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Diabetes, Type 2

Diabetes, Type 2

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Definition

Glucose is a type of sugar. It comes from food, and is also created in the liver. Glucose travels through the body in the blood. It moves from the blood to cells with the help of a hormone called insulin. Once glucose is in those cells, it can be used for energy. Insulin also helps glucose to move into the liver for storage if there is too much to use.

Diabetes is a condition that makes it difficult for the body to use or store glucose. This causes a buildup of glucose in the blood. It also means the body is not getting enough energy. Type 2 diabetes is one type of diabetes. It is the most common type in adults.

Medication, lifestyle changes, and monitoring can help control blood glucose levels.

Causes

Type 2 diabetes is often caused by a combination of factors. The initial factor is that the body becomes resistant to insulin. This means there is insulin in the body, but the body cannot use it effectively. Insulin resistance is often related to excess body fat. A second factor is that the body begins to make less insulin.

Risk Factors

Type 2 diabetes is more common in people who are aged 45 years and older, but can develop in children. It is also common in younger people who are obese and belong to at-risk ethnic groups. Other factors that increase the chance of type 2 diabetes include:

  • Prediabetes—impaired glucose tolerance and impaired fasting glucose
  • Metabolic syndrome—a condition marked by elevated cholesterol, blood glucose, blood pressure, and central obesity
  • Excess weight or obesity, especially central obesity
  • Family history of type 2 diabetes
  • History of gestational diabetes, or having a baby that weighs over 9 pounds at birth
  • Being born small or large for gestational age
  • Certain medications, such as glucocorticoids or thiazides
  • Certain ethnic groups, such as African American, Hispanic, Native American, Hispanic American, Asian American, or Pacific Islander
  • Endocrine disorders, such as Cushing’s syndrome, hyperthyroidism, acromegaly, polycystic ovary syndrome, or acute pancreatitis
  • Conditions associated with insulin resistance, such as acanthosis nigricans
  • Lack of exercise
  • Poor diet—high intake of processed meats, fats, sugar-sweetened foods and beverages, and calories
  • High blood pressure
  • History of cardiovascular disease
  • Depression

Symptoms

Diabetes may be present for years before symptoms occur.

Symptoms caused by high blood sugar include:

  • Increased urination
  • Extreme thirst
  • Hunger
  • Fatigue
  • Blurry vision
  • Irritability

Symptoms caused by chronic hyperglycemia may include

  • Frequent or recurring infections
  • Poor wound healing
  • Numbness or tingling in the hands or feet
  • Problems with gums
  • Itching
  • Problems having an erection
  • Symptoms of heart or kidney disease

Diagnosis

You will be asked about your symptoms and medical history. You will also be asked about your family history. A physical exam will be done.

Diagnosis is based on the results of blood testing. American Diabetes Association (ADA) recommends diagnosis be made if you have one of the following:

  • Symptoms of diabetes and a random blood test with a blood sugar level greater than or equal to 200 mg/dL (11.1 mmol/L)
  • Fasting blood sugar test is done after you have not eaten for 8 or more hours—showing blood sugar levels greater than or equal to 126 mg/dL (7 mmol/L) on two different days
  • Glucose tolerance test measures blood sugar 2 hours after you eat glucose—showing glucose levels greater than or equal to 200 mg/dL (11.1 mmol/L)
  • HbA1c level of 6.5% or higher—indicates poor blood sugar control over the past 2-4 months

mg/dL = milligrams per deciliter of blood; mmol/L = millimole per liter of blood

You may also need blood tests to confirm diabetes is type 1 and not type 2. These may include:

  • Insulin level or C-peptide tests—to see how much insulin is being made by the pancreas
  • Tests that look for antibodies that are working against your pancreas

You may also need other tests, including.

  • Cholesterol levels
  • Urine for glucose, ketones, or albumin
  • Liver and kidney function tests in adults

Treatment

Treatment aims to:

  • Maintain blood sugar at levels as close to normal as possible
  • Avoid hypoglycemia
  • Prevent or delay complications
  • Control other conditions, such as high blood pressure and high cholesterol

Diet, exercise, and weight loss are recommended for all patients. Most patients will also begin medication.

Complications

Over a long period of time, high blood glucose levels can damage vital organs. The risk of complications increases with increasingly poor control

Prevention

To help reduce your chance of type 2 diabetes:

  • Participate in regular physical activity
  • Maintain a healthy weight
  • Drink alcohol only in moderation (2 drinks per day for a man, and 1 drink per day for a woman)
  • Eat a well-balanced diet:
    • Get enough fiber
    • Avoid fatty foods
    • Limit sugar intake
    • Eat more green, leafy vegetables
    • Eat whole fruits, especially apples, grapes, and blueberries
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