Diabetes Type 2

Over the last couple of decades, doctors, healthcare practitioners, and medical experts have grown increasingly worried about the condition known as type 2 diabetes.

Diabetes mellitus (DM) is a chronic metabolic condition defined by hyperglycemia that persists. It might be related to decreased insulin secretion, resistance to insulin's peripheral activities, or both. Chronic hyperglycemia, when combined with other metabolic abnormalities in people with diabetes mellitus, can harm a variety of organ systems.

This results in the development of disabling and life-threatening health complications, the most prominent of which are microvascular complications such as retinopathy, nephropathy, and neuropathy, as well as macrovascular complications that increase the risk of cardiovascular disease by a 2- to 4-fold.

Type 1 diabetes, type 2 diabetes, and gestational diabetes are the three basic categories of diabetes based on etiology and clinical presentation (GDM). Monogenic diabetes and secondary diabetes are two less prevalent forms of diabetes.

Type 2 diabetes cases have risen sharply over the years, and currently, it is estimated that around 10% of US adults suffer from type 2 diabetes, though in reality this number is thought to be much higher.

One of the most frustrating things about type 2 diabetes is the fact that it can be avoided as many of the diabetes type 2 symptoms that people suffer from can be avoided by following a healthy and balanced diet and lifestyle.

Here is your ultimate guide to diabetes type 2 symptoms and treatment options.

What is diabetes type 2 Mellitus?

Type 2 diabetes mellitus (T2DM) accounts for around 90% of all diabetes cases. Insulin resistance is described as a decreased response to insulin in T2DM. During this condition, insulin is inefficient and is initially countered by an increase in insulin production to maintain glucose homeostasis, but this declines with time, leading to T2DM.

T2DM is more frequent in those over the age of 45. Nonetheless, it is becoming more common in children, adolescents, and young adults as a result of increased levels of obesity, physical inactivity, and energy-dense meals.

Diabetes type 2 is a disease in which the body is unable to utilize glucose in the blood, which is better known as blood sugar.

Ordinarily, your pancreas produces a hormone known as insulin which it secretes in order for the glucose in your blood to travel from your blood and into your cells. Insulin is basically the key that unlocks the cells so that the glucose in your blood can enter them and be used as energy.

Those suffering from diabetes type 2 symptoms often find that the pancreas is either unable to produce sufficient amounts of insulin, or the insulin that it does produce doesn’t have the desired effect on your blood glucose levels.

Basically, as the insulin is either insufficient or ineffective, this means that your blood sugar levels continue to rise and rise.

Other types of DM

Type 1 Diabetes Mellitus (T1DM)

Type 1 diabetes mellitus (T1DM) accounts for 5% to 10% of all diabetes cases and is characterized by autoimmune loss of insulin-producing beta cells in the pancreatic islets. As a result, there is an absolute insulin shortage. Autoimmunity has been linked to a mix of genetic susceptibility and environmental influences such as viral infection, toxins, or certain dietary components. T1DM is more frequent in children and teenagers, but it may occur at any age.

See more information: What is diabetes? Diabetes is a silent killer”

Gestational Diabetes Mellitus

When hyperglycemia is identified during pregnancy, it is referred to as gestational diabetes mellitus (GDM), also known as hyperglycemia in pregnancy. Although it can develop at any point during pregnancy, GDM is more common in the second and third trimesters. GDM complicates 7% of all pregnancies, according to the American Diabetes Association (ADA). Women with GDM and their children are more likely to acquire type 2 diabetes mellitus in the future.

GDM can be aggravated by hypertension, preeclampsia, and hydramnios, and it may also necessitate more surgical operations. The fetus may be overweight and large (macrosomia) or have congenital abnormalities. Even after delivery, such infants are at risk of developing respiratory distress syndrome, as well as childhood and teenage obesity. GDM risk factors include advanced age, obesity, high prenatal weight gain, a history of congenital abnormalities or stillbirth in prior infants, or a family history of diabetes.

Monogenic Diabetes

This kind of diabetes is caused by a single genetic mutation in an autosomal dominant gene. Conditions such as neonatal diabetes mellitus and young-onset diabetes are examples of monogenic diabetes (MODY). Monogenic diabetes accounts for 1 to 5% of all diabetes cases. MODY is a genetic condition that generally manifests itself before the age of 25.

Secondary Diabetes

Secondary diabetes is induced by the complication of other pancreas-related disorders (for example, pancreatitis), hormone imbalances (for example, Cushing disease), or medicines (for example, corticosteroids).

