Type 2 Diabetes

What is type 2 diabetes?

​​Type 2 diabetes is when your body doesn’t process sugar well, causing high blood sugar levels. Blood sugar, called glucose, is usually moved into muscle and fat cells with the help of the hormone insulin.

In type 2 diabetes, your cells become resistant to the effects of insulin, so blood sugar becomes elevated. This is more likely to happen in people who are overweight. Over time, elevated blood sugar levels can damage many body tissues including the heart, kidneys, nerves, and eyes. Type 2 diabetes affects more than 34 million Americans.

Type 2 diabetes symptoms

Early signs of type 2 diabetes

• Often there are no symptoms. You may not know you have type 2 diabetes until it’s found during routine blood testing.

Common symptoms

• Frequent urination
• Frequent thirst
• Blurry vision
• Fatigue

Symptoms as it worsens

• Rapid weight loss
• Nausea
• Vomiting
• Abdominal pain
• Difficulty breathing
• Lethargy

If you have any of these more severe symptoms, go to the ER right away. They could be a sign of a potentially life-threatening complication of diabetes called diabetic ketoacidosis (DKA). DKA is when insulin levels drop and your body cannot use blood sugar for fuel. Instead, other substances are broken down for fuel and blood acid then builds up, which is dangerous.

Type 2 diabetes vs type 1

The majority of people with diabetes (90%) have type 2 diabetes. In people at risk for diabetes, body tissue gradually becomes less sensitive to the effects of insulin, so the body can’t move sugar out of the blood and into cells, leading to high blood sugar levels.

The remaining 10% of people have type 1 diabetes, which means the body does not produce insulin. Type 1 diabetes develops when the immune system mistakenly attacks the cells in the pancreas that make insulin. It’s typically seen in younger people and is often an inherited condition.

Risk factors

There are many factors that increase your risk for developing type 2 diabetes including:

• Family members with diabetes
• Being overweight or obese
• Being older than 45 years old
• An unhealthy diet
• Not exercising
• High cholesterol
• High blood pressure
• Being of Hispanic, African, or Asian descent
• In people with risk factors, pregnancy can increase their risk of diabetes

Your doctor may screen you for diabetes if you’re overweight or obese and have one of the following risk factors:

• Parent or sibling with diabetes
• African American, Hispanic, Native American, Asian American, Pacific Islander
• Heart disease
• High blood pressure
• High cholesterol
• Physically inactive
• Women with polycystic ovarian syndrome

You may also be tested for diabetes if you’re age 45 and older, have prediabetes (impaired blood sugar tolerance), or are pregnant and have a family history of diabetes during pregnancy (gestational diabetes).

Treating type 2 diabetes

The goal of treatment is to keep your blood sugar levels in a healthy range. While it’s important to follow a healthy diet, lose weight if you’re overweight, and exercise, most people also need to take medication.

Maintaining normal blood sugars is also important for preventing long-term complications. Ask your doctor for the names of some registered dietitian—they can work with you to create an eating plan.

Healthy diet

• There is no one-size-fits-all eating plan for people with diabetes. You can choose the one that is best for you. Effective plans include the Mediterranean, plant-based, and DASH diets.
• Try to maintain a balanced diet of whole foods and foods that are low in added sugars and refined grains. And try to not eat processed foods. Carbohydrates really impact blood-sugar levels, so choose whole grain starches that are high in fiber and low in added sugars, and a lot of non-starchy vegetables.
• The plate method can help you limit your carbohydrates. Portion your plate so that half of it contains non-starchy vegetables, a quarter contains protein, and a quarter contains carbohydrates—ideally whole grain.

Regular exercise

• Try to exercise for 30 minutes 5 days a week for a total of 150 minutes. Include aerobic exercise (walking, jogging, cycling, swimming), resistance exercises for strength (like weights or resistance bands), and flexibility and balance exercises (like tai chi and yoga).
• Avoid sitting and being sedentary (not moving) for long periods of time. Stand up and do some light activity every 30 minutes.
• If you’re overweight, try to lose weight. Even small changes, like a 5% weight loss, can really improve your blood sugar levels.

