Worldwide, 400 million people have type 2 diabetes. Based on current trends, the prevalence of diabetes is expected to almost double by 2030.
With type 2 diabetes, the body does not produce enough insulin or does not correctly use the insulin it produces.
Over time, a progressive failure of the pancreatic islet β-cells to compensate for insulin resistance takes place and diabetes results. (1)
Type 2 diabetes, once considered adult diabetes, is an autoimmune disease that can occur at any age. It is a condition that results from insulin disorders. Insulin is a hormone produced by the beta cells of the pancreas.
The responsibility of insulin is to carry glucose from the bloodstream into the body’s cells. Furthermore, cells deprived of glucose begin to starve.
A healthy lifestyle is mandatory as well as an effective treatment plan to keep blood sugar level closer to normal. Consequently, type 2 diabetes can lead to severe complications.
- Hypoglycemia (low blood glucose)
- Hyperosmolar hyperglycemic nonketotic syndrome (high blood glucose)
- Kidney disease
- Diabetic retinopathy
- Diabetic neuropathy
- Macrovascular problems
Over 90 percent of diabetes patients are type 2 diabetes patients. The condition results from two physiological defects:
- Resistance to the action of insulin
- Deficiency in insulin secretion
To date, there are many debates as to the “primary defect,” causing diabetes. Mainly because molecular defects causing diabetes are unknown. However, there are identified contributors or causes associated with type 2 diabetes.
- Genetic factors
- Insulin resistance
- Insulin deficiency
- Obesity (2)
- Lack of exercise
- Bad communication between cells
- Broken beta cells
When insulin deficiency due to failure of the pancreatic β cells develops, a diabetes diagnosis is confirmed. During times of starvation of the cells, insulin levels are low. As a result, muscle, liver, and adipose tissue mobilize stored energy.
Muscle lacks glucose 6-phosphatase, the glycogen to glucose-1-phosphate, and glycogen breakdown does not occur for the release of glucose into the blood.
At the same time, muscle exports amino acids and other substrates to the liver for gluconeogenesis. Gluconeogenesis is a metabolic pathway resulting from the origination of glucose from specific non-carbohydrate carbon substrates. (3)
Genetics area factor in type 2 diabetes. However, as to date, only a handful of genes have been identified.
Type 2 diabetes can lead to more severe complications and illness. For this reason, it is crucial for individuals to know diabetes warning symptoms. When glucose levels are high, type 2 diabetes symptoms may include:
- Increased hunger
- Increased thirst
- Frequent urination
- Dry mouth
- Unexplained weight loss
- Blurred vision
- Loss of consciousness
Over time, symptom severity and changes vary from patient to patient.
Various tests help to diagnose type 2 diabetes (4) :
Glycated hemoglobin (A1C) test
The A1C test measures glucose levels in the blood over the past two to three months. When two or more tests results are between 5.7 and 6.4 percent blood sugar levels, the patient’s diagnosis is prediabetes.
If the patient has a unique form of hemoglobin or other specific conditions, tests may include the following as the condition can interfere with the test results:
Random blood sugar test
The random blood sugar test is a random blood sampling. There are no specifics to an empty stomach, time, etc. Glucose levels of 200 mg/dL or higher suggest diabetes.
Fasting blood sugar test
With the fasting blood sugar test, the patient needs to fast overnight. When glucose levels results are between 100 to 125 mg/dL, patients’ will be diagnosed with prediabetes. Glucose levels above 125 mg/dL result in a diabetes diagnosis.
Oral glucose tolerance test
Patients are required to fast overnight with this test. The oral glucose tolerance test is the least commonly used test. Before the test, patients will be given a sugary liquid to drink while in their doctors’ office. Testing of blood sugar levels occurs over two hours.
Blood sugar readings between 140 and 199 mg/dL indicate prediabetes. Readings higher after two hours suggests diabetes.
According to the American Diabetes Association, recommends types 2 diabetes screening for individual 45 years of age. After that, testing for patients with normal results should be every three years. For patients with borderline results, a second test is necessary.