Diabetes in diseases of the pancreas

Diabetes is a rather typical side effect of chronic pancreatitis. Around 50% of persons with chronic pancreatitis will acquire diabetes. Secondary diabetes refers to diabetes that is caused by another medical condition.

Diabetes is caused by pancreatitis, which affects the quantity of insulin produced by the body. As a result, diabetes caused by pancreatitis may necessitate insulin injections.

If you have chronic pancreatitis, it is important to be conscious of diabetic symptoms.

See more information: Pancreatic Cancer Treatment – How to Choose a Treatment Team

Diabetes insipidus

Diabetes insipidus (DI) is a disease condition that causes a reduction in the secretion or reaction to antidiuretic hormone (ADH, also known as vasopressin or AVP), resulting in electrolyte imbalances. Diabetes insipidus is classified into two types: central and nephrogenic, with both congenital and acquired causes.

The three most prevalent causes of cranial diabetes insipidus are a brain tumor that affects the hypothalamus or pituitary gland. a serious head injury that affects the hypothalamus or pituitary gland complications that arise during brain or pituitary surgery

See more information: Diabetes insipidus

Epidemiology

Diabetes is a global pandemic. Diabetes prevalence has grown globally as a result of changing lifestyles and rising obesity. In 2017, the global prevalence of diabetes was 425 million. According to the International Diabetes Federation (IDF), around 10% of the American population had diabetes in 2015. 7 million of these people were not diagnosed. The prevalence of diabetes rises as people get older. Diabetes affects around 25% of the population over the age of 65.

How exactly does type 2 diabetes occur?

type 2 diabetes

Insulin is essential for optimal cellular function. As we ourselves are basically just huge clusters of billions upon billions of cells, this shows just how important it is that our cells function as they should. Insulin basically shuttles sugar from the blood and into the cells to act as energy for our bodies.

T2DM is an insulin-resistance disorder accompanied by beta-cell malfunction. Initially, there is a compensatory increase in insulin production, which keeps glucose levels within normal limits. Beta cells shift as the illness advances, and insulin secretion is unable to maintain glucose homeostasis, resulting in hyperglycemia. The majority of T2DM patients are obese or have a greater body fat percentage, which is mostly concentrated in the abdominal area.

Those that suffer from diabetes type 2 symptoms still find that the body breaks down carbohydrates into glucose, and upon detecting this the pancreas does indeed produce and secrete insulin in an attempt to deal with the glucose. The problem is that it either doesn't work properly as the body may be insulin resistant, or it simply won’t be able to produce enough of this hormone if any.

Eventually, blood sugar levels may rise that much that the person suffering from diabetes type 2 symptoms may find themselves turning hyperglycaemic.

Diabetes type 2 symptoms

So, now that we understand what type 2 diabetes is and why it occurs, we now need to understand precisely what some of the main signs and symptoms of this condition are. The more we understand about an illness or disease, the better equipped we become to fight it or prevent it in the future.

Here are several common diabetes type 2 symptoms:

Increased thirst

We all get thirsty from time to time, especially after having eaten something salty, but for those suffering from type 2 diabetes, one of the tell-tale diabetes type 2 symptoms is increased thirst.

When our blood sugar levels are higher than usual, it has been found that we become thirstier than usual and we can therefore drink more liquid than usual. If you find yourself feeling thirstier than usual, even when you have had plenty to drink, this could be a warning of type 2 diabetes.

Frequent urination

This is a condition is also known as polyuria, and if you find that you are needing to go to the bathroom and urinate more frequently than usual, it could be yet another one of the diabetes type 2 symptoms.

Not only does type 2 diabetes make you want to drink more than usual, but when your blood sugar levels become too high, this excess blood glucose can make its way into your urine as your kidneys simply cannot keep up. The result of this is needing to pee more frequently than often.

If you find yourself needing to urinate a lot, perhaps waking up in the night to pee more frequently than usual, this could be a warning of type 2 diabetes.

Elevated hunger levels

Hunger is the body’s way of telling you that its energy levels are low and that you should replace them by eating more food.

We all feel hungry from time to time, but if you find yourself feeling hungrier than usual, this could be a sign that you are suffering from type-2 diabetes.

Increased hunger, or polyphagia, as it is also known can be one of the more common diabetes type 2 symptoms. You see, the body uses glucose in the blood to fuel your cells, yet without insulin, the glucose cannot enter the cells and so it cannot be used as fuel.

As the cells can't absorb this energy you feel hungry and the body looks for more energy, and to get it, it sends hunger signals out which cause incessant spells of hunger.

Weight loss

Being overweight can put you at risk of type-2 diabetes amongst other things, yet if you find yourself losing weight without warning, this could be a sign of diabetes.

