Could You Be A Type 2 Diabetic?

Kristine Napier, M.P.H., R.D., L.D.
Nutrio.com Team

November is National Diabetes Month. An astonishing 1 in 2 people who have type 2 diabetes do not know they have it, which means their continued high blood sugars silently cause problems throughout their bodies.

This article is to make you aware of the two types of diabetes, and encourage you to go for testing if you meet any of the criteria listed below that indicate you are at increased risk.

Essential Definitions
Two Types of Diabetes
What Is type 2 Diabetes?
Who has a Higher Risk of type 2 Diabetes?
When Should I be tested for type 2 diabetes?
What Do I Do if I Have type 2 Diabetes?
Sample Nutrio Menus for Diabetics

Essential Definitions

Because diabetes can be a complicated topic, here are a few terms that are simply defined to help you better understand the condition and be able to discuss it with your health care team:

Beta cells: Cells in the pancreas responsible for making the hormone insulin.

Blood Glucose = Blood Sugar: After food is digested into its simplest components, it is absorbed into the blood stream. Carbohydrates are eventually broken down into their simplest components, called glucose units. The glucose is absorbed into the blood. In order to be used by the body for energy, the glucose has to leave the bloodstream and enter the cells. It can only do so with the help of insulin. While the official name for glucose in the blood is blood glucose, many people often call it blood sugar.

Insulin: A hormone produced by the beta cells in the pancreas that helps cells take in sugar from the blood (officially called blood glucose) so that it can be used for energy.

Pancreas: The pancreas is an organ in the upper left part of your abdomen, near your stomach. Among other jobs, the pancreas is responsible for producing insulin. In fact, one particular type of cell, called the beta cell, makes insulin.

Two Types of Diabetes

There are two main types of diabetes mellitus, type 1 and type 2.

type 1: In people with type 1, the beta cells in the pancreas are destroyed and can no longer make insulin. People with this type of diabetes would die if they did not get insulin injections (or insulin by pump).

This type of diabetes often comes on at younger ages, such as during childhood (although it can still occur for the first time during adulthood). Of the over 16 million people that have diabetes mellitus, about 10 percent have type 1.

The symptoms of type 1 diabetes include:

• Weight loss, without trying
• Frequent urination
• Hunger
• Thirst
• Changes in vision
• Extreme fatigue

Some people with type 1 diabetes who aren't aware they have it can lapse into a coma when blood sugars rise extremely high. They need emergency medical treatment.

However, the majority of people in America who have diabetes have type 2 diabetes.

What is type 2 diabetes?

At one time, type 2 diabetes was called adult onset diabetes; it was also called noninsulin dependent diabetes. Both of these other two terms are still used, in fact, but the most accurate is type 2.

Until recently, type 2 diabetes only occurred in people over the age of 40 (which is the reason it was called adult onset). However, today, people are getting this type of diabetes at younger and younger ages. Why? Because of being overweight and underactive. The skyrocketing incidence of both overweight and obesity in kids, in fact, is the reason why we are now seeing this disease crop up in kids at frighteningly rapid increases.

The cause of type 2 diabetes is quite different than it is in type 1. Generally because of being overweight, people with type 2 diabetes become less sensitive to the effects of insulin. Yes, their beta cells continue to pump out insulin, but the cells are less sensitive to the effects of insulin. After as long as five to seven years of having insulin insensitivity (a time during which much damage can be done to the cells), the beta cells of people with type 2 diabetes simply cannot keep up with the demand. At this point, blood sugars begin to rise, and such people are said to have impaired glucose intolerance. In the next step, blood sugars rise even more, and this is when a person has type 2 diabetes, or blood sugars raging out of control.

One of the scary things about type 2 diabetes is that most people don't know they have it until they suffer some complication from it, which could be a serious infection leading to amputation, a heart attack, loss of vision, a stroke, or serious kidney disease. Many people have type 2 diabetes for up to five to seven years before they are diagnosed.

