I found this article on WebMD.com, and I have to say it's just about the best I've read anywhere. Included in this article are descriptions of the three different types of diabetes, which will hopefully put an end to much of the misconceptions being spread in various groups.
Type 2 Diabetes: Symptoms, Causes, Treatment
Written by WebMD Editorial
Contributors
Medically Reviewed by Poonam Sachdev on June 25, 2023
What Is Type 2
Diabetes?
Type 2 diabetes is a
lifelong disease that keeps your body from using insulin the
way it should.
People who are
middle-aged or older are most likely to get this kind of diabetes. It used to
be called adult-onset diabetes or diabetes mellitus. But type 2 diabetes also
affects kids and teens,
mainly because of childhood
obesity.
Type 2 is the
most common form of diabetes.
About 1 in 10 people in the U.S. have type 2. Nearly 1 in 3 have prediabetes,
meaning their blood sugar (or
blood glucose) is high but not high enough to be diabetes yet.
Symptoms of Type
2 Diabetes
The symptoms
of type 2 diabetes can
be so mild that you don't notice them. About 9 million people have it and don't
know it. Symptoms include:
- Being very
thirsty
- Peeing a lot
- Blurry vision
- Tingling or
numbness in your hands or feet
- Fatigue/feeling
worn out
- Wounds that
don't heal
- Yeast
infections that keep coming back
- Feeling
hungry
- Weight loss
without trying
- Getting
infections
If you have
dark rashes around
your neck or armpits, see your doctor. These are called acanthosis
nigricans, and they can be signs that your body is becoming
resistant to insulin.
Learn more about
type 2 diabetes symptoms .
Types of
Diabetes
There are three
main types of diabetes:
Type 2 diabetes
About 90%-95% of
all people with diabetes have this type. With type 2, your pancreas makes some
insulin -- the hormone that helps your cells turn glucose (a type of sugar)
from the food you eat into energy. In some people, your cells don't respond to
this hormone as they should (a condition called insulin resistance).
Type 1 diabetes
In type 1, your
immune system attacks and destroys the cells in your pancreas that make
insulin, leading to high blood sugar. Doctors aren't sure why this happens.
Type 1 isn't related to weight or lifestyle habits. It used to be called
insulin-dependent or childhood diabetes.
Gestational
diabetes
You only get this
type of diabetes when you're pregnant. It happens because hormonal changes and
weight gain during pregnancy can lead to insulin resistance. It usually goes
away after you have your baby.
Causes of Type 2
Diabetes
Usually, a
combination of things causes type 2 diabetes.
They might include:
- Genes. Scientists
have found different bits of DNA that affect how your body makes insulin.
- Weight. Having extra
weight or obesity can
cause insulin resistance.
- Metabolic
syndrome. People with insulin resistance often
have a group of conditions including high blood sugar, high blood
pressure, and high
cholesterol and triglycerides.
- Too much
glucose from your liver. When your blood sugar is low, your liver makes
and sends out glucose. After you eat, your blood sugar goes up, and your
liver usually slows down and stores its glucose for later. But some
people's livers don't. They keep making sugar.
- Bad
communication between cells. Sometimes, cells send the wrong signals or
don't pick up messages correctly. When these problems affect how your
cells make and use insulin or glucose, this can lead to diabetes.
- Broken beta
cells. If the
cells that make insulin send it out at the wrong time, your blood sugar
gets thrown off. High blood sugar can damage these cells, too.
Type 2 Diabetes
Risk Factors
Certain things
make it more likely that you’ll get type 2 diabetes. The more of these that
apply to you, the higher your chances of getting it are. Some things are
related to who you are:
- Age. 45 or
older
- Family. A
parent, sister, or brother with diabetes
- Ethnicity. African
American, Alaska Native, Native American, Asian American, Hispanic or
Latino, or Pacific Islander American
Risk factors
related to your medical history and health include:
- Insulin
resistance
- Prediabetes
- Heart and
blood vessel disease
- High blood
pressure, even if it's treated and under control
- Low HDL
("good") cholesterol
- High
triglycerides
- Being
overweight or having obesity
- Having a
baby who weighed more than 9 pounds
- Gestational
diabetes while you were pregnant
- Polycystic
ovary syndrome (PCOS)
- Depression
Other things that
raise your risk of diabetes have
to do with your daily habits and lifestyle. These are the ones you can do
something about:
Type 2 diabetes
epidemiology
Some 462 million
people worldwide, or about 6.3% of the population, have type 2 diabetes. It's
the ninth leading cause of death, responsible for more than 1 million deaths
each year. Cases of type 2 diabetes are increasing faster in developed
countries like the U.S. and Western Europe.
Scientists say
type 2 diabetes affects men and women at about the same rate.
