Type 2 diabetes or adult-onset diabetes, or non-insulin-dependent diabetes mellitus (NIDDM), is a chronic metabolic condition caused by high blood glucose levels resulting from the body’s inability to use or produce enough of it effectively. Insulin produced by the pancreas monitors the absorption and utilization of glucose by cells.
Type 2 diabetes: What’s the cause?
Causes of type 2 diabetes are multiple and involve genetic and environmental factors. Here’s a simplified explanation of the scientific mechanisms involved:
- Insulin obstruction: In this condition, the body becomes resistant to the effects of insulin, particularly in muscle, liver, and fat cells. These cells do not respond adequately to insulin, leading to reduced glucose uptake and increased blood sugar levels. The underlying mechanisms for insulin resistance are not fully understood. Still, they are thought to involve a combination of genetic factors, chronic inflammation, and lifestyle factors such as obesity and physical inactivity.
- Beta-cell dysfunction: Beta cells in the pancreas are responsible for producing insulin. In type 2 diabetes, these beta cells may gradually lose their ability to make sufficient insulin over time due to various factors, including genetic predisposition, chronic exposure to high blood sugar levels, and other factors that affect beta-cell function and survival.
- Glucose production by the liver: The liver plays a crucial role in maintaining normal blood sugar levels. In individuals with type 2 diabetes, the liver may produce excessive amounts of glucose, contributing to elevated blood sugar levels. Insulin typically suppresses glucose production by the liver, but in diabetes, this control mechanism is impaired.
- Incretin dysfunction: Incretins are gut hormones that stimulate insulin release after meals, promoting glucose uptake and lowering blood sugar levels. In type 2 diabetes, there may be impaired incretin function, resulting in reduced insulin secretion in response to meals and elevated blood sugar levels.
Insulin resistance, beta-cell dysfunction, increased hepatic glucose production, and impaired incretin function contribute to high blood sugar levels in type 2 diabetes.
Consequences of Type 2 Diabetes
Type 2 diabetes can have various consequences on multiple organ systems in the body.
- Cardiovascular complications: Type 2 diabetes significantly increases the risk of heart attacks, stroke, and peripheral artery disease. Increased blood glucose levels can damage blood vessels and promote the formation of fatty deposits, leading to atherosclerosis (hardening and narrowing of arteries) which can impair blood flow and oxygen supply to vital organs, increasing the risk of cardiovascular events.
- Microvascular complications: Chronic high blood sugar levels can harm the tiny blood vessels in the body. These microvascular complications primarily affect the eyes, kidneys, and nerves.
- Diabetic retinopathy: High blood sugar levels can hurt the blood vessels in the eyes, leading to diabetic retinopathy. It causes vision loss in grownups and can cause blindness if left untreated.
- Diabetic nephropathy: The kidneys have tiny blood vessels that remove waste from the blood. In diabetes, these blood vessels can be damaged, leading to diabetic nephropathy. It is a progressive kidney disease that can result in kidney failure if not appropriately managed.
- Diabetic neuropathy: Prolonged high blood sugar levels can damage the nerves, particularly in the legs and feet. Diabetic neuropathy can cause pain, tingling, numbness, and a loss of sensation. It can also lead to foot ulcers, infections, and in severe cases, amputations.
- Increased infection risk: Diabetes impairs the immune system, making individuals more susceptible to infections. Poorly controlled blood sugar levels provide a favorable bacterial and fungal growth environment. Common conditions among people with diabetes include skin infections, urinary tract infections, and yeast infections.
- Slow wound healing: Diabetes can impair the body’s ability to heal wounds due to poor circulation, nerve damage, and compromised immune function. Even minor cuts or sores can take longer to heal, increasing the risk of infection.
- Increased risk of other health conditions: This condition can increase the risk of several different health conditions, including:
- Hypertension (high blood pressure): Diabetes and high blood pressure often coexist, which can significantly increase cardiovascular disease risk.
- Dyslipidemia: Diabetes can lead to abnormal lipid profiles, characterized by high levels of triglycerides and low levels of high-density lipoprotein (HDL) cholesterol. This lipid profile contributes to a higher risk of cardiovascular diseases.
- Sleep apnea: There is an increased prevalence of obstructive sleep apnea in individuals with type 2 diabetes. Sleep apnea further disrupts sleep patterns and can worsen blood sugar control.
Medical Intervention in Type 2 Diabetes
Medical intervention plays a crucial role in the management of type 2 diabetes. It aims to control blood sugar levels, prevent or manage complications, and improve overall health. Here are some common medical interventions used in the treatment of type 2 diabetes:
- Oral Medications: Several oral medications are available to manage this condition. These medications work through various mechanisms, such as increasing insulin production, improving insulin sensitivity, or reducing glucose production by the liver. Some commonly prescribed oral medications include:
- Metformin: It is often the first-line medication for type 2 diabetes. Metformin reduces glucose production in the liver, improves insulin sensitivity in the body’s cells, and can help with modest weight loss.
- Sulfonylureas: These medications stimulate the pancreas to produce more insulin.
- Thiazolidinediones (TZDs): TZDs improve insulin sensitivity in the body’s cells and can help reduce insulin resistance.
- Dipeptidyl peptidase-4 (DPP-4) inhibitors: DPP-4 inhibitors reduce the breakdown of incretin hormones, stimulating insulin release after meals.
- Sodium-glucose co-transporter 2 (SGLT2) inhibitors: SGLT2 inhibitors lower blood glucose by increasing glucose excretion through urine.
- Glucagon-like peptide-1 (GLP-1) receptor agonists: GLP-1 receptor agonists increase insulin secretion, decrease glucagon production, slow gastric emptying, and promote satiety.
- Injectable Medications: In some cases, injectable medications may be used to manage type 2 diabetes. These include:
- Insulin: Insulin therapy may be prescribed when oral medications alone cannot adequately control blood sugar levels. Different types of insulin are available, including rapid-acting, short-acting, intermediate-acting, and long-acting, and they can be used in various combinations based on individual needs.
- GLP-1 receptor agonists: In addition to the oral form, GLP-1 receptor agonists are also available as injectable medications. GLP-1 receptor agonists help lower blood sugar levels, promote weight loss, and may have cardiovascular benefits.
- Blood Sugar Monitoring: This can be done using self-monitoring blood glucose devices or continuous glucose monitoring systems.
- Lifestyle Counseling: Medical interventions include comprehensive counseling to promote healthy eating habits, regular physical activity, weight management, and smoking cessation. These lifestyle modifications are crucial for blood sugar control, overall health improvement, and reducing the risk of complications.
- Regular Check-ups and Screening: People with type 2 diabetes require regular check-ups to monitor their blood sugar control, blood pressure, cholesterol levels, and kidney function. Routine screening for complications, such as eye exams, foot exams, and kidney function tests, is essential to detect potential issues early on.
