Diabetes

Diabetes is a disease where blood sugar levels are too high because the body can no longer make or use insulin properly. The condition could lead to serious complications and even death. An estimated 29.1 million Americans have diabetes, according to the Centers for Disease Control and Prevention.

Diabetes in the U.S.

There are several types of diabetes, including Type 1, Type 2 and gestational — a type that occurs in pregnant women. Type 2 is the most common, and about 95 percent of all people with diabetes in the U.S. have this type. An additional 86 million adults in the United States have prediabetes, a condition where your blood sugar is high but not elevated enough for a diabetes diagnosis.

Cases of diabetes increase each year, and every 19 seconds doctors diagnose someone in the U.S. with the disease. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 3 adults may be diagnosed with diabetes by 2050.

It’s important to keep blood sugar levels controlled because it can cause serious health problems — including kidney disease, heart problems, skin problems and limb amputations.

Even if Type 2 diabetes has no cure, it can be prevented and managed. People with the disease can control blood sugar with lifestyle changes and medication.

What is Type 2 Diabetes?

Type 2 diabetes is a disease in which your body loses its ability to produce and use insulin, a hormone made by the pancreas that the body uses to convert glucose into energy. Without the right amount of insulin, excess sugar builds up in the body and causes a number of health problems.

illustration of how glucose is broken down in those with type 2 diabetes

Where Type 1 typically occurs in younger people and is an immune disorder, Type 2 most often occurs later in life. In fact, the medical community used to call Type 2 diabetes “adult-onset” diabetes. Most people with Type 2 are 60 and older, but doctors are diagnosing younger people with the disease. About 3.7 percent of adults aged 20 to 40 have the disease.

Type 2 diabetes is a progressive disease. This means that it may worsen over time and require higher doses of medication or multiple medications to control blood sugar. The pancreas may stop producing insulin altogether, and this means a person with Type 2 will need to inject insulin along with other medications.

An Estimated

29.1 mil

Americans have diabetes

About

95%

Of all people with Diabetes have Type 2

An Additional

86 mil

Adults have prediabetes

History of Diabetes

Dr. Elliot Joslin publishes The Treatment of Diabetes Mellitus

Drs. Frederick Banting, Charles Best, then Banting's assistant, and Professor J.J.R. Macleod extract insulin from dogs and discover it lowers blood sugar in dogs without a pancreas.

James Collip purifies insulin for use in humans. Banting and Macleod win the 1923 Nobel Prize in Physiology or Medicine for their discovery.

Elli Lilly and Company is the first company to commercially produce insulin.

The American Diabetes Association is founded.

The American Diabetes Association funds its first research grants.

Urine glucose testing tablets become widely available.

Oral medications called sulfonylureas that stimulate the pancreas to produce more insulin hit the market.

Drs. Solomon Berson and Rosalyn Yalow discover a way to measure insulin in the blood and identify "insulin-dependent" (Type 1) and "non-insulin-dependent" (Type 2) diabetes.

The first color-coded glucose test strips hit the market.

The first glucose meter becomes available.

Researchers discover insulin receptors, and defective receptors are linked to possible insulin resistance in Type 2 diabetes.

Link between hyperglycemia and blood vessel disease discovered.

First insulin pumps invented.

Researchers use E. coli to produce insulin identical to human insulin.

Diabetes is classified into Type 1, Type 2, gestational and diabetes associated with other conditions.

FDA approved human insulin made by genetically altered bacteria.

Metformin becomes available in the U.S.

The drug Precose hit the market. Eli Lilly introduces the fast-acting insulin, Lispro.

Rezulin (troglitazone), the first of the thiazolidinedione class of diabetes drugs, hit the market. It was later removed from the market because of liver toxicity. Actos (pioglitazone), a drug in the same class, is available on the U.S. market, and some studies link it to bladder cancer.

Prandin (repaglinide) a drug in the meglitinide class, hits the market.

The American Diabetes Association defines prediabetes.

Byetta (exenatide) is the first incretin mimetic GLP-1 drug on the market.

FDA approves Januvia (sitagliptin), the first DPP-4 inhibitor.

Invokana (canagliflozin), the first SGLT2 inhibitor is available in the U.S.

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Symptoms
of Type 2 Diabetes

Symptoms of Type 2 are similar in most people, according to the American Diabetes Association. But some might have fewer or milder warning signs that make the disease more difficult to detect. Early detection and proper management of diabetes may help decrease the risk of complications.

