What is Type 2 Diabetes? 

                          Type 2 diabetes mellitus begins when insulin is resistant, (a condition in which cells fail to respond to insulin properly). As the disease progresses, insulin deficiency may also develop.In a healthy person, the pancreas (an organ behind the stomach) releases insulin to help the body store and use the sugar from the food you eat. Diabetes happens when one of the followings occurs: When the pancreas does not produce any insulin when the pancreas produces petite insulin. When the body does not respond appropriately to insulin, a condition called insulin resistance. This form was previously referred to as “noninsulin dependent diabetes mellitus” (NIDDM) or “adult onset diabetes.”

What are the causes of diabetes mellitus?

  •  The primary cause is excessive body weight and not enough exercise.
  • When an amount of glucose level high from certain level then insulin was not sufficient to respond appropriately.
  • It has a strong genetic link.
  • Reduce insulin sensitivity in the body.
  • Poor diet
  • Lack of physical activity.
  • Lack of exercise.
  • Excessive body fats.
  • Stress.
  • Excessive use of sweeteners.
  • Excessive consumption of saturated fats.
  • Excessive consumption of white rice.
  • What are the sign and symptoms of type 2 diabetes (diabetes mellitus)?
  • Weight loss
  • Polyuria (excessive urination)
  • Polydipsia (excessive thirst)
  • Polyphagia (excessive hunger)
  • Prolong high blood glucose.
  • Vision changes.
  • Skin rashes.
  • Itchy skin.
  • Numbness
  • Weakness
  • Slow healing of wounds.
  • Yeast infection.

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What are risk factors for type 2 diabetes?

Researchers don’t fully understand why some people develop pre-diabetes and type 2 diabetes and others don’t. It’s clear that certain factors increase the risk, however, including:Weight. The more fatty tissue you have, the more resistant your cells become to insulin.

Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.

Family history. Your risk increases if a parent or sibling has type 2 diabetes.

Race. Although it’s unclear why, people of certain races — including blacks, Hispanics, Native Americans and Asian-Americans — are at higher risk.

Age. Your risk increases as you get older, this may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.

Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.

Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.

High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.

Abnormal cholesterol and triglyceride levels. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.


Treatment for diabetes mellitus and what is management in type 2 diabetes?

Management of type 2 diabetes includes:

  • Healthy eating
  • Regular exercise
  • Possibly, diabetes medication or insulin therapy
  • Blood sugar monitoring
  • These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.
  • Eat healthily:
  • Contrary to popular perception, there’s no specific diabetes diet. However, it’s important to center your diet on these high-fibers, low-fat foods:
  • Fruits
  • Vegetables
  • Whole grains
  • You’ll also need to eat fewer animal products, refined carbohydrates, and sweets.
  • Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly the food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic index foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.A registered dietitian can help you put together a meal plan that fits your health goals, food preferences, and lifestyle. He or she can also teach you how to monitor your carbohydrate intake and let you know how many carbs you need to eat your meals and snacks to keep your blood sugar levels more stable.

Physical activity

Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor’s OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming, and biking. What’s most important is making physical activity part of your daily routine.

Aim for at least 30 minutes of aerobic exercise five days of the week. Stretching and strength training exercises are important, too. If you haven’t been active for a while, start slowly and build up gradually.

A combination of exercises — aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week — often helps control blood sugar more effectively than either type of exercise alone.

Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar.

Monitoring your blood sugar

                              Depending on your treatment plan, you may need to check and record your blood sugar level now and then or, if you’re on insulin, multiple times a day. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.Sometimes, blood sugar levels can be unpredictable. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication.

Diabetes medications and insulin therapy

                          Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.

Examples of possible treatments for type 2 diabetes include:

Metformin (Glucophage, Glumetza, others). Metformin is the first medication prescribed for type 2 diabetes. It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more efficiently.

Metformin also lowers glucose production in the liver. Metformin may not reduce blood sugar enough on its own. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active.

Nausea and diarrhea are possible side effects of metformin. These side effects usually go away as your body gets used to the medicine. If metformin and lifestyles changes aren’t enough to control your blood sugar level, other oral or injected medications can be added.

Sulfonylureas. These drugs help to increase insulin according to requirements. Examples of drugs in this class include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain.

Meglitinides. These medications work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they’re faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar, but this risk is lower than with sulfonylureas.

Weight gain is a possibility with this class of medications as well. Examples include repaglinide (Prandin) and nateglinide (Starlix).

Thiazolidinediones. Like metformin, these medications make the body’s tissues more sensitive to insulin. This class of medicines has to weight gain and other more-serious side effects, such as an increased risk of heart failure and fractures. Because of these risks, these medications aren’t the first-choice treatment.

Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones.

DPP-4 inhibitors. These medications help reduce blood sugar levels but tend to have a modest effect. They don’t cause weight gain. Examples of these drugs are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta).

GLP-1 receptor agonists. These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas. Their use is often associate with some weight loss. This class of medications is not recommended for use by itself.

Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists. Possible side effects include nausea and an increased risk of pancreatitis.

SGLT2 inhibitors. These are the newest diabetes drugs on the market. They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine.

Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga). Side effects may include yeast infections and urinary tract infections, increased urination and hypotension.

Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was used as a last resort, but today it’s often prescribed sooner because of its benefits.

Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Often, people with type 2 diabetes start insulin use with one long-acting shot at night.

Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks similar to an ink pen, except the cartridge is filled with insulin.

There are many types of insulin, and they each work in a different way. Options include:

  • Insulin glulisine (Apidra)
  • Insulin lisper (Humalog)
  • Insulin Aspart (Novolog)
  • Insulin glargine (Lantus)
  • Insulin detemir (Levemir)
  • Insulin isophane (Humulin N, Novolin N)

                      Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health.In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.

Bariatric surgery 

                            If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries.

                           Drawbacks to the surgery include its high cost, and there are risks involved, including a risk of death. Additionally, drastic lifestyle changes are required, and long-term complications may include nutritional deficiencies and osteoporosis

What is lifestyle modification in pre-diabetes?

  1. Exercise
  2. High fibers diet.
  3. Minimal use of sweeteners.
  4. Minimal use of saturated fat.
  5. Self-monitoring of blood glucose.

 What are Lifestyle modifications in type 2 diabetes?

Measure blood sugar before, during, and after exercise to determine their body’s typical response to exercise. If the pre-exercise blood sugar reading is 250 mg/dL (13.9 mmol/L) or higher, exercise should be postponed until the level is under control.

  • Consider a decrease in insulin dose by about 30 percent during exercise.
  • Choose an insulin injection site away from exercising muscles (for example, avoid the legs if running).
  • Keep rapidly absorbed carbohydrates on hand (glucose tablets, hard candies, or juice).
  • Eat a snack 15 to 30 minutes before exercise, and again every 30 minutes during exercise.
  • Eat a source of slowly absorbed carbohydrates (dried fruit, fruit jerky, granola bars, or trail mix) immediately after exercise. This is counter the Post-exercise drop in blood sugar.
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