11902 Health Library | Health and Wellness | Wellmont Health System
  • Type 2 Diabetes

    (Diabetes Mellitus Type 2; Insulin-Resistant Diabetes; Diabetes, Type 2)

    Definition

    Glucose is a type of sugar. It comes from food, and is also created in the liver. Glucose travels through the body in the blood. It moves from the blood to cells with the help of a hormone called insulin. Once glucose is in those cells, it can be used for energy.
    Diabetes is a condition that makes it difficult for the body to use glucose. This causes a buildup of glucose in the blood. It also means the body is not getting enough energy. Type 2 diabetes is one type of diabetes. It is the most common type.
    Medication, lifestyle changes, and monitoring can help control blood glucose levels.

    Causes

    Type 2 diabetes is often caused by a combination of factors. One factor is that your body begins to make less insulin. A second factor is that your body becomes resistant to insulin. This means there is insulin in your body, but your body cannot use it effectively. Insulin resistance is often related to excess body fat.

    Risk Factors

    Factors that increase your chance for type 2 diabetes include:
    • Having a family history of type 2 diabetes
    • Being obese or overweight, especially with excess weight in the upper body and abdomen
    • Eating a lot of meat, especially processed meat (eg, processed lunch meats, hot dogs, sausages)
    • Having cholesterol problems, especially low high-density lipoprotein (HDL) (good) cholesterol and high triglycerides
    • Having high blood pressure
    • Having a history of cardiovascular disease
    • Having depression
    • Having a history of gestational diabetes or having a baby that weighs over nine pounds at birth
    • Having an endocrine disorder (eg, Cushing’s syndrome, hyperthyroidism, acromegaly, polycystic ovary syndrome, pheochromocytoma, glucagonoma)
    • Having a condition associated with insulin resistance (eg, acanthosis nigricans)
    • Having previous blood test results that show impaired glucose tolerance and impaired fasting glucose
    • Taking certain medicines (eg, pentamidine, glucocorticoids, thiazides)
    • Having a sedentary lifestyle
    • Race: African American, Hispanic, Native American, Hispanic American, Asian American, or Pacific Islander
    • Age: 45 years or older and younger people who are obese and belong to at-risk ethnic groups

    Symptoms

    You may have diabetes for years before you have symptoms. Symptoms caused by high blood sugar or complications may include:
    • Increased urination
    • Extreme thirst
    • Hunger
    • Fatigue
    • Blurry vision
    • Irritability
    • Frequent or recurring infections
    • Poor wound healing
    • Numbness or tingling in the hands or feet
    • Problems with gums
    • Itching
    • Problems having an erection

    Diagnosis

    The doctor will ask about your symptoms and medical history. You will also be asked about your family history. A physical exam will be done.
    Diagnosis is based on the results of blood testing. American Diabetes Association (ADA) recommends diagnosis be made if you have one of the following:
    • Symptoms of diabetes and a random blood test with a blood sugar level greater than or equal to 200 mg/dL (11.1 mmol/L)
    • Fasting blood sugar test—Done after you have not eaten for eight or more hours—Showing blood sugar levels greater than or equal to 126 mg/dL (7 mmol/L) on two different days
    • Glucose tolerance test—Measuring blood sugar two hours after you eat glucose—Showing glucose levels greater than or equal to 200 mg/dL (11.1 mmol/L)
    • HbA1c level of 6.5% or higher—Indicates poor blood sugar control over the past 2-4 months
    mg/dL = milligrams per deciliter of blood; mmol/L = millimole per liter of blood

    Treatment

    Treatment aims to:
    • Maintain blood sugar at levels as close to normal as possible
    • Prevent or delay complications
    • Control other conditions that you may have, like high blood pressure and high cholesterol

    Diet

    Food and drinks have a direct effect on your blood glucose level. Eating healthy meals can help you control your blood glucose. It will also help your overall health. Some basic tips include:

    Weight Loss

    If you are overweight, weight loss will help your body use insulin better. Talk to your doctor about a healthy weight goal. You and your doctor or dietitian can make a safe meal plan for you.
    These options may help you lose weight:

    Exercise

    Physical activity can:
    • Make the body more sensitive to insulin
    • Help you reach and maintain a healthy weight
    • Lower the levels of fat in your blood
    Aerobic exercise is any activity that increases your heart rate. Resistance training helps build muscle strength. Both types of exercise help to improve long-term glucose control. Regular exercise can also help reduce your risk of heart disease.
    Talk to your doctor about an activity plan. Ask about any precautions you may need to take.

