Type 2 Diabetes

Of the different types of diabetes, Type 2 is by far the most common. It is sometimes referred to as age-related or maturity onset as it is more common in middle or later life. It is also referred to as Non-Insulin Dependent Diabetes Mellitus or NIDDM for short.

Type 2 mainly affects people over 40 and is more common in people who are overweight. The condition develops slowly and can go undetected for many years. Control can sometimes be gained by changes to diet alone, but oral drugs and sometimes insulin can become necessary.

In this condition the pancreas continues to secrete insulin, but the cells of the body become resistant to its effects. There is usually a combination of a partial failure of insulin production and a reduced response in the body to the hormone insulin.

This is often referred to as insulin resistance. When insulin supply fails, an increase in the blood glucose level results. The increase in sugar in our systems means that germs and infections can breed and develop more easily. Treatment is therefore aimed at regulating blood glucose levels.

The causes of Type 2 diabetes are not fully understood, although genetics (inherited genes) and being overweight are thought to be contributing factors. It is important that the condition is diagnosed as soon as possible, so that treatment can be prescribed and the risks of diabetic complications greatly reduced.

Many people only find out that they have diabetes when
they visit their GP with an associated diabetic complication.

Symptoms

Symptoms can range from nothing at all, to excessive thirst and passing lots of water, weight loss, tiredness, blurred vision, infections and a general feeling of being unwell.

Although the symptoms of both types of diabetes are similar, Type 1 tends to develop more quickly and severely than Type 2. It normally takes a routine medical check to discover Type 2 diabetes whereas in Type 1 diabetes the symptoms become very clear in a short space of time.

Diagnosis

There are many ways diabetes can be detected whether the symptoms are obvious or not. Your optician could refer you to your GP, if an eye test shows that you have signs of damage to the blood vessels in your eyes, as this might be due to diabetes, or you may simply have a test for diabetes during a routine medical examination. Once diabetes is suspected your doctor will ask for a blood test and urine test, which will confirm the diagnosis.

The most appropriate form of treatment can then be discussed in order to control the condition. In most cases it is quite obvious whether or not you have diabetes from the blood and urine tests, but occasionally it is necessary to refer you for more tests if your levels are borderline. You may hear the term Impaired Glucose Tolerance (IGT) which is used to describe people with higher than average levels, who do not actually have diabetes. Other people can suffer from Low Blood Sugar, but again, may not be diabetic.

Early diagnosis is vitally important to reduce the risk of diabetic complications and so testing for diabetes is becoming increasingly popular.

Diet

Diet is a crucial part of the treatment of all types of diabetes. Contrary to popular belief, your diet does not necessarily have to become a restrictive or regimental affair - you only have to follow the sensible healthy diet that is recommended for everyone. Basic points to consider are to eat regularly, (a common phrase is little and often) including some starchy carbohydrate food with each meal and opt for high-fibre versions where there is a choice. Limit intake of sugary items, use salt sparingly, do not drink too much alcohol and reduce the fat content in your diet. There is a diet section on this website and you should also speak to your GP or Dietician for individual help. If in doubt remember that you should opt for low everything and when indulging have a small taster rather than a big chunk!

Tablets

When you are on tablets there are four main types. Your GP should give you all the necessary advice regarding your treatments. The main types of tablet are listed below.

Sulphonylureas

These tablets work by stimulating the pancreas to release stored insulin. Although you are not actually taking insulin by injection, because the tablets increase insulin production, your blood glucose level could fall too low and you may experience the hypoglycaemia. To prevent this happening it is recommended that you eat regularly and take your pills either with or just before a meal. These tablets can make you feel hungry and it is important to control your urge to overeat to avoid putting on excess weight. There is a section on this website about Hypo's to help you recognize the symptoms. In a similar fashion to insulin, these tablets can be short, medium or long acting.

Biguanides

It is believed that these tablets slow down the absorption of glucose from the intestines. They are not recommended for people with liver or kidney problems. It is unlikely that glucose levels will drop dangerously low with these tablets, as they do not stimulate the release of insulin. People who are overweight are often prescribed these tablets, as they do not tend to make you feel hungry. Low initial doses may require increasing as the body becomes used to the tablets.

Acarbose

These tablets work by interfering with the breakdown of carbohydrates into sugar, which means your body's ability to absorb glucose from food is inhibited. As a result, an increase of sugars remaining in the stomach, can then lead to an increase in bacteria, as this is the ideal environment for them to breed. Nevertheless, you may still require these tablets as part of your treatment.

Thiazolidinediones

This drug improves sensitivity to insulin, enabling it to lower blood glucose more effectively. It does not stimulate insulin release however, so hypoglycaemia should not be a problem.

As with all drugs, there can be side effects and if you do experience any problems your GP will advise you.

Ongoing clinical trials and research will provide more answers in years to come and enable all the treatments available for diabetes to be improved.

The above tablets are all grouped under the term oral hypoglycaemic agents (OHA's) and can be taken alone or in combination. Normally, a sensible balance of diet, exercise and tablets is sufficient to control your diabetes although it may take a while to find out which combination suits you best. Refer back to your GP if your levels are higher than they should be, as there may be a more suitable alternative for you.

Some people with Type 2 Diabetes may need insulin injections in order to control their blood sugar levels. This can take some adjusting to and if it happens to you, you will have access to expert advice from a Diabetes Specialist Nurses and your GP.

This website also contains information about injections.

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