Let's Talk About Type 2 Diabetes
You’ve got questions! We’ve got answers! We went straight to the experts to get the latest info on one of the most common diseases in the U.S. Here’s what you should know.by Sunny Sea Gold Health Writer
It’s hard to say there’s “good news” about any disease diagnosis, but if there’s a silver lining with type 2 diabetes, it’s this: You are very much in control of your destiny. Type 2 diabetes can often be successfully managed through the actions you take in everyday life. A healthy diet and regular exercise, along with prescribed medications, can give you your life back. Here’s the deal with type 2 diabetes.
Our Pro Panel
We went to some of the nation’s top experts in diabetes to bring you the most up-to-date information possible.
Peter Goulden, M.D.
Medical Director of the Division of Endocrinology and Metabolism
Mount Sinai St. Luke's
New York, NY
Katherine Araque, M.D.
Director of Endocrinology
Pacific Neuroscience Institute at Providence Saint John’s Health Center
Santa Monica, CA
Laura Cason, R.D.
Certified Diabetes Educator and Spokesperson
Illinois Academy of Nutrition and Dietetics
Like many chronic illnesses, your genes can make you more susceptible to developing type 2 diabetes. But just because you have a strong family history of the illness doesn’t automatically mean you’re destined to get it. A healthful diet and plenty of exercise are associated with a lower risk of the disease.
Classic symptoms of type 2 diabetes include increased thirst and having to pee a lot. You might also feel fatigued, even though you haven’t been doing anything that strenuous. More advanced stages of the disease can also cause numbness and tingling in your extremities, blurry vision, and sores on the feet.
Everyone’s body reacts differently to foods and diet plans, so there’s no magic bullet. But vegetarian and vegan diets, a traditional Mediterranean diet rich in vegetables and seafood, and low-carbohydrate diets have all been shown to lower blood sugar and reduce the risk of developing type 2 diabetes.
There’s no exact prescription, but regular exercise is definitely good (whether or not you have the disease!). Current recommendations for all adults call for 150 minutes of moderate exercise a week. That’s about 30 minutes a day, five days a week.
What Is Type 2 Diabetes?
If you know someone with diabetes, chances are they have type 2, which accounts for 90% to 95% of all diabetes cases in the United States. Other common types include type 1, an autoimmune disorder, and gestational diabetes, which only happens during pregnancy.
People with all types of diabetes have one thing in common: high amounts of sugar (or glucose) in the blood.
Here’s what happens if your body is working normally: After you eat, food from your meal is broken down into a sugar called glucose (among other things) that serves as your entire body’s source of energy—the brain, heart, muscle cells, and everything else rely on glucose for fuel.
The glucose enters the bloodstream and in response, your pancreas releases insulin, a hormone that helps the glucose get out of your blood and into some cells so they can use it for energy.
But in type 2 diabetes, your body stops using the insulin it makes efficiently, requiring more and more insulin to help convert glucose into energy. Eventually, your pancreas can’t produce enough insulin to keep up with the demand, and your blood sugar rises. (This is different than type 1, where the body doesn’t make insulin at all, causing glucose to build up in the blood.)
Type 2 diabetes is very treatable, but not curable. Some people are able to keep it in check with a healthy diet and regular exercise, but many need to take medication as well.
It’s important to be diagnosed early and correctly because, if left untreated, type 2 diabetes greatly increases your risk of heart disease and can lead to complications like vision loss, kidney issues, nerve pain, foot problems, and even amputations.
Who Gets Type 2 Diabetes?
Anyone of any age, weight, or race can get type 2 diabetes. That said, type 2 diabetes does run in families. It’s also more common in adults, in people who are overweight, and in black, Latino, and Asian communities.
An estimated 27 million to 28.5 million people in the United States have type 2 diabetes. Additionally, more than 80 million people have prediabetes, meaning their blood sugar is elevated, but not high enough to be diabetes. Prediabetes greatly increases the chances a person will go on to develop type 2.
What Causes Type 2 Diabetes?
Doctors don’t know exactly why some people get type 2 diabetes and others don’t. But it’s clear that several things raise your odds of getting it:
Ethnicity/race. Certain ethnic groups are more likely to develop type 2 than others, including African Americans, Latinos, Pacific Islanders and Hawaiians, Native Americans and Native Alaskans.
