Type 2 Diabetes
(Diabetes Mellitus Type 2; Insulin-Resistant Diabetes; Diabetes, Type 2)
Definition
Glucose comes from the breakdown of food. It is the body's energy source. It can pass from the blood to cells with the help of a hormone called insulin . Without insulin, glucose will build up in the blood and cause hyperglycemia. At the same time, your body's cells are starved for glucose (energy).
A lack of insulin or a resistance to insulin causes diabetes. In type 2 diabetes the body is resistant to high levels of insulin. There is plenty of insulin in the body but the cells are unable to use it.
High blood sugar levels over a long period of time can damage vital organs. This can include the kidneys, eyes, and nerves.
How Type 2 Diabetes Occurs
Causes
Two conditions contribute to hyperglycemia in type 2 diabetes:
- Insulin resistance related to excess body fat
- Body's failure to make an adequate amount of insulin
Risk Factors
Factors that increase your chance for type 2 diabetes include:
- Having a family history of type 2 diabetes
- Being obese or overweight (especially excess weight in the upper body and abdomen)
- Having cholesterol problems (low HDL "good" cholesterol and high triglycerides )
- Having high blood pressure
- Having a history of cardiovascular disease
- Having a history of gestational diabetes or having a baby that weighs over nine pounds
- Having an endocrine disorder ( Cushing’s syndrome , hyperthyroidism , acromegaly , polycystic ovary syndrome , pheochromocytoma, glucagonoma)
- Having a condition associated with insulin resistance (eg, acanthosis nigricans )
- Having previous blood test results that show impaired glucose tolerance, and impaired fasting glucose
- Taking certain medicines (eg, pentamidine , nicotinic acid, glucocorticoids, thiazide)
- Having a sedentary lifestyle
- Having sleep difficulties
- Having a low birth weight
- Gender: more common in older women than men
- Race: African American, Hispanic, Native American, Hispanic American, Asian American, or Pacific Islander
- Age: 45 years or older and younger people who are obese and belong to at risk ethnic groups
A study has reported that having a high intake of certain foods can also put you at risk. This includes food such as red meat, low-fiber bread, eggs, and cheese.
Symptoms
You may not have symptoms for years. Symptoms due to high blood sugar or diabetic complications may include:
- Increased urination
- Extreme thirst
- Hunger
- Fatigue
- Blurry vision
- Irritability
- Frequent or recurring infections
- Poor wound healing
- Angina
- Painful leg cramps when walking
- Numbness or tingling in the hands or feet
- In women: frequent vaginal yeast infections
- Problems with gums
- Itching
- Impotence
Diagnosis
The doctor will ask about your symptoms and medical history. You will also be asked about your family history. A physical exam will be done.
Diagnosis is based on the results of blood tests and other criteria. These guidelines are from the American Diabetes Association (ADA):
- Symptoms of diabetes and a random blood test revealing a blood sugar level greater than or equal to 200 mg/dL [11.1 mmol/L]
- Blood sugar tests after you have not eaten for eight or more hours (called fasting blood sugar ) revealing blood sugar levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days
- Glucose tolerance test measuring blood sugar two hours after you consume glucose with a measurement greater than or equal to 200 mg/dL (11.1 mmol/L)
- HbA1c level of 6.5% or higher, indicating poor blood sugar control over the past 2-4 months
mg/dL=milligrams per deciliter of blood; mmol/L=millimole per liter of blood
Treatment
Treatment aims to:
- Maintain blood sugar at levels as close to normal as possible
- Preventing or delaying complications (regular medical care is important for this)
- Control other conditions that you may have like high blood pressure and high cholesterol
Diet
-
Follow a balanced meal plan. Eat consistent and moderate amounts of food at regular times.
- Nuts and peanut butter are a good choice for a snack. In women with diabetes, these snacks may help reduce the risk of cardiovascular disease.
- Do not skip meals.
- Eat plenty of vegetables and fiber .
- Eat limited amounts of fat .
- Eat moderate amounts of protein and low-fat dairy products .
- Carefully limit foods containing high concentrated sugar .
- Keep a record of your food intake. This will help a dietitian or doctor advise you.
Weight Loss
If you are overweight, talk to your doctor about a reasonable weight goal. You and your doctor can develop a safe diet program for you. Weight loss will help your body respond better to insulin.
Group education may help people recently diagnosed with their goals in weight loss.
