Type 2 Diabetes Treatment

What is type 2 diabetes?

Type 2 diabetes is a common condition affecting 1 in 10 people in the US. In type 2 diabetes, the body has difficulty producing or responding to insulin, causing too much glucose (sugar) in the blood.

How type 2 diabetes works

Type 2 diabetes can occur if your body no longer produces enough insulin, or if it is no longer as responsive to insulin (insulin insensitivity).  Insulin is a hormone created by the pancreas. It allows your body to process glucose from the food you eat, either by using it for energy or storing it for future use. In type 2 diabetes, the insulin is insufficient, which can lead to a build-up of glucose in your blood (hyperglycemia), which can have harmful effects, such as nerve damage (neuropathy), vision loss, and organ damage.

Why diabetes is dangerous

Diabetes is a serious condition. For most people, diabetes is a manageable condition. With the correct medication and lifestyle changes, you can live with diabetes. If your blood sugar is not kept under control, it can result in a range of conditions, some of which are more dangerous than others. These include erectile dysfunction, loss of vision, neuropathy, circulatory problems, heart disease, and others.  

Will diabetes kill me?

With proper management, diabetes is not a life-threatening condition. However, if left untreated or uncontrolled, diabetes can result in death. Diabetes can lead to serious complications, such as:

• Heart disease - which increases your risk of a heart attack
• Foot numbness (neuropathy) - which increases your risk of amputation and infection 
• Kidney disease - which increases your risk of kidney failure

Diabetes also increases your risk of a poor outcome from surgical interventions and some medical treatments. 

Will diabetes shorten my life?

Having type 2 diabetes can shorten your life expectancy by up to 10 years. This depends upon when your diabetes is diagnosed, if you have any other diseases and if you experience any significant complications as a result of your diabetes. 
Rigorously sticking to your medication plan, adjusting your diet, maintaining a healthy weight, exercising regularly, and generally taking care of yourself can help to improve your life expectancy with diabetes.
 

Can type 2 diabetes be cured?

There is currently no permanent cure for type 2 diabetes; however, there are treatment options available. Generally, Metformin (Glucophage, Glumetza, others) is the first medication prescribed for type 2 diabetes. Diabetes can be managed successfully with medication and lifestyle changes, such as maintaining a healthy weight and diet. It is also possible for diabetes to go into remission.

Can type 2 diabetes be reversed?

Type 2 diabetes can go into remission. This does not mean that your diabetes has been reversed or cured because your diabetes may come back. Instead, this means that your blood sugar will remain at healthy levels, without you needing to take medication. Losing a significant amount of weight (approximately 33lbs) within 3-5 months increases your chance of remission. This can be achieved through:

• Increased exercise
• Reduction in calorie intake
• Weight loss surgery (this option is not appropriate for everyone, so you should discuss this with your doctor)

If your diabetes goes into remission, you will need to continue to manage your weight and maintain a healthy diet, but you will not need to take diabetes medication. Nevertheless, little is known about the remission of diabetes and how likely it is to reoccur, so it is important that you continue to have an annual diabetes check-up with your doctor. 
 

What causes type 2 diabetes?

Diabetes occurs when the body becomes less sensitive to insulin, or when the pancreas no longer produces insulin. There are a number of factors that increase your risk of developing type 2 diabetes. This includes:

• Being overweight - Increased body fat can lead to cells becoming more resistant to insulin.
• Inactive lifestyle - Physical activity helps you to maintain a healthy weight, improve your overall fitness, use up glucose for energy, and it makes your cells more sensitive to insulin. 
• Genetics - It is thought there may be a genetic component to the risk of developing type 2 diabetes. People with a close family member (parent or sibling) who has diabetes are more likely to develop the disease themselves.
• Race - People of some races seem to have a higher risk of developing diabetes, but it is hard to separate this from other social factors. Black people, Hispanics, American Indians, and Asian-Americans are considered to have an increased risk of developing diabetes.
• Getting older - Diabetics is more common amongst the older population. This may be due to the association of aging with decreased exercise, increased weight, and other diabetes risk factors, such as high blood pressure. 
• Having high blood pressure - Having blood pressure above 140/90mgHg is connected with an increased risk of diabetes, although the relationship between the two conditions is not fully understood. High blood pressure is also more common in those who are overweight and have an inactive lifestyle. 
• Having abnormal blood lipids - Cholesterol and triglycerides are types of fat (lipids) found in your blood. Having a low level of ‘good cholesterol’ (high-density lipoprotein (HDL) cholesterol) or high levels of triglycerides increases the risk of developing diabetes.
• Having polycystic ovarian syndrome (PCOS) - PCOS is a hormonal condition in which the ovaries are enlarged and produce an excess of male hormones. Women with PCOS also have increased levels of insulin (another hormone). Therefore, women with PCOS are more likely to develop type 2 diabetes in the future. 
• A previous history of gestational diabetes - Gestational diabetes is a type of diabetes that only affects women during pregnancy. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life.
• Giving birth to a baby weighing over 9 pounds (4 kilograms) - Giving birth to a baby that weighs over 9lb is known to increase the mother’s risk of developing type 2 diabetes; however, the reasons for this are not yet understood. 
   