Family history and genetics. There is no single type 2 diabetes “gene” to test for, but if type 2 runs in your family, that means you are at higher risk of developing it, too.
High Body Mass Index (BMI). Higher levels of body fat, especially the kind that gathers in the belly, is linked to insulin resistance and risk of type 2 diabetes. Insulin resistance can also cause more weight gain, creating a frustrating cycle.
Insulin resistance. Type 2 often starts with insulin resistance—meaning that a person’s liver, muscles, adipose (fat) and other cells start to respond more slowly or weakly to insulin than they used to. Several things can contribute to insulin resistance, including certain medications, polycystic ovary syndrome, Cushing’s disease, and aging.
Sedentary lifestyle. Physical activity boosts your body’s ability to use insulin efficiently, lowering the risk of high blood sugar. Being sedentary makes your cells less sensitive to insulin, which leads to insulin resistance and increased risk of type 2 diabetes.
Symptoms of Type 2 Diabetes
Having one or more of these symptoms doesn’t automatically mean you or a loved one has type 2 diabetes, but it does mean you should get checked out. Possible indications of type 2 diabetes include:
Extreme thirst: When there’s too much sugar in the bloodstream, your body pulls water from surrounding tissues to try and dilute it. That makes you dehydrated and thirsty. Some people with diabetes feel like no matter how much they drink, they can’t quench their thirst.
Excessive pee: In an effort to filter out the high sugar content in your blood, your kidneys kick into gear. They dump sugar from your blood into your urine, creating more pee. In more advanced stages of the disease, damaged nerves around the bladder may cause some people to feel the urge to pee frequently, even if little or nothing comes out. You also have a higher risk of urinary tract infections (UTIs). Children may suddenly start to have accidents at night or during the day, even though they’ve been potty trained for years.
The munchies: If you’re hungry all the time, even after a good meal, it could be a sign that your muscles and other tissues in your body aren’t getting the energy—a.k.a. glucose—they need from the food you’re eating, because it’s hung up in your bloodstream. Your muscles signal to your brain that they’re starving (even though you ate plenty), making you feel hungry and continuing the cycle.
Fatigue: Type 2 diabetes can make you feel tired and weak because your brain, muscles, and other body systems aren’t getting the energy they need to work properly. Dehydration from frequent urination can make you tired, too. Listlessness and muscle weakness may also be a sign of a severe complication called ketoacidosis.
Tests for Type 2 Diabetes
The first step in getting a diabetes diagnosis is a blood test. You may have already had one or more of these tests during your yearly physical, or if you’ve ever been pregnant. (The U.S. Preventive Services Task Force recommends that anyone over age 40 with a BMI of 25 or higher should be screened, then checked every three years thereafter. People with additional risk factors should be screened earlier, and more often.)
If the test suggests you have diabetes, your doctor will likely perform additional testing to figure out whether it is type 2. Correct diagnosis is important since treatment differs depending on type.
A1C (or glycated hemoglobin) test. This common test measures what percentage of your red blood cells have been coated with glucose over the past two to three months. The higher your blood sugar, the higher your score. An A1C result below 5.7 is considered normal; 5.7 to 6.4 is prediabetic; 6.5 or above suggests diabetes.
Fasting blood sugar test. Blood will be drawn first thing in the morning before you eat or drink anything other than water. A result under 100 milligrams per deciliter is normal; 100 to 125 mg/dL is prediabetic; 126 mg/dL indicates diabetes. Your doctor will likely want to do the test twice before diagnosing you.
Random blood sugar test. Blood is drawn at any time of day, whether you’ve eaten recently or not. A result of 200 mg/dL means you may have diabetes.
Antibody test. To help differentiate between type 1 and type 2 diabetes, your doctor may also draw blood for an “autoantibody” test, to see if your immune system is attacking your pancreas. People with type 1 often test positive for several specific autoantibodies, while those with type 2 (or the rare monogenic diabetes) won’t.
Your doctor may want to test your urine for ketones, chemicals your body produces when it breaks down fat for energy. The test can be done at home or in a lab or doctor’s office by peeing into a specimen cup.
Extremely high levels of ketones are a sign of ketoacidosis, a potentially fatal complication of diabetes that requires emergency treatment. The condition is most common with type 1 diabetes but in rare cases can occur with type 2 as well.
