What is Type 2 Diabetes and How Can I Control It?

Entire textbooks are written about diabetes, and this blog will only scratch the surface of this condition. The goal is to give a simple overview of this condition, and why it is important to understand.

Alabama and Mississippi have the highest rates of diabetes and obesity in the nation. This is not a coincidence. Type 2 Diabetes is a condition where your body's cells become resistant to insulin, and as a result, blood glucose levels rise. This results in potential short term harm, and long term harm. The short term potential harm is the risk of a condition called ketoacidosis, which can be fatal if not treated aggressively when discovered. The long term potential harms include deterioration of four major organs - eyes, kidneys, nerves, and heart. 80% of all diabetic die of heart disease. My goal in educating people about diabetes is to reduce this number.

Unlike type 1 diabetes, which is a lack of insulin production, type 2 diabetes initially results in increase of insulin production, but due to the resistance to this insulin, the blood glucose rises.

Symptoms of type 2 Diabetes include excessive thirst, hunger, unexplained weight loss, excessive urination, blurry vision, fatigue, poor would healing, irritability. Presence of these symptoms should trigger a visit to your doctor to discuss if you have diabetes or if the symptoms are from some other condition.

Treatment of diabetes starts with dietary changes. The most important dietary change is to reduce your caloric intake, and decrease carbohydrate consumption. Carbohydrates include sugar, bread, potatoes, rice, and pasta. When the body needs to store excess carbohydrates, it puts it in the liver and into muscles in the form of glycogen. Then, when the body needs more carbohydrates than you are feeding it, it will pull the glycogen from these locations (this is the mechanism of the Atkins diet).

Exercise is very important, because it burns calories while exercising, and it also increases your metabolic rate while you are resting, so you actually burn more calories even when you are resting. Diet and exercise are an important combination that can help you to control your blood sugar levels. Diet without exercise is only as effective as the diet, without the synergy of the exercise component.

Medications may be necessary to control your blood sugar - the most widely used starting agent is called Metformin - this is a tablet that is inexpensive. Other medications we commonly use include sunfonureas like glyburide and glipizide, DPP4 inhibitors like Januvia. There are newer agents on the market that actually have a protective effect on the heart - one class is called a GLP-1 agonist, such as Victoza. Another class is called SGLT-2 antagonists, such as Jardiance or Invokana. We have moved away from the TZD class of diabetic meds (example Avandia) since they cause fluid retention, and can worsen heart failure. Your doctor will determine the best regimen for you, that works with your disease and your budget.

If one does not effectively control their diabetes, they are more likely to develop, over time, complications from the chronic high glucose levels. There are four main complications to be aware of: nerve dysfunction, kidney failure, retina disease, accelerated vascular disease.

1. Nerve dysfunction most commonly affects the longest nerves in the body, specifically the ones traveling from your spine to your feet. If those nerves are damaged, you can lose sensation in your feet, and may not feel a cut or scrape, increasing the risk of that injury becoming an open wound. As we already know, wounds take longer to heal in diabetics. Sometimes, wounds don't get sufficient blood supply due to the vascular disease diabetes accelerates. When this happens, wounds can get worse, and the tissue may die, resulting in gangrene. This can result in amputation of a foot or a leg.

2. Kidney failure from diabetes is the second most common reason for patients to go on dialysis, second only to high blood pressure. When kidneys don't work, patients become anemic (kidneys make blood cells) and they may need dialysis, a mechanical blood filtration system. Patients with kidney failure deposit more calcium in the arteries, which increases the plaque buildup inside arteries. Platelets don't work as well in kidney failure patients, so they are more likely to bleed longer.

3. Retina disease causes visual loss over time, and will eventually result in blindness. Laser surgery can delay this process (cannot restore vision, but delays the deterioration), but strict glucose control can prevent it. This is one of the most feared complications from uncontrolled diabetes. Loss of vision almost always results in a patient's loss of independence.

4. High blood glucose accelerates the buildup of plaque and cholesterol in arteries - if those arteries become narrowed from the plaque, they can close off completely. In the brain, this vessel closure is called a stroke. In the heart, it is called a heart attack. In the legs, it is called peripheral arterial disease. Untreated PAD can lead to amputation of the limb. We know that 80% of all diabetic die of heart and vascular disease. The only way to prevent this from happening is with tight control of your blood sugar.

If you think you or someone you love has symptoms of diabetes, see your doctor and ask what can you do to prevent the disease from shortening your life. It can be controlled and you can manage it in a way that you don't develop these complications.

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