Type 2 Diabetes, a form of diabetes mellitus, is an impairment in the way the body regulates and uses glucose (sugar) as a fuel. This results in a long-term chronic condition in which blood sugar level rises above a certain threshold. Eventually, these high sugar levels lead to complications of the heart, kidneys, and nervous system.
Before going into the details of diabetes, let's understand the relationship between insulin and blood sugar levels. As and when blood sugar levels rise, β-cells of the pancreas release insulin hormone to initiate the uptake of sugar in muscles, fats, and liver tissues where it gets utilized to produce energy. An excess amount of sugar gets stored in the body as glycogen in muscle and liver tissues. Whenever this particular chain reaction gets hampered, the blood sugar level rises. It can be because the pancreas fails to produce enough insulin or cells start resisting the amount of insulin getting produced. Both these results in less uptake of sugar in cells and thus lead to type 2 diabete s.
What is Insulin Resistance
In certain cases, like obesity, the usual response of insulin gets affected and the cells don’t respond to the insulin-mediated glucose transport. This led to more and more production of insulin by β-cells and thus causing hyperinsulinemia. This resistance by cells to the usual insulin response is called insulin resistance. If not managed well, this condition leads to prediabetes.
Prediabetes
Insulin resistance leads to hyperinsulinemia by producing more and more insulin as a response to high blood sugar levels. At this stage, the blood sugar levels are normal because more and more amounts of insulin can deliver the sugar to cells. But as the body’s demand for insulin keeps on increasing, insulin production gets hampered after a certain capacity and it leads to elevated blood sugar levels, called Prediabetes. This will turn into type 2 diabetes, but if managed well at the right time, it can be prevented.
Diagnosis of Diabetes
Fasting Plasma Glucose – Test that measures the amount of glucose in the blood after fasting (not eating or drinking, except water) for at least 8 hours.
2-hour postprandial glucose – Test that measures the glucose level after 2 hours of consuming a meal
A1C test (HbA1C Test) – It measures average blood glucose levels over the past three months.
Risk factors of type 2 diabetes
Multiple factors can increase the risk of getting type 2 diabetes:
- Obesity – Being overweight or obese is the main risk. An individual having BMI ≥ 30 (obese class 1 and 2) are at increased risk of developing diabetes
- Fat distribution – Studies have proved that storing fat in the abdomen (visceral fat) rather than hips and thighs (subcutaneous fat) indicates a greater risk
- Inactivity – Physical activity helps to control weight, uses blood sugar as energy, and makes cells more sensitive to insulin
- Family History – The risk factor increases if a parent or sibling had type 2 diabetes
- Age – Individuals more than 35 years of age are at high risk
- Race and Ethnicity – People of certain races and ethnicity are at high risk for unknown reasons – black, Hispanic, Asian people are more like to develop type 2 diabetes compared to white people
- Lipid Profile – An increased risk is associated with individuals having dyslipidemia
- Gestational Diabetes – Diabetes developed at the time of pregnancy can lead to type 2 diabetes later
Note: one important point to understand here is that not every obese individual is diabetic and not every lean individual is diabetic-free. Also, type 2 diabetes can be diagnosed at any age and not particularly after 35 years of age only.
Signs and Symptoms
The three most common symptoms of diabetes are
- Increased hunger (polyphagia)
- Increased thirst (polydipsia)
- Increased urination (polyuria)
Other signs and symptoms include lethargy, fatigue, weakness, blurred vision, frequent infections, unexplained weight loss, tingling sensation in hands or feet, dark color patches on the neck and armpits (acanthosis nigricans).
It is important to note that a diabetic individual can show multiple signs or symptoms or there is a possibility that an individual doesn’t show even a single sign or symptom of diabetes and it is only detected through the routine examination.
Complications
Managing diabetes and controlling blood sugar levels is important because it can prevent multiple comorbidities:
- Heart and blood vessels disease – Diabetes increases the risk of heart disease, stroke, high blood pressure, and atherosclerosis (narrowing of blood vessels)
- Nerve damage (neuropathy) – High blood sugar levels can lead to damage of nerves resulting in tingling, numbness, burning, pain, or loss of sensation at tips of fingers or toes
- Kidney damage (nephropathy) – Chronic kidney damage or end-stage kidney disease requiring dialysis or kidney transplant
- Eye damage (retinopathy) – Increases risk of cataracts and glaucoma, damage of blood vessels to retina leading to partial or complete blindness
- Slow healing of wounds – Untreated blisters, cuts, and blisters can get an infection and in certain conditions may lead to gangrene and amputation of toe, foot, or leg
Hypoglycemia
This is a condition in which blood sugar levels fall below 70mg/dl and happens in case of type 2 diabetes when:
- Overdose of medicine happens
- Medication has been taken but meals are missed
- Develops as a side effect of diabetes medication
- Exercise strenuously without food intake
Symptoms will differ from hyperglycemia. An individual can experience intense hunger, dizziness, excessive sweating, shaking or tremors of hands, anxiety, drowsiness, slurred speech, sleep disturbances, and in extreme conditions can lead to seizure or coma or even death.
In case of an episode of hypoglycemia, it is advisable to consume 15 to 20 gms of simple carbohydrates to bring back blood sugar levels within range.
Management of Diabetes
Note: always to be done under the guidance of a physician
- Medication – Metformin is generally the first line of medication but other drug therapies can also be used as advised by a physician like Sulfonylureas, Alpha-Glucosidase inhibitors, GLP-1 antagonists, DPP-4 inhibitors
- Lifestyle Modification – As per the studies, long-term lifestyle modification helps to keep blood sugar levels under check. Reduce 5-10% of body weight by going into a calorie deficit and adopting an active lifestyle. Weight training helps to transport glucose within the muscle cells by bringing glut-receptors on the surface without the insulin and thus mediate glucose transport in insulin-resistant muscle cells also
- Insulin Injections
- Bariatric surgery
Diabetes is a condition that doesn’t have any permanent cure as of now. Remission of diabetes is achievable through lifestyle modifications but as mentioned, follow a structured routine under expert guidance to avoid severe complications.