Treatment for Type 2 Diabetes
How you go about managing your condition will depend on multiple factors, including your blood sugar patterns, medical history, lifestyle, obligations, finances, and personal preferences. Your doctor will talk with you about various ways to treat the disease, including:
While there’s no official diet for diabetes, it should go without saying that sugary, fatty foods are not what your body needs when it’s already struggling with high blood sugar.
Research shows that plant-based diets, Mediterranean diets (rich in vegetables and seafood), and low-carbohydrate diets can all lower blood sugar and reduce the risk of developing type 2 diabetes or improve symptoms if you already have it.
Not sure how to start one of these programs? A registered dietitian or certified diabetes educator can help you plan meals based on these principles and figure out how to fit healthy eating into your budget and lifestyle.
No one’s asking you to scale Everest here, but if you want to beat this disease, you’ve got to move! Exercise improves your blood sugar levels by making your cells more sensitive to insulin—even a daily walk around the block can help.
Besides, national guidelines call for a minimum of 150 minutes weekly of moderate activity (that’s 30 minutes a day, five times a week), so even if you didn’t have type 2, you’d still need to get up and move.
Taking Oral Medications
If you have type 2 diabetes, there’s a chance you will be able to manage your blood sugar with exercise and what you eat. But you may need medication, too.
There are a lot of different drugs that can help lower blood sugar—your doctor might recommend one, or a combination of medications, based on your particular case. Some common type 2 medications include:
Actos and Avandia (thiazolidinediones) reduce circulating fat concentrations and improve sensitivity to insulin.
Amaryl, Glucotrol and Micronase (sulfonylureas), Prandin and Starlix (meglitinide), and Januvia and Onglyza (DPP-4 inhibitors), trigger the pancreas to produce more insulin.
Farxiga, Invokana, and Jardiance (SGLT2 inhibitors) boost the amount of sugar the kidneys can remove from your blood.
Glyset and Orecose (alpha-glucosidase inhibitors) slow the digestion and breakdown of starches into glucose and regulate how much glucose is absorbed by the small intestine.
Metformin (brands names Glucophage, Glumetza, Fortamet, Riomet) slows the breakdown of carbohydrates into sugar, and reduces how much glucose your liver produces.
Not every person with type 2 diabetes needs insulin, but some do. There are a few different ways to take it—the most common way is to inject insulin with a syringe, usually in the belly, upper arm, thigh, or butt. Some people find using an injection “pen” easier.
People who need multiple injections per day sometimes prefer an insulin pump that’s worn on your body and automatically delivers insulin through a tiny catheter that remains under your skin.
Checking Blood Glucose
Some people with type 2 diabetes may need to check their blood glucose occasionally, others need to do it multiple times a day.
Most people use a home glucose meter to do this. To use it, you poke a fingertip with a specialized lancet “pen” then drop the blood onto a test strip in the meter. For some people who have to check levels often, it makes more sense to use a continuous glucose monitor (CGM). A CGM is a tiny sensor inserted under the skin of your abdomen, arms, or thighs that checks glucose levels in body fluids regularly and will alert you if levels fall too low.
Getting Blood Tests
People with type 2 diabetes should have an A1C (or glycated hemoglobin) test two to four times per year. If levels go up, your doctor may decide to switch up your medications, or encourage you to put more emphasis on your diet and exercise goals.
Living With Type 2 Diabetes
Because of the associations between type 2 diabetes, BMI, and physical activity, there’s often a misguided sense that people with the disease have caused their condition themselves.
To be clear, eating too much takeout or lounging on the couch does not cause type 2 diabetes. A poor diet and lack of exercise does increase your risk, but there are other factors at play. Two people can be overweight, have a strong family history, sedentary lifestyle, and eat fast food—and one will get type 2, while the other won’t. Type 2 diabetes is a complex disease with multiple causes and (fortunately) solutions.
The really good news is that many of those solutions are things you can do starting right now. Along with medication, you can greatly improve your odds of reducing type 2 symptoms and living a full and happy life by following a Mediterranean or plant-based diet, reducing consumption of high-sugar foods, and squeezing in 30 minutes of moderate exercise, five days a week. No one is saying it’s easy, but neither is living with type 2 diabetes. Start making changes now. You’ve got this.
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