Type 2 diabetes: Symptoms, causes, risk factors, diagnosis, and treatment

Type 2 diabetes mellitus (type 2 diabetes) is much more common than type 1 diabetes - this form of the disease is diagnosed in 90% of people with high blood sugar (hyperglycemia). While previously the disease mainly developed after the age of 40, today type 2 diabetes is considerably younger, and the number of patients increases exponentially every year. Figuratively speaking, the world is gripped by a "pandemic" of T2DM. The insidious disease acts stealthily, It is almost asymptomatic in its initial stages and gradually turning a healthy person into a diseased one.

What is type 2 diabetes mellitus?

It is an endocrine system disorder that causes insulin deficiency and pancreatic cell dysfunction. It is characterized by frequent urination, increased thirst, itchy skin, increased appetite, fever, and muscle weakness.

Prevalence

Diabetes mellitus (both types 1 and 2) is a chronic disease whose global prevalence is increasing rapidly.

• Just 25 years ago, the number of people living with diabetes worldwide was less than 130 million.
• In 2019, their number increased to 463 million. By 2040, the total number of people living with diabetes worldwide could reach 700 million.

About half of people with T2DM are unaware of their disease, leading to its progression and serious complications. It can often take years from the onset of the first symptoms to diagnosis.

Type 2 diabetes causes and risk factors

Although the exact causes of insulin resistance are not yet known, the risk factors for type 2 diabetes are well understood. The reasons for developing type 1 and type 2 diabetes are different. For type 1, they are not precisely determined, but experts from the WHO (World Health Organization) often mention the following causes.

• Genetic factors.
• Viral infections such as chickenpox, rubella, Coxsackie virus, etc.
• Early feeding of the baby with cow's milk, which contains a special protein substance that promotes the formation of antibodies to the pancreatic cells.
• Lack of breastfeeding.

Factors that can contribute to the development of type 2 diabetes are divided into those that cannot be changed and those that can be changed.

Factors that cannot be changed

• Genetic predisposition: Family history with diabetes mellitus is an important factor that cannot be ignored. Tendency to hyperglycemia in children and grandchildren of diabetics is confirmed by many years of statistics. If any of your close relatives has or had diabetes, you should examine this and try to minimize the effect of external factors that can trigger the disease's onset.
• Race: Asians, Hispanics, and Africans are at greater risk than other groups.
• Age: The risk of developing T2DM increases with age.

Other risk groups:

• Pregnant women with carbohydrate metabolic disorders.
• Overweight pregnant women.
• Women who have had spontaneous abortions, birth defects in children, and other complications.
• Women who gave birth to babies weighing 4 kg or more.

Factors that could be changed

• Obesity: The risk of diabetes is directly proportional to body mass index. The greater the degree of obesity, the more likely a malfunction in hormonal regulation of glucose metabolism. The most dangerous fat deposits are of the android type i.e In the abdomen, around the buttocks and upper body, as well as fat accumulation inside the abdominal cavity (Visceral fat).
• Stress: Back in the 19th century, in the troubled times of economic crises, type 2 diabetes was aptly named "stockbrokers' disease. It was observed that stockbrokers who risked a lot of money every day, as well as other people whose occupation was associated with constant stress, very often got diabetes.
• Lack of physical activity: Modern man lives at high speeds. To keep up with everything, we use a private car, taxi, public transport. For a successful career, we sit at the computer screens for 10-12 hours. Luckily, morning jogging and cycling, swimming pool and gym activities have become fashionable mainstream lately. Unfortunately, not everyone understands their importance and makes them part of their life. In the absence of physical activity, metabolic disorders overtake a person at a much earlier age.
• Smoking: A 20-year study showed that 22% of smokers and 11.5% of non-smokers have pre-diabetes. Passive smokers are more likely to have diabetes than non-smokers.
• Improper nutrition: High caloric intake, large amounts of easily digestible carbohydrates and saturated fats of animal origin, "fast food" are features of the modern diet that are becoming life-threatening. They can lead not only to diabetes, but also to heart attacks, hypertension and strokes.
• Infectious diseases, hormonal and metabolic disorders: Polycystic ovarian disease(PCOS), hepatitis, hypertension, increased glucocorticosteroids, excess "bad" cholesterol, and insulin resistance have been found to be related.
• Gestational diabetes: Every pregnant woman should have a blood sugar test. This should not be considered a whim of the gynecologist or therapist. During pregnancy, a woman may have carbohydrate metabolism disorders that resolves itself after delivery without any treatment. Hyperglycemia complicates the course of pregnancy, so expectant mothers with high sugar should follow a special diet. Although after childbirth blood glucose levels usually normalize, it should be remembered that a history of gestational diabetes is one of the risk factors for the development of T2DM during the menopause.
• Alcohol: Avoiding alcohol abuse reduces the risk of type 2 diabetes by 30%.
• Improper sleeping habits: Interrupted, shallow night time sleep with insufficient ventilation is another cause of impaired glucose metabolism and the onset of type 2 diabetes. That's why it is so important to know and follow the rules of healthy sleep.

