Type 2 Diabetes: A Primer
Caring for an elderly parent, relative or close family friend often involves managing one or more age-related health problems, including type 2 diabetes.
What is diabetes?
When you eat, your food is broken down into a sugar called glucose.
Glucose gives your body the energy it needs to work. But to use glucose as energy, your body needs insulin.
When you have type 2 diabetes, your body does not make enough insulin or use it well.
Since your body’s cells can’t use the glucose from your food as energy, the glucose stays in your blood, where it can cause serious problems.
Diabetes is often called the silent killer because of its easy-to-miss symptoms. “Almost every day people come into my office with diabetes who don’t know it,” says Maria Collazo-Clavell, MD, an endocrinologist at the Mayo Clinic in Rochester, Minn.
The best way to pick up on it is to have a blood sugar test. But if you have these symptoms, see your doctor:
The kidneys kick into high gear to get rid of all that extra glucose in the blood, hence the urge to relieve yourself, sometimes several times during the night.
The excessive thirst means your body is trying to replenish those lost fluids.
These two symptoms go hand in hand and are some of “your body’s ways of trying to manage high blood sugar,” explains Dr. Collazo-Clavell.
Overly high blood sugar levels can also cause rapid weight loss, say 10 to 20 pounds over two or three months—but this is not a healthy weight loss.
Because the insulin hormone isn’t getting glucose into the cells, where it can be used as energy, the body thinks it’s starving and starts breaking down protein from the muscles as an alternate source of fuel.
The kidneys are also working overtime to eliminate the excess sugar, and this leads to a loss of calories (and can harm the kidneys). “These are processes that require a lot of energy,” Dr. Collazo-Clavell notes. “You create a calorie deficit.”
Excessive pangs of hunger, another sign of diabetes, can come from sharp peaks and lows in blood sugar levels.
When blood sugar levels plummet, the body thinks it hasn’t been fed and craves more of the glucose that cells need to function.
Itchy skin, perhaps the result of dry skin or poor circulation, can often be a warning sign of diabetes, as are other skin conditions, such as acanthosis nigricans.
“This is a darkening of the skin around the neck or armpit area,” Dr. Collazo-Clavell says.
“People who have this already have an insulin resistance process occurring even though their blood sugar might not be high. When I see this, I want to check their blood sugar.”
Infections, cuts, and bruises that don’t heal quickly are another classic sign of diabetes.
This usually happens because the blood vessels are being damaged by the excessive amounts of glucose traveling the veins and arteries.
This makes it hard for blood—needed to facilitate healing—to reach different areas of the body.
“Diabetes is considered an immunosuppressed state,” Dr. Collazo-Clavell explains. That means heightened susceptibility to a variety of infections, although the most common are yeast (candida) and other fungal infections, she says. Fungi and bacteria both thrive in sugar-rich environments.
Women, in particular, need to watch out for vaginal candida infections.
“When people have high blood sugar levels, depending on how long it’s been, they can get used to chronically not feeling well,” says Dr. Collazo-Clavell. “Sometimes that’s what brings them into the office.”
Getting up to go to the bathroom several times during the night will make anyone tired, as will the extra effort your body is expending to compensate for its glucose deficiency.
And being tired will make you irritable. “We see people whose blood sugar has been really high, and when we bring the blood sugar down, it’s not uncommon that I hear, ‘I didn’t realize how bad I felt,'” she says.
Having distorted vision and seeing floaters or occasional flashes of light are a direct result of high blood sugar levels.
“Blurry vision is a refraction problem. When the glucose in the blood is high, it changes the shape of the lens and the eye,” Dr. Collazo-Clavell explains.
The good news is that this symptom is reversible once blood sugar levels are returned to normal or near normal. But let your blood sugar go unchecked for long periods and the glucose will cause permanent damage, possibly even blindness. And that’s not reversible.
Tingling and numbness in the hands and feet, along with burning pain or swelling, are signs that nerves are being damaged by diabetes.
“If (the symptoms are) recent, it’s more likely to be reversible,” Dr. Collazo-Clavell says.
Still, as with vision, if blood sugar levels are allowed to run rampant for too long, neuropathy (nerve damage) will be permanent. “That’s why we try to control blood sugar as quickly and as well as possible,” she says.
