Diabetes Type 2 The Silent Killer

What is Type 2 Diabetes?

Type 2 diabetes is a chronic disease that affects the way the body metabolizes glucose, the body's main source of energy. A person with type 2 diabetes may have a resistance to the effects of insulin - the hormone that regulates the entry of sugar into cells - or not produce enough insulin to maintain a normal glucose level. If left untreated, diabetes can be fatal.

Causes

Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin. However, the body can create an insulin resistance - that is, the body does not respond the way it should to the action of insulin and does not use it properly. It can also happen that a person with type 2 diabetes doesn't produce enough insulin to meet the demands of his or her body. In this process, not enough insulin can carry all the sugar into the cells, and it ends up accumulating in the blood.

When you have type 2 diabetes, adipocytes (fat cells), myocytes (muscle cells), and hepatocytes (liver cells) do not respond properly to insulin, and so the sugar does not enter these cells, but stays in the bloodstream.

The adipocyte is our fat storage cell. When it is insulin sensitive, it means that it recognizes the circulating glucose and activates "saving" mechanisms, i.e., it doesn't remove the fat from inside it to make it available to the body as a form of energy. When the adipocyte is resistant to the action of insulin, it doesn't recognize the circulating glucose and understands that the body is lacking energy, so it releases the fat that is inside it into the blood; this is why the patient with diabetes besides having high glucose can also have high cholesterol.

The hepatocytes also function in a similar way, that is, when they are sensitive to the action of insulin, they absorb glucose and store it. When they are resistant, they don't recognize high glucose in the blood and understand that there is a lack of glucose, releasing more glucose into the blood and making the process worse.

The muscle cells also: With insulin they take up glucose to use as energy, without insulin they understand that there is a shortage and signal to the body that it needs to burn fat to provide energy.

Risk Factors

Anyone can have type 2 diabetes. But there are some conditions that increase the risk:

• Age over 45 years old
• Obesity and overweight
• Previous gestational diabetes
• Family history of type 2 diabetes
• Pre-diabetes
• Sedentary lifestyle
• Low HDL cholesterol levels
• Elevated triglycerides
• Hypertension
• High alcohol consumption

Symptoms of Type 2 Diabetes

Usually, people with type 2 diabetes have no symptoms at first, and may have the disease asymptomatic for many years. 

The first symptoms of type 2 diabetes may be:

• Frequent infections. Some examples are bladder, kidney, skin, and skin infections
• Wounds that take time to heal
• Vision changes (blurred vision)
• Numbness in the feet and boils
• The urge to urinate several times
• Frequent hunger
• Constant thirst

In the presence of these symptoms, especially in combination with risk factors, it is important to visit a doctor and have an investigation for type 2 diabetes.

Type 2 Diabetes Diagnosis

The diagnosis of type 2 diabetes is usually made using three tests:

Fasting Blood Glucose

Fasting blood glucose is a test that measures the level of sugar in your blood at that moment in time and is used to monitor your diabetes treatment. The reference values are between 65 and 99 milligrams of glucose per deciliter of blood (mg/dL). What abnormal results mean:

• Values above 100 mg/dl are indicative for further investigation with the glycemic curve and glycated hemoglobin.
• Two fasting glucose values above 126 mg/dl (7.2 mmol/l) are diagnostic for type 2 diabetes Fasting glucose values over 200 mg/dl (7.8 mmol/l) and associated symptoms are also considered diagnostic for type 2 diabetes.

Glycated Hemoglobin

Glycated hemoglobin (HbA1c) is the fraction of hemoglobin (protein inside the red blood cell) that binds to glucose. During the average 90-day lifespan of a red blood cell, the hemoglobin incorporates glucose as a function of the concentration of glucose in the blood.

If glucose levels are high during this period, or increase occasionally, then there will be an increase in the levels of glycated hemoglobin. Thus, the glycated hemoglobin test can show an average of the hemoglobin concentrations in our blood over the last few months.

The glycated hemoglobin values will indicate whether or not you have hyperglycemia, starting an investigation for type 2 diabetes. Normal glycated hemoglobin values:

• For healthy people: between 4.5% and 5.7%
• For patients already diagnosed with diabetes: below 7%
• Abnormal near borderline: 5.8% and 6.4%
• Consistent for diabetes: greater than or equal to 6.5%.

Glycemic Curve

The simplified OGTT measures how quickly your body absorbs glucose after you eat it. The patient ingests 75 g of glucose, and the amounts of the substance in his or her blood are measured two hours after ingestion. In Brazil the simplified glycemic curve test is used for diagnosis, which measures at time zero and after 120 minutes. The reference values are:

• Fasting: below 100mg/dl
• After 2 hours: 140mg/dl

A glycemic curve higher than 200 mg/dl after two hours of 75g of glucose is diagnostic for diabetes.

The Brazilian Diabetes Society recommends the following conditions as diagnostic criteria for type 2 diabetes:

• Glycated hemoglobin greater than 6.5% confirmed on another occasion (two altered tests).

