Type 2 diabetes
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Type 2 diabetes means reduced function of insulin-producing cells and/or reduced insulin sensitivity of body tissues and organs (insulin resistance). This form of diabetes usually appears in people over the age of 40, but nowadays it is more and more common in children and young adults. 85-95% of people with diabetes belong to this type. It is a disease that can be alleviated by losing weight, and can even be reversed in its initial state. In many cases, the change in lifestyle is not realized or does not prove to be sufficient, in which case the patients need to be given antidiabetic drugs and later insulin.
Insulin and its effects, symptoms of its deficiency
In the case of type 2 diabetes, there is a partial lack of insulin, which means that the key (insulin) to open the lock on the cells is present, but it does not fit perfectly into the lock. Therefore, it is unable to open the doors on the cells to an adequate extent, as a result of which some of the sugar in the blood cannot enter and be used, so the cells do not get enough energy. The blood sugar level rises, in response to which the pancreas tries to produce even more insulin. In addition, the starving cells send chemical signals to the liver, as a result of which the liver releases even more glucose from its stores into the circulation. This process starts a vicious cycle, the result of which is high blood sugar and insulin levels, despite which the body is actually starving. Due to increased hormone production, the cells of the pancreas become exhausted over time and are no longer able to produce adequate amounts of insulin.
Thus, the symptoms of type 2 diabetes can be similar to those described for type 1, although they often develop very slowly, and patients can even be symptom-free for a long time. Therefore, the disease can go undetected for many years while it damages the body's vital organ systems, including the cardiovascular system, nerves, eyes, and kidneys. It is therefore very important to make a diagnosis and start treatment as soon as possible, so it is not recommended to delay visiting your family doctor when you notice the above symptoms. Since the disease is often asymptomatic, it is also worth screening for those who are asymptomatic but belong to a high-risk group.
Reasons
The exact cause and mechanism of type 2 diabetes are not completely clear, but the following risk factors have been proven to accelerate the development and progression of the disease:
- Overweight : The more adipose tissue there is in the body, the greater the insulin resistance: insulin is not able to act on the cells of our body to an adequate extent, thus only a certain proportion of the glucose in the blood can enter the cells. Being overweight in the long term increases the risk of developing other diseases, such as: coronary artery calcification (ischemic heart disease), stroke, and some malignant tumors.
- Distribution of adipose tissue: Abdominal adipose tissue is more dangerous than adipose tissue located in other areas of the body (e.g. on the hips). The reason for this is that the fatty tissue surrounding the abdominal organs can emit chemical signals that can be harmful to the cardiovascular system and the metabolic state. Abdominal circumference above 80 cm for women and 94 cm for men indicates abdominal obesity.
- Sedentary lifestyle: Exercising not only helps to control body weight, but also increases the insulin sensitivity of muscle tissues, so that sugar enters the cells more easily. As a result, the blood sugar level decreases, and glucose can be broken down by the cells, thus providing energy.
- Age: With advancing age, especially over 45, the chance of developing the disease increases. The probable reason for this is that at this time we tend to exercise less, which results in a decrease in muscle tissue and an increase in body weight. But type 2 diabetes is becoming more and more common at a young age, which is in line with the appearance of obesity at an ever younger age.
- Hereditary factors: Diabetes occurring in close relatives (parents, siblings) poses a risk.
- Pre -diabetes (pre-diabetes condition, anteroom): Pre-diabetes covers a higher-than-normal blood sugar level, but this elevated blood-glucose level does not reach the value of people with diabetes. There are two types: IGT (impaired glucose tolerance), i.e. reduced glucose tolerance, and IFG (impaired fasting glucose), i.e. increased fasting blood sugar level. Without treatment, these conditions often end in type 2 diabetes. Nevertheless, the good news is that this process can be completely reversed if diagnosed in time and with lifestyle changes.
- Gestational diabetes (gestational diabetes): The likelihood of later developing type 2 diabetes increases if gestational diabetes occurred during pregnancy or if the newborn was born weighing more than 4 kg.
- PCOS (Polycystic Ovary Syndrome): PCOS is a complex gynecological-endocrinological disease, the characteristics of which may be: irregular menstrual cycle, elevated male hormone levels in the blood, excess weight, reduced insulin sensitivity, hair growth on abnormal body parts, cysts in the ovaries detected on ultrasound and even infertility.
If you are diagnosed with type 2 diabetes, it is advisable that you continue to pay attention to your health for the rest of your life, because if you do this, you can avoid many health problems or they will only appear in a milder form or at a later age.
After a diagnosis of type 2 diabetes or prediabetes, the first step is to change your lifestyle.
How to change?
- Eat healthy
- Reduce your excess weight
- Exercise regularly
Treatment
The goal of type 2 diabetes treatment is to maintain the most optimal blood sugar level possible and suppress symptoms in order to prevent further health damage.