Exercise
Physical activity:
- Can make the body become more sensitive to insulin
- Will help you reach and maintain a healthy weight
- Can lower the levels of fat in your blood
- Has been found to improve blood sugar control— Aerobic , fitness, and resistance training can help to improve HbA1c levels. Researchers have also found that long-term strength and endurance training may improve HbAIc, even in the absence of weight loss.
Talk to your doctor about any restrictions. Work with your doctor to make an activity plan. Even a brief counseling session may help to increase your activity levels.
Diabetes is a risk factor for heart disease. Exercising can help to reduce your risk for heart disease.
Oral Medication
Medications taken by mouth may be used to lower blood sugar:
- Metformin : a class of drug that reduces the body's production of glucose. It also makes the body more sensitive to insulin. This combination will help keep blood sugar levels within the normal limits.
-
Drugs that prompt the cells in the pancreas to make more insulin (eg, sulfonylureas [
glyburide
,
tolazamide
], dipeptidyl peptidase-4 inhibitors [
saxagliptin
,
sitagliptin
],
repaglinide
[Prandin])
- The FDA has warned that sitagliptin may increase the risk of acute pancreatitis.
- Insulin sensitizers—a class of drugs that help the body better use insulin (eg, pioglitazone )
- Starch blockers—a class of drugs (eg, acarbose , miglitol ) that lessen glucose absorption into the bloodstream
Injectable medication such as:
- Incretin-mimetic (eg, exenatide ) stimulate the pancreas to produce insulin and suppress appetite often leading to weight loss. (twice daily injections)
- Amylin analogues (eg, pramlintide ) replace a protein that is normally produced by the pancreas and is low in type 2 diabetes (injection before each meal)
Talk to your doctor about your drug program.
Insulin
In some cases the body does not make enough insulin. Insulin injections may be needed.
This is needed when blood sugar levels are not kept low enough with lifestyle change and medicine
Blood Sugar Testing
Checking blood sugar levels during the day can help you stay on track. It will also helps your doctor determine if you treatment is working. Testing is easy with a monitor. Keeping track of blood sugar levels is especially important if you take insulin. Frequency of testing is determined by how well your blood sugar control is doing.
The HbA1c may also be done at your doctor's office. Doctors advise that most keep their HbA1c levels below 7% (ADA recommendation). This level has been shown to lead to fewer diabetic complications.
Regular blood sugar testing may not be needed in patients with type 2 diabetes. It may not be needed for those whose condition is under reasonably good control without insulin. Talk with your doctor before stopping blood sugar monitoring.
Alternative Therapies
One study focused on people with a specific type 2 diabetes. When given vitamin E they showed a decrease in the rates of heart problems.
Prevention
Lifestyle changes seem to be most effective. To reduce your chances of developing type 2 diabetes:
- Participate in regular physical activity.
- Maintain a healthy weight.
- Drink alcohol in moderation (two drinks per day for a man, and one drink per day for a woman)
-
Eat a well-balanced diet:
- Get enough fiber
- Avoid fatty foods
- Limit sugar intake
RESOURCES:
American Diabetes Association
http://www.diabetes.org/
National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov/
CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca/
Team Diabetes Canada
Canadian Diabetes Association
http://www.diabetes.ca/
References:
American Association of Clinical Endocrinologists, American College of Endocrinology. Medical guidelines for the management of diabetes mellitus. The AACe system of intensive diabetes self-management. 2002 update. Endocrine Practice . 2002;8(suppl 1):S40-82.
Boren SA, Gunlock TL, Schaefer J, Albright A. Reducing risks in diabetes self-management: a systematic review of the literature. Diabetes Educ . 2007;33:1053-1077.
Calvagna M. Tips to help you stop smoking. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated January 2006. Accessed July 7, 2008.
Diabetes. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nccdphp/publications/aag/ddt.htm . Updated February 14, 2008. Accessed July 21, 2008.
Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://diabetes.niddk.nih.gov/ . Accessed July 22, 2008.
Diagnosis and classification of diabetes mellitus. Diabetes Care . 2005;28(suppl 1):S37-42.
FDA approves new drug treatment for type 2 diabetes. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm174780.htm . Published July 31, 2009. Accessed October 1, 2009.
Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med . 2003; 248:383-393.
Harsch IA. Inhaled insulins: their potential in the treatment of diabetes mellitus. Treat Endocrinol . 2005;4:131-138.
Information about acarbose (Precose). The Diabetes Monitor website. Available at: http://www.diabetesmonitor.com/acarbose.htm . Accessed on May 26, 2006.
