Type 2 diabetes is a disease characterized by chronic hyperglycemia, that is, by too much glucose (sugar) in the blood. This disease usually occurs in older adults and affects more obese or overweight people.

In a healthy individual, blood sugar is controlled by insulin, a hormone secreted by the pancreas. Insulin allows sugar to enter cells for use as fuel, especially in muscles and the liver. In a person with type 2 diabetes, the body becomes unable to regulate blood sugar levels, which is the level of glucose in the blood. This is when blood sugar levels rise (this is called hyperglycemia). In the long term, if blood sugar levels are not lowered by treatments, it can cause serious health problems, especially cardiovascular problems.

This chronic disease requires individualized treatment and close monitoring by the affected person and a medical team. Healthy lifestyles are the basis of treatment. If these habits are not enough to lower blood sugar, medication can be used.

There are 2 main forms of diabetes, type 1 diabetes and type 2 diabetes, both characterized by chronic hyperglycemia.

Type 1 diabetes occurs in young people and often develops in childhood. It is caused by autoimmune destruction of the pancreas that no longer produces insulin. The cause is poorly understood and there is currently no possible prevention. People with the condition are therefore dependent on insulin, which must be given by injection.

As for type 2 diabetes, which accounts for 90% of diabetes cases, it occurs later in life. It is mainly due to a state of insulin resistance and is associated with being overweight.

A rapidly growing disease

The number of people with type 2 diabetes is growing steadily and this trend is attributed to the “Western” lifestyle, which is associated with a sedentary lifestyle and obesity, as well as an aging population. Globally, the International Diabetes Federation predicts that the number of people with diabetes could rise from 285 million in 2010 to 438 million in 2030.

In the United States, more than 9% of the population have diabetes according to the Diabetes Research Institute. This risk of getting diabetes increases with age, reaching almost 18% among those 65 and over. In total, more than 30 million Americans have diabetes or prediabetes. In addition, many cases of diabetes are unknown because they go undetected.

Type 2 diabetes usually begins after the age of 40 but is now affecting more children and adolescents, due to obesity affecting more and more young people.

Causes of type 2 diabetes

Diabetes results from a combination of genetic and environmental factors, as well as lifestyle factors. In general, each person carries hereditary baggage that predisposes them to suffer from diabetes or, on the contrary, protects them. Researchers now know several genes that put an individual at risk for developing type 2 diabetes. In people genetically predisposed to the disease, it is generally overweight and particularly the accumulation of fat in the organs of the abdomen that leads to insulin resistance, the first step to type 2 diabetes.

Initially, to compensate for insulin resistance, the pancreas begins to produce more insulin. However, over time the pancreas becomes exhausted and insulin secretion decreases. There is therefore a relative lack of insulin and blood sugar levels remain continuously elevated.

Type 2 diabetes is therefore the result of 2 phenomena: first, insulin resistance, then exhaustion of the pancreas.

Diagnostic of type 2 diabetes

Because type 2 diabetes is rarely accompanied by symptoms in the early stages, it is often discovered incidentally during a routine medical examination.

Blood glucose tests can be used to detect it: a fasting or random blood glucose test and, sometimes, a test for induced hyperglycemia. This last test consists of blood sugar reading 2 hours after having ingested a sweet juice containing 75 g of glucose. Often, fasting blood sugar gradually rises over the years from a normal level to an intermediate state of prediabetes and then to the diabetic threshold.

Blood glucose can be measured by a blood test or estimated using a blood glucose meter (glucometer), which allows blood sugar levels to be analyzed on a drop of blood taken from the tip of your finger.

Even if the results are normal, it is usually recommended that these tests be taken at regular intervals in order to detect the disease as soon as possible.

Possible complications

In the long term, many diabetics see their condition worsen as a result of their disease, especially if the diabetes is not well controlled and monitored. This is because chronically high blood sugar gradually damages nerves and blood vessels, mainly in the eyes and kidneys. Diabetes can therefore be the cause of cardiovascular disease, irreversible vision loss, pain due to nerve damage, or kidney failure.

