Type 2 diabetes mellitus, also called non-insulin dependent, or maturity-onset diabetes mellitus is a disease where the pancreas makes normal or elevated levels of insulin, but the cells of the body do not respond to the insulin. Consequently, blood glucose concentration stays higher than normal, especially after a meal. Cells which do not respond to insulin are said to be insulin resistant.
Type 2 diabetes accounts for 90 % to 95 % of cases diagnosed with diabetes compared to type 1 diabetes which accounts for less than 10 %. Also, it is more common in adults above the age of 45 largely due to body weight and physical inactivity.
Signs and symptoms of type 2 diabetes
Signs and symptoms of type 2 diabetes include:
- Frequent urination: This is a way for your kidney to attempt to expel excess sugar.
- Increase thirst: This occurs because of frequent urination and dehydration. Dehydration occurs because the high level of glucose in your blood causes it to pull water from every possible direction in an attempt to dilute the sugar.
- Increase hunger: Glucose is not available for energy due to inability of the body to use insulin. This makes the body to be low in energy and hence creates a feeling of increase hunger.
- Unusual fatigue and body weakness: This occurs because your body is low in energy and can’t make use of glucose. In addition, it spends most of the little energy it has attempting to expel excess glucose out of the body.
- Unexplainable weight loss: Because insulin is not available to break down sugar, your body starts to burn fat and muscle for energy. This results in unexplained weight loss.
- Cuts and wounds take longer to heal: Excess sugar weakens and damages blood vessels. This causes poor circulation of blood to cells and tissues resulting in slow healing.
- Genital itching or thrush: Excretion of excess sugar through the genitals create a fertile ground for yeast infections.
- Blurred vision: Caused by accumulation of excess glucose in the lenses of the eye.
- Numbness or tingling or in the hands or feet: High sugar levels weaken and damage blood vessels making them unable to deliver oxygen and nutrients to the brain. The result is nerve damage which comes with a feeling of tingling or numbness.
- Darkened skin on certain areas of the body including the armpit, neck, elbows, and knees.
How to differentiate between type 1 and type 2 diabetes signs and symptoms
Signs and symptoms for type 2 diabetes are like those of type 1 diabetes. The main difference is that symptoms for type 1 diabetes are very sudden or rapid such that you won’t miss them while those of type 2 diabetes occur more slowly over time. The slow onset of symptoms from type 2 diabetes makes it difficult to be spotted. As such, some individuals can live with it for more than 10 years without knowing.
Causes and risk factors for type 2 diabetes
Type 2 diabetes (T2D) is caused by a combination of health issues, genetic factors, and unhealthy lifestyle. The following specific risk factors will increase your risk of developing T2D:
- Being physically inactive, overweight, or obese
- Fat distribution: Individuals with fat around their waist and upper body are more susceptible to T2D than those with fat on their hips and lower body.
- Age: Individuals aged 45 and above are at greater risk of developing T2D.
- Gender: Men are more susceptible to T2D than women.
- Family history of diabetes
- History of gestational diabetes mellitus (diabetes developed when pregnant)
- Polycystic Ovary Syndrome (PCOS): PCOS is a disorder in women which causes infertility. Most women with PCOS are insulin resistant and more than half of women with PCOS develop T2D by the age of 40.
- Sleep apnea: This is a sleep disorder in which breathing is interrupted (repeatedly stops and starts) during sleep. Individuals with sleep apnea are prone to insulin resistance and generally develop T2D.
- Prediabetes will eventually lead to T2D if not treated.
- High blood pressure.
- The use of statin medication.
- High cholesterol (non-high-density lipoprotein cholesterol or non-HDL cholesterol) levels.
- High triglyceride levels.
- Non-alcoholic liver disease.
- Race or ethnicity: That is being of African, Native American, Latino, Asian, or Pacific Islander descent.
- Genetic make-up.
- Socio-economic status.
- Geographical location.