If you are diagnosed with diabetes, your family doctor will refer you to a diabetologist who will help you understand the nature of the disease and possible ways to treat it. He monitors your condition during regular control examinations and monitors the development of complications caused by diabetes.
Lifestyle change: Diet, weight loss, physical activity
Diet
A diet rich in fiber and low in carbohydrates, sugars and fats (especially saturated fats) can help prevent and treat type 2 diabetes.
What exactly does this entail?
- Eat foods high in fiber such as whole grain bread or muesli, beans and lentils, fruits and vegetables.
- Choose low-fat foods and replace butter and animal fats with high-quality olive or coconut oil.
- Choose low-fat dairy products or replace them with low-calorie plant-based milks (eg coconut milk).
- Eat fish and low-fat meats (e.g. steamed chicken breast) instead of fatty or processed meat products (e.g. sausages, hamburger meat).
- The way the food is prepared is also crucial. Prepare your food by grilling, baking, boiling or steaming instead of frying in oil.
- Avoid foods high in fat, such as mayonnaise, chips, French fries. Choose steamed basmati rice, buckwheat or bulgur as a side dish.
- If you feel like snacking, eat fruits, unsalted hazelnuts, almonds, low-fat and low-sugar yogurt. Avoid cakes, biscuits, milk chocolate.
Weight reduction
If you are overweight or obese, i.e. your body mass index (BMI - body mass index) is over 25 kg/m 2 , your doctor may advise you to lose weight. This is not always an easy task, the point is to reduce calorie intake and increase physical activity. Losing 5-10% of your current body weight over the course of a year can be a realistic goal. The long-term goal is, of course, to reach a normal body mass index (18.5-24.9 kg/m 2 ). In order to be successful, contact specialists who can help you with this (e.g. diabetologist, dietitian, physiotherapist, coach).
Physical activity
Regular exercise is very important in the prevention, maintenance and treatment of type 2 diabetes.
Recommended minimum physical activity between the ages of 19 and 64:
- 150 minutes per week (2 and a half hours) of moderate-intensity, aerobic activity, such as cycling, walking, which should be done in episodes of at least 10 minutes
- At least twice a week, muscle-strengthening exercises that affect all major muscle groups, so they also work the muscles of the legs, hips, back, abdomen, chest, shoulders and arms.
An alternative to the above recommendations can be:
- 75 minutes per week of vigorous-intensity, aerobic activity, such as running or tennis
- At least twice a week, muscle-strengthening exercises that affect all major muscle groups, so they also work the muscles of the legs, hips, back, abdomen, chest, shoulders and arms.
This may seem like a lot, but it is worth knowing that even a small increase in physical activity can benefit your health and form the basis for future development. It may be a good idea to reduce the time you spend sitting in front of the television or computer. Go for a walk instead, or get off one stop earlier and walk home from work. This can be a good introduction to starting regular sports activities. Your family doctor and dietician will help you with even more advice and tools to help you live a more active life.
Drug treatment
Type 2 diabetes usually gets worse over time. Lifestyle change is crucial in the life of every patient, but it is often not enough in the long term. If it is not possible to achieve and maintain the ideal blood sugar level with diet, weight loss and adequate physical activity, drug treatment becomes necessary. These can be taken in tablet form and often represent a combination of several drugs. If oral medications (oral antidiabetics) are not effective enough on their own, they can be combined with insulin.
- Metformin : Metformin is usually the first drug prescribed to treat type 2 diabetes. It has several beneficial effects: it inhibits the release of glucose from the liver (thus preventing abnormally high blood sugar levels), increases the use of sugar in the muscles, slows down the absorption of glucose in the intestines, and reduces insulin resistance. In addition to all this, it reduces blood fat and increases the level of HDL cholesterol (good cholesterol) in the blood. It lowers systolic blood pressure (upper value) and inhibits blood clotting and platelet aggregation. In summary, it can be said that it optimizes blood sugar levels, does not cause obesity (in fact, it can help with weight loss) and has a positive effect on the cardiovascular system. Metformin does not affect the secretion of insulin, so when used, too low a blood sugar level (hypoglycemia) cannot occur. Mild side effects may occur after starting medication, such as nausea, diarrhea, abdominal cramps. Side effects can be reduced by gradually introducing metformin, and in the vast majority of cases they are reduced or disappear during treatment. Administration of metformin should be avoided in case of kidney disease, pregnancy, severe heart, lung and liver disease, and regular alcohol consumption.
- Sulfonylurea : The group of sulfonylureas includes several active substances, such as glibenclamide, glimepiride and gliclazide. Their mechanism of action: they increase the release of inulin from the beta cells of the pancreas. The most dangerous side effect of sulfonylureas can be understood based on the mechanism of action, since taking too high a dose or in the case of starvation, a larger amount of insulin may be released, resulting in abnormally low blood sugar levels. Their other most common side effect is weight gain. Pioglitazone : Pioglitazone can be used alone or in combination with metformin, sulfonylurea, or insulin. Its effect: it increases the insulin sensitivity of the cells, so that they can absorb more glucose from the blood. It can also cause weight gain and ankle swelling (edema) may occur as an additional side effect. Pioglitazone should not be given to patients who have heart failure or who are at increased risk of bone fracture.