Symptoms of type 2 diabetes

In its early stages, type 2 diabetes causes few or no symptoms. It can therefore go unnoticed for several years. However, some people may have symptoms caused by high blood sugar, such as:

• Frequent urge to urinate, especially at night. The kidneys make more urine in an attempt to remove excess glucose from the blood;
• Increased hunger and thirst, with a feeling of dry mouth;
• Excessive drowsiness which is noticed especially after meals;
• Blurred vision;
• More frequent bacterial or fungal infections (urinary tract infections, vaginitis, etc.)

People at risk of type 2 diabetes

• People with a first-degree relative (mother, father, brother or sister) with type 2 diabetes;
• People who are obese or overweight, especially when the body fat is concentrated in the abdomen rather than on the hips and thighs. This is because the fat lodged in the organs of the abdomen (especially the liver) is the one that most affects the function of insulin. Over 80% of type 2 diabetics are overweight;
• Certain populations are more at risk, including Africans, Latin Americans, Asians and indigenous peoples of North America.

Risk factors of type 2 diabetes

• Being over 40 years old. Type 2 diabetes mainly affects adults, and its prevalence increases with age;
• Having a sedentary lifestyle and consuming too many calories;
• For women, having suffered from gestational diabetes or having given birth to a baby weighing more than 4 kg;

Having metabolic syndrome: in the clinic, the doctor will assess the presence of the following factors (3 are sufficient for the diagnosis of this syndrome):

• abdominal obesity, determined by measuring the waist circumference;
• high blood triglycerides;
• low blood HDL (“good” cholesterol);
• high blood pressure;
• high fasting blood sugar.

Prevention of type 2 diabetes

Screening measures

The need for screening for diabetes in the absence of symptoms will be assessed with a doctor.

The earlier the disease is detected – even before symptoms appear – and the sooner you intervene to restore normal blood sugar levels, the lower the risk of complications (cardiovascular disorders, eye, kidney, or neurological disorders, etc.). There is growing evidence for the effectiveness of early intervention.

Below are the recommendations by health officials:

• The assessment of the risk of diabetes in adults should be done by the doctor during the annual checkup;
• A fasting blood sugar test should be done every 3 years in all adults over the age of 40, with symptoms or not. This screening should be done earlier or more frequently when risk factors have been found. A test for induced hyperglycemia may be undertaken to analyze further to establish the diagnosis;
• Screening children at high risk for the disease every 2 years is advised.

Basic preventive measures

• Lose weight

Type 2 diabetes can be prevented by simple means. A study, the Diabetes Prevention Program, showed that at-risk individuals who engaged in 30 minutes a day of physical activity and who successfully lost 5% to 7% of their weight reduced their risk of developing diabetes by 58%.

Being overweight increases the need for insulin and overwork the pancreas. A person’s healthy weight is determined by the body mass index (BMI). There are simple tools available online to help you determine yours.

• Adopt a healthy diet

A healthy and varied diet helps maintain a healthy weight. It also helps maintain relatively stable blood sugar levels throughout the day, as well as good blood pressure. To do this, eat as much as possible 3 meals a day at regular times, avoid excess animal fat and added sugars (glucose, fructose, dextrose, etc.), and favor foods rich in fiber.

• Exercise regularly

Regular physical activity also helps maintain a healthy weight or shed extra pounds if necessary. Also, being active makes insulin work more effectively. It is recommended to be active at least 2 hours 30 minutes per week, spreading physical activity throughout the week, in periods of at least 10 minutes at a time (brisk walking, swimming, jogging, cycling, etc.).

It is important to take it gradually and gradually increase the duration and intensity of the activity. Physical activity in itself can significantly reduce the risk of developing diabetes.

Measures to prevent complications

It is important that the anti-diabetic treatment is well adjusted. Adequately controlling blood sugar levels can prevent complications. To ensure that treatment is effective, regular self-monitoring of blood sugar using a blood glucose meter and medical follow-up is essential. Your doctor will use the level of glycated or glycosylated hemoglobin (HbA1c) in the blood (measured at least twice a year), which reflects the average blood sugar level over the past 3 months.

Blood sugar targets to aim for that reflect good control:

• a blood sugar of 4 mmol / l to 7 mmol / l before meals;
• a glycemia between 7 and 10 mmol / l 2 hours after the meal;
• a glycated hemoglobin level of less than 7%.

