Type 2 diabetes is when the body doesn’t produce enough insulin to function properly, or the body’s cells don’t react to insulin.
As a result, glucose stays in the blood and isn’t used as fuel for energy.
Carbohydrates are the body’s primary source of fuel and when eaten carbohydrates are broken down into simple sugars, most commonly glucose.
It is glucose that supplies energy to the cells in the body, which is supported by a hormone called insulin produced in the pancreas.
This hormone is responsible for maintaining blood glucose levels in the body. When the blood glucose increases postprandial, the pancreas will produce more insulin, signaling the cells to take in the glucose.
The difference between type 1 and type 2 diabetes
Type 1 diabetes is an autoimmune disease and is often diagnosed in childhood. It results from the immune system attacking parts of the body, including certain cells in the pancreas that produce insulin known as beta cells.
The immune system will continue to attack the beta cells until the pancreas can produce insulin no more. It is unknown why this happens and how to prevent the attack on the cells.
People diagnosed with type 1 diabetes are immediately started on insulin to compensate for the destruction of their beta cells; therefore, people with type 1 diabetes become insulin dependent.
Type 2 diabetes is different; the immune system does not attack beta cells. Instead, the body becomes resistant to insulin.
The body will try and produce more insulin to compensate for the inability of production. However, the amount is not always enough for the regulation of normal blood glucose levels.
Initial diagnosis does not always require treatment with insulin, however as the destruction to the beta cells increases over time, insulin production will diminish; it is at this stage insulin administration may be required, especially if other forms of treatment fail to control blood glucose levels.
Type 2 diabetes is more common than type 1 diabetes. It is also known as adult-onset diabetes because it usually develops in adulthood.
However, diagnosis in children and teens is becoming increasingly common, mainly due to poor diet and lifestyle practices.
Many risk factors can cause the development of type 2 diabetes, including ones that cannot be avoided or challenging to control, such as:
- Family history: Type 2 diabetes is hereditary. The risk increases if a family member or if a close relative has the disease.
- Race/ethnicity: It is not known why, but certain ethnicities have a higher chance of developing type 2 diabetes, including African- Caribbean, Hispanic, Asian, and Native Americans.
- Polycystic ovary syndrome (PCOS): Polycystic ovary syndrome is related to insulin resistance; therefore, the risk of getting type 2 diabetes increases.
- Gestational diabetes: Although gestational diabetes can disappear after birth, the risk of developing the condition is higher if the mother warrants the above.
- Steroids: Although beneficial for treating inflammatory conditions, steroid therapy can cause a rise in blood glucose, leading to the diagnosis of steroid-induced diabetes. This may or may not resolve when steroid therapy stops.
There are, however, more common causes of type 2 diabetes; all of which can be controlled to reduce the risk or even prevent the likelihood. These include:
- Lack of physical activity: A lack of physical activity increases the risk of becoming insulin resistance or worsens the condition in someone who has an established diagnosis.
- Unhealthy eating/ poor dietary habits: Foods and drinks high in refined sugar, saturated fats, and excess in calories increase the likelihood of type 2 diabetes and related disorders.
- Overweight/Obesity: Being overweight or obese increases the risk of becoming insulin resistance.
Symptoms of type 2 diabetes
Symptoms vary from person to person; however, the most common symptoms of type 2 diabetes include:
- Frequency of urinating increases, in particular at night
- Increased thirst
- Increased hunger
- Extreme fatigue/feeling tired a lot
- Blurry vision
- Delayed wound healing
- Unexplained weight loss
- Tingling sensation or numbness in the extremities, sometimes pain.
Although these symptoms are often prominent, they can go unnoticed.
Diagnosis and screening
Along with early intervention, screening can delay disease development, prevent the need for aggressive treatment, and even reverse the condition in some cases.
In turn, there is then a chance to increase life expectancy and reduce the risk of developing comorbidities and complications of type 2 diabetes.
Individuals who carry the risk factors are classed as having prediabetes (borderline diabetes).
