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Know & Controlling Your Diabetes

Definition
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 life-threatening.
More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases.
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.

Symptoms

Type 2 diabetes symptoms may develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for:
Increased thirst and frequent urination
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 hunger.
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.
Fatigue
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 infections
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, may be a sign of insulin resistance.
When to see a doctor
See your doctor if you notice any type 2 diabetes symptoms.

CausesHow Insulin Works
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.

How insulin works
Insulin is a hormone that comes from the pancreas, a gland situated behind and below the stomach.
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 bloodstream.

In the much less common type 1 diabetes, the pancreas
produces little or no insulin.

Risk factors
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 risk, including:
Weight
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 thighs.
Inactivity
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.
Race
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.
Age
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
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.

Complications

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 life-threatening.

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 Association.
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 kidney transplant.
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 glaucoma.
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 amputation.
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 hygiene.
Osteoporosis
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

Complications

Treatment for type 2 diabetes requires a lifelong commitment to:
Blood sugar monitoring
Healthy eating
Regular exercise
Possibly, diabetes medication or insulin therapy


These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

Monitoring 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:
Food
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.
Medication
Any medications you take may affect your blood sugar level, sometimes requiring changes in your diabetes treatment plan.
Illness
During a cold or other illness, your body will produce hormones that raise your blood sugar level.
Alcohol
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.
Stress
The hormones your body may produce in response to prolonged stress may prevent insulin from working properly
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:
  • Fruits
  • Vegetables
  • 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 in fiber.

Diabetes medications

Oral hypoglycemics
Insulin

Oral hypoglycemic:Diabride tablets
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 lifestyle changes, such as losing weight and becoming more active.
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 glimepiride (Diabride).
  • 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) or pioglitazone .
  • 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.

Insulin therapy
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:

 Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

 

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