Type 2 Diabetes Mellitus

Diabetes is a condition characterized by high glucose levels. Our body produces a hormone called insulin which enables glucose to enter our cells. If our bodies do not produce enough insulin, or if our cells are not able to respond well enough to insulin, glucose cannot enter our cells and instead accumulates in the bloodstream.

In type 2 diabetes (T2DM), the cells are not able to respond well enough to the insulin in the body. The cells require more insulin than usual in order to absorb glucose from the bloodstream. The body is not able to produce enough insulin to cope with these increased needs, causing glucose levels to rise.

Early symptoms of diabetes may not be obvious, or there may not be any symptoms at all.Some possible symptoms of high blood glucose levels are listed below:

• Excessive thirst and urination
• Fatigue
• Weight loss
• Blurred vision
• Slow-healing sores or frequent infections

Diabetes can also give rise to complications if it is not well controlled. These may include blindness, kidney failure, nerve damage, ulcers and amputations, heart attacks or strokes. With good control of diabetes, these complications can be prevented.

You can take steps to prevent type 2 diabetes, especially if you have risk factors or have prediabetes.

Lifestyle changes which can help to reduce the risk of type 2 diabetes include:

• Achieving a healthy body weight
  For people who are overweight or obese, aim to gradually achieve modest weight loss (5-10% of body weight)
• Aim to achieve a healthy body mass index (BMI) of less than 23kg/m2
• Increasing physical activity
  Moderate-intensity physical activity (150 minutes per week): brisk walking, slow cycling, dancing, housework / gardening, walking the dog OR
• Vigorous-intensity physical activity (75 minutes per week): running, fast cycling, competitive sports
• Maintaining a healthy and balanced diet
• Stop smoking

There are 7 main risk factors for type 2 diabetes:

• Being overweight or obese
• Having a sedentary lifestyle (doing very little physical activity)
• A family history of type 2 diabetes in a parent or sibling
• High blood pressure (above 140/90mmHg)
• Abnormal cholesterol levels
• Gestational diabetes, or delivering a baby weighing more than 4kg previously
• Polycystic ovarian syndrome

Blood tests can be done to diagnose diabetes. These include:

Random blood glucose

• This is a blood glucose sample that is taken without fasting
• A random blood glucose 11.1mmol/L or greater is suggestive of diabetes

Fasting blood glucose

• This is a blood glucose sample taken after an overnight fast
• Diabetes is diagnosed with the fasting blood glucose is 7.0mmol/L or greater

Oral glucose tolerance test (OGTT)

• A fasting blood glucose level will be taken, after which you will drink a standard amount of sugary drink (75g)
• Diabetes is diagnosed when the fasting blood glucose is 7.0mmol/L or greater, or a glucose reading 2 hours after the sugary drink is 11.1mmol/L or greater

People with symptoms of high blood glucose will only need one test to diagnose diabetes. People who do not have symptoms of high blood glucose will need to be tested on 2 separate occasions to diagnose diabetes.

Some people with type 2 diabetes can achieve their target blood glucose levels with diet and exercise alone, but many also need diabetes medications.

Most medications for type 2 diabetes are oral medications. Some come as injections, including insulin.

People with type 2 diabetes are often treated with oral medications. Some people with type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it is often prescribed sooner because of its benefits.

The classes of oral medications used to treat type 2 diabetes include: metformin, sulphonylureas, SGLT2 inhibitors, DPP-4 inhibitors, alpha-glucosidase inhibitors, and thiazolidinediones (TZD). The types of injections used to treat type 2 diabetes include GLP-1 receptor agonists, and insulin.

Besides taking medications aimed at achieving target blood glucose levels, it is also important to maintain a healthy blood pressure and blood cholesterol. Medications may be required to do this.

People with diabetes should undergo a yearly eye and foot screening. This will allow eye and foot problems to be detected and treated early.