Type 2 Diabetes

Type 2 diabetes is a chronic metabolic disorder affecting how your body processes blood sugar (glucose). Unlike type 1 diabetes, your pancreas still produces insulin, but your body doesn't use it effectively—a condition called insulin resistance. Affecting over 37 million Americans, type 2 diabetes can lead to serious complications if left unmanaged. However, with proper treatment, lifestyle changes, and regular monitoring, most people with diabetes can live long, healthy lives and prevent or delay complications.

⚠️ Diabetic Emergency Signs

Call 911 immediately for: blood sugar >400 mg/dL with symptoms, severe confusion or loss of consciousness, fruity breath odor with vomiting (DKA), extreme drowsiness with very high blood sugar (HHS), blood sugar <70 mg/dL not responding to treatment, seizures, or signs of stroke/heart attack. Diabetic emergencies can be life-threatening.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.

Understanding Type 2 Diabetes

Type 2 diabetes develops when your body becomes resistant to insulin or doesn't produce enough insulin to maintain normal blood glucose levels. This leads to chronically elevated blood sugar, which over time can damage blood vessels and organs throughout your body.

How Diabetes Develops

  • Insulin resistance: Cells don't respond properly to insulin
  • Pancreatic dysfunction: Beta cells can't keep up with insulin demand
  • Glucose production: Liver releases too much glucose
  • Incretin deficiency: Reduced gut hormones that regulate blood sugar
  • Fat cell dysfunction: Abnormal fat storage and hormone production

Key Statistics

  • 90-95% of all diabetes cases are type 2
  • 1 in 10 Americans have diabetes
  • 1 in 3 Americans have prediabetes
  • 80% with prediabetes don't know they have it
  • 7th leading cause of death in the US
  • Annual cost: $327 billion in the US

Risk Factors

Modifiable risk factors:

  • Overweight/obesity: Especially abdominal fat
  • Physical inactivity: Less than 150 min/week exercise
  • Poor diet: High in processed foods, sugary drinks
  • Smoking: Increases risk by 30-40%
  • Sleep: <6 or >9 hours per night
  • Stress: Chronic stress affects blood sugar

Non-modifiable risk factors:

  • Age: Risk increases after 45
  • Family history: Parent or sibling with diabetes
  • Race/ethnicity: Higher risk in African American, Hispanic, Native American, Asian American
  • Gestational diabetes: History increases risk
  • PCOS: Polycystic ovary syndrome
  • Low birth weight: Or high birth weight

Signs and Symptoms

Type 2 diabetes often develops gradually over years. Many people have no symptoms initially, which is why screening is important. When symptoms do occur, they're related to high blood sugar and its effects.

Classic Symptoms

  • Polyuria (frequent urination):
    • Especially at night (nocturia)
    • Body trying to eliminate excess glucose
    • Can lead to dehydration
  • Polydipsia (excessive thirst):
    • Due to fluid loss from urination
    • Dry mouth
    • Constant need for water
  • Polyphagia (increased hunger):
    • Cells starved of glucose
    • Despite eating, feel unsatisfied
    • May occur with weight loss

Other Common Symptoms

  • Fatigue:
    • Persistent tiredness
    • Lack of energy
    • Difficulty concentrating
  • Blurred vision:
    • High glucose affects lens shape
    • Usually temporary
    • Different from diabetic retinopathy
  • Slow healing:
    • Cuts and bruises heal slowly
    • Frequent infections
    • Poor circulation
  • Unexplained weight loss:
    • Despite normal or increased eating
    • Body breaking down fat/muscle
    • More common in uncontrolled diabetes

Skin Manifestations

  • Acanthosis nigricans: Dark, velvety patches in body folds
  • Skin tags: Small, soft growths
  • Frequent infections: Yeast, bacterial
  • Dry, itchy skin: Poor circulation
  • Diabetic dermopathy: Light brown scaly patches

Warning Signs of Complications

  • Neuropathy symptoms:
    • Numbness/tingling in feet or hands
    • Burning pain
    • Loss of sensation
  • Eye problems:
    • Floaters or flashes
    • Dark areas in vision
    • Vision loss
  • Kidney issues:
    • Foamy urine
    • Swelling in legs/ankles
    • Fatigue
  • Cardiovascular:
    • Chest pain
    • Shortness of breath
    • Leg pain when walking