    Medication

    Certain medicines will help to manage blood glucose levels.
    Medication taken by mouth may include:
    • Metformin—To reduce the amount of glucose made by the body and to make the body more sensitive to insulin
    • Medications that encourage the pancreas to make more insulin such as sulfonylureas (glyburide, tolazamide), dipeptidyl peptidase-4 inhibitors (saxagliptin, sitagliptin), and repaglinide (Prandin)
    • Insulin sensitizers such as pioglitazone—To help the body use insulin better
    • Starch blockers such as acarbose or miglitol—To decrease the amount of glucose absorbed into the blood
    Some medicine needs to be given through injections, such as:
    • Incretin-mimetics such as exenatide—To stimulate the pancreas to produce insulin and decrease appetite (can assist with weight loss)
    • Amylin analogs such as pramlintide—To replace a protein of the pancreas that is low in people with type 2 diabetes

    Insulin

    Insulin may be needed if:
    • The body does not make enough of its own insulin.
    • Blood glucose levels cannot be controlled with lifestyle changes and medicine.
    Insulin is given through injections.

    Blood Glucose Testing

    You can check the level of glucose in your blood with a blood glucose meter. Checking your blood glucose levels during the day can help you stay on track. It will also help your doctor determine if your treatment is working. Keeping track of blood sugar levels is especially important if you take insulin.
    Regular testing may not be needed if your diabetes is under control and you don't take insulin. Talk with your doctor before stopping blood sugar monitoring.
    An HbA1c test may also be done at your doctor's office. This is a measure of blood glucose control over a long period of time. Doctors advise that most people keep their HbA1c levels below 7%. Your exact goal may be different. Keeping HbA1c in your goal range can help lower the chance of complications.

    Decreasing Risk of Complications

    Over a long period of time, high blood glucose levels can damage vital organs. The kidneys, eyes, and nerves are most affected. Diabetes can also increase your risk of heart disease.
    Maintaining goal blood glucose levels is the first step to lowering your risk of these complications. Other steps include:
    • Take good care of your feet. Be on the lookout for any sores or irritated areas. Keep your feet dry and clean.
    • Have your eyes checked once a year.
    • Don't smoke. If you do, look for programs or products that can help you quit.
    • Plan medical visits as recommended.

    Prevention

    To reduce your chances of developing type 2 diabetes:
    • Participate in regular physical activity.
    • Maintain a healthy weight.
    • Drink alcohol in moderation (two drinks per day for a man, and one drink per day for a woman).
    • Eat a well-balanced diet:
      • Get enough fiber
      • Avoid fatty foods
      • Limit sugar intake
      • Eat more green, leafy vegetables

    RESOURCES

    American Diabetes Association http://www.diabetes.org/

    National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca/

    Team Diabetes CanadaCanadian Diabetes Association http://www.diabetes.ca/get-involved/supporting-us/team-diabetes/

    References

    American Association of Clinical Endocrinologists, American College of Endocrinology. Medical guidelines for the management of diabetes mellitus. The AACe system of intensive diabetes self-management. 2002 update. Endocrine Practice. 2002;8(suppl 1):S40-82.

    American Diabetes Association Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33:S62-S69.

    Boren SA, Gunlock TL, Schaefer J, Albright A. Reducing risks in diabetes self-management: a systematic review of the literature. Diabetes Educ. 2007;33:1053-1077.

    Calvagna M. Tips to help you stop smoking. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated January 2006. Accessed July 7, 2008.

    Diabetes. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nccdphp/publications/aag/ddt.htm. Updated February 14, 2008. Accessed July 21, 2008.

    Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://diabetes.niddk.nih.gov/. Accessed July 22, 2008.

    Diabetes mellitus type 2. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us/. Updated June 19, 2012. Accessed June 21, 2012.

    Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28(suppl 1):S37-42.

    Dietary considerations for patients with type 2 diabetes. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us/. Updated January 26, 2011. Accessed March 10, 2011.

    FDA approves new drug treatment for type 2 diabetes. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm174780.htm. Published July 31, 2009. Accessed October 1, 2009.

    Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003; 248:383-393.

    Harsch IA. Inhaled insulins: their potential in the treatment of diabetes mellitus. Treat Endocrinol. 2005;4:131-138.

    Information about acarbose (Precose). The Diabetes Monitor website. Available at: http://www.diabetesmonitor.com/acarbose.htm. Accessed on May 26, 2006.

    Juan D. Lifestyle changes to manage type 2 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated July 2007. Accessed July 7, 2008.

    Lee DC, Sui X, Church TS, Lee IM, Blair SN. Associations of cardiorespiratory fitness and obesity with risks of impaired fasting glucose and type 2 diabetes in men. Diabetes Care. 2009;32:257-262. Epub 2008 Nov 4.

    Marre M. Reducing cardiovascular risk in diabetes. J Hypertens. 2007;(supp 11)S19-22.

