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DIABETES TYPE 2 - NON INSULIN DEPENDENT DIABETES

What is Diabetes Type 2 ?

The word diabetes comes from a Greek expression meaning syphon . It refers to the large amounts of urine and the excessive thirst which often occurs in newly diagnosed or seriously uncontrolled diabetes. These symptoms are due to a build-up of glucose (sugar) in the blood which then overflows into the urine. However, there may be no symptoms at all for many years. As the glucose level rises higher, the lens of the eye may alter its shape, producing blurring of vision. When sugar overflows into the urine (where it can be easily tested), it draws water with it and produces more urine. This runs down the body's fluid reserves and creates thirst. The loss of essential chemicals into the urine can cause cramps, tiredness and weakness, together with weight loss. If the fluid loss is severe, dehydration, and even coma can occur. High glucose levels in the blood prevent the body's defence against infection, particularly of the skin, urine and lungs. It may be a severe or chronic infection which first alerts the doctor that you have diabetes. In some countries, tuberculosis is the first sign of diabetes. Sometimes, your type of diabetes may be picked up by a screening program on a blood or urine test.

How does Diabetes Type 2 occur ?

This type of diabetes is partly due to a lack of insulin, an important hormone that comes from the pancreas gland (sweetbread), which lies just beneath your liver in the upper abdomen. In addition, in many people with your type of diabetes, the insulin that is made in the body appears to be less effective. In people without diabetes, insulin holds down the glucose level in the blood to a level between 4 and 9 millimoles per litre (mmol/l) (70 to160 mg/dl) by helping the body's cells use the glucose as fuel. In your case, the glucose level in the blood will have been rather higher than this : it is important to know that high glucose levels do not necessarily cause symptoms. These rises of glucose in the blood can trigger other chemical reactions in the body . This can cause blood-vessel and nerve damage in the long term.

Why does Diabetes Type 2 occur ?

There is a strong inherited element to this type of diabetes, although the actual gene can only be identified in some cases. In addition there is often a lifestyle problem : gaining weight, eating too much fat and sugar, and being inactive are all things which are known to bring on the diabetes. They do this by causing bigger demands on your already reduced insulin supply. Certain drugs like steroids and water tablets (diuretics) raise the sugar level in the blood. They can cause the diabetes, as well as worsening it if it is already there. In many people, stress either due to infection, to accident, or to anxiety can raise the sugar level. Again this can appear to cause diabetes as well as make it worse once it is already present. In some cases, the pancreas gland is damaged by too much alcohol. Diabetes of this type may show itself for the first time during a pregnancy – and may go away afterwards. This is called gestational diabetes. However, the diabetes often reappears insidiously later in life, due to the effects of age, overweight and other factors. Pregnancy is therefore an ideal time to screen for diabetes, and take preventive measures against later development of more permanent diabetes.

Treatment Involved for Diabetes Type 2

A dietitian will advise you about special dietary needs. The principles are to cut back on calories, to avoid sugar and all sweet foods, cut down on fats and fried foods, and build up fibre. Most people with this type of diabetes are above ideal weight. Weight reduction may sometimes be enough to bring the diabetes under control. If this does not work, tablets need to be used. One type of drug (a sulphonylurea) stimulates the pancreas to make more insulin and to use it more efficiently. Another type of drug (metformin, a biguanide) works rather differently by helping glucose into the cells, and it may be used alone, or together with the first type to get a better effect. There are several other drugs which also work by stimulating the insulin-producing cells. Others (glitazones) work be making the body’s cells more sensitive to the insulin which is altready being made. Additional benefit sometime comes from the use of drugs which interfere with the breakdown of food in the bowel (acarbose) or the absorption of fat (orlistat). Once drugs are started, their doses are built up in order to achieve proper control . Tablet doses should not normally be changed without consulting the doctor. Sometimes, insulin needs to be used in this type of diabetes, either with tablets or alone. This can often be avoided if diet and weight are carefully controlled.

