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DIABETES TIPE 2

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:

Right away, your cells may be starved for energy. Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.

Finding out you have diabetes is scary. But don't panic. Type 2 diabetes is serious, but people with diabetes can live long, healthy, happy lives. While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.

1. Conditions & Treatment

Arm yourself with information about conditions associated with type 2 diabetes, and how to prevent them. Conditions associated with type 2 diabetes include hyperglycemia and hypoglycemia. You will also find helpful information about insulin, oral medications, various diagnostic tests including the A1c test, managing and checking your blood glucose, and tips on what to expect from your health care provider.

In type 2 diabetes, the body fails to properly use insulin, which is needed to take sugar from the blood to the cells. You can learn more about some conditions (including hyperglycemia and hypoglycemia) and how to prevent them in this section. You will also find helpful information about insulin, diagnostic tests and tips on what to expect from your health care provider.

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Hypoglycemia Hypoglycemia, or low blood sugar, can happen even during those times when you're doing all you can to control your diabetes.

Part of living with diabetes is learning to cope with some of the problems that go along with having the disease. Hypoglycemia or low blood glucose (sugar) is one of those problems. Hypoglycemia happens from time to time to everyone who has diabetes.

Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to manage your diabetes. So, although many times you can't prevent it from happening, hypoglycemia (low blood glucose) can be treated before it gets worse. For this reason, it's important to know what hypoglycemia is, what symptoms of hypoglycemia are, and how to treat hypoglycemia. What are the symptoms of hypoglycemia?

The symptoms of hypoglycemia include:

Shakiness Dizziness Sweating Hunger Headache Pale skin color Sudden moodiness or behavior changes, such as crying for no apparent reason Clumsy or jerky movements Seizure Difficulty paying attention, or confusion Tingling sensations around the mouth

How do you know when your blood glucose is low?

Part of managing diabetes is checking blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. The results from checking your blood will tell you when your blood glucose is low and that you need to treat it. You should check your blood glucose level according to the schedule you work out with your doctor. More importantly though, you should check your blood whenever you feel low blood

glucose coming on. After you check and see that your blood glucose level is low, you should treat hypoglycemia quickly. If you feel a reaction coming on but cannot check, it's best to treat the reaction rather than wait. Remember this simple rule: When in doubt, treat.
How do you treat hypoglycemia?

The quickest way to raise your blood glucose and treat hypoglycemia is with some form of sugar, such as 3 glucose tablets (you can buy these at the drug store), 1/2 cup of fruit juice, or 5-6 pieces of hard candy. Ask your health care professional or dietitian to list foods that you can use to treat low blood glucose. And then, be sure you always have at least one type of sugar with you. Once you've checked your blood glucose and treated your hypoglycemia, wait 15 or 20 minutes and check your blood again. If your blood glucose is still low and your symptoms of hypoglycemia don't go away, repeat the treatment. After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood glucose level up. It's important to treat hypoglycemia quickly because hypoglycemia can get worse and you could pass out. If you pass out, you will need IMMEDIATE treatment, such as an injection of glucagon or emergency treatment in a hospital. Glucagon raises blood glucose. It is injected like insulin. Ask your doctor to prescribe it for you and tell you how to use it. You need to tell people around you (such as family members and coworkers) how and when to inject glucagon should you ever need it. If glucagon is not available, you should be taken to the nearest emergency room for treatment for low blood glucose. If you need immediate medical assistance or an ambulance, someone should call the emergency number in your area (such as 911) for help. It's a good idea to post emergency numbers by the telephone. If you pass out from hypoglycemia, people should:

NOT inject insulin. NOT give you food or fluids. NOT put their hands in your mouth. Inject glucagon. Call for emergency help.

How do you prevent low blood glucose?

Good diabetes control is the best way we know to prevent hypoglycemia. The trick is to learn to recognize the symptoms of hypoglycemia. This way, you can treat hypoglycemia before it gets worse.
Hypoglycemia Unawareness

Some people have no symptoms of hypoglycemia. They may lose consciousness without ever knowing their blood glucose levels were dropping. This problem is called hypoglycemia unawareness. Hypoglycemia unawareness tends to happen to people who have had diabetes for many years. Hypoglycemia unawareness does not happen to everyone. It is more likely in people who have neuropathy (nerve damage), people on tight glucose control, and people who take certain heart or high blood pressure medicines. As the years go by, many people continue to have symptoms of hypoglycemia, but the symptoms change. In this case, someone may not recognize a reaction because it feels different. These changes are good reason to check your blood glucose often, and to alert your friends and family to your symptoms of hypoglycemia. Treat low or dropping sugar levels even if you feel fine. And tell your team if your blood glucose ever drops below 50 mg/dl without any symptoms

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Hyperglycemia Hyperglycemia is a major cause of many of the complications that happen to people who have diabetes. For this reason, it's important to know what hyperglycemia is, what its symptoms are, and how to treat it. You have diabetes, which means you have to deal with some of the problems that go along with having the disease. One of those problems is hyperglycemia. Hyperglycemia happens from time to time to all people who have diabetes. Hyperglycemia can be a serious problem if you don't treat it. Hyperglycemia is a major cause of many of the complications that happen to people who have diabetes. For this reason, it's important to know what hyperglycemia is, what its symptoms are, and how to treat it. Hyperglycemia is the technical term for high blood glucose (sugar). High blood glucose happens when the body has too little, or not enough, insulin or when the body can't use insulin properly.

A number of things can cause hyperglycemia. For example, if you have type 1 diabetes, you may not have given yourself enough insulin. If you have type 2 diabetes, your body may have enough insulin, but it is not as effective as it should be. The problem could be that you ate more than planned or exercised less than planned. The stress of an illness, such as a cold or flu, could also be the cause. Other stresses, such as family conflicts or school or dating problems, could also cause hyperglycemia.
What are the symptoms of hyperglycemia?

The signs and symptoms include: high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst. Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid the other symptoms of hyperglycemia. It's important to treat hyperglycemia as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel. So, your body breaks down fats to use for energy. When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood. This can lead to ketoacidosis. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:

shortness of breath breath that smells fruity nausea and vomiting a very dry mouth Talk to your doctor about how to handle this condition

How do you treat hyperglycemia?

Often, you can lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do NOT exercise.

Exercising when ketones are present may make your blood glucose level go even higher. You'll need to work with your doctor to find the safest way for you to lower your blood glucose level. Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don't work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.
How do you prevent hyperglycemia?

Your best bet is to practice good diabetes management. The trick is learning to detect and treat hyperglycemia early -- before it can get worse.

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What is Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)? Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2.

Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2. HHNS is usually brought on by something else, such as an illness or infection.

In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You make lots of urine at first, and you have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may be very thirsty. Even if you are not thirsty, you need to drink liquids. If you don't drink enough liquids at this point, you can get dehydrated.

If HHNS continues, the severe dehydration will lead to seizures, coma and eventually death. HHNS may take days or even weeks to develop. Know the warning signs of HHNS.

7 Warning Signs of HHNS

Blood sugar level over 600 mg/dl Dry, parched mouth Extreme thirst (although this may gradually disappear) Warm, dry skin that does not sweat High fever (over 101 degrees Fahrenheit, for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not there) Weakness on one side of the body If you have any of these symptoms, call someone on your health care team.

How to avoid HHNS

The best way to avoid HHNS is to check your blood sugar regularly. Many people check their blood sugar several times a day, such as before or after meals. Talk with your health care team about when to check and what the numbers mean. You should also talk with your health care team about your target blood sugar range and when to call if your blood sugars are too high, or too low and not in your target range. When you are sick, you will check your blood sugar more often, and drink a glass of liquid (alcohol-free and caffeine-free) every hour. Work with your team to develop your own sick day plan.
Related information

Another condition to watch signs for is ketoacidosis, which means dangerously high levels of ketones, or acids, that build up in the blood. Ketones appear in the urine when your body doesn't have enough insulin, and can poison the body.

