Type 2 diabetes

Type 2 diabetes: short overview

• Causes: Insulin resistance (insensitivity of the body cells to insulin); Various risk factors are involved in the pathogenesis, including genetic predisposition, overweight, lack of exercise, metabolic syndrome
• Age of onset: usually after the age of 40, but more and more often overweight children and adolescents also develop type 2 diabetes
• symptoms: develop creeping, for example fatigue, increased susceptibility to infection, dry skin, itching and increased thirst. When diagnosed sometimes symptoms of secondary diseases are already present such as blurred vision or circulatory disorders in the legs.
• Important investigations: Measurement of blood sugar and HbA1c, oral glucose tolerance test (oGTT), studies on concomitant and secondary diseases (hypertension, diabetic retinopathy, diabetic foot, etc.)
• Treatment options: Nutritional change, lots of exercise, hypoglycemic tablets (oral antidiabetics), insulin (in advanced stages)

Type 2 diabetes: description

Diabetes mellitus type 2 is a widespread disease affecting more than eight million people in Germany. In recent decades, the number of patients has increased significantly, including in other industrialized countries. In the past, type 2 diabetes was primarily a disease of the elderly. That’s why he was often referred to as “adult onset diabetes”.

Meanwhile, important risk factors of the disease (such as overweight, lack of exercise) often already at a young age. As a result, young adults and even children are becoming increasingly ill with Type 2 diabetes. The term “adult onset diabetes” has thus lost its validity.

Diabetes type 2 a / b (diabetes without or with overweight)

Some physicians make a fine grading in type 2 diabetes – depending on whether there is also an abnormal obesity (obesity = obesity) or not. This is the case for most patients. They are assigned to the subgroup diabetes mellitus type 2b. Only a small proportion of the patients are not obese: this is the diabetes type 2a group.

Type 2 diabetes: symptoms

Many people with type 2 diabetes are obese (obese) and older. The diabetes itself often causes no symptoms for a long time (asymptomatic course). Sometimes it also causes nonspecific symptoms such as tiredness, lack of concentration, itching or dry skin. In addition, the abnormally high blood sugar level makes patients more susceptible to infections, such as the skin and mucous membranes (such as fungal infections) or the urinary tract.

If the type 2 diabetes has already led to secondary diseases, corresponding symptoms can also occur. These can be, for example, blurred vision or even blindness due to diabetes-related retinal damage (diabetic retinopathy). If the constantly elevated blood sugar levels have damaged the vessels and nerves, poorly healing ulcers and wounds can develop on the foot or lower leg (diabetic foot).

Read more about signs and symptoms of type 2 diabetes in the article Diabetes Mellitus Symptoms.

Type 2 diabetes: causes and risk factors

An important role in type 2 diabetes is played by insulin. This hormone is produced by the beta cells of the pancreas and released into the blood when needed. It ensures that the circulating sugar (glucose) in the blood reaches the body cells, which need it for energy.

In type 2 diabetes, the pancreas usually initially produces sufficient amounts of insulin. However, the body cells (such as in the liver or muscles) are increasingly insensitive to it. The number of insulin binding sites on cell surfaces decreases. Because of this growing insulin resistance The existing amount of insulin is no longer sufficient to inject the blood sugar into the cells. It insists relative insulin deficiency.

The body tries to compensate for this by increasing insulin production in the beta cells of the pancreas. In late stages of the disease, this constant overload can deplete the pancreas enough to reduce insulin production. Then one can absolute insulin deficiency develop, which can be compensated only by insulin syringes.

Experts now know various risk factors that can promote the disease mechanism described here and thus contribute to the development of type 2 diabetes. A distinction is made between influenceable and uncontrollable risk factors. It is now believed that diabetes mellitus type 2 is caused by the coincidence of several factors and not by one factor alone.

Influencing risk factors

Affected individuals themselves have a major influence on influenceable risk factors. Minimizing these factors helps prevent type 2 diabetes. Even people who are already diabetic should, if possible, eliminate these risk factors. This often prevents complications and sequelae.

overweightThe majority of diabetics (type 2) are overweight or even obese (obese). Although overweight is not the sole cause of the disease, it may be the key trigger: fat cells (adipocytes) release different messenger substances (hormones, inflammatory substances) into the blood, which reduces the insulin sensitivity of the cells over time. Above all the fat cells of the belly fat seem to be dangerous, since they produce particularly many such messenger substances. An increased waist circumference (men:> 94 centimeters, women:> 80 centimeters) is therefore considered particularly harmful for the sugar metabolism.

lack of exercise: Lack of exercise has a negative effect on the energy balance: Anyone who moves burns energy absorbed by food. Without this movement, an excess of calories is produced while maintaining food intake. This is reflected in increased blood sugar levels and in the build-up of fatty tissue.

