Dr Aidin Rawshani

All about type 2 diabetes: symptoms, causes, treatment and diet

Contents

Diabetes Type 2

Diabetes Type 2 is the biggest health problem of our time

Type 2 diabetes is probably the biggest health problem of our time. Today, about 500 million people have type 2 diabetes and this figure is estimated to rise to 600 million by 2035. Approximately 400 thousand Swedes have diabetes, of which approximately 90% have type 2 diabetes. This means that about 1 in 25 Swedes have type 2 diabetes, which makes the disease one of our most common diseases. Type 2 diabetes is a fairly complicated disease that requires time, resources and great efforts from those who have the disease. In most cases, the disease is chronic but nowadays many can be cured by surgical treatment (see Obesity surgery/Obesity surgery/gastric bypass for overweight and obesity). Surgical treatment is a dramatic measure and it may seem strange that so many people come to a state that requires us to change how the body takes up nutrition. It should also be mentioned that intensive lifestyle change (better diet, more exercise) can also lead to treatment of type 2 diabetes.2

People with diabetes have 2 to 8 times increased risk of death and cardiovascular disease, compared with people without diabetes. People with diabetes have an increased risk of heart failure, heart attack, stroke, kidney disease (nephropathy), visual impairment (retinopathy), nerve damage (neuropathy), etc. But the truth is that the risk of these complications varies greatly between people who have diabetes. Some groups have more than 8 times the risk of these complications while in fact there are groups (with diabetes) that have no increased risk at all! These aspects and much more will be discussed in detail here at diabeteson.com.

In this chapter we will discuss type 2 diabetes (age diabetes) with an emphasis on causes, risk factors, risks, symptoms and treatments. You will then realize that there are many evidence-based, simple and effective measures (in addition to surgery) and these measures improve both physical and mental health. Some of the measures you have type 2 diabetes can perform immediately while others require the involvement of the caregiver. New Swedish research shows that aggressive treatment and lifestyle change can result in actually getting rid of most of the risks associated with the disease. However, this requires knowledge, ambition and perseverance.

diabeteson.com is an education for people with diabetes. The aim is to give you a deeper understanding of the disease and how it is managed in the best way to minimize risks and enjoy life as much as possible.

Definition of type 2 diabetes

There are many different types of diabetes. Most often, divide the disease into three forms, as follows:

  • Type 1 diabetes (“child diabetes”) – Most often affects children and adolescents and is caused by the immune system attacking the pancreas and destroying the cells that make insulin. Without insulin, blood sugar rises because insulin is required for the body to handle sugar. Read more about type 1 diabetes.
  • Type 2 diabetes (“age diabetes”) – Most often affects adults and the elderly. Approximately half of all people with type 2 diabetes have overweight or obesity.
  • Gestational diabetes – Affects pregnant women who have a special predisposition.

This classic definition is becoming increasingly criticized because it has been shown that the disease is more nuanced than these three categories highlight. For example, type 1 diabetes may affect people of all ages, including pensioners, which makes the term ‘child’ diabetes’ not so appropriate. Most likely, half of all people with type 1 diabetes get sick after 30 years of age. Read more about type 1 diabetes (causes, symptoms, treatment) here.

Type 2 diabetes is also known as age diabetes, which is due to the average age of about 60 years of illness. The fact that the disease is called age diabetes has certainly been appropriate for over 2000 years, but in the last 20 years young people and children have also started to fall ill with type 2 diabetes, and this is explained by the explosive increase in obesity in these age groups. The fact is that in some countries type 2 diabetes is now the most common type of diabetes among adolescents (usually type 1 diabetes predominates among adolescents).

In addition to type 1 diabetes and type 2 diabetes, there are also gestational diabetes, secondary diabetes, MODY and several subcategories of these. Here you can read more about different types of diabetes. Further discussion is only about type 2 diabetes.

To put the diagnosis of type 2 diabetes

Type 2 diabetes is characterised — like all diabetes — by high blood sugar (i.e. the amount of sugar in the blood is abnormally high). The medical term for sugar is “glucose” and blood sugar is thus the same as blood glucose. The terms sugar, glucose, blood sugar and blood glucose will be used alternately in this chapter.

In type 2 diabetes, you have abnormally high levels of blood sugar in your blood. To establish this, you need to measure blood sugar level in the blood. There are standardized methods to do this. The table below shows how the diagnosis can be established on the basis of a venous or capillary sample.

