Diabetes -Type 2

Posted in Disease Information

Introduction

Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high.

Types of diabetes

There are two main types of diabetes, referred to as type 1 and type 2.

Type 2 diabetes occurs when the body doesn’t produce enough insulin to function properly, or the body’s cells don’t react to insulin. This is known as insulin resistance.

Type 2 diabetes is far more common than type 1 diabetes, which occurs when the body doesn’t produce any insulin at all.

This topic focuses on type 2 diabetes. You can read more information on type 1 diabetes.

Type 2 diabetes usually affects people over the age of 40, although increasingly younger people are also being affected. It is more common in people of South Asian, African-Caribbean or Middle Eastern descent.

Diabetes symptoms

Diabetes can cause various symptoms. Symptoms common to both types of diabetes include:

• Feeling very thirsty
• Urinating frequently, particularly at night
• Feeling very tired
• Weight loss and loss of muscle bulk

You should visit Dr. B C Shah as soon as possible if you notice these symptoms.

Causes of type 2 diabetes

Insulin is a hormone produced by part of the pancreas, a large gland located behind the stomach.

Insulin controls the amount of glucose (sugar) in your blood. It moves glucose from the blood into your cells, where it is converted into energy.

In type 2 diabetes, not enough insulin is produced to maintain a normal blood glucose level (insulin deficiency), or your body is unable to use the insulin that is produced effectively (insulin resistance).

Treating type 2 diabetes

It is important diabetes is diagnosed as early as possible. Diabetes cannot be cured, but treatment aims to keep your blood glucose levels as normal as possible to control your symptoms and minimise health problems developing later.

If you are diagnosed with diabetes, you can meet Dr. B C Shah who will  provide you with first line diabetes care.

In some cases of type 2 diabetes, it may be possible to control your symptoms by altering your lifestyle, such as eating a healthy diet.

However, as type 2 diabetes is a progressive condition, you may eventually need medication to keep your blood glucose at normal levels. To start with this will usually take the form of tablets, but later on it may include injected therapies, such as insulin.

Complications

Left untreated, diabetes can cause many health problems. Large amounts of glucose can damage blood vessels, nerves and organs.

Even a mildly raised glucose level that doesn’t cause any symptoms can have damaging effects in the long term.

Living with diabetes

If you have type 2 diabetes, you will be advised to look after your health carefully. Caring for your health will also make treating your diabetes easier and minimise your risk of developing complications.

It helps to eat a healthy, balanced diet, stop smoking (if you smoke), drink alcohol in moderation and take plenty of regular exercise.

Symptoms of type 2 diabetes

Some diabetes symptoms are common to both type 1 and type 2 diabetes. Each has its own particular symptoms.

The main symptoms of diabetes common to both types are:

• Feeling very thirsty
• Urinating frequently, particularly at night
• Feeling very tired
• Weight loss and loss of muscle bulk

Many people have type 2 diabetes for years without realising because the early symptoms can be mild.

Visit Dr. B C Shah as soon as possible if you think you have diabetes. Early diagnosis and treatment may reduce your risk of developing complications later on.

Other symptoms of diabetes can include:

• Itchiness around the vagina or penis, or regular bouts of thrush (a yeast infection)
• Blurred vision that is caused by the lens of your eye becoming very dry
• Cramps
• Constipation
• Skin infections

Not everyone will experience the above symptoms, and they are not usually severe in those who do get them.

Hyperglycaemia (high blood glucose)

Type 2 diabetes develops when the pancreas (a large gland behind your stomach) is unable to produce enough insulin to control your blood glucose level, or when the body’s cells don’t respond properly to insulin that is produced.

Due to the lack of insulin or its inability to regulate blood glucose, your blood glucose levels may become very high.

Hyperglycaemia can occur for several reasons, including eating too much, being unwell and not taking enough diabetes therapy.