It is important they are screened, even if they are asymptomatic of type 2 diabetes.
Screening should also be carried out for those who are symptomatic and offered to the following groups:
- Pregnant women: especially if they have risk factors for developing type 2 diabetes. Screening is not only important for the mother, but also for the fetus as hyperglycemia increases the risk of congenital damage.
- Children and adolescents: although type 2 diabetes often develops in adulthood, there are now more children and adolescents being diagnosed with the disease. Therefore children or adolescents who carry risk factors must be screened.
- Older adults: the risk of prediabetes is higher in older adults. Screening is advised to prevent complications that could lead to functional impairment from type 2 diabetes.
One or all of the following tests are used to diagnose type 2 diabetes:
- A1C criteria.
- Plasma glucose criteria fasting plasma glucose (FPG).
- 2-h plasma glucose (2-h PG) value after a 75-g oral glucose tolerance test.
If the test comes back normal, it may be necessary to test again after a certain time frame, in particular for groups that hold greater risk.
Complications of type 2 diabetes
Over time, uncontrollable hyperglycemia can cause severe damage.
A failure to optimize blood glucose levels will result in complications; both short term and long term.
Achieving tight control of blood glucose is vital to prevent complications worsening.
Hypoglycemia occurs when the blood glucose drops below normal. Any blood glucose level below 4.0 mmol/L indicates that the individual has hypoglycemia.
Individuals taking hypoglycaemic medication, such as sulfonylurea, prandial glucose regulators, or insulin increases the likelihood of hypoglycemia.
While medication is the main factor involved in hypoglycemia, several other factors increase the risk, such as:
- Taking too much of the medication
- Not eating enough/delayed meals
- Increased physical activity
- Alcohol (as alcohol inhibits the release of glucose from the liver)
Hypoglycemia can only be detected by measuring blood sugar levels with a glucose meter (finger prick test).
However, the signs and symptoms are fairly obvious and include:
- Rapid heartbeat
- Excess sweating
- Pale and clammy skin
- Numbness in lips and extremities
- Slurred speech
- In severe cases, coma
A mild episode of hypoglycemia is treated via consuming 15-20g of a fast-acting carbohydrate such as glucose tablets, jelly sweets, or a sugary drink.
It may be advisable to follow up with a complex carbohydrate to stabilize the blood glucose levels, especially if the next meal is not due.
Testing the blood glucose via the finger prick test is advised shortly after to check if the blood glucose levels have returned to normal.
Severe cases can be treated with a hormone called glucagon (raises the blood glucose level by initiating the process) via an injection kit, but only if this is available and in date.
Although rare, in very severe cases, treatment can be only administrated via paramedics as cases as such can lead to immediate danger, even coma and potentially death.
Hyperosmolar Hyperglycaemic Nonketotic Syndrome
Hyperosmolar hyperglycaemic nonketotic syndrome (HHNS) occurs when blood glucose elevates to dangerous levels.
It is more common in type 2 diabetics. If not treated, it can cause death. Blood glucose levels above 33 mmol/l for extended periods of time increases the risk.
An illness or infection often trigger HHNS. The risk is higher in people who are sick and the elderly. As the blood glucose increases, the body will attempt to remove the excess via urination, which eventually leads to dehydration.
These individuals may have difficulties in rehydrating themselves, keeping fluids down and also may not have an awareness of high blood glucose levels. The continuous elevation of blood glucose and dehydration will be fatal if not treated immediately.
Ketoacidosis develops if there is very little insulin available to the body over an extended amount of time.
In the absence of insulin, the body will begin to breakdown fat to release ketones to be used as energy. If the ketones continue to rise, it can be dangerous.
Ketoacidosis mainly affects type 1 diabetics, who have very little insulin and also people who have had surgical removal of their pancreas (pancreatectomy).
However, it can also occur in people with type 2 diabetes that produce very little of their own insulin.
