Diabetes is a disorder characterized by abnormally high blood sugar levels usually caused by insensitivity to insulin. Insulin production is normal in type 2 diabetics. The condition is frequently associated with a family history and is seen in obese individuals. It is a leading risk factor for the development of heart attack, stroke, and peripheral vascular disease. It is also a leading cause of kidney disease, blindness, and death in the United States. Learn more about this condition and the different classes of type 2 diabetes medications available to order.
Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.
Type 2 diabetes is caused by insensitivity to insulin. In other words – there is no problem with insulin production, the problem is that tissues cannot properly handle insulin and use glucose. Diabetes is frequently associated with obesity, high cholesterol, elevated blood pressure (hypertension), kidney failure, heart disease, and stroke.
Long-term elevations in blood sugar lead to tissue injury and inflammation. This is especially problematic in the arteries, where it promotes the formation of fatty plaques. Arterial plaques lead to reduced blood supply to tissues and organs such as the heart, kidneys, eyes, and nervous system.
The most common risk factors for diabetes include:
- Family history
- Alcohol use
- Sedentary lifestyle
- Poor diet
Other conditions such as low thyroid function (hypothyroidism), Cushing syndrome, and certain medications (e.g. corticosteroids, beta blockers) can also cause diabetes.
Type 2 diabetes is an extremely common condition that is frequently evaluated in the primary care clinic. Advanced cases may require referral to an Endocrinology specialist. It is a leading cause of heart disease, stroke, kidney failure, blindness, and death in the United States.
It affects approximately 12% to 14% of Americans. The prevalence of diabetes is on the rise due to the Western diet and lifestyle.
Strokes do not always kill, 3.1% of American adults (7.8 million people) have experienced a stroke and are living with the after-effects.
The classic symptoms of diabetes usually occur in type 1 diabetes and include:
- Eating excessively (polyphagia)
- Excessive thirst (polydipsia)
- Frequent urination (polyuria)
Patients with severe type 2 diabetes may also develop these symptoms and often require the use of insulin to control their blood sugar levels.
Other symptoms of diabetes that occur due to its complications include:
- Eye disease leading to blindness (retinopathy)
- Kidney failure – results in high blood pressure and swelling in the legs
- Heart attack – chest & difficulty breathing – although heart attacks in diabetes may be “silent”
- Nerve damage in the feet & hands (peripheral neuropathy) causes burning pain
You may also develop complete loss of sensation and ulcer formation in the feet, which is a very dangerous sign. Complete sensory loss can also result in problems with balance. The foot examination is a critical part of the physical examination in patients with diabetes.
Diabetes is primarily diagnosed based on blood tests evaluating your glucose levels and hemoglobin A1C. Hemoglobin A1C gives your doctor an idea of how well your diabetes has been controlled in the past several months. The diagnosis of diabetes is made when your fasting glucose is >126 mg/dL, random blood glucose is >200, or if your hemoglobin A1C is >6.5%.
Your doctor will also likely order blood tests such as a CMP (comprehensive metabolic panel), CBC (complete blood cell count), cholesterol levels, urine microalbumin, and urine analysis.
If they suspect that you have heart disease they will likely obtain an EKG (electrocardiogram), and ultrasound of the heart (echocardiogram).
The treatment of type 2 diabetes is multifaceted and includes diet and exercise. Patients are encouraged to eat a low-carbohydrate diet. If you eat carbohydrates, they should be derived from fruits, whole wheat or whole grain products, or oatmeal. Your doctor will ask you to avoid sugar from sources such as high-fructose corn syrup, candy, pastries, or cakes. Patients with diabetes should also avoid alcohol use.
The most commonly prescribed type 2 diabetes medications include:
- Glucophage (Metformin)
- Glucotrol (Glipizide)
- Precose (Acarbose)
- Glyset (Miglitol)
- Byetta (Exenatide)
- Prandin (Repaglinide)
- Victoza (Liraglutide)
- Januvia (Sitagliptin)
- Invokana (Canaglifozin)
- Farxiga (Dapagliflozin)
Patients with severe disease may also require the use of insulin.
- Levemir (insulin detemir)
- Lantus (insulin glargine)
- NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart)
- Humalog Mix 75/25 (insulin lispro protamine-insulin lispro)
- Humalog Mix 50/50 (insulin lispro protamine-insulin lispro)
Your doctor may start you on low-dose aspirin depending on your age and presence of other cardiovascular risk factors. Patients with diabetes are also usually treated with cholesterol-lowering medications (eg, Lipitor – Atorvastatin) and blood pressure reducing therapies (e.g., Zestril – Lisinopril, Cozaar – Losartan).
- Pippitt K, Li M, Gurgle HE. Diabetes Mellitus: Screening and Diagnosis. Am Fam Physician. 2016 Jan 15;93(2):103-9. – https://www.aafp.org/afp/2016/0115/p103.html
- Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Recommendation Statement. Am Fam Physician. 2016 Jan 15;93(2):Online. – https://www.aafp.org/afp/2016/0115/od1.html