Living with Type 2 Diabetes
Ann Pietrangelo. Medically reviewed by Steve Kim, MD. Understanding Type 2 Diabetes. Healthline. March 31. 2016. Link: https://www.healthline.com/health/type-2-diabetes Citlaly Gutiérrez-Rodelo, Adriana Roura-Guiberna, Jesús Alberto Olivares-Reyes. Molecular Mechanisms of Insulin Resistance: An Update. Review. Gaceta Médica de México. 2017. Link:https://www.anmm.org.mx/GMM/2017/n2_english/3942AX171_153_2017_UK2_197-209.pdf Global Report on Diabetes. 2014 Link:http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf;jsessionid=4757A323C471E51F42BAFEE260D81911?sequence=1 Ramachandran. Know the signs and symptoms of diabetes. Indian Journal of Medical Research. 140(5): 579–581. Nov. 2014. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311308/ The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center. Risk Factors for Type 2 Diabetes. November. 2016. Link: https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes American Diabetes Association. Diabetes Care. Classification and Diagnosis of Diabetes. 2015. Link: http://care.diabetesjournals.org/content/diacare/38/Supplement_1/S8.full.pdf NICE guideline. UK. Type 2 diabetes in adults: management. Dec 2. 2015 Link:https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493 American Diabetes Association. Diabetes Care. Lifestyle Management. 40(Suppl. 1): S33–S43. 2017. Link:http://care.diabetesjournals.org/content/diacare/40/Supplement_1/S33.full.pdf Memoona Rasheed, Nadeem Islam, Wajiha Mahjabeen. Factors Associated with Uncontrolled Type 2 Diabetes Mellitus. Journal of Islamabad Medical & Dental College (JIMDC). (2):68-71. 2014 Link:https://pdfs.semanticscholar.org/ef02/9920f6236cc626e8fda8170ba865cbb4cb11.pdf Mihaela Gribovschi. The methodology of glucose monitoring in type 2 diabetes mellitus. Clujul Med. 86(2): 93–96. May. 2013. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462439/ 11. 2017 SEMDSA Guildelines https://www.semdsa.org.za/images/647-4385-1-pb.pdf Brought to you by merck-logo-2 Related Information OPEN WOUNDS Most wounds, cuts and scrapes are minor and can usually be treated at home. ADULT ALLERGIES While allergies can occur in adulthood, most of us get them for the first time in childhood. CHILD ALLERGIES While allergies can occur in adulthood, most of us get them for the first time in childhood. CHILDHOOD CONSTIPATION Childhood constipation in otherwise healthy children tends to peak between 2 years of age and 4 years of age and is often associated with toilet training. COLIC Colic normally starts between 2 and 4 weeks of age, when an otherwise healthy baby has unexplained episodes of fussing and crying for at least 3 hours per day. VAGINAL THRUSH Vaginal thrush is a type of yeast infection that afflicts approximately 75 % of all sexually active women at least once in their life PROBIOTICS Probiotics (good bacteria) antagonise potential pathogens (bad bacteria), improve the intestinal environment, bolster the intestinal barrier, downregulate inflammation, and up-regulate the immune response.
There were 1,826,100 cases of diabetes in South Africa in 2017.
What is diabetes?1,2,3
Diabetes is a long-term disease characterised by high blood glucose (sugar) levels that occur when:
The pancreas does not produce enough insulin1 and/or
When the body cannot effectively use the insulin it produces to move glucose into the cells of the body as a source of energy (insulin resistance = cells become resistant to the effects of insulin)2
Is diabetes common?
Diabetes has reached epidemic proportions and its prevalence continues to grow worldwide. By 2014 WHO (World Health Organization) estimated that, globally, 422 million adults over 18 years of age were living with diabetes.3
Type 2 Diabetes Mellitus (T2DM) is the most common form of Diabetes and accounts for up to 90% of all cases. T2DM is a considered a progressive lifestyle disease caused mainly by a poor diet and lack of exercise although some people are genetically at a higher risk of developing it. This informational leaflet focusses on T2DM.1,3,7
Gestational diabetes is a raised blood glucose level during pregnancy which occurs in some women. However blood glucose levels usually return to normal levels shortly after delivery.3
How Type 2 diabetes occurs4
Prediabetes is the grey area before developing T2DM in which:
Signs and symptoms are not yet profoundly visible but
Your blood glucose levels are starting to elevate beyond what is considered healthy
Prediabetes is a state in which following poor lifestyle choices your body’s cells may, over time, become less responsive to the insulin it produces. This is known as insulin resistance. In this state, your body requires and produces more and more insulin to maintain healthy blood glucose levels resulting in a state of hyperinsulinemia (raised insulin levels). Although still within normal ranges your blood glucose readings may start to elevate over a period of time due to:
The progressive nature of the disease and
because your body is no longer able to keep up production of insulin with the body’s ever-increasing requirement
Ignoring the early warning signs and risk factors could lead to the development of T2DM.
