According to a recent study published in The Lancet Diabetes & Endocrinology, 2 out of 5 Americans will develop type 2 diabetes in their lifetime.This common condition begins with a process called “insulin resistance”. Insulin is a hormone produced by the pancreas, a large organ behind the stomach. Normally, insulin breaks down the carbohydrates you eat and turns them into glucose, or “blood sugar”. The glucose then travels through the bloodstream, providing energy and nourishment. Type 2 diabetes develops when the body starts to “resist” the insulin it produces and stops carrying glucose into the body’s cells. The pancreas tries to compensate for the added demand for insulin by making more. Over time, the pancreas can no longer keep up with the body’s increased need for insulin. Excess sugar accumulates in the bloodstream and begins to cause long-term damage.

If a person with type 2 diabetes does not properly manage their condition, they will eventually need insulin injections. In the early stages of insulin resistance, a person is said to have pre-diabetes, which can often be reversed through diet, exercise, weight loss, and medical supervision. Type 2 diabetes used to be called adult-onset diabetes because it usually develops in adulthood, most commonly in people middle-aged and older. However, as childhood obesity increases, we are seeing more type 2 diabetes in children and young adults.

There are a number of risk factors for developing type 2 diabetes. One is genetics – a tendency to develop condition seems to run in families. However, lifestyle plays a significant role. People who are overweight and not physically active are more likely to develop type 2 diabetes, especially if they have a lot of belly fat.  In fact, obesity is thought to be a factor in in 55% of type 2 diabetes cases, and the more fatty tissue a person has, the greater their risk of developing the disease. A diet high in sugar and saturated fats is a contributing factor, as are smoking and drinking alcohol. Stress and inadequate sleep are also believed to increase the risk of developing the disease. 

Type 2 diabetes tends to develop slowly and some may have it for years before finally getting diagnosed.  Some people don’t develop symptoms for a long time. This puts them at risk because untreated type 2 will begin to cause damage to the body, even if the person does not yet have symptoms such as these:

  • Increased thirst and frequent urination.
  • Increased hunger
  • Weight loss
  • Fatigue.
  • Blurred vision
  • Slowed healing of cuts and bruises
  • Frequent skin infections
  • Areas of darkened skin (acanthosis nigricans), usually in the armpits and neck

Type 2 diabetes has to be carefully managed to keep complications from developing. Long term, inadequately managed type 2 diabetes can cause a variety of complications:

  • Diabetes increases the risk of cardiovascular problems, including coronary artery disease, heart attack, stroke, narrowing of the arteries, and high blood pressure.
  • Excess glucose can damage tiny blood vessels that supply blood to the nerves in the hands and feet. This nerve damage, known as diabetic neuropathy, can cause tingling, numbness, burning or pain at the ends of the fingers and toes. If neuropathy is allowed to progress, a person may eventually lose all feeling in the affected limbs.
  • Nerve damage and poor blood flow in the feet may lead to foot complications. People may injure their feet and not notice due to lack of sensation, and cuts and bruises heal poorly. In advanced cases, toe, foot, or leg amputation may be necessary.
  • Nerve damage in the gastrointestinal tract can lead to nausea, vomiting, diarrhea or constipation.
  • In men, damage to small blood vessels in the penis can lead to erectile dysfunction.
  • Nephropathy is damage to blood vessels in the kidneys. Over time, nephropathy may lead to kidney failure. If that occurs, a person needs to go on dialysis or have a kidney transplant.
  • When diabetes damages the tiny blood vessels of the retina, it causes a condition known as diabetic retinopathy, which potentially leads to blindness. Diabetes also increases the risk of cataracts and glaucoma.
  • Diabetes increases the risk of bacterial and fungal infections of the skin.
  • During pregnancy, high blood sugar levels can be dangerous for both  mother and baby. Unless diabetes is carefully managed, there is an increased risk of miscarriage, stillbirth and birth defects. In the mother, complications may include high blood pressure and preeclampsia. 

With proper management and a healthy lifestyle, people with type 2 diabetes can travel well through life with diabetes. This requires a combination of proper nutrition, exercise, weight loss (if necessary) and medication:

  • Medication: Some people with type 2 diabetes can manage their diabetes with healthy eating and exercise. However, your doctor may need to also prescribe oral medications:
    • Metformin is usually the first medication prescribed for type 2 diabetes. It helps your body use insulin more effectively.
    • Sulfonylureas and Meglitinides are two categories of drugs that stimulate the pancreas to secrete more insulin
    • Thiazolidinediones make the body's tissues more sensitive to insulin, like Metformin does, but they are not as well tolerated
    • DPP-4 inhibitors help reduce blood sugar levels
    • GLP-1 receptor agonists digestion and help lower blood sugar levels. They are usually taken in combination with another medication or medications.
    • SGLT2 inhibitors are relatively new drugs that prevent the kidneys from reabsorbing sugar into the blood.  Instead, excess glucose is passed in the urine.
  • Insulin: If type 1 diabetes is diagnosed too late, or not adequately managed, a person may become insulin dependent.  Insulin dependent people must learn to administer their insulin using insulin pens, or syringes, or an insulin pump. Medical supervision and some trial and error may be required to determine which insulin(s) are best for each individual.
  • Exercise: Staying physically active is an important component of proper diabetes care.  Beyond helping you stay fit and healthy, regular exercise helps stabilize blood glucose.
  • Nutrition: Every person with diabetes needs to work with a dietitian to understand the relationship between food and blood glucose and learn healthy meal planning.
  • Treating Comorbid Conditions: A comorbid condition is a condition that occurs along with another disease. Both high blood pressure and high cholesterol frequently occur along with Type 1 diabetes, and are often addressed as part of the diabetes treatment regime.
  • Daily testing: The American Diabetes Association recommends testing 3 or more times a day for both people with type 1 diabetes and insulin-dependent people with type 2 diabetes.  If you have type 2 diabetes and are prescribed insulin, your diabetes educator will explain the testing process and help you plan a testing routine. Keeping a logbook is a good way to track of testing results over time. When to test is something the patient and care team work out together, depending on a person’s age, activity level, general health, and other factors. Some common testing situations include:
    • Before each meal
    • 1 or 2 hours after a meal
    • Before a snack
    • In the middle of the night
    • Before exercising, to determine whether you should eat something first
    • During and after physical activity
    • If you think your blood sugar may be high, low, or dropping.
    • When you're sick or under stress
    Your doctor will set your blood glucose target based on the following factors:
    • How long you have had diabetes
    • Age/life expectancy
    • Comorbid conditions such as high blood pressure and cholesterol levels
    • Whether you have heart disease and/or damage to your blood vessels.
  • A1C Testing: This common blood test is first used to diagnose type 1 and type 2 diabetes. Once a person has been diagnosed, their doctor will periodically prescribe and A1C test to determine how well they are managing their diabetes. This blood test that provides information about a person’s average blood sugar levels over the three months just prior to testing. An A1C test result is reported as a percentage: A normal A1C level is below 5.7 percent. Anything above that number is an indication that blood sugar has been elevated over time. 
  • Ketone Testing: Ketone is a chemical the body produces when there isn’t enough insulin in the blood and the body starts using fat for energy instead of glucose. This is more likely to occur in type 1 diabetes than in type 2. Ketone upsets the chemical balance of your blood and is toxic to the body. Combined with high blood glucose, ketone in the blood is a sign of poorly managed diabetes. Talk to your doctor at once if your urine results show moderate or large amounts of ketone. 
    Signs of Elevated Ketone Levels
    • Blood glucose of more than 300 mg/dl
    • Nausea, vomiting and/or abdominal pain
    • Feeling tired all the time
    • Thirst and dry mouth
    • Flushed skin
    • Breathing difficulties
    • A strange, fruity breath odor
    • Feeling confused or "in a fog"

As a newly diagnosed diabetes patient, we had a 2:00 consultation with you yesterday at the Braden Center, and it was a life saver, maybe literally.

You gave us so much practical help, and thankfully that included info/directions on Hypoglycemia plus a tube of glucose tablets, so we were shocked but prepared when George awakened at 1:00 AM drenched in sweat, very cold, dizzy and kind of stunned. BS = 57. We followed your directions, my partner ate 4 glucose tablets, we tried to stay calm and in about 20-30 minutes, he was out of danger at BS = 101. If we had not had our consultation with you, we would have felt utterly panicked and just do not know with what result. So please add us to what must be a very long list of profoundly grateful patients.

We also want to thank you for everything else about our meeting with you. You really calmed us down and gave us so much to feel positive about, and for me, you really helped ease my fears. We have said to each other many times how lucky we feel to have been connected with you — along with all of your knowledge and experience, you have a truly exceptionally wonderful presence and we are so grateful to be beneficiaries of that.
~ Anonymous


The way the team at the Braden Diabetes Center explained diabetes, where you are currently at, and what you are trying to achieve with your diet. They provide excellent information! They are very knowledgeable, very calm and personable - during my time at the center, I never feet like I was going to a doctors appointment.
~ Anonymous


The Certified Diabetes Educators had a very dynamic understanding of what diabetics go through on a daily basis. I felt very comfortable at the center and I received good feedback from my care team. The Educator made some good suggestions about engaging in various exercises and athletic activities to help manage my condition.
~ Anonymous


The care I received at the Braden Diabetes Center left me with the feeling that I was more in control of my diabetes.
~ Anonymous


I was inquiring about a dietary plan to help manage my diabetes. I really appreciate that the Certified Diabetes Educators gave us an actual list of foods to choose from that you can buy at the store, including brand names, not just general food groups to try and pick from.
~ Anonymous

Taking steps to manage your diabetes does more than lower your blood glucose and improve your health. It significantly reduces your risk of serious long-term complications and helps build the confidence you need for successful lifelong diabetes management.

The Diabetes Care Program at Marin General Hospital provides a continuum of expert care and resources for diabetes patients, their families, and caregivers. With the proper education, support, and medical supervision, patients can learn to successfully manage their diabetes and live healthier lives.

Click here to listen, as Dr. Linda Gaudiani explains how Marin General Hospital partners with you to help make life with diabetes a full and satisfying journey

Sources

1. Eureka Alert: http://www.eurekalert.org/pub_releases/2014-08/tl-tld081214.php