Type 2 diabetes

Diagnosis

To diagnose type 2 diabetes, the doctor may need to do additional tests as followings:

• Glycated hemoglobin (A1C) test: This test is commonly used to detect diabetes type 2. The average blood sugar level over the previous two to three months is shown by this blood test. This is how the results are interpreted.
  • Normal: Below 5.7%
  • Prediabetes: 5.7% to 6.4%
  • Diabetes: 6.5% or higher on two separate tests.

The following test may be recommended by the healthcare professional if the A1C test isn’t available, or if the patient have certain conditions that interfere with an A1C test.

• Random blood sugar test: A random blood sample will be drawn, and other tests may be used to validate the results. A random blood sugar level of 200 mg/dL (11.1 mmol/L) or greater suggests diabetes regardless of when you last had your meal.
• Fasting blood sugar test. The blood sample will be taken following an overnight fasting, to check the sugar level in the blood. A healthy fasting blood sugar level is under 100 mg/dL (5.6 mmol/L). Prediabetes is defined as having a fasting blood sugar level between 100 and 125 mg/dL (5.6 and 6.9 mmol/L). You have diabetes if it is 126 mg/dL (7 mmol/L) or above on two separate tests.
• Oral glucose tolerance test: This test is commonly used during pregnancy. The patient’s blood sugar will be tested periodically for two hours after the consumption of sweeter glucose solution. The results are interpreted as follows:
  • Normal: Less than 140 mg/dL (7.8 mmol/L)
  • Prediabetes: 140 to 199 mg/dL (7.8 mmol/L to 11.0 mmol/L)
  • Diabetes: 200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes.

All persons aged 35 and older, as well as the following groups, should undergo routine screening with diagnostic testing for type 2 diabetes, according to the American Diabetes Association:

• Overweight or obese individuals under the age of 35 with one or more risk factors of type 2 diabetes.
• Women who had been diagnosed with gestational diabetes
• Those who have been given a prediabetes diagnosis
• Children who have a family member who have type 2 diabetes and are overweight or obese.

After the diagnosis

To differentiate between type 1 and type 2 diabetes, which frequently require different treatments, the doctor may need to do additional tests.

The healthcare professional will perform the test to determine the A1C levels at least twice a year, and whenever there are any treatment changes. The age and other factors may affect your A1C targets.

Patient with type 2 diabetes need to have a regular test for screening for any complications.

Treatment

The goal of treatment for diabetes type 2 is to maintain normal blood glucose levels. Type 2 diabetes management includes:

• Lifestyle changes: healthy diet and regular physical activity will help maintain the blood sugar level within the normal range by developing a meal plan for a healthy diet based on the present weight of the patient, and allowed physical activity.
  • Healthy diet: There are no specific diet for diabetes, it is highly important to focus the diet around fruits, vegetables, whole grains, and lean protein are the mainstays of a healthy diet, which also restricts overly refined carbs, such as sweets. These foods are also high in nutrition and fiber and low in fat and calories.

The healthcare professional could suggest that the patient consult a qualified dietician, who can:

• • Plan nutritious, balanced meals, and determine which of the eating preferences a healthy option.
  • Track the carbohydrate intake to maintain more consistent blood sugar levels.
• Physical activity: Exercise is vital for keeping a healthy weight. It also assists in controlling blood sugar levels. To make sure that activities are safe for the patient, they need to see their doctor before beginning or changing their exercise routine.
  • Aerobic exercise: The aerobic exercise should be based on what the patient enjoy doing, such as walking, swimming, biking or running. The patient should aim to accomplish at least 30 minutes or more of moderate aerobic exercise on most days of the week. Children should engage in 60 minutes per day of aerobic activity that ranges from moderate to vigorous.
  • Resistance exercise: Strength, balance, and the ability to carry out daily tasks are all improved with resistance training. Yoga and calisthenics are all forms of resistance training.

Adults with type 2 diabetes should strive to complete two to three sessions of resistance training per week. At least three days a week, kids should take part in exercises that increase their flexibility and strength.

• • Reduce inactivity: Blood sugar levels can be managed by breaking up extended periods of inactivity, such as computer time. Every thirty minutes, spend a little while standing up, moving around, or engaging in a light exercise.
• Daily blood sugar monitoring: To ensure that the blood sugar level stay within your target range, the healthcare professional will give recommendations on how frequently to check the blood sugar levels. For instance, a patient might need to check it before or after exercise and once per day. If they take insulin, they might need to repeat this process several times daily.
  • Blood glucose meter: measures the quantity of sugar in a drop of the blood, and is typically used for monitoring. These measurements must be recorded.
  • Continuous glucose monitoring: is an electronic device that uses a sensor inserted under the skin to record the blood sugar levels every few minutes. When levels are excessively high or low, the system can send alerts, and information can be transferred to a mobile device like the phone.
• Weight loss: It is recommended that the patient lose some weight if they are overweight or obese. When the patient start losing weight, it could result to good blood pressure, cholesterol, triglyceride, and better blood sugar regulation. The advantage to the health and illness management increases with weight loss.
• Medication (as prescribed): the blood sugar levels may need to be lowered with medications if healthy diet and physical exercise are insufficient to control the blood sugar. Prescription of oral medication or injectable will be discussed with the doctor to properly manage the diabetes type 2. The following are examples of type 2 diabetic medications.
  • Metformin: is typically the first recommended medicine for type 2 diabetes. It basically works by reducing the amount of glucose produced by the liver and enhancing insulin sensitivity to enhance insulin utilization.

Possible side effects, which could improve with time, include:

• • • B12 deficiency
    • Abdominal pain or bloating
    • Nausea
    • Diarrhea
  • Sulfonylureas: assist the body in producing more insulin. Glyburide, glipizide, and glimepiride are medicine examples. Side effects include low blood sugar and weight gain.
  • Glinides: increase the pancreas ability to produce more insulin. They work more quickly than sulfonylureas and have a shorter effect on the body. The side effect is same with sulfonylureas which is low blood sugar and weight gain.
  • Thiazolidinediones: increase the sensitivity of the body tissues to insulin. Examples include pioglitazone and rosiglitazone. Side effects may increase the risk of the following:
    • Congestive heart failure
    • Bone fractures
    • Weight gain
    • Bladder cancer (pioglitazone)
    • Increase cholesterol level (rosiglitazone)
  • DPP-4 inhibitors: assist in lowering blood sugar levels but typically have just a little effect. Saxagliptin, linagliptin, and sitagliptin are examples of DPP-4 inhibitors. Possible side effects include the risk to have pancreatitis, and joint pain.
  • GLP-1 receptor agonists: the injectable medicines that delay digestion and assist in lowering blood sugar. They frequently help people lose weight, and some of them may lower their risk of heart attack and stroke. Examples include exenatide, liraglutide and semaglutide. The medicines may increase the risk of pancreatitis, and have a side effect of nausea, vomiting, and diarrhea.
  • SGLT2 inhibitors: this medicine affects the filtering function of the kidneys by preventing the return of glucose to the bloodstream. In patients with a high risk of developing certain illnesses, these medications may lower the risk of heart attack and stroke. The glucose is then released in the urine.

Dapagliflozin, empagliflozin, and canagliflozin are examples of SGLT2 inhibitors. The following are possible risk and side effects:

• • • Gangrene
    • Vaginal yeast infections
    • Urinary tract infections
    • Low blood pressure
    • High cholesterol
    • Bone fractures (canagliflozin)
    • Amputations (canagliflozin)
  • Other medications: doctor may also recommend low-dose aspirin and blood pressure and cholesterol-lowering drugs in addition to diabetic medications to help prevent heart and blood vessel damage.
• Insulin therapy: If blood sugar targets aren’t achieved with lifestyle changes and other medications, insulin therapy may be administered sooner rather than later. The doctor will monitor for any side effect of insulin such as low blood sugar (hypoglycemia), high triglycerides, and diabetic ketoacidosis.

Long-acting insulin is intended to function all day or over the course of the night to maintain steady blood sugar levels, while short-acting insulin is used during meal time. The duration of an effect and the speed at which an effect takes place differ between different kinds of insulin.

