Type 2 diabetes, once known as
adult-onset or noninsulin-dependent
diabetes, is a chronic condition that
affects the way your body metabolizes sugar
(glucose), your body's main source of fuel.
With type 2 diabetes, your body either
resists the effects of insulin — a hormone
that regulates the movement of sugar into
your cells — or doesn't produce enough
insulin to maintain a normal glucose level.
Untreated, type 2 diabetes can be
More common in adults, type 2 diabetes
increasingly affects children as childhood
There's no cure for type 2 diabetes, but you
can manage the condition by eating well,
exercising and maintaining a healthy weight.
If diet and exercise don't control your
blood sugar, you may need diabetes
medications or insulin therapy.
Type 2 diabetes symptoms may develop
slowly. In fact, you can have type 2
diabetes for years and not know it. Look
- Increased thirst and frequent
Excess sugar building up in your bloodstream
causes fluid to be pulled from the tissues.
This may leave you thirsty. As a result, you
may drink — and urinate — more than usual.
- Increased hunger
Without enough insulin to move sugar into
your cells, your muscles and organs become
depleted of energy. This triggers intense
- Weight loss
Despite eating more than usual to
relieve hunger, you may lose weight. Without
the ability to metabolize glucose, the body
uses alternative fuels stored in muscle and
fat. Calories are lost as excess glucose is
released in the urine.
If your cells are deprived of sugar, you may
become tired and irritable.
- Blurred vision
If your blood sugar is too high, fluid may
be pulled from the lenses of your eyes. This
may affect your ability to focus clearly.
- Slow-healing sores or frequent
Type 2 diabetes affects your ability to heal
and resist infections.
- Areas of darkened skin
Some people with type 2 diabetes have
patches of dark, velvety skin in the folds
and creases of their bodies — usually in the
armpits and neck. This condition, called
acanthosis nigricans'Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds,such as the posterior and lateral folds of the neck, the armpits, groin, navel, forehead, and other areas.'
may be a sign of insulin resistance.
- When to see a doctor
See your doctor if you notice any type 2
Type 2 diabetes develops when the body
becomes resistant to insulin or when the pancreas
stops producing enough insulin. Exactly why this
happens is unknown, although excess weight and
inactivity seem to be contributing factors.
- The pancreas secretes insulin into the bloodstream.
- The insulin circulates, enabling sugar to enter your cells.
- Insulin lowers the amount of sugar in your bloodstream.
- As your blood sugar level drops, so does the secretion of insulin from your pancreas.
The role of glucose
Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues.
- Glucose comes from two major sources: food and your liver
- Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
- Your liver stores and makes glucose.
- When your insulin levels are low, such as when you haven't eaten in a while, the liver
breaks down stored glycogen into glucose to keep your glucose level within a normal range.
In type 2 diabetes, this process works improperly. Instead of moving into your cells, sugar builds up in your
In the much less common type 1 diabetes, the pancreas produces little or no insulin.
Researchers don't fully understand why some people
develop type 2 diabetes and others don't. It's
clear, however, that certain factors increase the
Being overweight is a primary risk factor for type 2
diabetes. The more fatty tissue you have, the more
resistant your cells become to insulin.
- Fat distribution
If your body stores fat primarily in your abdomen,
your risk of type 2 diabetes is greater than if your
body stores fat elsewhere, such as your hips and
The less active you are, the greater your risk of
type 2 diabetes. Physical activity helps you control
your weight, uses up glucose as energy and makes
your cells more sensitive to insulin.
- Family history
The risk of type 2 diabetes increases if your parent
or sibling has type 2 diabetes.
Although it's unclear why, people of certain races —
including blacks, Hispanics, American Indians and
Asian-Americans — are more likely to develop type 2
diabetes than whites are.
The risk of type 2 diabetes increases as you get
older, especially after age 45. That's probably
because people tend to exercise less, lose muscle
mass and gain weight as they age. But type 2
diabetes is also increasing dramatically among
children, adolescents and younger adults.
