Type 2 diabetes is a disease characterized by chronic hyperglycemia, that is, too high a level of glucose or sugar in the blood. What are its causes and possible complications? How to diagnose it? And treat it? Here are our explanations.
What is type 2 diabetes?
Type 2 diabetes is a disease characterized by chronic hyperglycemia, that is, too high a level of glucose or sugar in the blood. This disease usually occurs in adults as they age, and affects more:
- obese people;
- people who are overweight.
In a healthy individual, blood sugar is controlled by insulin, a hormone secreted by the pancreas. Insulin allows sugar to enter the cells so that it can be used as fuel, especially in the muscles and liver.
In a person with type 2 diabetes, the body becomes unable to regulate blood sugar, which is the level of glucose in the blood. That’s when blood sugar rises. This is called hyperglycemia. In the long term, if blood sugar is 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 the medical team. Healthy lifestyle habits are the basis of treatment. If these habits are not enough to lower blood sugar, medication may be used.
The different forms of diabetes
There are 2 main forms of diabetes, both characterized by chronic hyperglycemia:
- type 1 diabetes;
- type 2 diabetes.
Type 1 diabetes occurs in young people and often appears in childhood. It is caused by autoimmune destruction of the pancreas that no longer produces insulin. The cause is poorly known and there is currently no possible prevention. Sufferers are therefore dependent on insulin that must be administered by injection.
Type 2 diabetes, which accounts for 90% of diabetes cases, occurs later in life. It is mainly due to a state of insulin resistance and is associated with being overweight.
A disease on the rise
The number of people with type 2 diabetes is steadily increasing and this trend is attributed to the “Western” lifestyle, which is associated with physical inactivity and obesity, as well as an aging population. Globally, the International Diabetes Federation predicts that the number of diabetics could increase from 285 million in 2010 to 438 million in 2030.
10% of Canadians live with diagnosed diabetes. This rate increases with age to nearly 18% among those aged 65 and over. In total, nearly 11.5 million Canadians have diabetes or prediabetes. In addition, many cases of diabetes are unknown because they are not detected.
Type 2 diabetes usually manifests itself after the age of 40, but now affects more and more children and adolescents, because obesity that affects more and more young people.
What causes type 2 diabetes?
Diabetes results from the combination of:
- genetic factors;
- environmental factors;
- lifestyle factors.
In general, each person carries a hereditary baggage that predisposes him to suffer from diabetes or on the contrary protects him. Researchers now know several genes that make an individual at risk of developing type 2 diabetes.
In people genetically predisposed to the disease, it is usually overweight and especially the accumulation of fat in the organs of the abdomen that leads to insulin resistance, the first step towards 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 remains elevated continuously.
Type 2 diabetes is therefore the result of 2 phenomena:
- first, insulin resistance;
- then the exhaustion of the pancreas.
Type 2 diabetes: how to diagnose it?
Because type 2 diabetes is rarely accompanied by symptoms in its early stages, it is often discovered incidentally during a routine medical examination.
Blood glucose tests can detect it: a fasting or random blood glucose test and, sometimes, a test for induced hyperglycemia.
This last test consists of a blood glucose reading 2 hours after ingesting a sweet juice containing 75 g of glucose. Usually, fasting blood sugar rises gradually over the years from a normal level to an intermediate state of prediabetes and then to the diabetic threshold.
Blood glucose levels can be:
- measured by a blood test;
- estimated using a blood glucose meter, or glucometer, which analyzes blood glucose on a drop of blood taken from the fingertip.
Even if the results are normal, it is usually recommended to have these tests at regular intervals to detect the disease as early as possible.
Type 2 diabetes: possible complications
In the long term, many diabetics see their health worsen because of their disease, especially if diabetes is not well controlled and monitored. Indeed, chronically high blood sugar gradually damages nerves and blood vessels, mainly in the eyes and kidneys.
Diabetes can cause:
- cardiovascular disease;
- irreversible vision loss;
- pain due to nerve damage;
- renal failure.
In its early stages, type 2 diabetes causes few or no symptoms. It can therefore go unnoticed for several years. However, some people may experience symptoms caused by hyperglycemia.
What are the symptoms of type 2 diabetes?
Symptoms of hyperglycemia include:
- increased hunger;
- increased thirst, with a feeling of dry mouth;
- excessive sleepiness, which is noticeable, especially after meals;
- blurred vision
- more frequent bacterial or fungal infections such as urinary tract infections, vaginitis, etc.;
- a frequent urge to urinate, especially at night, as the kidneys produce more urine in an attempt to remove excess glucose from the blood.
