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Type 2 diabetes
Noninsulin-dependent diabetes; Diabetes - type II; Adult-onset diabetes; Diabetic - type 2 diabetes; Oral hypoglycemic - type 2 diabetes
Type 2 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes.
Causes
Insulin is a hormone produced in the pancreas by special cells, called beta cells. The pancreas is below and behind the stomach. Insulin is needed to move blood sugar (glucose) into cells. Inside the cells, glucose is stored and later used for energy.
When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy.
When sugar cannot enter cells, a high level of sugar builds up in the blood. This is called hyperglycemia. The body is unable to use the glucose for energy. This leads to the symptoms of type 2 diabetes.
Type 2 diabetes usually develops slowly over time. Most people with the disease are overweight or obese when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way.
Type 2 diabetes can also develop in people who are thin. This is more common in older adults.
Family history and genes play a role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your chance of getting the disease.
Symptoms
People with type 2 diabetes often have no symptoms at first. They may not have symptoms for many years.
Early symptoms of diabetes caused by a high blood sugar level may include:
- Bladder, kidney, skin, or other infections that are more frequent or heal slowly
- Fatigue
- Hunger
- Increased thirst
-
Increased urination
Increased urination
Excessive amount of urination means that your body makes larger than normal amounts of urine each day.
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After many years, diabetes can lead to serious health problems, and as a result, many other symptoms.
Exams and Tests
Your doctor may suspect that you have diabetes if your blood sugar level is higher than 200 milligrams per deciliter (mg/dL) or 11.1 mmol/L. To confirm the diagnosis, one or more of the following tests must be done.
-
Fasting blood glucose
level. Diabetes is diagnosed if it is higher than 126 mg/dL (7.0 mmol/L) two different times.
Fasting blood glucose
A blood glucose test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of t...
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Hemoglobin A1c (A1C) test
. Diabetes is diagnosed if the test result is 6.5% or higher.
Hemoglobin A1c (A1C) test
A1C is a lab test that shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your diabe...
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Oral glucose tolerance test
. Diabetes is diagnosed if the glucose level is higher than 200 mg/dL (11.1 mmol/L) 2 hours after drinking a special sugar drink.
Oral glucose tolerance test
The glucose tolerance test is a lab test to check how your body breaks down sugar. Tests to screen for diabetes during pregnancy are done differentl...
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Diabetes screening is recommended for:
- Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
-
Overweight adults (
BMI
of 25 or higher) who have other risk factors
BMI
A good way to decide if your weight is healthy for your height is to figure out your body mass index (BMI). You and your health care provider can us...
ImageRead Article Now Book Mark Article - Adults starting at age 45 every 3 years, or at a younger age if the person has risk factors
If you have been diagnosed with type 2 diabetes, you need to work closely with your doctor. See your doctor as often as instructed. This may be every 3 months.
The following exams and tests will help you and your doctor monitor your diabetes and prevent problems.
- Check the skin and bones on your feet and legs.
-
Check if your feet are getting numb (
diabetic nerve disease
).
Diabetic nerve disease
Nerve damage that occurs in people with diabetes is called diabetic neuropathy. This condition is a complication of diabetes.
ImageRead Article Now Book Mark Article - Have your blood pressure checked at least once a year (blood pressure goal should be 140/80 mm Hg or lower).
- Have your A1C tested every 6 months if your diabetes is well controlled. Have the test every 3 months if your diabetes is not well controlled.
- Have your cholesterol and triglyceride levels checked once a year.
-
Get tests once a year to make sure your kidneys are working well (
microalbuminuria
and
serum creatinine
).
Microalbuminuria
This test looks for a protein called albumin in a urine sample. Albumin can also be measured using a blood test or another urine test called the prot...
Read Article Now Book Mark ArticleSerum creatinine
The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys are working. Creatinine can ...
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Visit your eye doctor at least once a year, or more often if you have signs of
diabetic eye disease
.