    Physical activity/exercise and diabetes. Diabetes Care. 2004;27(suppl 1):S58-62.

    Rosenbloom AL, Silverstein JH, Amemiya S, et al. ISPAD Clinical Practice Consensus Guideline 2006-2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes. 2008;9:512-526.

    Rosenzweig JL, Ferrannini E, Grundy SM, et al. Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:3671-3689.

    Screening for type 2 diabetes. Diabetes Care. 2004;27(suppl 1):S11-4.

    Sitagliptin (marketed as Januvia and Janumet)—acute pancreatitis. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183800.htm. Published September 25, 2009. Accessed October 29, 2009.

    Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE and VA diabetes trials: a position statement of the American Diabetes association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Circulation. 2009;119:351-7.

    Standards of medical care in diabetes—2009. Diabetes Care. 2009;32:S13-61.

    Statement by an AACE/ACE Consensus Panel on Type 2 Diabetes Mellitus: An Algorithm for Glycemic Control. Endocr Pract. 2009;15:540-559.

    Traina AN, Kane MP. Primer on pramlintide, an amylin analog. Diabetes Educ. 2011;37(3):426-431.

    Type 2 diabetes. American Diabetes Association website. Available at: http://www.diabetes.org/type-2-diabetes.jsp. Accessed Nov 13, 2009.

    UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet. 1998; 352:954-965.

    US Preventive Services Task Force: Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148:846-54.

    US Preventive Services Task Force (USPSTF). Screening for type 2 diabetes mellitus in adults: recommendations and rationale. Ann Intern Med. 2003; 138:212-214.

    11/29/2006 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368:1673-1679.

    9/19/2006 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews. 2006;CD002968.

    6/1/2007 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007 May 21. [Epub ahead of print]

    7/13/2007 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Farmer A, Wade A, Goyder E, et al. Impact of self-monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ. 2007 Jun 25. [Epub ahead of print]

    12/13/2007 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Milman U, Blum S, Shapira C, et al. Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both type 2 diabetes mellitus and the haptoglobin 2-2 genotype. A prospective double-blinded clinical trial. Arterioscler Thromb Vasc Biol. 2007 Nov 21. [Epub ahead of print]

    2/13/2008 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: For safety, NHLBI changes intensive blood sugar treatment strategy in clinical trial of diabetes and cardiovascular disease. NIH News. National Institutes of Health website. Available at: http://www.nih.gov/news/health/feb2008/nhlbi-06.htm. Accessed February 13, 2008.

    2/21/2008 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Major international diabetes study does not confirm increased risk of death reported by US trial. Action in Diabetes and Vascular Disease: PreteraAx and DiamicroN MR Controlled Evaluation (ADVANCE) website. Available at: http://www.advance-trial.com/static/html/virtual/contents.asp?P=39. Accessed February 21, 2008.

    2/28/2008 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Davies MJ, Heller S, Skinner TC, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008 Feb 14. [Epub ahead of print]

    2/28/2008 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008;168:141-146.

    6/18/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-2572. Epub 2008 Jun 6.

    2/24/2009 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Liese AD, Weis KE, Schulz M, Tooze JA. Food intake patterns associated with incident type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2009;32:263-268. Epub 2008 Nov 25.

    5/11/2009 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Loimaala A, Groundstroem K, Rinne M, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. 2009;103:972-977.

    8/19/2009 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Li TY, Brennan AM, Wedick NM, Mantzoros C, Rifai N, Hu FB. Regular consumption of nuts is associated with a lower risk of cardiovascular disease in women with type 2 diabetes. J Nutr. 2009;139:1333-1338.

    10/12/2009 DynaMed Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Crandall JP, Polsky S, Howard AA, et al. Alcohol consumption and diabetes risk in the Diabetes Prevention Program. Am J Clin Nutr. 2009;90:595-601.

    11/20/2009 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Lund SS, Tarnow L, Frandsen M, et al. Combining insulin with metformin or an insulin secretagogue in non-obese patients with type 2 diabetes: 12 month, randomised, double blind trial. BMJ. 2009;339:b4324.

    12/21/2009 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2009 Nov 12.

    2/15/2010 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(suppl 1:S11-61).

    2/15/2010 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(suppl 1:S62-69).

    7/2/2010 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Micha R, Wallace SK, Mozaffarian D. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation. 2010;121(21):2271-2283.

    10/5/2010 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;341:c4229.

    1/4/2011 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Pan A, Lucas M, Sun Q, et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med. 2010;170(21):1884-1891.

    5/6/2011 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: US Food and Drug Administration. FDA approves new treatment for Type 2 diabetes. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm253501.htm. Updated May 2, 2011. Accessed May 6, 2011.

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