Type 2 diabetes (Diabetes mellitus type 2)

Diabetes is a life-long disease that affects the way your body handles glucose, a kind of sugar, in your blood. Most people with the condition have type 2. There are about 27 million people in the U.S. with it. Another 86 million have prediabetes: Their blood glucose is not normal, but not high enough to be diabetes yet.

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Blue circle - symbol of diabetes.

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Dr. Anirban Deep Banerjee

Your pancreas makes a hormone called insulin. It's what lets your cells turn glucose from the food you eat into energy. People with type 2 diabetes make insulin, but their cells don't use it as well as they should. Doctors call this insulin resistance.

At first, the pancreas makes more insulin to try to get glucose into the cells. But eventually it can't keep up, and the sugar builds up in your blood instead.

Usually a combination of things cause type 2 diabetes, including:

Genes. Scientists have found different bits of DNA that affect how your body makes insulin.

Extra weight. Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around the middle. Now type 2 diabetes affects kids and teens as well as adults, mainly because of childhood obesity.

Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.

Too much glucose from your liver. When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and usually the liver will slow down and store its glucose for later. But some people's livers don't. They keep cranking out sugar.

Bad communication between cells. Sometimes cells send the wrong signals or don't pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reaction can lead to diabetes.

Broken beta cells. If the cells that make the insulin send out the wrong amount of insulin at the wrong time, your blood sugar gets thrown off. High blood glucose can damage these cells, too.

While certain things make getting diabetes more likely, they won't give you the disease. But the more that apply to you, the higher your chances of getting it are.

Some things you can't control.

  • Age: 45 or older
  • Family: A parent, sister, or brother with diabetes
  • Ethnicity: African-American, Alaska Native, Native American, Asian-American, Hispanic or Latino, or Pacific Islander-American

Some things are related to your health and medical history. Your doctor may be able to help.

  • Prediabetes
  • Heart and blood vessel disease
  • High blood pressure, even if it's treated and under control
  • Low HDL ("good") cholesterol
  • High triglycerides
  • Being overweight or obese
  • Having a baby that weighed more than 9 pounds
  • Having gestational diabetes while you were pregnant
  • Polycystic ovary syndrome (PCOS)
  • Acanthosis nigricans, a skin condition with dark rashes around your neck or armpits
  • Depression

Other risk factors have to do with your daily habits and lifestyle. These are the ones you can really do something about.

  • Getting little or no exercise
  • Smoking
  • Stress
  • Sleeping too little or too much

Because you can't change what happened in the past, focus on what you can do now and going forward. Take medications and follow your doctor's suggestions to be healthy. Simple changes at home can make a big difference, too.

Lose weight. Dropping just 7% to 10% of your weight can cut your risk of type 2 diabetes in half.

Get active. Moving muscles use insulin. Thirty minutes of brisk walking a day will cut your risk by almost a third.

Eat right. Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.

Quit smoking. Work with your doctor to avoid gaining weight, so you don't create one problem by solving another.

The symptoms of type 2 diabetes can be so mild you don't notice them. In fact, about 8 million people who have it don't know it.

  • Being very thirsty
  • Peeing a lot
  • Blurry vision
  • Being irritable
  • Tingling or numbness in your hands or feet
  • Feeling worn out
  • Wounds that don't heal
  • Yeast infecrtions that keep coming back

Your doctor can test your blood for signs of diabetes. Usually doctors will test you on two different days to confirm the diagnosis. But if your blood glucose is very high or you have a lot of symptoms, one test may be all you need.

A1C: It's like an average of your blood glucose over the past 2 or 3 months.

Fasting plasma glucose: This measures your blood sugar on an empty stomach. You won't be able to eat or drink anything except water for 8 hours before the test.

Oral glucose tolerance test (OGTT): This checks your blood glucose before and 2 hours after you drink a sweet drink to see how your body handles the sugar.

You have lots of options to manage diabetes. Diet, exercise, and medication work together to bring your blood sugar under control.