It's more common
in people in middle age and older, affecting:
- 4.4% of
those ages 15-49
- 15% of those
ages 50-69
- 22% of those
70 and older
It's also more
common in people of color, including those whose heritage is:
- Black
- Hispanic
- Native
American
- Asian
Type 2 Diabetes
Diagnosis and Tests
Your doctor can
test your blood for signs of type 2 diabetes. Usually, they’ll test you on 2
different days to confirm the diagnosis. But if your blood glucose is very high
or you have many symptoms, one test may be all you need.
Blood tests for
type 2 diabetes include:
- A1c. It's
an average percent of your blood glucose over the past 2 or 3 months.
- Fasting
plasma glucose. This
is also known as a fasting blood sugar test. It measures your blood sugar
on an empty stomach. You won't be able to eat or drink anything except
water for 8 hours before the test.
- Oral glucose
tolerance test (OGTT). This checks your blood glucose before and 2
hours after you drink something sweet to see how your body handles the
sugar.
Learn more about
how type 2 diabetes is diagnosed.
Stages of Type 2
Diabetes
Researchers have
defined four stages of type 2 diabetes:
Insulin
resistance
In this stage, your body usually makes enough insulin to keep blood sugar levels in the normal range. But if your cells "resist" the insulin (don't use it correctly), your body will make more insulin to try to help the glucose get into them. Insulin resistance can be temporary, but it can also last. There's no test to detect insulin resistance, so it can be hard to diagnose.
Prediabetes
Eventually,
insulin resistance causes glucose to build up in your blood. You have
prediabetes when your blood sugar levels are higher than normal, but not high
enough to be considered diabetes. An A1c between 5.7% and 6.4% means you have
prediabetes. You may not have any symptoms. But prediabetes ups your risk
for heart disease, stroke, and type 2 diabetes.
Type 2 diabetes
If your A1c is
6.5% or higher, you have diabetes. You may have symptoms like increased thirst,
blurred vision, and numbness in feet or hands. Or you may not have any symptoms
at all.
Type 2 diabetes
with vascular complications
At this stage,
your diabetes has led to vascular (blood vessel) problems. You may have damage
to vessels in your eyes (retinopathy), kidneys (nephropathy), and certain
nerves (neuropathy). You might also develop heart disease, stroke, or
circulation issues.
Type 2 Diabetes Treatment
Managing type 2
diabetes includes a mix of lifestyle changes and medication.
Lifestyle changes
You may be able
to reach your target blood sugar
levels with diet and exercise alone.
- Weight loss. Dropping
extra pounds can help. While losing 5% of your body weight is
good, losing at least 7% and keeping it off seems to be ideal. That means
someone who weighs 180 pounds can change their blood sugar levels by
losing around 13 pounds. Weight loss can seem overwhelming, but portion
control and eating healthy foods are a good place to
start.
- Healthy eating. There’s
no specific diet for type 2 diabetes. A registered dietitian can teach you
about carbs and help you make a meal plan you can stick with. Focus on:
- Eating
fewer calories
- Cutting
back on refined carbs, especially sweets
- Adding
veggies and fruits to your diet
- Getting
more fiber
- Exercise. Try
to get 30 to 60 minutes of physical activity every day. You can walk,
bike, swim, or do anything else that gets your heart rate up.
Pair that with strength training, like yoga or weightlifting. If you take
a medication that lowers your blood sugar, you might need a snack before a
workout.
- Watch your blood sugar levels. Depending on your treatment, especially if you’re on insulin, your doctor will tell you if you need to test your blood sugar levels and how often to do it.
Medication
If lifestyle
changes don’t get you to your target blood sugar levels, you may need medication. Some of the
most common for type 2 diabetes include:
- Metformin (Fortamet, Glucophage, Glumetza, Riomet).
This is usually the first medication used to treat type
2 diabetes. It lowers the amount of glucose your liver makes
and helps your body respond better to the insulin it does make.
- Sulfonylureas. This
group of drugs helps your body make more insulin. They include glimepiride (Amaryl), glipizide (Glucotrol),
and glyburide (DiaBeta, Micronase).
- Meglitinides. They
help your body make more insulin, and they work faster than sulfonylureas.
You might take nateglinide (Starlix)
or repaglinide (Prandin).
- Thiazolidinediones. Like
metformin, they make you more sensitive to insulin. You could get pioglitazone (Actos)
or rosiglitazone (Avandia).
But they also raise your risk of heart problems, so they aren’t usually a
first choice for treatment.
- DPP-4
inhibitors. These
medications -- linagliptin (Tradjenta), saxagliptin (Onglyza),
and sitagliptin (Januvia)
-- help lower your blood sugar levels, but they can also cause joint pain and
could inflame your pancreas. They work by blocking DPP-4, which is an
enzyme that affects the hormone incretin.
