Synthetic insulin directly lowers blood sugar levels. There are several types of insulin, like long-acting and short-acting types. You may inject it with syringes or pens, use inhaled insulin, or use an insulin pump.  (https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199) 

Foods that can help support healthy blood sugar levels are lean proteins (chicken, eggs, fish and turkey), non-starchy vegetables (broccoli, green beans, salad greens and cucumbers), healthy fats (avocados, nuts, natural peanut butter and olive oil) and complex carbohydrate like beans, berries, sweet potatoes and whole-wheat bread.

What are the complications of T2D?

• Atherosclerosis and arterial diseases: coronary artery disease, peripheral artery disease, cerebrovascular disease, heart attack, stroke.
• Eyes: Diabetes-related retinopathy, diabetes related macular edema, cataract, glaucoma, blindness. 
• Diabetes related nephropathy.
• Diabetes-related neuropathy.
• Skin conditions like dryness with or without bacterial or fungal infections.
• Foot ulcers which may get infected resulting in gangrene and amputation.
• Gum disease or other oral problems.
• Hearing problems.
• Digestive problems, including gastroparesis.
• Sexual dysfunction. (https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes)