Diabetes (Type 2)

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is Type 2 diabetes?

The most common form of diabetes that develops slowly during adulthood—and is generally manageable with diet, weight reduction, and medication—is called Type 2 diabetes. With this form of diabetes, you aren’t producing enough insulin, and your cells are no longer responding to the insulin you do produce. The pancreas, an organ tucked against the back of your abdomen, produces insulin, a hormone that enables your body to use sugar (glucose). Without enough insulin, glucose builds up in your blood instead of entering your cells, which need it to function. This causes high blood sugar, the source of many complications. If you don’t treat it, it can eventually damage your eyes, kidneys, nerves, and blood vessels. In fact, diabetics are two to four times more likely to suffer a stroke or have heart disease. Up to 50 percent of diabetics develop nerve damage, which can lead to leg or foot amputation. Diabetes is the seventh leading cause of death by disease in Canada.

Who is at risk for Type 2 diabetes?

Generally, diabetes occurs for two reasons—it may run in your family, making you genetically susceptible, or you may have taxed your body’s glucose-balancing system from poor eating habits and excess weight gain. Type 2 diabetes accounts for about 90–95% of diabetes cases.

Treatment for Type 2 diabetes

Type 2 diabetes is a serious disease, and there’s a big payoff if you become proactive about managing it. You can learn how to minimize or even eliminate the need for drugs, and dramatically postpone complications. Keeping your blood glucose in the normal range and improving your body’s use of insulin are daily goals. Many people aim for “tight glucose control,” taking all the steps necessary (diet, drugs, frequent self-testing) to avoid marked fluctuations in their glucose levels. With Type 2 diabetes, lifestyle changes (meal planning, regular exercise, weight loss) can be very effective. In time, you may need to take oral diabetes drugs. About 40% of those with Type 2 diabetes eventually need insulin injections.

It’s important to see your doctor regularly (at least four times a year, plus specialist visits) and to develop a healthcare team to answer questions that help you implement an overall plan. Diabetes affects your entire body, so it’s critical to watch for complications and take preventive measures. To lessen certain health risks, you may need heart, blood pressure, or cholesterol-lowering drugs, and your eyes, kidneys, nerves, and feet may need special care.

Medications for Type 2 diabetes

The six main classes of oral diabetes drugs act on different sites in the body and employ different mechanisms, but they all have one goal: to control blood sugar levels. They’ll work only if your pancreas still produces some insulin. The drugs can be used alone, in combination, or with insulin. Your doctor will recommend insulin injections only when oral medications are losing their effect.

For over 30 years, sulfonylureas (Glucotrol, DiaBeta, and others) have been the first-line drugs for diabetes, lowering blood sugar by prompting the body to increase insulin production. Low blood sugar (hypoglycemia) is a common and serious side effect of these medications. Over time, a sulfonylurea drug may stop lowering your blood sugar sufficiently, so you’ll need to try something else.

To increase your body’s sensitivity to insulin (your own or injected forms), the oral medication metformin (Glucophage) is valuable. It reduces the liver’s production and release of glucose, and increases glucose uptake into muscle cells. This drug can be used alone before a sulfonylurea is tried, or with a sulfonylurea to boost its glucose-lowering effect. With Glucophage, hypoglycemia isn’t a problem: You may lose weight due to diminished appetite. Diarrhea can occur but may disappear over time.

Like the sulfonylureas, a group of drugs called meglitinides, such as Prandin, stimulate the pancreas to produce insulin. They work quickly and act for only a short time, so you need to take them before every meal. Because meglitinides lower blood sugar, their main side effect is hypoglycemia. Other drugs are taken with meals. The alpha-glucosidase inhibitors (Precose, Glyset) will delay the digestion of complex carbohydrates and table sugar. Their purpose is to blunt the increase in blood sugar that normally occurs after eating. Because these drugs interfere with digestion, some people experience mild gas and bloating, but these side effects often subside with long-term use.

Relatively new and quite pricey, thiazolidinediones (TZDs), or glitazones, decrease muscle-cell resistance to insulin by activating certain genes involved in fat synthesis and metabolism.

The new drug Starlix, a D-phenylalanine derivative, lowers glucose levels by stimulating the pancreas to release insulin. It works quickly and acts to prevent the blood glucose increase that occurs after eating. The risk for hypoglycemia is low.

Lifestyle Changes

Achieving a healthy lifestyle is critical for keeping diabetes under control. A good diet and weight reduction, if needed, are the first goals—and the most challenging. Anyone can swallow pills, but it takes real willpower to change long-established patterns of poor eating. A dietitian with training in diabetic meal planning can help formulate a program well suited to your needs. Sadly, more than half of all people with diabetes abandon their diet therapy. Relying on luck and medications, they risk serious problems down the line.