It is common for most people with diabetes to begin to develop long –term complications at a later stage of the disease.
These complications develop over many years, and they all relate to damage to both tiny (microvascular complications) and large blood vessels (macrovascular complications) caused by uncontrolled hyperglycemia.
The number of complications and the extent of damage depends on how well or how poor diabetes was controlled. It is necessary for all patients to be made aware of long- term complications when they are diagnosed.
The damage to the tiny blood vessels will affect the ability to transport blood efficiently resulting in microvascular complications to the eyes, kidney, and the nerves.
Diabetic eye disease (diabetic retinopathy)
Prolonged hyperglycemia can cause eye disease, including diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma; all which cause a loss of vision.
Eye check-ups are recommended, including tight control of blood glucose to prevent eye diseases developing.
Diabetic kidney disease (diabetic nephropathy)
Kidney disease can happen to anyone. However, it is more common in people with uncontrolled diabetes and hypertension.
If left untreated, there is a likelihood of impairment to kidney function, requiring dialysis and in the end, a kidney transplant.
For the prevention of diabetic nephropathy, it is advised to test for microalbumin; these are tiny particles found in the blood and urine, which indicate initial stages of kidney disease.
If microalbuminuria is diagnosed, appropriation medication is started to prevent further damage.
Diabetic nerve damage (diabetic neuropathy)
There are various types of diabetic neuropathy caused by poor control of blood glucose over time, all displaying different symptoms. The different forms include peripheral, autonomic, proximal, and focal.
- Peripheral Neuropathy:
This is the most common form of neuropathy, mainly affecting the feet and legs and sometimes hands and arms.
Many people with diabetic neuropathy may not realize they have it until a sore appears in the foot, which has the potential to become infected.
If left untreated, it can spread, leading to amputations of the foot or worse the leg. This is why regular foot exams are carried out for people with diabetes.
- Autonomic Neuropathy:
This involves damage to nerves that control the internal organs such as eyes, bladder, sweat glands, sex organs, digestive system, heart rate, and blood pressure.
- Proximal Neuropathy:
This is the less common form of diabetic neuropathy, damaging nerves, which leads to disability of one side of the body in the hip, buttocks, or thigh. The symptoms may resolve over a period of months or sometimes even years, depending on the extent of the damage.
- Focal Neuropathies:
This includes damage to single nerves, mainly in the hands, torso and head.
Macrovascular complications include damage to larger blood vessels to the heart and brain, increasing the risk of developing coronary artery disease, and therefore further increasing the risk of suffering heart attacks or strokes.
This risk is even higher if there is another comorbidity present such as hypertension, dyslipidemia, including obesity.
Macrovascular complications can also cause atherosclerotic narrowing of larger blood vessels in the periphery system, leading to poor blood flow, particularly in the extremities, resulting in peripheral vascular disease (PVD).
Treatment and management for type 2 diabetes
Treatment and management depend on individual circumstances, comorbidities, and the extent of the disease. However, the overall goal of treatment for type 2 diabetes is to achieve optimal blood glucose levels. This can be achieved with lifestyle changes, suitable medication, or insulin.
The first line of treatment always involves making lifestyle changes, which include:
- Consuming regular healthy meals with a balance of complex wholewheat carbohydrates, lean protein, healthy fats, and fruit and vegetables. Saturated fat, salt, and sugary foods should be limited.
- Aim to maintain a healthy weight. This can be achieved in combination with eating healthily and participating in regular physical activity. The amount of weight that needs to be lost to reverse diabetes is actually much more than was conventionally believed to be necessary. One study demonstrated that a loss of 20% body weight was associated with long-term remission in 73% of patients with type 2 diabetes.
- Stop smoking. Diabetes increases the risk of developing circulatory problems, heart disease, and stroke; the risk increases with smoking.
Adopting these lifestyle changes will also help reduce the risk or help treat other comorbidities.
It may be recommended to initiate medication if lifestyle changes alone do not suffice to keep blood glucose controlled.