Pre-diabetes is a condition in which your blood
sugar level is higher than normal, but not high
enough to be classified as diabetes. Left untreated,
pre-diabetes often progresses to type 2 diabetes.
- Gestational diabetes
If you developed gestational diabetes when you were
pregnant, your risk of later developing type 2
diabetes increases. If you gave birth to a baby
weighing more than 9 pounds (4 kilograms), you're
also at risk of type 2 diabetes.
Type 2 diabetes can be easy to ignore, especially in
the early stages when you're feeling fine. But
diabetes affects many major organs, including your
heart, blood vessels, nerves, eyes and kidneys.
Controlling your blood sugar levels can help prevent
these complications. Although long-term
complications of diabetes develop gradually, they
can eventually be disabling or even
Some of the potential complications of diabetes include:
- Heart and blood vessel disease
Diabetes dramatically increases the risk of various
cardiovascular problems, including coronary artery
disease with chest pain (angina), heart attack,
stroke, narrowing of arteries (atherosclerosis) and
high blood pressure. The risk of stroke is two to
four times higher for people with diabetes, and the
death rate from heart disease is two to four times
higher for people with diabetes than for people
without the disease, according to the American Heart
- Nerve damage (neuropathy)
Excess sugar can injure the walls of the tiny blood
vessels (capillaries) that nourish your nerves,
especially in the legs. This can cause tingling,
numbness, burning or pain that usually begins at the
tips of the toes or fingers and gradually spreads
upward. Poorly controlled blood sugar can eventually
cause you to lose all sense of feeling in the
affected limbs. Damage to the nerves that control
digestion can cause problems with nausea, vomiting,
diarrhea or constipation. For men,
erectile dysfunction may be an issue.
- Kidney damage (nephropathy)
The kidneys contain millions of tiny blood vessel
clusters that filter waste from your blood. Diabetes
can damage this delicate filtering system. Severe
damage can lead to kidney failure or irreversible
end-stage kidney disease, requiring dialysis or a
- Eye damage
Diabetes can damage the blood vessels of the retina
(diabetic retinopathy), potentially leading to
blindness. Diabetes also increases the risk of other
serious vision conditions, such as cataracts and
- Foot damage
Nerve damage in the
feet or poor blood flow to the feet increases the
risk of various foot complications. Left untreated,
cuts and blisters can become serious infections.
Severe damage might require toe, foot or even leg
- Skin and mouth conditions
Diabetes may leave you more susceptible
to skin problems, including bacterial and fungal
infections. Gum infections also may be a concern,
especially if you have a history of poor dental
Diabetes may lead to lower than normal bone mineral density,
increasing your risk of osteoporosis.
- Alzheimer's disease
Type 2 diabetes may increase
the risk of Alzheimer's disease and vascular
dementia. The poorer your blood sugar control, the
greater the risk appears to be. So what connects the
two conditions? One theory is that cardiovascular
problems caused by diabetes could contribute to
dementia by blocking blood flow to the brain or
causing strokes. Other possibilities are that too
much insulin in the blood leads to brain-damaging
inflammation, or lack of insulin in the brain
deprives brain cells of glucose.
- Hearing problems
Diabetes can also lead to hearing impairment.
Treatments and drugs
Treatment for type 2 diabetes requires a lifelong
Possibly, diabetes medication
or insulin therapy
Those steps will help keep your
blood sugar level closer to normal, which can delay
or prevent complications
your blood sugar
Depending on your treatment plan, you may check and
record your blood sugar level once a day or several
times a week. Ask your doctor how often he or she
wants you to check your blood sugar. Careful
monitoring is the only way to make sure that your
blood sugar level remains within your target range.
Even if you eat on a rigid schedule, the amount of
sugar in your blood can change unpredictably. With
help from your diabetes treatment team, you'll learn
how your blood sugar level changes in response to:
What and how much you eat will affect your blood
sugar level. Blood sugar is typically highest one to
two hours after a meal.
- Physical activity
Physical activity moves sugar from your blood into
your cells. The more active you are, the lower your
blood sugar level.
