Diabetes mellitus type 2 is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. This is in contrast to diabetes mellitus type 1 in which there is an absolute insulin deficiency due to destruction of islet cells in the pancreas and gestational diabetes mellitus that is a new onset of high blood sugars associated with pregnancy. Type 1 and type 2 diabetes can typically be distinguished based on the presenting circumstances. If the diagnosis is in doubt antibody testing may be useful to confirm type 1 diabetes and C-peptide levels may be useful to confirm type 2 diabetes, with C-peptide levels normal or high in type 2 diabetes, but low in type 1 diabetes.
DKA usually follows increasing hyperglycemia and symptoms of osmotic diuresis. Users of insulin pumps, by virtue of absent reservoirs of subcutaneous insulin, may present with ketosis and more normal blood glucose levels. They are more likely to present with nausea, vomiting, and abdominal pain, symptoms similar to food poisoning. DKA may manifest as respiratory distress.
George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology
Yet carbs are processed differently in the body based on their type: While simple carbs are digested and metabolized quickly, complex carbs take longer to go through this system, resulting in more stable blood sugar. “It comes down to their chemical forms: A simple carbohydrate has a simpler chemical makeup, so it doesn’t take as much for it to be digested, whereas the complex ones take a little longer,” Grieger explains.
Jump up ^ Emadian A, Andrews RC, England CY, Wallace V, Thompson JL (November 2015). "The effect of macronutrients on glycaemic control: a systematic review of dietary randomised controlled trials in overweight and obese adults with type 2 diabetes in which there was no difference in weight loss between treatment groups". The British Journal of Nutrition. 114 (10): 1656–66. doi:10.1017/S0007114515003475. PMC 4657029. PMID 26411958.
According to the American Diabetes Association, a child has a 1 in 7 risk of getting type 2 diabetes if his/her parent was diagnosed with type 2 diabetes before the age of 50, and a 1 in 13 risk of developing it if the parent was diagnosed after the age of 50. To see if you may be at risk for diabetes, consider taking this short and simple Type 2 Diabetes Risk Test from the ADA.
Research continues on diabetes prevention and improved detection of those at risk for developing diabetes. While the onset of Type I diabetes is unpredictable, the risk of developing Type II diabetes can be reduced by maintaining ideal weight and exercising regularly. The physical and emotional stress of surgery, illness, pregnancy, and alcoholism can increase the risks of diabetes, so maintaining a healthy lifestyle is critical to preventing the onset of Type II diabetes and preventing further complications of the disease.
Type 2 diabetes is one of the major degenerative diseases in the Western world today. It happens when your body can’t use insulin properly, or can’t make enough insulin. Insulin is a hormone the assists the body’s cells in utilizing glucose. It also helps the body store extra sugar in fat, liver, and muscle cells. If you don’t have insulin, your body can’t use the sugar in the bloodstream.
Pay attention if you find yourself feeling drowsy or lethargic; pain or numbness in your extremities; vision changes; fruity or sweet-smelling breath which is one of the symptoms of high ketones; and experiencing nausea or vomiting—as these are additional signs that something is not right. If there’s any question, see your doctor immediately to ensure that your blood sugar levels are safe and rule out diabetes.
Lifestyle factors are important to the development of type 2 diabetes, including obesity and being overweight (defined by a body mass index of greater than 25), lack of physical activity, poor diet, stress, and urbanization. Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of cases in Pima Indians and Pacific Islanders. Among those who are not obese, a high waist–hip ratio is often present. Smoking appears to increase the risk of type 2 diabetes mellitus.
Although age of onset and length of the disease process are related to the frequency with which vascular, renal, and neurologic complications develop, there are some patients who remain relatively free of sequelae even into the later years of their lives. Because diabetes mellitus is not a single disease but rather a complex constellation of syndromes, each patient has a unique response to the disease process.
Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight loss, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes).[medical citation needed]
Long-term complications arise from the damaging effects of prolonged hyperglycemia and other metabolic consequences of insulin deficiency on various tissues. Although long-term complications are rare in childhood, maintaining good control of diabetes is important to prevent complications from developing in later life.  The likelihood of developing complications appears to depend on the interaction of factors such as metabolic control, genetic susceptibility, lifestyle (eg, smoking, diet, exercise), pubertal status, and gender. [40, 41] Long-term complications include the following:
Type 2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin resistance. Insulin resistance, which is the inability of cells to respond adequately to normal levels of insulin, occurs primarily within the muscles, liver, and fat tissue. In the liver, insulin normally suppresses glucose release. However, in the setting of insulin resistance, the liver inappropriately releases glucose into the blood. The proportion of insulin resistance versus beta cell dysfunction differs among individuals, with some having primarily insulin resistance and only a minor defect in insulin secretion and others with slight insulin resistance and primarily a lack of insulin secretion.
Jump up ^ Palmer, Suetonia C.; Mavridis, Dimitris; Nicolucci, Antonio; Johnson, David W.; Tonelli, Marcello; Craig, Jonathan C.; Maggo, Jasjot; Gray, Vanessa; De Berardis, Giorgia; Ruospo, Marinella; Natale, Patrizia; Saglimbene, Valeria; Badve, Sunil V.; Cho, Yeoungjee; Nadeau-Fredette, Annie-Claire; Burke, Michael; Faruque, Labib; Lloyd, Anita; Ahmad, Nasreen; Liu, Yuanchen; Tiv, Sophanny; Wiebe, Natasha; Strippoli, Giovanni F.M. (19 July 2016). "Comparison of Clinical Outcomes and Adverse Events Associated With Glucose-Lowering Drugs in Patients With Type 2 Diabetes". JAMA: the Journal of the American Medical Association. 316 (3): 313–24. doi:10.1001/jama.2016.9400. PMID 27434443.
When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can't keep up, the excess sugar is excreted into your urine, dragging along fluids from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you'll urinate even more.
As of 2016, 422 million people have diabetes worldwide, up from an estimated 382 million people in 2013 and from 108 million in 1980. Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.5% among adults, nearly double the rate of 4.7% in 1980. Type 2 makes up about 90% of the cases. Some data indicate rates are roughly equal in women and men, but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and alcohol intake.
Does having type 2 diabetes affect life expectancy? While continued improvements in therapies and care for type 2 diabetes may be helping patients live longer, the unfortunate reality is that type 2 diabetes has been shown to decrease life expectancy by up to ten years, according to Diabetes UK. There is still much to be done to ensure that all patients have access to appropriate healthcare and treatments to live a happier and healthier life with type 2 diabetes.
Another dipstick test can determine the presence of protein or albumin in the urine. Protein in the urine can indicate problems with kidney function and can be used to track the development of renal failure. A more sensitive test for urine protein uses radioactively tagged chemicals to detect microalbuminuria, small amounts of protein in the urine, that may not show up on dipstick tests.
You are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease. To see if your weight puts you at risk for type 2 diabetes, check out these Body Mass Index (BMI) charts.
Insulin is the hormone responsible for reducing blood sugar. In order for insulin to work, our tissues have to be sensitive to its action; otherwise, tissues become resistant and insulin struggles to clear out sugar from the blood. As insulin resistance sets in, the first organ to stop responding to insulin is the liver, followed by the muscles and eventually fat. How does insulin resistance begin? The root of the problem is our diet.
Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren't meant to replace regular physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications, as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.
When you have diabetes, your body becomes less efficient at breaking food down into sugar, so you have more sugar sitting in your bloodstream, says Dobbins. “Your body gets rid of it by flushing it out in the urine.” So going to the bathroom a lot could be one of the diabetes symptoms you’re missing. Most patients aren’t necessarily aware of how often they use the bathroom, says Dr. Cypess. “When we ask about it, we often hear, ‘Oh yeah, I guess I’m going more often than I used to,’” he says. But one red flag is whether the need to urinate keeps you up at night. Once or twice might be normal, but if it’s affecting your ability to sleep, that could be a diabetes symptom to pay attention to. Make sure you know these diabetes myths that could sabotage your health.
Diet, exercise, and education are the cornerstones of treatment of diabetes and often the first recommendations for people with mild diabetes. Weight loss is important for people who are overweight. People who continue to have elevated blood glucose levels despite lifestyle changes, or have very high blood glucose levels and people with type 1 diabetes (no matter their blood glucose levels) also require drugs.
