Type 2 diabetes. Definition

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1 Type 2 diabetes Definitin Type 2 diabetes, nce knwn as adult-nset r nninsulin-dependent diabetes, is a chrnic cnditin that affects the way yur bdy metablizes sugar (glucse), yur bdy's imprtant surce f fuel. With type 2 diabetes, yur bdy either resists the effects f insulin a hrmne that regulates the mvement f sugar int yur cells r desn't prduce enugh insulin t maintain a nrmal glucse level. Mre cmmn in adults, type 2 diabetes increasingly affects children as childhd besity increases. There's n cure fr type 2 diabetes, but yu may be able t manage the cnditin by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enugh t manage yur bld sugar well, yu als may need diabetes medicatins r insulin therapy.

2 Symptms Type 2 diabetes symptms ften develp slwly. In fact, yu can have type 2 diabetes fr years and nt knw it. Lk fr: Increased thirst and frequent urinatin. Excess sugar building up in yur bldstream causes fluid t be pulled frm the tissues. This may leave yu thirsty. As a result, yu may drink and urinate mre than usual. Increased hunger. Withut enugh insulin t mve sugar int yur cells, yur muscles and rgans becme depleted f energy. This triggers intense hunger. Weight lss. Despite eating mre than usual t relieve hunger, yu may lse weight. Withut the ability t metablize glucse, the bdy uses alternative fuels stred in muscle and fat. Calries are lst as excess glucse is released in the urine. Fatigue. If yur cells are deprived f sugar, yu may becme tired and irritable. Blurred visin. If yur bld sugar is t high, fluid may be pulled frm the lenses f yur eyes. This may affect yur ability t fcus. Slw-healing sres r frequent infectins. Type 2 diabetes affects yur ability t heal and resist infectins. Areas f darkened skin. Sme peple with type 2 diabetes have patches f dark, velvety skin in the flds and creases f their bdies usually in the armpits and neck. This cnditin, called acanthsis nigricans, may be a sign f insulin resistance. Causes Type 2 diabetes develps when the bdy becmes resistant t insulin r when the pancreas stps prducing enugh insulin. Exactly why this happens is unknwn, althugh genetics and envirnmental factrs, such as excess weight and inactivity, seem t be cntributing factrs. Hw insulin wrks Insulin is a hrmne that cmes frm the gland situated behind and belw the stmach (pancreas). The pancreas secretes insulin int the bldstream. The insulin circulates, enabling sugar t enter yur cells. Insulin lwers the amunt f sugar in yur bldstream. As yur bld sugar level drps, s des the secretin f insulin frm yur pancreas. The rle f glucse

3 Glucse a sugar is a main surce f energy fr the cells that make up muscles and ther tissues. Glucse cmes frm tw majr surces: fd and yur liver. Sugar is absrbed int the bldstream, where it enters cells with the help f insulin. Yur liver stres and makes glucse. When yur glucse levels are lw, such as when yu haven't eaten in a while, the liver breaks dwn stred glycgen int glucse t keep yur glucse level within a nrmal range. In type 2 diabetes, this prcess desn't wrk well. Instead f mving int yur cells, sugar builds up in yur bldstream. As bld sugar levels increase, the insulinprducing beta cells in the pancreas prduce mre insulin, but eventually these cells becme impaired and can't make enugh insulin t meet the bdy's demands. In the much less cmmn type 1 diabetes, the immune system destrys the beta cells, leaving the bdy with little t n insulin. Treatments and drugs Management f type 2 diabetes includes: Healthy eating Regular exercise Pssibly, diabetes medicatin r insulin therapy Bld sugar mnitring These steps will help keep yur bld sugar level clser t nrmal, which can delay r prevent cmplicatins. Healthy eating Cntrary t ppular perceptin, there's n specific diabetes diet. Hwever, it's imprtant t center yur diet n these high-fiber, lw-fat fds: Fruits Vegetables Whle grains