- GLP-1
receptor agonists. You take these medications with a needle to
slow digestion and lower blood sugar levels. Some of the most common ones
are exenatide (Byetta, Bydureon), liraglutide (Victoza),
and semaglutide (Ozempic).
- SGLT2
inhibitors. These
help your kidneys filter
out more glucose. You might get bexagliflozin (Brenzavvy), canagliflozin (Invokana), dapagliflozin (Farxiga),
or empagliflozin (Jardiance).
Empagliflozin has also proven effective in reducing the risk of
hospitalization or death from heart failure.
- GIP and
GLP-1 receptor agonist. Tirzepatide (Mounjaro)
is the first in its class and activates both the GLP-1 and GIP
receptors, which leads to improved blood sugar control.
- Insulin. You
might take long-lasting shots at night, such as insulin
detemir (Levemir)
or insulin
glargine (Lantus).
Even if you change your lifestyle and take your medicine as directed, your blood sugar may still get worse over time. That doesn’t mean you’ve done something wrong. Diabetes is progressive, and many people eventually need more than one drug.
When you take
more than one drug to control your type 2 diabetes, that’s called combination
therapy. You and your doctor should work together to find the best mix for
you.
Some drugs
control blood sugar spikes (your doctor may call this hyperglycemia)
that come right after meals, for instance. Others are more effective at
stopping drops in blood sugar (hypoglycemia) between meals. Some may help with
weight loss or cholesterol, as well as your diabetes.
You and your
doctor should talk about any possible side effects. Cost may be an issue as
well.
If you take
medication for something else, that will need to be factored into any decision.
You’ll need to
see your doctor more often when you start taking a new combination of drugs.
You might find
that adding a second drug doesn’t bring your blood sugar under control. Or the
combination of two drugs might work only for a short time. If that happens,
your doctor might consider a third non-insulin drug, or you may start insulin
therapy.
Surgeries for
type 2 diabetes
Weight loss
surgery can effectively treat type 2 diabetes by helping you to lose weight.
These procedures limit how much food you can eat or how many nutrients your
body can take in. You'll need to commit to long-term healthy lifestyle changes
to get full benefits of this type of surgery.
Several types are
available. Talk to your doctor about whether weight loss surgery is right for
you.
Alternative treatments
for type 2 diabetes
There's not much
scientific evidence that any alternative treatment can you help manage your
blood sugar. Research into dietary supplements has found that:
- Chromium has
little benefit and can be harmful in large doses.
- Cinnamon might
lower fasting blood sugar levels, but doesn't affect A1c.
- Magnesium has
mixed results in studies, may cause side effects, and can be dangerous at
large does.
Some research has
found that mind-body practices like yoga and meditation might help with blood
sugar control when used along with diabetes drugs. That may be because of their
stress-relief benefits.
Always talk to your doctor before trying any alternative treatment. These treatments can't take the place of diabetes medications.
Type 2 Diabetes
Health Disparities
Some populations
are more likely to get type 2 diabetes. Latino (12%), Black (12%), and Asian
(10%) people have higher rates of diabetes than white people (7%). American
Indians get it at about twice the rate as white people (14.5%). Members of
racial and ethnic minority groups with type 2 are also likely to have worse
health outcomes.
Yet research
shows that members of minority groups are less likely to use newer diabetes
medications, regardless of their income or whether they have health insurance.
And no matter what their ethnicity, people with lower incomes were less likely
to take these medications. Across all races and ethnicities with diabetes, about
15% live in poverty, 19% have difficulties accessing food, and 51% have
low-quality diets.
Also, Black,
Latino, and Native American people are less likely to be included in clinical
studies to try new diabetes drugs.
Type 2 Diabetes
Complications
Over time, high
blood sugar can damage and cause problems with your:
- Heart and
blood vessels. You’re up to twice as likely to get heart
disease or have a stroke ,
and at a younger age. You’re also at high risk of blocked blood vessels (atherosclerosis)
and chest pain (angina).
- Kidneys. If
your kidneys are damaged or you have kidney failure, you could need dialysis or
a kidney replacement.
- Eyes. High
blood sugar can damage the tiny blood vessels in the backs of your eyes.
If this isn’t treated, it can cause blindness.
- Nerves. This
can lead to trouble with digestion, the feeling in your feet, and your
sexual response.
- Skin. Your
blood doesn’t circulate as well, so wounds heal slower and can become
infected.
- Pregnancy. Parents
with diabetes are more likely to have a miscarriage,
a stillbirth, or a baby with a birth defect.
- Sleep. You
might develop sleep apnea,
a condition in which your breathing stops
and starts while you sleep.
- Hearing. You’re
more likely to have hearing problems, but it’s not clear why.
