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Diabetes - Type 2 & Pre-Diabetes  

Introduction

Type 2 diabetes, also known as non-insulin dependent diabetes is the most common form of diabetes.  Diabetes is a disease that affects how the body uses glucose, a sugar that is a source of fuel.  Normally, the hormone insulin helps glucose get into the body’s cells where it is used for energy.  People with Type 2 diabetes produce insulin, but they either do not produce enough or the cells of the body are resistant to the absorption of insulin, and glucose remains in the bloodstream. Unlike type 1 diabetics, type 2 diabetics may not have to rely entirely on insulin to control their symptoms, though many diabetics do eventually end up taking insulin injections.  Too much sugar in the blood can cause a variety of different medical complications and make diabetics very ill. 

While many cases of type 2 diabetes may be controlled, it is the leading cause of diabetes-related complications such as blindness, lower leg amputations, and chronic kidney failure.  There is no cure for diabetes.  People with diabetes should diligently manage their disease to stay as healthy as possible and reduce the risk of medical complications.

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Anatomy

Your body is composed of millions of cells.  The cells need energy to function.  One way the cells receive energy is from the food that you eat.  Whenever you eat or drink, some of the food is broken down into glucose.  Glucose is a sugar released into your blood.  It is a major source of energy for your body cells.  Glucose is transported from your bloodstream and into your cells with the help of insulin.

Insulin is a hormone that is produced by the beta cells of your pancreas.  Your pancreas is a gland located near your stomach that produces chemicals for food digestion.  Insulin regulates the amount of glucose in your blood continually.  When you eat, the amount of glucose in your bloodstream rises.  In response to the elevated blood glucose level, your beta cells produce insulin.  The insulin moves the glucose out of the bloodstream and into your cells.  In turn, a lower level of glucose is left in the blood stream.  To prevent your blood glucose level from getting too low, your body signals you to eat.  This starts the process again so that your body cells receive the exact energy that they need.

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Causes

Type 2 diabetes occurs because the pancreas does not produce enough insulin or the body's cells are not allowing the insulin to be absorbed.  This is known as insulin resistance.  Insulin resistance is a condition in which the body does not recognize or respond to the insulin that is produced.  This results in elevated blood glucose levels because the glucose cannot get into the body cells for energy and remains in the bloodstream.

Type 2 diabetes most frequently develops in people who are over 40 years old and overweight but it can occur in people who are not overweight.  Overweight children can also develop type 2 diabetes and these rates are continuing to climb thanks to rising childhood obesity rates.   People with type 2 diabetes must manage their condition with weight control, diet, exercise, and medication. They may use insulin or an oral medication that helps their body make the most of their own insulin.

Before most people develop type 2 diabetes, they will experience “pre-diabetes.”  Pre-diabetes, also known as impaired glucose tolerance or impaired fasting glucose, is a condition in which blood glucose levels are elevated, but are not high enough to meet the criteria for type 2 diabetes.  A diagnosis of pre-diabetes means that you are likely to develop diabetes and may already experience adverse health effects.  Research shows that long-term damage to the heart and circulatory system may begin to occur during pre-diabetes.  People with pre-diabetes can delay or prevent type 2 diabetes if blood glucose levels are managed with nutrition and exercise during pre-diabetes and should use this time to take control of their health and lose weight. 

Some research has shown that type 2 diabetes is most likely to occur when poor health habits (lack of exercise, high calorie diets, and obesity) combine with an underlying genetic risk for the disease.

Major risk factors for type 2 diabetes include:

  • Age greater than 45 years (but remember it is happening more in children)
  • Weight greater than 120% of desirable body weight
  • Family history of type 2 diabetes in a first-degree relative
  •  Hispanic, Native American, African American, Asian American, or Pacific Islander descent
  • History of a previous abnormal glucose tolerance or impaired fasting glucose test
  • High blood pressure (>140/90 mm Hg) or high cholesterol (HDL cholesterol level < 40 mg/dL or triglyceride level >150 mg/dL)
  • History of gestational diabetes or delivering a baby with a birth weight of over 9 pounds
  •  Polycystic ovarian syndrome (which results in insulin resistance)

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Symptoms

Most people with pre-diabetes do not have any symptoms.  Symptoms of diabetes include increased thirst, frequent urination, blurred vision, or extreme tiredness.  Type 2 diabetes may or may not produce symptoms.  Many people with type 2 diabetes do not know that they have it.  In most cases, the symptoms develop gradually when blood sugar levels become high.  Symptoms and complications of type 2 diabetes are nearly identical to those of type 1 diabetes and they are:

 

  • Frequent urination
  • Thirst and dry mouth
  • Excessive hunger
  • Weight loss
  • Fatigue
  • Slow healing of cuts or sores or new sores that develop on the body
  • Itchy, red skin in the groin or vaginal area
  • Frequent yeast infections
  • Dark, velvety skin on the neck, in the armpits or groin
  • Erectile dysfunction in men
  • Sudden weight gain (for some people)
  • Numbness or tingling of the hands and/or feet
  •  Loss of vision/blurry vision

 

 

 

These symptoms may develop slowly and may even take years to develop significantly enough for you to notice.

Treatment for type 2 diabetes can prevent symptoms from happening. However, even with treatment, some problems associated with type 2 diabetes may occur.  These conditions include hyperglycemia, ketoacidosis, hypoglycemia, and hyperosmolar hyperglycemic nonketotic syndrome.

High Blood Sugar

Hyperglycemia, also called high blood glucose, can lead to medical complications.  Hyperglycemia can occur for many reasons.  People with type 2 diabetes may have high blood sugar if their body is not using insulin effectively, if they ate more than planned and exercised less than planned, or were sick or stressed.

The warning signs and symptoms of hyperglycemia include high blood glucose levels, high levels of sugar in the urine, frequent urination, and increased thirst.  You should follow your doctor’s instructions for treating hyperglycemia as soon as you detect high blood sugar levels or ketones in your urine—this is very important.  If you fail to do so, ketoacidosis could occur.  If you have ketones in your urine, do not exercise.  Exercising will only make the situation worse.

Ketoacidosis

Ketoacidosis is a serious condition and it can lead to diabetic coma or death. Ketoacidosis occurs rarely in people with type 2 diabetes.  Ketones are acids that accumulate in the blood when your body breaks down fats.  Your body releases ketones through urine.  Ketones appear in urine when the body does not have enough insulin.  Ketoacidosis occurs when all of the ketones cannot be released through urine and the amount of ketones remaining in the blood becomes high enough to poison the body.  Ketoacidosis usually develops slowly, but when vomiting occurs, the condition can develop in just a few hours. 

The first symptoms of ketoacidosis include thirst, dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine.  These symptoms are followed by dry or flushed skin; continual tiredness; nausea, abdominal pain, or vomiting; difficulty breathing; impaired attention span or confusion; and fruity smelling breath.  If you have any symptoms contact your doctor immediately; call emergency services, usually 911; or go to the nearest emergency room of a hospital.  Treatment for ketoacidosis usually involves a hospital stay.

You can help prevent ketoacidosis by monitoring yourself for warning signs and checking your urine and blood regularly.  Follow your doctor’s instructions if you detect high levels of ketones.  If you have high levels of ketones, remember not to exercise. 

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a serious condition that most frequently occurs in older persons with type 2 diabetes.  An illness or infection usually brings on HHNS.  HHNS can cause severe dehydration and lead to seizures, coma, and death.

HHNS triggers dehydration as your body tries to remove excess blood sugar by passing it out of your body in urine.  Urination may be frequent at first, but then decrease.  You may become very thirsty.  Your urine will become very dark.  It is important to drink plenty of liquids to remain hydrated.  Warning signs and symptoms of HHNS include a blood sugar level of over 600 mg/dl, a dry parched mouth, extreme thirst that may gradually disappear, warm dry skin that does not sweat, fever over 101° Fahrenheit, sleepiness or confusion, vision loss, auditory or visual hallucinations, seeing or hearing things that are not there, and weakness on one side of the body.  Call your doctor immediately if you experience any of these symptoms. 

You can avoid HHNS by checking your blood glucose levels regularly.  You need to check your blood glucose levels more often when you are sick or have an infection.  You should work with your doctor and health care professionals to develop a monitoring plan for when you are sick.

Hypoglycemia

Hypoglycemia, also called low blood sugar or insulin reaction, is not always preventable.  Hypoglycemia can occur even if you do everything that you can to manage your diabetes.    Symptoms of hypoglycemia include shakiness, dizziness, sweating, hunger, headache, pale colored skin, sudden moodiness, clumsiness, seizure, poor attention span, confusion, and tingling sensations around your mouth. 

Check your blood if you suspect that your blood glucose level is low.  You should treat hypoglycemia immediately.  The quickest way to treat hypoglycemia is to raise your blood sugar level with some form of sugar—glucose tablets, fruit juice, or hard candy.  Ask your doctor for a list of appropriate foods.  Once you have tested checked your blood glucose level and treated your hypoglycemia, repeat the process again until your signs and symptoms have cleared. 

It is important to treat hypoglycemia immediately or you could pass out.  If you pass out, you need immediate treatment.  You should receive an injection of glucagon.  Glucagon is a medication that raises blood sugar.  You should tell those around you how and when to use it.  If glucagon is not available, you need emergency medical assistance.  Someone should take you to the emergency room of a hospital or call emergency medical services, usually 911.  If you pass out from hypoglycemia, you should not inject insulin or consume food or fluids.

 

 

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Diagnosis

Because the symptoms of type 2 diabetes can come on slowly, your diagnosis may be delayed.  However, if you have risk factors for type 2 diabetes, or have been told by your doctor that you have pre-diabetes, you may be monitored more closely for the development of diabetes.

Urine Tests for Diabetes

Your doctor will test the urine for glucose and ketones.  Ketones are acids that accumulate in the blood and appear in urine when the body does not have enough insulin.  The tests are simple to conduct.  Test strips are simply placed in your urine sample. Your doctor will read the results after a few seconds. 

Blood Tests for Diabetes

Your doctor can also determine if diabetes is present by conducting blood glucose tests.  The Fasting Plasma Glucose Test (FPG) and the Oral Glucose Tolerance Test (OGTT) are commonly used.  The FPG measures blood glucose levels after you have fasted or not eaten for a period of time, usually 6-8 hours.   A normal fasting blood sugar is 70 to 100 milligrams per deciliter.  The OGTT test measures blood glucose levels after fasting and again a few hours after you drink a high-glucose beverage.  The FPG and the OGTT test indicate your blood glucose level for one time on a given day.  

Because blood glucose levels fluctuate from day to day, your doctor can also test how your blood glucose levels have been over a period of three months.  To do so, your doctor will use a Hemoglobin A1c test, also called a glycated hemoglobin or HbA1c test.  The A1c test measures your average hourly blood sugar during the past 90 days.  For someone who doesn't have diabetes, a normal A1C level can range from 4.5 to just below 6 percent.  Someone who's had uncontrolled diabetes for a long time might have an A1c level at 9 percent or above.

When the A1c test is used to diagnose diabetes, an A1c level of 6.5 percent or higher on two separate tests indicates you have diabetes.  A result between 5.7 and 6.4 percent is considered pre-diabetes, which indicates a high risk of developing diabetes.

For most people who have previously diagnosed diabetes, an A1c level of 7 percent or less is a common treatment target.

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Treatment

Treatment of pre-diabetes can return blood glucose levels back to normal and prevent or delay the onset of type 2 diabetes.  Treatment for pre-diabetes includes good nutrition, weight loss, and exercise.  Even a small amount of weight loss, as little 5-10% of your total body weight, can help.  You should also make an effort to participate in moderate exercise, such as walking, for 30 minutes each day, five days per week.

Because people with pre-diabetes have an increased risk for heart disease or stroke, they should be screened and treated for high blood pressure and high cholesterol.  Smokers should find a way to stop.  Not only does smoking raise blood glucose levels, but it can also contribute to heart disease, stroke, high blood pressure, and high cholesterol.

There is no cure for type 2 diabetes, but it can be treated and managed.  Treatment can help stop the symptoms from happening.  Treatment may also prevent or delay the development of medical complications associated with diabetes.  Your doctor and health care team will teach you how to keep your blood glucose levels as near to normal as possible with medication, nutrition, and exercise.

You should carefully follow your doctor’s instructions for monitoring your blood glucose levels.  You will need to check your blood glucose levels throughout the day.  To test your blood glucose level, you will prick your finger with a sharp needle or lancet.  Some newer monitoring devices allow you to prick your forearm or other sites on your body, which may be less painful.  You will place a small amount of blood on a test strip and then insert it into a glucose meter.  The meter will display your results. 

Your doctor will help you establish a schedule for checking your blood glucose.  Make sure that you write down the time that you tested your blood and the result.  Bring your logbook to each of your doctor appointments.  It is recommended that you keep a written log even if your glucose meter can store your results. 