Complications of type 2 diabetes
The blood sugar caused by type 2 diabetes needs to be treated or put under control. If left untreated or unattended, type 2 diabetes can lead to both short-term and long-term complications. Some of these complications might already be present at the time of diagnosis. This is because symptoms of type 2 diabetes develop very slowly and might be unnoticeable for several years. However, strict control of your blood sugar level can prevent these complications from getting even worst.
Short-term complications of type 2 diabetes include:
Hypoglycemia is a medical condition where your blood sugar (or glucose) levels are lower than normal. This occurs for diabetes patients who take insulin or a sulfonylurea drug (drug use to treat type 2 diabetes by triggering the release of insulin from the β-cells of the pancreas). If these patients eat less or get physically active, then the excess insulin intake or triggered by the drug will provoke a rapid drop in blood sugar.
Besides, excess alcohol intake will also prevent the liver from releasing glucose into the blood stream. Furthermore, consuming more than 81 mg of aspirin can trigger a drop in blood sugar levels.
Signs and symptoms of hypoglycemia include:
- Rapid heartbeat
- Slurred speech
- Numbness in fingers, toes, and lips
- Whiteness of skin
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS), also called hyperosmolar hyperglycemic state (HHS) is a rare but very dangerous medical condition which occurs when blood sugar (or glucose) gets very high. This causes the body to pass out excess sugar into the urine at a faster rate. Consequently, the rate of dehydration also increases. This can become so severe that it may lead to coma, seizure, swelling of the brain or even death if the person affected does not rehydrate regularly or take medication that can quickly lower their blood sugar level.
Hyperosmolar hyperglycemic nonketotic syndrome is common in elderly people and people who are sick. This is because this group of people can’t effectively hydrate themselves nor manage their blood sugar levels effectively.
Hyperosmolar hyperglycemic nonketotic syndrome can affect people with both type 1 and type 2 diabetes. However, it is mostly seen but in type 2 diabetes patients.
Signs and symptoms of hyperosmolar hyperglycemic nonketotic syndrome include:
- Very high blood sugar level (greater than 600 mg/dL or 33 mmol/L)
- Dry mouth
- Extreme thirst
- Frequent urination
- Blurred vision or loss of vision
- Confusion, drowsiness, hallucination, or fainting
- Weakness or paralysis on one side of the body.
Long-term complications of type 2 diabetes are caused by damage to blood vessels or accumulation of sugar (or glucose) to specific parts of the body over time. Blood vessels are channels or conduits which help blood to transport oxygen, nutrients, and waste. Persistent high blood sugar levels (hyperglycemia) overtime weakens and damage blood vessels. Damaged blood vessels cannot transport blood effectively to tissues or organs for delivery.
Long-term complications due to type 2 diabetes include:
Eye damage (Diabetic retinopathy)
Diabetic retinopathy is characterized by blur vision or complete loss of sight (blindness) and results from damage to the blood vessels at the back of the eye (the retina). It can also be caused by accumulation of glucose in the lens of the eye.
Kidney Disease (Nephropathy)
Kidney disease means the kidney is damaged and its functions are impaired. This results from damage to the tiny blood vessels (capillaries) that forms part of the kidney.
Diabetic neuropathy (nerve impairment or damage)
Here, blood vessels responsible for transporting oxygen and nutrients to the brain and nerves are weakened or damaged. Diabetic neuropathy can be peripheral, autonomic, proximal, or focal. But diabetic peripheral neuropathy is the most common type and affects the nerves going to the hands and feet. Complications with diabetic peripheral neuropathy can lead to amputation of the affected limb(s). Damage to nerves may come with a feeling of tingling, numbness, or pain especially at the tips of the fingers or toes.
Heart disease, stroke, or peripheral vascular disease
These may be triggered by buildups in the walls of blood vessels or blockage of blood vessels which causes them to narrow. In addition to carefully monitoring blood sugar levels, diabetic patients should also check their blood pressure and blood cholesterol levels to avoid theses complications.
High blood sugar can cause sugar to easily accumulate in your saliva or genital due to frequent urination. This creates a good environment for microorganisms to flourish. Consequently, individuals with type 2 diabetes are prone to fungal or bacterial infections of the mouth, urinary tract, or vagina.