What are the symptoms of diabetes?

The symptoms of type 2 diabetes can be subtle and go unnoticed for several years. Some of the signs and symptoms of type 2 diabetes are:

• Feeling very thirsty
• Needing to pee a lot
• Tiredness and fatigue
• Unexplained weight loss
• Blurred vision
• Slow wound healing
• Frequent yeast infections

How diabetes affects the body

Diabetes affects the body in a number of ways. In type 2 diabetes, your pancreas no longer produces enough insulin, or your body has become resistant to insulin. This can lead to a build-up of glucose in your blood. This excess blood glucose can damage small blood vessels, such as in your eyes, feet, and some internal organs. This blood vessel damage reduces the amount of oxygenated blood that reaches these body parts, which can cause further damage to nerves and organs themselves. This is why diabetes sometimes leads to neuropathy (reduced sensation), decreased vision, and heart or kidney disease. 

What are the symptoms of high and low blood sugar?

Diabetes with high blood sugar

High blood sugar, also known as hyperglycemia, has the following symptoms:

• Dry mouth
• Increased thirst
• Weakness
• Headache
• Blurred vision
• Frequent need to urinate
• Dry skin

Diabetes with low blood sugar

Low blood sugar, also known as hypoglycemia, has the following symptoms:

• Sweating 
• Shaking
• Pale skin
• Irritability
• Nervousness
• Increased hunger
• Lack of coordination 
• Drowsiness
• Confusion

The symptoms of low blood sugar are sometimes confused with drunkenness. Due to the high sugar content of alcohol, it is recommended that people with diabetes avoid drinking alcoholic beverages. But you should be aware that someone who may appear to be drunk, could be diabetic and hypoglycemic. 
 

How is diabetes diagnosed?

Diabetes is diagnosed through a blood test. Many people with diabetes do not experience any noticeable symptoms, so diabetes is often picked up through screening programs or other blood tests. 

There are two diabetes blood tests - a fasting blood sugar (FBS) test or an A1c blood test (also known as a glycated hemoglobin test). For the fasting test, you must not have anything to eat for at least 8 hours before your blood test (your doctor will often try to arrange this early in the morning to facilitate this). This works by measuring the amount of glucose in your bloodstream. 

You do not need to fast for an A1c blood test, because this measures the percentage of red blood cells (hemoglobin) that have been attached to glucose (sugar) molecules. 

You may also be given a glucose tolerance test, in which glucose is given orally, and blood samples are taken afterward at several time intervals to measure how quickly it has been cleared from the bloodstream. 

What do the diabetes test results mean?

If any of the following apply, you will be diagnosed with diabetes:

• Your blood sugar level is equal to or greater than 126 mg/dl (7 mmol/l).
• You have two random blood sugar tests that show your blood sugar to be at least 200 mg/dl (11.1 mmol/l), and you have diabetes symptoms.
• You have an oral glucose tolerance test with results over 200 mg/dl (11.1 mmol/l).
• Your A1c test is greater than 6.5 percent on two separate days.
   

Are diabetes tests accurate?

Both urine tests and blood tests are available for diabetes. They work by measuring the amount of glucose in the sample. However, urine tests are not considered to be accurate enough for a diagnosis, but they are often used in screening programs. Therefore, if you have had a urine test for diabetes, you should visit your doctor to confirm the results with a blood test. 

Some pharmacies and health fairs may offer blood glucose tests, but these are also not considered as accurate as the blood tests available from your doctor, so you should visit your doctor to confirm the results. 

