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Type 2 diabetes

Read in Hindi

Dr. Sachin Shelke
Internal Medicine

verified

Blood sugar levels are regulated by a hormone called insulin that is synthesised by beta cells of the pancreas. The main function of the hormone is to bind to receptors on the fat, liver and muscle cells so as to allow the entry of glucose molecules inside them. Inside the cells, glucose is stored and then utilised as an energy source whenever needed.

In type 2 diabetes, the cells of the fat, liver and muscles fail to respond to the presence of insulin. This means that even in the presence of insulin, glucose cannot enter cells. It results in an increased level of sugar in the blood. In other words, this condition, known as insulin resistance, triggers a spike in your blood sugar level.

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Symptoms

In most cases, symptoms of diabetes are not pronounced. So, millions of people live with type 2 diabetes without even knowing that they have it. Here are the red flags to watch out for.


  • Increased appetite (as the body is unable to utilise the glucose present in the blood)

  • Increased thirst (increase in blood sugar level causes dehydration)

  • Frequent urination (occurs because of an increased tendency to drink water due to constant feelings of thirst)

  • Sudden weight loss: In diabetics, the body is not able to utilise glucose for energy. Therefore, the body utilises fat to draw energy. This causes weight loss even without exercise and dietary changes.

  • Poor wound healing (occurs because of hardening of blood vessels and reduced blood flow, which in turn prevents the clotting substances to reach the site of injury)


Other symptoms include blurred vision, pain in the hands and feet or numbness, depression, frequent infections of the kidney, bladder and skin.

Causes And Risk Factors

Causes

A combination of factors contributes to diabetes. Here is a low-down on it.

Genes: Research observes that different parts of DNA influence your body’s capacity to produce insulin.

Excessive glucose production by your liver: When your blood is low on sugar, your liver produces and sends glucose to the blood. After your meals, your blood sugar levels spike up and your liver slows down and reserves the glucose for future use. However, in some cases, the liver does not function like this. It keeps producing sugar even when your blood is not depleted of sugar levels. This triggers diabetes.

Poor cell-to-cell communication: Sometimes, your cells send wrong signals or fail to pick up the signals in the right manner. These physiological circumstances influence your cell’s capacity to make and use insulin, leading to diabetes in a chain reaction.

Broken beta cells: If your insulin-producing cells start making the wrong amount of this hormone, your blood sugar levels go haywire.

A recent study demonstrated that alcohol abuse or excessive alcohol consumption increases the risk of type 2 diabetes, particularly in lean women. Moreover, type 2 diabetes may develop because of the use of steroids or hormonal problems.

Risk Factors

Type 2 diabetes is a silent killer as it progresses slowly over a period of time. Although non-modifiable factors like age, genetics and ethnicity do play a role in the development of type 2 diabetes, it is the modifiable risk factors like diet and lifestyle habits that have increased the incidence of this condition in the past few years.

Obesity: Most people who get diagnosed with type 2 diabetes are overweight. That is simply because increased fat stores make it harder for your body to use insulin in the right way.

Physical inactivity: Sedentary lifestyle is one of the main contributing factors for the development of obesity which is linked to diabetes.

Family history: Inheritance of faulty genes can cause type 2 diabetes. It has been estimated that children with one parent having diabetes have double the risk of developing it as an adult, while those having both parents with this condition have six times greater risk of developing diabetes compared to healthy individuals.

Prevention

There is no sure-fire way to prevent type 2 diabetes. However, sticking to a healthy lifestyle can reduce your risk of getting type diabetes.

Watch your weight: Several studies have revealed that overweight people can decrease their chance of type 2 diabetes just by shedding 7% to 10% of their weight.

Work out regularly: Research suggests that 30 minutes of brisk walking every day is likely to reduce your type diabetes risk by almost one third.

Know what you should eat and what you should not: Stay away from highly processed carbs, sugar-loaded foods and beverages, and trans and saturated fats. Make sure you have a lot of high-fibre options in your meals alongside fruits and vegetables.

