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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spanish version
Type 2 Diabetes Mellitus
What is type 2 diabetes mellitus?
When you have type 2 diabetes, your body does not make
enough insulin or is unable to use insulin properly. This
problem with insulin affects the level of sugar in your
blood.
Insulin is a hormone produced by the pancreas. (The
pancreas is the large gland that lies behind the stomach.)
When you digest food, your body breaks down much of the food
into sugar (glucose). Your blood carries the sugar to the
cells of your body for energy. Insulin helps the sugar
leave the bloodstream and enter the cells. This is how
insulin lowers the level of sugar in your blood.
When your body does not have enough insulin or has trouble
using insulin, the cells of your body do not absorb enough
sugar from your blood. As a result, you have high levels of
sugar in your blood. When you have too much sugar in your
blood, many problems may begin to occur. These problems can
be life-threatening if they are not treated. However,
proper treatment can control your blood sugar level.
Type 2 diabetes occurs mostly in adults over age 40,
especially overweight adults. Overweight children and
adolescents can also have this type of diabetes. More
people are becoming diabetic as more people become
overweight.
About 16 million people in the U.S. are diabetic. The
highest rates of type 2 diabetes in America are among native
Americans, Hispanics, and African Americans.
How does it occur?
The precise cause of type 2 diabetes is not known, although
age and weight appear to be factors. As people become older
or overweight, they are more likely to have diabetes. Cells
in the body become unable to use the insulin made by the
pancreas. Heredity is also an important factor.
Women who have given birth to large babies (for example,
babies weighing 9 pounds or more), or have had diabetes of
pregnancy (gestational diabetes), have a higher risk of
developing type 2 diabetes later in life.
What are the symptoms?
Type 2 diabetes may cause the following symptoms:
- increased urination
- excessive thirst and the drinking of a lot of fluids
- increased appetite
- weight gain or loss
- blurred vision
- skin infections
- vaginal infections
- tiredness
- slowly healing sores
- abnormal feelings of prickling, burning, or itching of
the skin, usually on the hands or feet
- infections of the foreskin in uncircumcised men.
Most people have no symptoms, especially at first.
How is it diagnosed?
Your health care provider will ask about your symptoms and
test the level of sugar in your blood. If your morning
fasting blood sugar (before breakfast) is above 126
milligrams per deciliter (mg/dL), you may be diabetic.
Sometimes another test called a glucose tolerance test is
done. For this test a sample of your blood is taken when
you have not eaten anything since the night before. Then
you drink a sugar drink and your blood is tested 2 hours
later. If after 2 hours your blood sugar level is over 200
mg/dL, you are probably diabetic.
Your health care provider may also test a sample of your
urine for sugar.
How is it treated?
The goal of treatment is to control the level of sugar in
your blood. You want to try to keep the sugar level in the
same range as a nondiabetic person. This is done by:
- measuring your blood sugar regularly
- meal planning
- exercise
- medicine.
Blood sugar measurements
Keep a log of your blood sugar measurements. Your health
care provider will check the log to see how well your
treatment is working. Also, a test called hemoglobin A1c
can show what your average blood sugar has been over the
past 3 months. Your provider may do this test every 3 to 6
months to check your overall control of your blood sugar
level.
Meal planning
Your health care provider or a dietitian will give you clear
guidelines about which foods you should eat and how many
calories you should eat each day. If you are overweight,
the main treatment is to eat less. Limiting the calories in
your diet will help you lose weight. Losing even 7 to
10 pounds can reduce or eliminate your need to take
medicine for diabetes.
Exercise
Physical activity is important in managing type 2 diabetes.
Exercise improves your circulation and uses up more sugar in
your blood. Walking is one of the best exercises you can
do. Ask your health care provider for exercise
recommendations.
Medicine
If you can't control your blood sugar with diet and
exercise, your health care provider will prescribe medicine
to lower your blood sugar. You may need more than one type
of medicine to keep your blood sugar in the normal range.
