Understanding Type 2 Diabetes: A Comprehensive Guide for Seniors

Type 2 diabetes is a chronic condition that affects the way your body metabolizes sugar (glucose), an important source of fuel for your body. With type 2 diabetes, your body either resists the effects of insulin, a hormone that regulates the movement of sugar into your cells, or doesn't produce enough insulin to maintain normal glucose levels.

More common in older adults, type 2 diabetes was once known as adult-onset diabetes. Today, however, more children are being diagnosed with the disorder, probably due to the rise in childhood obesity. There's no cure for type 2 diabetes, but losing weight, eating well, and exercising can help manage the disease. If diet and exercise aren't enough to manage your blood sugar well, you may also need diabetes medications or insulin therapy.

For seniors, managing diabetes presents unique challenges, including the presence of other chronic conditions, potential cognitive decline, and an increased risk of hypoglycemia (low blood sugar). A tailored approach under the guidance of a primary care provider like Dr. Ddamulira is essential for maintaining quality of life.

Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. When symptoms are present, they may include:

• Increased thirst and frequent urination: Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink and urinate more than usual.
• Increased hunger: Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger.
• Weight loss: Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine.
• Fatigue: If your cells are deprived of sugar, you may become tired and irritable.
• Blurred vision: If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus.
• Slow-healing sores or frequent infections: Type 2 diabetes affects your ability to heal and resist infections.
• Areas of darkened skin: Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies, usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance.

When to see a doctor

See your primary care provider if you notice any possible diabetes symptoms. Early diagnosis and treatment can prevent serious complications.

Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. Exactly why this happens is unknown, although genetics and environmental factors, such as being overweight and inactive, seem to be contributing factors.

How insulin works

Insulin is a hormone that comes from the gland situated behind and below the stomach (pancreas).

• The pancreas secretes insulin into the bloodstream.
• The insulin circulates, enabling sugar to enter your cells.
• Insulin lowers the amount of sugar in your bloodstream.
• As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose, a sugar, is a main source of energy for the cells that make up muscles and other tissues.

• Glucose comes from two major sources: food and your liver.
• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
• Your liver stores and makes glucose.
• When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

In type 2 diabetes, this process doesn't work well. Instead of moving into your cells, sugar builds up in your bloodstream. As blood sugar levels increase, the insulin-producing beta cells in the pancreas release more insulin, but eventually these cells become impaired and can't make enough insulin to meet the body's demands.

Factors that may increase your risk of type 2 diabetes include:

• Weight: Being overweight is a main risk factor for type 2 diabetes. However, you don't have to be overweight to develop type 2 diabetes.
• Fat distribution: If you store fat mainly in your abdomen, you have a greater risk of type 2 diabetes than if you store fat elsewhere, such as in your hips and thighs. Your risk of type 2 diabetes rises if you're a man with a waist circumference above 40 inches or a woman with a waist measure above 35 inches.
• Inactivity: The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
• Family history: The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes.
• Race and ethnicity: Although it's unclear why, people of certain races and ethnicities, including Black, Hispanic, Native American and Asian people, and Pacific Islanders, are more likely to develop type 2 diabetes than white people are.
• Age: The risk of type 2 diabetes increases as you get older, especially after age 45. That's probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
• Prediabetes: Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
• Pregnancy-related risks: Your risk of developing type 2 diabetes increases if you developed gestational diabetes when you were pregnant or if you gave birth to a baby weighing more than 9 pounds.
• Polycystic ovary syndrome (PCOS): Having PCOS, a common condition characterized by irregular menstrual periods, excess hair growth and obesity, increases the risk of diabetes.

Type 2 diabetes can be easy to ignore, especially in the early stages when you're feeling fine. But diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent these complications.

Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include:

• Heart and blood vessel disease: Diabetes dramatically increases the risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).
• Nerve damage (neuropathy): Excess sugar can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Eventually, you may lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
• Kidney damage (nephropathy): The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage (retinopathy): Diabetes can damage the blood vessels of the retina, potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage: Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections, which often heal poorly and may ultimately require toe, foot or leg amputation.
• Skin conditions: Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Hearing impairment: Hearing problems are more common in people with diabetes.
• Alzheimer's disease: Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be.

Healthy lifestyle choices can help prevent type 2 diabetes, and that's true even if you have biological relatives living with diabetes. If you've received a diagnosis of prediabetes, lifestyle changes may slow or stop the progression to diabetes.

A healthy lifestyle includes:

• Eating healthy foods: Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains.
• Getting active: Aim for 150 or more minutes a week of moderate to vigorous aerobic activity, such as a brisk walk, bicycling, running or swimming.
• Losing weight: Losing a modest amount of weight and keeping it off can delay the progression from prediabetes to type 2 diabetes. If you have prediabetes, losing 7% to 10% of your body weight can reduce the risk of diabetes.
• Avoiding inactivity for long periods: Keeping still for long periods can increase your risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes.

Sometimes medication is an option as well. Metformin, an oral diabetes medication, may be prescribed to reduce the risk of type 2 diabetes, but healthy lifestyle choices remain essential.

Type 2 diabetes is usually diagnosed using the glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months.

• An A1C level of 6.5% or higher on two separate tests indicates that you have diabetes.
• An A1C between 5.7% and 6.4% indicates prediabetes.
• Below 5.7% is considered normal.

If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate, such as pregnancy or an uncommon form of hemoglobin, your doctor may use the following tests to diagnose diabetes:

• Random blood sugar test: A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.
• Fasting blood sugar test: A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
• Oral glucose tolerance test: For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.

Screening for type 2 diabetes

The American Diabetes Association recommends routine screening for type 2 diabetes starting at age 35. If the results are normal, repeat the test every three years. If you have risk factors, such as being overweight, screening may begin earlier.

Management of type 2 diabetes includes:

• Healthy eating
• Regular exercise
• Weight loss
• Possibly, diabetes medication or insulin therapy
• Blood sugar monitoring

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

Healthy eating and diet

There's no specific diabetes diet. However, it's important to center your diet on:

• A regular schedule for meals and healthy snacks
• Smaller portion sizes
• More high-fiber foods, such as fruits, nonstarchy vegetables and whole grains
• Fewer refined grains, starchy vegetables and sweets
• Modest servings of low-fat dairy, low-fat meats and fish
• Healthy cooking oils, such as olive oil or canola oil
• Fewer calories

Physical activity

Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor's OK before you start an exercise program. Choose activities you enjoy, such as walking, swimming and biking.

Medications

If you can't maintain your target blood sugar level with diet and exercise, your doctor may prescribe diabetes medications or insulin therapy. Treatments for type 2 diabetes may include:

• Metformin: Generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.
• Sulfonylureas: These medications help your body secrete more insulin.
• Glinides: These medications stimulate the pancreas to secrete more insulin. They're faster acting than sulfonylureas, and the duration of their effect in the body is shorter.
• Thiazolidinediones: Like metformin, these medications make the body's tissues more sensitive to insulin.
• DPP-4 inhibitors: These medications help reduce blood sugar levels, but tend to have a very modest effect.
• GLP-1 receptor agonists: These injectable medications slow digestion and help lower blood sugar levels. Their use is often associated with weight loss.
• SGLT2 inhibitors: These drugs prevent the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine.
• Insulin therapy: Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it's often prescribed sooner because of its benefits.

Expert Primary Care in Avondale

Don't ignore your health. Schedule a comprehensive evaluation with Dr. Marion Ddamulira today. We accept Medicare and most major insurances.