Type 2 Diabetes: Diagnosis, Causes and Treatments

What is Type 2 Diabetes?

Type 2 diabetes is a long-term condition characterised by consistently high blood sugar levels (hyperglycaemia). Healthy blood sugar levels range from 70 to 99 milligrams per deciliter (mg/dL). with undiagnosed Type 2 diabetes, your levels will be typically 126 mg/dL or more.

This condition occurs when the pancreas does not produce enough insulin or the body does not respond properly to it. This is different from Type 1 diabetes, which results from the pancreas being unable to produce any insulin.

Symptoms of Type 2 Diabetes

As symptoms of Type 2 diabetes often develop slowly and can be mild, you may not realise it.

Common symptoms include:

• Extreme thirst.
• Increased urination, especially at night.
• Unusual fatigue, particularly after meals

Other signs of Type 2 diabetes include:

• Gastrointestinal issues, such as Bad breath, Constipation and Hiccups.
• Itchy skin
• Night sweats
• Obstructive sleep apnoea
• Vaginal fungal infections
• Unexplained weight loss
• Blurry vision
• Delayed wound healing

Causes of Type 2 Diabetes

Insulin resistance is the main cause of Type 2 diabetes. When the cells in your muscles, fat, and liver do not respond well to insulin, the pancreas tries to produce more insulin to manage blood sugar levels. Type 2 diabetes develops when the cells become too resistant and the pancreas cannot keep up.

Several factors may contribute to insulin resistance, such as:

• Genetics
• Excess body fat, especially around the abdomen and internal organs (visceral fat)
• Lack of physical activity
• A diet high in processed foods, sugars, and saturated fats
• Long-term use of medications like corticosteroids
• Hormonal disorders, such as hypothyroidism and Cushing syndrome
• Chronic stress and poor sleep

Risk Factors for Type 2 Diabetes

You may be at a higher risk of developing Type 2 diabetes if you:

• Have a family history of Type 2 diabetes (e.g., a parent or sibling)
• Are over 45 years old
• Are overweight or obese (with a BMI greater than 25)
• Are not physically active for at least three days a week
• Belong to certain ethnic groups, including Black, Hispanic, Native American, Asian American, or Pacific Islander
• Had gestational diabetes during pregnancy
• Have high blood pressure or high cholesterol
• Have prediabetes
• Have polycystic ovary syndrome (PCOS)

If you are at risk, having regular check-ups with your GP is essential as symptoms of Type 2 diabetes develop gradually. Your GP may perform tests, like a basic metabolic panel (BMP), to assess your blood sugar levels.

Diagnosing Type 2 Diabetes

Your GP diagnose Type 2 diabetes using the following blood tests:

• Fasting Blood Glucose Test: This test measures your blood sugar after fasting for eight hours. If the result is 126 mg/dL or higher, it may indicate diabetes.
• Random Blood Glucose Test: This test measures your blood sugar at any time of the day. A result of 200 mg/dL or higher suggests diabetes.
• HbA1C Test: This test shows your average blood sugar over the past two to three months. A result of 6.5% or higher points to diabetes.

In some cases, your GP may conduct an autoantibody test to distinguish between Type 1 and Type 2 diabetes.

Treatment for Type 2 Diabetes

Managing Type 2 diabetes is largely in your hands, though your healthcare team will provide guidance and support.

The most important aspects of managing Type 2 diabetes include:

• Lifestyle changes
• Regular blood sugar monitoring
• Medications

Exercise for Type 2 Diabetes

Regular exercise is essential for everyone, particularly for those with Type 2 diabetes. Regular physical activity helps by:

• Reducing blood sugar levels in both the short and long term
• Helping with weight loss
• Improving blood flow and lowering blood pressure
• Boosting energy and enhancing mood
• Helping manage stress

Before starting an exercise programme, consult your GP, especially if you are on insulin. The goal should be to get at least 150 minutes of moderate-intensity exercise per week.

Diet for Type 2 Diabetes

You can eat a variety of foods with Type 2 diabetes, but it is important to limit high-fat, high-sugar, and high-salt foods. Your GP can refer you to a registered dietitian for more personalised advice. Having a balanced diet in the right amounts is crucial to keep blood sugar levels stable.

Blood Sugar Monitoring

Monitoring your blood sugar allows you to track how well your treatment plan is working and make necessary adjustments and is vital for managing Type 2 diabetes effectively. You can monitor your blood sugar at home using:

• A glucose meter with a fingerstick
• A continuous glucose monitor (CGM) which has a sensor just under your skin and measures your glucose levels 24 hours a day.

Medications for Type 2 Diabetes

In addition to lifestyle changes, prescribed medications can help you control your blood sugar. These include:

• Oral Medications: These are for people who still produce some insulin to help manage blood glucose levels. Metformin is the most common oral medication.
• GLP-1 and Dual GLP-1/GIP Agonists: These injectable medications primarily control blood sugar and may also assist with weight loss.
• Insulin: Synthetic insulin lowers blood sugar levels. It may be delivered via syringes, pens, or an insulin pump.

Side Effects of Medications and Insulin

Some people experience side effects from their medication, such as:

• Bloating and diarrhoea
• Nausea
• Swelling due to fluid retention
• Weight changes

A key side effect to monitor is hypoglycaemia (low blood sugar), which occurs when your blood glucose drops below 4 mmol/L. Skipping meals, exercising unexpectedly, or taking too much medication increases risk of hypoglycemia. Careful management of your diabetes is crucial to avoid this side effect.

Complications of Type 2 Diabetes

If Type 2 diabetes is poorly managed, it can lead to complications such as:

• Heart-related issues: Coronary artery disease, peripheral artery disease, heart attack and stroke.
• Eye problems: Retinopathy, macular oedema, cataracts, glaucoma, and blindness.
• Kidney damage (Nephropathy)
• Nerve damage (Neuropathy)
• Skin problems: Dry skin and infections.
• Foot problems: Ulcers and infections.
• Oral health issues: Gum disease and other dental problems.
• Digestive issues: Gastroparesis.
• Hearing loss
• Sexual dysfunction

Short-Term Complications

A life-threatening complication of Type 2 diabetes is Hyperosmolar Hyperglycaemic State (HHS). HHS occurs when blood sugar levels rise excessively, leading to severe dehydration and confusion. It is a medical emergency and requires immediate treatment. Symptoms include:

• Extremely high blood sugar (over 600 mg/dL)
• Mental changes like confusion, delirium, or hallucinations
• Loss of consciousness
• Dry mouth and intense thirst
• Frequent urination
• Vision Impairments
• Weakness or paralysis, often affecting one side of the body

When to See a Healthcare Provider

If you experience symptoms of complications or any unusual changes, contact your GP. Regular visits to your healthcare team are essential for managing Type 2 diabetes. As your management plan may need to be adjusted after any change occur in your condition, lifestyle, and routines.

For more information or treatment options for type 2 diabetes, kindly reach out to us to book an appointment.