A person with diabetes type 2 either:
- Does not produce enough insulin. Or
- Suffers from 'insulin resistance'. This means that the insulin is not working properly.
The majority of people with Type 2 have developed the condition because they are overweight. Type 2 generally appears later on in life, compared to Type 1. Type 2 is the most common form of diabetes.
In the case of insulin resistance, the body is producing the insulin, but insulin sensitivity is reduced and it does not do the job as well as it should do. The glucose is not entering the body's cells properly, causing two problems:
- A build-up of glucose in the blood.
- The cells are not getting the glucose they need for energy and growth.
In the early stages of Type 2 insulin sensitivity is the main abnormality - also there are elevated levels of insulin in the blood. There are medications which can improve insulin sensitivity and reduce glucose production by the liver.
As the disease progresses the production of insulin is undermined, and the patient will often need to be given replacement insulin.
"Excess abdominal fat is much more likely to bring on Type 2 Diabetes than excess fat under your skin"
Many experts say that central obesity - fat concentrated around the waist in relation to abdominal organs - may make individuals more predisposed to develop Type 2 diabetes.
Central obesity does not include subcutaneous fat - fat under the skin. The fat around your waist - abdominal fat - secretes a group of hormones called adipokines. It is thought that adipokines may impair glucose tolerance.
The majority of people who develop diabetes Type 2 were overweight during the onset, while 55% of all Type 2 patients were obese during onset.
"Sometimes all the patient needs is to do more exercise,
lose weight and eat fewer carbs"
It is not uncommon for people to achieve long-term satisfactory glucose control by doing more exercise, bringing down their bodyweight and cutting down on their dietary intake of carbohydrates.
However, despite these measures, the tendency towards insulin resistance will continue, so the patient must persist with his/her increased physical activity, monitored diet and bodyweight.
If the diabetes mellitus continues the patient will usually be prescribed orally administered anti-diabetic drugs. As a person with Type 2 does produce his/her own insulin, a combination of oral medicines will usually improve insulin production, regulate the release of glucose by the liver, and treat insulin resistance to some extent.
If the beta cells become further impaired the patient will eventually need insulin therapy in order to regulate glucose levels.
The risk factors for type 2
Age and ethnicity. The older you are the higher your risk is, especially if you are over 40 (for white people), and over 25 (for black, South Asian and some minority groups). It has been found in the UK that black people and people of South Asian origin have five times the risk of developing Type 2 compared to white people.
Diabetes in the family. If you have a relative who has/had diabetes your risk might be greater. The risk increases if the relative is a close one - if your father or mother has/had diabetes your risk might be greater than if your uncle has/had it.
Bodyweight (and inactivity combined with bodyweight). Four-fifths of people who have Type 2 became so because they were overweight. The more overweight a person is the higher his/her risk will be. The highest risk is for a person who is overweight and physically inactive. In other words, if you are very overweight and do not do any exercise your risk is greatest.
Cardiovascular problems and stroke. A person who has had a stroke runs a higher risk of developing Type 2. This is also the case for people who suffer from hypertension (high blood pressure), or have had a heart attack. Any diagnosis of a problem with circulation indicates a higher risk of developing Type 2.
Gestational Diabetes. A woman who became temporarily diabetic during pregnancy - gestational diabetes - runs a higher risk of developing Type 2 later on. Women who give birth to a large baby may run a higher risk, too.
Impaired fasting glycaemia (IFG) - Impaired glucose tolerance (IGT). A person who has been diagnosed as having impaired fasting glycaemia or impaired glucose tolerance and does not have diabetes runs a significantly higher risk of eventually developing Type 2. People with IFG or IGT have higher than normal levels of glucose in their blood. In order to prevent diabetes it is crucial that you eat healthily, keep an eye on your weight and do exercise.
Severe mental health problems. It has been found that people with severe mental health problems are more likely to develop Type 2.
Diabetes and cardiovascular diseases
People with diabetes type 2 are much more likely to develop cardiovascular diseases, such as coronary heart disease, stroke, hypertension, inflammatory heart disease and other cardiovascular conditions. Treatments tend to be similar to the ones used on patients who do not have diabetes. Stents versus bypass surgery for clogged artery - Patients with diabetes who have one clogged artery tend to have better results from heart bypass surgery than drug coated stents, researchers from Saint Luke's Mid-America Heart Institute in Kansas City, Missouri, explained at the American Heart Association's (AHA's) Scientific Sessions 2012 in Los Angeles (4 November, 2012).
Although stents may be cheaper and appear initially to be a better option, over the long term, bypass surgery patients in a trial had fewer heard attacks and were less likely to die prematurely, the investigators explained.
Senior author, Elizabeth A Magnuson, said "Our results demonstrate that bypass surgery is not only beneficial from a clinical standpoint, but also economically attractive from the perspective of the US healthcare system. The economic data are important because of the large number of people with diabetes who are in need of procedures to unblock clogged arteries."
The findings confirm the American Heart Association’s recommendations which have been in place since the 1990s that diabetes patients with one clogged heart artery should receive bypass surgery.
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