Understanding Insulin

Many type 2 diabetics start out with a pill that’s taken by mouth to try to control blood sugar.  But if this approach, along with weight loss, healthy diet and exercise are unsuccessful, you may need to inject yourself with insulin.  The insulin will help lower your blood glucose level.  Your doctor will let you know how much insulin to use.  It will depend on your weight, what you eat, and how active you are. 

There are different types of insulin that differ in onset, peak time, and duration.  Onset refers to how long it takes the insulin to reach the bloodstream and begin lowering the blood glucose level.  The peak time indicates when the insulin is at its maximum strength.  Insulin duration describes the length of time that the insulin works to lower blood glucose levels.  

Some types of insulin may be used alone or with another type of insulin for maximum effect.  Additionally, there are new types of medications that enhance the way that insulin works.  Medications may require mixing or they may be purchased in a convenient premixed pen.  Ask your doctor about which medications are right for you.

Before meal rapid-acting insulins should be injected 15 minutes before a meal.  These types of insulins work about 15 minutes after they are injected, peak in an hour, and continue to work for 2 to 4 hours.  Before meal rapid-acting insulins leave the bloodstream quickly and reduce the chance of hypoglycemia after meals.  After meal rapid-acting insulins are well-suited for children because it can be difficult to predict how many calories a child will eat prior to a meal.  After meal rapid-acting insulins are also useful for people with delayed stomach emptying.

Short or regular-acting insulins reach the bloodstream within 30 minutes after they are injected, peak in 2 to 3 hours, and continue to work for 3 to 6 hours.  Short-acting insulin is often used with another type of insulin, intermediate-acting insulin.  Intermediate-acting insulins reach the bloodstream 2 to 4 hours after they are injected, peak 4 to 12 hours later, and continue to work for about 12 to 18 hours.  

Insulin Delivery Methods

Insulin can be administered in a variety of ways that are easy and relatively painless.  Insulin delivery methods include small needles, a pen, or a pump.  Needles are smaller than ever before and have special coatings that make injecting easy and nearly pain-free. 

An infuser may be used to reduce the number of daily injections.  An infuser or a portal is a catheter device that is placed into your skin.  Insulin injections are given into the infuser instead of your skin.  An infuser can remain in place for 48 to 72 hours.

The insulin pump is a small device that you can wear on your belt or carry in a pocket.  Insulin travels through soft plastic tubes to a catheter that is placed in the skin.  Some insulin pumps allow the catheter to remain in place while only needles are removed.  The insulin pumps are computerized to deliver steady doses of insulin and surge doses, per your instructions.  This continual release is most like the normal insulin production your body would make on its own.  You will need to check your blood glucose levels more frequently than with other delivery methods.  However, many people prefer the pump because it allows them to have a more flexible lifestyle.  Newer pumps now offer a wireless version that holds a pre-set amount of insulin and stays in place for athletics, and even swimming.  Many diabetics enjoy the freedom a wireless pump gives.

Jet injectors deliver insulin without using needles.  Jet injectors force insulin through the skin with pressure.  In some cases, this method may cause bruising. This method is used less often than injections or pumps.

Counting Carbs for Better Control

Blood sugar management is further improved with carbohydrate counting and bolus insulin doses at meals.  This method works best for type 2 diabetics who use an insulin pump or take several injections throughout the day, but carbohydrate control is also extremely helpful for diabetics who do not take insulin.  Most diabetics will have a basal dose of insulin that is released steadily around the clock, but will also require bolus doses with meals.  Carbohydrate counting gives diabetics more flexibility at meals by counting the carbs in the meal and then giving a bolus or extra dose of insulin for it.  This prevents blood sugar highs and lows and gives steadier blood sugar management.

Carbohydrates are the component of food that contribute most to the post-meal blood sugar reading and are the main factor that determines how much insulin should be taken.  For some patients, a nutritionist or other medical provider will establish a ratio of insulin to carbohydrate to follow for meals.  Based on blood sugar readings over time, ratios may be adjusted by your doctor but can range from 1 unit per every 5 carbohydrates consumed to 1 unit for every 30 units consumed or anything in between.  Diabetics will base their insulin dose on the number of carbohydrates in the meal.  To count carbohydrates, diabetics must use the nutritional information on the food’s package or carry a reference to determine the number of carbohydrates in a particular food paying close attention to portion sizes.  Books may be purchased for this, or you may even purchase an app for your phone.

