Diabetes: Type 2

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KEY POINTS

• Type 2 diabetes means that there is too much sugar in your blood. Your body makes insulin but cannot use it to get sugar from the blood into your cells.
• Too much sugar in your blood can cause problems such as heart disease, stroke, blindness, and kidney failure.
• Your healthcare provider will help you learn to manage your diabetes by testing your blood sugar, eating the right diet, exercising, and taking medicine as prescribed.

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What is type 2 diabetes?

Having diabetes means that there is too much sugar (glucose) in your blood. Your body breaks down some of the foods you eat into sugar. Your blood carries the sugar to the cells of your body. You need some sugar in your cells for energy, but too much sugar in your blood is not good for your health.

What is the cause?

Diabetes is a problem with the way your body makes or uses insulin. Insulin is a hormone made by the pancreas, which is an organ in your upper belly. Your body uses insulin to help move sugar from the blood into the cells. When your body does not have enough insulin or has trouble using its own insulin, sugar cannot get into your cells and builds up in your blood. Diabetes can damage small blood vessels and nerves, causing problems in the eyes, heart, brain, kidneys, skin, and feet.

The exact cause of type 2 diabetes is not known. You have a higher risk of having type 2 diabetes if you have a family background of Alaska Native, American Indian, African American, Hispanic/Latino, Asian American, or Pacific Islander. Your risk is also increased if you have a family history of type 2 diabetes, don't get enough physical activity, have a high-calorie diet, or are overweight.

If you have given birth to large babies (for example, babies weighing 9 pounds or more), or had gestational diabetes during pregnancy, you have a greater risk of type 2 diabetes. Also, if your mother had gestational diabetes when she was pregnant with you, you have a higher risk of type 2 diabetes.

This type of diabetes usually starts in adulthood. However, more teenagers and even children are developing type 2 diabetes.

What are the symptoms?

Symptoms may start suddenly or they may develop over days to weeks. Most people, however, have no symptoms for months or even years. This is why it is so important to get your blood sugar checked as often as your healthcare provider recommends.

Not everyone has the same symptoms. Symptoms may include:

• Urinating a lot
• Increased thirst
• Increased hunger
• Blurry vision
• Feeling tired all the time
• Unexpected weight gain or weight loss
• Dry, itchy skin
• Frequent infections—for example, of the skin, gums, or bladder
• Frequent yeast infections of the vagina
• Infections of the foreskin in uncircumcised males
• Thickened, darkened skin on the neck or in body folds, such as under the arms

If diabetes is not diagnosed and treated, your blood sugar could get so high that you go into a coma and die.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You will have tests to measure the level of sugar in your blood. Tests may include:

• Fasting blood sugar test (FBS). For this test, your blood sugar is tested in the morning after not eating any food or drinking anything except water for several hours.
• Hemoglobin A1C. The A1C is a blood test that can be used to check your average blood sugar over the past 3 months.
• Glucose tolerance test (GTT). For this test, a sample of your blood is taken when you have not eaten anything since the night before. Then you drink a special sugar drink and your blood is tested again 1 to 2 hours later. Your blood sugar may be tested several more times after the first test, every 30 to 60 minutes.
• Random blood sugar test (RBS) at a time when you have been eating normally.

You may have other blood tests to see what type of diabetes you have.

How is it treated?

The goal of treatment is to control the level of sugar in your blood and keep it in a normal range. Controlling your blood sugar can prevent or delay serious problems caused by diabetes.

When you have type 2 diabetes, high blood sugar often can be controlled by eating healthy foods, getting regular exercise, and losing weight if you are overweight. You need to check your blood sugar regularly to make sure your diet and exercise are working for you. If diet and exercise are not controlling your blood sugar, then you’ll need to take medicine to help keep sugar levels normal. It is also important to learn about diabetes, including recognizing and treating symptoms of high and low blood sugar.

• Diet

  Your healthcare provider will give you guidelines about which foods you should eat and how many calories to eat each day. Your prescribed diet will include a lot of lean protein, complex carbohydrates (such as whole grain pastas breads, and cereals), fresh fruits and vegetables, and foods high in fiber. You may be able to have a snack with sugar sometimes, but your regular diet should not include sugary food such as soft drinks, candy, and desserts. You will also learn how to space your meals so you don’t go too long without food.

  Your provider may refer you to a dietitian or diabetes educator for help with meal planning. Choosing healthy foods for your diet may help you lose weight if you need to, and improve your health. Sometimes losing just 7 to 10 pounds can lower your blood sugar enough to keep you from needing to take medicine to treat the diabetes.