Treatment of type 2 diabetes

People with diabetes can expect to lead active, independent, and dynamic lives without any limitations. It is still important to respect some basic principles, in particular with regard to:

• an appropriate diet;
• adopting an active lifestyle;
• monitoring of capillary blood glucose.

For some, adherence to this lifestyle will be enough to control blood sugar levels, while for others, it will also be necessary to intervene with medication. The aim of treatment is to keep the level of glucose (sugar) in the blood within normal values. The ways to do this differ from person to person.

There is no definite cure for diabetes. It is a chronic disease and lifelong treatment is needed. Adopting a better diet and participating in regular physical activity, however, is a real method of treatment, and can help avoid the need for medication. If these measures are not enough, doctors may prescribe one or more of the following diabetes medicines, all of which work to lower or help control blood sugar.

• Metformin is the cornerstone of treatment in the vast majority of type 2 diabetics. Its action helps reduce insulin resistance, which helps the body to use glucose more efficiently, without risk of hypoglycemia. It also promotes weight loss;
• Drugs that increase insulin secretion (or insulin secretors) include sulfonylureas and glinides. They directly stimulate the production of insulin by the pancreas by different mechanisms. They are very effective in controlling blood sugar, but with the potential risk of causing hypoglycemia;
• Thiazolidinediones (or glitazones), a class of drugs that includes rosiglitazone and pioglitazone, improve blood sugar levels by lowering insulin resistance. These drugs are being prescribed less and less by doctors and warnings have been issued by surveillance agencies because of the risk of heart attacks and the risk of fractures noted in certain populations. It should be noted that rosiglitazone-based drugs were withdrawn from the European market at the end of 2010 due to their undesirable cardiovascular effects;
• Acarbose which is an alpha-glucosidase inhibitor decreases the absorption of carbohydrates in the intestine. They must be taken with a meal to be effective and can cause bloating and gas caused by unabsorbed sugars;
• Incretino-mimetics (or incretins) are a new family of drugs including Januvia (sitagliptin), Byetta (exenatide), Onglyza (saxagliptin) and Victoza (liraglutide). They work by increasing insulin secretion after a meal, without causing hypoglycemia. Oral medicines (sitagliptin and saxagliptin) have a neutral effect on weight. Newly on the market, Victoza is administered by injection and is associated with weight loss. However, its effects and long term safety are unknown.
• Medicines that cause weight loss such as orlistat (Xenical) may be considered in people with diabetes who are obese. They are useful in improving blood sugar levels by allowing weight loss. However, their cost is high and they are not suitable for all patients.

Insulin injection treatment is a very valid option, although it is often used after oral medication has failed. It can also be given transiently in cases of severe hyperglycemia, infection, hospitalization, or surgery, for example. This is because insulin injections may be required when medication is no longer sufficient because insulin secretion decreases over time in type 2 diabetics. Usually, one injection per day, often given in the evening. Some people can also be treated with an insulin pump.

In conclusion

If you have type 2 diabetes, you can get some control over your disease by actively participating in your treatment. Diabetes is a demanding disease of course, but with the advantage for those who have it that they can change the course of their disease by getting involved in its treatment. You will reap long-term benefits.

There are many tools to improve your blood sugar and adopting a healthy lifestyle is the basis of treatment. It is also important to monitor your blood sugar regularly. This will tell you immediately whether your diabetes is well controlled or not. The frequency of checks varies from person to person but should increase at least 1 week before the meeting with your doctor, to allow him or her to analyze the variations in your capillary blood sugar levels during the day and to better adjust your treatment.

In addition, preventing complications from diabetes involves, among other things, stopping smoking and controlling blood pressure and cholesterol levels that your doctor will assess.

The goal is to achieve and maintain an acceptable blood sugar average without hypoglycemia. This average is reflected by the measurement of glycated hemoglobin. You can ask your doctor to share your results with you so you know where you are compared to targets.

Finally, several avenues have been studied to prevent this disease, including drugs. However, it is the simple habits of healthy eating and exercise that are most effective. These recommendations are achievable and have no side effects, but most importantly, they provide health benefits that go well beyond preventing diabetes.