Type 2 diabetes — A silent presence

Type 2 diabetes is a disease that occurs when there is a consistently high level of sugar (glucose) in the blood. According to the American Diabetes Association (ADA), nearly 16 million Americans have type 2 diabetes. More surprising is that about one-third of those people don’t know that they have the disease.

There are a few reasons for this. First, most people don’t know if they’re at risk for type 2 diabetes. Second, many people with type 2 diabetes are asymptomatic — that is, although they have the disease and it may be progressing, they don’t have any noticeable symptoms. Third, it’s common to misinterpret diabetes symptoms. For example, excess thirst, frequent urination, lack of energy, weight loss and even blurred vision come on gradually and might be attributed to the aging process, when in fact they’re classic symptoms of type 2 diabetes disease progression.

Who gets diabetes?

Type 2 diabetes has a strong genetic link — it tends to “run in the family.” Type 2 diabetes often affects people who are overweight or obese, and over 45 years old — although the rate is increasing in younger people. Some other type 2 risk factors include:

  • Family history of diabetes
  • Lack of regular exercise
  • History of gestational diabetes, a form of diabetes occurring during pregnancy
  • Giving birth to a baby weighing more than nine pounds
  • Ethnicity: African-Americans, Latinos, Native Americans, Asian and Pacific Islanders

Special considerations for ethnic populations

Although anyone of any race, gender or ethnicity can be at risk for diabetes, there is a higher incidence in people within certain ethnic groups. For example:

  • African-Americans: Twice as likely as non-Latino whites (that is, Caucasians) to have diabetes — 25% of African-American women over 55 have the disease.
  • Native Americans: Over 12% aged 19 or older have type 2 diabetes. In one Arizona tribe, 50% of adults between the ages of 30 and 64 have the disease.
  • Mexican Americans: About 24% in the U.S. have diabetes.
  • Puerto Ricans: 26% between the ages of 45 and 74 have diabetes.

In addition, people in these groups are more likely to develop serious diabetes-related complications, like heart disease, blindness, lower-limb amputation and kidney failure.

The role of sugar and insulin in diabetes

Your body converts most of the food you eat into sugar. Sugar supplies the energy your body needs to do what it needs to do. Insulin, a hormone that’s made by your pancreas, sends a signal telling your body’s cells to let sugar in from the bloodstream. Once in the cells, the sugar provides the energy your body needs to work. With type 2 diabetes, your body simply isn’t able to use that sugar the way it should.

Type 2 diabetes develops when either the body can’t make enough insulin, or when the cells don’t always “listen” to the insulin and won’t let enough sugar in. This is called “insulin resistance.” Either way, too much sugar is left in the bloodstream. If left unchecked, having too much sugar in the bloodstream can lead to diabetes and related complications.

Identifying type 1 and type 2 diabetes

For about 1 in 10 people with diabetes, the pancreas has completely stopped making insulin. This is type 1 diabetes. No insulin means no messages are being sent to the body’s cells telling them to let sugar in. Then sugar builds up in the bloodstream instead. The only treatment for type 1 diabetes is daily insulin. Type 1 diabetes usually develops in children, teenagers and young adults.

The other 9 out of 10 people with diabetes have type 2, which can occur for many reasons. One of the most common reasons is insulin resistance. In fact, 90% of people with type 2 diabetes are insulin resistant. People with type 2 diabetes often continue to make their own natural insulin but their bodies simply don’t use it properly. This means the body’s cells don’t always “listen” to the messages the insulin sends, telling the cells to let sugar in. This makes it hard for the sugar to enter the cells, which leads to an unhealthy buildup of sugar in the blood. Type 2 diabetes has a strong genetic link — that is, it “runs in the family.” Most often, it occurs in adults over the age of 45.

Taking control of blood sugar levels

At this point, there’s no cure for diabetes. But there is a way to help you possibly avoid some of the serious medical problems caused by the disease: maintain normal blood sugar levels by following a doctor’s advice regarding diet, exercise, weight control and using prescribed medication.

Testing blood sugar levels

The goal of treatment for type 2 diabetes is to maintain a “normal” blood sugar level. What’s a “normal” blood sugar level? In addition to daily blood sugar testing, a hemoglobin A1c (or A1c) test can show your average blood sugar over the last two to three months.

People with type 2 diabetes may do at-home blood sugar tests before or after meals, or as recommended by a doctor to measure current blood sugar levels. According to the ADA, the blood sugar level before a meal should be 90-130 mg/dL. Approximately 2 hours after a meal, the blood sugar level should be less than 180 mg/dL.