If you are testing your blood sugar using a home test kit, it is important that the test strips are in date and have not been damaged in any way, and the blood glucose meter is good quality and has been calibrated accurately. 
 

What are the different types of diabetes?

There are three main diseases that come under the bracket of diabetes. 

Type 1

Type 1 diabetes occurs most commonly in children and young adults, although it can occur at any age. In type 1 diabetes, your body produces very little or no insulin. People with type 1 diabetes are insulin-dependent and need daily injections of insulin to keep their blood sugar levels under control. 

Type 2

Type 2 diabetes is more common in adults, although increasing numbers of children are now developing type 2 diabetes. Type 2 diabetes is strongly linked to being overweight, a lack of exercise, and other health conditions such as high blood pressure and high cholesterol. In type 2 diabetes, you may produce an insufficient level of insulin, or your body can be less sensitive to the insulin that it does produce. Type 2 diabetes may be controlled by dietary changes, exercise, and maintaining a healthy weight, however, this does not work for everyone, and most people will also need medication to help them to keep their blood sugar under control. 

Gestational Diabetes

Gestational diabetes is the occurrence of diabetes with pregnancy. It involves high blood sugar levels that last until shortly after the child is born. Gestational diabetes can cause complications for both the mother and child. The treatment for gestational diabetes varies from person to person. Some people can use diet and exercise to keep it under control, whereas others may need medications such as Metformin or Insulin.

What is prediabetes?

Prediabetes is similar to diabetes. While your blood sugar is raised in prediabetes, it is not high enough for a diagnosis of diabetes to be made. Prediabetes often progresses into type 2 diabetes, although if appropriate changes are made, it is possible to prevent this development.  

Can diabetes cause weight gain?

In type 2 diabetes, insulin levels can be high. Insulin has several roles, one of which is to help with the storage of fat and to reduce the fat used by the body. Therefore, it can be harder for people with diabetes to lose weight, and if the diet is not strictly controlled, people with diabetes are more likely to put on excess weight as well. 

How diabetes affects the feet

Increased levels of glucose in the blood can cause damage to the nerves in the feet. This means that you may become less sensitive to pain. At first, this may appear to be a benefit, but it actually means that you can cause serious damage to your feet without being aware of it. Charcot foot disease occurs when people with diabetes break their feet without noticing it. And many people require amputation after a foot injury that went undetected. 

In addition, diabetes can also reduce your circulation and cause damage to the blood vessels in your feet. This means that if you do get a foot injury, it will heal much more slowly than normal. Poor blood supply to the feet also increases the risk of foot ulcers and infection, which can lead to amputation. 

To avoid foot problems associated with diabetes, it is important that you check your feet regularly - at least once a day. You should check for any cuts, bruises, swelling, or other injuries even if you do not feel that anything is wrong. Identifying a problem early makes it much more likely that you will recover quickly and avoid any serious complications. 
 

How diabetes affects kidneys

Diabetes is the leading cause of kidney disease in the US. Over several years, the high glucose levels in your blood can damage the blood vessels in the kidneys. This damage affects how well the kidneys can function and leads to kidney disease. High blood pressure is also common among people with type 2 diabetes and can also lead to kidney damage. 

To avoid doing damage to your kidneys, you should try to maintain your blood glucose levels within the target range, and you should take steps to prevent or reduce high blood pressure. A healthy diet, exercise, and maintaining a healthy weight should help you to avoid increased blood glucose or blood pressure.
 

When diabetes affects the eyes

The retina is the part of the eye that is sensitive to light. It contains delicate blood vessels, which, over time, can be damaged by elevated glucose levels in the blood, as found in diabetes. This can cause: 

• Blurred vision
• Changes in your perception of color
• Dark patches in your visual field
• Blindness

This condition is known as diabetic retinopathy, and the changes usually occur in both eyes. 

Risk factors for diabetic retinopathy include:

• High blood glucose levels
• High blood pressure
• High cholesterol
• Length of time you have had diabetes
• Pregnancy
• Smoking
• Being African-American, Hispanic or Native American

Some of these risk factors are beyond your control. However, healthy lifestyle choices, such as maintaining a healthy weight, not smoking, exercising regularly, and eating a diabetes-friendly diet, can reduce your chances of diabetic retinopathy.
 