Your doctor will help you figure out if you need to take medicine, which kind is right for you, and how often you should take it.

Over your lifetime, you'll probably handle your disease in different ways. Sometimes medications stop working, and you'll have to switch. You'll need to adjust to changes in your body as you age. And researchers are looking for new diabetes medicines and ways to treat it.

Check Your Blood Sugar

Your blood glucose number tells you how well your treatment is working. Your doctor will let you know how many times a day you need to check it. It depends on what diabetes medications you're taking.

When you're sick, you'll have to check your ketones, too.

Diet and Exercise

There's no one-size-fits-all diabetes diet. You'll need to pay attention to carbs, fiber, fat, and salt to manage your blood sugar and avoid complications of diabetes. How much and when you eat are important, too. Talk to your diabetes team or a registered dietitian to help you plan your meals and snacks.

Physical activity -- from working out to doing chores -- lowers your blood sugar. It helps your cells use insulin. It also helps your muscles use glucose. Make sure you check your blood sugar before and after exercise.

Eating right and being active help you lose extra pounds and stay at a healthy weight. That will also help control your blood sugar.

Pills

Oral medications are often the first kind of medicine people with type 2 diabetes try when diet and exercise alone aren't enough to keep their blood sugar in a healthy range. There are many of them, and they work in different ways.

A drug doctors often prescribe tells your liver to hang on to some of the glucose it makes. The generic name is metformin.

Some medications tell your pancreas to make more insulin. These are meglitinides and sulfonylureas.

One kind keeps your body from breaking down hormones that give your pancreas the "go" signal for insulin. This means they work longer when you need to lower your blood sugar after a meal. They're known as DPP-4 inhibitors.

Other medicines help insulin work better. They lower insulin resistance from your cells so your pancreas doesn't have to work as hard. Doctors call these thiazolidinediones, TZDs, or glitazones.

Some slow the digestion of food with complex carbohydrates, like bread, pasta, rice, potatoes, and corn. This keeps your blood sugar from shooting up after you eat. These are alpha-glucosidase inhibitors.

Some work by letting your kidneys pee out extra sugar. They're SGLT2 inhibitors.

Cholesterol-lowering drugs called bile acid sequestrants can also help lower your blood glucose.

You can take these medications by themselves or in combination with others, including insulin. Some pills have more than one kind of drug.

Dopamine receptor agonists work directly on the brain to help it process dopamine. This, in turn, can help increase your sensitivity to insulin. which means your body doesn't need as much of it. Those taking dopamine receptors should also implement some lifestyle changes such as a healthy diet and excercise for the medication to be more ffective.  

Injectable Drugs

These medications slow how quickly food leaves your stomach and make you feel full. And they tell your liver to back off making glucose around mealtimes.

Some also help your pancreas make insulin. These are GLP-1 receptor agonists. Some of them you take every day, while others last a week.

A different drug acts like a hormone, amylin, that your pancreas sends out with insulin. You only take pramlintide (Symlin) if you're also using insulin.

Insulin

People with type 2 diabetes sometimes need insulin. It could be a short-term fix for a stressful situation, or because other medicines aren't enough to control their blood sugar.

You can take insulin with a needle and syringe, with a device called an insulin pen, or with an inhaler. Some people use an insulin pump to get it continuously.

Types of insulin are grouped by how fast they start to work and how long their effects last. You might have to use more than one kind of insulin. Some insulins come pre-mixed.

Weight Loss Surgery

Of course, this gets rid of extra pounds. And that alone will help control your blood sugar.

But it also raises the level of hormones in your gut called incretins. These tell your pancreas to make insulin. Over time, you may be able to take less medication.

It isn't for everyone, though. Doctors usually recommend weight loss surgery only for men who are at least 100 pounds overweight and women with at least 80 extra pounds.

The best way to avoid these complications is to manage your diabetes well.

  • Take your diabetes medications or insulin on time.
  • Check your blood glucose.
  • Eat right, and don't skip meals.
  • See your doctor regularly to check for early signs of trouble.

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