Improving the quality of patient education via physician-certified medical video and multimedia alternatives

Home | Products | Upload Video | Second Life | Music Therapy | Quizzes | About Us | Sign In

Diabetes Type 2

Type 2 Diabetes

What is Type 2 Diabetes?

Type 2 Diabetes is a disease that results in abnormally high blood sugars. Because it commonly affects those who are overweight or obese, the rate of Type 2 Diabetes in the U.S. has increased dramatically in the past decade. Currently, it is estimated that over 18 million people have diabetes, many of whom are undiagnosed.
You may be wondering, "how do you develop diabetes? " Due to genetics, low activity, excess body weight, and a poor diet, the muscle, liver and fat cells in your body can become resistant to insulin, a hormone made by the pancreas, which is an organ in your body. The pancreas is responsible for sugar control, along with your liver and other parts of your body. Cells become more resistant to insulin in type 2 diabetics. Without insulin, cells cannot process the sugar in your body very well, resulting in "cell starvation" and high blood sugars. The pancreas responds to this "cell starvation" by secreting more and more insulin. Eventually, the pancreas slows down or stops secreting insulin altogether.

What are the risk factors for Type 2 Diabetes?

Some risk factors include:
1) Overweight or obesity.
2) Asian, Latino, African or American Indian descent
3) Family history of Type 2 Diabetes
4) Low activity levels/lack of exercise.
5) Overeating and eating foods high in fat, cholesterol, and sugars.
6) Age >45yrs.
7) History of diabetes in pregnancy.

How do I prevent diabetes?

Although there is a genetic component to Type2 Diabetes that cannot be changed, you can definitely help to prevent diabetes by staying active, eating healthy foods, avoiding too much stress and trying to maintain a healthy weight. Also, try to get 7 to 8 hours of restful sleep a night.

How do I know if I have Diabetes?

Your doctor can screen you for Diabetes, especially if you have any of the risk factors mentioned above. Symptoms of diabetes include increased thirst and urination, extreme hunger, blurry vision, bad breath, and unexplained weight loss. If you suffer from any of these symptoms, you should definitely notify your doctor.

Screening for diabetes is done by either checking a fasting blood sugar test after an overnight 12 hr fast, or by having a glucose tolerance test, which requires you to ingest a sugar drink and then have your blood sugar checked 2 hrs afterwards.

Another blood test, called a Hemoglobin A1C, may also be checked by your doctor in addition to the above tests.

You will be diagnosed with diabetes if:
1) Your fasting sugar is over 126 mg/dl;
2) Any random blood sugar level is 200 mg/dl or greater
3) Your blood sugar level two hours after a sugar drink is 200 mg/dl or greater.

You may have borderline high levels of blood sugar, and be diagnosed with what is
known as pre-diabetes or impaired glucose tolerance (IGT If you are pre-diabetic, you should diet and exercise to prevent the onset of full-blown diabetes in the future, under the supervision of your doctor.

What are the treatments for Type 2 Diabetes?

Treatments can include diet and exercise alone, or diet and exercise as well as medication. The majority of diabetics require some form of medication to control their diabetes. These medications can be oral ( or pills) or injection forms, such as insulin. Oral medications include medicines such as metformin or glyburide, which help to keep your sugars at a normal level. All forms of medicine, whether oral or injected, need to be taken on a regular basis as prescribed by your doctor.

Some common types of diabetic pills include:

1) Biguanides, such as Metformin (trade names include: Fortamet, Glucophage, and others)
This type of medication reduces the amount of sugar released by your liver between meals
They may promote weight loss; may reduce cholesterol and triglycerides
2) Meglitinides
Some examples are Repaglinide (Prandin) or nateglinide (Starlix)
These pills stimulate your pancreas to release more insulin.
They work quickly when taken with meals;and they are less likely than sulfonylureas to cause low blood sugar
3) Sulfonylureas
Some examples are Glipizide (Glucotrol); glyburide (DiaBeta, Glynase, Micronase); and glimepiride (Amaryl)
These drugs also help to stimulate your pancreas to release more insulin
And are often used with other oral diabetes drugs, but may cause low blood sugar (hypoglycemia) and weight gain
4) Thiazolidinediones
Some example are Rosiglitazone (Avandia); pioglitazone (Actos)
These make your tissues more sensitive to insulin

Injection forms of medication such as insulin can be delivered by a needle and syringe, an injection pen, an insulin pump, or more rarely, by inhalation. For Type 2 diabetics, the needle and syringe and injection pen forms are the most widely prescribed form of insulin.