GlUCOSE CONCENTRATION IN PLASMA (MMOL/L)
VENOUS TESTCAPILLARY TEST
FOR DIABETES DIAGNOSIS
FASTING VALUE≥ 7,0≥ 7,0
VALUE 2H AFTER GLUCOSE LOAD≥ 11,1≥ 12,2
FOR PRE-DIABETES DIAGNOSIS
FASTING VALUE≥ 6,1 och < 7,0≥ 6,1 och < 7,0
VALUE 2H AFTER GLUCOSE LOAD≥ 7,8 och < 11,1 ≥ 8,9 och < 12,2

The diagnosis of diabetes is thus determined by measuring the blood sugar concentration in fasting or after a so-called glucose load, which means drinking a sugar solution. If your blood sugar is too high in fasting, or after a glucose load, it indicates that you have diabetes.

You can also diagnose type 2 diabetes if you have symptoms (see below) and a sporadic blood sugar level is 11.1 mmol/L or higher.

It should be mentioned that type 2 diabetes can now also be diagnosed by measuring long-term blood sugar (HbA1c). If HbA1c is 48 mmol/mol or higher, you have diabetes. There are disadvantages in using HbA1c to diagnose type 2 diabetes.

It is important to point out that it is actually a fluid transition from normal to diabetes, which means that the person who develops diabetes does it gradually and blood sugar (as well as long-term blood sugar) rises gradually. So you may have a disturbed metabolism (for blood sugar) even before the diagnosis of type 2 diabetes can be made. Therefore, the concept of prediabetes has been established to identify individuals who have blood sugar between normal levels and diabetes levels. People with prediabetes also have an increased risk of cardiovascular disease and other complications caused by diabetes.

Why does blood sugar (glucose) rise in type 2 diabetes?

To understand type 2 diabetes, we first need to clarify how blood sugar is regulated normally and this is illustrated in Figure 1. The food we eat (and not infrequently the drink) contains carbohydrates and these come in many variations (here you can read about carbohydrates, fats and protein in the food). Carbohydrates are absorbed in the small intestine. The most important carbohydrate is glucose and it is also the carbohydrate that the cells of the body can use as an energy source. Glucose is actually the most used energy source on the planet! When the glucose gets into the bloodstream, it reaches the beta cells of the pancreas. Glucose stimulates the beta cells to release insulin, which is a hormone that the rest of the body needs to absorb glucose from the blood. The beta cells are therefore central to the context. The organs most dependent on insulin are the liver, muscles and fatty tissue. When insulin reaches these tissues, mechanisms are started that lead to the following:

  1. In the liver, glucose is absorbed from the blood and glucose is stored (the storage form is called glycogen).
  2. In the fatty tissue, glucose is absorbed from the blood, and glucose is converted into fat so that it can be stored.
  3. In the muscles, glucose is absorbed from the blood.

Paragraphs 1, 2 and 3 therefore lead to glucose being absorbed into the tissues, thereby decreasing blood sugar levels. See Figure 1 where these steps are illustrated.

Some further processes should be mentioned:

  • When we eat food, hormones are also released from the intestines. Two of these hormones are GLP-1 (Glucagon Like Peptide 1) and GIP (Gastric Inhibitory Polypeptide). GLP-1 and GIP are also called incretins. These hormones also stimulate the beta cells to release insulin and in fact 60% of insulin release is stimulated by incretins! 
  • In the pancreas there is a type of cells called alpha-cells, which release the hormone glucagon whose effect is to increase blood sugar (including by stimulating the liver to produce new glucose). The insulin released after a meal prevents the release of glucagon, which is reasonable because no more glucose is likely to be needed than that contained in the meal.
  • When fasting, the glucose level in the blood is low and therefore the insulin levels are low. Low insulin levels lead to the breakdown of fat in the adipose tissue. The explanation for this is simple: fat is very energy-rich and it breaks down into fatty acids that the body’s cells can use as an energy source. When we eat, insulin levels in the blood rise and insulin prevents fat cells from breaking down fat. It means that the intake of carbohydrate-rich food leads to the fact that we break down less fat.

To balance blood sugar, beta cells need to communicate with the liver, fat tissue and muscles. This is illustrated in Figure 2. The figure shows that there is a feedback between the beta cells and the tissues sensitive to insulin. When we eat, insulin is released into the bloodstream and the insulin affects insulin sensitive tissues (especially liver, fat, muscles). These tissues react to insulin by taking up glucose from the blood and adjusting their metabolism. As the cells absorb glucose, their needs (for glucose) are satisfied and they signal back to the beta cells, which can then reduce insulin release. Scientists today know that this feedback (between beta cells and insulin-sensitive tissues) exists but it has not been able to identify the hormone that signals back to the beta cells).

In type 2 diabetes, all these processes are disturbed and this leads to the fact that glucose can not be handled normally. The main disorders in type 2 diabetes are as follows:

  1. In diabetes, sensitivity to insulin is impaired. Impaired sensitivity to insulin means that muscles, liver and fat react less to insulin. This condition is also called insulin resistance. When sensitivity to insulin gets worse, more insulin is needed to meet the needs of muscles, fat and liver. Therefore, to obtain more insulin, more signals are sent to the beta cells, which respond by releasing more insulin. Insulin resistance usually develops many years before the diagnosis of type 2 diabetes is made. In addition to liver, muscle and fat, insulin resistance is also found in the kidneys, gastrointestinal tract, blood vessels and brain.
  2. Beta-cells ability decreases over time. Insulin resistance leads to increased pressure on the beta cells, which are becoming more and more exhausted. Insulin production may eventually become inadequate and this further aggravates the situation. In fact, after many years of illness, 30 -40% of beta cells have died.

Insulin resistance and beta-cell defect (leading to insulin deficiency) ultimately lead to:

  1. In muscles, less blood sugar is absorbed
  2. In the liver, less glucose is absorbed and blood sugar rises. The liver produces more glucose and releases it to the blood (this is why you have high blood sugar when fasting).
  3. In the kidneys, more glucose is produced, which is released to the blood.
  4. Fat accumulates in the liver and muscles and this worsens insulin resistance.

This means that type 2 diabetes is a consequence of insulin resistance (impaired insulin sensitivity) and impaired beta-cell function. The development from normal blood sugar to diabetes is gradual and takes, as a rule, many years. This means that you can have type 2 diabetes without having any symptoms, or precursors of type 2 diabetes.

How does high blood sugar (glucose) affect health?

People with diabetes have an increased risk of multiple complications. Three of these complications are very typical for diabetes:

  • Retinopathy (damage to the retina)
  • Neuropathy (damage to the nerves, especially in the feet)
  • Nephropathy (kidney damage)

These three complications are called microvascular complications, as they are explained by damage to the smallest blood vessels. There are also macrovascular complications, such as heart attack, stroke and atherosclerosis of the legs. However, these conditions are not specific to diabetes (other people also have a heart attack) but people with diabetes are significantly higher at risk of these conditions.

High blood sugar is undoubtedly the cause of microvascular complications (although other risk factors such as hypertension also accelerate the process). High blood sugar is also a cause of macrovascular complications, but where other risk factors tend to play a major role (e.g. lipid disorder, high blood pressure, etc.).

It is believed that high blood sugar (hyperglycemia) causes these complications by giving rise to harmful substances in the cells. Excess sugar can thus lead to the accumulation of harmful substances in cells (in the retina, kidneys, nerves, blood vessels, etc.).

HbA1c is an excellent measure of the individual’s sugar control. HbA1c explains how blood sugar has been in the last 6 weeks and is excellent for predicting the risk of complications.

Thousands of studies have shown that the better the sugar control is (i.e. the lower HbA1c), the less risk of microvascular complications and the less risk of macrovascular complications. The fact is that up to 95% of the risk of these microvascular complications is explained by sugar control (glycemic control).

Risk factors for type 2 diabetes: what causes type 2 diabetes?

Denna figuren illustrerar vad som orsakar typ 2 diabetes. Sambandet mellan diabetes och fetma är mycket starkat. Personer med fetma har inte sällan diabetes eller förstadier till diabetes. Fetma och diabetes har många gemensamma orsaker, som kan delas upp i arv och miljö.
This figure illustrates what causes type 2 diabetes. The relationship between diabetes and obesity is very strong. People with obesity do not rarely have diabetes or precursors of diabetes. Obesity and diabetes have many common causes, which can be divided into inheritance and environment.