Diabetes testing is suggested for individuals under 45 years of age when:
- Heart disease risk factors
- Genetic risk
- Past gestational diabetes
- High blood pressure
Once a diabetes diagnosis is confirmed, tests will be administered to distinguish between type 1 diabetes and type 2 diabetes.
Various treatments are used to manage type 2 diabetes
- Healthy eating
- Weight loss
- Insulin therapy
- Diabetes medication
- Regular exercise
- Blood sugar monitoring
Type 2 diabetes treatment includes diet, exercise, and a combination of anti-hyper-glycaemic drug treatment with lipid-lowering, antihypertensive, and antiplatelet therapy.
Not all type 2 diabetes patients require insulin therapy. (5)
However, the longer the patient has type 2 diabetes, the more likely they will require insulin. According to data from the U.K. Prospect Diabetes Study, there may be a connection between early insulin treatment and lower macrovascular risk in type 2 diabetes patients. (6)
With coronary microvascular disease, the small blood vessels that branch off the coronary arteries narrow, causing chest pain.
Several factors will determine a type 2 diabetes patient’s start of insulin therapy:
- Severity of hyperglycemia
- Side effects of insulin as opposed to other hypoglycemic agents
- Patient willingness
- Oral hypoglycemic agents with or without GLP1 analogs are effective
- Patient’s lifestyle factors and work schedule
Insulin for short term blood sugar control in type 2 diabetes
According to the American Association of Clinical Endocrinologists, diabetes patients with A1C of higher than 7 percent require more intensive medication plans. Patients with an A1C above 9 percent should start on insulin.
Insulin for long term blood sugar control in type 2 diabetes
Typically, type 2 diabetes patients require insulin therapy after 10 to 20 years. The reason for insulin therapy is due to the eventual loss of cells in the pancreas that make insulin. Because of this, type 2 diabetes medication will no longer help.
Types of type 2 diabetes insulin include:
- Long-acting forms of insulin
- Rapid-acting insulin
- Premixed combinations
Type 2 Diabetes Insulin Therapy Drawbacks
Drawbacks can occur with insulin therapy. Insulin therapy drawbacks include:
- Weight gain
With type 2 diabetes diet, and exercise are crucial. Lifestyle management influences the effectiveness of medications, as well as the need for insulin. (7)
Dietary and lifestyle factors of type 2 diabetes include:
- Overweight or obesity
- Lack of exercise
- Poor diet
- Alcohol abstinence
A type 2 diabetes diet focuses on four things:
Carbs in the diet should be complex carbohydrates. Complex carbs take longer for the body to digest. Therefore, the body receives steady energy and fiber. For type 2 diabetes patients, counting carb grams is necessary.
Just as distributing them evenly between meals. The reason is that carbs influence blood sugar levels.
It is crucial for type 2 diabetes patients to have a carb plan that helps to stabilize their blood sugar to normal levels. Typically, two to four servings of 15 carb grams per meal or snack are suitable.
Fiber is essential in the type 2 diabetes diet. It helps type 2 diabetes patients to feel full, as well as helps with blood sugar control. Fiber includes plant foods like fruits, vegetables, nuts, whole grains, legumes, and beans.
Type 2 diabetes patients with a high fiber diet are at a lower risk for heart disease and high blood pressure.
Diabetes risks include heart disease. Therefore, limiting unhealthy fat like trans-fat and saturated fat.
High blood pressure is associated with type 2 diabetes. Therefore, restricting or reducing salt in the diet is crucial. Salt is proven to increase the risk of high blood pressure.
Healthy eating and exercising are essential to avoid and help to manage type 2 diabetes. Other factors crucial in helping to control type 2 diabetes include maintaining a healthy weight. Insulin therapy may be encouraged early on with the disease.
However, most type 2 diabetes patients do not start insulin therapy for 10 to 20 years after the onset of their disease. Type 2 diabetes is not curable, but it is controllable. Management is crucial as poor management can lead to serious complications.