Quit smoking and go slow on alcohol: Both of them make you more susceptible to high blood sugar levels, thanks to the chemicals released from them.

Diagnosis

You need to see a doctor if you experience the already-mentioned signs of type 2 diabetes. He will go through your medical history and review the manifestations. He may suggest the following blood tests for confirmatory diagnosis.

A1C test or glycohaemoglobin test: This blood test calculates a person’s average blood glucose levels over the past three months. Here’s how to read the result:


  • Normal: A1C level below 5.7%

  • Prediabetes: A1C ranging between 5.7% to 6.4%

  • Diabetes: A1C level of 6.5% or above.


Fasting Plasma Glucose (FPG) test: This blood test is conducted after an 8-hour fasting window to check a person’s glucose levels. A reading of 126 mg/dL or above confirms diabetes. Your doctor may advise you to repeat the test to be doubly sure. You can perform the test at home with a glucometer.

Postprandial Plasma Glucose Test: This blood test checks your body’s tolerance towards glucose. For this, you need to take 75g of glucose orally. Your blood will be drawn 2 hours after this activity. A reading of 200 mg/dl or above confirms diabetes. If the result shows a reading between 140 mg/dl and 200 mg/dl, your doctor will diagnose impaired glucose tolerance.

Treatment

Diabetes cannot be cured or reversed. Treatment options involve medication for controlling and preventing a sudden spike in blood sugar levels. Here are medications and different treatment options for type 2 diabetes.

Sulfonylureas: These drugs increase the release of insulin from the pancreas to lower blood glucose levels. However, sulfonylureas are known to cause abnormally low levels of blood sugar (hypoglycaemia) that could lead to confusion and even coma.

Meglitinides: They aid in insulin production and work faster than sulfonylureas.

Biguanides: They lower the amount of glucose released from the liver and reduces its absorption in the intestines. For example, metformin is the preferred and most commonly used first-line drug to manage high glucose level in type 2 diabetes.

Thiazolidinediones: They lower blood glucose by increasing the sensitivity of the muscle and fat cells to insulin. These drugs may be taken with metformin and/or a sulfonylurea. They can cause mild liver problems but are reversible with discontinuation of the drug.

Sodium-glucose co-transporter-2 (SGLT2) inhibitors: These drugs reduce the blood sugar level by stimulating the kidney to remove additional sugar through the urine. Examples of SGLT2 inhibitors include dapagliflozin, canagliflozin and empagliflozin. This class of drugs are recommended in people with type 2 diabetes and also for cardiovascular diseases (for people with a very risk of cardiovascular diseases and to reduce the incidence of cardiovascular events)

Glucagon-like peptide-1 (GLP-1) receptor agonists: These drugs help to maintain normal blood sugar level by increasing insulin release from the pancreas. Moreover, they help to reduce the risk of cardiovascular diseases. Examples include liraglutide, dulaglutide and semaglutide. SGLT2 inhibitors and GLP-1 receptor agonists are the preferred drug after metformin.

Insulin injections: Insulin injections are required when blood glucose levels cannot be controlled by diet, weight loss, exercise and oral medicines. The different types of insulin, depending on their range of acting, are as follows:


  • Rapid-acting insulin starts working in ~15 min and lasts for 3–5 h

  • Short-acting insulin starts working in about 30–60 min and lasts for 5–8 h


Bariatric surgery: Bariatric surgery is recommended for diabetics who are morbidly obese. This weight loss surgery limits the person’s caloric intake and increases insulin secretion from the pancreas and sensitivity of body cells to the pancreas.

Lifestyle/management

What you eat is extremely important in influencing your blood sugar levels. You need to consult a nutritionist alongside your diabetologist to chalk out a meal plan. Make sure that your diet has balanced proportions of carbohydrates, proteins and fats. Your nutritionist will tell you about the quantity after examining your blood sugar levels, body weight and personal preferences. If you are overweight, she may recommend a low-carb, low-fat, and low-calorie meal. Avoiding trans fats and high-sugar foods is a must if you are diabetic. High intake of fruits and vegetables, moderate consumption of alcohol, and other food rules suggested by your nutritionist need to be followed diligently. Remember, mealtimes matter a lot for diabetics.