Diabetic foot disease, due to changes in blood vessels and nerves, often leads to ulceration and subsequent limb amputation. It is one of the most costly complications of diabetes, especially in communities with inadequate footwear. It results from both vascular and neurological disease processes. Diabetes is the most common cause of non-traumatic amputation of the lower limb, which may be prevented by regular inspection and good care of the foot.
Injections of insulin may either be added to oral medication or used alone. Most people do not initially need insulin. When it is used, a long-acting formulation is typically added at night, with oral medications being continued. Doses are then increased to effect (blood sugar levels being well controlled). When nightly insulin is insufficient, twice daily insulin may achieve better control. The long acting insulins glargine and detemir are equally safe and effective, and do not appear much better than neutral protamine Hagedorn (NPH) insulin, but as they are significantly more expensive, they are not cost effective as of 2010. In those who are pregnant insulin is generally the treatment of choice.
If, on the other hand, you are already starting to develop complications or your medication regimen has changed because your blood sugars are getting higher, remember that diabetes is a progressive disease—and sometimes these things just happen without any influence from your own actions. As you age, beta cells in the pancreas get tired and stop working. If you've had diabetes for 20 years and now need to start insulin, for example, it doesn't mean you've failed. It just means that your body needs some help. Make sure you continue to receive education and that you continue to have someone to lean on when you need it, and keep the lines of communication open with your doctor. It truly can make a difference.
When it comes to diabetes, there's no real answer yet. Yes, science has begun to uncover the roots of this disease, unearthing a complex interplay of genes and environment—and a lot more unanswered questions. Meanwhile, there's plenty of misinformation to go around. (How often have you had to explain that diabetes doesn't happen because someone "ate too much"?)
While there is a strong genetic component to developing this form of diabetes, there are other risk factors - the most significant of which is obesity. There is a direct relationship between the degree of obesity and the risk of developing type 2 diabetes, and this holds true in children as well as adults. It is estimated that the chance to develop diabetes doubles for every 20% increase over desirable body weight.
Given the diverse peculiarities involving the issue, studies have shown that Diabetes mellitus has been extensively investigated in its pathophysiological aspects, highlighting the search for strong evidence that can be used in the clinical practice of the Primary Care nurse, with attributions focused on health promotion, prevention of complications, treatment and rehabilitation of the health of individuals and community, carried out in an interdisciplinary and multidisciplinary manner (Matumoto, Fortuna, Kawata, Mishima, & Pereira, 2011; Florianopolis, 2015).
If you are a diabetic and are pregnant you can have a normal, healthy pregnancy, but you need to take extra steps to avoid gaining excess weight and high blood sugars. Lifestyle habits (eating primarily vegetables and lean protein and exercising every day) will prevent problems during pregnancy. If you are a diabetic and become pregnant, monitor your blood sugar levels often. Talk with your doctor about exploring additional health care professionals, for example, a nutritionist, health coach, or naturopathic doctor about a healthy eating plan. If your blood sugar gets out of control you may:
What does the research say about proactive type 2 diabetes management? Research shows that proactive management can pay off in fewer complications down the road. In the landmark UKPDS study, 5,102 patients newly diagnosed with type 2 diabetes were followed for an average of 10 years to determine whether intensive use of blood glucose-lowering drugs would result in health benefits. Tighter average glucose control (an A1c of 7.0% vs. an A1c of 7.9%) reduced the rate of complications in the eyes, kidneys, and nervous system, by 25%. For every percentage point decrease in A1c (e.g., from 9% to 8%), there was a 25% reduction in diabetes-related deaths, and an 18% reduction in combined fatal and nonfatal heart attacks.
Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels. The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher. Attention is also paid to other health problems that may accelerate the negative effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Specialized footwear is widely used to reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the efficacy of this remains equivocal, however.
People with full-blown type 2 diabetes are not able to use the hormone insulin properly, and have what’s called insulin resistance. Insulin is necessary for glucose, or sugar, to get from your blood into your cells to be used for energy. When there is not enough insulin — or when the hormone doesn’t function as it should — glucose accumulates in the blood instead of being used by the cells. This sugar accumulation may lead to the aforementioned complications.