Several tests are used to check for diabetes, but a single test result is never enough on its own to diagnose diabetes (the test has to be repeated).
One is the fasting plasma glucose test, which checks your blood sugar after a night (or eight hours) of not eating.
Blood glucose above 126 milligrams per deciliter (mg/dL) on two occasions means you have diabetes.
The normal cutoff is 99 mg/dL while a blood sugar level of 100 to 125 mg/dL is considered prediabetes, a serious condition on its own.
To begin with, learn as much as you can about type 2 diabetes. The more you and your parent learn, the better equipped you both will be to make the lifestyle adjustments that come with good diabetes management. Contact the American or Canadian Diabetes Association to find a Diabetes Education Center in your area.
Recommended reading: Your Type 2 Diabetes Action Plan from the American Diabetic Association, published 2016
If you or someone you care for has just been diagnosed with type 2 diabetes, first, take a deep breath.
When people first find out that they have diabetes, it’s sometimes really scary, or sad, or even hard to believe.
After all, you probably don’t feel sick, or any different than you felt before you were told you have diabetes. And yet it is very important to take this disease seriously.
Some people who learn they have diabetes worry that it means their life is over, or that they won’t be able to do everything they used to do. Neither of those things is true.
At first, learning all you need to know about diabetes may seem daunting, perhaps even a little frightening. Depending on your parent’s physical and cognitive abilities, you may be required to help with medications, test and track blood glucose (sugar) levels, and ensure they are eating well. Fortunately, many services are available to help you and your parent learn more about diabetes and what you can do to help manage the disease.
What is true is that you may need to change some things about your daily routine.
It’s not your fault that you got diabetes, but it is your job to take care of yourself.
Luckily, there’s a lot that you can do to keep yourself healthy.
You Can Manage Your Diabetes
There is no cure for type 2 diabetes, but it can be managed. Balancing the food you eat with exercise and medicine (if prescribed) can keep your blood glucose in a healthy range.
Many people with diabetes live long and healthful lives.
Your diabetes care team may include:
- your doctor
- diabetes educator
- any other health care provider working to help you care for your diabetes.
And remember, you and your family and friends are the most important members of your diabetes care team.
Your diabetes care team will help you, but day-to-day diabetes care is up to you.
That care includes:
- Choosing what, how much, and when to eat
- Getting physically active
- Taking medicine (if your doctor prescribes it)
- Checking your blood glucose (if your doctor prescribes it)
- Going to your appointments
- Learning all you can about diabetes
Choosing what, how much, and when to eat: In the past, diets for people with diabetes were very restrictive. Things are different now. There isn’t a one-size fits all diabetes diet.
While you may need to make some changes in what and how much you eat, you have flexibility in deciding what’s on the menu. With a little planning, you can still include your favorite foods.
What does healthy eating really mean?
- Eating a variety of foods, including vegetables, whole grains, fruits, non-fat dairy foods, healthy fats, and lean meats or meat substitutes.
- Trying not to eat too much food.
- Trying not to eat too much of one type of food.
- Spacing your meals evenly throughout the day.
- Not skipping meals.
Trying to figure out how you’re supposed to eat now that you have diabetes? A good place to begin is the “Plate Method.”
For people with diabetes, a good diabetic cookbook provides ideas to trim fat from their diet and gives detailed nutritional analysis and exchanges for each recipe.
The American Diabetes Association publishes new cookbooks every year filled with recipes that meet the Association’s diabetes nutrition guidelines.
Being active is another part of living healthy and managing diabetes. Any type of physical activity you do helps lower your blood glucose.
Other benefits of physical activity include:
- Having more energy
- Relieving stress
- Keeping your joints flexible
- Lowering your risk for heart disease and stroke
- Feeling great
Talk to your doctor if you have questions about which activities are right for you.
Examples of different types of physical activity include:
- Aerobic activity (walking, biking, swimming)
- Being active throughout the day (taking the stairs instead of an elevator)
- Strength training (lifting weights or using resistance bands)
- Flexibility exercises (stretching and yoga)
- Go dancing
- Take an aerobics class
- Go for a bike ride or use a stationary bike indoors.
If you haven’t been very active recently, you can start out with 5 or 10 minutes a day and work up to more time each week.
