Type 2 Diabetes is a chronic metabolic lifestyle disorder characterised by varying levels of insulin resistance and a relative absence of effectively functioning insulin levels.
Paradoxically there are high insulin levels for which body cells are resistant to allow glucose entry into the cells. Hence, glucose does not enter cells to give energy and sugar increases in the blood.
Diagnosis Of Diabetes
American Diabetes Association(ADA) recommendations
| Result* | A1C Test | Fasting Blood Sugar Test | Glucose Tolerance Test | Random Blood Sugar Test |
| Diabetes | 6.5% or above | 126 mg/dL or above | 200 mg/dL or above | 200 mg/dL or above |
| PreDiabetes | 5.7 – 6.4% | 100 – 125 mg/dL | 140 – 199 mg/dL | N/A |
| Normal | Below 5.7% | 99 mg/dL or below | 140 mg/dL or below | N/A |
Incidence of Type 2 Diabetes
China is the leading country in Diabetes population followed by India. It is increasing at a very high rate because of our unhealthy lifestyle and urbanisation.
Risk factors for Type 2 Diabetes
- Obesity
- Hypertension
- Family history of Diabetes
- For females - PCOD, gestational Diabetes
- Metabolic syndrome
- Age 45 yrs and above
- Sedentary lifestyle
- High cholesterol- high triglycerides and LDL, low HDL
- Certain drugs - steroids, thiazide diuretics,
What are the tests to detect and confirm Type 2 Diabetes?
- Best test to detect Diabetes early is OGTT - oral glucose tolerance. Here 75 gms of oral glucose is given to drink and blood sugars are tested after 2 hours.
- Fasting and Postprandial insulin levels can be checked to detect insulin resistance and prevent Diabetes even before the frank onset of Diabetes. Normal fasting insulin levels must be between 2 to 20 microunits/ml. Normal postprandial insulin levels are between 5 to 55 microunits/ml.
- HbA1c is a standard reliable test to confirm the diagnosis of Diabetes.
Treatment for Type 2 Diabetes
Drugs
There are many antidiabetic drugs for Type 2 Diabetes. They fall under the following groups,
- Drugs to increase insulin sensitivity. Example: Metformin, pioglitazone.
- Drugs to increase secretion of insulin from the beta cells of the pancreas. Examples include Sulfonylureas like glimepiride, gliclazide, and Meglitinides like Repaglinide.
- Drugs to slow the absorption of carbohydrates in the gut. Example: Alpha-glucosidase inhibitors like acarbose and voglibose.
- Drugs to increase the action of GLP 1 in the gut. Example: GLP agonists like liraglutide and Gliptins like vildagliptin.
- Drugs to increase urinary excretion of excess glucose. Example: SGLT 2 inhibitors like dapagliflozin.
In addition to the above, different types of insulin injections are available depending on the duration of action and onset of action.
- Regular or short-acting insulin
- Rapid-acting insulin. Example: Aspart
- Intermediate-acting insulin. Example: NPH
- Long-acting insulin. Example: glargine, levemir
- Ultra long-acting insulin. Example: Degludec
- Mixed insulins where both short-acting and long-acting insulins are mixed. Example: Mixtard.
Insulin injections are available in vials, disposable and reusable pens and cartridges.
In addition to the drugs, the following lifestyle changes should be followed to control the sugars very well.
Diet
- Low carbohydrate diet
Low glycemic load and low glycemic index foods are to be included.
Glycaemic index is a number indicating the measure of how quickly carbohydrates break down and the body is able to absorb them. This will affect how quickly the blood sugar level rises in the body
The GI categorises food into high, medium and low by ranking them on a scale of 1 - 100. Food with a low glycaemic index is food that has a ranking of 55 or less.
- High fibre intake in the form of green, non-starchy vegetables.
- High protein like lentils, pulses, eggs and fish.
- Normal fat content is recommended.
5. Fruits are necessary because of antioxidants, minerals, vitamins and fibre content. They play a vital role in preventing diabetic complications. Avoid fruit juice.
6. Consume food rich in Vitamin D, Magnesium, Selenium and Chromium.
Micronutrient deficiencies in the body may also lead to high blood sugar levels. Therefore, including food that is rich in magnesium and chromium can improve fat and carbohydrate metabolism.
This will regulate the blood sugar level in the body. Some foods like meat, whole grains, vegetables, fruits and nuts are rich in chromium, while dark leafy vegetables, pumpkin seeds, tuna, dark chocolate, bananas and beans are rich in magnesium.
Maintain healthy body weight
Maintaining a healthy weight promotes optimal blood sugar levels and reduces the risk of developing various heart diseases and Diabetes.
Physical activity
Any physical activity for a period of 30 minutes 5 days a week is recommended. 2 days of strengthening exercises is to be added to this regime to build up muscles and increase insulin resistance.
Sleep
Poor sleep increases blood sugar levels. A normal human needs 7 to 9 hours of good sound sleep every day. So, develop healthy sleep hygiene to control your blood sugars.
Stress
Stress increases blood sugar levels very drastically. So, pay attention to your stress levels. Develop your personalised ways to manage them.
- Listening to music
- Meditation
- Breathing exercises
- Hobby
- Social networking
- Gratitude journaling
- Spirituality
Can Diabetes complications be prevented?
YES!!! Follow the given medical advice and regularly visit your doctor.
- Maintain your blood sugars within the target range. Time in range is the duration of time your sugars are maintained within a normal range. It should at least be 70 % for a single day. Use continuous glucose monitoring systems (CGMS) to keep your sugars within time in range.
- Check your HbA1c levels every 3 to 6 months.
- Regularly do lab tests like spot urine microalbumin and urine protein creatinine ratio once every 6 months for early detection of kidney damage.
- Regularly do retinal screening for early detection of diabetic eye damage.
- Cardiac evaluation is also a must because heart attacks in diabetics are silent. Coronary calcium scoring (CAC score) is a non-invasive early investigation for the detection of coronary lesions to prevent heart attack.
- Regularly self-examine your foot for any signs of nerve damage.
- Self-management of Diabetes is a very important skill to acquire because your knowledge will help you to detect early warning signs and get a doctor’s help immediately whenever it is needed.
Can one prevent Type 2 Diabetes?
YES!!! It is possible to prevent or postpone the development of Diabetes if detected early in life and healthy lifestyle measures are adopted. Prediabetes is the early stage before developing full-blown Diabetes.
Can Type 2 Diabetes be reversed?
YES!!! It is possible to reverse Type 2 Diabetes by following a strict diet, losing weight and adopting healthy lifestyle changes.