There are also different types of insulin. These include:

1) Aspart (Novolog) or Lispro (Humolog) -these types of insulin act quickly to lower your sugar and should be taken immediately prior to meals. The duration of action is 2-5 hrs.
2) Regular insulin (such as Humulin R, Novolin R) work within 30-60 minutes and can be taken roughly half an hour before meals. The usual effective duration is 3-6 hrs.
3) NPH (Humulin N)-works more slowly (within 2 to 4 hours) and but lasts about 10-16 hrs in your body.
4) Lente (Insulin Zinc suspension) takes 3-4 hrs to work and remains active 12-18 hrs in your body.
5) Ultralente-this is a peakless, long acting insulin that does not work until 6-10 hrs after injection and works for up to 20 hrs.
6) Glargine (lantus) -this is peakless insulin that works in roughly an hr after injection and lasts 24 hrs in your body.

These insulins can be used in combination with one another (such as a mix of NPH and regular insulin). They can also be used in combination with oral medication, or alone... depending on your doctor's recommendations. Please consult your doctor as to which types of medications are best for you.

Why should I check my blood sugars?

When starting a new medication, it is especially important to monitor and log your blood sugars since medication adjustments may be needed. Once an appropriate dose has been established, it is very important to take your medication on a regular basis as recommended by your doctor. It is also advisable to continue to check your blood sugars up to four times daily to ensure that your blood sugars are under control.

The ADA currently recommends that your blood sugars 2 hrs after eating be less than180 mg/dl. Fasting sugars should be between 90-130 mg/dl. You may also want to check your sugar if you feel tired, confused, irritable, or sweaty, since these are signs of hypoglycemia, or low blood sugar. If you are urinating more than usual, or excessively thirsty, these could be signs that your blood sugar is too high.

How do I check my blood sugar?

Although different machines may operate differently, here are some general guidelines for checking your blood sugar. If you have further questions, please talk to your doctor.

First, wash your hands with warm water and soap to remove any excess dirt or bacteria. Wipe your finger with an alcohol pad. Most machines require a droplet of blood from the pad of your finger (although some allow you to use your arm instead.) If you are drawing blood from your finger, use the sterile lancet to prick your finger, and place of droplet of blood onto the test strip. Place the strip into the glucometer, and read the number that appears on the screen.

Log your blood sugar level into a diary or notebook, noting the time and date that you checked your blood sugar. You can note whether the sugar was checked in the morning before eating, or whether it was taken 1-2 hrs after a meal. If you choose, you can also log the type of meal you ate if you note an unusually high reading so you can improve your eating habits.

Possible complications of Type 2 DM

Not taking your medication regularly may cause your blood sugars to rise, and cause damage to your blood vessels and organs. This can lead to heart attacks, strokes, kidney failure, blindness, nerve damage, and other medical problems. (animation) You can minimize these damaging effects caused by diabetes by keeping your blood sugars under control.

Here are some things you can do to reduce the damaging effects of diabetes:

1) Take medication as prescribed by your doctor
2) Maintain strict control of blood sugars, with a goal HgbA1c of less than 7%; try to keep a blood sugar diary and show it to your doctor so that he or she can better control your medication dosages. Checking your sugars can also help you to know when you might have eaten too much, too little, and to determine what foods to avoid.
3) Maintain a healthy diet, avoiding excessive sugars, carbohydrates, saturated fats, and high cholesterol foods. Try to eat plenty of vegetables and whole grain products. Keep in mind that fruits contain sugar, but moderate amounts of fruit are usually ok. Avoid sweet drinks or regular soda and try to drink diet soda or water instead. Sugar substitutes such as Nutrasweet can be used instead of sugar. Choose low fat dairy products, nuts, fish and skinless poultry.
4) Exercise regularly. If you are over 40, you will need to have a stress test to ensure your heart is in good condition before starting an exercise program. Please talk to your doctor before starting any exercise regimen.
5) Keep your blood pressure less than 130/80
6) Keep cholesterol levels low as recommended by your doctor
7) Quit smoking.
8) Take a low-dose aspirin every day with your meals, if your doctor says this is ok.
9) Wash your feet daily with warm water and mild soap, looking for any lesions or ulcers. Wear comfortable shoes, avoid going barefoot, and change your socks once a day. Use lotion to keep skin on shins and top of feet from becoming dry and cracked.
10) Get your eyes checked by an eye doctor at least once a year to screen for diabetic retinopathy, or vessel damage in the back of the eye.
11) Visit your doctor regularly for periodic exams and lab tests.

Sources:

http://diabetes.niddk.nih.gov/intro

Griffith's 5-Minute Clinical Consult 2006 for PDA: Powered by Skyscape, Inc. (The 5-Minute Consult Series) by Mark R Dambro; Type 2 diabetes mellitus

http://diabetes.niddk.nih.gov/intro

http://familydoctor.org/350.xml

Insulin Therapy for Type 2 Diabetes: Rescue, Augmentation, and Replacement of Beta Cell Function
JENNIFER A. MAYFIELD, M.D., M.P.H., Seattle, Washington
RUSSELL D. WHITE, M.D., University of South Florida College of Medicine, Tampa, FloridaAmerican Family Physician® > Vol. 70/No. 3 (August 1, 2004)

http://familydoctor.org/821.xml#1