Why diabetes leads to amputation

Every day 230 Americans with diabetes have an amputation. This is usually the result of a diabetic foot ulcer. Diabetic foot ulcers are sores that fail to heal. High blood glucose levels over time, can damage the blood vessels and nerves in the feet. This means that if damage to the foot occurs, you are less likely to experience pain, and the healing process will be slower. This makes people more prone to infection and extensive tissue damage, so in some cases, amputation is the best course of treatment. 

Maintaining your blood glucose targets, and living a healthy lifestyle reduces your chances of developing neuropathy and blood vessel damage. But it is still a good idea to check over your feet daily so that you will notice if you do start to lose sensation and if any injuries occur.

Why diabetes causes neuropathy

Neuropathy is a type of nerve damage affecting at least half of all people with diabetes. Over time, high blood glucose levels cause damage to the small blood vessels that supply your nerves. This means that the nerves don’t get enough nutrients and oxygen, and therefore, the nerves become damaged. 

Your nerves are responsible for many different types of signaling inside your body. Peripheral neuropathy is common in people with diabetes and causes a numbness or tingling sensation in the feet. But autonomic neuropathy affects as many as 30% of people with diabetes. Autonomic neuropathy is where the nerves that communicate with your internal organs become damaged. You may not notice this yourself, but it can cause changes in your heart rate, blood pressure, and digestive system, among others. 

Other types of neuropathy that you may experience are focal neuropathy and proximal neuropathy. Focal neuropathy is damage to a single nerve. This means that only a small area is affected. Carpal tunnel syndrome is a type of focal neuropathy. Proximal neuropathy is a rare and severe type of nerve damage that occurs around your hip, buttock, and thigh. Proximal neuropathy can be very painful and can also cause weakness in the legs and weight loss. 
 

Why diabetes causes hypertension (high blood pressure)

Diabetes and high blood pressure (hypertension) often co-exist. Many people have hypertension before they are diagnosed with diabetes. This is because many of the health and lifestyle factors that predispose someone to high blood pressure (obesity, lack of exercise, poor diet) are also risk factors for type 2 diabetes. However, diabetes can also increase your chances of developing high blood pressure. This is because elevated glucose levels can, over time, cause damage to the nervous system. The nervous system is responsible for our sense of touch and pain, but it also plays a role in processes such as maintaining blood pressure and heart rate (this is known as the autonomic nervous system). When the nerves in the autonomic nervous system become damaged (autonomic neuropathy), 

Diabetic yeast infections

Yeast infections are caused by an overgrowth of candida albicans - a fungus naturally found on the body. Candida is part of the skin’s natural microbiome, but if it proliferates too much, it can cause a yeast infection and uncomfortable symptoms such as itching, pain, and a soft-cheese-like discharge.

High blood sugar is one of several factors that can make the skin more ‘friendly’ to candida, allowing it to grow out of control. Therefore, diabetes can increase the chances of developing yeast infections. Maintaining appropriate blood glucose levels and avoiding other risk factors for yeast infections, such as smoking and obesity, can reduce the chances of recurrent diabetic yeast infections.
 

Diabetes and depression

Diabetes can be a difficult condition to manage. It involves closely monitoring your diet and making significant lifestyle changes. Therefore, depression is common among people with diabetes. In addition, diabetes can lead to several other health conditions, which can further increase your risk of depression. 

There are several treatment options available for people with diabetes and depression. 

• Diabetes self-management programs (DSMPs) are designed to help you manage your diabetes symptoms as well as any psychological challenges that you may face. They can help you to make lifestyle changes that can improve your diabetes, as well as your mental health. 
• Cognitive-behavioral therapy (CBT) is a type of psychotherapy therapy that helps you to modify your behaviors and thought process to improve your mental health. Many people with diabetes report improved psychological wellbeing through CBT, which leads to improved management of diabetes.
• Various medications are available to help with depression. You may need to try a few different options before finding the one that works best for you, but many people find these to be effective, especially when combined with other lifestyle changes.
• Lifestyle changes such as increased exercise and a healthy diet can improve mental health.

With all these options available, if you think you have both diabetes and depression, you should speak to a doctor about what options are available and which solutions may be most effective in your situation. 

