What is type 2 diabetes?
Type 2 diabetes (also called diabetes mellitus type 2) is the most common form of diabetes. Insulin is not required for survival in type 2 diabetes. That is why they used to call it non-insulin dependent diabetes. Insulin resistance is the main problem in type 2 diabetes. It means that your body can’t use insulin effectively. You still make insulin but it is less effective. So, you need more insulin to do the same job. Without effective use of insulin, you blood sugar levels go up. That is what happens in type 2 diabetes. (They don’t call it non-insulin dependent diabetes anymore to avoid the perception that insulin has nothing to with type 2 diabetes.) Many type 2 diabetes patients need insulin to effectively treat high blood sugars because their bodies do not make enough insulin to overcome the insulin resistance.
Type 2 Diabetes symptoms
Type 2 diabetes symptoms develop very slowly. You may already have diabetes, but may not even have the first signs of diabetes for many years.
Here is the list of 10 classic diabetes symptoms:
- Frequent urination
- Excessive hunger
- Excessive thirst (dry mouth)
- Unusual weight loss
- Extreme fatigue and irritability
- Frequent infections
- Blurred vision
- Cuts/bruises are slow to heal
- Tingling numbness in the hands or feet
- Recurring skin, gum or bladder infection
If someone asks you, “What are the symptoms of diabetes?”, this list makes it easy to answer the question. However, the list of 10 diabetes symptoms does not help people figure out if they have diabetes. Many patients with type 2 diabetes have no symptoms for many years. When they finally have classic diabetes symptoms, they already have complications of diabetes.
Uncontrolled type 2 diabetes symptoms
Uncontrolled type 2 diabetes leads to many complications. These complications of diabetes (some people refer to them as side effects of diabetes) can affect multiple organ systems and can be life or limb threatening.
Here are some of the uncontrolled type 2 diabetes symptoms:
- Feet problems: Nerve damage in your feet makes them numb. You may not feel any cuts, blisters or burns. Overtime, you may have non-healing wounds and ulcers on your feet. You may even require amputation.
- Sexual problems:
- Type 2 diabetes symptoms in men include erectile dysfunction. Men who have uncontrolled diabetes are 2 to 3 times more likely to have erectile dysfunction than men who do not have diabetes. If a man under 45 years of age has erectile dysfunction, he needs to be tested for diabetes. Erectile dysfunction may be one of the early type 2 diabetes symptoms in men under 45.
- Uncontrolled type 2 diabetes symptoms in women also includes sexual problems. Decreased vaginal lubrication and decreased sexual desire can be the signs of diabetes in women
- Eye problems related to diabetes: Eye symptoms may include blurred vision from high blood sugar levels. Diabetes can also cause serious damage to your retina. Other eye problems with diabetes includes cataract and glaucoma.
- Stomach problems: Nausea with diabetes (type 2) can be a sign stomach nerve damage. Diabetes can cause gastroparesis, a condition that slows down your stomach muscles. Nerve damage from uncontrolled diabetes is the most common cause of this condition. Uncontrolled type 2 diabetes symptoms related to gastroparesis may include stomach fullness, nausea, vomiting, decreased appetite , stomach pain and bloating.
- Other problems: Uncontrolled diabetes can also cause kidney damage, heart attacks and strokes.
What causes diabetes type 2?
Some people call type 2 diabetes a “lifestyle disease” because your lifestyle can increase or decrease your risk of getting type 2 diabetes. However, that is not completely true. Unhealthy lifestyle increases your risk of getting type 2 diabetes but not all people with unhealthy lifestyle develop diabetes. Also, some people develop type 2 diabetes despite living a healthy lifestyle. There are other causes of type 2 diabetes you can’t control. (such as your family history or your genes)
Here are some of the diabetes (type 2) causes that are related to lifestyle:
- Obesity : When you have excess fat in your body, you develop insulin resistance. You need more and more insulin to lower your blood sugar. Eventually, you won’t be able to produce enough insulin to overcome this insulin resistance and you develop type 2 diabetes.
- Sedentary lifestyle: In addition to causing obesity, inactive lifestyle can directly cause type 2 diabetes in genetically predisposed people.
How to tell if you have diabetes?
It is very easy to tell if you have diabetes or not. You just need to check your blood sugar levels. A fasting blood sugar level is a reliable test to accurately tell if you have diabetes or not. Fasting blood sugar levels are checked in the morning after at least 8 hours of not eating or drinking any carbohydrates. Non-fasting blood sugar levels fluctuate widely. If you want to use non-fasting blood sugar levels to diagnose diabetes, you need to check your blood glucose exactly 2 hours after taking 75 grams of glucose.
You may not have symptoms for a long time in type 2 diabetes. Therefore, you can’t rely on symptoms to tell if you have diabetes (type 2). Blood sugar levels will tell you if you have diabetes or pre diabetes.