Why you need to know your A1c

The ADA recommends people with type 2 diabetes maintain A1c levels lower than 7%. With every 1 percent increase in A1c above 7%, the risk of heart attack, stroke or other long-term complication increases. Ask your doctor to perform an A1c test two to four times each year to ensure good, long-term blood sugar measurement.

Strategies to help keep blood sugar down

Many people with type 2 diabetes can maintain good blood sugar levels through dietary changes, weight loss and/or increased physical activity. Others need medication to help keep sugar from building up in the bloodstream.

The importance of blood sugar control

It’s important to consistently maintain blood sugar levels within a normal range to help avoid the short- and long-term complications of diabetes. Day-to-day blood sugar highs and lows prevent people from feeling their best, and can make it hard to concentrate and function normally. With the right strategy, it’s very possible for people with type 2 diabetes to manage their condition, help avoid future complications and be stronger than diabetes.

Long-term problems

In 1999, almost a half million deaths occurred among people with diabetes aged 25 years and older. Without management, type 2 diabetes can lead to serious complications, including kidney failure, blindness, heart attack, lower-limb amputation and stroke. Uncontrolled blood sugar levels make it harder for infections to heal, which could lead to gangrene and even lower-limb amputation.

There are a few simple, effective strategies to help avoid complications and to help improve the chance of leading a healthier life with type 2 diabetes:

  • Keeping your blood sugar close to normal
  • Adopting a diabetes-friendly diet
  • Exercising
  • Controlling weight
  • Testing blood sugar regularly (including A1c tests)
  • Taking doctor-prescribed medications as directed
  • Scheduling regular medical visits for tests and follow-up
  • Keeping your blood pressure under control
  • Keeping your cholesterol in control

Specific complications of diabetes

These are some of the more common complications associated with diabetes:

Heart disease or stroke

Cardiovascular disease (CVD) is a serious complication of type 2 diabetes. The National Cholesterol Education Program considers diabetes to be a “coronary heart disease risk equivalent.” This means that diabetes carries the same risk for heart disease as someone without diabetes who already has heart disease.

In many cases, heart disease is more severe in people with diabetes.

Kidney disease

  • Up to 21% percent of all people with diabetes develop kidney disease.
  • About 43% of new cases of end-stage (advanced) renal disease are attributed to diabetes.

Blindness and Glaucoma

  • People with diabetes are 40% more likely to suffer from glaucoma, and 60% more likely to develop cataracts than people without diabetes.
  • Diabetes is the leading cause of new cases of blindness among adults between the ages of 20 and 74.
  • Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Nervous system damage and amputation

  • About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. Severe cases are a major contributing cause of lower-limb amputation.
  • More than 60% of non-traumatic lower-limb amputations in the U.S. occur among people with diabetes.

Gender-specific illnesses

  • Women with diabetes have an increased risk of vaginal infections and complications during pregnancy.
  • The incidence of impotence in men over the age of 50 has been reported to be as high as 50%.

Prevention: A life-long commitment

As of now, type 2 diabetes can’t be cured. Once you’re diagnosed, you will have the illness for life.

Because diabetes is a life-long condition, diabetes management must be a life-long commitment. Sticking to a diabetes program and taking medication as prescribed helps control blood sugar and may reduce your chances of serious complications.

Treatment Options

The primary goal of treatment for type 2 diabetes is to maintain normal blood sugar levels. There are several ways to help accomplish this.

Diet, weight loss, and physical activity

By working with your healthcare professional and/or nutritionist, and staying committed, you may be able to use dietary changes to control your blood sugar. Research has shown that certain types of foods elevate blood sugar levels. By limiting these foods in your diet, you may be able to help keep your blood sugar levels under control.

Unfortunately, many people with type 2 diabetes are overweight or obese. Often, just losing weight can improve blood sugar levels.

Some level of physical activity is a good idea for everyone with type 2 diabetes. It can contribute to losing weight, and it has been shown to enhance the body’s response to its own natural insulin. Regular physical activity can improve the effectiveness of how your body uses its own natural insulin, which is essential to controlling your blood sugar levels. Of course, you should talk with your doctor before beginning or increasing the intensity of an exercise program.

Medication

Some people with type 2 diabetes can control their blood sugar by using a combination of diet and exercise. However, you may be among those who need oral medication(s), insulin injections or a combination of the two — in addition to diet and exercise — to control your blood sugar. It’s important to remember that diabetes treatments that lower blood sugar never take the place of healthy eating and exercise. Everyone with type 2 diabetes needs to practice healthy eating and, when possible, get some physical activity every day — whether or not he or she is on diabetes medications.

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