What is Type 2 Diabetes?
Type two diabetes is the most common form and is growing dramatically. Why does it happen? What are the signs, symptoms, and risk factors?
Today I get back to diabetes. My previous article on diabetes gave the foundation for this article's information, so if you haven’t listened to that one, you probably should. I won’t be mad at you if you don’t, but you may get confused. It’s no fun being confused.
What is Type 2 Diabetes?
Today I am going to discuss the more common form of diabetes known as Type 2 diabetes mellitus. About 90-95 percent of diabetics are type two, and this number is growing (in more ways than one). The absolute number of diabetics has been rising dramatically over recent years. The reason for this rise is that Americans have been growing dramatically over those same years. Diabetes is much more likely as a person’s pant size goes up, and we Americans have pursued maximum pantage with an unmatched vigor.
Type 2 Diabetes and Insulin
Why is obesity linked to diabetes? Let me first give a brief recap of the biology of Type 2 diabetes. The root problem in this disease is the malfunction of insulin receptors, which are the proteins on the outside of cells in our bodies that bring glucose into the cells for fuel. When insulin receptors malfunction it is known as insulin resistance, and there are two main bad things that happen as a result of this phenomenon:
The level of insulin in the blood goes up to compensate for this defect.
The level of glucose in the blood rises. Initially this rise only happens after a person eats high-carbohydrate food, but eventually it stays up all of the time.
Both high insulin and glucose levels are the source of the bad complications seen in Type 2 diabetes.
What is the Link Between Obesity and Diabetes?
Obesity makes a person even more insulin resistant than normal, and so someone who already has a predisposition for developing diabetes will have a much more likely chance of developing it if they gain weight; especially if they gain it around their waistline (for tips on losing weight please refer to Nutrition Diva and Get-Fit Guy). Scientists have termed a person who tends to carry more weight around the abdomen as being apples, and have termed people who carry more fat on the hips and buttocks as being pears. I guess this is a politically correct way to put it.
The upshot of the apple vs. pear physique is this:
It’s much better to have a big butt than a big belly.
Losing abdominal fat can reduce insulin resistance and prevent diabetes.
Hungry scientists come up with strange names for things.
Metabolic Syndrome and Diabetes
The trouble caused by insulin resistance does not start when a person develops full-blown diabetes, it starts much earlier in the form of a condition known as metabolic syndrome. Metabolic syndrome used to be called syndrome x, which I think sounds much cooler - it kind of sounds like you are a mutant super hero. I guess they didn’t want people to think it was cool to have this condition, so they renamed it something dull.
Metabolic syndrome is basically a pre-diabetic state, and is defined by having at least three of the following:
Triglyceride Cholesterol over 150
HDL (or good cholesterol) under 40
Mild elevation of blood glucose level
Abdominal obesity, defined as having a waste line over 40 inches for men and 36 inches for women.
So what’s the big deal? First off, people with metabolic syndrome will frequently become diabetics over time. More importantly, however, is the fact that people with metabolic syndrome are at significantly higher risk of having heart problems and other serious problems. This increase in risk is felt to be related to the increased insulin levels, not high glucose levels.
Metabolic syndrome usually doesn’t have any symptoms at all, and can go on for years without being detected.
Once the blood glucose level goes up enough, a person with metabolic syndrome is considered diabetic. Diabetics have an even higher risk of heart disease and the other complications of high blood sugar come into play.
How to Treat Type 2 Diabetes
Both metabolic syndrome and diabetes will get better if a person reduces their abdominal fat.
But as many people know, just because something sounds simple, it doesn’t mean it is easy. Even without weight loss, decreasing the consumption of carbohydrates will bring down the blood glucose levels. Upon first diagnosing patients with Type 2 diabetes, I generally send them to a dietician so they can learn exactly what they should and shouldn’t eat.
If diet and/or weight loss doesn’t work, the next step is to use oral medication to bring the blood glucose levels down. If these medications don’t work, then insulin injection is the next step. Most of my Type 2 diabetics don’t use insulin.
How Can You Reduce Your Risk for Diabetes?
So how can you reduce your risk for developing diabetes? The easy answer is to keep from becoming an apple. But even people who are not overweight can become Type 2 diabetics, so the real key is to know your risk. The main way to know this is to know your family history. Do you have any immediate family members with diabetes?
The second--and equally important thing-- is to get your cholesterol checked. Refer to my cholesterol podcast for a discussion on this. If you have no other risk factors, you should get your cholesterol checked every five years after age thirty, and you should get it checked more often if your risk is higher. Remember that most people with Type 2 diabetes don’t have the symptoms of frequent thirst and urination that most people associate with diabetes.
What to Do if You Have Type 2 Diabetes
For people who do have Type 2 diabetes, the key to staying healthy is close monitoring. Here are my Quick and Dirty Tips for people with Type 2 diabetes:
1. Monitor your sugars – get a home glucose monitor and check your sugar at least once a day. It’s hard to hit a target with your eyes shut. Knowing your glucose levels--especially the fasting level done before breakfast--is key.
2. Look out for complications – you and your doctor should be monitoring for numbness and tingling in the feet, which could be a sign of early nerve damage. You should also be screened for kidney damage at least once a year.
3. Know your A1c – Hemoglobin A1c is a blood test that measures how sugar-coated your red blood cells get over a three month period. It is essential to get this checked two or more times each year to know your real control.
4. Keep your blood pressure and cholesterol under control – Once a person develops diabetes, the risk of heart disease and stroke goes up significantly. That means that high blood pressure and cholesterol should be treated aggressively.
5. Take a baby aspirin once a day – It’s cheap insurance for people with increased risk of stroke and heart attack.
6. Be educated – This is the best defense against this deadly disease. If you have diabetes, or are close to someone who does, you should become experts on it. You should know more about it than your doctor.
There is a whole lot more to say, but I’ll stop here. If you have more questions about diabetes and metabolic syndrome, the American Diabetes Association website has excellent information. Find it at diabetes.org.
Also on Audible is the latest audiobook by Lisa Marshall my fellow Quick and Dirty Tips podcaster, The Public Speaker. It’s called The Public Speaker's Guide To Ace Your Job Interview and is now available from iTunes and Audible.
Let me remind you that this article is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!