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March 25, 2024
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What is it?
Type 2 diabetes mellitus (T2DM) is a chronic, metabolic disorder that presents with hyperglycemia, which refers to a condition of elevated sugar levels in the blood. This disease is brought about by abnormalities in the secretion of insulin, which is a vital hormone responsible for the regulation of blood sugar levels. In patients with T2DM, there is also an increase in the production of glucose, or sugar, from the liver.¹ A key phenomenon in T2DM is the presence of insulin resistance, which refers to an impairment in the uptake of glucose in skeletal muscles and peripheral tissues, resulting to hyperglycemia.
Who are at risk to have it?
Some individuals may have an increased risk for developing T2DM. These people are those who are overweight or obese, those with impaired fasting glucose level, those with high levels of triglycerides and those with conditions such as hypertension or a high blood pressure, schizophrenia, acanthosis nigricans and polycystic ovary syndrome. Having a sedentary lifestyle is also a risk factor for developing T2DM.² Women who had a history of diabetes during pregnancy, or gestational diabetes mellitus, have as much as a 60% lifetime risk of developing type 2 diabetes.³ A family history of diabetes mellitus is also a risk factor for acquiring T2DM. Individuals who are afflicted with these risk factors must be screened for the presence of T2DM in a timely manner. If you don’t have any of the above risk factors, it is recommended for Filipinos to be screened starting at the age of 40 years old.
What are its symptoms?
Commonly, patients with T2DM may not experience any bothersome symptoms and the disease would simply be detected on a routine laboratory examination. Individuals with high blood sugar levels may experience increased thirst (polydipsia), more frequent urination (polyuria), and excessive urination at night (polydipsia). Weight loss is a sign of uncontrolled diabetes, which reflects the deficiency of insulin.
People living with diabetes must be on the look-out for more serious symptoms such as blurring of vision, frothy urine (bubbly urine), tingling sensation of the feeling of having “pins and needles” on the hands and feet, leg pain and abdominal discomfort and pain because these may be indicative of the presence of the multi-systemic complications of diabetes. Wounds that take a long time to heal, especially on the feet, may be found in people with diabetes.
How is it diagnosed?
T2DM is diagnosed by requesting laboratory examinations. Recommended screening test is fasting blood sugar. If the level is 126 mg/dL (7 mmol/L) or higher on 2 separate occasions is already considered to have T2DM. Other tests that your doctor might request are 75 grams oral glucose tolerance test (OGTT) and HbA1c, which is your average blood sugar levels for the past 3 months.
How is it treated?
Proper nutrition and a healthy lifestyle are crucial pillars in the management of T2DM. A well-balanced diet consisting mostly of vegetables, legumes, lentils, noodles, rice, bread, grains, and non-sweet fresh fruits, with moderate amounts of protein-rich food such as fish, seafoods, eggs, lean meat, skin-less chicken, low-fat cheese, low-fat yogurt, and nuts. Sugar-sweetened beverages and foods that have a high salt, sugar, and fat content should be avoided. A person living with diabetes should not skip meals.²
Exercise is a vital aspect in maintaining a healthy lifestyle for persons with diabetes. Moderate intensity exercise, as tolerated by the individual, for about 150 minutes per week, at least thirty minutes per day on most days of the week, is highly recommended.4 Health protocols must be observed when performing such aerobic activity during this time of the COVID-19 pandemic. Outdoor exercises, such as running, walking, jogging, and biking, are preferred. Gardening, which is also a gratifying activity that has become popular during the quarantine period, also helps burn calories.
T2DM may be treated by medications in the form of oral anti-hyperglycemic agents, such as metformin, which belongs to the class of drugs called biguanides, sulfonylureas, dipeptidyl-peptidase inhibitors, and other medications such as pioglitazone and acarbose. Some patients need to be treated with insulin injections. It is crucial to regularly consult with the doctor so you can be advised on the most appropriate treatment for you.
What are its complications?
Various organs of the body may be affected by T2DM. In long-standing T2DM, the blood vessels of the eyes may be involved, in a condition called diabetic retinopathy. Persons living with T2DM must undergo an eye exam upon diagnosis of their condition. Diabetes may also have a detrimental effect on the kidney’s filtering ability, leading to a condition known as diabetic nephropathy. The nerves of the legs and feet may also be damaged as part of the complication of diabetes, and may present as numbness, pain, or tingling sensation of the lower extremities, referred to as diabetic neuropathy. Persons living with diabetes should examine their feet daily for the presence of wounds. Retinopathy, nephropathy, and neuropathy are all known as microvascular complications of diabetes.⁴
Diabetes may also cause narrowing of the large blood vessels of the body from inflammation and injury, giving rise to a condition known as atherosclerosis, which fuels the macrovascular complications of diabetes, which can be in the form of heart disease, stroke, or peripheral arterial disease⁴.
Persons with diabetes should consistently follow-up with their physicians so that they could be regularly monitored for the presence of complications and could be treated in a timely manner.
When do you need to see an endocrinologist?
It is recommended that persons with diabetes who have high blood sugar levels, with bothersome symptoms, and complications should see an endocrinologist. Those who need insulin therapy would also benefit from an endocrinology consult.
References:
The PCEDM is a sub-specialty society of the Philippine College of Physicians, a founding member of the ASEAN Federation of Endocrine Societies, and a member of the International Society of Endocrinology.