Common Symptoms Include:

  1. Frequent Urination
  2. Feeling very hungry or thirsty
  3. Extreme fatigue
  4. Blurry Vision
  5. Bruises or wounds that are slow to heal
  6. Tingling, pain or numbness in feet or hands
  7. Dry itchy skin
1 Frequent Urination
2 Feeling Very Hungry or Thirsty
3 Extreme Fatigue
4 Blurry Vision
5 Bruises or Wounds That Are Slow To Heal
6 Tingling, Pain or Numbness in Feet or Hands
7 Dry Itchy Skin
Rebecca Montrone of Wondrous Roots discusses symptoms her patients with Type 2 diabetes have described

Type 2 Risk Factors

Most people may be aware that being overweight increases the risk of developing Type 2 diabetes, but there are a few other factors. In fact, not all people with Type 2 are overweight. Diabetes is complex and no two people with the disease are the same.

The National Institute of Diabetes and Digestive and Kidney Diseases offers a checklist for Type 2 diabetes risk factors.

The National Institute of Diabetes and Digestive & Kidney Diseases checklist

Check all that apply to you for a quick analysis of your risk level

Back to Test

You are at an Increased Risk.

People at risk should speak to their doctor about whether they should be tested

Back to Test

You are at a Low Risk.

Even people at low risk should speak to their doctor about whether they should be tested

* If one or more of the following apply to you, you may be at increased risk. People at risk can speak to their doctor about whether they should be tested.

Get Your Results

Lowering Your Type 2 Diabetes Risk

The most effective ways to lower your risk of Type 2 diabetes are by making smarter food choices and increasing your physical activity. Experts recommend at least 30 minutes of activity each day. Of course, it is not always easy to make these changes overnight. The American Diabetes Association recommends making these changes over time so you can adopt them as a lifestyle.

Here are some tips for making small sustainable changes:

  • Set realistic goals and start slow.
  • Set a timeframe to complete them.
  • Keep goals specific.
  • Reward yourself for accomplishing goals.

One misconception about lowering your risk by losing weight is that weight loss has to be significant, such as 50 to 100 pounds. The truth is losing as little as 10 pounds can have a dramatic impact on health and diabetes risk.

Related To Diabetes

Diagnosing
Type 2 Diabetes

Because the symptoms of Type 2 diabetes seem mild or might not appear at all, many people don’t know they have it. The American Diabetes Association estimates that 8.1 million people may be living with undiagnosed Type 2 diabetes. Many health care professionals can check for diabetes with simple blood tests.

There are three main tests for diagnosing diabetes and prediabetes: fasting plasma glucose (FPG), A1C and oral glucose tolerance test (OGTT).

FPG Diabetes Test

Fasting Plasma Glucose FPG (FPG)

This test measures levels of fasting blood sugar. Patients should be fasting for at least 8 hours prior to the test. This is the most popular test.

A1C Diabetes Test

A1C

This test measures average blood glucose over the course of 2 to 3 months. It is a simple blood test and, like the FPG, patients must be fasting. Doctors may opt to do both FPG and A1C tests at the same time.

OGTT Diabetes Test

Oral Glucose Tolerance Test (OGTT)

Patients must be fasting with the OGTT. OGTT can also diagnose gestational diabetes. The patient's blood glucose is measured before and after drinking a special sugary drink.

After Diabetes Diagnosis

A diagnosis of Type 2 diabetes is serious, but with the right help people can take the correct steps to maintain their health. A diagnosis may mean many changes in lifestyle, but it doesn’t mean life is over. For example, the American Diabetes Association has a number of great resources to help make sensible lifestyle changes.

Many people may feel it is their fault they got Type 2 diabetes. But, this isn’t true.

What is true is that they must be more vigilant about their health. To that end, it is important to find the right professionals to help you manage your blood sugar. This may include your doctor, nurse, pharmacist, dietitian and diabetes educator. The diabetes care team can help create a treatment plan that works.

Diabetes
Treatments

When doctors first discovered diabetes in the early 1900s, there were few options for treatment. It wasn't until the 1990s that people with Type 2 diabetes had oral medications like metformin— still a mainstay of treatment for many people with diabetes.

Now, in addition to injected insulin, there are a number of oral medication classes to choose from, all with their own benefits and risks. But diet and exercise are still an important part of Type 2 diabetes treatment. Now, even special types of surgery can help people with Type 2 diabetes manage their blood sugar.