Obesity is the main risk factor for type 2 diabetes. Obesity can be assessed in the form of a body mass index (BMI), which is calculated on the basis of body weight and height. The formula of BMI is simple. One takes his weight (kilos) and divides by the height (meters) squared:

BMI = weight / length2

A person weighing 100 kg and is 180 cm tall has a BMI of:

100/1.82 = 30.9

Here’s how the World Health Organization (WHO) categorizes different BMI levels:

CATEGORYBMI – kg/m2
Severe Thinness< 16
Moderate Thinness16 – 17
Mild Thinness17 – 18.5
Normal18.5 – 25
Overweight25 – 30
Obese Class I30 – 35
Obese Class II35 – 40
Obese Class III> 40

Read our review of the causes, risks and treatments of obesity and overweight here.

There is an increased risk of type 2 diabetes if you have a first-day family (parents or siblings) with type 2 diabetes. There is a hereditary aspect in type 2 diabetes and this is evident because (1) in many families there are many cases of type 2 diabetes and (2) people whose first class relatives have type 2 diabetes exhibit a lower beta cell function than people whose first class relatives do not have type 2 diabetes.

Beta-cell function also decreases with age, which explains why older people have a higher risk of type 2 diabetes. In fact, after 30 years of age, the human pancreas does not receive any new beta cells, which means that the number of beta cells we have at the age of 30 is the amount we have available for the rest of our lives.

Ethnicity is extremely important for beta-cell function and insulin resistance. Some ethnic groups have very impaired beta-cell function (e. g. South Asians) and therefore develop diabetes earlier and with lower BMI. It is actually the case that screening of South Asians is recommended at a BMI of 23, which is normal for a Swedish person. The discussion about ethnicity is rather complicated, but as a rule, non-European immigrants fall ill earlier in life and they fall ill at lower BMI, compared to Swedes.

Genes (inheritance) and environment: is type 2 diabetes a hereditary disease?

We inherit our genes from our parents. The genes are encoded in our DNA and they control how the body produces, uses and recycles proteins, as well as the function of proteins. This applies to all proteins in the body and therefore the genes control how the body works. We humans are extremely genetically similar, which means that our DNA sequences vary only slightly from person to person. In fact, 99.9% of our DNA sequences are identical, no matter who you are and where you come from. Environment is everything in our environment: the diet we eat, the exhaust gases that the vehicles emit, the number of sidewalks and trees in which we live, etc.

Inheritance (genes) and environment are important for type 2 diabetes. Both of these factors affect the functioning of beta cells and the sensitivity of insulin in the body. However, all research suggests that the environment is many times more important than genes (this applies to the vast majority of people with type 2 diabetes). This is easy to understand because the incidence of type 2 diabetes has increased avalanche in recent decades and in that period our genes have not changed significantly, but our environment and lifestyle have changed dramatically. Thus, the increase in type 2 diabetes in the population is due to changes in our environment (lifestyle, malnutrition, sedentary lifestyle, etc.).

Are there specific genes associated with type 2 diabetes?

There are several genes and sites in our DNA that have been linked to type 2 diabetes. This means that some variants of genes present an increased risk of type 2 diabetes. We have learned a lot about these genes over the last 20 years, but much remains to be clarified before this knowledge can be used in everyday life.

The first gene that could be associated with type 2 diabetes was PPARG. Since then, about 100 gene variants and sites in our DNA have been linked to type 2 diabetes. The gene with the strongest link to type 2 diabetes is TCF7L2. Some of these gene variants are common and therefore occur more frequently in people with type 2 diabetes compared to people who do not have type 2 diabetes. It appears that the locations/genes identified are associated with beta-cell function, insulin sensitivity and fat metabolism in the body. However, it has not been possible to identify the effects of different gene variants on beta cells, insulin sensitivity and fat metabolism, and this is due to the fact that the methods used to identify the genes cannot tell how different gene variants affect disease development (studies are ongoing to clarify this).

However, as mentioned above, the environment is a stronger risk factor than genes. Having one or a couple of genes associated with type 2 diabetes actually means only a small increase in risk. In fact, half of all people in Sweden have at least one gene associated with an increased risk of type 2 diabetes. Much remains to be learned about the impact of genes on type 2 diabetes.

Why often have several people in the family type 2 diabetes, if the inheritance is of secondary importance?

It is true that type 2 diabetes often affects several people in each family. If a sibling in the family has type 2 diabetes, the other siblings have 2-3 times increased risk of type 2 diabetes (compared to if no one in the family has the disease). If two siblings have type 2 diabetes, the other siblings have 30 times increased risk of type 2 diabetes. It seems that the risk to children is greatest if the mother has type 2 diabetes.

Against this background, it can be assumed that the genes play a very important role, but the fact is that you inherit more than just your genes. We also inherit (in many ways) our environment, our lifestyle and much more that can affect the risk of type 2 diabetes.

So how important are the genes for type 2 diabetes?

Probably genes are important, but the environment is far more important. We don’t really even need to know anything about the genes in order to accurately predict who will develop type 2 diabetes. It is possible to use simple risk factors (especially BMI, but also age, gender, waist circumference, blood pressure and blood lipids) to predict who will develop the disease.

What changes in the environment are most important?

A careful review of changes in our lifestyle and living environment is discussed in the History of type 2 diabetes and type 1 diabetes. In short, the most significant change is the one that concerns:

  1. Energy intake (caloric intake)
  2. Energy consumption.

Our energy intake has risen violently over the last few decades, which means that the total amount of energy we receive exceeds the daily requirement. This is due to increased availability (there is simply a large supply of food) and increased energy density of food. It should also be noted that harmful substances have become more common in food (e.g. trans fats). Energy intake is something that the individual himself can influence.

Decreased energy consumption means that we spend less and less energy. This is due to the fact that we become more sedentary and perform less manual work. The explanation for this is the enormous technological developments that have taken place over the last 100 years. Transport, work and everyday life have been automated with machines. Today you have become accustomed to taking the elevator even if you are only going upstairs, which is, of course, a tragic development (provided you can climb stairs). Read more about The importance of physical activity for type 2 diabetes.

In the long run, excess energy and reduced energy consumption lead to fat being stored in the body and as we become fatter insulin resistance increases and beta cells function deteriorates. It is especially the fat around the belly (abdominal fat) that appears to be driving in this process. Fat under the skin (subcutaneous fat) has a minor role in this connection.

Essential Nutrients

The most important nutrient element is carbohydrates, since carbohydrates lead to greater weight gain than other nutrients (protein, fat). A careful review of the importance of the diet is discussed in diet and type 2 diabetes.

The meaning of age

An environmental change that is inevitable is the aging of the population. As we get older, more people reach an age when organs, including beta cells, work worse. In fact, as soon as we’re 30 years old, we’ve got all the beta cells we’re gonna own for the rest of our lives! As a result, the function of beta cells becomes worse and some of them will also die as a normal consequence of aging. For people with type 2 diabetes, this development is faster: beta-cell function deteriorates earlier and more beta cells die. Approximately 30 -40% of all beta cells (and hence 30 -40% of all insulin production) die during the course of the disease and this is an important explanation of why you need to inject insulin using syringes after some time. It is unclear what leads to the death of beta cells, but it is believed that glucolipotoxicity (which is harmful effects of fats) and amyloidosis (accumulation of proteins that cannot be removed) leads to the death of beta cells.

Other risk factors for type 2 diabetes

Research also suggests that the environment of fetal life affects our future risk of obesity and diabetes. It is believed that the future regulation of genes of the fetus can be affected by the mother’s food intake. Being malnourished during fetal life has been associated (quite strongly) with the risk of type 2 diabetes and it is believed that this is because early malnutrition makes the body unable to handle large amounts of energy later in life. In other words, the period in the womb is also significant for our future metabolism.

The importance of the intestines in type 2 diabetes

The intestine affects our blood sugar in several ways. When we eat food, GLP-1 and GIP are released by the intestines. GLP-1 and GIP are hormones that increase the insulin release of beta cells and therefore lower blood sugar. In addition, GLP-1 leads to a decrease in the release of glucagon (a hormone that raises blood sugar) and therefore blood sugar does not rise as much after a meal. In fact, 60 -70% of the stimulation that beta cells receive (to release insulin) comes from GLP-1. After obesity surgery (Gastric bypass, Obesity surgery), the release of GLP-1 from the intestine actually increases and this is believed to be part of the explanation for the beneficial effect of obesity surgery.

When we eat food, the liver secretes bile acids and these also lead to a drop in blood sugar. Bile acids lower blood sugar by affecting the intestines to release the hormone FGF19 which leads (1) to reduce the production of glucose by the liver and (2) other intestinal cells release GLP-1.

Intestinal flora (bacteria in the intestine, “microbiomet”)

The human intestine is colonized by bacteria. This flora of bacteria is called intestinal flora, or in medical terms microbiome. The human intestinal flora (microbiome) produces huge amounts of various substances, some of which affect the human metabolism. Several studies have seen links between the intestinal flora and the risk of diabetes, obesity and atherosclerosis. So there is a connection between the intestinal flora and the metabolism. Studies have also shown that transferring intestinal flora from narrow individuals to overweight individuals improves insulin sensitivity in the overweight.

