Medical Editor: Erica Oberg, ND, MPHMedical Editor: Jerry R. Balentine, DO, FACEP
Ask the experts
I’ve just been diagnosed with type 2 diabetes, and it was a big wake-up call. I want to avoid medications and try to handle this with lifestyle changes. What can I do to reverse this? Is there a diabetes diet?
Not all people with diabetes need drug therapy. A healthy eating plan and exercisealone can be enough if the person makes significant lifestyle changes. This health condition can be prevented by following a low glycemic load diet (basically, a diet low in sugars), staying physically active, and getting regular medical screenings.
If you have this type of diabetes the foods you eat should have a low glycemic load (index) (foods higher in fiber, protein or fats) like vegetables and good quality protein such as fish, chicken, beans, and lentils. From that base, other types of nutritious foods like fruit, whole grains, low-fat dairy products, and nuts should be added.
Foods with a high glycemic index (foods that raise blood sugar too quickly) are foods to avoid, such as processed foods, high in carbohydrates, sugars, or animal fat. Examples of foods to avoid include:
A good rule of thumb is to avoid white foods (except for cauliflower!).
Can exercise help manage type 2 diabetes?
Exercise is very important if you have this health condition. Exercise makes cells more insulin sensitive, pulling glucose out of the blood. This brings down blood sugar, and more importantly, gives you better energy because the glucose is being transferred to the cells. Any type of exercise will do this, but extra benefit is gained when the activity helps build muscle, such as weight training or using resistance bands. The benefits of exercise on blood sugar last about 48-72 hours, so it is important for you to be physically active almost every day.
Type 2 Diabetes: Signs, Symptoms, Treatments
Type 2 diabetes can affect all people, regardless of age. Early symptoms of type 2 diabetes may be missed, so those affected may not even know they have the condition. An estimated one out of every three people within the early stages of type 2 diabetes are not aware they have it.
Diabetes interferes with the body’s ability to metabolize carbohydrates for energy, leading to high levels of blood sugar. These chronically high blood sugar levels increase a person’s risk of developing serious health problems.
Over the long term, potential consequences of untreated high blood sugar include:
- Nerve problems
- Vision loss
- Joint deformities
- Cardiovascular disease
- Diabetic coma (life-threatening)
Although people with type 2 diabetes may not have specific symptoms, an increase in thirst is one symptom that is characteristic of the condition. The increased thirst can accompany other symptoms like frequent urination, feelings of unusual hunger, dry mouth, and weight gain or loss.
Other symptoms that can occur if high blood sugar levels persist are fatigue, blurred vision, and headaches.
Often, type 2 diabetes is only identified after its negative health consequences are apparent. Certain infections and sores that take a long time to heal are a warning sign. Other possible signs include frequent yeast infections, urinary tract infections, and itchy skin.
Sexual problems can occur as a result of type 2 diabetes. Since diabetes can damage the blood vessels and nerves in the sex organs, decreased sensation can develop, potentially leading to difficulties with orgasm. Vaginal dryness in women and impotence in men are other complications of diabetes. Estimates suggest that between 35% and 70% of men with diabetes will eventually suffer from impotence. Statistics for women show that about one-third of women with diabetes will have some sexual dysfunction.
At Risk for Type 2 Diabetes?
Certain risk factors related to both lifestyle choices and medical conditions can increase your risk of developing type 2 diabetes. These include:
- Cigarette smoking
- Being overweight or obese, especially around the waist
- Lack of exercise
- Consuming a diet that is high in processed meat, fat, sweets, and red meats
- Triglyceride levels over 250 mg/dL
- Low levels of “good” HDL cholesterol (below 35 mg/dL)
Inherited Type 2 Diabetes Risk Factors
Some risk factors for diabetes can’t be controlled. Hispanics, Native Americans, Asians, and African Americans have a higher than average risk for getting diabetes. Having a family history (parent or sibling) with diabetes increases your risk. Those over 45 have a higher risk of type 2 diabetes than younger people.
What Are Women’s Type 2 Diabetes Risks?
Women who developed gestational diabetes in pregnancy have a higher risk for developing type 2 diabetes later in life. The same goes for women who have babies larger than 9 pounds.
Polycystic Ovary Syndrome
Polycystic ovary syndrome is a health problem characterized by many small cysts in the ovaries, irregular periods, and high levels of androgen hormones. Because one symptom of polycystic ovary syndrome is insulin resistance, women with this condition are considered at higher risk for diabetes as well.
How Does Insulin Work?
Insulin is a hormone that allows the body to efficiently use glucose as fuel. After carbohydrates are broken down into sugars in the stomach, glucose enters the blood circulation and stimulates the pancreas to release insulin in the proper amount. Insulin allows body cells to uptake glucose as energy.