A doctor may recommend one type of treatment or a combination of the three.

Medications

When changes in diet and increased physical activity are not enough to control blood glucose levels, doctors will prescribe medications. There are several different types, or classes, of medications available to treat Type 2 diabetes. Each controls blood sugar in different ways. Some people may take more than one medication to more effectively control sugar levels. There are many medications to treat Type 2 diabetes, and typically they are organized into groups that represent the condition that they target. These drugs are then organized into classes by mechanism of action.

Type 2 Diabetes Groups

  • Increase release of glucose through urination
  • Increase insulin sensitivity of liver, fat and muscle cells
  • Stimulate insulin production by the pancreas
  • Slow the digestion of carbohydrates

SGLT2 Inhibitors

A new class of diabetes medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors release excess glucose in the body through urination. The FDA approved Invokana (canagliflozin), the first drug in the class, in 2013. Several others followed. But the agency has also released a number of warnings for serious side effects linked to these medications.

Popular Drugs in This Class Include:

  • Invokana (canagliflozin)
  • Invokamet (canagliflozin and metformin)
  • Invokamet XR (canagliflozin and metformin extended release)
  • Farxiga (dapagliflozin)
  • Xigduo (dapagliflozin and metformin)
  • Jardiance (empagliflozin)
  • Glyxambi (empagliflozin and linagliptin)

Side Effects of SGLT2 Inhibitors May Include:

  • Urinary tract infections
  • Yeast infections
  • Increased urination
  • Diabetic ketoacidosis (DKA)
  • Low blood pressure
  • Increased cholesterol
  • Hypoglycemia (low blood sugar)
  • Nausea
  • Fatigue
  • Dry mouth

The FDA warned UTIs caused by SGLT2s can lead to other serious infections. The first is urosepsis, a serious systemic blood infection that can be fatal. The second is pyelonephritis, a serious kidney infection. Pyelonephritis may also lead to a blood infection. Both types of infection require hospitalization and antibiotics.

Additional FDA safety communications warned about kidney injury and diabetic ketoacidosis, a condition that occurs when too many toxins build up in the blood. New studies also show these drugs may also cause acute pancreatitis, a condition caused by the swelling and inflammation of the pancreas — the organ that produces insulin.

Biguanides

Biguanides are a class of drugs that work by making the body more sensitive to insulin. They also stop the liver from making glucose and releasing it into the blood. They may also make fat and muscle cells more insulin sensitive.

Currently, there is only one drug in this class available on the market: Glucophage (metformin). This is one of the most widely used Type 2 diabetes medications in the world. Since it has been around since the 1920s, its side effects are very well known. It became available in the U.S. in the 1990s. Many doctors are very comfortable prescribing it as a frontline medication or in combination with other medications.

In fact, most combination oral medications contain metformin. Newer drugs also test their effectiveness against metformin in clinical trials.

Metformin's Side Effects May Include:

  • Nausea
  • Decreased absorption of B12
  • Skin rashes
  • Lactic acidosis (too much lactic acid in the blood)
  • Diarrhea
  • Abdominal pain

Thiazolidinediones (TZDs)

TZDs work by decreasing blood glucose levels by making muscle, fat and liver cells more sensitive to insulin. The FDA approved many of these drugs in the 1990s. The two most popular drugs in this class are Actos and Avandia. But these drugs were linked to serious side effects including bladder cancer and heart failure.

Thiazolidinediones (TZDs) medication

Actos (Pioglitazone):

It has been one of the most popular drugs in the United States for treating Type 2 diabetes since 2007. It has only been on the market since 1999. The drug recently came under fire for causing an increased risk of congestive heart failure and its link to bladder cancer. The drug’s maker, Takeda, paid $2.37 billion to settle thousands of lawsuits by people who claimed Actos caused their bladder cancer.

Avandia (Rosiglitazone):

This drug comes from the same controversial class of drugs as Actos, and works in a similar way. Studies link it to an increased risk of heart failure. A number of countries in Europe stopped selling the drug and banned it. Although not banned in the United States, it can only be prescribed by a small group of doctors.

TDS side effects may include:

  • Bone fractures
  • Macular edema
  • Liver failure
  • Heart failure
  • Sinus infection
  • Sore throat
  • Fatigue
  • Muscle pain
  • Headache
  • Skin rashes
  • Hypoglycemia

Sulfonylureas and non-sulfonylurea secretagogues

These drugs stimulate the pancreas to produce more insulin. There are several well-known Type 2 diabetes drugs that use sulfonylureas as their base. These include Glucotrol (glipizide), Diabeta (glyburide) and several others. The FDA approved the first of these drugs in the 1980s.