4 Yu'll als need t eat fewer animal prducts, refined carbhydrates and sweets. Lw glycemic index fds als may be helpful. The glycemic index is a measure f hw quickly a fd causes a rise in yur bld sugar. Fds with a high glycemic index raise yur bld sugar quickly. Lw glycemic fds may help yu achieve a mre stable bld sugar. Fds with a lw glycemic index typically are fds that are higher in fiber. A registered dietitian can help yu put tgether a meal plan that fits yur health gals, fd preferences and lifestyle. He r she can als teach yu hw t mnitr yur carbhydrate intake and let yu knw abut hw many carbhydrates yu need t eat with yur meals and snacks t keep yur bld sugar levels mre stable. Physical activity Everyne needs regular aerbic exercise, and peple wh have type 2 diabetes are n exceptin. Get yur dctr's OK befre yu start an exercise prgram. Then chse activities yu enjy, such as walking, swimming and biking. What's mst imprtant is making physical activity part f yur daily rutine. Aim fr at least 30 minutes f aerbic exercise mst days f the week. Stretching and strength training exercises are imprtant, t. If yu haven't been active fr a while, start slwly and build up gradually. A cmbinatin f exercises aerbic exercises, such as walking r dancing n mst days, cmbined with resistance training, such as weightlifting r yga twice a week ften helps cntrl bld sugar mre effectively than either type f exercise alne. Remember that physical activity lwers bld sugar. Check yur bld sugar level befre any activity. Yu might need t eat a snack befre exercising t help prevent lw bld sugar if yu take diabetes medicatins that lwer yur bld sugar. Mnitring yur bld sugar Depending n yur treatment plan, yu may check and recrd yur bld sugar level every nw and then r, if yu're n insulin, multiple times a day. Ask yur dctr hw ften he r she wants yu t check yur bld sugar. Careful mnitring is the nly way t make sure that yur bld sugar level remains within yur target range. Smetimes, bld sugar levels can be unpredictable. With help frm yur diabetes treatment team, yu'll learn hw yur bld sugar level changes in respnse t fd, exercise, alchl, illness and medicatin.

5 Diabetes medicatins and insulin therapy Sme peple wh have type 2 diabetes can achieve their target bld sugar levels with diet and exercise alne, but many als need diabetes medicatins r insulin therapy. The decisin abut which medicatins are best depends n many factrs, including yur bld sugar level and any ther health prblems yu have. Yur dctr might even cmbine drugs frm different classes t help yu cntrl yur bld sugar in several different ways. Examples f pssible treatments fr type 2 diabetes include: Metfrmin (Glucphage, Glumetza, thers). Generally, metfrmin is the first medicatin prescribed fr type 2 diabetes. It wrks by imprving the sensitivity f yur bdy tissues t insulin s that yur bdy uses insulin mre effectively. Metfrmin als lwers glucse prductin in the liver. Metfrmin usually wn't lwer bld sugar enugh n its wn. Yur dctr will als recmmend lifestyle changes, such as lsing weight and becming mre active. Nausea and diarrhea are pssible side effects f metfrmin. These side effects usually g away as yur bdy gets used t the medicine. If metfrmin and lifestyles changes aren't enugh t cntrl yur bld sugar level, ther ral r injected medicatins can be added. Sulfnylureas. These medicatins help yur bdy secrete mre insulin. Examples f medicatins in this class include glyburide (DiaBeta, Glynase), glipizide (Gluctrl) and glimepiride (Amaryl). Pssible side effects include lw bld sugar and weight gain. Meglitinides. These medicatins wrk like sulfnylureas by encuraging the bdy t secrete mre insulin, but they're faster acting, and they dn't stay active in the bdy fr as lng. They als have a risk f causing lw bld sugar, but nt as much risk as sulfnylureas d. Weight gain is a pssibility with this class f medicatins as well. Examples include repaglinide (Prandin) and nateglinide (Starlix). Thiazlidinedines. Like metfrmin, these medicatins make the bdy's tissues mre sensitive t insulin. This class f medicatins has been linked t weight gain and ther mre serius side effects, such as an increased risk f heart failure and fractures. Because f these risks, these medicatins generally aren't a first-chice treatment.