Unexplained weight loss is yet another of the diabetes type 2 symptoms that you will need to keep a lookout for, regardless of whether or not you could stand to lose a few pounds or not. If you are actively trying to lose weight then that's all well and good, but if you are losing weight for no obvious reason, unexplained weight loss is yet another sign of the disease in question.

This is largely due to the fact that much of the glucose in your system cannot be used by the cells so it can’t be converted to fat and stored, so it simply makes its way into your urine and is excreted.

Fatigue

Diabetes type 2 symptoms

Everybody feels tired from time to time and while the occasional bout of tiredness and fatigue is nothing to worry about, if you find yourself constantly feeling tired and fatigued, this may be one of the many symptoms of type 2 diabetes.

Constant tiredness and fatigue are often warning signs of diabetes, which is largely due to the fact that your cells aren't getting the energy they need to fuel your body and function as they should, so essentially you are deprived of energy. When this occurs, your body’s metabolism slows down in order to preserve existing energy stores, which in turn can leave you feeling tired and rundown.

Blurred vision

If you find that your vision isn't what it once was and that it has become blurred and/or distorted, it could be due to the fact that you are suffering from type 2 diabetes.

If you have too much glucose in your blood, this excess blood sugar can actually damage the blood vessels located in your eyes, which in turn can cause your vision to become blurred, fuzzy, or distorted.

This blurred vision could affect either, both eyes, or it could alternate, plus it may come and go. If you notice your vision becoming blurred, even if it clears up quickly, you should still make sure to seek medical advice and get checked.

If it is diabetes causing your vision to become blurred, you must seek treatment right away because over time this excess blood glucose could damage the eyes to a point where they become permanently damaged and you could even experience a complete loss of sight.

Dark-colored skin patches

Finally, if you notice that you are developing dark-colored skin patches on certain parts of your anatomy, this could be yet another of the diabetes type 2 symptoms which we're covering today.

Dark patches of skin around the body are called acanthosis nigricans and it commonly affects the neck, the armpits, and the groin area. Not only does the skin turn a darker color, it also becomes thicker.

These dark and discolored patches of skin are caused by excess insulin in the blood, which stays there due to insulin resistance, which is often a precursor for type 2 diabetes.

Be sure to examine your body regularly, and if you do notice any dark patches of skin or any thick patches of skin, be sure to seek medical advice and potentially care and treatment as well.

Diabetes type 2 diagnosis

Diabetes can be diagnosed using either the hemoglobin A1C or plasma glucose concentration criteria (fasting or 2-hour plasma glucose).

Fasting Plasma Glucose (FPG)

After an overnight fast of 8 hours, a blood sample is collected. Fasting plasma glucose (FPG) levels of greater than 126 mg/dL (7.0 mm/L) are compatible with the diagnosis, according to the ADA.

Two-Hour Oral Glucose Tolerance Test (OGTT)

The plasma glucose level is tested before and two hours after ingesting 75 gm of glucose in this test. Diabetes is diagnosed when the plasma glucose (PG) level in a 2-hour sample exceeds 200 mg/dL (11.1 mmol/L). It is also a routine test, although it is cumbersome, more expensive than FPG, and has significant variability difficulties. Patients must consume at least 150 g of carbs per day for 3 to 5 days and refrain from taking any drugs that might impair glucose tolerance, such as steroids and thiazide diuretics.

Glycated Hemoglobin (Hb) A1C

This test provides an average of blood glucose levels over the previous two to three months. Diabetes is diagnosed in patients with a Hb A1C of more than 6.5 percent (48 mmol/mol). Hb A1C is a simple, quick, standardized test with little variance owing to pre-analytical factors. Acute sickness or stress has little effect on it.

Sickle cell disease, pregnancy, hemodialysis, blood loss or transfusion, and erythropoietin treatment all have an impact on Hb A1C. Anemia caused by iron or vitamin B12 deficiency causes a false rise of Hb A1C, restricting its usage in countries with a high prevalence of anemia. Furthermore, the relationship between Hb A1C and FPG is unsatisfactory in youngsters and the elderly.

Notes

If the person is asymptomatic, all of the aforementioned tests should be performed later to confirm a diagnosis of diabetes mellitus.
Random plasma glucose of more than 200 mg/dL is also adequate to diagnosis DM in individuals with characteristic hyperglycemia symptoms (increased thirst, increased appetite, increased urine).
FPG, 2-hour PG during 75-g GTT, and Hb A1C are all acceptable for DM diagnosis. There is no relation between the outcomes of these tests.

Screening

People above the age of 40 should be tested once a year. Individuals with extra diabetes risk factors should be screened more frequently.