The basics of a diabetes diet are the principles of healthy eating, with calorie restrictions. When you start getting 50% of your daily calories from carbohydrates, 30% from fats, and 20% from protein, you’ll realize that if everyone ate like this, less obesity as well as diabetes would persist. Such an eating plan also reduces your chances of developing heart disease and cancer. The real challenge is portion control.

If you’re overweight, shedding a few pounds will improve your blood glucose levels: Losing just 10% of your body weight can slow the progression of diabetes. If weight is an issue for you, consider a support group, like Weight Watchers, and ask your doctor about one of the new drugs for weight control, like Meridia or Xenical. Regular exercise combined with calorie restriction will speed your weight loss. When you have diabetes, exercise has an added benefit: It increases your cells’ sensitivity to insulin and enables them to use glucose more efficiently. Exercising as little as 30 minutes, three times a week can help, but engaging in something vigorous every day is best. Choose activities that are aerobic: bicycling, swimming, or walking, as opposed to resistance exercises, like weight lifting.

Kick the smoking habit! The double damage inflicted on your circulation by diabetes and smoking can eventually result in amputation of your toes or feet. Diabetes greatly increases the risk of hardening of the arteries (artherosclerosis), which leads to heart attacks, stroke, and narrowing of the arteries that supply blood to the lungs. These problems are the major cause of death in diabetics. They may be prevented by smoking cessation, and through cholesterol and blood pressure control.

Questions for Your Doctor

• Will l ever need insulin?
• How can I tell if I’m developing complications from the diabetes?
• Should I aim for very tight blood glucose control?
• How often do I need a hemoglobin A1c test done?

Living with Type 2 Diabetes

If you’re living with Type 2 Diabetes, here are some quick hints to help you take control:

• Expand your annual check-up. Be sure to add an eye exam by an eye specialist (ophthalmologist) and foot exam by a podiatrist. Don’t forget a flu shot and ask your doctor if you need another pneumonia vaccination.
• Have a hemoglobin A1c test. At first, your doctor will check your long-term glucose control every two to three months with this blood test, also known as HbA1c. A score higher than 8 means you need more control. Below 7 is ideal. If your doctor hasn’t done this test, consider finding a more knowledgeable doctor.
• Avoid foot problems. Give your feet the best possible care. Wear shoes that fit.
• Eat at regular times. Many foods are converted to glucose, and you need to hold those levels steady. Schedule meals and snacks for about the same time every day. Try to eat consistent amounts—and don’t skip meals.

Prevention of Type 2 diabetes

• Doctor your diet. For most people, carbohydrates (especially complex carbohydrates that are high in fibre) should form the bulk of the diet. Protein foods (meat, soy foods, and dairy) should make up 10 to 20 percent of daily calories. Choose protein foods that are lower in fat, especially saturated fat. That means emphasizing fish, poultry, beans, and low-fat or no-fat dairy products.
• Stick to a schedule. Avoid delaying or skipping meals and binge eating, all of which can play havoc with blood-sugar levels.
• Shed some pounds. At least 80 percent of people who develop Type 2 diabetes are overweight. Slim down and you may avoid the disease. Even if you can’t get to your ideal weight, a 10-pound loss can dramatically lower blood-sugar levels.
• Move it. Exercise improves your body’s sensitivity to insulin, aids glucose control, and can help you lose weight. Brisk walking an hour a day could cut your risk of developing diabetes in half.
• Get a diabetes test. A simple blood test called a random plasma glucose test should be part of your regular health checkup. It can even be done shortly after eating. If the result is 11.1 mmol/L or higher, you may have diabetes and your doctor will order additional tests. If your blood-sugar level isn’t high enough to classify you as diabetic, you still should take precautions if you have one of two forms of higher-than-normal levels: impaired fasting glucose (IFG), when results of a standard blood test, after an 8-hour fast, are between 6.1 and 6.9 mmol/L; or impaired glucose tolerance (IGT), when results of a 2-hour oral glucose tolerance test are greater than 7.0 mmol/L. These readings indicate that your body isn’t using and/or secreting insulin properly, increasing your risk of diabetes, cardiovascular disease, and premature death. For either condition, follow the diet and exercise recommendations for people who already have diabetes; taking these steps may help prevent you from developing the disease.
• Protect yourself with E. Some experts recommend taking a supplement of 200 to 400 mg of vitamin E daily.
• Lower your stress. Excess stress, in combination with poor coping skills, can raise your blood-sugar levels.