6 Rsiglitazne (Avandia) and piglitazne (Acts) are examples f thiazlidinedines. DPP-4 inhibitrs. These medicatins help reduce bld sugar levels, but tend t have a mdest effect. They dn't seem t cause weight gain. Examples f these medicatins are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). GLP-1 receptr agnists. These medicatins slw digestin and help lwer bld sugar levels, thugh nt as much as sulfnylureas. This class f medicatins isn't recmmended fr use alne. Exenatide (Byetta) and liraglutide (Victza) are examples f GLP-1 receptr agnists. Pssible side effects include nausea and an increased risk f pancreatitis. SGLT2 inhibitrs. These are the newest diabetes drugs n the market. They wrk by preventing the kidneys frm reabsrbing sugar in the bld. Instead, the sugar is excreted in the urine. Examples include canagliflzin (Invkana) and dapagliflzin (Farxiga). Side effects may include yeast infectins and urinary tract infectins. Insulin therapy. Sme peple wh have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was used as last resrt, but tday it's ften prescribed sner because f its benefits. Because nrmal digestin interferes with insulin taken by muth, insulin must be injected. Depending n yur needs, yur dctr may prescribe a mixture f insulin types t use thrughut the day and night. Often, peple with type 2 diabetes start insulin use with ne lng-acting sht at night. Insulin injectins invlve using a fine needle and syringe r an insulin pen injectr a device that lks similar t an ink pen, except the cartridge is filled with insulin. There are many types f insulin, and they each wrk in a different way. Optins include: Insulin glulisine (Apidra) Insulin lispr (Humalg) Insulin aspart (Nvlg) Insulin glargine (Lantus) Insulin detemir (Levemir) Insulin isphane (Humulin N, Nvlin N)

7 Discuss the prs and cns f different drugs with yur dctr. Tgether yu can decide which medicatin is best fr yu after cnsidering many factrs, including csts and ther aspects f yur health. In additin t diabetes medicatins, yur dctr might prescribe lw-dse aspirin therapy as well as bld pressure and chlesterl-lwering medicatins t help prevent heart and bld vessel disease. Bariatric surgery If yu have type 2 diabetes and yur bdy mass index (BMI) is greater than 35, yu may be a candidate fr weight-lss surgery (bariatric surgery). Bld sugar levels return t nrmal in 55 t 95 percent f peple with diabetes, depending n the prcedure perfrmed. Surgeries that bypass a prtin f the small intestine have mre f an effect n bld sugar levels than d ther weight-lss surgeries. Drawbacks t the surgery include cst, and there are risks invlved, including a risk f death. Additinally, drastic lifestyle changes are required and lng-term cmplicatins may include nutritinal deficiencies and steprsis. Pregnancy Wmen with type 2 diabetes may need t alter their treatment during pregnancy. Many wmen use insulin therapy during pregnancy. Chlesterl-lwering medicatins and sme bld pressure drugs can't be used during pregnancy. If yu have signs f diabetic retinpathy, it may wrsen during pregnancy. Visit yur phthalmlgist during the first trimester f yur pregnancy and at ne year pstpartum. Signs f truble Because s many factrs can affect yur bld sugar, prblems smetimes arise that require immediate care, such as: High bld sugar (hyperglycemia). Yur bld sugar level can rise fr many reasns, including eating t much, being sick r nt taking enugh glucselwering medicatin. Check yur bld sugar level ften, and watch fr signs and symptms f high bld sugar frequent urinatin, increased thirst, dry muth, blurred visin, fatigue and nausea. If yu have hyperglycemia, yu'll need t adjust yur meal plan, medicatins r bth. Hyperglycemic hypersmlar nnkettic syndrme (HHNS). Signs and symptms f this life-threatening cnditin include a bld sugar reading higher than