These work to decrease blood glucose levels by stimulating insulin release by the beta cells in the pancreas. Pancreatic beta cells are the cells primarily responsible for releasing insulin.

Side effects of sulfonylureas include:

  • Nausea
  • Dizziness
  • Rash
  • Diarrhea
  • Weight Gain

Drugs that Slow Digestion of Carbohydrates

One of the issues with Type 2 diabetes is glucose entering the bloodstream faster than the body can process it. Slowing the digestive process of starches and sugars slows down the rate that glucose enters the bloodstream.

young woman shopping in a grocery story, examining an item

Alpha-glucosidase inhibitors and amylin analogues:

These drugs slow the digestion of sugar. Because these medications affect the digestive system, side effects of nausea and flatulence are common. Alpha-glucosidase inhibitors are the least effective medications for lowering blood sugar and are rarely used in the United States. Precose (acarbose) and Glyset (miglitol) belong to this class. Amylin analogues also have a modest effect on blood sugar, and are injected with a dosing pen. The only product available is called pramlintide.

Dipeptidyl peptidase-4 inhibitors (DPP-4):

These drugs keep the hormone incretin from being broken down, stimulating insulin production and slowing digestion. Popular brand names are Januvia, Onglyza and Tradjenta. Generic names are sitagliptin, saxagliptin and linagliptin. Side effects include: joint pain, pancreatitis, sore throat, swelling of hands or feet, nausea, hypoglycemia and diarrhea.

Diet/Exercise

Healthy eating helps keep blood sugar down and is a critical part of managing Type 2 diabetes, according to the National Institutes of Health. The NIH recommends talking to a registered dietitian or nutritionist to develop an eating plan that works around each individual’s lifestyle, weight, medicines and other health problems. The National Institute of Diabetes and Digestive and Kidney Diseases has tips for healthy eating.

These include:

  • Eating a lower sodium diet
  • Eating smaller portions spread out over the day
  • Keeping track of when and how many carbohydrates you eat
  • Eating less fat
  • Limiting alcohol consumption
  • Eating a variety of vegetables, fruits and whole grains

Exercise is also beneficial for controlling blood glucose. A personal trainer or a diabetes expert can help you set meaningful goals. An exercise plan does not have to be strenuous to impart benefits.

Nutritionist Rebecca Montrone discusses the role of diet and exercise in Type 2 diabetes management

In fact, new research in the journal Diabetologia shows that short 10-minute walks after meals can help lower blood sugar. Researchers at the University of Otago in New Zealand found these short walks after meals helped control blood glucose better than a single 30-minute walk by 12 percent.

Other 2016 research in Diabetologia by Dr. Bernard Duvivier of Maastricht University in the Netherlands found simply sitting less and by standing more and doing light walking may control blood sugar better than higher intensity exercise.

Bariatric Surgery

Bariatric surgery is growing in popularity as a treatment for Type 2 diabetes. There are a few methods of performing the surgery, but they all involve shrinking the size of the stomach or rerouting the path of food.

The most familiar type of surgery is gastric bypass. It creates a small pouch at the top of the stomach about the size of a walnut. The surgeon then reconnects the small intestine to this new walnut-sized stomach.

One study published in 2011 in Diabetes Care showed the surgery is highly effective in very obese patients with Type 2 diabetes. A review of clinical literature showed diabetes death rates lowered by up to 90 percent after gastric-bypass surgery.

As with any surgery, there are risks, including:

  • Poor nutrition
  • Vomiting from eating too much
  • Scarring that could lead to blockages
  • Injury to the stomach and intestines
  • Heartburn or ulcers
  • Leaking from stomach incisions

Type 2 Diabetes
Complications

While many people with Type 2 diabetes might not immediately notice symptoms of the disease, it can still cause serious complications if left untreated.

Diabetic Ketoacidosis (DKA)

While diabetic ketoacidosis (DKA) is a side effects of some Type 2 diabetes medications such as Invokana, people with diabetes are at increased risk even without taking the medication. Lack of insulin production can lead to DKA. This occurs when the body cannot use glucose for fuel and burns fat instead. The byproducts of breaking down fat for fuel are called ketones. When ketones build up in the body, they become toxic.

This condition is rare in people with Type 2 diabetes, though, and usually affects people with Type 1 diabetes whose bodies do not produce insulin at all.

Risk of Pancreatitis and Pancreatic Cancer

People with diabetes are at increased risk for pancreatitis (swelling of the pancreas) and pancreatic cancer.

Acute pancreatitis may happen suddenly and symptoms include pain in the abdomen, nausea, fever and rapid heartbeat. Chronic pancreatitis develops over time and symptoms include oily stools, diarrhea, weight loss and vomiting. One study published in Diabetes Care found that people with Type 2 diabetes were almost twice as likely to have acute pancreatitis as people without Type 2. But researchers found insulin slightly decreased this risk. Pancreatitis can lead to pancreatic cancer.

Diabetes can be a risk factor or a symptom of pancreatic cancer. Typically, this type of cancer is more prevalent in people who have had diabetes for more than five years, according to the Pancreatic Cancer Action Network. Researchers found that health conditions connected to Type 2 diabetes such as insulin resistance, inflammation and high blood sugar all contribute to development of pancreatic cancer. But people with pancreatic cancer may also develop diabetes as a symptom of the cancer.

Some Type 2 diabetes medications may also increase the risk of pancreatitis and possibly pancreatic cancer, including DPP-4 inhibitors such as Januvia, Janumet and Victoza.

Increased Mortality

Diabetes also increases mortality. Diabetes was mentioned as a cause of death on 234,051 death certificates in 2010, according to American Diabetes Association statistics. The ADA also says diabetes may be underreported as the cause of death.

Other Type 2 Diabetes Complications Include:

  • Eye complications
  • High blood pressure
  • Skin problems
  • Nerve damage (neuropathy)
  • Heart disease
  • Amputation of limbs
  • Heart stroke

Pregnancy
and Type 2 Diabetes

Uncontrolled Type 2 diabetes is especially dangerous during pregnancy. Not only does it affect the mother, but it can also endanger the baby. Women planning to get pregnant should make sure they have their blood sugar under control before and during pregnancy.

High blood sugar before and during pregnancy can:

  1. Increase the risk of birth defects
  2. Increase the risk of miscarriage or stillbirth
  3. Worsen long-term complications of diabetes, including, kidney disease, heart disease and eye problems
  4. Increase problems for the baby such as premature birth, breathing problems or low blood sugar after birth

Preeclampsia

Diabetes can also cause preeclampsia, a condition where there is too much protein in the urine and blood pressure is too high in the second half of pregnancy. It can cause serious, life-threatening problems. The problem only resolves after giving birth.

If it occurs later in the pregnancy, the baby is usually delivered via cesarean section. If it occurs early in the pregnancy, the mother must take medications and be on bed rest to allow the baby to develop enough for delivery.

Here are some tips for a healthy pregnancy:

  • Quit smoking
  • Check blood glucose levels often
  • Have a diabetes and pregnancy care team in place
  • Check ketone levels through urine or blood
  • Keep regular appointments with your doctor
  • Eat a proper diet
  • Avoid alcoholic beverages
  • Daily physical activity
  • Check medications to see if they may affect the baby

Type 2
Diabetes Research

Type 2 diabetes research focuses on four main areas: education, new technology and medications, prevention of the disease and prevention of complications. In addition to government funding of research, many drug companies also conduct their own studies to find new medications for the disease. The American Diabetes Association also funds studies.

Some of the questions researchers may ask include:

Who is at risk for Type 2 and what are the first signs of the disease?
Can Type 2 diabetes be reversed?
What are the physical differences between people with and without the disease?
What new technologies make living with diabetes easier for patients?
Why does Type 2 run in families?
How can complications develop and how can they be prevented?

Some the most recent findings include:

July 2016

Dr. Marilyn Corneli, a nutritionist and assistant professor at Northwestern University Feinberg School of Medicine, found people who drink coffee have a lower risk of Type 2 diabetes, and she is doing more research to find out why.

March 2016

Dr. Rebecca Hasson, an exercise physiologist at University of Michigan, found a link between environmental stress and Type 2 diabetes. Research suggests that when under stress, the body produces a hormone called cortisol. Cortisol contributes to insulin resistance.

July 2015

Dr. Laura D. Baker found aerobic exercise improves brain function in people with prediabetes. Type 2 diabetes and prediabetes are the second biggest risk factors for Alzheimer’s. Diabetes increases the risk by 65 percent. Even small amounts of exercise improve cognition.

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