You can also split up your activity for the day: For example, take a quick 10-minute walk before or after each meal instead of 30 minutes all at once.
Being Active Throughout the Day
In addition to aerobic activity, there are many ways to be more active during your day.
This can help you burn calories and lower your blood glucose. Here are some examples:
- Walk instead of drive
- Get off the bus a stop early and walk the rest of the way
- Work in the garden, rake leaves or wash the car
- Play actively with kids
- Walk around while talking on the phone
- Park at the far end of the lot and walk
Your doctor or diabetes care team may suggest you try to lose some weight.
Losing weight can improve your blood glucose, blood pressure and cholesterol.
You don’t have to lose a lot of weight to start seeing results. Just losing 10-15 pounds can make a difference.
There are many types of weight loss plans to choose from. If you’re having trouble losing weight, talk with your doctor or a registered dietitian.
Recommended: Diabetes Weight Loss
Your doctor may prescribe medicine to help get and keep your blood glucose in your target range.
There are different types of diabetes medicines that work in different ways to lower blood glucose.
Your doctor may prescribe more than one to help you get to your target range.
Some people with type 2 diabetes take both pills and insulin or insulin by itself.
If you are starting new medicines, ask your doctor, pharmacist or diabetes educator the following questions:
- How many pills do I take?
- How often should I take them, and when?
- Should I take my medicine on an empty stomach or with food?
- What if I forget to take my medicine and remember later?
- What side effects could I have?
- What should I do if I have side effects?
- Will my diabetes medicine cause a problem with any of my other medicines?
If you think you are having side effects from your medicine, or have questions, call your doctor or pharmacist. Don’t stop taking it unless the doctor tells you to.
Remember, your medicine will work best if you also make healthy changes to how you eat and if you are active.
Checking Blood Glucose
Your doctor may want you to start checking your blood glucose at home.
If this is the case, you will need to get a small machine called a blood glucose meter. Meters are available in drug stores and online.
Recommended: Bayer Complete Diabetes Testing Kit includes: Bayer contour next EZ meter plus 100 Bayer contour next test strips plus 100 active1st 30g lancets plus lancing device plus contour next control solution plus instruction booklet plus active1st carry case.
Ask your doctor or diabetes educator to help you select a meter that works best for you and is covered by your insurance.
Meters work by testing a small drop of your blood for glucose.
Most people prick their fingertip to get the blood drop, but you can ask your diabetes educator or doctor about other methods.
It is important to check your blood glucose because before you had diabetes, no matter what you ate or how active you were, your blood glucose automatically stayed within a normal range; with diabetes, this is no longer true.
Checking your blood glucose is one way you can know how food, activity and medicine affect your blood glucose.
It can help you make sure your blood glucose isn’t going too high or too low.
Recommended: Medport On the Go Organizer for Diabetic Supplies.
- Insulin Travel Bag
- Sturdy and Durable Diabetic Case
- Freezer Pack included
- Two clear pockets
- A meter compartment to organize supplies for the day
Talk with your doctor or your diabetes care team about how often and when you should check your blood glucose.
Before a meal or two hours after a meal are common times to check blood glucose.
Also talk with your doctor about what your target numbers should be.
Different people have different feelings about getting type 2 diabetes.
Some of the usual reactions are:
- A sense of loss
- Disbelief and not wanting to think about it.
The thing to remember is that all of these feelings are completely normal.
Finding out that you have diabetes is a big deal. And even if you’re doing great with it now, there may be moments where you feel bad about what has happened to you.
It’s a great idea to talk to family, friends, or your doctor about how you’re feeling. Sometimes just putting your thoughts into words makes dealing with them easier.
Other people may be able to help you see the positive side of things, or figure out ways to reduce the stress.
TIP: Ask your diabetes care team to help if your feelings are overwhelming you or affecting the way you take care of yourself.
There’s a lot to learn about living well with diabetes. Getting in control might take some time. It’s going to mean making some changes in your life, but you can start with small changes, and you don’t have to make them all at once.
Have you or has someone you care about been diagnosed with type 2 diabetes? Please help others by sharing your tips and experience in the comment section below.
Proactive diabetes management can go a long way toward reducing the risk of long term complications.
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