Diagnosis

Diagnostic Criteria

Diabetes is diagnosed if any of the following are met:

1. Hemoglobin A1C:

  • ≥6.5% (48 mmol/mol)
  • Reflects average blood sugar over 2-3 months
  • No fasting required
  • Confirm with repeat test

2. Fasting Plasma Glucose (FPG):

  • ≥126 mg/dL (7.0 mmol/L)
  • No caloric intake for ≥8 hours
  • Preferred for initial diagnosis

3. Oral Glucose Tolerance Test (OGTT):

  • 2-hour glucose ≥200 mg/dL (11.1 mmol/L)
  • After 75g glucose drink
  • More sensitive than FPG

4. Random Plasma Glucose:

  • ≥200 mg/dL (11.1 mmol/L)
  • With classic symptoms
  • Any time of day

Prediabetes Ranges

  • A1C: 5.7-6.4% (39-47 mmol/mol)
  • FPG: 100-125 mg/dL (5.6-6.9 mmol/L)
  • OGTT: 140-199 mg/dL (7.8-11.0 mmol/L)

Screening Recommendations

Screen all adults beginning at age 45

Screen earlier if BMI ≥25 (≥23 in Asian Americans) PLUS one risk factor:

  • First-degree relative with diabetes
  • High-risk race/ethnicity
  • History of CVD
  • Hypertension (≥140/90 or on therapy)
  • HDL <35 mg/dL or triglycerides >250 mg/dL
  • PCOS
  • Physical inactivity
  • Acanthosis nigricans
  • History of gestational diabetes

Additional Testing

  • C-peptide: Assess insulin production
  • Autoantibodies: Rule out type 1 diabetes
  • Lipid profile: Cardiovascular risk
  • Kidney function: Creatinine, eGFR, urine albumin
  • Liver function: Screen for NAFLD
  • Thyroid function: If symptoms present

Treatment

Treatment Goals

  • A1C targets:
    • General: <7%
    • Tight control: <6.5% if achievable safely
    • Less stringent: <8% for elderly/comorbidities
  • Blood glucose targets:
    • Fasting: 80-130 mg/dL
    • Post-meal (2 hr): <180 mg/dL
    • Bedtime: 90-150 mg/dL

Lifestyle Management

Medical Nutrition Therapy:

  • No one-size-fits-all diet
  • Focus on whole foods
  • Carbohydrate counting or plate method
  • Limit added sugars and refined grains
  • Increase fiber (25-35g/day)
  • Healthy fats (olive oil, nuts, avocados)
  • Regular meal timing

Physical Activity:

  • 150 min/week moderate aerobic activity
  • Resistance training 2-3 times/week
  • Break up sitting time every 30 minutes
  • Activities: walking, swimming, cycling
  • Check blood sugar before/after exercise

Weight Management:

  • 5-10% weight loss significantly improves control
  • More aggressive goals if appropriate
  • Bariatric surgery for BMI ≥35

Medications

First-line: Metformin

  • Reduces liver glucose production
  • Improves insulin sensitivity
  • Start 500mg daily, titrate to 2000mg
  • GI side effects common initially
  • Rare risk of lactic acidosis
  • Check B12 levels annually

Second-line Options:

  • GLP-1 agonists:
    • Semaglutide, dulaglutide, liraglutide
    • Weekly or daily injections
    • Weight loss benefit
    • Cardiovascular protection
  • SGLT2 inhibitors:
    • Empagliflozin, canagliflozin, dapagliflozin
    • Increase glucose excretion in urine
    • Heart and kidney protection
    • Risk of genital infections
  • DPP-4 inhibitors:
    • Sitagliptin, linagliptin
    • Well tolerated
    • Weight neutral
  • Sulfonylureas:
    • Glipizide, glimepiride
    • Increase insulin secretion
    • Hypoglycemia risk
    • Weight gain

Insulin Therapy:

  • When to start:
    • A1C >10% or glucose >300 mg/dL
    • Symptoms of insulin deficiency
    • Failure of oral medications
  • Types:
    • Basal: Long-acting (glargine, detemir)
    • Bolus: Rapid-acting (lispro, aspart)
    • Premixed formulations
  • Starting regimen:
    • Usually basal insulin first
    • 10 units or 0.1-0.2 units/kg
    • Titrate based on fasting glucose

Monitoring and Follow-up

Self-Monitoring

  • Blood glucose monitoring:
    • Frequency depends on treatment
    • More frequent with insulin
    • Before meals and bedtime
    • Keep log of results
  • Continuous glucose monitors (CGM):
    • Real-time glucose readings
    • Trends and patterns
    • Alarms for highs/lows
    • Reduces fingersticks

Regular Medical Care

Every 3-6 months:

  • A1C testing
  • Blood pressure check
  • Weight and BMI
  • Medication review
  • Hypoglycemia assessment
  • Foot inspection

Annual screening:

  • Eye exam: Dilated retinal exam
  • Kidney function:
    • Urine albumin-creatinine ratio
    • eGFR
  • Lipid profile: Cholesterol levels
  • Comprehensive foot exam:
    • Monofilament testing
    • Pulse check
    • Visual inspection
  • Dental exam: Increased gum disease risk
  • Vaccinations: Flu, pneumonia, hepatitis B

Complications

Acute Complications

  • Hypoglycemia:
    • Blood sugar <70 mg/dL
    • Symptoms: shaking, sweating, confusion
    • Treatment: 15g fast-acting carbs
    • Recheck in 15 minutes
  • Diabetic ketoacidosis (DKA):
    • More common in type 1 but can occur
    • High glucose + ketones
    • Nausea, vomiting, abdominal pain
    • Fruity breath odor
  • Hyperosmolar hyperglycemic state (HHS):
    • Extreme hyperglycemia (>600 mg/dL)
    • Severe dehydration
    • Altered mental status
    • High mortality rate

Chronic Complications

Microvascular:

  • Retinopathy:
    • Leading cause of blindness
    • Annual eye exams crucial
    • Laser treatment available
  • Nephropathy:
    • Kidney damage
    • Monitor albumin/creatinine
    • ACE/ARB medications protective
  • Neuropathy:
    • Peripheral: numbness, pain in feet
    • Autonomic: GI, bladder, sexual dysfunction
    • Daily foot checks essential

Macrovascular:

  • Cardiovascular disease:
    • 2-4x higher risk
    • Leading cause of death
    • Aggressive risk factor control
  • Stroke:
    • 1.5-2x higher risk
    • Control blood pressure
  • Peripheral artery disease:
    • Poor circulation to legs
    • Increased amputation risk

Living Well with Diabetes

Daily Management Tips

  • Meal planning:
    • Consistent carbohydrate intake
    • Read nutrition labels
    • Portion control
    • Healthy snacks available
  • Exercise safely:
    • Check blood sugar before/after
    • Carry glucose tablets
    • Wear medical ID
    • Proper footwear
  • Medication adherence:
    • Use pill organizers
    • Set reminders
    • Never skip doses
    • Refill before running out
  • Stress management:
    • Regular sleep schedule
    • Relaxation techniques
    • Support groups
    • Professional help if needed

Sick Day Management

  • Continue diabetes medications
  • Check blood sugar more frequently
  • Check ketones if glucose >240 mg/dL
  • Stay hydrated
  • Have sick day food supplies
  • Know when to call doctor

Travel Considerations

  • Pack extra supplies
  • Carry medications in carry-on
  • Letter from doctor
  • Time zone adjustments
  • Snacks for delays
  • Medical ID
  • Insurance information

Technology Tools

  • Diabetes apps for tracking
  • Smart insulin pens
  • Connected glucose meters
  • Telemedicine options
  • Online support communities

Living with type 2 diabetes requires daily attention, but it doesn't have to limit your life. With proper management, regular monitoring, and a positive approach, people with diabetes can pursue all their goals and live full, active lives. The key is staying informed, working closely with your healthcare team, and making your health a priority.