During Treatment for Diabetes Type 2

To decide how well your diabetes is controlled, your blood glucose, or less ideally urine glucose level needs to be tested with special strips. It is unlikely that diabetes is properly controlled unless sugar is absent from the urine both before and after meals. Blood tests are done on finger-prick blood samples, by using special strips these either change colour according to glucose level, or are part of a meter system which gives a digital readout. Doctors like the blood-glucose level to be less than 10 mmol/l (180mg/dl) at most times of day, and ideally below 7mmol/l (125mg/dl) before meals. They will check a special blood test (haemoglobin A1, HbA1c or fructosamine) to see whether control is satisfactory. The commonly used HbA1c level shows control over the previous 10 weeks or so : a value below 7.0% is ideal and below 8% acceptable. The higher the levels the more likely the risks of complications longterm. Ask your doctor to check your HbA1c at least every 6 months. One type of blood-sugar lowering drug (sulphonylurea) can occasionally make blood sugar levels fall too low, causing hypoglycaemia. This produces sweating, shakiness, hunger, a confused feeling, and even loss of consciousness. Sugar in some form should be taken immediately, and the doctor needs to be consulted about reducing the dose. Metformin can produce nausea and diarrhoea. This is usually a reason to reduce the dose rather than stop it. Other drugs can also cause side-effects, usually abdominal discomfort and excessive wind. If the sugar level rises too high (often as a result of some type of stress), the original symptoms of the diabetes may return quite quickly. Any loss of control should be notified to your doctor, or to a specialist diabetic nurse who works with the doctor. Identification, such as a bracelet, should be carried at all times, indicating that you have diabetes.

After Treatment for Diabetes Type 2

Even after quite a short time, the eyes, the kidneys and the nerves may be affected. This is particularly so if diabetes control has not been good. An important research study (UKPDS) has shown that a 1% lower HbA1c results in a 25% lower risk of eye and kidney problems. You should let your doctor know if there is any change of eyesight. He/she will in any case need to check your eyes with an ophthalmoscope every year. An eye doctor may need to give special laser treatment. Feet are very important, since nerve damage can interfere with the ability to feel dangerous objects, cuts or other problems in the feet. Tingling or numbness of the feet are a warning that you may have developed nerve problems. Any self-treatment of the feet or toenails should be first discussed with the doctor; often it is best performed by a chiropodist. Good footwear is essential. You should never walk barefoot. Hardening of the arteries affecting the legs (calf pain) and the heart (angina) is more often a problem in diabetics. Smoking increases the risk of these problems. No diabetic should therefore smoke. A physical check-up and blood test is advised at strict yearly intervals to be sure that all is well, particularly keeping an eye on the cholesterol and other fat levels : a drug (statin or fibrate) may be prescribed for this problem. Your blood pressure will be checked regularly, and pressure lowering drugs will be often prescribed. The UKPDS study showed that lowering blood pressure further reduced the risk of eye damage and heart propblems as well as the risk of stroke. It is likely that blood pressure control is as important as blood sugar control in the protecting you from the effects of diabetes complications. Aspirin or a similar drug is sometime advised to further reduce the risk of artery blockage.

If Diabetes Type 2 is Left Untreated

Untreated or poorly controlled diabetes, even if you feel perfectly well, causes progressive damage to tissues in the body, particularly the eyes, the kidneys, and the nerves. Treatment means keeping the sugar levels as normal as possible. The closer the sugar levels are to what is found in normal people, the less likely the complications will be to develop. Coma can occur if blood sugar rises rapidly in an untreated patient who encounters some form of stress.

Effects on Family of Diabetes Type 2

Relatives need to be aware that they are at increased risk of having diabetes themselves. Some doctors recommend that relatives be screened for diabetes. The type of diet recommended for people with diabetes is also very suitable for other members of the family. Dieting is always easier when the whole family takes part. Diabetes never goes away and must be regularly supervised by a doctor.