Type 2 diabetes

Type 2 diabetes typically begins after age 40. This is the most common type of diabetes, accounting for about 90% of the cases diagnosed in North Americans, Asian Americans, Native Americans, and Pacific Islanders are at particular risk. The number of people affected with this form of diabetes is especially on the rise; primarily because of wide spread inactivity and obesity in our population. In fact, recently there has been a substantial increase in type 2 diabetes in children, due mostly to an increase in overweight in this population (coupled with limited physical activity). This type of diabetes is also genetically linked, but the initial problem is not with the beta cells of the pancreas. Instead, it arises with the insulin receptors on the cell surfaces of certain body tissues, especially muscle tissue. In this case, blood glucose is not readily transferred into cells, so the patient develops hyperglycemia as a result of the glucose’s remaining in the bloodstream. The pancreas attempts to increase insulin output to compensate, but there is a limit to its ability to do this. Thus, rather than insufficient insulin production, there is an abundance of insulin, particularly during the onset of the disease. As the disease develops, pancreatic function can fail, leading to reduced insulin output. Because of the genetic link for type 2 diabetes, those who have a family history should be careful to avoid risk factors such as obesity, a diet rich in animal and other solid fats, and high glycemic load foods, and inactivity. Being tested regularly for hyperglycemia is also important.

Many cases of type 2 diabetes (about 80%) are associated with obesity (especially fat located in the abdominal region), but the hyperglycemia is not directly caused by the obesity. In fact, some lean people also develop this type of diabetes. Obesity associated with oversized fat cells simply increases the risk for insulin resistance by the body, in turn increasing the risk for type 2 diabetes.

Type 2 diabetes linked to obesity often disappears as weight is lost. Achieving a healthy weight should be a primary goal of treatment, but even limited weight loss can to better blood glucose regulation. Oral medications can also help. Some examples are medications that reduce glucose production by the liver (metformin [glucophage]), increase the ability of the pancreas to release insulin (glipizide [glucotro]), and increase the body’s response to its own insulin (rosiglitazone [avandia]). Another class of oral agents used works by delaying carbohydrate digestion and glucose absorption (acarbose [precose]). A tablet is taken with the first bite of each meal and may be combined with other therapy.(Note that pregnant women cannot use these oral medications because they will affect the blood glucose of the developing fetus.)

Sometimes it may be necessary to provide insulin injections in type 2 diabetes because nothing else is able to control blood glucose. (This eventually becomes the case in about half of all cases of type 2 diabetes.) Regular physical activity also helps the muscles take up more glucose. And a regular meal pattern, with an emphasis on control of energy intake, consumption of low glycemic load foods, with ample fiber, is important therapy. Note that nuts fulfill the last two goals. An almost daily intake of nuts was even shown to reduce the risk of developing type 2 diabetes in one recent study.) Some intake of sugar is fine with meals, but again these must be substituted for other carbohydrates, not simply added to the meal plan. Distributing carbohydrates throughout the day is also important, as this helps minimize the high and low swings in blood glucose concentrations. Moderate alcohol use is fine (one serving per day). One recent study showed that this practice substantially reduced heart attack risk in people with type 2 diabetes. Still, the person must be warned that alcohol can lead to hypoglycemia and that the person must test him- or herself regularly for this possibility. Supplemental vitamin E may also be prescribed, as was discussed for type 1 diabetes, but again the benefits of such a practice are in doubt.

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