The main symptoms of diabetes are due to hyperglycaemia. They include:

• Extreme thirst
• A dry mouth
• Blurred vision
• Drowsiness
• A need to pass urine frequently

Causes of type 2 diabetes

Type 2 diabetes occurs when the pancreas does not produce enough insulin to maintain a normal blood glucose level, or your body is unable to use the insulin that is produced (insulin resistance).

The pancreas (a large gland behind the stomach) produces the hormone insulin, which moves glucose from your blood into your cells, where it is converted into energy.

In type 2 diabetes, there are several reasons why the pancreas doesn’t produce enough insulin.

These are discussed below.

Risk factors for type 2 diabetes

You are more likely to develop type 2 diabetes if you:

• are over 40 years old
• have a relative with the condition
• are of South Asian, African-Caribbean or Middle Eastern origin
• are overweight or obese

Age

Your risk of developing type 2 diabetes increases with age.

This may be because people tend to gain weight and exercise less as they get older. Maintaining a healthy weight through a healthy, balanced diet and exercising regularly are ways of preventing and managing diabetes.

Type 2 diabetes often develops in white people over the age of 40. People of South Asian, African, African-Caribbean and Middle Eastern descent have an increased risk of developing type 2 diabetes at a much earlier age.

However, in recent years, an increasing number of younger people from all ethnic groups are developing the condition.

It is also becoming more common for children, in some cases as young as seven, to develop type 2 diabetes.

Genetics

Genetics is one of the main risk factors for type 2 diabetes. Your risk is increased if you have a close relative, such as a parent, brother or sister, who has the condition. The closer the relative, the greater the risk.

A child who has a parent with type 2 diabetes has about a one-in-three chance of also developing it .

Ethnicity

People of South Asian, African, African-Caribbean and Middle Eastern descent are more likely to develop type 2 diabetes.

People of South Asian and African-Caribbean origin also have an increased risk of developing complications of diabetes, such as heart disease, at a younger age than the rest of the population.

Being overweight or obese

If you are overweight or obese (you have a body mass index of 30 or greater), you are at greater risk of developing type 2 diabetes.

In particular, fat around your abdomen (tummy) puts you at increased risk. This is because it releases chemicals that can upset the body’s cardiovascular and metabolic systems. This then increases your risk of a developing various conditions, including heart disease, stroke and some types of cancer.

A quick way of assessing your diabetes risk is to measure your waist. This is a measure of abdominal obesity, which is a particularly high-risk form of obesity.

Women have a higher risk of developing type 2 diabetes if their waist measures 31.5 inches (80cm) or more. Asian men with a waist size of 35 inches (90cm) or over have a higher risk, as do white or black men with a waist size of 37 inches (94cm) or over.

Reducing your body weight by about 5% and exercising regularly could reduce your risk of getting diabetes by more than 50%.

Other risks

Your risk of developing type 2 diabetes is also increased if you have impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT).

These conditions are sometimes referred to as “pre-diabetes” and mean that your blood glucose level is higher than normal but not high enough to cause diabetes. IFG and IGT can both progress to type 2 diabetes if you do not take preventative steps.

Women who have gestational diabetes during pregnancy also have a greater risk of developing diabetes in later life.

Diagnosing type 2 diabetes

It is important for diabetes to be diagnosed early so treatment can be started as soon as possible.

If you experience the symptoms of diabetes, visit Dr. B C Shah as soon as possible. They will ask about your symptoms and may request urine and blood tests.

Urine and blood tests

Your urine sample will be tested for glucose. Urine doesn’t usually contain glucose, but if you have diabetes, glucose can overflow through the kidneys and into your urine.

If your urine contains glucose, a specialised blood test called a glucose tolerance test (see below) can be used to determine whether you have diabetes.

Glucose tolerance test

A glucose tolerance test (GTT), also sometimes known as an oral glucose tolerance test (OGTT), can show whether your body is having problems processing glucose.

Prior to having the test, you will be asked not to eat or drink certain fluids for 8-12 hours. You may also need to avoid taking certain medications before the test because they may affect the results. You will be advised about this.

