Diabetes Type 2

The key to dealing with this disease, which affects about 520,000 Australians and 105,000 New Zealanders, is to feel a sense of control. Most diabetes problems can be prevented or delayed with a measure of dilligence and the right medications.

What is happening

 The type of diabetes that develop slowly during adulthood--and is generally managerable with diet, weight reduction and mediacation--is called type 2. With this form of disease, you either aren't producing enough insulin any more or your cells are no longer responding it to corectly. It's the pancreas, an organ tucked against the back of your abdomen, that produces insulin, a hormone that enable your body to use sugar (glucose). When you don't have enough insulin, glucose builds up in your blood instead of entering your cells, which need it to function. This causes high blood sugar, the source of many complications. If you don't treat it, over time your eyes, kidneys, nerves and blood vessels can be damaged (see on shortly).
  Usually diabetes occurs for two reasons: It may run in your family, so you are genetically susceptible; or you may have taxed your body's glucose-balancing system to exhaustion, probably from poor eating habits and excess weight. Type 2 accounts for about 85 to 90 percent of diabetes cases. Most of the remainder, termed type 1, are found before age 30 and occur when the immune system attacks insulin-producing cells in the pancreas (see on previous). A third type (gestational) appears only during pregancy and disappears after childbirth.

LIKELY FIRST STEPS

• Lifestyle changes (healthy diet, regular exercise) to lower blood sugar and enhance overall health.
• Weight reduction to prevent worsening of disease and reduce risk of complications.
• Oral medications to stave off intiating insulin injections.

QUESTIONS TO ASK

• Will I ever need insulin?
• How can I tell I'm developing complications?
• How often do I need a haemologin A1c test done?

>Do I have diabetes?Type 2 diabetes can often be present with few, if any, symptoms. That is why, if you are over age 45, it is important to check for it, especially if you have other risk factors such as obesity, a family history of the disease, a history of heart disease or gestational diabetes, or you have polycystic ovary syndrome. Also, certain racial groups are at higher risk of developing type 2 diabetes--these include people of Torres Strait Island, Aboriginal, Pacific Island or Indian descent. Symptoms of diabetes include excessive thirst, increasing urination, fatigue, hunger, nausea, blurred vision, weight loss and frequent infections.

Treatments

Type 2 diabetes is a serious disease, and there's a big payoff when you become proactive about managing it. You can learn how to minimise or even eliminate the need for drugs and to dramatically postpone complications. Keeping your blood sugar in the normal range and improving your body's use of insulin are daily goals. Many people aim for 'tight glucose control', taking all the steps necessary (diet, drugs, frequent self-testing) to avoid marked fluctuations in their glucose levels. And with type 2 diabetes, lifestyle changes (meal planning, regular exercise, weight loss) can be very effective. Eventually you may need to go on oral diabetes drugs. For various reasons, about one-third of people with type 2 diabetes eventually need insulin injections.
   It's important to see your doctor regularly (at least four times a year, plus visits to specialists) and to develop a health-care team to answer questions and help you implement on overall plan. Because diabetes affects your entire body, it's critical to watch for complications and take preventive measures. To lessen certain health risks, you may need heart, blood pressure or cholesterol-lowering drugs, and if affected, your eyes, kidneys, nerves and feet will need special care.

TAKING CONTROL

• Expand your annual check up. Be sure to add an eye exam by an eye specialist (opthalmologist) and foot exam by a podiatrist. And don't forget vaccinations against flu and pneumonia.
• Have a haemoglobin A1c test. Intially, every two to three months, your doctor will check your long-term glucose control with this blood test, also known as HbA1c. A score higher than  9 means you need more control; below 7 is ideal.
• Avoid foot problems. Give your feet the best poosible care and wear shoes that really it. With a doctor's referral, some expenses related to footwear can be covered by insurance.
• Eat at regular times. Because many foods get converted to glucose, and those levels need to be kept steady, schedule meals and snacks for about the same time everyday. Try to eat consistent amounts--and don't skip meals.

                                                                 Treatment Options 

LIFESTYLE CHANGES
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 Diet/weight control                                Essential for good diabetes management.
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Exercise                                                       Make cells more insulin-sensitive.

MEDICATIONS
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Sulfonylureas                                        First-line drugs; promote insulin production.
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Biguanide                                               Most popular oral diabetics medication.
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Meglitinides                                           Fast and flexible; good before meals.
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Alpha-glucosidase inhibitor                Delays complex carbohydrate digestion.
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Thiazolidinediones                                 Decrease insulin resistance