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Definition  

Glucose is a type of sugar. It comes from food, and is also created in the liver. Glucose travels through the body in the blood. It moves from the blood to cells with the help of a hormone called insulin. Once glucose is in those cells, it can be used for energy.

Diabetes is a condition that makes it difficult for the body to use glucose. This causes a buildup of glucose in the blood. It also means the body is not getting enough energy. Type 2 diabetes is one type of diabetes. It is the most common type.

Medication, lifestyle changes, and monitoring can help control blood glucose levels.

Causes  

Type 2 diabetes is often caused by a combination of factors. One factor is that your body begins to make less insulin. A second factor is that your body becomes resistant to insulin. This means there is insulin in your body, but your body cannot use it effectively. Insulin resistance is often related to excess body fat.

Risk Factors  

Factors that increase your chance for type 2 diabetes include:

  • Having a family history of type 2 diabetes
  • Being obese or overweight, especially with excess weight in the upper body and abdomen
  • Eating a lot of meat, especially processed meat (eg, processed lunch meats, hot dogs, sausages)
  • Having cholesterol problems, especially low high-density lipoprotein (HDL) (good) cholesterol and high triglycerides
  • Having high blood pressure
  • Having a history of cardiovascular disease
  • Having depression
  • Having a history of gestational diabetes or having a baby that weighs over nine pounds at birth
  • Having an endocrine disorder (eg, Cushing’s syndrome, hyperthyroidism, acromegaly, polycystic ovary syndrome, pheochromocytoma, glucagonoma)
  • Having a condition associated with insulin resistance (eg, acanthosis nigricans)
  • Having previous blood test results that show impaired glucose tolerance and impaired fasting glucose
  • Taking certain medicines (eg, pentamidine, glucocorticoids, thiazides)
  • Having a sedentary lifestyle
  • Race: African American, Hispanic, Native American, Hispanic American, Asian American, or Pacific Islander
  • Age: 45 years or older and younger people who are obese and belong to at-risk ethnic groups
Symptoms  

You may have diabetes for years before you have symptoms. Symptoms caused by high blood sugar or complications may include:

  • Increased urination
  • Extreme thirst
  • Hunger
  • Fatigue
  • Blurry vision
  • Irritability
  • Frequent or recurring infections
  • Poor wound healing
  • Numbness or tingling in the hands or feet
  • Problems with gums
  • Itching
  • Problems having an erection
Diagnosis  

The doctor will ask about your symptoms and medical history. You will also be asked about your family history. A physical exam will be done.

Diagnosis is based on the results of blood testing. American Diabetes Association (ADA) recommends diagnosis be made if you have one of the following:

  • Symptoms of diabetes and a random blood test with a blood sugar level greater than or equal to 200 mg/dL (11.1 mmol/L)
  • Fasting blood sugar test—Done after you have not eaten for eight or more hours—Showing blood sugar levels greater than or equal to 126 mg/dL (7 mmol/L) on two different days
  • Glucose tolerance test—Measuring blood sugar two hours after you eat glucose—Showing glucose levels greater than or equal to 200 mg/dL (11.1 mmol/L)
  • HbA1c level of 6.5% or higher—Indicates poor blood sugar control over the past 2-4 months

mg/dL = milligrams per deciliter of blood; mmol/L = millimole per liter of blood

Treatment  

Treatment aims to:

  • Maintain blood sugar at levels as close to normal as possible
  • Prevent or delay complications
  • Control other conditions that you may have, like high blood pressure and high cholesterol
Diet  

Food and drinks have a direct effect on your blood glucose level. Eating healthy meals can help you control your blood glucose. It will also help your overall health. Some basic tips include:

Weight Loss  

If you are overweight, weight loss will help your body use insulin better. Talk to your doctor about a healthy weight goal. You and your doctor or dietitian can make a safe meal plan for you.

These options may help you lose weight:

Exercise  

Physical activity can:

  • Make the body more sensitive to insulin
  • Help you reach and maintain a healthy weight
  • Lower the levels of fat in your blood

Aerobic exercise is any activity that increases your heart rate. Resistance training helps build muscle strength. Both types of exercise help to improve long-term glucose control. Regular exercise can also help reduce your risk of heart disease.

Talk to your doctor about an activity plan. Ask about any precautions you may need to take.

Medication  

Certain medicines will help to manage blood glucose levels.

Medication taken by mouth may include:

  • Metformin—To reduce the amount of glucose made by the body and to make the body more sensitive to insulin
  • Medications that encourage the pancreas to make more insulin such as sulfonylureas (glyburide, tolazamide), dipeptidyl peptidase-4 inhibitors (saxagliptin, sitagliptin), and repaglinide (Prandin)
  • Insulin sensitizers such as pioglitazone—To help the body use insulin better
  • Starch blockers such as acarbose or miglitol—To decrease the amount of glucose absorbed into the blood

Some medicine needs to be given through injections, such as:

  • Incretin-mimetics such as exenatide—To stimulate the pancreas to produce insulin and decrease appetite (can assist with weight loss)
  • Amylin analogs such as pramlintide—To replace a protein of the pancreas that is low in people with type 2 diabetes
Insulin  

Insulin may be needed if:

  • The body does not make enough of its own insulin.
  • Blood glucose levels cannot be controlled with lifestyle changes and medicine.

Insulin is given through injections.

Blood Glucose Testing  

You can check the level of glucose in your blood with a blood glucose meter. Checking your blood glucose levels during the day can help you stay on track. It will also help your doctor determine if your treatment is working. Keeping track of blood sugar levels is especially important if you take insulin.

Regular testing may not be needed if your diabetes is under control and you don't take insulin. Talk with your doctor before stopping blood sugar monitoring.

An HbA1c test may also be done at your doctor's office. This is a measure of blood glucose control over a long period of time. Doctors advise that most people keep their HbA1c levels below 7%. Your exact goal may be different. Keeping HbA1c in your goal range can help lower the chance of complications.

Decreasing Risk of Complications  

Over a long period of time, high blood glucose levels can damage vital organs. The kidneys, eyes, and nerves are most affected. Diabetes can also increase your risk of heart disease.

Maintaining goal blood glucose levels is the first step to lowering your risk of these complications. Other steps include:

  • Take good care of your feet. Be on the lookout for any sores or irritated areas. Keep your feet dry and clean.
  • Have your eyes checked once a year.
  • Don't smoke. If you do, look for programs or products that can help you quit.
  • Plan medical visits as recommended.
Prevention  

To reduce your chances of developing type 2 diabetes:

  • Participate in regular physical activity.
  • Maintain a healthy weight.
  • Drink alcohol in moderation (two drinks per day for a man, and one drink per day for a woman).
  • Eat a well-balanced diet:
    • Get enough fiber
    • Avoid fatty foods
    • Limit sugar intake
    • Eat more green, leafy vegetables