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Managing Your Blood Glucose Keeping your blood sugar as close to normal as possible helps you feel better and reduces the risk of long-term complications of diabetes. Learn about checking your blood sugar, tight diabetes control, and an A1C test.

Ac1 test

8 Because you have diabetes, you and your doctor, diabetes educator, and other members of your health care team work to keep your blood glucose (sugar) at ideal levels. There are two powerful reasons to work for effective blood sugar control:

You will feel better. You may prevent or delay the start of diabetes complications such as nerve, eye, kidney, and blood vessel damage. One way to keep track of your blood sugar changes is by checking your blood sugar at home. These tests tell you what your blood sugar level is at any one time.

But suppose you want to know how you've done overall. There's a test that can help. An A1C (also known as glycated hemoglobin or HbA1c) test gives you a picture of your average blood glucose control for the past 2 to 3 months. The results give you a good idea of how well your diabetes treatment plan is working. In some ways, the A1C test is like a baseball player's season batting average. Both A1C and the batting average tell you about a person's overall success. Neither a single day's blood test results nor a single game's batting record gives the same big picture.
How It Works

You know from the name that the test measures something called A1C. You may wonder what it has to do with your blood sugar control. Hemoglobin is found inside red blood cells. Its job is to carry oxygen from the lungs to all the cells of the body. Hemoglobin, like all proteins, links up with sugars such as glucose. You know that when you have uncontrolled diabetes you have too much sugar in your bloodstream. This extra glucose enters your red blood cells and links up (or glycates) with molecules of hemoglobin. The more excess glucose in your blood, the more hemoglobin gets glycated. It is possible to measure the percentage of A1C in the blood. The result is an overview of your average blood glucose control for the past few months.
Thanks for the Memories

How does the A1C test look backward? Suppose your blood sugar was high last week. What happened? More glucose hooked up (glycated) with your hemoglobin. This week, your blood glucose is back under control. Still, your red blood cells carry the 'memory' of last week's high blood glucose in the form of more A1C. This record changes as old red blood cells in your body die and new red blood cells (with fresh hemoglobin) replace them. The amount of A1C in your blood reflects blood sugar control for the past 120 days, or the lifespan of a red blood cell.

In a person who does not have diabetes, about 5% of all hemoglobin is glycated. For someone with diabetes and high blood glucose levels, the A1C level is higher than normal. How high the A1C level rises depends on what the average blood glucose level was during the past weeks and months. Levels can range from normal to as high as 25% if diabetes is badly out of control for a long time. You should have had your A1C level measured when your diabetes was diagnosed or when treatment for diabetes was started. To watch your overall glucose control, your doctor should measure your A1C level at least twice a year. This is the minimum. There are times when you need to have your A1C level tested about every 3 months. If you change diabetes treatment, such as start a new medicine, or if you are not meeting your blood glucose goals, you and your doctor will want to keep a closer eye on your control.
How Does It Help Diabetes Control?