- Brain. High
blood sugar can damage your brain and might put you at higher risk of
Alzheimer’s disease.
- Depression. People
with the disease are twice as likely to get depressed as people who don’t
have it.
The best way to
avoid these complications is to manage your type 2 diabetes well.
- Take your
diabetes medications or insulin on time.
- Check your
blood sugar.
- Eat right,
and don't skip meals.
- See your doctor regularly to check for early signs of trouble.
Living With Type
2 Diabetes
Managing diabetes
is complicated. You'll need to adopt healthy lifestyle habits, check your blood
sugar regularly, and keep up with doctor visits and treatments. But your
efforts can have a big impact on your health and your quality of life.
Type 2 diabetes
diet
A dietitian can
help you create a personalized meal plan that takes your needs and preferences
into account. A healthy diabetes diet should focus on:
- Limiting
highly processed foods
- Reducing
added sugars and low-fiber refined grains like white bread
- Boosting
your intake of non-starchy vegetables like broccoli and green beans
Type 2 diabetes
costs
On
average, people diagnosed with diabetes spend about 2.3 times more on
medical care than those who don't have the condition. Their medical expenses
average about $16,750 a year, $9,600 of which is due directly to
diabetes.
These expenses
include doctor visits, hospitalizations, and medication. You may have other
costs as well, such as lost time and less productivity at work.
Managing type 2
diabetes
Managing your
type 2 diabetes well helps you avoid complications and feel your best. Along
with a healthy diet, regular exercise, and medication as prescribed:
- Keep your
blood pressure and cholesterol levels in the healthy range. High levels of
either could raise your risk of diabetes complications.
- Get regular
eye exams, dentist visits, and physicals.
- Check your
feet daily for sores, redness, or swelling and let your doctor know if you
notice any issues.
- Get at least
7 hours of good-quality sleep each night, as sleep loss interferes with
blood sugar control. Ask your doctor for help if you have a hard time
sleeping.
- Be careful
with alcohol. Limit alcoholic drinks to 1-2 drinks a day, depending on
your size and gender. If you do drink alcohol, check your blood sugar
afterward.
- Work with
your doctor to come up with a sick day plan. Even a minor illness can
interfere with your blood sugar and insulin levels. You may need to adjust
your medications or check your blood sugar more often.
Type 2 diabetes and mental health
A long-term
health condition can take a toll on your mental health. People with
diabetes are more than twice as likely to have depression, and 20% more likely
to have anxiety, than those without the condition. Many don't get diagnosed or
treated, even though therapy, medication, or a combination can work very well.
Many people with
diabetes sometimes get overwhelmed by the pressures of trying to manage the
condition. This is called diabetes distress, and it can lead to you to neglect
your health. A support group or counseling could help you overcome it.
If you're worried
about your emotional health, ask your doctor to recommend a mental health
professional.
Type 2 Diabetes
Prognosis
The long-term
outlook for people with type 2 varies, depending on how effectively they manage
the condition. At age 50, the average life expectancy (LE) for those with type
2 is 6 years shorter than those without the condition. But proper care and
treatment can help you improve those odds.
Can type 2
diabetes be cured?
There's no cure
for type 2. You may be able to get your blood sugar under control by losing
weight and making healthy lifestyle changes, and might even be able to stop
taking diabetes medications. But this isn't the case for everyone.
What to expect
with type 2 diabetes
Type 2 is a
serious condition that calls for a lifelong commitment to managing it. Over the
long term, high blood sugar can lead to heart, vision, and kidney problems. But
you can take steps to avoid these complications and extend your life. Several
studies show that:
- Reducing
your A1c levels from 10% to under 8% can increase life expectancy by
almost 3.5 years.
- Quitting
smoking can increase LE in women over 50 by almost a year, and by almost 2
years in men over 70.
- Lowering LDL
("bad") cholesterol can improve LE by almost a year.
All these things
also reduce your risk of developing other diseases.
Type 2 Diabetes
Prevention
Adopting a
healthy lifestyle can help you lower your risk of diabetes :
- Lose weight. Dropping
just 7% to 10% of your weight can cut your risk of type 2 diabetes in
half.
- Get active. 30
minutes of brisk walking a day will cut your risk by almost a third.
- Eat right. Avoid
highly processed carbs, sugary drinks, and trans and saturated fats. Limit
red and processed meats.
- Quit smoking. Work with your doctor to keep from gaining weight after you quit, so you don't create one problem by solving another.
Takeaways
Type 2 diabetes
is a serious condition that requires lifelong management. Weight loss, a
healthy lifestyle, and medications, if needed, can help you keep it under
control. They can also help you live a longer, healthier life.
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Have a great week, everyone, and thank you for your support!
Blessed be… and happy cooking!
Chef Michael R