Some people are more vulnerable than others to type 2 diabetes. Especially since risk factors can favor its appearance.
Type 2 diabetes: people at risk
People at risk for type 2 diabetes are:
- people whose first-degree relative – mother, father, brother, or sister – have type 2 diabetes;
- obese people;
- Overweight people, especially when fat mass is concentrated in the abdomen rather than on the hips and thighs. Indeed, the fat lodged in the organs of the abdomen, especially in the liver, is the one that most interferes with insulin function. More than 80% of type 2 diabetics are overweight.
Certain populations are also at higher risk, including:
- Africans;
- Latin Americans;
- Asians;
- indigenous peoples of North America.
What are the risk factors for type 2 diabetes?
Risk factors for type 2 diabetes include:
- be over 40 years old. Type 2 diabetes mainly affects adults, and its prevalence increases with age;
- have a sedentary lifestyle;
- consuming too many calories;
- for women, who have had gestational diabetes or have given birth to a baby weighing more than 4 kg;
- have metabolic syndrome.
In the clinic, the doctor will evaluate the presence of the following factors, knowing that 3 are enough to diagnose this syndrome:
- abdominal obesity, as determined by measuring waist circumference;
- high blood triglycerides
- low levels of blood HDL, i.e. “good” cholesterol;
- high blood pressure
- high fasting blood sugar
In order to prevent type 2 diabetes, there are basic preventive measures, as well as screening measures.
Type 2 diabetes: prevention measures
Diabetes screening measures
The need for diabetes screening in the absence of symptoms will be assessed by the doctor.
The earlier the disease is detected – even before symptoms appear – and the earlier it is done to restore normal blood sugar, the lower the risk of complications. These include:
- cardiovascular disorders;
- eye conditions;
- kidney disease;
- neurological conditions;
There is growing evidence of the effectiveness of early intervention.
Here are the recommendations of the Canadian Diabetes Association, to which doctors refer:
- the assessment of the risk of diabetes in adults should be made by the doctor during the annual examination;
- screening for the disease in high-risk children every 2 years is advised;
- A fasting blood glucose test should be undertaken every 3 years in all adults from 40 years of age, with or without symptoms.
This screening should be done earlier or more frequently when risk factors have been found. A test for induced hyperglycemia may be undertaken to further analyze the diagnosis.
Basic preventive measures
Weight control
Type 2 diabetes can be prevented by simple means. A study by the Diabetes Prevention Program showed that at-risk individuals who engaged in 30 minutes a day of physical activity and who had managed to lose 5 to 7% of their weight decreased their risk of becoming diabetic by 58%.
Being overweight increases insulin requirements and overworks the pancreas. Body mass index or BMI determines a person’s healthy weight. Calculate yours using our BMI and waist circumference test. It’s not about aiming for a healthy weight at all costs. However, a weight loss of 5 to 10% in 6 months already allows for obtaining significant health benefits.
Healthy eating
A healthy and varied diet helps maintain a healthy weight. It also helps maintain relatively stable blood sugar 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;
- avoid excess added sugars: glucose, fructose, dextrose, etc.;
- Choose foods rich in fiber.
Physical exercise
Regular physical activity also helps maintain a healthy weight or eliminate extra pounds if necessary. In addition, being active makes insulin work more effectively. It is recommended to be active at least 2 h 30 per week, spreading physical activity throughout the week, into periods of at least 10 minutes at a time, such as:
- brisk walking;
- swimming;
- jogging;
- cycling;
It is important to go gradually and gradually increase the duration and intensity of the activity. Physical activity in itself significantly reduces the risk of becoming diabetic.
Measures to prevent complications
It is important that the antidiabetic treatment is well-adjusted. Proper blood sugar control prevents complications. To ensure that treatment is effective, regular self-monitoring of blood glucose using a blood glucose meter as well as medical monitoring are essential.
Your doctor will use the level of glycated or glycosylated hemoglobin or HbA1c in the blood, measured at least 2 times a year, which reflects the average blood glucose levels over the past 3 months.
Glycemic targets to aim for that reflect good control:
- blood glucose of 4 to 7 mmol/L before meals;
- blood glucose between 7 and 10 mmol / l 2 hours after the meal;
- a glycated hemoglobin level of less than 7%.
Diabetics can expect to lead an active, autonomous, and dynamic life without any limitations. Nevertheless, in addition to following some basic measures, some will need drug treatment.
How to treat type 2 diabetes?