Diabetes Supplies and Tools

Purchasing diabetes care supplies can be confusing.  You should select the products that you are most comfortable with and that you will use.  The American Diabetes Association has an extensive list of diabetes care supplies in their Resource Guide.  The Resource Guide provides detailed information that allows you to compare the features of various products.  You should also talk to your health care professionals for product advice, demonstration, and trial.

Blood glucose meters have advanced over the past 20 years.  They have become easier to use and there are many types to choose from.  Some meters are easier to use than others.  Most meters provide results in less than a minute.  Some of the newer meters display results in just five seconds.  “Talking” meters are helpful for people with visual impairments.  The talking meters provide verbal instructions and results.  Some of the units are available in Spanish and other languages.

You should take your time when deciding on a glucose meter.  You should select the one that you are the most comfortable with because you will be using it regularly.  When purchasing a blood glucose meter, check to see if your insurance company covers the meter and the care supplies, such as the test strips.  You should compare prices for items not covered by insurance.  

For many years, insulin was given with a syringe and needle, but newer alternatives offer delivery with

Some methods of insulin delivery have been approved that allow the patient to spray insulin into his nostrils.  Speak to you doctor and find out if this method is an appropriate treatment option for you.

Scheduled Screenings and Maintenance

Every few months, you will need to have your doctor check your blood glucose average with an A1c test.  The A1c test measures your blood glucose level average for the course of about three months.  Your doctor will use this information to alter your course of treatment, if necessary. 

You will also need to test your urine per the guidelines set by your doctor.  People with type 2 diabetes should test their urine for ketones when their blood glucose level is high.  Urine testing involves placing test strips in your urine sample and reading the results after a short period of time. 

 Managing type 2 diabetes also includes a nutritional component.  Your doctor or a registered nutritionist can help you plan what to eat to help regulate your blood glucose levels, cholesterol, and blood pressure.  A balanced meal plan includes a wide variety of foods, particularly vegetables, whole grains, non-fat dairy products, beans, lean meats, poultry, and fish.  Your health care professional can help you learn to read nutrition labels, measure portion sizes, and plan balanced meals.

Exercise is another important element for managing Type 2 diabetes.  Exercise may help to lower your blood glucose level, blood pressure, and cholesterol.  It also may help your body use insulin better.  You should strive for a combination of aerobic activity, strength training, and stretching.  Ideally you should exercise aerobically for 30 minutes a day, five days per week.  You can break the time period into three ten minute segments throughout the day or exercise for the entire 30 minutes.  Aerobic exercise includes physical activities that work your heart, lungs, and vascular system, such as quick walking, riding a stationary bike, or running.

In addition to managing your blood sugar, eating smart, and exercising, you should also maintain appropriate cholesterol and blood pressure levels.  It is also important not to smoke.  Smoking increases blood sugar and can contribute to the development of medical complications.  It is important that you take care of yourself daily and keep all of your doctor appointments. 

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Prevention

Pre-diabetes can be treated and prevented.  You may even be able to return your blood glucose level to the normal range.  If you are at risk for pre-diabetes or suspect that you may be having symptoms talk to your doctor as soon as possible and ask to be tested.

Some doctors suggest that people at risk for type 2 diabetes be screened starting at age 30. If you are at risk or experience the symptoms of type 2 diabetes, you should contact your doctor.  Some factors such as heredity, ethnicity, and family history cannot be changed.  However, you can change your lifestyle to help prevent or delay type 2 diabetes.

Generally, it is helpful to reduce your weight and pay special attention to the “big belly”.  Having a large abdomen can be indicator a high amount of visceral fat—or fat that surrounds the organs inside the belly.  Visceral fat and obesity has been shown to impair the way that insulin works and contributes to insulin resistance.  Ask your doctor to recommend diet changes, nutrition plans, and exercise programs that are right for you.

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Am I at Risk

Risk factors may increase your likelihood of developing type 2 diabetes.  People with all of the risk factors may never develop the disease; however, the chance of developing diabetes increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Type 2 diabetes is occurring in children and adults of all ages as obesity rates increase.  Additionally, people of ethnic minority groups, including African Americans, Native Americans, Hispanics, Latinos, Asians, and Pacific Islanders, develop diabetes more frequently than Caucasians.