Before the test, a blood sample is taken so your blood glucose can be measured. You will then be given a sweet glucose drink.

After drinking the glucose drink, your blood glucose will be measured again after two hours. As you’ll have a long time to wait between blood tests, it’s a good idea to take something to read or listen to.

Test results

After your glucose tolerance test is complete it should be possible to determine whether you have impaired glucose tolerance (IGT) or diabetes, based on the amount of glucose in your blood both before and after drinking the glucose drink.

Blood glucose is measured in millimoles per litre, often written as mmol/l.

For someone without diabetes, the amount of glucose in their blood should be:

• Less than 6 mmol/l before the test
• Less than 7.8 mmol/l two hours after the test

If you have IGT, the amount of glucose in your blood will be:

• 6-7 mmol/l before the test
• 7.9-11 mmol/l two hours after the test

If you have diabetes, the amount of glucose in your blood will be:

• More than 7 mmol/l before the test
• More than 11 mmol/l two hours after the test

If your test results indicate you have IGT, you may be advised to make lifestyle changes. Medication to lower your blood glucose level may also be recommended.

If your results indicate you have diabetes, medication will probably be prescribed to lower your blood glucose level and help keep it under control.

Treating type 2 diabetes

There is no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms to prevent health problems developing later in life.

If you have been diagnosed with diabetes, Dr. B C Shah will be able to explain your condition to you in detail and help you to understand your treatment. He will closely monitor your condition to identify any health problems that may occur.

If there are any problems, you can contact Dr. B C Shah..

Care standards for diabetes

In treating diabetes, the aim is to help people with the condition control their blood glucose levels and minimise the risk of developing future complications.

Good diabetes care includes:

• Awareness of the risk factors for type 2 diabetes
• Advice and support to help people at risk of type 2 diabetes reduce that risk
• Access to information and appropriate support for people with type 1 and type 2 diabetes
• An agreed care plan, helping all people with diabetes to manage their care and lead a healthy lifestyle, including a named contact for their care
• Information, care and support to enable all people with diabetes to optimise their blood glucose level, maintain an acceptable blood pressure and minimise other risk factors for developing complications
• Access to services to identify and treat possible complications, such as screening for diabetic retinopathy and specialised foot care
• Effective care for all people with diabetes admitted to hospital, for whatever reason

Complications caused by diabetes

If diabetes is not treated, it can lead to a number of different health problems. High glucose levels can damage blood vessels, nerves and organs.

Even a mildly raised glucose level that does not cause any symptoms can have damaging effects in the long-term.

Heart disease and stroke

If you have diabetes, you are up to five times more likely to develop heart disease or have a stroke.

Prolonged, poorly controlled blood glucose levels increase the likelihood of atherosclerosis (a condition involving the furring and narrowing of your blood vessels).

This may result in a poor blood supply to your heart, causing angina (a dull, heavy or tight pain in the chest). It also increases the chance that a blood vessel in your heart or brain will become blocked, leading to a heart attack or stroke.

Nerve damage

High blood glucose levels can damage the tiny blood vessels in your nerves. This can cause a tingling or burning pain that spreads from your fingers and toes up through your limbs. It can also cause numbness which can lead to ulceration of the feet.

If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation.

Retinopathy

Retinopathy is where the retina (the light-sensitive layer of tissue) at the back of the eye is damaged. Blood vessels in the retina can become blocked or leaky, or can grow haphazardly. This prevents light from fully passing through to your retina. If it is not treated, it can damage your vision.

Annual eye checks are usually organised by a regional photographic unit. If significant damage is then detected, you may be referred to an ophthalmologist (a doctor who specialises in treating eye disease).

The better you control your blood sugar levels, the lower your risk of developing serious eye problems.

Diabetic retinopathy can be managed using laser treatment if it is caught early enough. However, this will only preserve the sight you have; it will not improve it.

Kidney disease

If the small blood vessels of your kidney become blocked and leaky, your kidneys will work less efficiently. It is usually associated with high blood pressure, and treating this is a key part of management.

