Type 2 Diabetes
Type 2 diabetes has been called by many different names down the time. You may have heard it referred to as adult diabetes, maturity onset diabetes, old age diabetes, or non-insulin-dependant diabetes (shortened to NIDDM).
Most of these names stem from the fact that it is most often, but not always, diagnosed in people over 40. The NIDDM came about because most, but again not all, people with Type 2 can be treated without the use of insulin.
Unlike Type 1 it is not an autoimmune disease. The disease, which can develop over a long time, weeks to months, comes about for two reasons, or sometimes a combination of both.
1. Your pancreas no longer makes sufficient insulin for your body's needs.
2. You have developed Insulin Resistance (IR). You produce enough insulin but the cells in your body no longer know how to use that insulin properly.
Okay, so now I have added something that you may have heard about but do not properly understand - Insulin Resistance.
Let me try and explain it simply. As you know your body is made up of trillions of individual cells. Now the cells that form the brain, the muscles, the liver and fat cells etc all need glucose for energy - thinking and moving both use energy don't they? The brain is lucky, it does not need insulin to help it get it's glucose but the other poor cells do.
So these cells have receptors on the outside of them. A simple way to think of them is as locks that need a key (insulin) to let the glucose in. Insulin from the bloodstream attaches to these receptors, unlocks them and lets the glucose in.
Now, when we are insulin resistant, some of those receptors on the cell are not working properly (the locks have been changed) and they ignore the insulin. Why the receptors become this way is something that appears not to be understood, though different researchers have suggested various reasons. For us it does not really matter, all we need to know is that it happens.
Since the insulin is being ignored the cells can no longer take up the glucose and it builds up in the blood, hence high blood sugars.
Because the blood sugars are high the pancreas is stimulated to produce yet more insulin to deal with it. Eventually this can cause the beta cells of the pancreas to overwork and get tired and what would you do under those circumstances? Slow down or wear out, wouldn't you? That is exactly what the beta cells do, so now you have less insulin being made and therefore yet higher blood sugars. Once these go over the normal range you are diagnosed with Type 2 diabetes.
There are certain factors that put one at risk of developing Type 2 diabetes. The one I really like is :-
1. Hereditary.
After all it is fashionable to blame ones parents for ones problems! However in this instance there would appear to be some justification in blaming, if not our parents, at least our ancestors.
Apparently we have a special gene that predisposes us to diabetes. Way back when, our ancestors tended to live in times of feast or famine. Those with this special gene, sometimes called a 'thrifty gene' were able to better utilise their food, storing it as fat until times of famine where it could be used to see them through. A very sensible gene to have at the time I am sure, but in these days of abundantly available food and less physical activity it is a dashed inconvenient one!
And the one I like least is:-
2. Overweight.
Most Type 2 diabetics are overweight. Some people say that should read 'all', not 'most', working on the assumption that the few thin people diagnosed with type 2 are actually type 1 that for some reason has not fully progressed.
You are particularly at risk if you have what is termed an 'apple shape', i.e. you carry most of your fat around your stomach and abdomen.
In women this means having a waist measurement of +35 inches and 80% that of your hips and in men having a waist measurement of +40 inches and the same or more than your hips.
If you are still unsure if you are overweight you can check your BMI - Body Mass Index. This is your height to weight ratio. A BMI over 25 is considered overweight while over 30 is obese.
There are a number of BMI calculators on the web. Try www.halls.md/body-mass-index/av.htm
Overweight is a prime factor in the development of insulin resistance. The more abdominal fat you have the more insulin resistant you are likely to be.
Then there are all the others:-
3. Inactivity.
Exercise increases your muscle mass and this makes you more sensitive to insulin.
Lack of exercise contributes to insulin resistance and the increased risk of developing diabetes.
4. High blood pressure - 140/90 or higher.
As insulin levels rise, so does blood pressure. See our section on hypertension
5. Cholesterol HDL less than 35mg/dl (0.90 mmol/L.
6. Triglyceride levels of 250mg/dl (2.83 mmol/L) or higher.
7. Age - 45 years or older.
8. Ethnic origins.
The predisposition to diabetes appears to be higher in certain ethnic groups e.g. African Americans, American Indians, Hispanic Americans, South Asians and African-Caribbeans, to name a few. It is possibly due to genetic differences in how the body processes and stores fat, or ancestors who may have really needed that thrifty gene!
Generally
Type 2 is a progressive disease. If untreated it will develop to the stage where you no longer have any beta cells left functioning and you will then be in the same situation as a Type 1, requiring external insulin.
However there are various treatments that halt or retard this progression.
See our section on the causes of Type 2 diabetes or our section on Type 2 treatment.