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    The Brooklyn Hospital Center's Division of Head and Neck Surgery manages the diagnosis and surgical treatment of benign and malignant tumors of the head and neck. Staffed by a team of highly capable sur ...

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Type 2 Diabetes

Definition

Type 2 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes.

Alternative Names

Noninsulin-dependent diabetes; Diabetes - type 2; Adult-onset diabetes

Causes

Insulin is a hormone produced in the pancreas by special cells, called beta cells. The pancreas is behind the stomach. Insulin is needed to move blood sugar (glucose) into cells. There, it is stored and later used for energy.

When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy.

When sugar cannot enter cells, a high level of sugar builds up in the blood. This is called hyperglycemia.

Type 2 diabetes usually occurs slowly over time. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way.

Type 2 diabetes can also develop in people who are thin. This is more common in the elderly.

Family history and genes play a role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your chance of getting the disease.

Symptoms

People with type 2 diabetes often have no symptoms at first. They may not have symptoms for many years.

Early symptoms of diabetes may include:

The first symptom may also be:

Exams and Tests

Your doctor may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.

Diabetes blood tests:

Diabetes screening is recommended for:

If you have been diagnosed with type 2 diabetes, you need to work closely with your doctor. You will likely need to see your doctor every 3 months. At these visits, you can expect your doctor to:

The following tests will help you and your doctor monitor your diabetes and prevent problems.

Treatment

The goal of treatment at first is to lower your high blood glucose levels. Long-term goals are to prevent problems from diabetes.

The most important way to treat and manage type 2 diabetes is activity and nutrition.

Learning diabetes management skills will help you live well with diabetes. These skills help prevent health problems and the need for medical care. Skills include:

It may take several months to learn these skills. Keep learning about diabetes, its complications, and how to control and live with the disease. Stay up-to-date on new research and treatments.

Checking your blood sugar levels yourself and writing down the results tells you how well you are managing your diabetes. Talk to your doctor and diabetes educator about how often to check.

To check your blood sugar level, you use a device called a glucose meter. Usually, you prick your finger with a small needle called a lancet. This gives you a tiny drop of blood. You place the blood on a test strip and put the strip into the meter. The meter gives you a reading that tells you the level of your blood sugar.

Your doctor or diabetes educator will help set up a testing schedule for you. Your doctor will help you set a target range for your blood sugar numbers. Keep these factors in mind:

Keep a record of your blood sugar for yourself and your doctor. Based on your numbers, changes may need to be made to your meals, activity or medicines to keep your blood sugar level in the right range.

Work closely with your doctor, nurse, and dietitian to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your lifestyle and habits and should include foods that you like.

Managing your weight and having a well-balanced diet are important. Some people with type 2 diabetes can stop taking medicines after losing weight. This does not mean that their diabetes is cured. They still have diabetes.

Very obese patients whose diabetes is not well managed with diet and medicine may consider weight loss (bariatric) surgery.

Regular activity is important for everyone. It is even more important when you have diabetes. Reasons why exercise is good for your health:

Talk to your doctor before starting any exercise program. People with type 2 diabetes may need to take special steps before, during, and after physical activity or exercise.

If diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may prescribe medication. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one drug.

Some of the most common types of medication are listed below. They are taken by mouth or injection.

You may need to take insulin if your blood sugar cannot be controlled with any of the above medicines. Insulin must be injected under the skin using a syringe, insulin pen, or pump. It cannot be taken by mouth because the acid in the stomach destroys insulin.

Your doctor may prescribe medicines or other treatments to reduce your chance of developing some of the more common complications of diabetes, including:

People with diabetes are more likely than those without diabetes to have foot problems. Diabetes damages the nerves. This can make you less able to feel pressure on the foot. You many not notice a foot injury until you get a severe infection.

Diabetes can also damage blood vessels. Small sores or breaks in the skin may become deeper skin sores (ulcers). The affected limb may need to be amputated if these skin ulcers do not heal or become larger, deeper or infected.

To prevent problems with your feet:

Support Groups

There are many diabetes resources that can help you understand more about type 2 diabetes. You can also learn ways to manage your condition so you can live well with diabetes.

Outlook (Prognosis)

Diabetes is a lifelong disease and there is no cure.

Some people with type 2 diabetes no longer need medicine if they lose weight and become more active. When they reach their ideal weight, their body's own insulin and a healthy diet can control their blood sugar level.

Possible Complications

After many years, diabetes can lead to serious problems:

When to Contact a Medical Professional

Call 911 right away if you have:

These symptoms can quickly get worse and become emergency conditions (such as convulsions or hypoglycemic coma).

Also call your doctor if you have:

Prevention

You can help prevent type 2 diabetes by keeping a healthy body weight and an active lifestyle.

References

American Diabetes Association. Standards of medical care in diabetes -- 2014. Diabetes Care. 2014;37 Suppl 1:S14-S80.

Stone NJ, Robinson JG, Lichtenstein AH, Goff DC Jr, Lloyd-Jones DM, Smith SC Jr, et al. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Ann Intern Med. 2014 Mar 4;160(5):339-43.

Eisenbarth GS, Polonsky KS, Buse JB. Type 2 diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 31.

Inzucchi SE, Sherwin RS. Type 2 diabetes mellitus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 237.

Pories WJ, Mehaffy JH, Staton KM. The surgical treatment of type two diabetes mellitus. Surg Clin North Am. 2011;91:821-836.



Review Date: 6/18/2013
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial update: 05/14/14
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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