Risk factors for Type 2 diabetes include:

  • Family History of diabetes is associated with an increased chance of developing type 2  diabetes.  If your parents, brothers, or sisters have diabetes, your risk increases.
  • Obesity and particularly carrying weight on the abdomen is a risk factor.  Obesity can promote insulin resistance and reduce the use of insulin.
  • People over the age of 45 have an increased risk because as people age, they are less able to process glucose appropriately.
  • High blood pressure increases the risk of developing diabetes.  The mechanism is unclear, but it appears that the higher the blood pressure, the worse the insulin resistance.
  • High cholesterol increases the risk of developing diabetes.  Insulin resistance is associated with low HDL levels or good cholesterol, and high triglyceride levels.
  • Inactive people or people who do not exercise regularly are at an increased risk for diabetes.  They may have higher blood sugar levels from lack of exercise.  Exercise helps to move glucose out of the bloodstream. 
  • Women who developed gestational diabetes during pregnancy or delivered a baby weighing over nine pounds have an increased risk of developing type 2 diabetes later on in life.
  • Women with Polycystic Ovary Syndrome (PCOS) have an increased risk because of irregular hormone production that can cause insulin resistance and diabetes.

Many doctors believe in testing for pre-diabetes at age 30 for people with a family history of diabetes or who are overweight.  You should be tested for pre-diabetes if you have any of the risk factors for diabetes that are listed above or if you have previously had an abnormal glucose tolerance test or impaired fasting glucose level.

 

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Complications

In addition to managing your blood sugar, eating smart, and exercising, you should also maintain appropriate cholesterol and blood pressure levels.  It is also important to not smoke.  Smoking increases blood sugar and can contribute to the development of medical complications.  It is important that you take care of yourself daily and keep all of your doctor appointments.  Type 2 diabetes may be a lifelong condition however, you can still live a healthy, happy, and long life with good care.  

Many people with diabetes also have high cholesterol and high blood pressure.  These three factors combined—diabetes, high cholesterol, and high blood pressure, increase the risk of developing a variety of serious medical complications.  Some of the symptoms may be obvious, while others may be subtle and develop over time.  It is important that you monitor yourself for signs and symptoms of medical complications and complete all screenings recommended by your doctor.  Report any concerns to your doctor promptly.  The following paragraphs describe some of the medical complications associated with type 2 diabetes.  

Heart and Cardiovascular System

Type 2 diabetes is associated with an increased risk of coronary artery “heart” disease, heart attack, and stroke.  Heart disease is the leading cause of diabetes related death in the United States.  Coronary artery disease causes the vessels that carry blood to your heart to narrow.  They can also become completely or partially blocked by fatty deposits.  A heart attack occurs when the heart does not receive blood or does not receive enough blood.  A stroke occurs when the brain does not receive blood or does not receive enough blood.  A heart attack or stroke can be fatal.  They can also cause permanent or temporary impairments and disability.

Kidney and Renal System

Kidney disease, also called nephropathy, can also be caused by diabetes.  Your kidneys remove waste products from your blood.  Diabetes can damage the filtering system in the kidneys resulting in kidney disease or kidney failure.  Persons with kidney failure need dialysis, a process in which a machine filters the blood.  Some people may even need a kidney transplant.

Eye Health

People with diabetes have a higher risk of eye problems and blindness than those who do not have diabetes.  A long history of diabetes and older age are factors associated with developing glaucoma.  Glaucoma occurs when pressure builds up in the eye and causes gradual vision loss. People with diabetes tend to develop cataracts at a younger age and at a quicker rate than people without diabetes.  Cataracts cause the clear lens in the eye to become cloudy, diminishing vision.  

Diabetic retinopathy or retinal disorders can also be caused by diabetes.  The retina is the part of your eye that receives images. Nonproliferative retinopathy is a condition that affects the capillaries in the retina.  Retinal swelling can cause vision loss.  In some people, retinopathy progresses to a more serious condition called proliferative retinopathy.  The blood vessel damage caused by proliferative retinopathy causes scarring and eventual retinal detachment destroys vision.

Nerves and Neurologic System

Nerve damage caused by diabetes is called diabetic neuropathy.  Nerves carry messages between your brain and body about pain, temperature, and touch.  They also control your muscle movements and organ systems, such as the processes for food digestion and urination.  Sensorimotor neuropathy and autonomic neuropathy are two common types of nerve damage.

