Type 2 Diabetes Treatment

What is Type 2 Diabetes?

Diabetes is a disorder characterized by abnormally high blood sugar levels usually caused by insensitivity to insulin.  Insulin production is normal in type 2 diabetics.  The condition is frequently associated with a family history and is seen in obese individuals.  It is a leading risk factor for the development of heart attack, stroke, and peripheral vascular disease.  It is also a leading cause of kidney disease, blindness, and death in the United States.

Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes Type 2 Diabetes?

Type 2 diabetes is caused by insensitivity to insulin.  In other words – there is no problem with insulin production, the problem is that tissues cannot properly handle insulin and use glucose.  Diabetes is frequently associated with obesity, high cholesterol, elevated blood pressure (hypertension), kidney failure, heart disease, and stroke.

Long-term elevations in blood sugar lead to tissue injury and inflammation.  This is especially problematic in the arteries, where it promotes the formation of fatty plaques.  Arterial plaques lead to reduced blood supply to tissues and organs such as the heart, kidneys, eyes, and nervous system.

The most common risk factors for diabetes include:

  • Obesity
  • Family history
  • Alcohol use
  • Sedentary lifestyle
  • Poor diet

Other conditions such as low thyroid function (hypothyroidism), Cushing syndrome, and certain medications (e.g. corticosteroids, beta blockers) can also cause diabetes.

How common is Type 2 Diabetes?

Type 2 diabetes is an extremely common condition that is frequently evaluated in the primary care clinic.  Advanced cases may require referral to an Endocrinology specialist.  It is a leading cause of heart disease, stroke, kidney failure, blindness, and death in the United States.

It affects approximately 12% to 14% of Americans. The prevalence of diabetes is on the rise due to the Western diet and lifestyle.

What are the symptoms and signs of Type 2 Diabetes?

The classic symptoms of diabetes usually occur in type 1 diabetes and include:

  • Eating excessively (polyphagia)
  • Excessive thirst (polydipsia)
  • Frequent urination (polyuria)

Patients with severe type 2 diabetes may also develop these symptoms and often require the use of insulin to control their blood sugar levels.

Other symptoms of diabetes that occur due to its complications include:

  • Eye disease leading to blindness (retinopathy)
  • Kidney failure – results in high blood pressure and swelling in the legs
  • Heart attack – chest & difficulty breathing – although heart attacks in diabetes may be “silent”
  • Nerve damage in the feet & hands (peripheral neuropathy) causes burning pain

You may also develop complete loss of sensation and ulcer formation in the feet, which is a very dangerous sign.  Complete sensory loss can also result in problems with balance.  The foot examination is a critical part of the physical examination in patients with diabetes.

How is Type 2 Diabetes diagnosed?

Diabetes is primarily diagnosed based on blood tests evaluating your glucose levels and hemoglobin A1C.  Hemoglobin A1C gives your doctor an idea of how well your diabetes has been controlled in the past several months.  The diagnosis of diabetes is made when your fasting glucose is >126 mg/dL, random blood glucose is >200, or if your hemoglobin A1C is >6.5%.

Your doctor will also likely order blood tests such as a CMP (comprehensive metabolic panel), CBC (complete blood cell count), cholesterol levels, urine microalbumin, and urine analysis.

If they suspect that you have heart disease they will likely obtain an EKG (electrocardiogram), and ultrasound of the heart (echocardiogram).

How is Type 2 Diabetes treated?

The treatment of type 2 diabetes is multifaceted and includes diet and exercise.  Patients are encouraged to eat a low-carbohydrate diet.  If you eat carbohydrates, they should be derived from fruits, whole wheat or whole grain products, or oatmeal.  Your doctor will ask you to avoid sugar from sources such as high-fructose corn syrup, candy, pastries, or cakes.  Patients with diabetes should also avoid alcohol use.

The most commonly prescribed drugs for type 2 diabetes include:

  • Glucophage (metformin)
  • Glucotrol (glipizide)
  • Precose (acarbose)
  • Glyset (miglitol)
  • Byetta (exenatide)
  • Prandin (repaglinide)
  • Victoza (liraglutide)
  • Januvia (sitagliptin)
  • Invokana (canaglifozin)
  • Farxiga (dapagliflozin)

 Patients with severe disease may also require the use of insulin.

  • Levemir (insulin detemir)
  • Lantus (insulin glargine)
  • NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart)
  • Humalog Mix 75/25 (insulin lispro protamine-insulin lispro)
  • Humalog Mix 50/50 (insulin lispro protamine-insulin lispro)

Your doctor may start you on low-dose aspirin depending on your age and presence of other cardiovascular risk factors.  Patients with diabetes are also usually treated with cholesterol-lowering medications (eg, Lipitor - atorvastatin) and blood pressure reducing therapies (e.g., Zestril - lisinopril, Cozaar – losartan).

 

Type 2 Diabetes Summary:

  • Type 2 diabetes is a very common condition characterized by abnormally high blood sugar levels caused by insensitivity to insulin. 
  • Insulin production is normal in type 2 diabetics.
  • Diabetes is frequently associated with obesity, high cholesterol, elevated blood pressure (hypertension), kidney failure, heart disease, and stroke. 
  • Risk factors include obesity, family history, alcohol use, sedentary lifestyle, and poor diet.
  • Patients may be asymptomatic – people with severe disease can develop excessive thirst, excessive hunger, and frequent urination.
  • Complications include heart attack, visual loss (retinopathy), kidney disease (nephropathy), peripheral vascular disease, loss of balance, peripheral neuropathy, ulcers, foot infections, and gangrene.
  • The diagnosis of type 2 diabetes mellitus can be made if your fasting glucose is >126 mg/dL, random blood glucose is >200 mg/dL, or if your hemoglobin A1C is >6.5%.
  • The treatment of diabetes is multifaceted and includes diet and exercise - patients are encouraged to eat a low carbohydrate diet.
  • Medical therapy may include the use of Glucophage (metformin), Glucotrol (glipizide), Byetta, (exenatide), Prandin (repaglinide), Victoza (liraglutide), Januvia (sitagliptin), Invokana (canaglifozin), Faxiga (dapagliflozin), or Invokana (canagliflozin).
  • Patients with severe disease may require treatment with insulin such as Levemir (insulin detemir), Lantus (insulin glargine), NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart), Humalog Mix 75/25 (insulin lispro protamine-insulin lispro), Humalog Mix 50/50 (insulin lispro protamine-insulin lispro).

 

References:

  1. Pippitt K, Li M, Gurgle HE. Diabetes Mellitus: Screening and Diagnosis. Am Fam Physician. 2016 Jan 15;93(2):103-9.
  2. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Recommendation Statement. Am Fam Physician. 2016 Jan 15;93(2):Online.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.