Routine health check-ups are critical in managing type 2 diabetes as it helps to keep off type 2 diabetes associated health problems at bay. You should check your average blood sugar every three months if you are newly diagnosed. Once your condition is stable, you can have these checks every six months. You should also undergo check-ups for your eyes, feet, blood pressure, kidney function and cholesterol at least once a year.

Studies have shown that exercises help maintain normal blood sugar level in people with type 2 diabetes. Moreover, it has been shown to contribute to weight loss, reduce the risk of cardiovascular diseases and improve your overall well-being.

Prognosis And Complications

Prognosis

You should maintain the blood glucose level within the recommended range by taking the prescribed medicines, doing regular physical activity, eating healthy and maintaining healthy body weight.

Complications

This condition comes with a lot of associated complications. Here is a low-down on them:

Peripheral neuropathy: This is a disorder characterised by the malfunction of nerves, which makes the nerves send wrong or no signal.

Diabetic retinopathy: Diabetics often start experiencing blurred vision, vision loss or swelling around the eyes. This is known as diabetic retinopathy.

Diabetic nephropathy: It refers to kidney damage caused because of diabetes. Nephropathy is more likely to occur if the blood sugar level remains elevated for prolonged duration and the resulting high blood pressure is left unchecked.

Diabetic gastroparesis: In certain individuals with diabetes, the vagus nerve responsible for contracting stomach muscles gets damaged. It causes the food to move slowly or stop moving altogether in the digestive tract, which thereby causes digestion problems known as diabetic gastroparesis.

Erectile dysfunction: It is true that erectile dysfunction and other sort of sex-related problems are extremely common among diabetics. It is estimated that 60-70% men who live with diabetes suffer from erectile dysfunction.

Heart disease: People with diabetes undoubtedly have a greater than average risk of suffering from heart disease because they carry a larger number of risk factors. According to statistics, the risk is four times higher in adults with type 2 diabetes compared to those without diabetes. In fact, heart disease and stroke are the leading causes of death in people with type 2 diabetes.

Hair loss: Diabetes reduces the blood flow to the upper and low extremities of the body. Poor blood circulation to the scalp results in hair loss and prevents further hair growth.

References


  1. Alcohol use among diabetics: Increased risks and treatment complications. American AddictionCenters Alcohol.org. Available at: https://www.alcohol.org/comorbid/diabetes-and-alcoholism/#:~:text=Research%20published%20in%20the%20journal,in%20women%20who%20were%20lean.

  2. Diabetes Mellitus. StatPearls [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551501/.

  3. van Baar MJB, et al. Diabetes Care. 2018;41(8):1543-56.

  4. Sodium-glucose cotransporter-2 (SGLT2) inhibitors. U.S. Food and Drug. Available at: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors.

  5. Metformin no longer regarded as first-line therapy in new ESC/EASD guidelines on diabetes. European Primary Care Cardiovascular Society. Available at: https://ipccs.org/2019/09/04/metformin-no-longer-regarded-as-first-line-therapy-in-new-esc-easd-guidelines-on-diabetes/.

  6. Hinnen D. Diabetes Spectr. 2017;30(3):202-210.

  7. Kashyap SR, et al. Cleve Clin J Med. 2010;77(7):468-476.

  8. Going for regular check-ups. NHS. Available at: https://www.nhs.uk/conditions/type-2-diabetes/going-regular-check-ups/#:~:text=Every%203%20months&text=Checks%20your%20average%20blood%20sugar,your%20GP%20or%20diabetes%20nurse.

  9. Colberg SR, et al. Diabetes Care. 2016;39(11):2065-2079.

  10. Diabetes type 2. BetterHealth Channel. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-type-2.

  11. Type 2 diabetes mellitus. Harvard Health Publishing. Available at: https://www.health.harvard.edu/a_to_z/type-2-diabetes-mellitus-a-to-z.

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