Symptoms and Complications
People with type 2 diabetes may not have symptoms for years or decades, but as the disease progresses, symptoms develop. People with type 2 diabetes may have the following signs and symptoms:
- blurred sight
- decreased sensation or numbness in the hands and feet
- dry, itchy skin
- frequent bladder and vaginal infections
- frequent need to urinate
- increased thirst and hunger
- male impotence (erectile dysfunction)
- slow healing of cuts or sores
Unfortunately, many people with type 2 diabetes go undiagnosed for several years and are not diagnosed until they go to the doctor with complications of diabetes.
High blood sugar levels (hyperglycemia) can lead to a condition called glucose toxicity. This leads to further damage to the pancreas, and the body is less able to produce insulin. Without insulin, glucose levels continue to rise to levels that can cause damage to organs such as the eyes, nerves, and kidneys. These problems are similar to the complications associated with type 1 diabetes.
People with diabetes are at greater risk for problems that involve damage to small blood vessels and nerves due to high levels of glucose in the blood. They are also at a greater risk of developing hardening of large arteries (atherosclerosis), which can result in a heart attack, stroke, or poor blood flow to the legs.
Damage to small blood vessels can affect the eyes, kidneys, and nerves. Damage to eyes, specifically the retina, is called diabetic retinopathy and is the leading cause of blindness. Damage to the kidneys, called diabetic nephropathy, can lead to kidney failure and the need for dialysis. Damage to the nerves that supply the legs and arms and gastrointestinal tract is called neuropathy. Some people with diabetes who develop peripheral neuropathy (damage to the nerves in the legs) and have poor blood flow to the legs may eventually need an amputation.
If blood glucose levels become very high, especially when there are other stresses such as infection, people with type 2 diabetes may become confused, dizzy, and have seizures. This can lead to a condition called non-ketonic hyperglycemic-hyperosmolar
coma and requires immediate medical attention.
Fortunately, the complications of diabetes can be prevented, delayed, or slowed by controlling blood glucose levels to as close to the normal range as possible. The normal range is 70 mg/dL to 126 mg/dL (3.9 mmol/L to 7 mmol/L).
Making the Diagnosis
To diagnose diabetes, doctors will take a medical history (ask you about symptoms) and ask for blood and urine samples. Finding protein and sugar in the urine are signs of type 2 diabetes. Increased glucose and triglyceride (a type of lipid or fat) levels in the blood are also common findings. In most cases, blood glucose levels are checked after a person has been fasting for 8 hours.
If the fasting blood glucose level is 7.0 mmol/L (126 mg/dL) or higher, a diagnosis of diabetes is made. If the fasting blood glucose level is between 5.5 mmol/L and 6.9 mmol/L (100 mg/dL and 125 mg/dL), the person has impaired fasting glucose and may later develop diabetes.
Diabetes is also diagnosed if a blood glucose level taken anytime of the day without regard to meals is 200 mg/dL (11.1 mmol/L) or higher plus you have symptoms characteristic of diabetes (e.g., increase thirst, increase urination, unexplained weight loss). A doctor may also examine the eyes for signs of damage to the blood vessels of the retina (back of the eye). Finally, diabetes mellitus is diagnosed if the 3-month cumulative blood sugar average test, known as hemoglobin A1C or glycated hemoglobin, is 6.5% or higher.
Treatment and Prevention
The main goal of diabetes management is to maintain blood glucose levels within the normal range as much as possible. Weight control, diet, and exercise are all important components of management. The most important and main treatment for type 2 diabetes is nutritional.
Although some people with this type of diabetes are thin, the majority of people (90%) are overweight. Losing weight, even 5 lb to 10 lb (2 kg to 5 kg) can help lower blood glucose levels. For many people, following a healthy diet and an exercise program may be all that is needed to help control glucose levels. For others, healthy eating and exercise alone aren't enough to lower blood glucose levels.
They may need to take medications in order to keep glucose levels within a healthy range. Medications for type 2 diabetes are usually taken by mouth in the form of tablets and should always be taken around meal times and as prescribed by the doctor. But if blood glucose is not controlled by oral medications, a doctor may recommend insulin injections.