In rare, severe cases, kidney disease can lead to kidney failure and a kidney replacement treatment with dialysis (or sometimes kidney transplantation) will be necessary.

Foot problems

Damage to the nerves of the foot can mean small nicks and cuts are not noticed and this, in combination with poor circulation, can lead to a foot ulcer developing. About 1 in 10 people with diabetes get a foot ulcer, which can cause serious infection.

If you have diabetes, look out for sores and cuts that do not heal, puffiness or swelling and skin that feels hot to the touch. You should also have a foot examination at least once a year.

If poor circulation or nerve damage is detected, check your feet every day and report any changes to Dr. B C Shah or podiatrist (foot care specialist).

Sexual dysfunction

In men with diabetes, particularly smokers, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication.

Women with diabetes may experience:

• A reduced sex drive
• Reduced pleasure from sex
• Vaginal dryness
• A reduced ability to orgasm
• Pain during sex

If you experience a lack of vaginal lubrication, or you find sex painful, you can use a vaginal lubricant or a water-based gel.

Miscarriage and stillbirth

Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If your blood sugar level is not carefully controlled during the early stages of pregnancy, there is also an increased risk of the baby developing a birth defect.

Pregnant women with diabetes will usually have their antenatal check-ups in hospital , ideally with an obstetrician (a doctor who specialises in pregnancy care).

This allows Dr. B C Shah to keep a close eye on your blood sugar levels and control your insulin dosage more easily, as well as monitoring the growth and development of your baby.

Living with type 2 diabetes

If you have type 2 diabetes, you will need to look after your health very carefully.

Caring for your health will make treating your diabetes easier and minimise your risk of developing complications of diabetes.

Self care

Self care is an integral part of daily life. It means you take responsibility for your own health and wellbeing with support from those involved in your care.

Self care includes things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions.

People living with long-term conditions can benefit enormously if they receive self care support. They can live longer, experience less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent.

Regular reviews

As type 2 diabetes is a long-term condition, you will be in regular contact with Dr. B C Shah. Developing a good relationship with the team will enable you to freely discuss your symptoms or any concerns you have.

The more the team knows, the more they can help you. Dr. B C Shah will also need to check your eyes, feet and nerves regularly because they can also be affected by diabetes.

Healthy eating

It is not true that if you have diabetes you will need to eat a special diet. You should eat a healthy diet high in fibre, fruit and vegetables and low in fat, salt and sugar.

Different foods will affect you in different ways, so it is important to know what to eat and when to get the right amount of glucose for the insulin you are taking. A diabetes dietitian can help you work out a dietary plan that can be adapted to your specific needs.

Regular exercise

As physical activity lowers your blood glucose level, it is very important to exercise regularly if you have diabetes.

Like anyone else, you should aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week. However, before starting a new activity, speak to Dr. B C Shah first.

As exercise will affect your blood glucose level, you and Dr. B C Shah may have to adjust your insulin treatment or diet to keep your blood glucose level steady.

Do not smoke

If you have diabetes, your risk of developing a cardiovascular disease, such as a heart attack or stroke, is increased.

As well as increasing this risk further, smoking also increases your risk of many other serious smoking-related conditions, such as lung cancer.

If you want to give up smoking, Dr. B C Shah will be able to provide you with advice, support and treatment to help you quit.

Limit alcohol

If you have diabetes, drink alcohol in moderation (if you drink), and never drink alcohol on an empty stomach. Depending on the amount you drink, alcohol can cause either high or low blood glucose levels (hyperglycaemia or hypoglycaemia).

Drinking alcohol may also affect your ability to carry out insulin treatment or blood glucose monitoring, so always be careful not to drink too much. The recommended daily alcohol limit is 3-4 units for men and 2-3 units for women.

Keeping well

People with a long-term condition, such as type 2 diabetes, are encouraged to get a flu jab each autumn to protect against flu (influenza). A pneumoccocal vaccination, which protects against a serious chest infection called pneumococcal pneumonia, is also recommended.