Type 2 Diabetes Mellitus

Dr. Nicholas Kaloudis

Type 2 Diabetes and Pre-Diabetes are conditions in which blood glucose (sugar) levels are higher than normal. The pancreas, an organ located just behind the stomach, produces insulin. Insulin is a hormone that helps move glucose from the bloodstream into your body’s cells where it is used for energy. This process controls the amount of glucose in your blood, keeping it from getting too low or too high.

Type 2 Diabetes and Pre-Diabetes occur when the body doesn’t make enough insulin or can’t use it properly.

Type 2 Diabetes is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor.

In the early stage of Type 2, the predominant abnormality is reduced insulin sensitivity. At this stage, hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. As a result, glucose levels build up in the bloodstream. Pre-Diabetes occurs when glucose levels are higher than normal, but not as high as in diabetes. Having Pre-Diabetes puts you at risk for developing Type 2 Diabetes.

People can have Pre-Diabetes or Type 2 Diabetes for years and not have any obvious signs or symptoms. Type 2 Diabetes is often not diagnosed until health problems appear as a result of high blood glucose.

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease. The main “macrovascular” diseases (related to atherosclerosis of larger arteries) are coronary artery disease, stroke, and peripheral vascular disease. About 75% of deaths in diabetics are due to coronary artery disease.

Diabetes also damages the capillaries. Diabetic retinopathy, which affects blood vessel formation in the retina of the eye, can lead to visual symptoms including reduced vision and potentially blindness. Diabetic nephropathy, the impact of diabetes on the kidneys, can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of protein in the urine, and eventually chronic kidney disease requiring dialysis.

Another risk is diabetic neuropathy, the impact of diabetes on the nervous system — most commonly causing numbness, tingling, and pain in the feet, and also increasing the risk of skin damage due to altered sensation. Together with vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and occasionally require amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.

In the United States, there were approximately 675,000 diabetes-related emergency department visits in 2013 that involved neurological complications, 409,000 ED visits with kidney complications, and 186,000 ED visits with eye complications.

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:

• Fasting plasma glucose level ≥ 126 mg/dl
• Plasma glucose ≥ 200 mg/dL two hours after a 75g oral glucose load as in a glucose tolerance test
• Glycated hemoglobin (Hb A1C) ≥ 6.5% which is a blood test that shows your average blood glucose values over the past 3 months.

Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal (“euglycemia”) as possible, without causing hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications. Patient education, understanding, and participation is vital, since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. Attention is also paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.

Getting screened is an important first step. Knowing your blood glucose levels and working with your doctor to keep your levels as close to normal will help you enjoy a long and healthy life.

[sws_green_box box_size=”620″] Dr. Nicholas Kaloudis is a highly regarded, board certified endocrinologist. He is a diplomate of the American Board of Internal Medicine and owner of EndoHealthMD, in Manhasset, NY. His center provides comprehensive specialty care using current evidence-based practices, and the latest advances in medical aesthetics. He holds an appointment as Associate Clinical Professor at North Shore University in Manhasset. He has received numerous awards, and he has published articles in the field of Endocrinology. For more information and a listing of services provided call: 516 365 1150. [/sws_green_box]