Let's take a look at the toll that diabetes takes on America's health (and remember, most of this toll comes from people who have type 2 diabetes):

• Diabetes is the leading cause of new cases of blindness in people ages 20 to 74.
• Diabetes is the leading cause of end-stage kidney disease, accounting for about 40 percent of the nearly 28,000 people diagnosed yearly.
• A person with diabetes is 15 to 40 times more likely to have an amputation of a toe, foot or leg than is someone without diabetes. Each year, more than 56,000 diabetics must have an amputation.
• People with diabetes are two to four times more likely to have atherosclerotic, or artery-clogging, heart disease. Heart disease, in fact, is a contributing factor to three-quarters of diabetes-related deaths.

Who has a higher risk of type 2 diabetes?

Risk factors for type 2 diabetes can be divided into two categories:

1. Risk factors you cannot get rid of, but that you can influence; and
2. Risk factors you can control.

Risk factors you cannot get rid of, but that you can influence include:

• Genetics (family history)
• Race (Hispanics, African-Americans and American Indians, for example, are at exceptionally high risk)
• Increasing age
• Giving birth to a baby over 9 pounds and/or had gestational diabetes (diabetes during pregnancy).

Risk factors you can control:

• Excess weight: being too heavy
• Carrying excess weight around your middle section
• The couch potato syndrome: being too sedentary
• Eating a diet too high in fat, especially saturated fat

What do we mean by risk factors you can influence? We know that people at high risk of diabetes because of genetics, race, and/or increasing age may never get diabetes unless they become overweight, don't exercise, and/or eat a diet too high in fat, especially saturated fat. So even for those risk factors that you cannot get rid of, you can influence them by working on the risk factors that you can control.

When should I be tested for type 2 diabetes?

If you are over age 40, are overweight and do not exercise, you should be tested. Your doctor might recommend testing at younger ages if you have a strong family history, or if you have certain symptoms that suggest your blood sugars might be running high. Some of these symptoms include:

• Headache
• Blurry vision
• Excessive thirst and the need to urinate frequently
• Dry, itchy skin

What do I do if I have type 2 Diabetes?

The most important thing is to discuss with your physician and a registered dietitian or certified diabetes educator the best type of treatment plan to bring your blood sugars down to normal readings. This could involve any one or all of the following strategies:

1. A meal plan low enough in calories to help you lose weight if you need to, but balanced with protein, carbohydrate and fat appropriately. The American Diabetic Association recommends that people with type 2 diabetes reduce fat, especially saturated fat; total fat calories should make up no more than 20 to 30 percent of a day's worth of calories.
• About 50 to 55 percent of a day's calories, says the American Diabetic Association, should come from carbohydrates. These carbohydrate calories should include nutrient-rich foods such as grains (especially whole grain foods, vegetables, fruits and legumes (such as split peas and beans).
• About 10 to 20 percent of a day's calories should come from protein foods, with an emphasis on lower fat choices such as lean meats, skinless poultry, fat-free milk, lower fat cheeses and cottage cheese, fish and legumes. To cut down on the fat and saturated fat that you would normally get from meat and poultry, try to have a few fish meals and also a few vegetarian meals each week.
2. Exercise: Exercise is just as important to controlling blood sugars in type 2 diabetes as is eating more healthfully. This is because exercise helps the muscles take up glucose more efficiently.
   Always check with your physician before starting any new exercise regimen, especially if you haven't been terribly active. Remember, diabetes can affect the heart, and so you need to have your heart checked out before embarking on vigorous exercise routines.
   Remember exercise can be a sport or recreational activity, or can also be another physical activity (like gardening or household chores) that is done on a regular basis.
3. Medications: Oral medications that help lower blood sugar and/or injected insulin. Only your doctor will know for sure which medications or combination of them will best control your individual case of type 2 diabetes.

Remember, the goal in type 2 diabetes is to reduce body weight to a leaner level so that medications are no longer necessary, and so that just a well-structured diet and regular exercise will control blood sugars.

Embark on this goal only with your doctor's advice and frequent monitoring.