Type 2 Diabetes Mellitus

In type 2 diabetes, the body's cells respond less well to insulin and absorb less glucose. This is called insulin resistance. Because less glucose is absorbed, blood glucose levels rise. The pancreas responds by producing more insulin. Initially, the increased insulin production can compensate for the insulin resistance of the body's cells so that enough sugar is absorbed into the cells and the blood glucose level remains within the normal range. As a result, the disease often goes unnoticed for a long time.

What Happens in Type 2 Diabetes?

Diabetes mellitus is a metabolic disease whose main characteristic is elevated blood sugar. A distinction is made between type 1 diabetes and type 2 diabetes. The latter is the most common form. About 90 percent of people with diabetes have type 2 diabetes, where the body's cells react less sensitively to insulin.

The hormone insulin is produced in the ß-cells of the pancreas and ensures that sugar (glucose) can be absorbed from the blood into the body's cells. After a meal, the pancreas releases insulin, and glucose from the blood is absorbed by the liver, muscle, or fat cells. The body's cells need glucose as a source of energy.

If the fasting blood glucose level is slightly elevated but not yet as high as in diabetes, this is referred to as impaired glucose tolerance or prediabetes.

It often takes years before the body can no longer compensate for insulin resistance. Due to years of increased insulin release, the ß-cells "exhaust" and produce increasingly less insulin, and an insulin deficiency develops in addition to insulin resistance. This allows the body's cells to absorb less glucose. As a result, blood glucose rises, and diabetes manifests.

How Does Type 2 Diabetes Manifest?

The symptoms are often unspecific at first and develop gradually so that the disease is often not noticed in the first few years or is discovered by chance when other complaints are clarified.

Typical symptoms of advanced disease with out-of-control blood sugar are increased thirst, frequent urination, tiredness, fatigue, poor concentration, and a feeling of pressure in the head. Visual deterioration and skin changes are also common, for example, itching or reddened skin in the face, hands, and cheeks.

Loss of appetite and ravenous appetite can be symptoms of diabetes. Other possible complaints include potency problems, muscle cramps, numbness, nausea, and abdominal pain. People with diabetes are also more susceptible to infections; for example, recurrent urinary tract infections can indicate diabetes.

Type 2 diabetes often occurs along with high blood pressure, a lipometabolic disorder, and so-called truncal obesity - the term used to describe morbid obesity with fat deposits in the abdomen. These symptoms are grouped under the term "metabolic syndrome."

How Is Type 2 Diabetes Diagnosed?

In people with diabetes, blood glucose levels are elevated. Since this is also elevated in healthy people after food intake, a simple blood glucose measurement is usually not suitable for diagnosis. However, if the value is very high - more than 200mg/dl - this indicates diabetes.

A better diagnostic tool is the HbA1c value, the long-term blood glucose value. This value is a measure of the average blood glucose concentration over the last 8 to 12 weeks.

Fasting blood glucose values can also be determined for diagnosis. For this, the last food intake must be at least eight hours ago. Usually, the value is a maximum of 100 mg/dl; people with diabetes have a value of 126 mg/dl or more.

For further clarification, the doctor usually performs a so-called oral glucose tolerance test. The doctor determines the blood glucose fasting two hours after the patient takes a glucose solution in this test. In the case of diabetes, both values are elevated. This test can also be used to detect impaired glucose tolerance or so-called prediabetes, the preliminary stage of diabetes.

What Treatment Options Are Available?

An essential part of the treatment of type 2 diabetes is a lifestyle change. This includes a healthy diet, weight reduction, and plenty of exercises.

Regular exercise can lower the long-term blood glucose value HbA 1 c similarly well as oral antidiabetic drugs. Physical activity improves insulin uptake into muscle cells and can thus lower blood glucose levels. Exercise should include strength and endurance training. People with diabetes should exercise at least three times a week. Regular exercise is essential to avoid blood sugar fluctuations.

In addition, various medications are available for diabetes therapy. The use of these drugs depends on the severity of the disease, secondary symptoms, the ability of the ß-cells to produce insulin, and the patient's age. For some patients, a lifestyle change is sufficient to control diabetes. Most, however, need additional medication to lower blood glucose levels.

Oral antidiabetics are tablets that lower blood glucose levels. Various active ingredients can also be combined.

The best known is Metformin. It is suitable for diabetes therapy and prevention. Metformin is well tolerated and safe, and part of the standard therapy for diabetes. Therefore, drug therapy is usually started with this drug. Metformin causes increased sugar absorption in muscle and fat cells and inhibits the formation of new sugar in the liver. It works well, especially in younger patients who are overweight and produce enough insulin.

If Metformin alone is not sufficient, it can be combined with other oral antidiabetic agents, for example, sulfonylureas, glinides, or gliptins. These agents increase insulin production. Sulfonylureas have long been used in diabetes therapy. However, glinides are now only recommended in exceptional cases in the latest version of the health care guideline.