Certain racial/ethnic groups (Native American, African American, Hispanics, or Asian American, Pacific Islander)
Overweight or obese people having a BMI greater than or equal to 25 kg/m2 (23 kg/m2 for Asian Americans)
Diabetes mellitus in a first-degree relative
A history of heart disease or hypertension
Hypertriglyceridemia or low HDL cholesterol
Women suffering from a polycystic ovarian syndrome
Physical inactivity
Acanthosis nigricans, which is a condition associated with insulin resistance.

Women who have gestational diabetes mellitus (GDM) should be tested at least every three years for the rest of their lives. For all other patients, testing should begin at the age of 45, and if findings are normal, individuals should be checked every three years.

Diabetes is detected and diagnosed using the same methods. These tests can help discover those who have pre-diabetes.

Diabetes type 2 treatment

Diet and exercise are the cornerstones of treatment for both T1DM and T2DM. A diet high in fiber and monounsaturated fats, low in saturated fat, processed carbs, high fructose corn syrup, and high in fiber and monounsaturated fats should be promoted. Aerobic exercise for 90 to 150 minutes per week is also recommended. Weight loss is the primary goal of T2DM patients who are obese.

Metformin is the first-line medication if sufficient glycemia cannot be attained. Many additional medications, such as oral sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors, were used after metformin. There are glucagon-like peptide-1 (GLP-I) receptor agonists, sodium-glucose co-transporter-2 (SGLT2) inhibitors, pioglitazone, especially if the patient has fatty liver disease, alpha-glucosidase inhibitors, and insulin.

Recent research has demonstrated that the SGLT2 inhibitor empagliflozin (EMPA) and the GLP-1 receptor agonist liraglutide prevent substantial CV events and death. As a result, in individuals with CVD, these medicines should be examined first. The cornerstone of treatment for people with T1DM is a basal-bolus insulin regimen.

In addition, insulin pump treatment is a viable option. Because hypoglycemia predicts higher mortality, medications that do not generate hypoglycemia, such as DPP-4 inhibitors, SGLT-2 inhibitors, GLP-I receptor agonists, and pioglitazone with metformin, should be prioritized. Other benefits of SGLT-2 inhibitors and GLP-I receptor agonists include decreased bodyweight, blood pressure (BP), and albuminuria.

The aim of Hb A1C should be less than 7% to minimize microvascular problems in the majority of patients. In addition, the blood pressure aim should be less than 130/85 mmHg, with angiotensin-converting enzyme (ACE)/angiotensin receptor blocker (ARB) medication preferred. Fundal examinations, as recommended by recommendations, should be performed at least twice a year, as should urine albumin excretion.

The target for the lipid panel should be LDL-C less than 100 mg/dl if no atherosclerotic cardiovascular disease (ASCVD) is present, or less than 70 mg/dl if ASCVD is present. A statin is the medicine of choice since it reduces CV events and death.

Diabetes type 2 diet

Complex carbs such as brown rice, whole wheat, quinoa, oatmeal, fruits, vegetables, beans, and lentils are examples of foods to eat for a type 2 diabetes diet meal plan.

Foods with a low glycemic load (index) cause just a minor rise in blood sugar and are therefore preferable alternatives for diabetics. Good glycemic control can aid in the prevention of type 2 diabetes's long-term consequences.

Diabetes type 2 foods to avoid

Nothing is entirely off-limits. Even goods you would consider to be "the worst" could be occasional delights in little doses. However, they will not assist you with your nutrition, and it is easier to control your diabetes if you stick to the "best" alternatives.

Carbohydrates in meals are classified into three types: starch, sugar, and fiber. Starches and sugars are the most problematic for diabetics since the body converts them to glucose.

Diabetes patients should exercise caution when ingesting dried fruit, prepared juices, or fruit salad, as they frequently include added sugar. Although artificial sweeteners are low in calories, research reveals that they have a detrimental effect on blood sugar via raising insulin resistance. More research is needed to assess the magnitude of this effect.

Choosing the best protein sources for diabetics is mostly determined by the amount of fat and carbs in these foods. Protein-rich diets that are also heavy in fat might contribute to weight gain and excessive cholesterol.

Diabetes type 2 insulin

Diabetes type 2 insulin

People with type 2 diabetes may not necessarily need to take insulin immediately away; this is more typical in type 1 diabetes patients. The longer a person has type 2 diabetes, the more probable it is that they will need insulin.