Diabetic eye disease
Diabetes can harm the eyes. It can damage the small blood vessels in the retina, the back part of your eye. This condition is called diabetic retin...
ImageRead Article Now Book Mark Article - See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
Treatment
The goal of treatment at first is to lower your high blood glucose level. Long-term goals are to prevent complications. These are health problems from diabetes.
The most important way to treat and manage type 2 diabetes is by being active and eating healthy foods.
Everyone with diabetes should receive proper education and support about the best ways to manage their diabetes. Ask your doctor about seeing a diabetes nurse educator and a dietitian.
LEARN THESE SKILLS
Learning diabetes management skills will help you live well with diabetes. These skills help prevent health problems and the need for medical care. Skills include:
- How to test and record your blood glucose
- What, when, and how much to eat
- How to safely increase your activity and control your weight
- How to take medicines, if needed
- How to recognize and treat low and high blood sugar
-
How to
handle sick days
Handle sick days
Sick-day management - diabetes; Diabetes - sick day management
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It may take several months to learn these skills. Keep learning about diabetes, its complications, and how to control and live well with the disease. Stay up-to-date on new research and treatments.
MANAGING YOUR BLOOD SUGAR
Checking your blood sugar level yourself and writing down the results tells you how well you are managing your diabetes. Talk to your doctor and diabetes educator about how often to check.
Your blood sugar level
Hyperglycemia - control; Hypoglycemia - control; Diabetes - blood sugar control; Blood glucose - managing
To check your blood sugar level, you use a device called a glucose meter. Usually, you prick your finger with a small needle called a lancet. This gives you a tiny drop of blood. You place the blood on a test strip and put the strip into the meter. The meter gives you a reading that tells you the level of your blood sugar.
Your doctor or diabetes educator will help set up a testing schedule for you. Your doctor will help you set a target range for your blood sugar numbers. Keep these factors in mind:
- Most people with type 2 diabetes only need to check their blood sugar once or twice a day.
- If your blood sugar level is under control, you may only need to check it a few times a week.
- You may test yourself when you wake up, before meals, and at bedtime.
- You may need to test more often when you are sick or under stress.
- You may need to test more often if you are having more frequent low blood sugar symptoms.
Keep a record of your blood sugar for yourself and your doctor. Based on your numbers, you may need to make changes to your meals, activity, or medicines to keep your blood sugar level in the right range.
HEALTHY EATING AND WEIGHT CONTROL
Work closely with your health care providers to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your lifestyle and habits and should include foods that you like.
Managing your weight and having a well-balanced diet are important. Some people with type 2 diabetes can stop taking medicines after losing weight. This does not mean that their diabetes is cured. They still have diabetes.
Well-balanced diet
When you have type 2 diabetes, taking time to plan your meals goes a long way toward controlling your blood sugar and weight.
Very obese people whose diabetes is not well managed with diet and medicine may consider weight loss (bariatric) surgery .
Weight loss (bariatric) surgery
Gastric bypass is surgery that helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, you...
REGULAR PHYSICAL ACTIVITY
Regular activity is important for everyone. It is even more important when you have diabetes. Exercise is good for your health because it:
- Lowers your blood sugar level without medicine
- Burns extra calories and fat to help manage your weight
- Improves blood flow and blood pressure
- Increases your energy level
- Improves your ability to handle stress
Talk to your doctor before starting any exercise program. People with type 2 diabetes may need to take special steps before, during, and after physical activity or exercise.
MEDICINES TO TREAT DIABETES
If diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may prescribe medicine. Since these drugs help lower your blood sugar level in different ways, your doctor may have you take more than one drug.
Some of the most common types of medicines are listed below. They are taken by mouth or injection.