You are also more likely to develop diabetes if you have depression. It is thought that this is because depression can lead you to live a less healthy lifestyle, such as smoking, lack of exercise, weight gain, and an unhealthy diet. If you feel that you may have depression, you should speak to your doctor or a psychiatrist who can help you to deal with your problems and reduce the impact on your physical health. 
 

What is like diabetes but not diabetes?

Some of the symptoms of diabetes, such as fatigue, shaking, drowsiness, and confusion, can be found in several other conditions. This leads many people to wonder if they have diabetes or something else entirely. If you have any of the diabetes symptoms, it is a good idea to go to your doctor for a blood test to confirm whether you have diabetes. One of the things that may be picked up instead is prediabetes. Prediabetes is a condition in which you do have raised blood sugar levels, but they are not high enough to warrant a diagnosis of diabetes. Unless appropriate lifestyle changes are made, prediabetes does often develop into type 2 diabetes. 

Diabetes and pancreatic cancer

Diabetes is a symptom of pancreatic cancer, which can be worrying for many people who know or suspect that they may have diabetes. However, diabetes is far more common than pancreatic cancer affecting 10.5% of the US population, compared to only 57,600 people in the US (0.017%) who will be diagnosed with pancreatic cancer each year. In addition, the symptoms of pancreatic cancer are far more severe than those of diabetes, including:

• Jaundice (yellowing of the skin and eyes caused by liver failure)
• Abdominal pain, caused by the tumor putting pressure on surrounding organs
• Weight loss and reduced appetite
• Nausea and vomiting (caused by the tumor putting pressure on the stomach) 
• Gallbladder or liver enlargement
• Blood clots
• Therefore, you should be reassured that having symptoms of diabetes does not mean that you have pancreatic cancer. But if you are concerned, you should speak to your doctor who can examine you and explain things in more detail. 
   

How diabetes is treated

Diabetes treatment depends upon the stage of your diabetes. Some people can control their diabetes through diet and lifestyle changes alone, some people may require medication, such as Metformin, and some may be insulin-dependent. Your doctor will help you to know which treatment is most suitable for you. 

What treatment is used when diabetes starts?

In the early stages of diabetes (especially in prediabetes), lifestyle changes may be enough, depending upon your situation and any delay in diagnosis. Improving your diet, losing weight, quitting smoking, and exercising more are some of the steps you could take to keep your diabetes under control. 

Metformin for diabetes

Metformin is a medication used for people who cannot control diabetes through lifestyle changes alone, but they are not yet insulin-dependent (their pancreas still produces insulin). Metformin  

What happens when diabetes medication stops working?

Many people begin taking a medication called Metformin. Metformin only works as long as your pancreas continues to produce insulin. If your pancreas no longer produces insulin, your doctor will no longer prescribe you Metformin. Instead, they will prescribe you insulin via self-injection to allow you to regulate your blood sugar. 

What happens when diabetes goes untreated?

If diabetes goes untreated, it will continue to worsen. This can result in serious health problems, including irreversible damage to your eyes, heart, kidneys, and nervous system. If you have been diagnosed with diabetes, it is vital that you follow the treatment plan as outlined by your doctor. If you suspect that you may have diabetes, you must ensure that you get tested so that you can take steps to prevent the disease from progressing. 
 

• CDC > Type 2 diabetes
• Diabetes.co.uk > Diabetes life expectancy
• Mayo Clinic > Diabetes
• MedicineNet > Diabetes urine tests
• Harvard Health Publishing > What's the difference between blood sugar and hemoglobin A1c?
• Cleveland Clinic > Diabetes Mellitus
• International Diabetes Federation > About diabetes
• Wilcox, G. Insulin and Insulin Resistance. Clinical Biochemist Reviews, 2005, 26(2), 19–39.
• Mayo Clinic > Diabetic neuropathy
• National Institute of Diabetes and Digestive and Kidney Diseases > Diabetic kidney disease
• Mayo Clinic > Diabetic retinopathy
• National Institute of Diabetes and Digestive and Kidney Diseases > Diabetic neuropathy
• Pancreatic Cancer Action Network > Diabetes and pancreatic cancer
• Diabetes Research Institute Foundation > Diabetes statistics
• American Cancer Society > Signs and symptoms of pancreatic cancer
• Mayo Clinic > Diabetes and depression
• CDC > Managing diabetes
• Diabetes UK > What is diabetes remission?