In type 2 diabetes, the body’s cells cannot take up glucose properly, leading to high levels of glucose in the blood. Insulin resistance means that although the body can produce insulin, the body’s cells do not respond properly to the insulin that is made. Over time, the pancreas reduces the amount of insulin that it produces.
How Type 2 Diabetes is Diagnosed
The hemoglobin A1c test measures the amount of glycosylated hemoglobin (hemoglobin bound to glucose) in your blood and provides information about your average blood glucose levels over the previous 2 to 3 months. Hemoglobin A1c levels over 6.5% are suggestive of diabetes. Another diagnostic test is the fasting blood glucose test. If your fasting blood glucose level is over 126, this establishes that diabetes is present. Random blood glucose levels over 200 are also consistent with diabetes.
Diabetes & Diet
Keeping good control over blood sugar levels can help reduce the risk of getting complications from diabetes. Your doctor can refer you to a registered dietician or diabetes counselor to help you formulate a healthy eating plan. Many people with type 2 diabetes will need to monitor intake of carbohydrates and reduce calories. Watching total fat and protein consumption is also recommended.
Regular exercise, including walking, can help people with type 2 diabetes lower their blood glucose levels. Physical activity also reduces body fat, lowers blood pressure, and helps prevent cardiovascular disease. It’s recommended that people with type 2 diabetes get 30 minutes of moderate exercise on most days.
Stress is particularly worrisome for people with diabetes. Stress not only increases blood pressure, but it can also increase blood glucose levels. Many people with diabetes find that relaxation techniques can help manage their condition. Examples are visualization, meditation, or breathing exercises. Taking advantage of social support networks is also helpful, like talking with a relative or friend, member of the clergy, or counselor.
Oral medication is recommended for people with type 2 diabetes who cannot adequately control their blood sugar with diet and exercise. Many types of oral diabetes medications are available, and these may be used in combination for the best results. Some increase insulin production, others improve the body’s use of insulin, while still others partially block the digestion of starches. Your doctor can determine the best medication for your individual requirements.
Some people with type 2 diabetes also take insulin, sometimes in combination with oral medications. Insulin is also used in “beta-cell failure,” a condition in which the pancreas no longer produces insulin in response to elevated blood glucose. This can occur in people with type 2 diabetes. If insulin is not produced, insulin treatment is necessary.
There are other non-insulin drugs given in injection form that are used to treat type 2 diabetes. Examples are pramlintide (Symlin), exenatide (Byetta), and liraglutide (Victoza). These drugs stimulate the release of insulin.
Testing Your Blood Sugar
Your doctor can suggest how often you should test your blood glucose. Testing can give a good idea of the extent to which your diabetes is under control and can tell you if your management plan needs to be altered.
Common Times to Test Blood Sugar
- First thing in the morning
- Before and after meals
- Before and after exercise
- Before bed
Type 2 Diabetes and Heart Attacks
Around two out of every three people with diabetes die of heart disease. Over time, elevated blood sugar levels damage the blood vessels, leading to an increased risk of clots. This increases the risk of heart attack. People with diabetes are also at an increased risk for stroke because of the damage to blood vessels.
Kidney Risks Related to Type 2 Diabetes
The risk for developing chronic kidney disease increases with time in people with diabetes. Diabetes is the most common cause of renal failure, making up about 44% of cases. Keeping your diabetes under control can reduce the risk of kidney failure. Medications are also used to reduce the risk of kidney disease in people with diabetes.
Type 2 Diabetes and Eye Damage
Diabetic retinopathy is damage to the tiny blood vessels within the retina of the eye due to high blood sugar levels over time. This can cause progressive and permanent vision loss. Diabetic retinopathy is the most common cause of new blindness in people between 20 and 74. This image shows pools of blood, or hemorrhages, in the retina.
Tingling, numbness, and a sensation of “pins and needles” are all symptoms of diabetic neuropathy, or nerve damage related to diabetes. This is most common in the hands, feet, fingers, or toes. Controlling diabetes can help prevent this complication.
Foot Damage and Type 2 Diabetes
Damage to nerves caused by diabetes can make it hard to feel injuries to the feet. At the same time, damage to the blood vessels can reduce circulation in the feet of people with diabetes. Sores that heal poorly and even gangrene are complications of diabetes that can occur in the feet. Amputation may be the result in severe cases.
Type 2 Diabetes Prevention
Type 2 diabetes is preventable in many patients. At the least, it is possible to reduce the incidence of complications of diabetes by eating a healthy diet, getting moderate exercise, and maintaining a healthy weight. It’s also helpful for people at risk to be screened for diabetes and prediabetes, so that management can begin early in the course of the disease. This reduces the risk of long-term problems.