Type 2 Diabetes
Type 2 diabetes used to be known as non-insulin dependent diabetes or adult onset diabetes. Those affected may produce insulin, but it is either not in a sufficient amount to meet their needs or their body has become resistant to its effects. At the time of diagnosis, people with type 2 diabetes will frequently have both high glucose levels and high insulin levels, but they may not have any symptoms. About 90-95% of diabetes cases in the United States are type 2. It generally occurs later in life, in those who are obese, sedentary, and over 45 years of age. Factors associated with type 2 diabetes include:
- Obesity or being overweight
- Lack of exercise
- Family history of diabetes - having a close (first-degre) relative with diabetes
- Having prediabetes
- Ethnicity: African American, Hispanic American, Native American, Asian American, Pacific Islander
- Having gestational diabetes during pregnancy or having a baby weighing more than 9 pounds
- Being a woman with polycystic ovarian syndrome (PCOS)
- Having high blood pressure
- Having high triglycerides, high cholesterol, low HDL cholesterol
- Having an A1C equal to or above 5.7% or prediabetes identified by previous testing
- Having a history of cardiovascular disease (CVD)
Since Americans are becoming more obese and not getting enough regular exercise, the number of those diagnosed with type 2 diabetes is continuing to rise and it is developing at younger ages.
The American Diabetes Association (ADA) and the United States Preventive Services Task Force recommend screening for adults age 45 and older and for adults who are under 45 years of age who are overweight and have any additional risk factors for type 2 diabetes. The ADA also recommends that children who are overweight and have two or more risk factors should be considered for diabetes screening.
Signs and Symptoms
People with type 2 diabetes may or may not have any noticeable signs or symptoms at the time of diagnosis. The signs and symptoms may be subtle at first and then worsen if the condition is not diagnosed and treated. See the section on Signs and Symptoms for detailed descriptions.
In addition to diabetes tests, used for screening, diagnosing and monitoring, a few other tests may be used in the evaluation of type 2 diabetes:
- Diabetes autoantibodies – this test may help distinguish between type 1 and type 2 diabetes if the diagnosis is unclear. The presence of one or more of these antibodies indicates type 1 diabetes.
- Insulin, C-peptide – to monitor insulin production
- Urine and/or blood ketone tests may be ordered to monitor people who present at the emergency room with symptoms suggesting acute hyperglycemia and to monitor those who are being treated for ketoacidosis. A build up of ketones can occur whenever there is a decrease in the amount or effectiveness of insulin in the body.
Prevention and Treatment
The risk of having type 2 diabetes can be greatly decreased by losing excess weight, exercising, and eating a healthy diet with limited fat intake. By identifying pre-diabetic conditions and making the necessary lifestyle changes to lower glucose levels to normal levels, it may be possible to prevent type 2 diabetes or delay its onset by several years. Normalizing blood glucose can also minimize or prevent damage to veins, arteries and kidneys.
Type 2 diabetics usually self-check their glucose one or more times a day. Type 2 diabetics are on a continuum, ranging from those who can control their glucose levels with diet and exercise, to those who can take oral medications, to those who need to take daily insulin injections. Many will move along the continuum as their disease progresses.
The oral medications available fall into three classes. They include drugs that:
- Stimulate the pancreas to produce more insulin
- Help make the body more sensitive to the insulin it is producing
- Slow the absorption of carbohydrates in the stomach (slowing down the post-meal increase in blood glucose)
- Block glucose from being reabsorbed from the urine by the kidneys
Type 2 diabetics often take two or more of these medications and/or insulin injections, whatever it takes to achieve glucose control.
Type 2 diabetics may occasionally encounter serious complications if they have ignored initial symptoms, if they have neglected their ongoing treatment, or if they have a serious stress to their system such as a heart attack or stroke or a severe infection. The effects of very high blood glucose levels and dehydration can be cumulative, leading to weakness, confusion, and in severe cases, to convulsions and coma that require immediate hospitalization.