Type 2 Diabetes

Dr Chinnadorai Rajeswaran, consultant diabetologist explains all about investigations, treatment and complications of type 2 diabetes. Please email him if you need more information.

Diabetes mellitus is a combination of two words, “diabetes’, meaning siphon in Greek  and “mellitus” means, sweet in Latin. So, diabetes mellitus is passing through of something sweet. Common symptoms of diabetes includes excessive urination, weight loss and excessive thirst.

There are several types of diabetes mellitus, and the commonest type is type 2 diabetes. There are several other types of diabetes mellitus including type 1 diabetesMODYtype 3 diabetes, type one and half diabetes and diabetes due to underlying problems.

About 90% of people with diabetes have type 2 diabetes. Type 2 diabetes results when our body is not able to produce adequate amount of insulin to over come insulin resistance. Normally when blood glucose goes up, our pancreas produces insulin, which metabolises the excess sugar. However as years go by, beta cells in the pancreas which produce insulin get tired and are not able to produce enough insulin. Increasing body weight prevents the action of insulin, which is also called insulin resistance.

Weight loss can help reduce insulin resistance and improve the functioning of insulin.

What is good blood glucose control?

Usual measure of good blood glucose control is a test called HbA1C (Glycosylated haemoglobin). This is usually checked once in 3-4 months time. This test provides an idea of what your average blood glucose control is over the last three months. Sugar in the blood gets stuck to the haemoglobin in the red blood cell. Average life of a red blood cell is around 120 days. Hence HbA1C is checked every 3-4 months. This only provides the average and does not tell us the fluctuations during the last three months.

Complications can occasionally be seen in people even with good HbA1C. This is because their blood glucose has been fluctuating through the day, having very high and very low blood glucose. So, you not only need to have a good HbA1C but also need to ensure there is no gross fluctuation in blood glucose.

Complications of type 2 diabetes

Complications of type 2 diabetes can be classified into short and long term complications.

Short term complications:

This is usually due to high blood glucose , which can lead to excessive thirst, urge to pass urine and weight loss. High blood glucose or hyperglycaemia should be treated as soon as possible. Persistently high blood glucose can lead to dehydration. There can be delay in healing of ulcers or any infection.

Hypoglycaemia or low blood glucose is not common in type 2 diabetes , when compared to type 1 diabetes. People with type 2 diabetes taking insulin and/or certain diabetes tablets like gliclazide, glimepiride, glibenclamide or more likely to experience hypos or hypoglycaemia. Hypos occur when the level of glucose drops too low, usually below 4 mmol/L. Hypos usually occur when meals are skipped, are considerably reduced or the dose of insulin or medication is more than required.

Click here to read more about hypoglycaemia.

Long term complications of type 2 diabetes:

Long term complications usually occur when blood glucose remains high for a long duration. This is shown by high HbA1C. Complications in type 2 diabetes also occur when blood pressure and cholesterol is not well controlled. So, long term complications of type 2 diabetes include:

  1. Eye problems predominantly retinopathy, which can lead to blindness
  2. Neuropathy or nerve damage leading to loss of sensation, numbness and tingling
  3. Peripheral vascular disease, which is due to narrowing of blood vessels in the limbs.
  4. Foot ulcers and amputations, which is due to neuropathy and/or loss of blood supply
  5. Heart problems, like coronary artery disease leading to heart attack and heart failure
  6. Kidney disease, starting initially with proteinuria or leakage of protein in the urine leading finally to kidney failure
  7. Hyperosmolar Hyperglycaemic State or HHS  is a life-threatening emergency seen in people with type 2 diabetes. HHS  is brought on by very high blood glucose and dehydration. If HHS is not treated promptly, stroke , kidney failure and other serious complications could follow.

People who have had type 2 diabetes for a very long duration can also have Diabetic Keto Acidosis or DKA. This is because they have lost all the beta cells in their pancreas, which produces insulin and they behave like type 1 diabetes.

In the recent pandemic more people with diabetes had COVID-19 related complications leading to admission in intensive care unit. Click on the video to find out why  people with poorly controlled diabetes had problems.

Annual check up for type 2 diabetes

It is important for every one with diabetes to have yearly check up with their nurse or diabetes team. This helps to identify any problems and prevent complications. Below is a list of checks, which needs to be done every year:

  1. Check and review HbA1c (glycosylated haemoglobin)
  2. Blood pressure check
  3. Cholesterol check
  4. Eye screening, using digital retinal screening
  5. Foot and leg check
  6. Kidney tests (blood test and urine for microalbuminuria)
  7. Weight management advice if applicable
  8. Enrol in DESMOND or relevant course of type 2 diabetes
  9. Flu jab
  10. Alcohol and smoking cessation advice
  11. Advice for any sexual problems
  12. Psychological support if required
  13. Advice on insulin injection technique if applicable
  14. Contraception advice and  advice if  planning to have a baby
  15. Advice on hypoglycaemia and its treatment

These checks should also be done during the year if applicable to ensure blood glucose, blood pressure and cholesterol is well controlled and there are no impending complications.

Treatment for type 2 diabetes

Treatment of high blood glucose depends on the duration of diabetes, age, kidney function and blood glucose control. Treatment may also be different for people who are driving heavy goods vehicle.

Treatment for type 2 diabetes could be single medication or a combination of medication and/or insulin. Following are the treatment modalities for type 2 diabetes:

  • Diet control
  • Metformin
  • Pioglitazone (Actos)
  • Sulphonylureas (Gliclazide, glimepiride,glibenclamide)
  • SGLT2i (Forxiga, Invokana, Jardiance)
  • GLP-1 analogues (Trulicity, Bydureon, Lyxumia, Victoza)
  • Insulins (Humulin M3, Lantus, Humalog Mix25, Detemir, Apidra, Humalog, Novorapid)

It is important for medications to be reviewed regularly and the dose adjusted, based on blood glucose control, hypoglycaemia and kidney function.

To learn more about Ozempic, click here

Can type 2 diabetes be cured?

Well, type 2 diabetes can be reversed or brought into remission. Complete remission means your HbA1c is less than 48mmol/mol and also do not require any medications to reduce blood glucose. Remission of type 2 diabetes depends on the duration of diabetes. If you have had type 2 diabetes for a short duration, remission is more successful.

The Diabetes Remission Clinical Trial (DiRECT) showed that at 12 months, almost 50%  of the participants achieved remission to a non-diabetic state and were off glucose-lowering medications. It was found that people who followed this regime had less fat in their pancreas and liver, probably this improved the action of insulin and reduced insulin resistance.

Dr Chinnadorai Rajeswaran is a consultant Physician specialising in Endocrinology, Diabetes and Obesity. As a private endocrinologist he  has private endocrine, diabetes and weight loss clinics in Harley Street, London, Chennai (India), Claremont Hospital, Sheffield, Nuffield Hospital, Leeds and Simplyweight, Bradford.

He has face to face consultations with people from Barnsley, Rotherham, Chesterfield, Doncaster, Wakefield, Huddersfield, Bradford, Harrogate, Leeds, Sheffield, London and Chennai (India). He also offers video consultations.

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