The type 2 diabetes is a disease characterized by hyperglycemiareview, that is to say by a too high level of glucose ( sugar ) in the blood. This disease usually occurs in older adults, and affects more obese or overweight people.
In a healthy individual, glycemic control is by insulin , a hormone secreted by the pancreas. Insulin allows sugar to enter the cells for use as fuel, especially in the muscles and liver. In a person with type 2 diabetes, the body becomes unable to regulate blood glucose , which is the level of glucose in the blood. That’s when blood sugar rises (we talk about hyperglycemia). In the long term, if blood glucose is not lowered by treatments, it can cause serious health problems, especially cardiovascular problems .
This chronic disease requires individualized treatment and close supervision by the person with the disease and the medical team. The healthy habits are the basis of treatment. If these habits are not enough to lower blood sugar, medications can be used.
|There are 2 main forms of diabetes, type 1 diabetes and type 2 diabetes, both characterized by chronic hyperglycemia.
The Type 1 diabetes occurs in young people and often appears in childhood. It is caused by an autoimmune destruction of the pancreas that no longer produces insulin. The cause is poorly known and there is no prevention currently possible. Affected people are therefore dependent on the insulin that must be given by injection .
As for type 2 diabetes , which accounts for 90% of diabetes cases, it occurs later in life. It is mainly due to a state of insulin resistance and is associated with overweight .
A disease in sharp progression
The number of people with type 2 diabetes is steadily increasing and this trend is attributed to the “Western” way of life, which is associated with sedentary and obesity, as well as the aging of the population. Globally, the International Diabetes Federation predicts that the number of diabetics could increase from 285 million in 2010 to 438 million in 2030.
In Canada, in 2009, 6% of people over the age of 12 reported being diabetic. This rate increases with age to reach nearly 18% among those aged 65 and over. In total, more than 9 million Canadians have diabetes or prediabetes, including 650,000 Quebeckers. In addition, many cases of diabetes are unknown because they are not detected.
Type 2 diabetes usually occurs after the age of 40, but is now reaching more and more children and adolescents as obesity affects more and more young people.
Causes of Type 2 diabetes
The diabetes results from a combination of genetic and environmental factors , as well as factors related to lifestyle . In general, each person carries an inherited baggage which predisposes them to suffer from diabetes or on the contrary protects it. Researchers now know several genes that make an individual at risk of developing type 2 diabetes. In people genetically predisposed to the disease, it is usually overweight and particularly the accumulation of fat in the organs of the body. abdomen that cause insulin resistance, the first step towards type 2 diabetes.
Initially, to compensate for insulin resistance , the pancreas starts producing more insulin. However, over time, the pancreas becomes depleted and the secretion of insulin decreases. There is a relative lack of insulin and the blood glucose remains high continuously.
The type 2 diabetes is the result of two phenomena: first insulin resistance, then the exhaustion of the pancreas.
Diagnostic of Type 2 diabetes
Since type 2 diabetes is rarely accompanied by symptoms in its early stages, it is often discovered by chance during a routine medical examination.
Blood glucose tests can be used to detect it: a fasting or fasting blood sugar test and, sometimes, an induced hyperglycemia test. This last test consists of a reading of the blood glucose 2 hours after ingesting a sweet juice containing 75 g of glucose. Often, fasting blood glucose gradually rises over the years from normal to intermediate prediabetes and then diabetic.
Blood glucose can be measured by a blood test or estimated by a glucose meter (glucometer), which allows the analysis of blood glucose on a drop of blood taken at the fingertip.
Even if the results are normal, it is usually recommended to take these tests at regular intervals to detect the disease as soon as possible.
For information on acute complications (hypoglycaemia and hyperglycemia caused by treatment adjustment and hyperosmolar hyperglycemia syndrome in untreated diabetics), see our Diabetes (overview) fact sheet.
In the long-term, many people with diabetes experience a worsening of their health because of their disease, especially if diabetes is not well controlled and monitored. In fact, chronically elevated blood sugar gradually damages the nerves and blood vessels, mainly to the eyes and kidneys. Diabetes can cause cardiovascular disease, irreversible vision loss , pain due to nerve damage or kidney failure. For more information, see our Complications of Diabetes fact sheet.
Symptoms of type 2 diabetes
At first, the type 2 diabetes causes few or no symptoms . It can go unnoticed for several years. Some people, however, may experience symptoms caused by high blood sugar , such as:
- A frequent urge to urinate , especially at night. The kidneys produce more urine to try to eliminate excess glucose in the blood;
- An increase in hunger and thirst , with a feeling of dry mouth;
- Excessive drowsiness, especially after meals
- A blurred vision ;
- Some infections bacteria or fungus frequently (urinary tract infections, vaginitis, etc.)
People at risk
- People whose first-degree relative (mother, father, brother or sister) has type 2 diabetes;
- Obese people or with overweight , especially when body fat is concentrated in the abdomen rather than the hips and thighs. In fact, the fat lodged in the organs of the abdomen (especially the liver) is the one that most damages the function of insulin. More than 80% of type 2 diabetics are overweight;
- Some populations are at higher risk, including Africans, Latin Americans, Asians and North American Indigenous Peoples.
Risk factors for Type 2 diabetes
- To be over 40 years old Type 2 diabetes mostly affects adults, and its prevalence increases with age;
- Have a sedentary lifestyle and consume too many calories ;
- For women, have had gestational diabetes or gave birth to a baby weighing more than 4 kg;
Have a metabolic syndrome. In the clinic, the doctor will evaluate the presence of the following factors (3 are sufficient for the diagnosis of this syndrome):
- abdominal obesity, determined by measurement of waist circumference ;
- high blood triglyceride levels
- low blood HDL (“good” cholesterol)
- high blood pressure
- high blood glucose fasting.