It remains important to respect certain basic principles, in particular:
- have an appropriate diet;
- adopt an active lifestyle;
- Perform capillary glucose monitoring.
For more details on the lifestyle to adopt in case of type 2 diabetes, see our Diabetes Fact article, in which you will find:
- a pattern of glucose uptake;
- a video showing how to use a blood glucose meter;
- a table of optimal glycemic values for adolescents and adults with diabetes;
- an eating plan (on this subject, see also our special diet sheet: Diabetes) ;
- suggestions for physical exercises;
- ways to manage stress.
For some, diligent adherence to this lifestyle will be enough to control blood sugar, while for others, it will also be necessary to intervene with medication. The goal of treatment is to keep the concentration of glucose or sugar in the blood within normal values. The means to achieve this are different from one person to another.
Medical treatment for diabetes
No treatment can cure diabetes once and for all. It is a chronic disease and lifelong treatment is necessary. However, eating better and exercising regularly is a real mode 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 medications, all of which lower or help control blood sugar:
- Metformin – Glucophage® or Glumetza® – is the cornerstone of treatment in the vast majority of type 2 diabetics. Its action reduces insulin resistance, which helps the body use glucose more efficiently, without the risk of hypoglycemia. It also promotes weight loss;
- drugs that increase insulin secretion, so-called insulin secretors, include sulfonylureas – Diabeta®, Diamicron® – and glinides – Starlix®, GlucoNorm®. They directly stimulate the production of insulin by the pancreas through 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 or Avandia® and pioglitazone or Actos®, improve blood sugar by decreasing insulin resistance. These drugs are increasingly being prescribed in Canada and warnings have been issued by oversight agencies because of the risk of heart events and fracture risk in some populations. It should be noted that rosiglitazone-based medicines were withdrawn from the European market at the end of 2010 due to their adverse cardiovascular effects;
- Acarbose or Glucobay® which is an alpha-glucosidase inhibitor has the effect of decreasing the absorption of carbohydrates in the intestine. It must be taken at mealtime to be effective and can lead to bloating and flatulence caused by unabsorbed sugars;
- Incretino mimetics or incretins are a family of medicines that includes Januvia® or sitagliptin, Byetta® or exenatide, Onglyza or saxagliptin, and Victoza®® or liraglutide. They work by increasing insulin secretion after a meal, without causing hypoglycemia. Orally administered drugs, such as sitagliptin and saxagliptin have a neutral effect on weight. Victoza® is given by injection and is associated with weight loss. However, it is not indicated in the first line and its long-term effects and safety are unknown;
- Weight-loss medications such as orlistat or Xenical® may be considered in people with diabetes who are obese. They are useful for improving blood sugar by allowing weight loss. However, their cost is high and they are not appropriate for all patients;
- Insulin injection therapy is a very valid option, although it is often used after the failure of oral medications. It may also be given transiently in cases of significant hyperglycemia, infection, hospitalization, or surgery, for example. Indeed, insulin injections may be necessary when medications are no longer sufficient because insulin secretion decreases over time in type 2 diabetics. One injection is usually given daily, often given in the evening. Some people can also be treated with an insulin pump.
Self-medication using complementary approaches for type 2 diabetes can lead to serious problems. When starting treatment that changes your blood glucose levels, your blood sugar should be monitored very closely. It is also necessary to inform your doctor so that he can, if necessary, review the dosage of conventional hypoglycemic drugs.
Type 2 diabetes: complementary approaches
Panax ginseng and Panax quinquefolium
A growing number of high-quality studies tend to validate the traditional use of ginseng roots and rootlets to treat diabetes, but trials involving more subjects would lead to more reliable conclusions. Ginseng would help normalize blood sugar in people with diabetes, especially after meals.
Psyllium or Plantago ovata
The main effect of taking psyllium at mealtime is to lower the total glycemic index of the meal. This causes that after the meal, glucose and insulin levels decrease by 10 to 20%. The action of psyllium is comparable to that of acarbose, a drug used by some type 2 diabetics: it slows down the assimilation of carbohydrates in the digestive system.
An analysis of 7 randomized studies concluded that psyllium was an attractive treatment option in type 2 diabetics receiving medication, but still with high blood sugar spikes after meals.
Glucomannan
Glucomannan is a soluble fiber, similar to psyllium, but even more absorbent and emollient than psyllium. It is composed of konjac flour, a type of tuber, in a purified form. Results from several clinical trials indicate that glucomannan may be helpful in reducing or controlling blood sugar in people with diabetes or obesity.