Here is a blood sugar levels chart to help you decide
|Fasting blood sugar level is equal to or greater than 126 mg/dl
Blood sugar level 2 hour after taking 75 grams of glucose is equal to greater than 200mg/dl
|Yes, you have diabetes|
|Fasting blood glucose level is equal to or less than 99mg/dl
Blood sugar level 2 hour after taking 75 grams of glucose is equal to or less than 139mg/dl
|No, you don’t have diabetes|
|Fasting blood glucose level between 100mg/dl and 125mg/dl.
No, you don’t have diabetes.
But you are almost there.
It is called prediabetes.
Prediabetes symptoms and risks
Prediabetes symptoms are silent. It means that you don’t actually have any symptoms from pre diabetes itself. However, you may have other signs such as obesity that puts you at a high risk for prediabetes.
Fasting blood glucose level is a simple reliable prediabetes test you can do to find out if you have prediabetes.
You need prediabetes test even without any diabetes symptoms in following conditions:
- If you have a first degree relative with diabetes
- If you are physically inactive
- If you had gestational diabetes when you were pregnant
- If you are in a high risk ethnic group such as Asian American
- If you have history of coronary heart disease or stroke
- If you have high blood pressure
- If you have high cholesterol
- If you have a history of polycystic ovary syndrome
- If you are above 45
- If it has been more than 3 years since your last prediabetes test
10 important facts about diabetes you need to know
- Diabetes is the leading cause of kidney failure.
- More than 85% of patients with type 2 diabetes are overweight or obese.
- Diabetes kills 69 thousand Americans directly and it contributes to the death of 234 thousand Americans every year.
- 37% of Americans 20 and older have prediabetes.
- Almost 89% of Americans with prediabetes do not know they have it.
- At the current rate, it is predicted that 1 in 3 Americans will have diabetes by 2050.
- Diabetic eye disease is the leading cause of blindness in adults worldwide
- Diabetics are 1.8 times more likely to be admitted to the hospital with heart attacks than non-diabetics
- Diabetics are 1.5 times more likely to be admitted to the hospital with strokes than non-diabetics
- Diabetic foot is the leading cause of leg amputation in America.
A real life example of type 2 diabetes symptoms
A 52 year old female with swelling all over the body
Mrs Y is a very cheerful 52 year old high school teacher and a mother of 4 kids. She is always busy with her work and taking care of her children and her house. She always puts other’s need before her own. She had been happy and healthy all her life. She had not been to a doctor for the last 12 years.
In the last month or so, she has not felt very well. She seemed to have developed some generalized weakness and is just not feeling well. Her appetite has gone down and she feels nauseated at times. She has noticed that her clothes do not fit her anymore and she had to buy a new pair of shoes as her legs seemed to be getting bigger. She was getting puffier everyday. She tried her best to hide her symptoms as she did not want to bother anyone. But her husband noticed the changes and was very concerned. He took her to the doctor. The doctor ran some blood tests and immediately sent the patient out to the hospital for further investigation.
I evaluated her in the hospital. I looked at the blood work and asked her a few more questions to see if she had any symptoms in the past. She told me the only symptoms she had was the tiredness, swelling and some nausea. She also insisted that everything started about a month ago. She denied ever having any other symptoms prior to that.
On the blood tests, patient had a very low albumin. Albumin is a protein present in our blood. Our blood is composed of both solid and liquid parts. Water is the most important liquid component of our blood. Albumin helps prevent the leakage of water from our blood vessels. When the albumin is low, our tissue absorbs more than normal amounts of water from the blood and that reduces our circulating blood volume. The leaked water causes our body to swell up.
I then ran some tests on her urine. She had a very large amount of albumin in her urine. It could account for all the albumin lost from her blood.
Her blood sugars were high enough for a diagnosis of diabetes but not too high to cause any problem or symptom in the short term. She probably had diabetes for many years. Her elevated blood sugars probably affected many of her internal organs and slowly damaged them internally.
In her kidneys, the persistently high blood sugar levels damaged the urine filter. Normally, this filter keeps the albumin inside the blood vessel and prevents it from going out with the urine. High blood sugar levels in diabetics can literally create holes in this filter. These holes allow albumin to escape.
In summary, diabetes related kidney damage eventually caused her body swelling by lowering her blood albumin. She did not have any diabetes symptoms until her whole body swelled up.
After further investigation, it was clear that diabetes had affected several of her other organs. She had no idea how diabetes was damaging her organs without ever causing any diabetes symptoms.
I hope this sad story of a wonderful woman helped you learn that the most common symptom of diabetes is no symptom at all. I hope this will encourage you to get tested for diabetes and avoid complications of undiagnosed and uncontrolled diabetes.