- Alpha-glucosidase inhibitors
- Biguanides
- DPP IV inhibitors
- Injectable medicines (GLP-1 analogs)
- Meglitinides
- SGL T2 inhibitors
- Sulfonylureas
- Thiazolidinediones
You may need to take insulin if your blood sugar cannot be controlled with any of the above medicines. Most commonly, insulin is injected under the skin using a syringe, insulin pen, or pump. Another form of insulin is the inhaled type. Insulin cannot be taken by mouth because the acid in the stomach destroys the insulin.
PREVENTING COMPLICATIONS
Your doctor may prescribe medicines or other treatments to reduce your chance of developing some of the more common complications of diabetes , including:
Common complications of diabetes
Diabetic complications - long term
- Eye disease
- Kidney disease
-
Heart disease and stroke
Heart disease and stroke
Diabetes complications - heart; Coronary artery disease - diabetes; CAD - diabetes; Cerebrovascular disease - diabetes
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FOOT CARE
People with diabetes are more likely than those without diabetes to have foot problems . Diabetes damages the nerves. This can make your feet less able to feel pressure, pain, heat, or cold. You may not notice a foot injury until you have severe damage to the skin and tissue below, or you get a severe infection.
Foot problems
Diabetes - foot care - self-care; Diabetic foot ulcer - foot care; Diabetic neuropathy - foot care
Diabetes can also damage blood vessels. Small sores or breaks in the skin may become deeper skin sores (ulcers). The affected limb may need to be amputated if these skin ulcers do not heal or become larger, deeper, or infected.
To prevent problems with your feet:
-
Stop smoking
if you smoke.
Stop smoking
It is hard to quit smoking if you are acting alone. Smokers may have a much better chance of quitting with a support program. Stop smoking programs...
Read Article Now Book Mark Article - Improve control of your blood sugar.
- Get a foot exam by your doctor at least twice a year to learn if you have nerve damage.
- Check and care for your feet every day. This is very important when you already have nerve or blood vessel damage or foot problems.
- Treat minor infections, such as athlete's foot, right away.
- Use moisturizing lotion on dry skin.
- Make sure you wear the right kind of shoes. Ask your doctor what type of shoe is right for you.
Support Groups
There are many diabetes resources that can help you understand more about type 2 diabetes. You can also learn ways to manage your condition so you can live well with diabetes.
Diabetes resources
The following sites provide further information on diabetes:American Diabetes Association -- www. diabetes. orgJuvenile Diabetes Research Foundation ...
Outlook (Prognosis)
Diabetes is a lifelong disease and there is no cure.
Some people with type 2 diabetes no longer need medicine if they lose weight and become more active. When they reach their ideal weight, their body's own insulin and a healthy diet can control their blood sugar level.
Possible Complications
After many years, diabetes can lead to serious health problems:
- You could have eye problems , including trouble seeing (especially at night), and light sensitivity. You could become blind.
- Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be amputated. Infection can also cause pain and itching in other parts of the body.
- Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, and other problems. It can become harder for blood to flow to your legs and feet.
-
Nerves in your body can get damaged
, causing pain, tingling, and numbness.
Nerves in your body can get damaged
Nerve damage that occurs in people with diabetes is called diabetic neuropathy. This condition is a complication of diabetes.
ImageRead Article Now Book Mark Article - Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection.
-
High blood sugar and other problems can lead to
kidney damage
. Your kidneys may not work as well as they used to. They may even stop working so that you need
dialysis
or a
kidney transplant
.
Kidney damage
Kidney disease or kidney damage often occurs over time in people with diabetes. This type of kidney disease is called diabetic nephropathy.
ImageRead Article Now Book Mark ArticleDialysis
Dialysis treats end-stage kidney failure. It removes harmful substances from the blood when the kidneys cannot. This article focuses on peritoneal d...
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A kidney transplant is surgery to place a healthy kidney into a person with kidney failure.
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When to Contact a Medical Professional
Call 911 right away if you have:
- Chest pain or pressure
-
Fainting, confusion or
unconsciousness
Unconsciousness
Decreased alertness is a state of reduced awareness. A coma is a state of decreased alertness from which a person cannot be awakened. A long-term co...