8 600 mg/dl (33.3 mml/l), dry muth, extreme thirst, fever greater than 101 F (38 C), drwsiness, cnfusin, visin lss, hallucinatins and dark urine. Yur bld sugar mnitr may nt be able t give yu an exact reading at such high levels and may instead just read "high." HHNS is caused by sky-high bld sugar that turns bld thick and syrupy. It tends t be mre cmmn in lder peple with type 2 diabetes, and it's ften preceded by an illness r infectin. HHNS usually develps ver days r weeks. Call yur dctr r seek immediate medical care if yu have signs r symptms f this cnditin. Increased ketnes in yur urine (diabetic ketacidsis). If yur cells are starved fr energy, yur bdy may begin t break dwn fat. This prduces txic acids knwn as ketnes. Watch fr lss f appetite, weakness, vmiting, fever, stmach pain and fruitysmelling breath. Yu can check yur urine fr excess ketnes with an ver-thecunter ketnes test kit. If yu have excess ketnes in yur urine, cnsult yur dctr right away r seek emergency care. This cnditin is mre cmmn in peple with type 1 diabetes but can smetimes ccur in peple with type 2 diabetes. Lw bld sugar (hypglycemia). If yur bld sugar level drps belw yur target range, it's knwn as lw bld sugar (hypglycemia). Yur bld sugar level can drp fr many reasns, including skipping a meal r getting mre physical activity than nrmal. Lw bld sugar is mst likely if yu take glucse-lwering medicatins that prmte the secretin f insulin r if yu're taking insulin. Check yur bld sugar level regularly, and watch fr signs and symptms f lw bld sugar sweating, shakiness, weakness, hunger, dizziness, headache, blurred visin, heart palpitatins, slurred speech, drwsiness, cnfusin and seizures. If yu develp hypglycemia during the night, yu might wake with sweat-saked pajamas r a headache. Due t a natural rebund effect, nighttime hypglycemia might cause an unusually high bld sugar reading first thing in the mrning. If yu have signs r symptms f lw bld sugar, drink r eat smething that will quickly raise yur bld sugar level fruit juice, glucse tablets, hard candy, regular (nt diet) sda r anther surce f sugar. Retest in 15 minutes t be sure yur bld glucse levels are nrmal. If they're nt, treat again and retest in anther 15 minutes. If yu lse cnsciusness, a family member r clse cntact may need t give yu an

9 emergency injectin f a hrmne that stimulates the release f sugar int the bld (glucagn). Preventin Healthy lifestyle chices can help yu prevent type 2 diabetes. Even if yu have diabetes in yur family, diet and exercise can help yu prevent the disease. If yu've already received a diagnsis f diabetes, yu can use healthy lifestyle chices t help prevent cmplicatins. And if yu have prediabetes, lifestyle changes can slw r halt the prgressin frm prediabetes t diabetes. Eat healthy fds. Chse fds lwer in fat and calries and higher in fiber. Fcus n fruits, vegetables and whle grains. Get physical. Aim fr 30 minutes f mderate physical activity a day. Take a brisk daily walk. Ride a bike. Swim laps. If yu can't fit in a lng wrkut, spread 10- minute r lnger sessins thrughut the day. Lse excess punds. If yu're verweight, lsing 7 percent f yur bdy weight can reduce the risk f diabetes. T keep yur weight in a healthy range, fcus n permanent changes t yur eating and exercise habits. Mtivate yurself by remembering the benefits f lsing weight, such as a healthier heart, mre energy and imprved self-esteem. Smetimes medicatin is an ptin as well. Metfrmin (Glucphage, Glumetza, thers), an ral diabetes medicatin, may reduce the risk f type 2 diabetes but healthy lifestyle chices remain essential.

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