Prevention of type 2 diabetes
|The need for diabetes screening in the absence of symptoms will be assessed with the physician.
The sooner the disease is detected – even before the onset of symptoms – the earlier you intervene to restore normal blood glucose , the lower the risk of complications (cardiovascular disorders, ocular, renal or neurological disorders, etc.). There is growing evidence of the effectiveness of early intervention.
The following are recommendations from the Canadian Diabetes Association, to which physicians refer :
|Basic preventive measures|
Weight control, healthy eating and exercise
Type 2 diabetes can be prevented by simple means. One study, the Diabetes Prevention Program, found that at-risk individuals who exercised 30 minutes a day of physical activity and who had lost 5% to 7% of their weight decreased their risk of becoming diabetic by 58%.
Being overweight has the effect of increasing insulin requirements and overworking the pancreas. It is by the body mass index (BMI) that one determines the healthy weight of a person. Calculate yours using our Body Mass Index (BMI) and Waist Test . It is not a question of aiming for a healthy weight at any price, but a weight loss of 5% to 10% in 6 months already allows to obtain important benefits on the health.
A healthy and varied diet helps maintain a healthy weight. It also helps maintain a relatively stable blood glucose throughout the day, as well as good blood pressure. To do this, eat as much as possible 3 meals a day at regular times, avoid excess animal fat and added sugars (glucose, fructose, dextrose, etc.) and choose foods rich in fiber . For an overview of basic principles, see How to eat well?
Regular physical activity also helps maintain a healthy weight or eliminate unwanted pounds when necessary. In addition, being active makes insulin work more effectively. It is recommended to be active at least 2 h 30 a week, spreading physical activity throughout the week, in periods of at least 10 minutes at a time (brisk walking, swimming, jogging, cycling, etc. .). It is important to go gradually and gradually increase the duration and intensity of the activity. Physical activity itself significantly reduces the risk of becoming diabetic. For tips on incorporating activities into your daily life, visit our Fitness section.
|Measures to prevent complications|
|It is important that the antidiabetic treatment is well adjusted. By properly controlling blood sugar, complications are prevented. To ensure that treatment is effective, regular self-monitoring of blood glucose with a blood glucose meter and medical follow-up are essential. Your doctor will use glycated or glycosylated hemoglobin (HbA1c) in the blood (measured at least twice a year), which reflects the average blood glucose level in the last 3 months.
The glycemic targets to aim at reflecting good control:
See also the Prevention section of our Complications of Diabetes fact sheet.
Medical treatments for type 2 diabetes
|Diabetics can hope to live an active, independent and dynamic life without any limitation. It remains important to respect certain basic principles, in particular as regards:
For more details about the type of lifestyle to adopt for type 2 diabetes, see our Diabetes (overview) sheet, in which you will find:
For some, adherence to this lifestyle will be sufficient to control blood sugar levels, while for others it will also be necessary to intervene with medication . The purpose of the treatment is to maintain the glucose (sugar) concentration in the blood within the normal range. The ways to do this differ from person to person.
No treatment can cure diabetes permanently . It is a chronic disease and a treatment for life is necessary. However, adopting a better diet and regular physical activity is a real treatment option and can help to avoid the need for medication. If these measures are not sufficient, physicians may prescribe one or more of the following anti-diabetic medications , all of which have the effect of lowering blood glucose levels or helping to control them.
- The metformin (Glucophage or Glumetza) is the cornerstone of treatment in the vast majority of type 2 diabetics Its action reduces the resistance to insulin, which helps the body use glucose more efficiently, without risk of hypoglycemia. It also promotes weight loss;
- The drug increases the secretion of insulin (or insulin-) include sulfonylureas (Diabeta, Diamicron, Diabeta) and Glinides (Starlix, GlucoNorm). They directly stimulate the production of insulin by the pancreas by different mechanisms. They are very effective at controlling blood sugar, but with the potential risk of causing hypoglycaemia;
- The thiazolidinediones (or glitazones), a class of drugs which comprises rosiglitazone (Avandia) and pioglitazone (Actos), improve blood glucose by reducing insulin resistance. These medications are becoming less common in Canada and warnings have been issued by surveillance agencies because of the risk of heart failure and the risk of fracture noted in some populations. It should be noted that rosiglitazone medicines were withdrawn from the European market at the end of 2010 due to their adverse cardiovascular effects;
- The acarbose which is an inhibitor of alpha-glucosidase (Glucobay) has the effect of reducing the absorption of carbohydrates in the intestine. They must be taken at the time of a meal to be effective and may cause bloating and flatulence caused by unabsorbed sugars;
- The incretin mimetic (or incretins ) are a new class of drugs which includes Januvia (sitagliptin), Byetta (exenatide) Onglyza (saxagliptin) and Victoza (liraglutide). They work by increasing insulin secretion after a meal, without causing hypoglycemia. Oral medications (sitagliptin and saxagliptin) have a neutral effect on weight. Victoza is new on the market, it is administered by injection and is associated with weight loss. However, it is not indicated on the front line and its long-term effects and safety are unknown.
The drugs causing weight loss such as orlistat (Xenical) can be considered in diabetic obese people. They are useful for improving blood sugar by enabling weight loss . However, their cost is high and they are not appropriate for all patients.
Insulin treatment with injections is a very valuable option, although it is often used after a failure of oral medications. It can also be used transiently in case of high hyperglycemia, infection, hospitalization or surgery, for example. Indeed, insulin injections may be required when drugs are no longer sufficient, since insulin secretion decreases over time in type 2 diabetics. One injection is usually done daily, often given in the evening. Some people may also be treated with insulin pumps.