Type 2 Diabetes - Symptoms, Diagnosis, and Management
Of the more than 38 million Americans who have diabetes, the overwhelming majority—about 90% to 95%—have type 2 diabetes. While type 2 diabetes most often develops in people in their mid-40s or older, children, teens, and young adults are also at risk for it.
Unlike type 1 diabetes , which is an autoimmune disorder that can develop suddenly, type 2 diabetes is primarily brought on by lifestyle factors and develops slowly over time. Sometimes, symptoms are so mild that they go unnoticed even while causing nerve damage and diseases of the heart, kidney, and eyes.
What is Type 2 Diabetes?
Type 2 diabetes is a chronic disease that occurs due to insulin resistance. Insulin is a hormone released in the pancreas which helps move sugar from the bloodstream into our body’s cells. When insulin resistance happens, insulin does not work as effectively at moving sugar into the cells and as a result, more sugar backs up in the bloodstream, raising blood sugar levels and putting a person at risk for diabetes.
Diabetes can also develop after many years of having insulin resistance-the pancreas can start to lose its full capacity to release insulin into the body.
Both issues affect how the body regulates and uses glucose. Over time, it leads to too much glucose in the bloodstream, which damages blood vessels, nerves, tissue, and organs.
While there is no cure for type 2 diabetes, focusing on improving your insulin resistance can bring sugar levels down out of the diabetes range. There are three areas of focus for a healthy lifestyle which can improve insulin resistance and help manage diabetes: moderate carbohydrates, modest weight loss and increase physical activity.
Symptoms of type 2 diabetes include:
- Increased hunger, thirst, and urination
- Extreme fatigue
- Weight loss
- Blurry vision
- Darkened skin patches, mostly in the neck and armpits
- Slow-healing cuts or bruises
- Numbness and tingling in the hands or feet
Symptoms often develop over several years making them easy to miss. In some cases, there aren't any noticeable symptoms at all.
Type 2 diabetes is usually diagnosed with a blood test called the A1C test , which measures your average blood sugar level over the past two to three months. A normal A1C level is below 5.7%, while a level between 5.7% and 6.4% indicates prediabetes. A level of 6.5% or higher on two separate tests indicates diabetes.
Other blood tests that can be used to diagnose type 2 diabetes include:
- Fasting blood sugar test to measure your blood sugar levels after not eating overnight
- Non-timed blood sugar test to check glucose levels in a non-fasting state
- Oral glucose tolerance test to measure the body’s response to glucose. Commonly used to check for gestational diabetes during pregnancy
Managing type 2 diabetes involves a combination of lifestyle changes, self-monitoring, and sometimes medication.
Because what you eat and when has a huge impact on your blood glucose levels, it’s important to:
- Establish and stick to a regular schedule for meals and snacks
- Eat smaller portions
- Adjust your diet to include:
- More high-fiber foods
- More low- or non-starch vegetables
- More whole grain so fewer starchy vegetables, sweets, refined grains (white rice, white flour, pasta, etc.), foods with added sugar (soda, sugary cereals, juice, sweet tea, etc.), alcoholic beverages
Your healthcare provider can connect you with a dietitian to help you understand how food impacts your glucose level and how to plan and make meals that keep levels in a healthy range and keep you feeling your best.
Other important lifestyle changes that can help manage type 2 diabetes include:
- Being physically active (at least 150 minutes of moderate to vigorous aerobic activity a week)
- Losing weight (as advised by your doctor)
- Getting enough sleep
- Managing stress
- Self-monitoring glucose levels using a glucose meter several times a day
If you’re unable to maintain healthy blood glucose levels with lifestyle changes alone, your doctor may prescribe medications that lower levels or insulin therapy, or a combination of both. Blood pressure and cholesterol medications may also be recommended to help prevent heart and blood vessel disease.
Complications
Type 2 diabetes can lead to serious—and even life-threatening—health problems. Recognizing and reporting changes to your health to your doctor is key to managing the disease and lowering your risk of diabetes-related complications.
Common complications of type 2 diabetes include:
Cardiovascular disease - People with diabetes are twice as likely to have heart disease or a stroke than people without diabetes. You can reduce your risk through good disease management, including regular exercise and eating well.
Chronic kidney disease - Diabetes is the leading cause of chronic kidney disease. Managing your diabetes and blood pressure can both work to reduce your risk.
Diabetic ketoacidosis (DKA) - When the body doesn’t have enough insulin to use glucose, it burns fat for energy, which produces and releases ketones into the bloodstream. When the ketone level gets too high, it makes the blood acidic. Unchecked, it can lead to diabetic coma or even death.
Diabetes-related eye disease - Diabetes affects blood vessels in the retina, the light-sensitive layer of tissue in the back of the eye, and can lead to poor vision and blindness. Regular comprehensive eye exams, including dilation, can detect problems early and help prevent or delay vision loss.
Foot problems - Diabetes frequently damages nerves and blood vessels in the feet.
Nerve damage in the foot (diabetic neuropathy) can cause tingling, burning or stinging pain, weakness, and loss of feeling in the feet. The latter is particularly concerning as it makes it hard to notice wounds, blisters, and ulcers, making them prone to infection.
Poor circulation brought on by diabetes further complicates things as reduced blood flow makes it hard for the body to fight infections and slows wound healing. This can lead to gangrene. In severe cases that don’t improve with treatment, amputation of the toe, foot, or part of the leg may be required.
Skin complications - Skin problems are sometimes the first sign that a person has diabetes. People with diabetes often experience more itching and bacterial and fungal infections than people without diabetes. Other conditions unique to diabetes can lead to changes in the appearance and texture of the skin. These include light brown, scaly patches (diabetic dermopathy); tan or brown raised areas appear on the sides of the neck, armpits, and groin (acanthosis nigricans); firm, yellow, pea-like enlargements in the skin (eruptive xanthomatosis); thick, waxy skin on the backs of the hands, toes, and forehead (digital sclerosis); and more.
Most conditions can be managed by practicing good hygiene and skin care or with the help of a dermatologist.
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