The type of insulin that is right for the patient and when to take it will discussed with the doctor. Depending on how steady the blood sugar level are, the patient may need to adjust their insulin type, dosage, and schedule. Insulin is often administered through injection.

• Weight-loss surgery: This treatment is just one element of a comprehensive treatment approach. Additionally, the treatment plan will include instructions on the exercise routine, diet, and nutritional supplements.

The digestive system structure and functionality are changed by weight-loss surgery. Patients could manage type 2 diabetes, their weight, and other obesity-related diseases with the help of this operation. Different surgical treatments will assist in weight loss by reducing the amount of food the patient able to consume. The amount of nutrients they can absorb is also restricted by some procedures.

A lifetime commitment to making lifestyle changes is necessary after weight-loss surgery. Nutritional deficits and osteoporosis are long-term side effects. For persons with type 2 diabetes with a body mass index (BMI) of 35 or higher, weight-loss surgery may be an option. Using weight and height, the BMI formula calculates an estimate of body fat. Surgery may be an option for someone with a BMI under 35, depending on the severity of their diabetes or comorbid diseases.

• Pregnancy: It is likely that women with type 2 diabetes will need to modify their treatment regimens and follow diets that strictly limit their carbohydrate consumption. Pregnant women who need insulin therapy may also have to stop taking other drugs, such as blood pressure medications.

If the woman with type 2 diabetes is planning to get pregnant, they are recommended to have a consultation with an ophthalmologist at each trimester, one year postpartum or as advised, to prevent the development of diabetic retinopathy or to prevent the worsening of the conditions.

Danger signs

To prevent serious consequences, it’s important to regularly check the blood sugar levels. Recognize the following complications that may point to abnormal blood sugar levels and the requirement for prompt medical attention:

• Hyperglycemia (high blood sugar): High blood sugar can be brought on by eating particular foods or eating excessive amounts of food, being ill, or not taking medications as prescribed.
  • Excessive thirst
  • Frequent urination
  • Blurry vision
  • Dry mouth
  • Fatigue or weakness
  • Headache
• Hyperglycemic hyperosmolar nonketotic syndrome (HHNS): A blood sugar level more than 600 mg/dL (33.3 mmol/L) indicates this life-threatening condition. If you use certain steroids or medications that make you urinate frequently, have an infection, or do not take your medications as directed, your risk of developing HHNS may increase. Some warning signs and symptoms are:
  • Excessive thirst
  • Dry mouth
  • Drowsiness or confusion
  • Seizures
  • Dark-colored urine
• Diabetic ketoacidosis: When the body starts using fat as fuel instead of sugar because of a lack of insulin, the condition is known as diabetic ketoacidosis. Certain conditions, pregnancy, trauma, and medications, particularly the diabetes drugs known as SGLT2 inhibitors, can cause diabetic ketoacidosis.

Type 2 diabetes normally results in a mild form of diabetic ketoacidosis, although the acids’ toxicity can be dangerous. Ketoacidosis can cause the following in addition to the symptoms of hypoglycemia, such as increased thirst and frequent urination:

• • Nausea and vomiting
  • Abdominal pain
  • Shortness of breath
  • Fruity-odor breath
• Hypoglycemia (low blood sugar): when the blood sugar level falls below the desirable range. Skipping meals, accidentally taking more medication, or engaging in more physical activity than usual are just a few of the many factors that might cause the blood sugar levels to drop. Signs and symptoms include:
  • Sweating
  • Blurry vision
  • Headache or dizziness
  • Confusion or drowsiness
  • Seizures
  • Weakness
  • Slurred speech
  • Hunger
  • Irritability
  • Heart palpitations

If the patient is experiencing any of the signs and symptoms of low blood sugar, they should immediately consume either fruit juice, glucose tablets, hard candies, or another source of sugar to quickly boost their blood sugar level. Patient should check their blood glucose level after 15 minutes, if the results are not at the target range then they need to consume another sugary intake.

For emergency situation such as the patient lose consciousness, an injection of glucagon will be administered. Glucagon increases the releasing of sugar in to the bloodstream.