Type 2 Diabetes
(Non-insulin Dependent Diabetes Mellitus; NIDDM; Adult-Onset Diabetes Mellitus; Diabetes Mellitus Type 2; "Stable" Diabetes; Insulin-Resistant Diabetes; Diabetes, Type 2)
Definition
Type 2 diabetes is when the body is resistant to high insulin levels. Insulin is a hormone made by the pancreas. Insulin helps your body convert food into energy. Without insulin, glucose (sugar) from the food you eat cannot enter cells. This causes glucose to build up in the blood. Meanwhile, your body tissues are starved for energy. However, in type 2 diabetes, there is plenty of insulin but the cells are resistant to its action.
Long-term, high blood sugar levels can damage the kidneys, eyes, nerves, and other tissues.
The Pancreas
© 2008 Nucleus Medical Art, Inc.
Causes
Two conditions contribute to type 2 diabetes:
- Insulin resistance related to excess body fat (The body is unable to use the insulin it makes.)
- Body's failure to make an adequate amount of insulin
Risk Factors
These factors increase your chance of developing type 2 diabetes. Tell your doctor if you have these risk factors:
- Age: 40 or older
- Sex: more common in older women than men
- Obesity or being overweight (especially excess weight in the upper body and abdomen)
- Lack of physical activity
- Family members with type 2 diabetes
- History of gestational diabetes
- History of impaired glucose tolerance
- Race: African American, Hispanic, Native American, Asian American, or Pacific Islander
- Endocrine disorders (Cushing’s syndrome, hyperthyroidism, acromegaly, polycystic ovary syndrome, pheochromocytoma, glucagonoma)
- Medications (pentamidine, nicotinic acid, glucocorticoids, thiazide)
- Genetic factors
Symptoms
You may not have symptoms for years if you have type 2 diabetes. Symptoms may be due to either high blood sugar or diabetic complications. These symptoms may include:
- Weight loss
- Increased urination
- Extreme thirst
- Hunger
- Fatigue
- Blurry vision
- Irritability
- Frequent or recurring infections
- Poor wound healing
- Angina
- Painful leg cramps when walking
- Numbness or tingling in the hands or feet
- In women: frequent vaginal yeast infections
- Problems with gums
- Itching
- Impotence
Diagnosis
The doctor will ask about your symptoms and medical and family history, and perform a physical exam.
Diagnosis is based on the results of blood tests and other criteria, including:
- Symptoms of diabetes and a random blood test revealing a blood sugar level greater than or equal to 200 milligrams per deciliter of blood (mg/dL) [11.1 millimole per liter (mmol/L)]
- Blood sugar tests after you have not eaten for eight or more hours revealing blood sugar levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days
- A glucose tolerance test measuring blood sugar two hours after you consume glucose with a measurement greater than or equal to 200 mg/dL (11.1 mmol/L)
Treatment
Diabetes treatment aims to maintain blood sugar at levels as close to normal as possible. Regular medical care is important for preventing or delaying complications.
Diet
- Follow a balanced meal plan, eating consistent and moderate amounts of food at regular times.
- Do not skip meals.
- Eat plenty of vegetables and fiber.
- Eat limited amounts of fat.
- Eat moderate amounts of protein and low-fat dairy products.
- Carefully limit foods containing sugar.
- Keep a record of your food intake to help a dietitian or doctor advise you based on your nutritional needs.
Weight Loss
If you are overweight, talk to your doctor about a reasonable weight goal and a safe diet program.
Group education may help people recently diagnosed with type 2 diabetes reach their goals in losing weight and quitting smoking. * 8 This is important because losing weight helps your body respond better to insulin. Also, quitting smoking can decrease your chance of getting many diseases, including heart disease, which is common in people with diabetes.
Exercise
Physical activity helps the body use blood sugar. It will also help you reach and maintain a healthy weight, and lower the levels of fat in your blood. Follow your doctor's advice for activity levels and restrictions. Exercise was found to improve blood sugar control in patients with type 2 diabetes. * 2 Also, patients who received brief counseling during their regular doctor's appointments didn't have a difference in weight loss, but did have an increase in physical activity.*9 Exercising more can help you improve glucose control and reduce your risk for heart disease.
Oral Medication
Medications taken by mouth may be used to lower blood sugar:
- Drugs that prompt the cells in the pancreas to make more insulin (eg, sulfonylureas [glyburide, tolazamide])
- Insulin sensitizers—a class of drugs that help the body better use insulin (eg, rosiglitazone and pioglitazone)
- Starch blockers—a class of drugs (eg, acarbose and miglitol) that lessen glucose absorption into the bloodstream
- Drugs that reduce the production of glucose by the liver (eg, metformin)
- Amylin analogues (eg, pramlintide)
- Dipeptidyl peptidase IV (DDPP-4) inhibitor (eg, sitagliptin)
- Incretin-mimetic (eg, exenatide)
Two studies show the potential of increased harm when using the medications rosiglitazone or gliclazide to reach intensive blood sugar goals (hemoglobin A1C <6.5%).*3,6,7,10
Insulin
Insulin by injection supplement the insulin made by the body. Insulin therapy is needed when blood sugar levels are not kept low enough with diet, exercise, and medications.
Blood Sugar Testing
Checking blood sugar levels during the day helps you keep track of the amount of glucose in your blood. This also determines if the dosage or type of antidiabetic treatment needs to be adjusted. Testing is easy with a blood glucose monitor. Keeping track of blood glucose levels is important if you take insulin.
However, many patients with type 2 diabetes can use another test called glycosylated hemoglobin or hemoglobin A1c (HbA1c). This is done in the doctor's office. Unlike blood sugar levels, HbA1c has the advantage of measuring average blood glucose levels over the previous three-month period. This shows the effectiveness of diabetes management over the long-term. Doctors advise that most diabetics keep their HbA1c levels below 7%.
A study suggests that regular blood sugar testing may not be needed in patients with type 2 diabetes whose condition is under reasonably good control without insulin. * 4 However, talk with your doctor before stopping blood sugar monitoring.
Alternative Therapies
Researchers studied vitamin E supplementation in a particular group of patients—those with type 2 diabetes mellitus and a certain genotype (called Haptoglobin 2-2). Vitamin E was associated with a decrease in the rates of cardiovascular events. * 5
Prevention
Regular physical activity and maintaining a healthy weight can reduce your chance of developing type 2 diabetes. In a trial of patients who were overweight and had prediabetes, lifestyle changes reduced the incidence of diabetes for up to seven years. * 1
Lifestyle changes seem to be more effective than medications in those with glucose intolerance. But ask your doctor if taking a drug, such as metformin or rosiglitazone, may reduce your risk of getting type 2 diabetes.
RESOURCES:
American Diabetes Association
http://www.diabetes.org/
National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov/
CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca/
Team Diabetes Canada
Canadian Diabetes Association
http://www.diabetes.ca/
References:
American Association of Clinical Endocrinologists, American College of Endocrinology. Medical guidelines for the management of diabetes mellitus. The AACe system of intensive diabetes self-management. 2002 update. Endocrine Practice. 2002;8(suppl 1):S40-82.
Boren SA, Gunlock TL, Schaefer J, Albright A. Reducing risks in diabetes self-management: a systematic review of the literature. Diabetes Educ. 2007;33:1053-1077.
Calvagna M. Tips to help you stop smoking. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated January 2006. Accessed July 7, 2008.
Diabetes. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nccdphp/publications/aag/ddt.htm. Updated February 14, 2008. Accessed July 21, 2008.
Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) website. Available at: http://diabetes.niddk.nih.gov/. Accessed July 22, 2008.
Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28(suppl 1):S37-42.
Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003; 248:383-393.
Harsch IA. Inhaled insulins: their potential in the treatment of diabetes mellitus. Treat Endocrinol. 2005;4:131-138.
Information about Acarbose (Precose). The Diabetes Monitor website. Available at: http://www.diabetesmonitor.com/acarbose.htm. Accessed on May 26, 2006.
Juan D. Lifestyle changes to manage type 2 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated July 2007. Accessed July 7, 2008.
Marre M. Reducing cardiovascular risk in diabetes. J Hypertens. 2007;(supp 11)S19-22.
Physical activity/exercise and diabetes. Diabetes Care. 2004;27(suppl 1):S58-62.
Screening for type 2 diabetes. Diabetes Care. 2004;27(suppl 1):S11-4.
Type 2 diabetes. American Diabetes Association website. Available at: http://www.diabetes.org/type-2-diabetes.jsp. Accessed July 22, 2008.
UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet. 1998; 352:954-965.
US Preventive Services Task Force (USPSTF). Screening for type 2 diabetes mellitus in adults: recommendations and rationale. Ann Intern Med. 2003; 138:212-214.
* 1 11/29/06 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368:1673-1679.
* 2 9/19/06 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews. 2006; No.: CD002968. DOI: 10.1002/14651858.CD002968.pub2.
* 3 6/1/2007 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007 May 21. [Epub ahead of print]
* 4 7/13/2007 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Farmer A, Wade A, Goyder E, et al. Impact of self-monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ. 2007 Jun 25. [Epub ahead of print]
* 5 12/13/2007 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Milman U, Blum S, Shapira C, et al. Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both type 2 diabetes mellitus and the haptoglobin 2-2 genotype. A prospective double-blinded clinical trial. Arterioscler Thromb Vasc Biol. 2007 Nov 21. [Epub ahead of print]
* 6 2/13/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: For safety, NHLBI changes intensive blood sugar treatment strategy in clinical trial of diabetes and cardiovascular disease. NIH News. National Institutes of Health website. Available at: http://www.nih.gov/news/health/feb2008/nhlbi-06.htm. Accessed February 13, 2008.
* 7 2/21/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Major international diabetes study does not confirm increased risk of death reported by US trial. Action in Diabetes and Vascular Disease: PreteraAx and DiamicroN MR Controlled Evaluation (ADVANCE) website. Available at: http://www.advance-trial.com/static/html/virtual/contents.asp?P=39. Accessed February 21, 2008.
* 8 2/28/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Davies MJ, Heller S, Skinner TC, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008 Feb 14. [Epub ahead of print]
* 9 2/28/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008;168:141-146.
* 10 6/18/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-2572. Epub 2008 Jun 6.
Last reviewed March 2008 by David Juan, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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