Other oral antidiabetic agents include alpha-glucosidase inhibitors and SGLT2 inhibitors (Gliflozine). Alpha-glucosidase inhibitors prevent the breakdown of twofold- or multiple sugars into single sugars in the intestine. However, the effect on blood glucose levels is weak.

SGLT2 inhibitors inhibit the reabsorption of sugar in the kidney and thus ensure that more sugar is excreted in the urine. According to recent studies, they appear to affect the progression of cardiovascular and renal sequelae positively.

Therefore, they can be given together with Metformin at the beginning of therapy in patients at increased risk or with cardiovascular and renal disease.

GLP-1 receptor agonists are diabetes medications for injection. They have a more substantial effect than oral antidiabetic drugs. They can be used when these do not work or in patients with cardiovascular and renal disease combined with Metformin. Like SGLT2 inhibitors, they have a beneficial effect on these patients.

All medications can have side effects - for example, gastrointestinal distress. Some can also lead to hypoglycemia. Therapy should therefore be individually adapted to the patient - depending on tolerability and efficacy.

If therapy with oral antidiabetics and GLP-1 receptor agonists and a lifestyle change is not enough, injecting insulin is still available. Insulin therapy is usually started with basal insulin. These are long-acting insulins that cover the basic need for insulin. If necessary, insulin therapy can be intensified.

How Severe Is Type 2 Diabetes?

There are often hardly any symptoms at first with type 2 diabetes tempts people not to take the disease seriously and maintain their old lifestyle habits.

However, this can have severe consequences for health. If diabetes persists for a long time, secondary diseases can develop. One consequence of diabetes is vascular changes. These can even develop during the first years without symptoms - long before diabetes becomes noticeable. Despite normal blood glucose levels, the metabolic state is already altered at this early stage, and organs can be damaged as a result.

Arteriosclerotic changes occur in larger vessels. In arteriosclerosis, deposits form on the inside of the arteries. These can obstruct blood flow. Diabetes can also damage small blood vessels and capillaries. This mainly affects the retina of the eye and the kidneys. In diabetic retinopathy, high blood sugar damages the walls of the retina's tiny blood vessels, which can cause severe vision problems. In the kidneys, damage to the vessels leads to poorer blood flow and limited function. This kidney dysfunction is called diabetic nephropathy.

Diabetes can also damage the nerves. Diabetic neuropathy is one of the most common consequences of prolonged diabetes. The nerve damage is usually manifested by pain, insensitivity, and numbness in the hands and feet.

Other possible consequences include diabetic foot syndrome, heart disease, and high blood pressure.

Secondary diseases are often difficult to treat. Nerve damage, for example, cannot be reversed. However, timely and consistent measures such as a change in diet, weight reduction, and exercise can still stop the disease in its early stages, when the ß-cells are still producing sufficient insulin.

Can Type 2 Diabetes Be Prevented?

Type 2 diabetes is a widespread disease. A genetic predisposition plays a significant role in the condition. If other family members have diabetes, they are more likely to develop the disease themselves.

In addition, being overweight and having an unhealthy lifestyle - such as lack of exercise, a high-fat diet, smoking, and alcohol - are essential factors contributing to the development of the disease. Advanced age, certain medications, hormonal disorders, pregnancy, and depression are also risk factors for diabetes.

Those who have an increased risk of diabetes can do a few things to prevent the disease.

Above all, one should pay attention to a healthy diet with high-fiber foods and little fat. This includes whole grains, fruits, vegetables, legumes, and small amounts of low-fat meat and dairy products.

Exercise is also important. Experts recommend at least 150 minutes of light exercise per week, such as walking, or at least 75 minutes of sports, such as jogging or cycling.

Since smoking can also promote the development of diabetes, people at risk for diabetes should avoid smoking as much as possible.

Which Doctors Are Specialists for Diabetes?

People with type 2 diabetes are usually treated by their general practitioner. However, in complex cases, patients may also need an appointment in specialized practices or with diabetologists.

We can help you find an expert for your condition. All listed physicians and clinics have been reviewed by us for their outstanding specialization in type 2 diabetes mellitus and are awaiting your inquiry or request for treatment.

Sources:

• Helmholtz Zentrum München, Deutsches Zentrum für Diabetesforschung, Deutsches Diabetes-Zentrum. Diabinfo – Das Diabetesinformationsportal. www.diabinfo.de. Aufgerufen am 27.04.2021
• Hien, Böhm, Claudi-Böhm, Krämer, Kohlhas. Diabetes- Handbuch, 7.Auflage, 2013
• Nationale Versorgungsleitlinie Typ-2-Diabetes. Teilpuplikation der Langfassung, 2. Auflage, Version 1, 2021. WMF-Register-Nr. nvl-001