CONDITIONS
Diabetes Mellitus Type 2
Diabetes Mellitus Type 2
There are 3 types of diabetes –
Pre- diabetes: Where blood glucose levels are too high to be considered normal but not high enough to be labelled diabetes (fasting blood glucose level is between 100 mg/dL and 125 mg/dL). The risk of developing diabetes is significantly reduced by losing 5-10% of the body weight with healthy eating and active lifestyle.
Diabetes Mellitus Type 1 (T1DM): In Type 1 diabetes (earlier known as juvenile diabetes or insulin-dependent diabetes, the insulin-making cells (beta cells) in the body (in pancreas) is destroyed by the body’s own immune system. Because of this, insulin is unable to show its effects resulting in increase blood glucose levels. Hardly 10% of people suffer from this type of diabetes and most people suffering are children and young people.
Diabetes Mellitus Type 2 (T2DM): In type 2 diabetes (earlier known as non–insulin-dependent diabetes or adult-onset diabetes), 2 things may happen – a. not enough insulin is produced in the body (pancreas) or b. cells respond poorly to insulin and take in less sugar. This results in increase in the blood sugar levels.
There is an increasing prevalence of diabetes in India as seen 7.1% in 2009 to 8.9% in 2019 In numbers, approximately 7.7 crore individuals were diagnosed with diabetes in India, expecting to rise to over 13.4 crore by 2045.
The important thing to understand is that around 57% of individuals remain undiagnosed in India. Increasing prevalence of overweight and unhealthy lifestyles are making Indians prone to diabetes.
What are the symptoms of diabetes?
- Excessive thirst
- Increased hunger (even occurs after eating)
- Frequent urination
- Weight loss without trying
- Extreme tiredness
- Blurry vision
- Sores or wound that heals slowly
- Numbness or tingling in the hands or feet.
Pigmentation (darkening of skin) usually in the armpits and neck
What are the causes and risk factors for Type 2 diabetes?
Type 2 diabetes develop because of two main problems:
- The cells in muscle, fat and the liver become resistant to insulin. Insulin transports sugar to the cells and hence, in this case, the cells don’t take in enough sugar and that sugar builds up in the blood.
- The pancreas can’t make enough insulin to keep blood sugar levels within a healthy range.
A combination of things causes type 2 diabetes, and these might be:
- Genetic: The body’s DNA affects the process of insulin production
Following are the risk factors for developing Type 2 Diabetes:
- Weight: Having extra weight or obesity can cause insulin resistance.
- Fat distribution: Fat storage mainly near the abdomen — rather than the hips and thighs — indicates a greater risk of T2DM. The risk is higher in men as compared to women.
- Inactivity: Physical activity controls weight and makes cells more sensitive to insulin. The less active a person is, the greater the risk.
- Family history: The risk of type 2 diabetes increases if a parent or sibling has type 2 diabetes.
- Race and ethnicity: Although unclear why, African American, Alaska Native, Native American, Asian American, Hispanic or Latino, or Pacific Islander American are more likely to develop type 2 diabetes.
- Metabolic syndrome: A group of conditions such as high blood sugar, high blood pressure, and high cholesterol and triglycerides increases the risk of developing Type 2 diabetes.
- Age: Increases with age with 45 or older at higher risk
- Polycystic ovary syndrome (PCOS): A condition in women, having PCOS— a condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes as the body becomes resistant to insulin in this condition.
- Prediabetes: If unchecked, consistent high blood sugar levels may lead to diabetic condition.
- Gestational diabetes: Diabetes while a woman were pregnant increases the risk of developing diabetes at a later stage.
Other risk factors that a person can control to prevent diabetes are:
- Getting little or no exercise
- Smoking
- Stress
- Sleeping too little or too much
How is Diabetes Type 2 diagnosed?
The healthcare practitioner generally conducts a blood test if type 2 diabetes is suspected.
The blood tests for type 2 diabetes include:
Random blood sugar test (taken at any random time) and confirmed by additional tests. Irrespective of the contents of last meal, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.
Fasting blood sugar test is a blood test post fasting overnight. A level of less than 100 mg/dL (5.6 mmol/L) is healthy, 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes while 126 mg/dL (7 mmol/L) or higher after 2 tests is considered diabetes.
