The Definitive Guide to Type 2 Diabetes
Does it feel like you manage your diabetes, or like your diabetes handles you? So often, I find that clients with newly diagnosed type 2 diabetes feel overwhelmed when it comes to their condition. This article will give you all the information you need about type 2 diabetes, from signs and symptoms to the best ways to get better blood sugars.
Diabetes Type 1 vs. Diabetes Type 2
Type 1 diabetes is sometimes called "Juvenile Diabetes." Type 1 diabetes is a form of autoimmune disease that occurs when the beta cells in the pancreas stop working. Beta cells are responsible for producing insulin, but they don't function at all in people with type 1 diabetes.
In the earlier stages of type 2 diabetes, the beta cells in the pancreas are still producing plenty of insulin. They may be producing more insulin than a person without diabetes might produce. However, the body's cells are resistant to that insulin. A vicious cycle ensues, where the pancreas produces higher levels of insulin while the body's peripheral tissues are unable to use it. Eventually, type 2 diabetes destroys the beta cells and their ability to make insulin.
Causes of Type 2 Diabetes
The exact cause of Type 2 Diabetes is unknown, but we do know that some people are at higher risk for developing type 2 diabetes than other people are. People with a family history of type 2 diabetes are at increased risk, as are people who are considered overweight. A woman who had gestational diabetes during pregnancy or who delivered a baby weighing more than nine pounds is at higher risk of Type 2 diabetes. A sedentary lifestyle is another risk factor. The recommendation for adults is that we get at least 150 minutes of physical activity per week (30 minutes, five days a week), to avoid developing type 2 diabetes.
Prevalence of Type 2 Diabetes
Approximately ten percent of the US population has diabetes, and about ninety percent of those people have type 2 diabetes. Additionally, an estimated thirty percent of Americans are in the pre-diabetic state. In short, we have type 2 diabetes in epidemic proportions.
Diabetes Signs and Symptoms
The classic signs and symptoms of diabetes are unusual thirst & frequent urination, headache, dry, itchy skin, fatigue, and poor wound healing. Some people may experience persistent or recurrent infections. Other people who have mild to moderate cases of diabetes don't experience any noticeable symptoms. It's still essential to treat the condition to avoid long-term complications later in life.
Testing and Diagnosis of Diabetes
Two different kinds of tests can determine whether or not you have diabetes. The first test is a measurement of your blood glucose level. If you are fasting (you haven't eaten in the last 8-12 hours), a healthy blood glucose level is less than 100 mg/dL. After a meal, the blood sugar of a person without diabetes rarely rises to more than 140 mg/dL.
A fasting blood glucose of 125 mg/dL or more on two different occasions is enough to diagnose diabetes. Anytime a person's blood glucose level is more than 200 mg/dL (fasting or not), a diagnosis of diabetes is appropriate.
The second test that can determine diabetes is called hemoglobin A1C (HgbA1C). HgbA1C is a measure of how much sugar is attached to your red blood cells. HgbA1C of 5.6 or less is considered normal, and a level of 6.5 or higher indicates diabetes. In between, there exists an area that we call "pre-diabetes."
There are two ways to monitor your blood glucose. The first is to use finger sticks and a glucometer. The other is a newer technology called continuous glucose monitoring.
Finger sticks and Glucometers
Glucometers have been in existence since 1971. In the early days, glucometers were primarily for hospital use. As time went on, people who used insulin were recommended to have home glucometers. Today, glucometers are lightweight and portable, and they use a relatively small sample of blood. Any person with diabetes should have access to a glucometer and enough supplies to test their blood sugar daily if needed. Some people with type 2 diabetes will need to check their blood sugar multiple times per day.
Continuous Glucose Monitoring
The first continuous glucose meter arrived in 1999, but this technology has only recently been available for a large number of people with diabetes. A continuous glucose monitor is a small sensor with a thin wire that inserted under the skin. The insertion process is quick and painless, and many patients can accomplish this for themselves. The sensor, worn for as many as ten days at a time, allows for bathing and swimming. CGMs provide real-time data about a person's blood glucose level. They can also predict whether blood glucose is heading up, down, or is likely to remain steady. These devices can alert the user to dangerously low blood glucose as much as twenty minutes ahead of time. Most insurance carriers require two things before they will cover the cost of a continuous glucose monitor. 1) a person must be injecting insulin several times per day, and 2) the person must be performing multiple finger sticks per day.
When I first started my career as a Registered Dietitian, the diet for diabetes was highly restrictive and complicated. Twenty years later, the rules have relaxed quite a bit; people with diabetes now learn to count carbohydrates as part of a healthy eating plan. It's crucial to learn to count carbohydrates if you are a person with diabetes because carbs are the component of food that causes your blood glucose to rise. Carbohydrates exist in a wide variety of foods. Sugary foods aside, fruits, juices, starchy vegetables, and grains contain carbohydrate. Popular culture has recently made much of the keto diet, and that has perpetuated the misconception that carbs are bad. Carbs are our bodies' preferred source of fuel, and they provide fiber as well as many vitamins and minerals. The key is knowing how much carbohydrate is right for you and eating it in controlled amounts throughout the day. If you would like a sample meal plan for people with diabetes, you can find one here.
Complications of Diabetes
Before I dive into this subject, I want to reassure you that none of the complications of diabetes are foregone conclusions. These difficulties arise when a person has poorly managed blood sugars. The risk of these problems increases with the duration of abnormal blood sugar levels.
Diabetes Neuropathy (Diabetic Nerve Pain)
Diabetic neuropathy is a disease of the nervous system. People with neuropathy might experience numbness or pain in their hands and feet. Neuropathy is the most likely cause of diabetic foot pain.