Common oral blood-sugar-lowering medicines used for type 2
diabetes are:
- Sulfonylureas, which help your pancreas release more
insulin. Examples of this type of medicine are
tolbutamide (Orinase), tolazamide (Tolinase), glyburide
(DiaBeta, Glynase, Micronase), glipizide (Glucotrol), and
glimepiride (Amaryl). These medicines are taken by mouth
1 to 3 times a day. They often cause weight gain,
especially if your diet is not well controlled.
- Repaglinide (Prandin) and nateglinide (Starlix), which
also help release more insulin. They are taken by mouth
before meals.
- Metformin (Glucophage), which lowers blood sugar without
causing weight gain. It is taken by mouth 2 to 3 times a
day. It may be combined with a sulfonylurea medicine or
insulin.
- Rosiglitazone (Avandia) and pioglitazone (Actos), which
help the body use insulin better. They are taken by
mouth once a day and may be combined with sulfonylureas,
metformin, or insulin. While you are taking either of
these medicines, you will have blood tests to check the
effect on your liver.
Insulin is used when diet, exercise, and oral medicines are
not keeping your blood sugar levels normal. Insulin is
available in different forms:
- regular insulin, which is short-acting
- NPH and lente insulins, which are intermediate-acting
- long-acting forms of insulin (ultralente).
If you need insulin, your health care provider will teach
you how to give shots to yourself. You may need a shot 1 to
4 times a day. It is common to combine short-acting and
intermediate-acting forms in one dose (in one needle and
syringe).
When you are using any type of diabetic medicine, you must
carefully follow your health care provider's directions for
checking your blood sugar. This will not only help you
achieve good blood sugar control, but it will help you
prevent possibly life-threatening low levels of blood sugar
(hypoglycemia).
How long will the effects last?
Exercising more and not overeating can often help the body
restore its balance of sugar and insulin. You may or may
not need to continue taking medicine. Your improvement
depends on following the diet and exercise plans prescribed
by your health care provider to keep your blood sugar in the
recommended range.
How can I take care of myself?
Taking good care of yourself to avoid complications is
especially important with diabetes. Possible diabetic
complications include heart disease, stroke, blindness,
kidney failure, and nerve damage, especially to your feet
and legs. Carefully controlling your blood sugar and blood
pressure will delay or prevent these complications.
Follow your diet plan.
- Learn how to make healthy choices when you eat out.
- Ask for diabetic meals when you travel (for instance, at
hotels or on planes).
- Drink water or other noncaloric drinks when you have the
urge to eat between meals.
- Avoid compulsive eating.
- Limit the amount of alcohol you drink.
- Buy only the types of food included in your diet plan.
- Eat on a regular schedule.
- Eat slowly and chew your food thoroughly.
Follow your health care provider's advice for physical
activity.
- Choose activities you like.
- Exercise with friends.
Stop smoking.
Carefully follow the instructions your health care provider
has given you for taking any medicine he or she has
prescribed.
Other things you can do are:
- Learn how to do proper skin and foot care every day.
- Always carry identification that says you have diabetes,
in case of an emergency.
Learn about diabetes and its complications so you can make
the correct decisions to control your blood-sugar levels.
Many hospitals have diabetes educators and dietitians who
can help you. Ask your health care provider to refer you to
these people.
You can get pamphlets and information about
diabetes, including diabetic cookbooks, from:
The American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 800-DIABETES (800-342-2383)
Web site: http://www.diabetes.org
How can I help prevent type 2 diabetes?
Even if there is a history of diabetes in your family, you
may be able to avoid developing the disease if you:
- Maintain your recommended weight.
- Exercise regularly according to your health care
provider's recommendations.
- Eat a healthy diet.
Reviewed and approved by the Wilmer Eye Institute of The Johns Hopkins
Medical Institutions, Baltimore, MD. Web site: http://www.wilmer.jhu.edu
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