Metformin is the first choice of medication in type 2 diabetics.
It works by reducing the amount of glucose released from the liver and supports the uptake glucose by the muscles.
If metformin fails in doing the job or not suitable, then medications (including hypoglycaemic agents) will be started; sometimes a combination may be included in the management.
Insulin is introduced when medication alone is not enough to control high blood glucose levels.
Insulin is usually administrated via an injection and delivered daily or a few times a day.
The prescription and regime of insulin will depend on the individual.
Insulin pumps are also available that delivers insulin continuously. Some prefer insulin pumps as an alternative to injections as they reduce the need for multiple injections daily.
Close monitoring of blood glucose is required on a daily basis via a finger prick test to avoid the risk of developing hypoglycemia.
Close monitoring also enables adjustments to insulin dosage according to the amount carbohydrate is eaten
Is type 2 diabetes reversible?
Reversing type 2 diabetes is a possibility and is associated with a notable long-term improvement in insulin responsiveness.
This includes achieving remarkable A1C values without the use of medications; when this is achieved, it is said that type 2 diabetes has been reversed or resolved.
Loss of body weight and reaching a healthy BMI, along with other positive lifestyle changes hugely benefits the progression reversing the condition.
Supplements for diabetes
Certain vitamins and minerals may support type 2 diabetes management, such as:
Chromium is a trace element that may help to maintain blood glucose by optimizing insulin activity once bound to the cells, therefore encouraging glucose uptake.
It is commonly found in brewers yeast. Chromium tissue concentration also increases with exercise.
A meta-analysis, published in 2017, which looked at 28 studies, concluded that chromium supplementation reduced fasting glucose and A1C levels, plus improving triglycerides and HDL (“good”) cholesterol.
ALA (alpha-lipoic acid)
ALA is a potent antioxidant. Antioxidants are excellent in removing free-radical damage, which can cause pain in complications such as diabetic neuropathy.
GLA (gamma-lipoic acid)
GLA is also a potent antioxidant which can support the function of damaged nerves by diabetic neuropathy. It is naturally found in evening primrose oil, borage oil, and blackcurrant seed oil.
A study published in the journal Diabetes Care entered 111 patients with mild diabetic neuropathy into a randomized, double-blind, placebo-controlled parallel study of GLA (gamma-lipoic acid) at a dose of 480 mg/day.
For all 16 parameters, the change over 1 yr in response to GLA was more favorable than the change with placebo, and for 13 parameters, the difference was statistically significant.
Biotin increases the activity of the enzyme glucokinase, working closing with insulin.
Glucokinase supports the normal function of the body by initiating glucose utilization.
The concentration of glucokinase tends to be low in people with diabetes. Therefore supplementation of biotin may help control blood glucose efficiently.
Coenzyme Q10 may support carbohydrate metabolism. Coenzyme Q10 is found naturally in the body but may be low in people with diabetes. Furthermore, it may help patients with prediabetes.
A Korean study reviewed the effects of coenzyme Q10 on insulin resistance in patients with prediabetes.
The results showed that Patients with prediabetes who were administered coenzyme Q10 showed a significant reduction in HOMA-IR values.
Therefore, administration of coenzyme Q10 in patients with impaired glucose tolerance may slow the progression from prediabetes to overt diabetes.
Studies have also found that CoQ10 can help to lower high blood pressure.
Carnitine (L-Carnitine, Acetyl L-Carnitine)
Carnitine naturally supports the production of energy by the utilization of fat. Carnitine helps to break down fatty acids in the body; therefore, it may reduce the likelihood of diabetic ketoacidosis.
Although these supplements may support the management of type 2 diabetes, the requirement will solely depend on the treatment plan, and any use of supplements must be discussed with a health professional.
It is also important to note that supplements should not be relied upon for treating diabetes alone.
The evidence for improving lifestyle practices, glycemic control, along with medication, insulin (as needed) and regular monitoring, is stronger and should be a crucial part of management.