- Gliptins (DPP-4 inhibitors): Gliptins (linagliptin, saxagliptin, sitagliptin, vidagliptin) prevent the release of a hormone, GLP-1 (Glucagon-like peptide-1, in Hungarian, glucagon-like protein-1), which is normally released in our body. decomposition. GLP-1 helps the release of insulin caused by high blood sugar, but unfortunately it is a molecule that breaks down quickly. By inhibiting the breakdown of these molecules, gliptins help prevent high blood sugar levels, but unlike sulfonylureas, they do not cause hypoglycemic episodes or weight gain.
- SGLT2 inhibitors : SGLT-2 (sodium-glucose transporter-2) molecules are found in the kidney and their task is to return glucose filtered from the blood to the kidney tubules back into the circulation. Since in diabetes there is too much sugar in the circulation, it may seem like a good idea to inhibit these transport molecules, which results in the excretion of sugar in the urine. The family of SGLT-2 inhibitors includes dapaglifosine, canaglifosine, and empaglifosine. As they increase the concentration of glucose in the urine, they can predispose to urinary tract and genital infections.
- GLP-1 agonists (liraglutide, exenatide): GLP-1 agonists act similarly to the GLP-1 (glucagon-like peptide-1) hormone. GLP-1 helps with insulin release caused by high blood sugar. They are administered by injection and there is no risk of hypoglycemia when using them.
- Acarbose : Acarbose inhibits the action of the enzymes that break down carbohydrates into glucose in the intestine. As a result, the digestion process is prolonged, the nutrients taken in are absorbed more slowly and raise the blood sugar level less. Due to its side effects (flatulence, diarrhea), this drug is used less often
- Glinides : Nateglinide and repaglinide, belonging to the group of glinides, can stimulate the release of insulin from the pancreas. They are not often used, but they can be used in patients who eat irregularly, as their effect is short-term and can work when taken right before a meal. They may have side effects: weight gain and too low blood sugar levels.
It is important to emphasize that there is no good, bad or best pill, your doctor will decide which of the above preparations is the most suitable for the treatment of your disease based on your age, general condition and co-morbidities.
Insulin treatment
If oral antidiabetics are not sufficient to maintain normal blood sugar levels, your doctor may start you on insulin therapy. There are many insulin preparations on the market, which have different absorption rates and duration of action. The correct dose and combination of these preparations is crucial, so its setting must be entrusted to a diabetologist.
When administered orally, insulin breaks down quickly in the stomach and cannot enter the bloodstream in this form. Therefore, it has to be delivered to the body in a different way. An excellent solution for this is administration under the skin using an injection needle. The diabetologist specialist and the diabetologist specialist assistant will do their best to make it easier for you to get used to the above-mentioned intervention. You can get help learning how to inject yourself, how to store insulin and how to dispose of used needles. Most patients need insulin injections 2-4 times a day.
Other treatment methods
Diabetes increases the risk of developing cardiovascular diseases (ischemic heart disease, heart attack, cerebrovascular disease/stroke) and kidney disease. In order to reduce the risk, your doctor may prescribe the following medicines:
- blood pressure-lowering medicines (or antihypertensives), which lower blood pressure. ACE inhibitors (angiotensin-converting enzyme inhibitors), such as analapril, lisinopril, ramipril can be used if you have early symptoms of diabetic kidney disease, which can be diagnosed by albumin appearing in the urine. If caught and treated early, it can be reversible.
- statins, which reduce blood cholesterol and thus atherosclerosis
- low-dose aspirin treatment, which can help prevent heart attacks and strokes by inhibiting platelet aggregation
Self-monitoring of blood sugar levels
If you measure your blood sugar yourself, the measurement shows the current blood sugar level at the time of the check. You can check this several times a day, which helps you get an idea of how your meals, physical activity and diabetes medications affect your blood sugar level.
Record the values because the information is valuable to your doctor in optimizing your treatment. It raises the blood sugar level when the body is affected by some kind of stress (e.g. infection, fever). In addition, alcohol intake, taking other medications, and in the case of women, hormonal changes in the menstrual cycle can also result in changes in blood sugar levels.
The blood glucose measuring device is a small, portable device, which also comes with a finger prick device. The blood sugar level can be measured from the drop of blood that appears after pricking the fingertip. It doesn't matter where you stab: it's worth aiming for the edge of the fingertip and not the middle. With the help of this small device, both too low and too high blood sugar values can be measured. The machine displays the measured blood sugar level in units of millimol/liter (mmol/l). The normal value is between 4-6 mmol/l before a meal (preprandial) and below 8mmol/l two hours after a meal (postprandial), although these values can vary from person to person.
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