Important: The combination of the above factors further increases the risk of type 2 diabetes and the presence of the disease in turn:

• Reduces the tolerance of the cardiovascular system to stress and physical exertion.
• Reduces muscle tone and endurance.
• Disrupts night sleep and metabolism.
• Making the normal desire to lose weight a nearly impossible task.

Symptoms and consequences of type 2 diabetes unlike type 1 diabetes, type 2 diabetes develops slowly and unnoticed: mild or moderate hyperglycemia for a long time (often years) does not manifest itself at all. However, a disorder in glucose metabolism can already be detected at an asymptomatic stage, either by accident or during a routine preventive examination.

If this can be done at the very beginning, the onset of the disease can be at least postponed, and without any treatment. A good night's rest, avoidance of stress, weight reduction and correction of the diet allow to restore hormonal regulation, improve metabolism and forget about the problem for many years.

The first symptoms of type 2 diabetes usually occur when the disease has already started, hyperglycemia is persistent and the person needs antidiabetic therapy.

What are the first symptoms of type 2 diabetes?

At first, the increase in blood sugar signals the following symptoms:

• Dry mouth, Excessive thirst, As a result of which the person drinks a lot of fluids;
•  Extreme fatigue, Diabetics constantly feel sleepless, get tired quickly during physical and mental activity;
• Frequent urination, including at night;
• Itching of the skin, which is mostly in the thin skin areas(such as the crotch in women).
• Extremely intense hunger;
• Slowly and poorly healing wounds - even the smallest scratches don't heal well with a person with diabetes;
• Blurred vision;
• Numbness in the limbs (diabetic neuropathy).

Symptoms of moderate to severe disease

As type 2 diabetes progresses, the symptoms become more severe, and the following symptoms are joined by signs of organ dysfunction.

Most importantly, the cells of the brain and heart need glucose and oxygen. They are the first to "get hit", experiencing chronic oxygen deprivation and lack of "fuel".

Furthermore, an excess of sugar in the blood causes arterial vessel obliteration - they lose elasticity and firmness (become "glassy"), the lumen of the arteries narrows, and cholesterol plaques develop on the walls. As a result, the patient's

• Their heart rhythm is disturbed;
• The blood pressure rises;
• The risk of heart attack and stroke increases dramatically.

Diabetes affects blood vessels, heart, brain, kidneys, lower extremities. Diabetics also experiance kidney and liver damage, their resistance to infections is reduced, osteoporosis develops, and trophic ulcers appear on the feet and lower legs. Even cold can lead to major problems, and pneumonia is especially difficult to cure, which is why covid is usually severe in patients with type 2 diabetes.

Diagnosis

In modern clinical practice, the diagnosis of diabetes mellitus is made on the basis of the glycated hemoglobin assay (HbA1C). Once in the blood, glucose molecules can penetrate red blood cells and firmly bind to hemoglobin protein receptors - to glycate it. The more glucose in the blood, the more of its molecules are "deposited" on hemoglobin. Glucose stays on the protein for 3-4 months, preventing it from performing its function of transporting oxygen and carbon dioxide.

In a healthy person this figure does not exceed 5.7%. Glycated hemoglobin levels between 5.7% and 6% signal the onset of problems with glucose metabolism. An increase in HbA1C up to 6.1%-6.4% indicates prediabetes, a figure higher than these values indicates the presence of the disease.

Knowing the percentage of glycated hemoglobin, the doctor can not only make a diagnosis, but also track the progression of disease and adjust treatment as needed.

Diagnosis of type 2 diabetes also requires an assessment of pancreatic function. This indicator influences the selection of anti-diabetic medication.

Furthermore, diabetics are identified using a "lipid panel," which evaluates the condition of the kidneys, fundus, peripheral nerves, and blood vessels, if possible and if necessary - appoint a daily monitoring of blood pressure (BP) and cardiogram (Holter monitoring).

Understanding the peculiarities of the course and competent treatment of type 2 diabetes reduces the severity of the disease's symptoms, improves quality of life, and lowers the risk of severe complications.

Treatment methods for type 2 diabetes mellitus

T2DM treatment is chosen and carried out based on the stage of the disease, the condition of the insulin-producing "Langerhans islets" in the pancreas, and any associated pathologies.

At HbA1C levels of 5.7% to 6%, diet and lifestyle adjustments are sufficient.

• Weight loss;
• Reducing the consumption of sugar and fast carbohydrates;
• Increased physical activities;
• Improving the quality of sleep at night;
• Eliminating the source of constant stressful situations (if necessary - up to changing jobs, places of residence, etc.).