There are several types of oral diabetes medications, also called oral hypoglycemics, which work to lower blood glucose:
- sulfonylureas: This family of medications includes chlorpropamide*, gliclazide, glimepiride, glyburide, glipizide, and tolbutamide. These medications are widely recommended for type 2 diabetes and work by stimulating the pancreas to release more of its stored insulin and by increasing the effectiveness of insulin in the body. But these medications don't work for type 1 diabetes.
- biguanides: These medications include metformin and work to improve insulin sensitivity and to reduce the glucose produced by the liver.
- acarbose: This type of medication prolongs the absorption of carbohydrates after a meal. For these pills to work, they must be taken with or after a meal.
- thiazolidinediones: This family of medications includes pioglitazone and rosiglitazone and they work to improve insulin sensitivity.
- meglitinides: This family of medications includes repaglinide and nateglinide lowers postprandial (after meals) glucose levels by stimulating the pancreas to release more of its stored insulin.
- dipeptidyl peptidase-4 inhibitors: This class of medications includes sitagliptin and saxagliptin. They help improve insulin release from the pancreas and decrease liver release of glucose.
- glucagon-like peptide 1 analogues: This class of medications includes exenatide and liraglutide, both of which are taken by subcutaneous injections. They help improve the effectiveness of insulin secretion in response to meals, decrease the making and release of glucose by the liver, slow gastric emptying, and decrease appetite. In addition to being effective in lowering blood glucose levels, these medications have also been shown to effectively help with weight loss.
- SGLT-2 inhibitors: the first agent in this class, Canagliflozin with the brand name Invokana, was approved for clinical use by the FDA a few months ago, with a few other agents in this class seeking approval over the next year or two. This class promotes a more robust urine excretion of glucose, thus lowering blood glucose levels. In addition to lowering blood sugar, this class has shown effectiveness in promoting weight loss, as well as a modest drop in blood pressure.
Doctors may recommend one or more types of medications to help control diabetes. While taking medications, it's important for people with diabetes to regularly test their blood glucose levels at home. There are many different blood glucose meters available on the market. Speak to a doctor or pharmacist about these meters to help you select the best meter for your needs.
As part of proper diabetes management, it is important to be aware of the symptoms of abnormal blood glucose levels and know how to properly monitor your blood glucose levels using a home glucose meter. You should remember to always keep glucose tablets or candies containing sugar with you to mange low blood glucose levels (hypoglycemia). Symptoms of low blood glucose include:
- cold, clammy skin
- rapid heart rate
To prevent complications, it's important to follow your diabetes management plan with a well-balanced diet and exercise. If you take medications for your diabetes, it is important to take them exactly as prescribed by your doctor.
Here are some tips to help you stay healthy and prevent some of the long-term complications:
Foot care: Poor circulation and nerve damage caused by diabetes reduce sensitivity in the feet. It's important to check your feet regularly, looking for any blisters, cuts, or sores. Always keep your feet clean and dry and protect them by wearing socks and comfortable shoes.
Eye care: Eye problems (retinopathy) due to diabetes can lead to blindness. Therefore, have your eyes checked by an eye doctor (ophthalmologist) at least once a year. By treating problems early, serious complications can be avoided.
Skin care: High blood glucose and poor circulation can lead to skin problems such as slow healing after an injury or frequent infections. Make sure to wash every day with a mild soap and warm water, protect your skin by using sunscreen, take good care of any cuts or scrapes with proper cleansing and bandaging, and see your doctor when cuts heal slowly or if an infection develops.
Education: People with diabetes should learn as much as possible about this condition and how to manage it. The more you know about your condition, the better prepared you are to manage it on a daily basis. Many hospitals offer diabetes education programs and many nurses and pharmacists have been certified to provide diabetes education. Contact a local hospital, doctor, or pharmacist to find out about programs and diabetes educators in your area.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Ahmad Al-Mubaslat, MD, FACE, Endocrinologist at the Medical Group of Kansas City, MO. Review provided by VeriMed Healthcare Network.