The importance of the brain in type 2 diabetes

The nervous system affects several aspects of metabolism. The nervous system affects the release of insulin, glucagon and the production of glucose by the liver, etc. The hypothalamus is the area of the brain that is most closely related to these aspects. However, this area is rather unexplored and requires more knowledge before statements can be made.

Inflammation and type 2 diabetes

People with excess weight and obesity often exhibit a general inflammation of the body. This is known by measurements of proteins CRP (C-reactive protein), Interleukin-6 (IL-6), TNfA (Tumour Necrosis factor alpha) These proteins are produced in inflammation and for some reason the levels of CRP, TNfA and IL-6 are increased in type 2 diabetes and obesity. This indicates that these people have a subfebrile and constantly ongoing inflammationin the body. Research shows that there is inflammation in both the pancreas (pancreas) and other organs (e.g. liver, muscle, fat). It has also been proven that inflammation is directly harmful to beta cells and also causes insulin resistance in the liver, fat and muscles. People with diabetes or obesity who manage to implement lifestyle changes (more exercise and better diet) get lower values of CRP, TNfA and IL-6, indicating that these measures reduce the inflammation that they have in the body. Both beta-cell function and insulin sensitivity are improved in parallel with decreases in CRP, TNfA and IL-6.

Smoking and type 2 diabetes

Smoking is associated with an increased risk of type 2 diabetes (no matter how much one weighs).

Getting type 2 diabetes during pregnancy

If you have had gestational diabetes (diabetes that debuts during pregnancy), you have an increased risk of having type 2 diabetes later in life. Women who have had diabetes during pregnancy have been shown to have inferior beta cell function than women without gestational diabetes.

Summary of risk factors for type 2 diabetes

90% of all cases of type 2 diabetes can be prevented by maintaining a healthy lifestyle (diet and exercise), which means that BMI must be 25 kg/m2. Physical activity is very favorable and smoking is harmful.

Does antibodies contribute to the development of type 2 diabetes?

No, people with type 2 diabetes do not have significant amounts of autoantibodies to beta cells (island-cell antibodies). In type 1 diabetes, on the other hand, island-cell antibodies (against structures called GAD and IA2A) are most often found.

Typical characteristics of people with type 2 diabetes

The vast majority of people who get type 2 diabetes are 35 years of age or older. The younger you are when the disease debuts, the more overweight/fat you are. Thus, people who develop type 2 diabetes at the age of 20 are (as a rule) extremely overweight. Although weight is central to the risk of developing diabetes, the importance of weight decreases as you grow older, which is due to the fact that the function of beta cells decreases with age. Thus, type 2 diabetes can develop without being particularly overweight if you are older and this is because older people have poor beta-cell function and reduced insulin sensitivity in the body due to age.

The most common and most important type of obesity is abdominal obesity (also called central obesity or abdominal obesity). Abdominal obesity is the fat that is found around the organs of the abdomen (around the liver, kidneys, stomach and intestines). Abdominal fat appears to be particularly harmful to insulin sensitivity and beta cells. Fat under the skin (subcutaneous fat) does not appear to be as harmful.

People with type 2 diabetes also tend to show other disorders, such as dyslipidemia (high blood lipids or otherwise impaired blood lipids (lipid disorder)), hypertension (high blood pressure) and possibly signs of kidney damage (detected by measuring the amount of proteins excreted in urine). High blood lipids, hypertension and kidney damage are each strong risk factors for complications, and the constellation of these risk factors is called Metabolic syndrome and this is discussed in a separate article. For the blood lipid disorder in type 2 diabetes, it is typical to have high levels of triglycerides and low levels of HDL cholesterol (“good cholesterol”). The more risk factors you have, the higher the risk of complications.

Some people discover their type 2 diabetes by chance, for example during a health check. Others have had symptoms for some time. The most common symptoms of type 2 diabetes are now being discussed.

Symptoms (symptoms) of type 2 diabetes

Here is a summary of symptoms of type 2 diabetes. A more detailed review of all the symptoms can be found in the chapter: Symptoms (symptoms) of type 2 diabetes.

