Type 2 diabetes

What is Type 2 Diabetes?

Type 2 diabetes is a chronic condition that causes high blood sugar levels, insulin resistance, and inadequate insulin production. Insulin is a hormone that is produced by the pancreas. Insulin transports glucose (sugar) from the bloodstream to the tissues to produce energy. This function of insulin does not take place in type 2 diabetes. Thus, glucose piles up in the bloodstream, leading to high blood sugar levels.

Alternate names

• Diabetes mellitus type 2
• Adult-onset diabetes
• Non-insulin-dependent diabetes mellitus

Is type 2 diabetes a medical emergency?

Non-insulin-dependent diabetes mellitus is not a medical emergency.

Causes

The exact causes of diabetes mellitus type 2 are unclear, but genetics and environmental factors contribute to the development of Non-insulin-dependent diabetes mellitus.

Risk factors

Factors that influence the development of type 2 diabetes are:

• Obesity
• Advanced age
• A sedentary lifestyle or lack of physical activity
• Prior family history of diabetes
• Unhealthy diet: Eating a lot of junk foods
• Stress
• Excess body fat
• Smoking
• Gestational diabetes: Women who acquire diabetes during pregnancy have an increased risk of developing adult-onset diabetes
• Medical conditions: Other medical conditions like acromegaly, Cushing's syndrome, hyperthyroidism, polycystic ovarian syndrome, etc., can contribute to the development of type 2 diabetes
• Medications: Medications like glucocorticoids, thiazides, beta-blockers, atypical antipsychotics, and statins can increase the risk of developing Adult-onset diabetes mellitus

Signs & symptoms

Signs and symptoms are not recognized immediately. The symptoms develop slowly, and they include:

• Increased thirst (polydipsia)
• Frequent urination (polyuria)
• Fatigue and tiredness
• The increased appetite (polyphagia)
• Unexplained weight loss
• Non-healing sores
• Frequent infections
• Vision changes

Investigations

Investigations for diabetes mellitus type 2 are:

• Glycated hemoglobin (HbA1C) test: This test measures the average blood sugar level for the past two to three months
  • The normal A1C level is below 5.7 percent.
  • An A1C level between 5.7 and 6.4 percent is considered prediabetes
  • An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.
• Random blood sugar test: A blood sample is collected irrespective of the food consumed. The blood sugar level of 200 mg/dL (11.1mmol/L) or above suggests diabetes.
• Fasting blood sugar test: A blood sample is collected after an overnight fast
  • A blood sugar level of less than 100 mg/dL (5.6 mmol/L) is normal.
  • Blood sugar level from 100 to 125 mg/dL (5.6 to 6.9mmol/L) is considered prediabetes.
  • A blood sugar level of 126 mg/dL (7mmol/L) or higher on two separate tests is considered diabetes.
• Oral glucose tolerance test: A sugary liquid drink is consumed following an overnight fast. Blood sugar levels for the next two hours are checked.
  • A blood sugar level of less than 140 mg/dL (7.8 mmol/L) is normal.
  • A blood sugar level between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.
  • The blood sugar level of 200 mg/dL (11.1mmol/L) or higher after two hours indicates diabetes

After being diagnosed positive for diabetes mellitus type 2, the A1C level is checked every few months. The change in the A1C level indicates a change in medication and diet plans. Blood and urine tests are performed periodically to check cholesterol, thyroid, liver, and kidney function. An eye checkup is also recommended to identify any diabetes-induced eye disorders.

Diagnosis

The diagnosis of adult-onset diabetes depends on the results of investigation tests.

Treatment options

There is no cure for adult-onset diabetes. Treatment focuses on controlling the sugar levels and taking steps to avoid further complications.

Medical treatment

T2D Mellitus can be controlled with diet and exercise; however, in a few cases, blood sugar levels can’t be controlled with diet and exercise alone. They require medications to keep blood sugar levels under control. Medications used for the treatment are:

• Metformin
• Sulfonylureas
• Meglitinides
• Thiazolidinediones
• DPP-4 inhibitors
• GLP-1 receptor agonists
• SGLT2 inhibitors
• Insulin therapy

Indications for surgery/surgical treatment

T2D that is caused due to obesity may need a weight loss reduction procedure called bariatric surgery.

Role of Diet/Exercise/Lifestyle changes/Preventive measures

Preventive measures and lifestyle modifications for T2D include:

• Maintaining adequate weight
• Healthy diet: Consuming more green leafy vegetables and limiting sugary drinks
• Engaging in regular exercise
• Avoiding a sedentary lifestyle
• Quitting smoking or other tobacco products
• Limiting alcohol intake
• Keeping blood pressure and cholesterol under control
• Scheduling regular eye exams

Complications

T2D Mellitus can lead to various complications affecting many major organs like the heart, kidneys, eyes, blood vessels, and nerves. Some of them are listed below.

• Heart disorders: T2D can lead to heart abnormalities like cardiovascular disease, ischemic heart disease, and stroke
• Nerve damage: Excessive sugar levels in the blood can cause tingling, numbness, and pain at the tips of the toes and fingers. Gradually, it leads to sensory loss in the affected limbs. Erectile dysfunction can occur in a few men.
• Kidney damage: Diabetes can cause kidney failure and can lead to kidney transplantation
• Eye damage: Diabetes can lead to eye disorders like cataracts and glaucoma. It can damage the blood vessels in the retina, leading to complete blindness.
• Non-healing sores: Untreated sores or injuries can progress into serious infections that can eventually lead to amputation
• Hearing loss: Diabetes can cause impairments in hearing
• Infections: Individuals with diabetes are more vulnerable to develop bacterial and fungal infections
• Obstructive sleep apnea: Sleep apnea is a common condition that develops in people with diabetes
• Dementia: T2D increases the risk of dementia and cognitive dysfunction. It can cause Alzheimer's or vascular dementia.

Prognosis

The prognosis of T2D varies from individual to individual. It depends upon how well the sugar levels are maintained. However, diabetes can lead to complications of other organs and could be life-threatening.

When to contact the doctor/How to identify the complications?

Medical consultation is recommended after noticing any signs and symptoms of Adult-onset diabetes, such as frequent urination, excessive thirst, and unexplained weight loss.

Indications for hospitalization if required

Hospitalization is required in individuals with type 2 diabetes for uncontrolled sugar levels and any potential vascular complications.

Suggested clinical specialists/Departments to consult for this condition

• Endocrinology