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- Shortness of breath
These symptoms can quickly get worse and become emergency conditions (such as convulsions , hypoglycemic coma or hyperglycemic coma).
Convulsions
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. The term "seizure...
Also call your doctor if you have:
- Numbness, tingling, or pain in your feet or legs
- Problems with your eyesight
- Sores or infections on your feet
- Symptoms of high blood sugar (extreme thirst, blurry vision, dry skin, weakness or fatigue, the need to urinate a lot)
- Symptoms of low blood sugar (weakness or fatigue, trembling, sweating, irritability, trouble thinking clearly, fast heartbeat, double or blurry vision, uneasy feeling)
Prevention
You can help prevent type 2 diabetes by staying at a healthy body weight. You can get to a healthy weight by eating healthy foods, controlling your portion sizes, and leading an active lifestyle. Some medicines can also delay or prevent type 2 diabetes in people at risk of developing the disease.
References
Cagliero E. Diabetes and long-term complications. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 51.
Moustarah F, Brethauer SA, Schauer PR. Glycemic control and cardiovascular disease risk reduction after bariatric surgery. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy . 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:682-691.
Polonsky KS, Burant CF. Type 2 diabetes mellitus. In: Melmed S, Polonsky KS, Burant, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier Saunders: 2016: chap 31.
Standards of Medical Care in Diabetes-2016: Summary of Revisions. Diabetes Care . 2016;39 Suppl 1:S4-S5. PMID: 26696680 www.ncbi.nlm.nih.gov/pubmed/26696680 .
Vijan S. In the clinic. Type 2 diabetes. Ann Intern Med . 2015;3;162(5):ITC1-ITC16. PMID: 25732301 www.ncbi.nlm.nih.gov/pubmed/25732301 .
-
Type II diabetes
Animation
-
Diabetes and exercise - illustration
A person with type 2 diabetes can use exercise to help control their blood sugar levels and provide energy their muscles need to function throughout the day. By maintaining a healthy diet and sufficient exercise, a person with type 2 diabetes may be able to keep their blood sugar in the normal non-diabetic range without medicine.
Diabetes and exercise
illustration
-
Diabetic emergency supplies - illustration
An individual with diabetes should wear or carry I.D. information (such as an alert bracelet) that emergency medical staff can find. A sugar source, such as glucose tablets or raisins should be carried in case blood sugar levels become too low.
Diabetic emergency supplies
illustration
-
Starchy foods - illustration
All food that you eat turns to sugar in your body. Carbohydrate-containing foods alter your sugar levels more than any other type of food. Carbohydrates are found in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets. Other possible sources include peas, milk, and yogurt. more
Starchy foods
illustration
-
Low blood sugar symptoms - illustration
Symptoms such as weakness, feeling tired, shaking, sweating, headache, hunger, nervousness and irritability are signs that a person's blood sugar is getting dangerously low. A person showing any of these symptoms should check their blood sugar. If the level is low (70 mg/dl), a sugar-containing food should be eaten right away.
Low blood sugar symptoms
illustration
-
15/15 rule - illustration
To treat low blood sugar the 15/15 rule is usually applied. Eat 15 grams of carbohydrate and wait 15 minutes. The following foods will provide about 15 grams of carbohydrate: 3 glucose tabletsHalf cup (4 ounces or 120 milliliters) of fruit juice or regular soda6 or 7 hard candies1 tablespoon (15 grams) of sugar 3 glucose tablets 3 glucose tablets Half cup (4 ounces or 120 milliliters) of fruit juice or regular soda 6 or 7 hard candies 1 tablespoon (15 grams) of sugar After the carbohydrate is eaten, the person should wait about 15 minutes for the sugar to get into their blood. If the person does not feel better within 15 minutes more carbohydrate can be consumed. Their blood sugar should be checked to make sure it has come within a safe range.