Sensorimotor neuropathy affects sensation and movement.  It may cause your feet and hands to feel weak, tingly, numb, or painful.  Autonomic neuropathy affects the nerves that regulate involuntary functions or actions that you cannot directly control, such as your heartbeat.  Of great concern, it can cause a loss of the typical warning signs of a heart attack or low blood glucose levels.  Autonomic neuropathy can cause dizziness or faintness.  It can also create problems with digesting food; vomiting, diarrhea, or constipation; bladder function; sex; increased or decreased sweating; and changes in the way the eyes function in the dark or light.

Diabetes can often lead to nerve damage called peripheral neuropathy.  Peripheral neuropathy is a condition in which nerve function deteriorates in the limbs.  This leads to a gradual loss of feeling in the hands, arms, legs, and feet.  This is often problematic because pain is what enables you to know when something is wrong.  Without pain, you may not realize that you have bruises, cuts, blisters or burns and seek medical treatment.  It is important that people with diabetes receive medical treatment for foot sores because diabetes-related circulation problems can lead to more medical conditions.

Conditions of the Feet

The feet are very vulnerable to diabetes-related complications.  There are a variety of foot problems that can occur.  Foot problems are the leading reason for diabetes-related hospitalization.  Further, diabetes is the leading cause of lower leg and foot amputation.  Diabetes-related foot conditions are most frequently caused by poor blood circulation, infection, and nerve damage that can result in ulcers or sores, deformities, and trauma.

Peripheral vascular disease is a common diabetes-related circulation disorder.  Poor circulation results in reduced blood flow to the feet.  It can restrict the delivery of oxygen and nutrients that are required for normal wound maintenance and repair.  As a result, foot injuries, infections, and ulcers may heal slowly or poorly.  Minor skin problems on the feet can become worse and lead to infection.

Wounds and injuries can be difficult to heal if diabetes is uncontrolled.  This can be especially true of wounds in the feet.  Infections tend to get worse or remain undetected, especially in the presence of diabetic neuropathy or vascular disease.  Neuropathy can cause you to be unaware of wounds.  Additionally, the increased pressure from the feet carrying the body weight aggravates foot wounds.  Further, shoes can cause skin friction, rubbing, and tearing.  The hot moist environment of shoes is favorable to infection and foot ulcers.  Foot ulcers are sores caused by skin breakdown.  They can be exacerbated by infection.  Foot ulcers tend to develop over areas of high pressure, such as bony prominences or foot deformities. 

Foot deformities are another common problem associated with diabetes.  They occur when the ligaments and muscles that stabilize the foot bones deteriorate.  This can cause the bones to shift out of position or an arch to collapse.  

A hammertoe deformity is a common condition that occurs most frequently in the second toe, although it can be present in more than one toe.  Increased pressure on the tips of the toes and the lack of muscle stability causes a joint in the toe to become permanently flexed with a claw-like appearance.  The toe deformity and pressure displacement makes the toe susceptible to skin ulcers.

Charcot foot is another common foot deformity associated with diabetic neurogenic arthropathy.  Neurogenic arthropathy is a progressive degenerative arthritis that results from nerve damage. Charcot foot most frequently affects the metatarsal and tarsal bones located in the midfoot and forefoot.

Charcot foot causes the foot muscles, ligaments, and joints to degenerate or break down.  Without support, the foot becomes wider and deformed.  Without joint stability, the foot becomes unstable, making walking difficult.  Inflammation and pressure eventually can cause bone dislocation.  

People with Charcot foot have impaired or absent abilities to feel pain, temperature, and trauma.  They may not be able to sense the position that their foot is in.  This makes them vulnerable to injury, such as fractures, sprains, joint dislocation, bone erosion, cartilage damage, and foot deformity.  They may even continue to walk on a broken bone without knowing it, because they cannot feel it.

Skin Conditions

People with diabetes are generally more prone to skin infections and skin disorders compared to those without the disease.  People with diabetes have a greater tendency to get bacterial infections, fungal infections, and itchy skin.  Some skin problems happen mostly to or only to people with diabetes. 

Bacterial infections tend to manifest as sties on the eyelid, boils, infected hair follicles, deep infections under the skin, and nail infections.  Bacterial infections cause the skin to become hot, swollen, red, and painful.  Fungal infections are caused by yeast-like organisms that can grow and spread in diabetics whose sugar levels are uncontrolled.  They create itchy rashes in moist areas of the skin.  Common fungal infections include jock itch, athlete’s foot, ringworm, and vaginal infections.  Both bacterial infections and fungal infections can be treated with prescription medication.