Avena sativa
Research indicates that eating oatmeal helps prevent blood glucose rises following a meal or postprandial hyperglycemia. Oatmeal would also allow better control of glucose levels in the long term. Indeed, like psyllium, they contain a lot of soluble fiber, which slows down gastric emptying.
Chromium
Chromium is an essential trace element for human health, naturally present in many foods. In particular, it increases the sensitivity of tissues to insulin, which helps normalize blood sugar levels.
A meta-analysis of 41 trials, including 7 in patients with type 2 diabetes, showed that chromium supplements decreased glycated hemoglobin by 0.6% and fasting blood glucose by 1 mmol/L. However, the use of chromium supplements, up to 200 to 1,000 μg per day, by people with diabetes remains controversial given the highly variable quality of the studies conducted so far.
Trigonella foenum-graecum
The results of some clinical studies conducted on diabetics have shown that fenugreek seeds could contribute to the regulation of blood glucose levels in type 2 diabetes.
Although promising, these trials had a number of flaws, so it is not possible at this time to suggest a treatment protocol.
Cinnamomum Verum or C. cassia
Some small studies have shown that cinnamon helps reduce blood glucose levels in people with diabetes, but more comprehensive studies will be needed to confirm these findings.
Tai chi
Some researchers have hypothesized that Thai Chi may help regulate blood glucose levels in diabetics. To date, different studies have presented contradictory results.
Some studies report improvements, while others do not.
Aloe Vera
Aloe is one of the plants to which Ayurvedic medicine, i.e. from India, attributes hypoglycemic or antidiabetic properties.
The studies conducted so far tend to confirm this use but are few in number.
Dosage: Although the effectiveness of the gel as a hypoglycemic substance is not clearly established, it is usually recommended to take 1 tsp, 2 times daily, before meals.
Vaccinium myrtilloides and Vaccinium myrtillus
In Europe, blueberry leaves have been used for over 1,000 years to lower blood glucose levels. Animal tests tend to confirm this traditional use. However, the use of blueberry leaves for this disease has not been tested in humans.
Dosage: Practitioners recommend infusing 10 g of blueberry leaves in 1 liter of boiling water and taking 2 to 3 cups of this infusion per day.
Gymnema Sylvestre
In many countries such as India, Japan, Vietnam, and Australia, traditional doctors use Gymnema to lower glucose levels in diabetics.
However, no double-blind placebo clinical trials have been conducted, so there is no scientifically valid evidence of its efficacy.
Dosage: Rather than dried leaves, an extract standardized to 24% gymnemic acid is now used. This extract often referred to as GS4, is the raw material for the majority of commercial products. Take 200 to 300 mg of this extract, 2 times a day while eating.
Momordica charantia
Momordic, also called gourd, is a tropical climbing plant that produces fruits reminiscent of cucumbers. Traditionally, several people have used its fruits to treat a host of ailments. The consumption of fresh fruit juice would help regulate the blood sugar of diabetic people, by a hypoglycemic action.
This effect has been confirmed by several in vitro and animal tests. Human studies are in the preliminary stages.
Dosage: traditionally, it is recommended to drink 25 to 33 ml of fresh fruit juice, about the equivalent of 1 fruit, 2 to 3 times a day before meals.
Opuntia ficus indica
The stems of the nopal, a cactus from the desert regions of Mexico, have been used in traditional medicine to reduce fasting blood glucose in diabetics. This effect has been observed in a few clinical trials conducted by Mexican researchers.
Rich in dietary fiber, the nopal would act mainly by decreasing glucose absorption.
Dosage: In positive studies, 500 g of roasted nopal meat was used daily.
Naturopathy
American naturopath J.E. Pizzorno suggests diabetics take a multivitamin and mineral supplement, as the disease would generate an increased need for nutrients. In his experience, this practice:
- improves blood glucose control;
- helps prevent the main complications of diabetes.
A double-blind placebo study of 130 subjects, aged 45 and over, indicates that people with diabetes who took multivitamins for 1 year had fewer respiratory infections and flu than untreated diabetic subjects.
In addition, the naturopath considers it important that diabetics consume a large number of flavonoids, in food form, for their antioxidant effect. Indeed, there would be more oxidation and inflammation reactions in the body of people with diabetes. Flavonoids are mainly present:
- in fruits;
- vegetables, such as artichoke, onion, asparagus, red cabbage, and spinach, in even greater quantities in berries.
They are also found in the form of supplements.
These measures do not treat diabetes but may improve overall health.
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