Metabolic syndrome: The metabolic syndrome is a combination of abdominal obesity (abdominal obesity), elevated blood lipid levels (dyslipoproteinemia), high blood pressure (hypertonicity) and a disorder of sugar metabolism (insulin resistance). It is considered to be an important risk factor for type 2 diabetes as well as other diseases such as heart attack and stroke.

Other risk factors for type 2 diabetes include:

• Smoke
• Low-fiber, high-fat and high-sugar diet
• certain medicationswhich worsen sugar metabolism, such as the contraceptive pill, antidepressants, diuretics and antihypertensives

Non-influenceable risk factors

The following risk factors can not be influenced by those affected. Nevertheless, one should know them: A type 2 diabetes can go undetected for a long time. People with the risk factors mentioned here should therefore keep a close eye on their blood sugar:

inheritance: Genetic predisposition seems to play an important role in type 2 diabetes. For example, identical twins almost always both develop type 2 diabetes, not just one. Daughters of ill mothers are at about a 50 percent risk of also developing type 2 diabetes. If both parents are ill, the risk for children increases to 80 percent. Researchers now know more than 100 genes that may increase the risk of type 2 diabetes.

Age: The type 2 diabetes risk increases with age, as the effect of insulin in old age as well as in overweight people can decline over time. The pancreas releases more insulin into the bloodstream to compensate, which in turn reduces its effectiveness on the cell surface.

Hormonal diseases:Endocrine disorders can also increase the type 2 diabetes risk. This applies, for example, to the polycystic ovarian syndrome (PCO).

Type 2 diabetes: examinations and diagnosis

If you have a type 2 diabetes, the right contact person is your family doctor or a specialist in internal medicine and endocrinology or diabetology.

The doctor first collects your medical history (anamnesis) by talking extensively with you. He can describe your complaints and possible pre-existing diseases exactly. Possible questions from your doctor in this conversation include:

• Do you often have to spend a lot of water lately?
• Do you suffer from constant thirst, even though you drink large quantities?
• Do you often feel weak and tired?
• Does someone in your family have diabetes type 2?

After that follows one physical examination, Here the doctor pays particular attention to whether you can feel fine touches on the hands and feet. A loss of sensitivity could already point to diabetes-related nerve damage (diabetic polyneuropathy). In addition, the doctor looks at whether possibly have already developed wounds on the foot due to the emotional disorder (diabetic foot). Basically, a study of the ocular fundus is one of the typical diabetes studies. However, this is usually done by the ophthalmologist.

Diabetes Test

Very important for the diagnosis of diabetes is the analysis of one blood samplewhich is taken on an empty stomach. In this sample, the fasting blood sugar is measured. The so-called HbA1c value in the blood is also determined. It indicates how high the average blood sugar level has been in the last two to three months.

The sugar content of a urine sample is also determined: When the blood sugar level is very high, the body tries to get rid of the excess via the kidneys.

To better assess the performance of the sugar metabolism, the doctor can give you one oral glucose tolerance test (oGTT) undergo.

Read more about the necessary tests and tests for the diagnosis of diabetes mellitus in the article Diabetes Test.

Type 2 diabetes: treatment

The diabetes type 2 treatment aims to permanently lower the elevated blood sugar levels to a healthier Nievau. This is the only way to prevent severe complications of type 2 diabetes.

To monitor the therapeutic success is the periodic HbA1c certainly. In non-diabetics, it is generally less than 6.0 percent. In diabetes type 2 patients, he often goes much higher untreated. They are usually advised to use a HbA1c target of 6.5 to 7.5 percent desirable. Elderly people who do not have typical diabetes symptoms may also be better off with a higher target.

In general, how much the blood sugar level should be lowered in individual cases depends on the age and the general state of health of the patient as well as on any comorbidities (high blood pressure, lipid metabolism disorders, obesity, etc.).

A successful diabetes type 2 treatment also includes the therapy of such comorbidities. This helps to positively influence the course of the disease.

Diabetes type 2 treatment: Step pattern

The basis of diabetes type 2 therapy forms one Lifestyle change with a change in diet, more exercise, reduction of obesity and smoking cessation. In addition, patients should be at one Diabetes education take part.

A better understanding of one’s own disease and lifestyle change is enough in some patients to lower the high blood sugar level. If that fails, the doctor prescribes additionally drugs: Hypoglycaemic (oral hypoglycemic agents) and / or insulin.

Overall, the diabetes type 2 treatment is based on a step pattern. Each level is for three to six months applied. If the individual HbA1c target value could not be reached during this time, the next level of Type 2 diabetes treatment will be switched:

step 1	Diabetes education and lifestyle change (weight loss, exercise, diet change, smoking cessation)
Level 2	Monotherapy with one oral antidiabetic (mostly metformin)
level 3	combination two oral antidiabetics or insulin
Level 4	Insulin therapy possibly in combination with oral antidiabetic

Diabetes education

As the very first therapy before medications are used, the lifestyle should always be adjusted. Participating in diabetes type 2 training can help. There, sufferers learn more about the development of type 2 diabetes, the possible symptoms and sequelae and the treatment options. Among other things, they receive helpful tips on nutrition, weight loss and physical activity. Talk to your attending physician about ways to attend such training.

More movement

Physical activity is one of the most important therapy building blocks for type 2 diabetes. It can improve the effect of insulin and thus lower the blood sugar level. In addition, physical activity prevents dangerous consequences of type 2 diabetes (such as cardiovascular disease), increases fitness and improves the quality of life of patients.

For this purpose, patients should for one more exercise in everyday life to care. This is possible, for example, by taking regular walks or taking the stairs instead of the elevator more often.

For another, people with type 2 diabetes should if possible Sports float. First of all, diabetes type 2 patients should be examined by a doctor: the training program must be adapted to the patient’s age, physical fitness and general health. The doctor (or a sports therapist) helps to select a suitable sport and to create a personalized training plan. Endurance training (such as cycling, swimming, Nordic walking, etc.) and / or strength training are recommended.

The rule is that moving regularly on a regular basis several times a week is much more beneficial and healthier than exhaustion once a week. In addition, it prevents such dangerous incidents as a sudden severe hypoglycemia (hypoglycemia).

By the way: Helpful for your own motivation can be training together with friends, in a sports group or in a sports club!

Adaptation of nutrition

The right diet for type 2 diabetes improves blood sugar levels, possibly promotes weight loss and prevents the development of secondary diseases. The nutritional recommendations are thus adapted to the individual therapy goal and risk profile of a patient. In addition, they should consider personal likes and dislikes, otherwise the diet change difficult.

Experts disagree on how high the proportion of each major nutrient (carbohydrate, fat, protein) in diet should be in type 2 diabetes. However, studies indicate that it is less important to the exact percentage of the main nutrients than their type and source.

So should with the carbohydrates preference is given to those products which contain many soluble fibers or which have little influence on the blood sugar level. These include, for example, whole grains, legumes, potatoes, vegetables and fruits. Household sugar, honey, sweets and sweetened drinks (such as cola, soda) should consume at most in low-volume diabetes type 2 patients – especially in overweight.

at fats Care should be taken to ensure a high level of monounsaturated or polyunsaturated fatty acids. It is found especially in vegetable fats such as olives and rapeseed oil. Animal fats (meat, sausage, cream, butter, etc.) should be consumed sparingly. Especially overweight people with diabetes type 2 should prefer low-fat products like low-fat cheeses.

Proteins (proteins) should not account for more than 10 to 20 percent of the total energy delivered during the day. This recommendation applies to people with type 2 diabetes if they show no signs of kidney damage (nephropathy). With existing kidney weakness, diabetics should consume a maximum of 0.8 grams of protein per kilogram of body weight. Important protein sources are fish, meat and dairy products.

There are many in the trade “Diabetic products” and “diet products” available for diabetics. These industrially manufactured foods should be avoided, experts advise. Although many products contain no sugar, but more fat and calories than the corresponding normal products.

In addition, diet products often contain a lot fructose (Fructose). However, this has a harmful effect on the health in large quantities: It promotes obesity, favors the metabolic syndrome, increases blood lipid levels and uric acid levels. Diabetics should therefore refrain from products with a lot of fructose. In addition, normal household sugar should not be replaced with fructose (as is often the case) when baking cakes.

alcohol should be consumed in diabetic type 2 at most in moderate amounts. That means: no more than one or two small glasses per day. Many experts recommend the simultaneous intake of carbohydrate-rich foods: the carbohydrates raise the blood sugar level, the alcohol lowers it. For example, a bottle of beer a day can balance the effect on blood sugar.

smoking cessation

Type 2 diabetes promotes the development of cardiovascular diseases such as stroke and myocardial infarction. This risk is exacerbated when diabetics are still smoking. Therefore, should be avoided if possible on cigarettes & Co. A doctor can advise smokers on the possibilities of smoking cessation (nicotine patches, etc.) to advise and provide valuable assistance.