Diabetic dermopathy and necrobiosis lipoidica diabeticorum (NLD) are similar skin disorders caused by changes in the blood vessels.  Both conditions cause brown spots to appear on the skin.  Diabetic dermopathy is harmless, but NLD can cause the skin to crack and bleed.  NLD is a rare condition affecting mostly adult women.  Open sores need to be treated by a doctor.

People with diabetes tend to get atherosclerosis at a younger age than people without diabetes.  Atherosclerosis causes the arteries to thicken, narrowing the route for blood flow.  It results in skin changes.  The skin becomes hairless, thin, cool, and shiny.  The toes become cold, and the toenails thicken and discolor.  Atherosclerosis can also cause wounds to heal more slowly or become infected because of a lack of blood flow.

Digestive System

People with type 2 diabetes can experience gastroparesis, a stomach disorder in which the movement of food is slowed or stopped.  Gastroparesis occurs when high blood glucose levels damage the vagus nerve and the nerves that regulate stomach functioning over a period of time.  The muscles in the stomach and intestines stop working properly.  Signs and symptoms of gastroparesis include heartburn, nausea, vomiting, feeling full early when eating, weight loss, bloating, erratic blood glucose levels, lack of appetite, reflux, and stomach spasms.  

If food stays in the stomach too long it can be dangerous.  Delayed stomach emptying can lead to bacterial overgrowth and stomach or intestinal obstructions.  Medications and nutritional changes can treat gastroparesis.  In severe cases, a feeding tube may need to be inserted to deliver nutrients to the small intestine. 

Mental and Psychological

Finally, people with diabetes have a greater risk of depression than people without diabetes.  Depression is a real medical condition that can be treated.  Depression is not a “normal part” of every ay life.  Symptoms of depression include continually feel sad, irritable, tired, and uninterested in activities that you used to find enjoyable.  Other common symptoms of depression include changes in appetite, having difficulty getting a good night’s sleep, moving the body at a much slower pace, and not being able to remember things or concentrate as easily as before. 

Doctors are not exactly sure why people with diabetes are at risk for developing depression.  They suspect that people cope with diabetes management differently.  Additionally, some of the symptoms of low or high blood sugar can cause symptoms that look like depression.  You should discuss your concerns with your doctor in order to receive appropriate diagnosis and treatment.

Preventing Complications

Wear a MedicAlert bracelet and carry a MedicAlert card in your wallet.  In the case of an emergency, the MedicAlert information will be helpful to the healthcare professionals treating you.  Because the medical complications associated with diabetes can be serious and life-threatening, people that develop type 2 diabetes need to diligently manage their disease to remain healthy.  The following are suggestions for preventing complications from diabetes.

Monitor your blood glucose levels carefully, and treat yourself with insulin daily, as instructed by your doctor.  Make sure that your write down the time that you tested your blood and the result.  Take your logbook to each of your appointments.  See a physician regularly to prevent and stay on top of any problems that might develop.

Eat a balanced diet and consult a nutrition expert for help with meal planning.  Exercise regularly and reduce your weight if you are overweight.  Even losing small amounts of weight is helpful for diabetes management.

Monitor your blood pressure.  Ask your doctor what your blood pressure should be, and contact your doctor when it is out of range.  You should also keep your cholesterol within normal limits.  Have regular cholesterol checks throughout the year, and follow your doctor’s instructions for lowering cholesterol.  

People with diabetes should have an eye exam at least once a year.  The eye examination should include screening for glaucoma, cataracts, and diabetic retinopathy.  

Attend all of your scheduled medical appointments.  Your feet should be inspected at every visit.  Discuss any concerns about depression with your doctor as well.

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Advancements

Prevention, technology, and research have greatly improved the management of this diabetes.  Sugar-free foods, new types of insulin, and easy-to-use insulin delivery methods have made diabetes management more convenient.

Increasing knowledge and more aggressive detection and management of diabetes by physicians is also helping patients live longer lives with fewer complications.  Over the last decade, more and more new classes of medications have been introduced to the market that change the way the body absorbs and manages its glucose stores.  Some of these methods include injecting specific hormones or taking combination drugs that lower blood sugar and reduce the number of medications patients take every day.

The American Diabetes Association’s Resource Guide is a great resource for new products, treatment plans, medications and lifestyle suggestions that may be beneficial in your fight against the development of type 2 diabetes or management of the disease if you already have it.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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