• Exercise

  Exercise is very important. Exercise improves blood flow, uses up more of the sugar in your blood, and helps your body use insulin better. Getting enough exercise is all some people need to control their blood sugar. A good activity plan can help control your blood sugar level. It also helps keep you healthy and avoid some of the problems caused by diabetes. Talk to your healthcare provider about the right activity plan for you.

• Medicine

  If you can’t control your blood sugar with diet and exercise, your healthcare provider may prescribe an oral medicine to lower it. You may need more than 1 type of medicine to keep your blood sugar in a normal range. You may also need shots of insulin if diet, exercise, and oral medicines are not keeping your blood sugar levels normal.

  When you are taking medicine for diabetes, you must carefully follow your provider's directions for checking your blood sugar. This will help keep your blood sugar from getting too high or too low. Blood sugar that is too low can make you sick and cause headaches, nausea, cold sweats, and seizures. It can even be life-threatening if it gets too low.

• Blood sugar tests

  You will learn how to check your blood sugar with a small machine called a blood glucose meter. Your provider will tell you when and how often you need to check your blood sugar.

  You will need to keep a record of your blood sugar measurements and bring it to every appointment. Your provider will check the record at your appointments to see if any changes need to be made to your treatment plan.

  You may have an A1C test every 3 to 6 months to check your overall control of your blood sugar. This is the best way to see if you are keeping your diabetes under control. However, it does not replace daily blood sugar measurements. Daily checks of your blood sugar show whether your treatment is working throughout the day.

• Education

  When you are diagnosed with diabetes, there is a lot to learn about the disease. This education may be done at your provider's office, a learning center, or for 2 or 3 days at a diabetes clinic. This education is very important. Ask your healthcare provider about your choices.

  Healthcare providers will teach you what diabetes is, and how to give shots of the proper amounts of insulin if needed. You will learn how to test for sugar in your blood and for ketones in your blood or urine. You will learn how to treat high and low blood sugar and other ways to keep yourself healthy.

How can I take care of myself?

You can learn to take good care of yourself in a few weeks and you can keep doing most of your favorite activities. You need to work with your healthcare provider, change your eating habits, add or continue physical activities, maintain a healthy weight, and check your blood sugar on the schedule your provider recommends.

Taking good care of yourself to avoid complications is especially important with diabetes. Carefully controlling your blood sugar and blood pressure will prevent or delay serious health problems. Good control of diabetes depends on following the diet and exercise plans prescribed by your healthcare provider to keep your blood sugar in the target range. If your diabetes is not controlled by diet and exercise, it is important to take medicines as directed by your healthcare provider. Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Try to always have your meals, snacks, and exercise at the same time each day. Carry a protein snack, such as cheese and crackers or peanuts, to make sure you eat as often as you should.
• Follow your healthcare provider's instructions for testing your blood and adjusting your insulin dosage according to the results of your blood tests.
• Get your eyes checked as often as your provider recommends.
• Exercise regularly according to your healthcare provider's advice. Wear well-fitting, supportive, and well-cushioned shoes when you exercise.
• Learn how to check and care for your feet every day.
• Don’t smoke. Smoking speeds up damage to the heart and blood vessels.
• Get other medical problems treated, especially high blood pressure and high cholesterol.
• Carry a medical ID (such as a card or bracelet) that says you have diabetes.
• Learn about diabetes and its complications so you can make the correct decisions to control your blood sugar levels. There is a lot to learn. It's good for your family also to learn about diabetes.
• Following all of the steps to manage your diabetes may feel overwhelming. If you feel stressed or depressed, talk with a counselor.

Ask your provider:

• How and when you will get your test results
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests. Be sure to take your sugar logs or your glucose meter to all appointments.

How can I help prevent type 2 diabetes?

Unlike type 1 diabetes, type 2 can be prevented. Even if there is a history of diabetes in your family, you may be able to avoid having the disease if you:

• Keep a healthy weight.
• Exercise regularly according to your healthcare provider's recommendations.
• Eat a healthy diet that includes fruits, vegetables, lean protein, and high-fiber grains. Limit sugars, soda, desserts, white rice, white potatoes, and foods made with white flour. Choose whole grain and whole wheat breads and cereals instead.

If you have a family history of diabetes or are overweight, you should get your blood sugar checked as often as recommended by your healthcare provider.

You can get more information from:

• The American Diabetes Association
  800-342-2383
  http://www.diabetes.org