Complications during pregnancy
High blood sugar causes complications during pregnancy and can be life threatening to both a mother and her baby. For the baby, there’s risk of miscarriage, still birth or birth defects. On the other hand, the mother runs the risk high blood pressure, preeclampsia, or diabetic ketoacidosis.
Weakened and damaged blood vessels will affect circulation to every part of the body, especially the feet which are furthest from the heart. In addition, nerve damage may also affect the feet causing wounds or infections to go unnoticed. Consequently, diabetics with infections or wound on the feet might not heal easily and such can lead to gangrene. Ultimately, the need for toe, foot or leg amputation may arise.
Damage or narrowing of blood vessels due to high blood sugar can restrict the flow of blood to sexual organs. In men, this may result to erectile dysfunction (impotency) while in women it may result to a loss of sensation.
How to prevent type 2 diabetes
Type 2 diabetes can be prevented or delayed through several ways:
- Maintain a healthy body weight. Because overweight or obesity is one of the major risk factors for diabetes losing weight will greatly decrease your chance of developing type 2 diabetes.
- Stay physically active through regular exercise or brisk walk for at least 150 minutes per week.
- Reduce sugar or sweet beverage intake by keeping your A1C below 7 %.
- Avoid meals containing saturated fat.
- Maintain your blood pressure below 140/90 mmHg.
- Maintain your cholesterol (non-HDL) level below 130 mg/dL. A less stringent value of < 160 mg/dL might still be acceptable.
- Avoid smoking.
- Intake of diabetic medications.
To get the best outcome for preventing type 2 diabetes, discuss your options with your doctor.
Treatment of type 2 diabetes
Type 2 diabetes cannot be cured but unlike type 1 diabetes, it can be prevented and put into remission by regularly monitoring your blood sugar level, regular exercise, healthy diet, and some medications.
Management of type 2 diabetes
Type 2 diabetes can be managed and even put under remission. Managing diabetes is important because it prevents you from having complications and helps you to live a normal life. You can manage your type 2 diabetes as follows:
- Regularly check your blood sugar level and stay within target range as recommended by your doctor.
- Take your diabetes medications regularly as directed by your doctor.
- Eat healthy and balanced diet.
- Stay physically active. That is exercise regularly or brisk walk for at least 150 minutes per week.
- Pay closer attention to your blood sugar levels when you are sick, stress or engaged in a physical activity.
- If your blood sugar goes above 400 mg/dL, immediately seek medical attention.
- Make sure you stay hydrated through regular fluid intake. This might include water, orange juice or any other suitable rehydrating fluid.
- Avoid drinking excess alcohol and never drink alcohol on an empty stomach.
- Always get some rest.
- Know the signs of severe complications such as hypoglycemia and Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) and immediately seek medical attention if need arises.
- Stop smoking.
- Individuals at risk of developing hypoglycemia should always carry glucagon with them. Glucagon is a hormone produced by the alpha cells of the pancreas and stimulates the production of glucose in the liver. So, in the event you get unresponsive or unconscious, a quick injection of glucagon will help to raise your glucose levels back to normal. Under mild cases, taking an orange juice or eating a glucose tablet can quickly raise your blood sugar as well.
- Take good care of your feet, mouth, or genitals to prevent infection or wound.
- Regularly go for medical, dental or eye checkup.
- Diabetes Report Card 2019
- National Diabetes Statistics Report 2020
- Gene-Based Elevated Triglycerides and Type 2 Diabetes Mellitus Risk in the Women’s Genome Health Study
- Statin use and risk of developing diabetes: results from the Diabetes Prevention Program
- Time‐ and Dose‐Dependent Association of Statin Use With Risk of Clinically Relevant New‐Onset Diabetes Mellitus in Primary Prevention: A Nationwide Observational Cohort Study
- Obesity and Type 2 Diabetes: What Can Be Unified and What Needs to Be Individualized?