15/15 rule
illustration
-
Glucose in blood - illustration
After being diagnosed with diabetes, the first goals are to eliminate the symptoms and stabilize your blood glucose levels. The ongoing goals are to prevent long-term complications and prolong your life. The primary treatment for type 2 diabetes is exercise and diet.
Glucose in blood
illustration
-
Alpha-glucosidase inhibitors - illustration
Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels.
Alpha-glucosidase inhibitors
illustration
-
Biguanides - illustration
Biguanides (Metformin) tell the liver to decrease its production of glucose, which lowers glucose levels in the bloodstream.
Biguanides
illustration
-
Sulfonylureas drug - illustration
Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.
Sulfonylureas drug
illustration
-
Thiazolidinediones - illustration
Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's sensitivity (responsiveness) to insulin.
Thiazolidinediones
illustration
-
Food and insulin release - illustration
Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood.
Food and insulin release
illustration
-
Monitoring blood glucose - Series
Presentation
-
Diabetes and exercise - illustration
A person with type 2 diabetes can use exercise to help control their blood sugar levels and provide energy their muscles need to function throughout the day. By maintaining a healthy diet and sufficient exercise, a person with type 2 diabetes may be able to keep their blood sugar in the normal non-diabetic range without medicine.
Diabetes and exercise
illustration
-
Diabetic emergency supplies - illustration
An individual with diabetes should wear or carry I.D. information (such as an alert bracelet) that emergency medical staff can find. A sugar source, such as glucose tablets or raisins should be carried in case blood sugar levels become too low.
Diabetic emergency supplies
illustration
-
Starchy foods - illustration
All food that you eat turns to sugar in your body. Carbohydrate-containing foods alter your sugar levels more than any other type of food. Carbohydrates are found in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets. Other possible sources include peas, milk, and yogurt. more
Starchy foods
illustration
-
Low blood sugar symptoms - illustration
Symptoms such as weakness, feeling tired, shaking, sweating, headache, hunger, nervousness and irritability are signs that a person's blood sugar is getting dangerously low. A person showing any of these symptoms should check their blood sugar. If the level is low (70 mg/dl), a sugar-containing food should be eaten right away.
Low blood sugar symptoms
illustration
-
15/15 rule - illustration
To treat low blood sugar the 15/15 rule is usually applied. Eat 15 grams of carbohydrate and wait 15 minutes. The following foods will provide about 15 grams of carbohydrate: 3 glucose tabletsHalf cup (4 ounces or 120 milliliters) of fruit juice or regular soda6 or 7 hard candies1 tablespoon (15 grams) of sugar 3 glucose tablets 3 glucose tablets Half cup (4 ounces or 120 milliliters) of fruit juice or regular soda 6 or 7 hard candies 1 tablespoon (15 grams) of sugar After the carbohydrate is eaten, the person should wait about 15 minutes for the sugar to get into their blood. If the person does not feel better within 15 minutes more carbohydrate can be consumed. Their blood sugar should be checked to make sure it has come within a safe range.
15/15 rule
illustration
-
Glucose in blood - illustration
After being diagnosed with diabetes, the first goals are to eliminate the symptoms and stabilize your blood glucose levels. The ongoing goals are to prevent long-term complications and prolong your life. The primary treatment for type 2 diabetes is exercise and diet.
Glucose in blood
illustration
-
Alpha-glucosidase inhibitors - illustration
Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels.
Alpha-glucosidase inhibitors
illustration
-
Biguanides - illustration
Biguanides (Metformin) tell the liver to decrease its production of glucose, which lowers glucose levels in the bloodstream.
Biguanides
illustration
-
Sulfonylureas drug - illustration
Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.
Sulfonylureas drug
illustration
-
Thiazolidinediones - illustration
Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's sensitivity (responsiveness) to insulin.
Thiazolidinediones
illustration
-
Food and insulin release - illustration
Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood.
Food and insulin release
illustration
-
Monitoring blood glucose - Series
Presentation
-
Diabetes - type 2
(In-Depth)
Review Date: 7/24/2015
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