Everyone needs regular aerobic exercise, and people
who have type 2 diabetes are no exception. Get your
doctor's OK before you start an exercise program.
Then choose activities you enjoy, such as walking,
swimming or biking. What's most important is making
physical activity part of your daily routine. Aim
for at least 30 minutes of aerobic exercise most
days of the week. Stretching and strength training
exercises are important, too. If you haven't been
active for a while, start slowly and build up
gradually. Remember that physical activity lowers
blood sugar. Check your blood sugar level before any
activity. You might need to eat a snack before
exercising to help prevent low blood sugar if you
take diabetes medications that lower your blood
sugar. Diabetes medications and insulin therapy
Some people who have type 2 diabetes can manage
their blood sugar with diet and exercise alone, but
many need diabetes medications or insulin therapy.
The decision about which medications are best
depends on many factors, including your blood sugar
level and any other health problems you have. Your
doctor might even combine drugs from different
classes to help you control your blood sugar in
several different ways.
Any medications you take may affect your blood sugar
level, sometimes requiring changes in your diabetes
During a cold or other illness, your body will
produce hormones that raise your blood sugar level.
Alcohol and the substances you use to make mixed
drinks can cause either high or low blood sugar,
depending on how much you drink and whether you eat
at the same time.
The hormones your body may produce in response to
prolonged stress may prevent insulin from working
- For women, fluctuations in hormone levels
As your hormone levels fluctuate during your
menstrual cycle, so can your blood sugar level —
particularly in the week before your period.
Menopause may trigger fluctuations in your blood
sugar level as well.
- Healthy eating
Contrary to popular perception, there's no diabetes
diet. However, it's important to center your diet on
these high-fiber, low-fat foods:
- Whole grains
- You'll also need to eat fewer animal
products, refined carbohydrates and sweets.
A registered dietitian can help you put together
a meal plan that fits your health goals, food
preferences and lifestyle.
Remember the importance of consistency. To keep your
blood sugar on an even keel, try to eat the same
amount of food with the same proportion of
carbohydrates, proteins and fats at the same time
every day. Low glycemic index foods also may be
helpful. The glycemic index is a measure of how
quickly a food causes a rise in your blood sugar.
Foods with a high glycemic index raise your blood
sugar quickly. Low glycemic foods may help you
achieve a more stable blood sugar. Foods with a low
glycemic index typically are foods that are higher
Often, people who are newly diagnosed will be
prescribed metformin (Metformin,
others), a diabetes medication that improves your
body tissues' sensitivity to insulin and lowers
glucose production in the liver.
Your doctor will also recommend
changes, such as losing weight and becoming more
When metformin is not enough to control your glucose
level, other oral or injected medications can be
added to treat type 2 diabetes.
Medications lower glucose in different ways:
Some diabetes medications stimulate your
pancreas to produce and release more insulin.
They include glipizide, glyburide and
Still others block the action of enzymes that break down carbohydrates in the intestine,
such as acarbose or make your tissues more sensitive to insulin, such as metformin (Metformin)
If you can't take metformin, other oral drugs include: Sitagliptin , Saxagliptin,
Repaglinide , Nateglinide.
Recently approved drugs given by injection are: Exenatide , Liraglutide.
Discuss the pros and cons of different drugs with
your doctor. Together you can decide which
medication is best for you considering many factors,
including costs and other aspects of your health.
Rosiglitazone has been linked to heart
attacks, and its use has been restricted by the FDA.
In addition to diabetes medications, your doctor
might prescribe low-dose aspirin therapy as well as
blood pressure and cholesterol-lowering medications
to help prevent heart and blood vessel disease.
Some people who have type 2 diabetes need insulin
therapy as well. Because normal digestion interferes
with insulin taken by mouth, insulin must be
injected. Insulin injections involve using a fine
needle and syringe or an insulin pen injector — a
device that looks like an ink pen, except the
cartridge is filled with insulin.
Types of insulin are many and include: