What is type 2 diabetes?Type 2 diabetes is a condition in which the body becomes resistant to the normal effects of insulin and gradually loses the capacity to produce enough insulin in the pancreas. The condition has strong genetic and family-related (non-modifiable) risk factors and is also often associated with modifiable lifestyle risk factors. We do not know the exact genetic causes of type 2 diabetes. People may be able to significantly slow or even stop the progression of the condition through changes to diet and increasing the amount of physical activity they do. Show
Type 2 diabetes:
What happens with type 2 diabetes?Type 2 diabetes develops over a long period of time (years). During this period of time insulin resistance starts, this is where the insulin is increasingly ineffective at managing the blood glucose levels. As a result of this insulin resistance, the pancreas responds by producing greater and greater amounts of insulin, to try and achieve some degree of management of the blood glucose levelsi. As insulin overproduction occurs over a very long period of time, the insulin-producing cells in the pancreas wear themselves out, so that by the time someone is diagnosed with type 2 diabetes, they have lost 50 – 70% of their insulin-producing cells. This means type 2 diabetes is a combination of ineffective insulin and not enough insulin. Lifestyle changes may be able to slow this process in some people. Initially, type 2 diabetes can often be managed with healthy eating and regular physical activity. Over time many people with type 2 diabetes will also need tablets, and/or non-insulin injectable medications and many eventually require insulin injections. It is important to note that this is normal, and taking tablets, non-insulin injectable medications or insulin as soon as they are required can result in fewer long-term complications. What causes type 2 diabetes?Diabetes runs in the family. If you have a family member with diabetes, you have a genetic disposition to the condition. While people may have a strong genetic disposition towards type 2 diabetes, the risk is greatly increased if people display a number of modifiable lifestyle factors including high blood pressure, being overweight, not being active enough, eating a poor diet and having the classic ‘apple shape’ body where extra weight is carried around the waist. People are at a higher risk of getting type 2 diabetes if they:
Check your risk – answer 11 short questions to better understand your risk of developing type 2 diabetesii. Read our section on preventing type 2 diabetes. SymptomsMany people with type 2 diabetes have no symptoms. As type 2 diabetes is commonly (but not always) diagnosed at a later age, sometimes signs are dismissed as a part of ‘getting older’. In some cases, by the time type 2 diabetes is diagnosed, the long-term complications of diabetes may already be present. Symptoms include:
Managing type 2 diabetesWhile there is currently no cure for type 2 diabetes, the condition can be managed through lifestyle modifications and medication. Effectively managing diabetes is the best way to prevent diabetes-related complications. If you have recently been diagnosed with type 2 diabetes or have a family member with type 2 diabetes, view information here on managing type 2 diabetes. Diabetes remissionResearch shows that it is possible for some people with type 2 diabetes to achieve type 2 diabetes remissioniii. We define type 2 diabetes remission as an HbA1c of under 6.5% (48mmol/mol) for at least three months without the need for glucose-lowering medications. The most common ways people have achieved remission is by achieving substantial weight loss following very intensive dietary changes or through bariatric surgery. Remission is not achievable for everyone with type 2 diabetes. In all studies of intensive dietary modifications, less than half of participants were able to achieve remission after one year. Remission does not mean type 2 diabetes is cured or reversed – it simply means that people have blood glucose levels below the type 2 diabetes levels. It is important that people in remission continue to access regular diabetes monitoring at least annually and keep up their Annual Cycle of Care health care checks. Ongoing monitoring is required as some of the macrovascular and microvascular damage which cause long term complications has already begun. People with type 2 diabetes who want to attempt diabetes remission need to do so in close consultation with their diabetes healthcare team, as intensive dietary and weight changes need careful management, monitoring and support. People who do not achieve or sustain remission should not feel that they have ‘failed’. The health benefits of weight loss and a reduction in HbA1c are significant even if remission does not occur, as these reduce the risk of developing diabetes-related complications and may lead to reducing or stopping glucose-lowering medications. Diabetes Australia has developed a position statement on diabetes remissioniv to help people with diabetes and health professionals make informed choices. 2021_Diabetes-Australia-Position-Statement_Type-2-diabetes-remission_2 Type 2 diabetes and meLearn how to live well with diabetes by accessing a free National Diabetes Services Scheme online course, called Type 2 Diabetes and Me, here or attending one of the many free online, virtual or face-to-face programs here. They will help you learn how to live well with diabetes, manage your glucose levels, show you where to go for support and provide you with links to additional information. [i] Leszek Szablewski. (2011). Glucose homeostasis and insulin resistance. Bentham Science. https://benthambooks.com/book/9781608051892/ p126-128 [ii] https://www.health.gov.au/resources/apps-and-tools/the-australian-type-2-diabetes-risk-assessment-tool-ausdrisk [iii] Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., Rodrigues, A. M., Rehackova, L., Adamson, A. J., Sniehotta, F. F., Mathers, J. C., Ross, H. M., McIlvenna, Y., Stefanetti, R., Trenell, M., & Welsh, P. (2018). Primary care-led Weight Management for Remission of Type 2 Diabetes (DiRECT): an open-label, cluster-randomised Trial. The Lancet, 391(10120), 541–551. https://doi.org/10.1016/s0140-6736(17)33102-1 [iv] StackPath. (n.d.). www.diabetesaustralia.com.au. https://www.diabetesaustralia.com.au/wp-content/uploads/2021_Diabetes-Australia-Position-Statement_Type-2-diabetes-remission_2.pdf What is the first recommendation for a recently diagnosed diabetic?Eat a variety of foods, including vegetables, whole grains, fruits, non-fat dairy foods, healthy fats, and lean meats or meat substitutes. Try not to eat too much food. Try not to eat too much of one type of food. Space your meals evenly throughout the day.
What patient history should be taken for a diabetic patient?weight gain or loss, polyuria, polydypsia, polyphagia, weakness, fatigue, blurred vision, recent skin or other infection, vulvovaginitis/balanitis, abdominal pain, medication history (e.g., corticosteroids, medication compliance), family history of diabetes mellitus, and social history (e.g., cigarette use)
What should you assess for type 1 diabetes?Random blood sugar test.
This is the primary screening test for type 1 diabetes. A blood sample is taken at a random time. A blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher, along with symptoms, suggests diabetes.
What is the history of type 1 diabetes?Discovery of diabetes
Over 3,000 years ago, the ancient Egyptians mentioned a condition that appears to have been type 1 diabetes. It featured excessive urination, thirst, and weight loss. The writers recommended following a diet of whole grains to reduce the symptoms.
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When obtaining the history of a client recently diagnosed with type 1 diabetes
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