How can your A1C test results help your control? Here are two examples. Bob D., 49 years old, has type 2 diabetes. For the past seven years, he and his doctor have worked to control his blood sugar levels with diet and diabetes pills. Recently, Bob's control has been getting worse. His doctor said that Bob might have to start insulin shots. But first, they agreed that Bob would try an exercise program to improve control. That was three months ago. Bob stuck to his exercise plan. Last week, when the doctor checked Bob's blood sugar, it was near the normal range. But the doctor knew a single blood test only showed Bob's control at that time. It didn't say much about Bob's overall blood sugar control. The doctor sent a sample of Bob's blood to the lab for an A1C test. The test results would tell how well Bob's blood sugar had been controlled, on average, for the past few months. The A1C test showed that Bob's control had improved. With the A1C results, Bob and the doctor had proof that the exercise program was working. The test results also helped Bob know that he could make a difference in his blood sugar control. The A1C test can also help someone with type 1 diabetes. Nine-year-old Lisa J. and her parents were proud that she could do her own insulin shots and urine tests. Her doctor advised her to begin a routine of two shots a day and to check her blood sugar as well. Lisa kept records of all her test results. Most were close to the ideal range. But at her next checkup, the doctor checked her blood and found her blood sugar level was high. The doctor sent a sample of Lisa's blood for an A1C test. The results showed that Lisa's blood glucose control had in fact been poor for the last few months. Lisa's doctor asked Lisa to do a blood sugar check. To the doctor's surprise, Lisa turned on the timer of her meter before pricking her finger and putting the blood drop on the test strip. The doctor explained to Lisa and her parents that the way Lisa was testing was probably causing the blood sugar test errors.

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With time and more accurate blood sugar results, Lisa and her parents got better at using her results to keep food, insulin, and exercise in balance. At later checkups, her blood sugar records and the A1C test results showed good news about her control. A1C tests can help:

Confirm self-testing results or blood test results by the doctor Judge whether a treatment plan is working Show you how healthy choices can make a difference in diabetes control.

Test Limit

Although the A1C test is an important tool, it can't replace daily self-testing of blood glucose. A1C tests don't measure your day-to-day control. You can't adjust your insulin on the basis of your A1C tests. That's why your blood sugar checks and your log results are so important to staying in effective control. It is important to know that different labs measure A1C levels in different ways. If you sent one sample of your blood to four different labs, you might get back four different test results. For example, an 8 at one lab might mean that blood glucose levels have been in the near-normal range. At a second lab, a 9 might be a sign that, on average, blood glucose was high. This doesn't mean that any of the results are wrong. It does mean that what your results say depends on the way the lab does the test. Talk to your doctor about your A1C test results. Know that if you change doctors or your doctor changes labs, your test numbers may need to be "read" differently. The A1C test alone is not enough to measure good blood sugar control. But it is good resource to use along with your daily blood sugar checks, to work for the best possible control.

1.5.

About Insulin In people with type 2 diabetes, either the body does not produce enough insulin, or the cells ignore the insulin.

1.6.

Insulin Pumps Learn how you can use an insulin pump to help manage your diabetes

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1.7.

Other Medications for Type 2 Diabetes The first treatment for type 2 diabetes is often meal planning for blood sugar control, weight loss, and exercising. Sometimes these measures are not enough to bring blood sugar down near the normal range. The next step is taking a medicine that lowers blood glucose levels in people with diabetes, blood glucose levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs. But for glucose to pass into a cell, insulin must be present and the cell must be "hungry" for glucose. People with type 1 diabetes don't make insulin. For them, insulin shots are the only way to keep blood glucose levels down. People with type 2 diabetes tend to have two problems: they don't make quite enough insulin and the cells of their bodies don't seem to take in glucose as eagerly as they should. All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels

Can diabetes pills help me?

Only people with type 2 diabetes can use pills to manage their diabetes. These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels. Diabetes pills don't work for everyone. Although most people find that their blood glucose levels go down when they begin taking pills, their blood glucose levels may not go near the normal range. What are the chances that diabetes pills will work for you? Your chances are low if you have had diabetes for more than 10 years or already take more than 20 units of insulin each day. On the other hand, your chances are good if you developed diabetes recently or have needed little or no insulin to keep your blood glucose levels near normal. Diabetes pills sometimes stop working after a few months or years. The cause is often unknown. This doesn't mean your diabetes is worse. When this happens, oral combination therapy can help. Even if diabetes pills do bring your blood glucose levels near the normal range, you may still need to take insulin if you have a severe infection or need surgery. Pills may not be able to control blood glucose levels during these stressful times when blood glucose levels shoot up.

