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Type 2 Diabetes

Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use the hormone insulin, made in the pancreas, to help them process blood glucose into energy.

People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the pancreas cannot make enough insulin for the body’s needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.

Signs and Symptoms

Type 2 diabetes symptoms may seem harmless at first. In fact, you can have type 2 diabetes for years and not even know it. Look for:

  • Increased thirst and frequent urination. As excess sugar builds up in your bloodstream, fluid is pulled from your tissues. This may leave you thirsty. As a result, you may drink and urinate more than usual.

  • Extreme hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger that may persist even after you eat.

  • Weight loss. Despite eating more than usual to relieve your constant hunger, you may lose weight. Without the energy sugar supplies, your muscle tissues and fat stores may simply shrink.

  • Fatigue. If your cells are deprived of sugar, you may become tired and irritable.

  • Blurred vision. If your blood sugar level is too high, fluid may be pulled from your tissues including the lenses of your eyes. This may affect your ability to focus.

  • Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and fight infections. Bladder and vaginal infections can be a particular problem for women.

Some people who have type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies usually in the armpits and neck. This condition, called acanthosis nigricans, is a sign of insulin resistance.

Causes

To understand type 2 diabetes, first you must understand how glucose is normally processed in the body.

Glucose is a main source of energy for the cells that make up your muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.

The hormone insulin comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

Your liver acts as a glucose storage and manufacturing center. When your insulin levels are low when you haven't eaten in a while, for example your liver releases the stored glucose to keep your glucose level within a normal range.

In type 2 diabetes, this process works improperly. Instead of moving into your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin. Exactly why this happens is uncertain, although excess fat especially abdominal fat and inactivity seem to be important factors.

Risk Factors

Researchers don't fully understand why some people develop type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:

  • Weight. Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to insulin.

  • Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.

  • Family history. The risk of type 2 diabetes increases if a parent or sibling has type 2 diabetes.

  • Race. Although it's unclear why, people of certain races including blacks, Hispanics, American Indians and Asian Americans — are more likely to develop type 2 diabetes.

  • Age. The risk of type 2 diabetes increases as you get older, especially after age 45. Often, that's because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is increasing dramatically among children, adolescents and younger adults.

  • Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.

  • Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds, you're also at risk of type 2 diabetes.

Screening and Diagnosis

Various blood tests can be used to screen for diabetes, including:

  • Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) or higher suggests diabetes.

  • Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level between 70 and 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes, which indicates a high risk of developing diabetes. If it's 126 mg/dL or higher on two separate tests, you'll be diagnosed with diabetes.

The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, repeat the test every three years. If the results are borderline, repeat the test every year.

If you're diagnosed with diabetes, your doctor may do other tests to distinguish between type 1 and type 2 diabetes — which may require different treatment strategies. Your doctor may also recommend a glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. Generally, a target A1C result is 7 percent or less. 

  • Osteoporosis. Diabetes may lead to lower than normal bone mineral density, increasing your risk of osteoporosis.

Prevention

Healthy lifestyle choices can help you prevent type 2 diabetes. Even if diabetes runs in your family, diet and exercise can help you prevent the disease. And if you've already been diagnosed with diabetes, the same healthy lifestyle choices can help you prevent potentially serious complications.

  • Eat healthy foods. Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.

  • Get more physical activity. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.

  • Lose excess pounds. If you're overweight, losing even 10 pounds can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glucophage) and rosiglitazone (Avandia) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.

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