Diabetes

Definition

Type 2 diabetes is characterized by the body's inability to make or properly use insulin. Without insulin, cells cannot take up sugar from the blood. As a result, blood-sugar (blood glucose) levels can climb, leading to prediabetes and eventually type 2 diabetes. Persistently high blood sugar can cause damage throughout the body over time. Type 2 diabetes can have a slow onset, and some people have diabetes for years without knowing it. An estimated 24 million Americans have diabetes, and about one-quarter of them do not know it. (EDITOR: SOURCES, NIDDK, Mayo Clinic, Cleveland Clinic)
Causes

Type 2 diabetes occurs because the pancreas does not make enough of the hormone insulin or the body develops insulin resistance, a condition in which cells fail to use insulin properly. Although the pancreas compensates at first by producing more insulin, it eventually loses its ability to make the hormone. Without adequate insulin, sugar from foods doesn't get taken up by cells for energy, and remains in the blood. Prediabetes and type 2 diabetes are defined based on blood glucose level and how much higher it is than normal.
Symptoms

Early symptoms can be confused with signs of stress, being overweight, or a poor diet. Other common symptoms of diabetes are:

• Increased thirst and frequent urination

• Increased appetite

• Unusual weight loss

• Fatigue

• Irritability

• Blurred vision

• Tingling, numbness, or burning in the hands and feet

• Itchy skin

• Cuts and bruises that are slow to heal

• Frequent infections
Risk Factors

Genetics is a major risk factor. If you have a parent, brother, or sister who has type 2 diabetes, you have a greater chance of developing the disease. People who are overweight, do not exercise regularly, or have low levels of HDL "good" cholesterol, high triglycerides, or high blood pressure are at increased risk of type 2 diabetes. The risk of developing the disease increases with age, especially after 45. For reasons that are not clear, African Americans, Hispanics, Native Americans, and Asians are more likely to develop the disease. Other conditions that put you at risk for type 2 diabetes—and that are also linked to obesity and a lack of physical activity—include:

• Polycystic ovary syndrome (PCOS), a hormone imbalance that interferes with normal ovulation

• Metabolic syndrome, a group of risk factors, including abdominal obesity and high cholesterol, which are related to the body's metabolism
Diagnosis

For centuries, diabetes testing mostly consisted of a physician dipping his pinkie into a urine sample and tasting it to pick up on abnormally high sugar. Thankfully, testing for type 2 diabetes is a lot easier now—at least for doctors.

Urine tests can still pick up diabetes. However, sugar levels need to be quite high (and diabetes more advanced) to be detected on a urine test. Hence, this is not the test of choice for type 2 diabetes.

Almost all diabetes tests are now conducted on blood samples, which are collected in a visit to your physician or obstetrician (if you're pregnant). If you have an abnormal result—meaning blood sugar is too high—on any of these tests, you'll need to have more testing.

Tests include:

• Oral glucose tolerance test (OGTT). You typically have your blood drawn after fasting for at least eight hours. Then you drink a syrupy glucose solution and have your blood drawn at 30- to 60-minute intervals for up to three hours to see how your body is handling the glut of sugar. The test can diagnose both diabetes and prediabetes and is often the test of choice for pregnant women.

Normal result: Less than 140 milligrams per deciliter (mg/dL) two hours after drinking the sugary liquid; a reading of 140-199 mg/dL indicates prediabetes; a reading over 200 mg/dL indicates diabetes

• Fasting blood-sugar test. This is a common test because it's easy to perform. After fasting overnight, you have your blood drawn at an early morning doctor's visit and tested to see if your blood sugar is in the normal range. Although it is less sensitive than OGTT, it can detect prediabetes as well as diabetes.

Normal result: 70-99 milligrams per deciliter (mg/dL) or less than 5.5 millimoles per liter (mmol/L); a reading of 100-125 mg/dL indicates prediabetes; a reading of 126 mg/dL or above indicates diabetes

• Two-hour postprandial test. This blood test is done two hours after you have eaten ("prandial" means meal).

Normal result: 70-145 mg/dL (less than 7.9 mmol/L)

• Random blood-sugar test or casual blood-sugar test. A blood-sugar test is performed regardless of when you last ate a meal.

Normal result: 70-125 mg/dL (less than 7.0 mmol/L); a reading of 200 mg/dL or more is suggestive of diabetes

• Hemoglobin A1C test. This test measures how much sugar is stuck to your red blood cells, which generally have a lifespan of three months.

Therefore, this test gauges how high your blood sugar has been in recent months, and is the preferred method for assessing long-term blood-sugar control.

Normal result for nondiabetics: 4% to 6%

Normal result for diabetics: 7% or lower (some groups suggest aiming for 6.5% or lower). If a hemoglobin A1C test result is 8% or higher, it's a sign that blood sugar is not under control. However, making lifestyle changes can reduce your A1C.
Treatments

A good diet and regular exercise do more than just lower your blood sugar—they also keep your weight down and protect your heart and brain, which is an extremely important benefit since roughly three-quarters of people with diabetes die of heart disease or stroke.
Medications

If your blood sugar is very high when you are diagnosed or you cannot get it under control with diet and exercise, you may need to take oral medication or insulin to get blood sugar into a safe range, which can actually increase the effectiveness of lifestyle changes.