Symptoms of type 2 diabetes usually develop slowly. You can have type 2 diabetes for many years without noticing because the symptoms can be very discreet. The most common symptoms are as consequences:

  • Increased thirst and increased water throwing. When you get high blood sugar, the kidneys can’t save all the glucose that is filtered out into the kidneys and then the sugar sucks with them water. So you pee out more sugar and more water and therefore you get both more often piss and thirsty. 
  • Increased hunger. Because the insulin has a reduced effect, the body’s cells get less sugar to use. This leads to getting hungrier.
  • Weight loss. Some patients lose weight, even though they eat more to saturate hunger. This is due to the fact that insulin efficacy is impaired in diabetes, which means that the cells do not burn sugar equally. And when sugar can not be burned, the cells are forced to burn fat, which is why you lose weight. In addition, you lose large amounts of glucose in the urine, which means that the amount of available glucose also decreases.
  • Fatigue — If the cells are unable to burn glucose normally, sugar shortages may occur that lead to fatigue and irritation.
  • Blurred vision (vision becomes foggy) — If the blood sugar becomes very high , fluid in the lens of the eye is sucked out and the light breaks worse, resulting in blurred vision.
  • Poor wound healing and repeated infections — people with type 2 diabetes often get repeated infections and also get wound healing worse.
  • Acanthosis nigricans (dark areas of skin) — insulin resistance also affects skin, especially around the armpits, groin and other folds. Insulin resistance leads to darkening of these skin areas.

Complications already at the time of diagnosis

Between 20% and 50% of people diagnosed with type 2 diabetes have cardiovascular disease or other complications already when the diagnosis is made. Among the complications are coronary heart disease, heart failure, albuminuria (abnormally large protein clusters with urine, signs of kidney damage), retinopathy (retina damage), neuropathy (nerve damage). You can read more about Complications in Diabetes here.

Other conditions that may be similar to type 2 diabetes

  • Alcohol abuse can sometimes imitate type 2 diabetes.
  • Type 1 diabetes can sometimes be difficult to distinguish from type 2 diabetes.
  • Pancreatic diseases (pancreatitis, surgical complications, tumors)
  • MODY (Maturity onset Diabetes in Young) — This is a special type of diabetes in which change in a single gene causes disease.
  • Steroid treatment for a long time leads to diabetes, especially in people who are overweight.

What is prediabetes (pre-diabetes)?

Diabetes is always preceded by pre-diabetes, which is simply a precursor to diabetes. In pre-diabetes, blood sugar is higher than normal but lower than is required to diagnose diabetes. Pre-diabetes is diagnosed by making a glucose load (you can drink a large amount of sugar solution), or by measuring blood sugar on an empty stomach, or by measuring HbA1c.

The risk of ketoacidosis in type 2 diabetes

Ketoacidosis is a serious condition due to the fact that the body is unable to burn sugar (glucose). Ketoacidosis occurs if insulin sensitivity is so severely impaired that tissues cannot be stimulated by the insulin. Then the tissues are also unable to burn sugar and instead they are forced to burn fats that are converted to ketones. Ketones are acidic and can lead to severe disturbances in the functioning of the body. Ketoacidosis sometimes occurs in type 1 diabetes but is very rare in type 2 diabetes. This is because people with type 1 diabetes make very little or no insulin and therefore they are at high risk of ketoacidosis. For people with type 2 diabetes, the risk of ketoacidosis is very low, but it may nevertheless occur if insulin resistance is high and insulin production low. Today, more and more people with type 2 diabetes are eating a low carbohydrate high fat diet (LCHF) that means that the amount of carbohydrates in their diet is very low and the risk of ketoacidosis rises. However, it should be mentioned that the risk of ketoacidosis is very low in LCHF, unless there is an extremely low intake of carbohydrates as part of the diet.

Are you supposed to be screened for type 2 diabetes?

30% of all people with type 2 diabetes do not know they have the disease. It is favorable to diagnose these people early, which can only be done by screening. Early diagnosis means that treatments and other measures can be started earlier, thereby reducing the risk of future complications. It is even possible to prevent the progression from pre-diabetes to diabetes by aggressive efforts (diet, exercise, medicines).

If you are 45 years or older and are overweight or fat, you should examine your blood sugar. This is especially important if someone in the family has type 2 diabetes (especially first-time relatives). Furthermore, people who are not from Europe (especially those from Africa, the Middle East and Asia) are to be screened early because they are at high risk of type 2 diabetes.

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