• An 
  glycated hemoglobin
   test combined with fasting glucose greater than 200 mg/dl in the presence of symptoms of diabetes.

• Symptoms of intense urination and thirst, weight loss despite food intake, with an out-of-fasting blood glucose greater than 200 mg/dl.

• Fasting blood glucose greater than or equal to 126 mg/dl on at least two samples on different days.

• Glycemia greater than 200 mg/dl two hours after ingesting 75 g of glucose.

It is important to have these tests done regularly, along with your medical check-up. This is because type 2 diabetes can take a long time to show symptoms.

Type 2 Diabetes Treatment

Type 2 diabetes treatment is aimed at lowering the patient's blood glucose levels and making sure that they do not suffer any complications. The main precautions for treating type 2 diabetes include:

Physical Exercises

Physical activity is essential in the treatment of type 2 diabetes, as it helps keep blood sugar levels under control and helps with weight loss. Exercise should be performed at least three times a week.

If the type 2 diabetes is uncontrolled, with very high blood glucose levels, exercise can cause the release of counter-regulatory hormones, further increasing the blood glucose - so it is important to visit your doctor and always take blood glucose medication before starting physical activity.

It is important that the patient with type 2 diabetes always agree with their doctors on the best options for physical activity and frequency. Remembering that the ideal is to favor light exercise, because when the caloric expenditure is higher than the replacement of nutrients after training, hypoglycemia may occur.

Diet Control

People with type 2 diabetes should limit the sugars present in sweets and simple carbohydrates, such as pasta and bread, because they have a very high glycemic index. When a food has a low glycemic index, it slows down the absorption of glucose, which does not concentrate in the blood. But when the index is high, this absorption is fast and accelerates the increase of glucose rates in the blood, generating hyperglycemia.

Carbohydrates should constitute 50 to 60% of the total calories ingested by the person with diabetes, preferably complex carbohydrates (nuts, walnuts, whole grains), which will be absorbed more slowly. It is also important that the diet of the person with type 2 diabetes be balanced, cutting out the excess fat and prioritizing the consumption of fruits and vegetables.

When exercising, it is important to check the glycemic control before the beginning of the activity, and then choose the best food - if the glycemia is too low, it is advisable to give preference to carbohydrates, as well as avoid them if it is high. The choice of food also depends on the type of exercise: long duration aerobic exercises (such as running and swimming) tend to lower blood glucose, and a greater intake of food is required.

Checking Your Blood Glucose

Some people with type 2 diabetes need to take regular insulin measurements, some daily. To do this you need to have a glucometer at home, a device that can measure the exact concentration of glucose in your blood. There are different types of devices. Usually, the person pierces the finger with a small needle called a lancet. A small drop of blood appears on the tip of the finger. The blood is placed on a reagent strip that is inserted into the device. The results appear in about 5 seconds.

Your doctor or other diabetes professional will help you set up a home testing schedule. Your doctor will help you set goals for your glucose levels, and you should use the test results to alter your meals, activities, or medications to keep your glucose levels normal. This procedure can help identify high and low blood glucose levels before they cause problems.

Easy with The Alcohol Consumption

The consumption of alcohol is not forbidden for people with type 2 diabetes, but it should be in moderation and always accompanied by food, because the consumption alone can cause hypoglycemia. This can cause nausea, body tremors, excessive hunger, irritability, and headaches. It is also important to monitor your blood glucose before and after consuming alcoholic beverages.

Avoid Saunas and Scalding Feet

Type 2 diabetes affects the microcirculation, damaging the small arteries (arterioles) that nourish the tissues, affecting especially the legs and feet. Due to this circulatory alteration, the risks of exposure to high temperatures and thermal shocks can worsen or trigger angiopathies and other cardiac problems. In addition, diabetes affects the sensitivity of the feet, and the person may not perceive the very hot water when scalping feet.

Increase Eye Care

The retinal cells of the type 2 diabetes patient may show differences that are not found in most of those who do not have diabetes.

Control Stress

People with diabetes are more likely to have anxiety and depression. Patients may feel a sense of anxiety about controlling hypoglycemia, applying insulin, or gaining weight.

Stop Smoking

Diabetes and smoking multiply the risk of heart attack by up to five times. The substances in cigarettes help to create fatty deposits in the arteries, blocking circulation. Consequently, the blood flow gets slower and slower, until the artery gets clogged. In addition, smoking also contributes to hypertension in the patient with type 2 diabetes.

Take Care of Oral Health

Oral hygiene after every meal for the diabetes patient is crucial. This is because the blood of people with diabetes, with its high concentration of glucose, is more prone to the development of bacteria. As it is an entry route for food, the mouth also receives several foreign bodies that, added to the accumulation of food debris, favor the proliferation of bacteria. Brushing well and visiting the dentist once every six months is essential.