Oral medications

Most people with type 2 diabetes need medication to help control it. If your blood sugar levels are not that high, your doctor may wait to put you on medication. They may have you keep track of blood sugar levels for a few months to see if lifestyle changes make a difference.

First choice

Metformin: This increases the body’s sensitivity to insulin and decreases sugar production from the liver. Metformin is the first choice for diabetes because of its effectiveness, tolerability, and low cost.

Other oral medications

If you can’t take metformin, your doctor may try you on other types of medications.

GLP-agonists (e.g. Ozempic, Semaglutide, etc) make you feel full faster, reducing your food intake and helping you lose weight.

Sulfonylureas and glinides increase the body’s insulin production.

Thiazolidinediones increase sensitivity to insulin.

Di-peptidyl peptidase-4 inhibitors reduce the breakdown of insulin.

Alpha-glucosidase inhibitors and sodium-glucose co-transporter 2 inhibitors eliminate sugar through the gut or urine.

SGLT2 inhibitors have been shown to slow the worsening of heart-related complications in people who have cardiovascular disease, particularly heart failure or chronic kidney disease.

Injectable hormones

Non-insulin injections (glucagon-like peptide 1 agonists) can increase the production of insulin from the pancreas, improve body tissue sensitivity to insulin, and help with weight loss by slowing down the emptying of the stomach. Treatment ranges from once daily to once a week. Your doctor may recommend these if you have cardiovascular or kidney disease.

Insulin

Insulin is injected under the skin to move sugar from the blood and into the cells. When your blood sugar levels are very high, you may need insulin to quickly lower blood sugars. Typically, a rapid-acting insulin is injected several times a day before eating, and a long-acting insulin is injected once a day to keep a constant level of blood sugar control.

Some people who have problems with certain medications or those with serious kidney or liver disease may need insulin as well.

Next steps

If you notice symptoms of diabetes, talk to your doctor about being tested. There are several tests used to diagnose diabetes, including:

• Random blood sugar test (can do right away—no fasting)
• Fasting plasma glucose test (no food or drink for 8 hours)
• Glycated hemoglobin (A1C) test
• Oral glucose tolerance test

If you have diabetes, your doctor may want you to see an endocrinologist (hormone specialist) to check how the diabetes is affecting your body and create a treatment plan.

• You’ll have lab tests to evaluate your average blood sugar (hemoglobin A1C), kidney function, liver function, and cholesterol.
• The doctor will order tests to look for signs of diabetes complications, such as a urine sample (to check how well the kidneys are working) and a foot exam (to check for any damage to blood vessels, nerves, skin, and nails).
• You also need to see an eye doctor. They will dilate your eyes to check for any retina damage caused by diabetes.

At-home blood sugar monitoring

An important part of controlling your blood sugar is to check your levels regularly. Your doctor will recommend that you test your blood sugar at various times of the day, such as after eating a meal or exercising. How often you do this depends on what medications you’re taking.

If you’re taking insulin, you’ll check it more frequently (up to 6–8 times daily). Other medications may only require blood sugar checks 1–2 times daily. Types of blood sugar monitoring include:

• Finger prick test. You use a lancet to make a small cut on the fingertip. Extracted blood is applied to a test strip that’s attached to a glucose reading machine called a glucometer.
• Continuous glucose monitoring. This is a wearable device that measures sugar levels from beneath the skin. You usually put on a new one every 10–14 days.

What are the top 3 things you can do to help control your blood sugar?

• A continuous glucose monitor, a wearable device to see blood sugar levels instantaneously, is a helpful tool and dramatically helps with diabetes control.
• There are many health-based apps you can download to help with wiser diet choices.  They have the nutrition facts from most brand-label food products as well as non-branded items such as fruits.
• A common misconception is that medications alone will fix diabetes.  Medications are used as an aid but not a substitution for diet and exercise modifications.  People who achieve the greatest diabetes control are those who maintain healthy diets and regular exercise along with their daily medications.