Juan D. Lifestyle changes to manage type 2 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated July 2007. Accessed July 7, 2008.
Lee DC, Sui X, Church TS, Lee IM, Blair SN. Associations of cardiorespiratory fitness and obesity with risks of impaired fasting glucose and type 2 diabetes in men. Diabetes Care. 2009;32:257-262. Epub 2008 Nov 4.
Marre M. Reducing cardiovascular risk in diabetes. J Hypertens . 2007;(supp 11)S19-22.
Physical activity/exercise and diabetes. Diabetes Care . 2004;27(suppl 1):S58-62.
Rosenbloom AL, Silverstein JH, Amemiya S, et al. ISPAD Clinical Practice Consensus Guideline 2006-2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes. 2008;9:512-526.
Rosenzweig JL, Ferrannini E, Grundy SM, et al. Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:3671-3689.
Screening for type 2 diabetes. Diabetes Care . 2004;27(suppl 1):S11-4.
Sitagliptin (marketed as Januvia and Janumet)—acute pancreatitis. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183800.htm . Published September 25, 2009. Accessed October 29, 2009.
Standards of medical care in diabetes—2009. Diabetes Care. 2009;32:S13-61.
Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE and VA diabetes trials: a position statement of the American Diabetes association and a scientific statement of the American College of Cardiology Foundation and the American Heart Assocaition. Circulation. 2009;119:351-7.
Type 2 diabetes. American Diabetes Association website. Available at: http://www.diabetes.org/type-2-diabetes.jsp . AccessedNov 13, 2009.
UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet . 1998; 352:954-965.
US Preventive Services Task Force: Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148:846-54.
US Preventive Services Task Force (USPSTF). Screening for type 2 diabetes mellitus in adults: recommendations and rationale. Ann Intern Med . 2003; 138:212-214.
11/29/2006 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet . 2006;368:1673-1679.
9/19/2006 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews . 2006;CD002968.
6/1/2007 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med . 2007 May 21. [Epub ahead of print]
7/13/2007 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Farmer A, Wade A, Goyder E, et al. Impact of self-monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ . 2007 Jun 25. [Epub ahead of print]
12/13/2007 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Milman U, Blum S, Shapira C, et al. Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both type 2 diabetes mellitus and the haptoglobin 2-2 genotype. A prospective double-blinded clinical trial. Arterioscler Thromb Vasc Biol . 2007 Nov 21. [Epub ahead of print]
2/13/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : For safety, NHLBI changes intensive blood sugar treatment strategy in clinical trial of diabetes and cardiovascular disease. NIH News. National Institutes of Health website. Available at: http://www.nih.gov/news/health/feb2008/nhlbi-06.htm . Accessed February 13, 2008.
2/21/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Major international diabetes study does not confirm increased risk of death reported by US trial. Action in Diabetes and Vascular Disease: PreteraAx and DiamicroN MR Controlled Evaluation (ADVANCE) website. Available at: http://www.advance-trial.com/static/html/virtual/contents.asp?P=39 . Accessed February 21, 2008.
2/28/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Davies MJ, Heller S, Skinner TC, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ . 2008 Feb 14. [Epub ahead of print]
2/28/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med . 2008;168:141-146.
6/18/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med . 2008;358:2560-2572. Epub 2008 Jun 6.
2/24/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Liese AD, Weis KE, Schulz M, Tooze JA. Food intake patterns associated with incident type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2009;32:263-268. Epub 2008 Nov 25.
5/11/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Loimaala A, Groundstroem K, Rinne M, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. 2009;103:972-977.
8/19/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Li TY, Brennan AM, Wedick NM, Mantzoros C, Rifai N, Hu FB. Regular consumption of nuts is associated with a lower risk of cardiovascular disease in women with type 2 diabetes. J Nutr. 2009;139:1333-1338.
10/12/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Crandall JP, Polsky S, Howard AA, et al. Alcohol consumption and diabetes risk in the Diabetes Prevention Program. Am J Clin Nutr. 2009;90:595-601.
11/20/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Lund SS, Tarnow L, Frandsen M, et al. Combining insulin with metformin or an insulin secretagogue in non-obese patients with type 2 diabetes: 12 month, randomised, double blind trial. BMJ. 2009;339:b4324.
12/21/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2009 Nov 12.
2/15/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(suppl 1:S11-61).
2/15/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(suppl 1:S62-69).
Last reviewed November 2009 by Bridget Sinnott, MD, FACE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.