People with diabetes might also have trouble with the nerves in their gastrointestinal tract, causing problems with digestion and elimination. Some people with diabetic neuropathy have "hypoglycemia unawareness." These people don't have any signs or symptoms of low blood sugar. Lack of awareness of low blood sugar is particularly dangerous since it requires quick treatment.
Diabetic Retinopathy (Diabetic Eye Disease)
Diabetic retinopathy is the loss of vision resulting from poorly controlled blood sugars. Typically, a person with diabetic retinopathy would have vision changes in both eyes. It's essential to get an annual eye exam even if you don't have any visual changes. Your eye doctor can see changes in your eyes before you notice a loss of vision.
Diabetic Kidney Disease
The kidneys are vital organs that filter waste from the blood. Poorly controlled diabetes can result in kidney damage, eventually leading to the need for kidney dialysis. Early kidney disease can be detected through blood work. Many people with diabetes take medications called ACE inhibitors or ARBs to help protect their kidneys.
Cardiovascular Disease (Heart Disease)
It's important to note that heart disease is a severe complication of diabetes. We already know that about 2/3 of Americans who die at age 65 or older meet their maker due to heart disease. We also know that people with diabetes are at least twice as likely as others to experience cardiovascular problems. Heart disease is the number 1 cause of death for people with diabetes.
This complication of diabetes can be fatal, but it is not common in people with type 2 diabetes. Diabetic ketoacidosis happens when there is not enough insulin in a person's body. The body then breaks down fat and turns it into acidic ketone bodies. A person with diabetic ketoacidosis will have high blood glucose as well as ketones present in the urine.
First, the "treatment" for diabetes that most people don't think about right off the bat: increased physical activity and a change in your diet. Lifestyle changes are as effective as many of the medications that are used to help manage diabetes.
The minimum amount of physical activity recommended for adults is 150 minutes per week, or 30 minutes 5 times per day. Moderate exercise is best. How do you know if you're doing moderate exercise? Try the "talk test." If the activity you're doing is right for you, you should be able to talk while you exercise, but you should be working too hard to sing.
Diabetes Food & Meal Plans
People with type 2 diabetes are encouraged to eat moderate amounts of carbohydrate. There is also evidence that a plant-based diet, including lots of fiber, can help improve diabetes. Find a sample plant-based meal plan here.
There are numerous medications available for the treatment of type 2 diabetes, and new medicines become available with some regularity. Let's break them down:
Metformin is usually the first drug prescribed for a person with type 2 diabetes. Metformin works by decreasing the amount of glucose (sugar) produced by your liver and helping your body's cells use the insulin you produce more efficiently. Metformin sometimes causes stomach upset, especially diarrhea, when a person begins to take it. Symptoms of diarrhea can be minimized by starting with a low dose and gradually increasing it.
These are an older class of medicines. Sulfonylureas work by increasing the amount of insulin produced by the pancreas. I think of them as "pancreas squeezers." These work well in the early stages of type 2 diabetes when a person still has beta-cell function. Sulfonylureas can cause low blood sugar, so it's important to know that before taking them. Glyburide, glimepiride, and glipizide are common sulfonylureas.
More commonly known as Starlix and Prandin, these medications are also "pancreas squeezers." They work much more quickly than the sulfonylureas mentioned above and are meant to be taken no more than 30 minutes before the start of a meal. (Taking them earlier can cause a person to have low blood sugar.)
Actos and Avandia can help make your cells less resistant to the insulin your body produces. These medications have been linked to heart disease and weight gain, so most physicians don't prescribe these medications without trying alternatives first.
Januvia, Tradjenta, and Onglyza reduce blood sugars, but they don't have a dramatic effect. They may work best for people without extremely high blood glucose levels.
GLP-1 Receptor Agonists
These injectable medications include Byetta, Victoza, and Ozempic. These medications cause the stomach to empty more slowly, which results in lowered blood sugars. GLP-1 Receptor Agonists are also associated with weight loss. Some people experience nausea with these medications, and there is also an increased risk of pancreatitis.
Jardiance, Invokana, and Farxiga are examples of SGLT2 Inhibitors. These medications encourage the kidneys to excrete sugar in the urine. These medications may reduce your risk of heart attack and stroke if you are at high risk for those health conditions. They also increase your risk of urinary tract infection, yeast infection, diabetic ketoacidosis, and low blood pressure.
Most people with type 2 diabetes want to do everything they can to avoid insulin, but it can be the best way to manage your blood sugar. Six years after diagnosis with diabetes, the average person produces only 25% of the insulin he produced before he had the disease.
Insulin syringe needles are very thin and short compared to what you might remember. Patients are usually started on just one injection per day to help manage their blood sugars. A Certified Diabetes Educator can help you learn to inject insulin without breaking into a sweat!
Despite coverage for this service, only six percent of Medicare recipients with diabetes receive diabetes education. Diabetes education is a set of lessons approved by the American Association of Diabetes Educators or the American Diabetes Association. Typically taught to a group, diabetes education can occur as a one-on-one service. For Medicare, this requires a physician's statement that a person has a condition that makes it challenging to participate in a group, such as hearing or vision impairment. Click here for more information about how to participate in a program that will fully inform you about how to manage your diabetes.
If you have type 2 diabetes, you can feel confident in your ability to manage your condition. There's a lot to know and a lot to do to take care of diabetes, but, with a little help, you are fully capable of taking care of this! Get help--the first step is booking a free 15-minute clarity call that will allow us to find out how we might work together.
I look forward to hearing from you!
Julie Cunningham, MPH, RD, LDN, CDE, IBCLC