A lot of people with diabetes, unfortunately, don't have their blood sugar in good control. A 2005 study from the American Association of Clinical Endocrinologists involving more than 157,000 people with diabetes found that more than two-thirds weren't adequately controlling their blood sugar, which put them at risk for blindness, kidney failure, foot amputation, and other complications. Needing oral medication or insulin to manage your blood sugar does not mean you've somehow "failed" in your effort to control diabetes.

There are six types of oral medications available for people with type 2 diabetes, and most of them are taken two or three times a day. These medicines are not safe for pregnant women. Side effects are generally mild and can include low blood sugar, diarrhea, weight gain, nausea, and upper respiratory infections. For reasons that are not clear, diabetes pills can stop working after months or years. In these cases, a combination of oral medications might help. These oral medications are:

• Metformin (Fortamet, Glucophage, and other brand names) is often the first type of oral medication that people with type 2 diabetes take. It helps keep blood glucose levels in check by decreasing the liver's production of glucose. If metformin doesn't work on its own, it can be combined (often in one pill) with other oral medications.

• Sulfonylureas (Diabinese, Glucotrol, Micronase, Glynase, Diabeta, Amaryl) are drugs that stimulate the pancreas to produce more insulin.

• Meglitinides (Prandin, Starlix) also stimulate the pancreas to produce more insulin.

• Thiazolidinediones (Avandia, Actos) help boost insulin's effectiveness in muscle and fat, and also reduce the liver's production of glucose. However, due to evidence that indicates that Avandia increases the risk of heart disease, this drug is only available to patients who cannot control their blood sugar using other medications or Actos.

• Alpha-glucosidase inhibitors (Precose, Glyset) reduce blood-sugar levels by inhibiting the breakdown of sugars from food in the intestine.

• DPP-4 inhibitors (Januvia, Onglyza) increase the levels of a compound that in turn reduces blood-sugar levels.

Insulin is a good treatment option because it lowers blood-sugar levels quickly and ultimately lowers the risk of complications. And for people who have diabetes for a long time (more than 10 years), have difficulty controlling their blood sugar with lifestyle changes and oral medications, or are under stress (due to an infection, for example) insulin is often the best option. Side effects are often associated with dangerous drops in blood-sugar levels, and include dizziness, confusion, irritability, nausea, and headache.

"Insulin is a powerful tool that allows us to protect them against the complications of diabetes very well," says Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists.

Because insulin gets broken down during digestion, it can only be taken by injection. However, there are a number of delivery methods, from a pen to thin needle to pump, and different types of insulin, from once-a-day injections to those taken before meals:

• Rapid-acting insulin (Humalog, NovoLog, Apidra) is taken just before or after meals, starts working within 15 minutes, and lasts three to five hours.

• Short-acting insulin (Humulin R, Novolin R) is taken about 30 minutes to an hour before meals, starts working within about 30 minutes to an hour, and lasts about five to eight hours.

• Intermediate-acting insulin (Humulin N, Novolin N) starts working within one to four hours. It can control blood-sugar levels for about 12 hours or longer and can be used overnight.

• Long-acting insulin (Lantus, Levemir) takes an hour to start working and lasts 20 to 26 hours. It is often taken once a day at bedtime.

• Pre-mixed insulin (Humulin 70/30, Novolin 70/30, NovoLog 70/30, Humulin 50/50, Humalog mix 75/25, Humalog mix 50/50) combines the properties of intermediate- and short-acting insulin.
Prognosis

Type 2 diabetes is serious business, but it's not a death sentence. With proper management, people can live relatively normal lives. "I think sometimes people still understand diabetes as being the disease where you get your legs cut off and go blind," says Thomas Blevins, MD, an endocrinologist and founder of Texas Diabetes and Endocrinology, a private practice in Austin.
Coping

Diabetes management has come a long way in recent years thanks to a flurry of research, more drug options, advances in home glucose monitoring, and, in many cases, earlier diagnosis. While diabetes has become more manageable, it isn't necessarily easier.

You'll need to cope with added health costs; diabetes burnout (a point when the daily grind of finger pricking, food monitoring, and exercise may get you down); social functions, like the office holiday party; and family members who may be less than supportive—or overzealous in their support. Turning down a second piece of cake is no piece of cake. But you may need to handle temptation as well as well-meaning family and friends who morph into the "food police," interrogating your every food choice.

Your first ally in learning how to live with diabetes will most likely be a diabetes educator, a health professional who teaches the finer points of living with diabetes. You might find other allies in online communities or in-person support groups. To find a program in your area, go to the American Diabetes Association's website.

Read more: http://www.righthealth.com/topic/diabetes/overview/healthcomunique#ixzz1FOd4a1xh