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Also, if you plan to become pregnant, you will need to control your diabetes with diet and exercise or with insulin. It is not safe for pregnant women to take oral diabetes medications. There is no "best" pill or treatment for type 2 diabetes. You may need to try more than one type of pill, combination of pills, or pills plus insulin.
Using diabetes medications wisely

In general, diabetes pills are safe and work well. But like any other drug, they must be used with care. All diabetes pills can interact with other medicines. Because of the chance of medication interactions, you need to tell your doctor about all medicines you are taking. While you're taking diabetes pills, you should check with your doctor even before starting anything new -- even overthe-counter items. Any sulfonylurea or meglitinide can cause blood glucose levels to drop too low (hypoglycemia). Metformin or the glitazones rarely cause hypoglycemia unless taken with insulin stimulators (sulfonylureas or repaglinide) or insulin injections. Acarbose or meglitol, taken as prescribed, does not cause hypoglycemia. However, hypoglycemia can occur when acarbose or meglitol is taken in combination with other oral diabetes medications.

1.8.

Transplantation Diabetes sometimes damages kidneys so badly that they no longer work. When kidneys fail, one option is a kidney transplant.

1.9.

Related Conditions Learn more about Agent Orange, hemochromatosis and frozen shoulder, and how they relate to type 2 diabetes, in this section.

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2. Complications

Having type 2 diabetes increases your risk for many serious complications. Some complications of type 2 diabetes include: heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy). Learn more about these complications and how to cope with them.

Heart Disease and Stroke People with diabetes have extra reason to be mindful of heart and blood vessel disease. Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulation. 2.2. Kidney Disease Diabetes can damage the kidneys, which not only can cause them to fail, but can also make them lose their ability to filter out waste products. 2.3. Eye Complications Diabetes can cause eye problems and may lead to blindness. People with diabetes do have a higher risk of blindness than people without diabetes. Early detection and treatment of eye problems can save your sight. 2.4. Diabetes, Oral Health and Hygiene There are more bacteria in your mouth right now than there are people on Earth. If those germs settle into your gums, you've got gum disease. "Not me?" you say. Read more. 2.5. Diabetic Neuropathy and Nerve Damage One of the most common complications of diabetes is diabetic neuropathy. Neuropathy means damage to the nerves that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs. 2.6. Foot Complications People with diabetes can develop many different foot problems. Foot problems most often happen when there is nerve damage in the feet or when blood flow is poor. Learn how to protect your feet by following some basic guidelines. 2.7. Skin Complications As many as one-third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Luckily, most skin conditions can be prevented or easily treated if caught early. 2.8. Gastroparesis and Diabetes Gastroparesis is a disorder that affects people with both type 1 and type 2 diabetes. 2.9. Depression Feeling down once in a while is normal. But some people feel a sadness that just won't go away. Life seems hopeless. Feeling this way most of the day for two weeks or more is a sign of serious depression.
2.1.

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3. Diabetes Learning Center for the Recently Diagnosed

You've just been diagnosed with diabetes. Chances are you have a million questions running through your head. To help you answer those questions, and take the first steps toward better diabetes care, visit the Diabetes Learning Center -- an area for people who are newly diagnosed with diabetes, or those needing basic information.

4. Your Body's Well Being

Make it a priority to take good care of your body. The time you spend now on eye care, foot care and skin care, as well as your heart health and oral health, could delay or prevent the onset of dangerous type 2 diabetes complications later in life. Plus, some of the best things you can do for your body are to stop smoking, and reduce the amount of alcohol you drink.

5. Common Concerns

This section addresses various areas to help you live with type 2 diabetes. What do you do when you're sick? What do you do when you travel? Can you get a flu shot with diabetes? How do you cope with having type 2 diabetes? Are you being discriminated against because you have diabetes? You'll find answers to these questions, and more in this section.