Type 2 Diabetes - Part II

Over 30 million Americans have type 2 diabetes.  We will continue our discussion of this topic today, focusing on diagnosis and treatment.

How is type 2 diabetes diagnosed?

Unlike type 1 diabetes, the symptoms of type 2 diabetes can come on gradually and sometimes may not even be noticed.  Also, sometimes symptoms are presumed by patients to be from another cause, and they might not see their doctor about the symptoms or even mention them to their doctor.  For instance, frequent urination might be blamed on an overactive bladder, or blurry vision might be blamed on age-related far-sightedness.  For these reasons, the American Diabetes Association (ADA) and the U.S. Preventive Services Task Force have recommended screening for type 2 diabetes.  The primary purpose of any screening test is to detect early disease in large numbers of apparently healthy individuals.  Screening allows us to make a diagnosis earlier and treat earlier.  In diabetes, this can help prevent complications, which helps to prevent blindness, kidney failure, and premature death.

The ADA guidelines recommend that the following people should be screened for diabetes:

• Anyone with a body mass index (BMI) higher than 25 (23 for Asian Americans), regardless of age, who has additional risk factors, such as high blood pressure, abnormal cholesterol levels, a sedentary lifestyle, a close relative with diabetes, a history of polycystic ovary syndrome (PCOS), or a history of heart disease.
• Anyone older than age 45 should have an initial blood sugar screening test.  If the results are normal, they should be screened every 3 years after that.
• Women who have had gestational diabetes should be screened every 3 years after the pregnancy.
• Anyone who has been diagnosed with prediabetes should be tested every year.
  

The tests for diagnosing type 2 diabetes are the same as those done for type 1 diabetes, which includes:

• Blood tests - To check the blood sugar level and/or the hemoglobin A1c test.
• Urine tests - To test for glucose and/or ketones in the urine.
  

How is type 2 diabetes treated?

There is nothing that can cure type 2 diabetes.  However, it can be treated to manage blood sugar levels and decrease the risk of complications.  Some of the treatments include:

• Lifestyle changes - Including eating a healthy diet, increasing physical activity, and losing weight if you are overweight.  Sometimes these lifestyle changes alone can keep blood sugar levels managed well at normal levels.
• Medications taken by mouth - There are six types of diabetes pills.  They work in different ways.  Metformin is generally the first medication prescribed for type 2 diabetes.  It inhibits the production and release of glucose from the liver.  Other oral medications work by preventing the kidneys from reabsorbing sugar into the blood, by making your cells more sensitive to insulin, by increasing production of insulin in the pancreas, or by blocking breakdown of carbohydrates in the digestive tract.
• Insulin - Many people with type 2 diabetes are treated with insulin, usually in combination with oral medications.  Adding insulin helps to overcome insulin resistance when the pancreas can't make enough insulin to keep up with the demand.  There are many types of insulin available now.  They all need to be given by injection or by an insulin pump.  
• Other injectable medications - There are some newer medications for type 2 diabetes that are injected once a week.  They work by stimulating insulin release and lowering another hormone that is responsible for raising blood sugar.
• Blood sugar checks - Done regularly, this can help you and your doctor manage your blood sugar levels.
• Bariatric (weight loss) surgery - While this is not considered a specific treatment for type 2 diabetes, people with type 2 diabetes who have a BMI over 35 may benefit from surgery such as gastric bypass.  The weight loss associated with bariatric surgery has been shown to result in significant improvements in blood sugar levels.  The long-term risks and benefits of this procedure for diabetes are still unknown.  
  

If you have type 2 diabetes, you and your doctor will work together to find the best treatment for you.

Next week, we will continue our discussion of diabetes.

If you have any questions about diabetes, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor