What is Type 2 Diabetes?

Type 2 diabetes was originally called adult-onset diabetes, and it usually develops after the age of 35 to 40, accounting for more than 90% of patients with diabetes.

Basic Information

English name: diabetes mellitus, type 2
Visiting department: Endocrinology

Multiple groups: Middle-aged and elderly, people with family history, obese people
Common causes: Genetics, environment, race, age, lifestyle, etc.
Common symptoms: Drink more, drink more urine, eat more and lose weight, fatigue, obesity

Causes of Type 2 Diabetes

Genetic factor

Like type 1 diabetes, type 2 diabetes has a more pronounced family history. Some of these genes have been identified, and some are still in the research stage.

2. Environmental factors

Epidemiological studies have shown that obesity, high-calorie diets, insufficient physical activity, and aging are the most important environmental factors for type 2 diabetes, and factors such as hypertension and dyslipidemia also increase the risk of disease.

3. Age factor

Most type 2 diabetes develops after age 30. In half of newly diagnosed patients with type 2 diabetes, the age of onset is 55 years or older.

4. Race factors

Compared with Caucasians and Asians, type 2 diabetes is more likely to occur in Native Americans, African-Americans, and Hispanics.

5. Lifestyle

Ingesting high-calorie and irrational diets can lead to obesity. With weight gain and lack of physical exercise, insulin resistance can progressively increase, which can lead to insulin secretion defects and type 2 diabetes.

The main causes of type 2 diabetes include obesity, low physical activity, and stress. Stress includes stress, fatigue, mental irritation, trauma, surgery, childbirth, other major illnesses, and the use of blood sugar-elevating hormones. Due to the above-mentioned incentives, the patient's insulin secretion ability and body's sensitivity to insulin gradually decrease, and blood sugar rises, leading to diabetes.

So far, we have not been able to control the genetic factors of the human body. However, we can intervene on environmental factors to reduce the prevalence of type 2 diabetes.

Clinical manifestations of type 2 diabetes

Has a family history; can occur at any age, more common in adults; most are concealed, the symptoms are relatively mild, only mild fatigue, thirst, and no symptoms in more than half; some patients due to chronic complications, associated illness or Found during the medical examination.

Type 2 diabetes test

Type 2 diabetes is caused by the ineffective function of insulin (less binding to the receptor), so not only to check fasting blood glucose, but also to observe blood glucose 2 hours after a meal, especially for islet function tests.

The specific values are as follows: Normal fasting blood glucose: 3.9 to 6.1 mmol / L, and the blood glucose at 2 hours after a meal is below 7.8 mmol / L. If fasting blood glucose is 7.0 mmol / L, and 2 hours after a meal, blood glucose is 11.1 mmol / L, diabetes can be diagnosed. For example, fasting blood glucose is 6.1 to 7.0 mmol / L, and 2 hours postprandial blood glucose is between 7.8 to 11.1 mmol / L, which is impaired sugar regulation, which is a manifestation of early diabetes. The urine glucose test is for reference only, and cannot be used to diagnose diabetes and medication.

Islet function test: The examiner observed the changes of blood glucose, insulin, and C-peptide after taking 300 g of 75 g glucose water orally.

Type 2 diabetes diagnosis

In July 1997, the American Diabetes Association proposed criteria for the diagnosis and classification of diabetes.

1. Symptoms of diabetes, and random blood glucose 11.1 mmol / L. Random blood glucose is the blood glucose level at any time. Typical symptoms of diabetes include polyuria, thirst, and weight loss without other causes.

2. Fasting blood glucose 7.0mmol / L, fasting state is defined as no caloric intake for at least 8 hours.

3. 2 hour blood glucose at OGTT 11.1 mmol / L. OGTT is still carried out in accordance with WHO requirements.

Patients who do not have symptoms of diabetes and meet one of the above criteria will be diagnosed with diabetes if they meet one of the three criteria on the next day's follow-up.

In the new classification criteria, diabetes and impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are both hyperglycemic states, which are corresponding to normal glucose levels with normal glucose regulation. The diagnostic criteria of IGT are: 2-hour blood glucose at OGTT 7.8 mmol / L, but <11.1 mmol / L, and IFG is fasting blood glucose 6.1 mmol / L but <7.0 mmol / L.

2010 ADA Diabetes Diagnostic Criteria:

1. Glycated hemoglobin HbA1c 6.5%.

2. Fasting blood glucose FPG 7.0mmol / L. Fasting is defined as no caloric intake for at least 8 hours.

3. Blood glucose 11.1 mmol / L at 2 hours during oral glucose tolerance test.

4. In patients with typical symptoms of hyperglycemia or hyperglycemia crisis, the random blood glucose is 11.1mmol / L.

In the absence of clear hyperglycemia, repeated testing should be used to confirm criteria 1 to 3.

Compared with the past, there are two improvements: increased glycated hemoglobin index; weakened symptoms index, more people are included in the category of diabetes, and early diagnosis and treatment have been obtained.

Type 2 diabetes treatment

Oral hypoglycemic agent

(1) Biguanides (such as metformin) have the ability to reduce glucose output from the liver, and can help muscle cells, fat cells and the liver absorb more glucose from the blood, thereby lowering blood glucose levels.

(2) The main role of sulfonylureas (such as Glimepiride, Glibenclamide, Glipizide , and Glipidone) is to stimulate the islets to release more insulin.

(3) Thiazolidinediones (such as rosiglitazone and pioglitazone) can increase insulin sensitivity and help muscle cells, fat cells and the liver absorb more glucose from the blood. However, rosiglitazone may increase the risk of heart disease.

(4) The mechanism of action of drugs such as benzoic acid derivatives (such as riglitinide and nateglinide) is similar to that of sulfonylureas, mainly to stimulate the pancreas to produce more insulin to lower blood sugar.

(5) Alpha-glucosidase inhibitors (such as acarbose and voglibose) can reduce the absorption of sugars in the digestive tract of the human body, and the main role is to reduce postprandial blood sugar.

2. Insulin drugs

If you still can't control your blood sugar well by changing your lifestyle and using oral hypoglycemic drugs, or if taking other drugs can have an adverse effect on you, your doctor may recommend you use insulin. At present, insulin cannot be taken orally, and can only be injected subcutaneously using a device such as a syringe or an insulin pen.

Different insulin preparations have different onset time and duration of action. Patients need to choose the type of insulin suitable for their current condition under the guidance of a doctor, and develop an appropriate insulin injection time.

In order to achieve the best blood glucose control, it is sometimes possible to premix multiple insulins and inject them. Usually, the frequency of insulin injection is 1 to 4 times / day.

By losing weight and strengthening physical activity, some people with type 2 diabetes find they can no longer need medication. Because when their weight reaches the ideal range, they can control blood sugar through their own insulin secretion and diet regulation.

It is unclear whether pregnant women take oral hypoglycemic drugs safely. Women with type 2 diabetes may need to stop taking oral hypoglycemic drugs and inject insulin during pregnancy and lactation.