Take Care of Comorbidities

Type 2 diabetes is usually accompanied by other problems such as obesity and overweight, sedentary lifestyle, high triglycerides, and hypertension. Therefore, it is important to consult your physician and also take care of these other diseases and problems that may appear along with type 2 diabetes. This way, you can ensure your health and control all the diseases more safely.

Metabolic Surgery

Metabolic surgery is a variant of bariatric surgery, but focused on the treatment of type 2 diabetes and accompanying health conditions, such as hypertension, high cholesterol, and high triglycerides. The principle of metabolic surgery is to promote changes in the stomach and/or the food pathway in the intestine, which cause changes in hormones that control metabolism, insulin secretion, satiety, and energy expenditure.

Besides alterations in the intestinal hormones, weight loss and the decrease in food intake facilitate the action of insulin, decreasing the body's resistance, characterized by type 2 diabetes.

Different surgical techniques can be used, but the most common method is the Gastric Bypass, the same used in the treatment of morbid obesity. The procedures are usually done by laparoscopy, with small incisions, and are quite safe. About 2/3 of diabetics who undergo this surgery go on to have normal sugar and glycated hemoglobin levels, even without taking medication or insulin. Learn more about metabolic surgery here.

Controlling Associated Diseases

Many people with type 2 diabetes have difficulty controlling changes in glucose, cholesterol, and blood pressure. These diseases, which are based on insulin resistance, characterize the Metabolic Syndrome. Therefore, the treatment of diabetes also involves the control of associated diseases. In these cases, bariatric surgery, indicated for diabetic patients with high obesity, or even metabolic surgery can help in the treatment of diabetes and also in the control of the Metabolic Syndrome diseases.

Medications for Type 2 Diabetes

The most commonly used drugs for the treatment of type 2 diabetes are:

• Diamicron MR
• Glibenclamide
• Gliclazide
• Glifage
• Glifage XR
• Glimepiride
• Galvus
• Galvus Met
• Metformin
• Victoza

Only a doctor can tell you which medication is best for you, as well as the correct dosage and duration of treatment. Always follow your doctor's instructions to the letter and NEVER treat yourself. Do not discontinue use of the drug without first consulting a doctor, and if you take it more than once or in much larger amounts than prescribed, follow the directions on the package insert.

Possible Complications

Diabetic Retinopathy

Lesions that appear on the retina of the eye, which can cause small bleeds and, as a consequence, loss of visual acuity.

Arteriosclerosis

Hardening and thickening of the walls of the arteries.

Diabetic Nephropathy

Changes in the blood vessels of the kidneys that cause a loss of protein through the urine. The organ may reduce its function slowly, but progressively until it is completely paralyzed.

Diabetic Neuropathy

The nerves are altered, causing symptoms such as tingling, numbness, or burning in the legs, feet, and hands, local pain and imbalance, muscle weakening, low blood pressure, digestive disturbances, excessive sweating, and impotence.

Diabetic Foot

It occurs when an injured or infected area on the feet of people with type 2 diabetes develops an ulcer (sore). It can occur when blood circulation is poor and blood glucose levels are poorly controlled. Any foot injury should be treated promptly to avoid complications that can lead to amputation of the affected limb.

Myocardial Infarction and Stroke

These occur when large blood vessels are affected, leading to obstruction (arteriosclerosis) of vital organs such as the heart and brain. Good glucose control, physical activity, and medications that can combat high blood pressure, increase cholesterol, and stop smoking are essential safety measures. The incidence of this problem is two to four times higher in people with diabetes, both type 1 and type 2 diabetes.

Infections

Excess glucose can damage the immune system, increasing the risk that a person with diabetes will get some kind of infection. This is because the white blood cells (responsible for fighting viruses, bacteria, etc.) become less effective with hyperglycemia. The high blood sugar level is conducive for fungi and bacteria to proliferate in areas such as the mouth and gums, lungs, skin, feet, genitals, and surgical incision sites.

Hypertension

There are some common risk factors between type 2 diabetes and hypertension, such as obesity, a sedentary lifestyle, and poor diet. In addition, the patient with diabetes has a higher propensity to develop kidney problems, and this compromises the elimination of substances through urine, such as salt and water. The increased salt and water in the circulation is related to increased blood pressure, leading to hypertension.

Another recurring problem in patients with type 2 diabetes is that the blood vessels oxidize faster than normal due to the excess sugar in the blood. As a result, the arteries can become clogged, increasing blood pressure.

Living with Diabetes/Prognosis

Patients with diabetes should be advised to:

• Perform daily foot examination to prevent the appearance of lesions
• Maintain a healthy diet
• Use prescribed medications
• Practice physical activities
• Maintain good glycemic control by correctly following medical guidelines.

Prevention

Patients with a family history of type 2 diabetes or risk factors should be advised to:

• Maintain normal weight
• Do not smoke
• Control blood pressure
• Avoid medications that could potentially harm the pancreas
• Practice regular physical activity.