What are the risk factors?2,5
The risk factors for developing T2DM include:
Obesity, especially around the waist, indicating insulin resistance
Body Mass Index (BMI) of 25kg/m2 or more
Inactivity – lack of exercise
Diet rich in refined carbohydrates and sugar
High blood pressure
Family history of T2DM
High cholesterol levels
History of cardiovascular disease
High stress levels
Signs and Symptoms6
The signs and symptoms of abnormal blood glucose levels include:
Frequent urination (day and night)
Changes in appetite
Unexplained weight loss
Unusually sweet-smelling breath
Tingling in your limbs
Slow healing cuts and wounds
If you are at risk for developing T2DM and/or experience some of the signs and symptoms, you should consult your healthcare provider immediately.
Diagnosis and treatment6
Your doctor takes a thorough medical history and you have a general medical examination. If they suspect T2DM, laboratory tests are performed to evaluate your blood glucose levels. At least two glucose tests are required and ideally should be performed on two separate days. A fasting blood glucose reading of ≥7 mmol/l, a random blood glucose level of ≥11 mmol/l, or a two-hour post glucose ingestion reading of ≥ 11 mmol/l is required for diabetes to be confirmed. An HbA1c (this test shows the average blood glucose levels over 3 months) level of ≥6,5% is also adequate to confirm the diagnosis.
Once the T2DM diagnosis is confirmed, treatment will commence and will consist of a combination of lifestyle changes and medical intervention.
Healthy eating – eliminating sugars and refined carbohydrates
Resistance training (to increase muscle strength) and cardiovascular exercise (to improve heart and lung strength)
Losing 10-15% of your body weight and maintaining the weight loss
Managing stress effectively
Your doctor will assess your individual treatment needs and prescribe the medication that will control your diabetes adequately.
Current treatment guidelines recommend metformin as the first choice of medication in the treatment of most newly-diagnosed type 2 diabetic patients unless there is a contra-indication to it. If the patients experience gastric side effects (eg. diarrhoea, nausea, vomiting, cramping, bloating and flatulence) on standard release metformin, then they may be switched to an extended release formulation of metformin. If metformin is contra-indicated, then another oral medication (eg. gliclazide MR, a DPP-4 inhibitor, pioglitazone, or an SGLT2 inhibitor) may be used according to the desired HbA1c target. For patients initiated on metformin treatment, if the target HbA1c is not achieved after titration to the maximum allowable daily dosage, a second medication may be added to metformin. If the HbA1c is still not controlled, then a third medication may be added to achieve this. If the HbA1c is not controlled after using three types of medications, patients should be referred to a specialist team for management11
Why is it important to adhere to your treatment?9
If T2DM is not managed effectively through lifestyle and treatment interventions, severe complications can occur. Poorly managed T2DM significantly increases your risk of developing:
Diabetic retinopathy and subsequent blindness
Kidney impairment and/or failure
Why diabetics must monitor blood glucose levels10
Besides adhering to treatment, diabetic patients must remember to regularly monitor their blood glucose levels and maintain them within normal levels.
Regular blood glucose monitoring tests are required to confirm that the condition is managed correctly to avoid complications.
The following methods can be used:
Regular finger prick tests (can be done at home)
Your HbA1c may need to be checked every six months if your blood glucose levels are on target and if your treatment has changed
If you are not on target or if your treatment has changed, you may need your HbA1c checked every three months
If you find that your blood glucose levels remain elevated despite medication and lifestyle changes, consult your healthcare provider immediately. Adjustments in your treatment regimen may be required.
Living with Type 2 diabetes1,7,8
Useful tips and what to expect:
T2DM is not a death sentence if it is managed properly
Make use of diabetic support groups, a councilor and/or diabetic clinic for assistance in understanding your condition better and to obtain guidance on managing it
Schedule regular check-ups with your doctor to ensure your condition is well controlled
Your doctor may recommend that you also consult with other healthcare providers such as a podiatrist (foot specialist) or an optometrist or ophthalmologist (eye specialists)
A nutritionist can provide useful guidance and support on diabetic meal planning
You may experience incidents of low blood sugar levels (hypoglycaemic events), characterised by dizziness, confusion, sweating, fainting and shivering – always carry a glucose-containing food element on you, such as glucose tablets