Types of Insulin

Rapid-acting insulin: This type of insulin takes effect in 15 minutes or less and is administered before a meal. When someone does not have type 2 diabetes, the body produces the appropriate quantity of insulin when they eat; the insulin should aid in the processing and utilization of the carbs in the meal. Bolus secretion refers to the release of insulin during meals. Insulin with a short half-life mimics bolus secretion.
Regular or Short-acting Insulin: Regular (sometimes known as short-acting) insulin acts within 30 minutes. It is similarly administered before a meal, but its impact lasts longer than that of rapid-acting insulin. Regular or short-acting insulin mimics bolus secretion as well.
Intermediate-acting insulin: has a half-life of 10 to 16 hours. It is typically given twice daily and is meant to mimic basal secretion. The basal secretion is the tiny quantity of insulin that is constantly present in your bloodstream.
Long-acting insulin: Long-acting insulin, like intermediate-acting insulin, mimics basal secretion. Long-acting insulin lasts 20-24 hours, so you only need to take it once a day; intermediate-acting insulin must be taken twice a day.

Bariatric surgery for type 2 diabetes

Weight-loss surgery, often known as bariatric surgery, can be performed in a minimally invasive manner and used to manage Type 2 diabetes. Diabetes is treated with surgery that regulates the amount of sugar in the blood.

Patients lose up to 25% of their total body weight after bariatric surgery, compared to standard weight-loss procedures. Furthermore, 87 percent of patients with type 2 diabetes gain improved glucose control and require fewer antidiabetic drugs, while an average of 78 percent achieve normal glycemic control without using any antidiabetic medications at all.

See more information: Bariatric Surgery. An effective treatment option for obesity and diabetes

Prevention of type 2 diabetes

Even if you're at high risk, you may prevent or postpone type 2 diabetes with proven, achievable lifestyle modifications like decreasing a little amount of weight and being more physically active. Continue reading to learn more about the CDC's lifestyle change initiative and how you can become involved.

See more information: The global problem is obesity. Why is it so dangerous?

Differential Diagnosis

Diabetes mellitus has several differential diagnoses, all of which present similar signs and symptoms:

Drug-induced due to corticosteroids, neuroleptics, pentamidine, etc.
Genetic aberrations in beta-cell function and insulin action
Metabolic syndrome
Infection
Endocrinopathies such as acromegaly, Cushing disease, pheochromocytoma, hypothyroidism, etc.
Complications of iron overload (hemochromatosis)
Conditions affecting the exocrine part of the pancreas such as pancreatitis, cystic fibrosis.

Prognosis

Diabetes is linked to an increased risk of atherosclerotic cardiovascular disease (ASCVD), therefore controlling blood pressure, using statins, getting enough exercise, and quitting smoking are all important ways to reduce risk. The overall excess mortality rate in persons with T2DM is roughly 15% higher, however, this varies greatly.

In the United States, the prevalence of vision-threatening diabetic retinopathy is around 4.4 percent among persons with diabetes, while it is 1 percent for end-stage renal disease.

Today, vascular complications can be adequately managed with pharmacotherapy for hyperglycemia, as well as lowering LDL cholesterol and managing blood pressure with ACEI/ARB therapy, as well as other antihypertensive medications and aspirin in secondary prevention, resulting in a reduction in morbidity and mortality.

Complications

In untreated diabetes mellitus, persistent hyperglycemia can lead to a number of acute and chronic problems. Diabetes is a primary cause of cardiovascular disease (CVD), blindness, renal failure, and lower-limb amputation. Hypoglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar condition, and hyperglycemic diabetic coma are all examples of acute complications.

Chronic microvascular problems include nephropathy, neuropathy, and retinopathy, whereas chronic macrovascular issues include coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease. Every year, it is projected that 1.4 to 4.7 percent of middle-aged diabetics would experience a CVD episode.

Conclusion

Type 2 diabetes is a complex illness characterized by a multidimensional metabolic imbalance that results in hyperglycemia. Diabetes can be caused by a number of drugs and endocrine problems. Although aggressive interventions such as lifestyle modification, early intensive medication, and bariatric surgery can restore euglycemia, it is uncertain if the underlying pathophysiological alterations are restored.

An interprofessional team is in charge of diagnosing and managing type 2 diabetes mellitus. These individuals must be sent to an ophthalmologist, nephrologist, cardiologist, or vascular surgeon. Patients must also be advised about lifestyle modifications that might assist reduce blood glucose levels.

All obese patients should be urged to reduce weight, exercise regularly, and consume a nutritious diet. The primary care practitioner and the diabetic nurse must advise all diabetics to quit smoking and refrain from alcohol consumption. Diabetes consequences are limb and life-threatening, and they significantly reduce one's quality of life.