Glycated hemoglobin (A1C) test is a measure of the average blood sugar level for the past 2 to 3 months and for most people, the American Diabetes Association recommends an A1C level below 7% as a target A1C for diabetics.
Oral glucose tolerance test (OGTT): Less commonly used than the others, except during pregnancy. Post fasting for a short time, the doctor then requests the patient drink a sugary liquid following which the blood sugar levels then are tested periodically for two hours. The results are interpreted as follows:
- Healthy – Less than 140 mg/dL (7.8 mmol/L) after two hours
- Prediabetes – 140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L)
- Diabetes – 200 mg/dL (11.1 mmol/L) or higher after two hours
What are the treatment options for Type 2 Diabetes Mellitus?
There is no cure for diabetes, but it can be managed by a mix of lifestyle changes and medication.
Lifestyle changes:
Weight loss: Dropping extra kgs helps in controlling the sugar levels. Losing 5% of body weight is good while losing at least 7% and maintaining it is ideally required.
Healthy eating: A registered dietician for diabetes will recommend a diet that includes fewer animal products and refined carbohydrates, such as white bread and sweets. A diet including nutritious, low-fat, high-fibre foods such as fruits, vegetables, and whole grains is recommended.
Exercising regularly: Physical activity is known to lower blood sugar levels. People who have type 1 diabetes need regular aerobic exercises like walking or swimming. A moderate aerobic exercise for atleast 150 minutes a week is recommended Pair that with strength training, like yoga or weightlifting. If blood glucose lowering medicine is prescribed, a snack might be required before working out.
Monitoring blood sugar levels: Monitoring may be done using a small, at-home device called a blood glucose meter, which measures the amount of sugar in a drop of blood.
Diabetes medications:
If target blood sugar level is not maintained with diet and exercise, the health care provider may prescribe diabetes medications to help lower glucose levels, or they may also suggest insulin therapy in case of uncontrolled sugar levels. A wide range of medicines are available and based on the type of control and the level of diabetes, the doctor prescribes them.
Surgeries for type 2 diabetes:
In some cases, the doctor may suggest weight loss surgery. A weight loss surgery can effectively treat type 2 diabetes by helping a person to lose weight. Generally, these procedures limit the amount of food consumed and the number of nutrients taken in by the body. A long-term commitment to healthy lifestyle changes is a must to get full benefits of this type of surgery.
How can a person with Type 2 diabetes effectively and routinely manage the condition?
A well-managed type 2 diabetes helps in avoiding complications of diabetes and feel better in everyday life. Along with a healthy diet, regular exercise, and medication as prescribed, following things are noteworthy:
- Keeping blood pressure and cholesterol levels in check.
- Getting regular eye exams, dentist visits, and physical check-ups.
- Keeping the feet clean and neat and checking it daily for sores, redness, or swelling.
- Getting good-quality sleep each night (at least 7 hours). Ask the doctor for help if this is difficult.
- Restrict alcohol intake to 1-2 drinks a day, depending on size and gender.
- Even a minor illness may interfere with the blood sugar and insulin levels and adjustment in the medications may be required.
How can Type 2 diabetes be prevented?
Adopting a healthy lifestyle can help you lower your risk of diabetes :
- Losing weight
- Getting active
- Eating right
- Quit smoking
What are the initiatives by government of India for Type 1 Diabetes?
The Government of India took initiative to launch the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in the year 2008 which was primarily adult centric.
“National Framework for Joint Tuberculosis-Diabetes collaborative activities” has been developed to articulate a national strategy for ‘bi-directional screening’, early detection and better management of Tuberculosis and Diabetes co-morbidities in India.
Under NPCDCS, 677 NCD district-level clinics, 187 District Cardiac Care Units, 266 District Day Care Centres and 5,392 NCD Community Health Centre-level clinics have been set up to provide access to free glucose monitoring systems and treatments.
References
- Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Indian J Ophthalmol. 2021 Nov;69(11):2932-2938.
- Type 2 diabetes. Mayo Clinic. January 2024. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199
- Type 2 diabetes. WebMD. January 2024. https://www.webmd.com/diabetes/type-2-diabetes