Recently, renowned Western diabetologists have repeatedly advised such patients to combine the above mentioned measures with the administration of medications that function in both directions:

• Restoring the muscle cell's ability to respond to insulin and use glucose for their vital functions;
• Slowing down and preventing absorption of easily digestible carbohydrates in the intestine.

How to prevent type 2 diabetes in youth?

To prevent the onset of diabetes, early carbohydrate metabolism disorders are diagnosed. The American Diabetes Association recommends routine glycemic assessment for all persons with a BMI more than 25 kg/m2 and any of the other risk factors.

People with average body weight should begin frequent screening after the age of 45. If glucose metabolic parameters are normal, it is sufficient to repeat tests every three years; if impairment is indicated, testing should be repeated once a year or more frequently.

The detection of glucose in venous blood on an empty stomach at 7 mmol/l, the occasional level at 11.1 mmol/l, and glycated hemoglobin at 6.5 percent or greater are the diagnostic thresholds for diabetes mellitus.

T2DM complications

T2DM patients may experience both short- and long-term complications affecting various organs, including the heart, blood vessels, nerves, and eyes, which can develop to even more severe complications over time. Effective blood sugar control with syringe pens or an insulin pump can go a long way toward minimizing the complications of diabetes.

Here are some of the most common complications of type 2 diabetes:

• Damage to the heart and blood vessels
• Nerve damage
• Eye and foot damage
• Diabetes dramatically increases the risk of a variety of cardiovascular problems, including coronary heart disease and hypertension, which can eventually lead to a heart attack.
• High blood sugar (glucose) levels over a long period of time can damage the capillaries responsible for nerve endings in the extremities, such as the feet. As a result, a tingling or numb feeling can occur, which eventually leads to a loss of sensation in the affected areas.
• Diabetes can have a significant impact on the blood vessels of the eyes, leading to cataracts, glaucoma, and, in severe cases, blindness.
• Nerve injury and inadequate blood flow are also common problems in the feet. Because diabetic patients' wound healing processes are slower, any minor injury to the foot can soon grow into a major lesion.

Frequently asked questions

Is it possible to cure type 2 diabetes without insulin?

It is possible to lower blood glucose levels without insulin injections if the pancreas is not yet entirely "exhausted" and releases the hormone in the amount required by the body.

In the early stages of mild type 2 diabetes, medications that enhance glucose metabolism, combined with a low-carbohydrate diet and sugar-lowering foods (topinambur, ginger, chicory, cinnamon, decoctions and infusions of blueberry, bean pods, and others), may usually control the disease. to see how well it works is assessed by the level of glycated hemoglobin: against the background of treatment it should not exceed 6.5%-7%.

The endocrinologist may prescribe additional drugs if necessary. Diabetics are also given medication to help them stick to their sugar-lowering schedule and avoid complications from the disease:

• Magnetotherapy improves renal and pancreatic function while reducing the symptoms of diabetic neuropathy and angiopathy;
• Antioxidant injections;
• Hypotensive drugs, antiarrhythmics, etc.

Important! Each medication has its own set of adverse effects. As a result, it is required to pass tests on a regular basis during treatment. Based on their findings, the doctor modifies the plan of anti-diabetic and adjuvant therapy.

What steps should you take if you have been diagnosed with type 2 diabetes?

You should not be panicked if you have been diagnosed with diabetes. Modern treatment has made it possible to successfully control this disease while maintaining your quality of life.

• Find a doctor you trust and follow all his recommendations for the treatment and control of diabetes.
• Regularly undergo checkups to avoid or detect any complications of diabetes from the eyes, cardiovascular and nervous systems, and kidneys in the early stages.
• Examine all aspects of your lifestyle that can be changed to improve the situation: balance your diet, lose weight, increase physical exercise, break bad habits (smoking, alcohol), and avoid stress at work if possible.

Patients can now effectively control their diabetes, significantly reduce the risk of complications, and maintain a high quality of life thanks to the personalized blood glucose monitoring devices (glucose meters), innovative blood glucose-lowering drugs, and the availability of information and education.

Can type 2 diabetes be cured forever?

Unfortunately, there is no method or cure yet for this chronic disease. However, such an answer to the question "can type 2 diabetes be cured" would be incomplete and incorrect.

You can and should learn to live with diabetes, and this life can be quite comfortable, long and happy. Make it so will help the right attitude to the disease, or rather - to their health. 

When type 2 diabetes is treated with insulin

If the disease is diagnosed at advanced stages, and the "exhausted" gland is unable to produce the necessary amount of insulin, insulin therapy is added to the course of therapy. The type of insulin, number of injections, and dose are all determined by the blood sugar level and the body's response.

Facts about type 2 diabetes

1. 90% of all cases of diabetes are type 2 diabetes.
2. Patients with diabetes have 2-4 times the risk of developing cardiovascular disease.
3. People who are obese have 5 times the risk of developing type 2 diabetes.
4. 380 million people live with type 2 diabetes.