Oral antidiabetics

If the lifestyle change does not manage type 2 diabetes, oral antidiabetics are also used. As a rule, a single active substance is started (monotherapy, usually with metformin). If this is not enough, the doctor prescribes either two oral antidiabetics or insulin to the patient.

The following active ingredients are available:

drug group	Examples	effect	possible side effects
biguanides	metformin	Increases the insulin effect. Lowers blood lipids and cholesterol. Slows appetite and therefore contributes to weight loss.	Rare but dangerous side effect: lactic acidosis (hyperacidity of the blood)
sulfonylureas	Glibenclamide, gliquidone, glimepiride etc.	Increases insulin release from the pancreas.	Weight gain. Risk of low blood sugar.
Glinide (“sulfonylurea analogues”)	Repaglinide, nateglinide	Increases insulin release from the pancreas.	Weight gain. Risk of low blood sugar.
Glitazone (“insulin sensitivityhe”)	pioglitazone	Cells become more sensitive to insulin	increase in weight
Alpha-glucosidase inhibitors	acarbose	Inhibit sugar splitting enzymes in the intestinal mucosa. So sugar is not absorbed, but excreted undigested.	Often poor compatibility
Gliptin (DPP-IV inhibitor)	Sitagliptin, vildagliptin etc.	Increases insulin release from the pancreas.	Low weight gain
SGLT2 inhibitors (Gliflozine)	dapagliflozin	Increased excretion of glucose via the urine	Urinary tract infections

The longest in use in type 2 diabetes are metformin and sulfonylureas. The others are newer antidiabetics.

For some time, there are so-called Incretin mimetics (like exenatide). They are not taken as a tablet, but injected under the skin. In studies they were able to lower the blood sugar level and reduce the HbA1c value. Incretin mimetics are suitable, for example, if the combination of various oral antidiabetic agents does not work sufficiently.

insulin therapy

There are many different insulins. Above all, they differ in how fast and how long they work after the meal (spray-eating distance and duration of action). In addition, insulin can be used in different ways.

For example, some people with type 2 diabetes are being treated with both an oral antidiabetic and insulin. They take, for example, metformin and injected before a meal or so-called normal insulin, in the subcutaneous fat tissue about the abdomen.

Other patients are treated exclusively with insulin, with different regimens:

Conventional insulin therapyConventional insulin therapy is especially useful for Type 2 diabetic patients who have a fixed daily and nutritional schedule (for example, in nursing homes). It is usually twice a day (before breakfast and dinner) a so-called mixed insulin injected. It consists of a short-acting and a long-acting insulin analogue, thus acting simultaneously fast and long. Before each of the blood sugar is determined.

This relatively rigid scheme does not allow for significant variations in the diet and in the level of physical activity. If a meal is forgotten or left out, low blood sugar threatens. In addition, conventional insulin therapy tends to gain weight.

Intensified insulin therapy (basic bolus principle): The so-called intensified insulin therapy requires more effort from the patient, but at the same time offers more freedom. In addition, it can more effectively prevent diabetes sequelae by more effectively lowering blood sugar.

According to the so-called basic bolus principle, a long-acting insulin is usually injected once or twice a day. It covers the basic insulin requirement one day (basal insulin or basal insulin). In addition, normal insulin or a short-acting insulin is added before a meal (bolus). Before that, the current blood glucose value is measured. The dose of bolus insulin depends on its amount and the carbohydrate content of the planned meal.

This form of therapy for type 2 diabetes requires particularly good training and cooperation from patients (compliance). But they are allowed to eat what they want and when they want, and they can exercise if they are adequately well-adjusted. Extreme physical exertion, however, can derail sugar metabolism due to increased adrenaline release.

A insulin Pump, as it is often used in type 1 diabetes, in type 2 diabetes is only in individual cases in question.

Type 2 diabetes: disease progression and prognosis

Whether a type 2 diabetes is curable depends heavily on the patient’s involvement and his willingness to change his lifestyle (healthier diet, more exercise, etc.). However, such general measures and diabetes medications (if needed) definitely help to slow down the progression of the disease and prevent possible complications: the better it is to lower the blood sugar level, the lower the risk of complications such as heart attack, stroke or kidney weakness. The extent of the sequelae decisively determines the prognosis of type 2 diabetes!

Prevent type 2 diabetes

The best way to prevent Type 2 diabetes is to have a healthy body weight, a balanced, varied diet and regular, adequate exercise. Especially people who already have a disturbed glucose tolerance (but still no diabetes), should implement these measures. In addition, they should go to regular check-ups at the family doctor. So may possibly Type 2 diabetes be recognized early and treated.

Additional information:

guidelines:

• National Care Guideline “Therapy of Type 2 Diabetes” (as of 2014)