Diabetes mellitus type 2 (also known as type 2 diabetes) is a

long-term metabolic disorder that is characterized by high blood

sugar, insulin resistance, and relativelack of insulin. ... Type 2
diabetes primarily occurs as a result of obesity and lack of
exercise.
If you have type 2 diabetes your body does not use insulin properly. This is
called insulin resistance. At first, your pancreas makes extra insulin to
make up for it. But, over time it isn't able to keep up and can't make enough
insulin to keep your blood glucose at normal levels.
PubMed Health Glossary
(Source: NIH - National Institute of Diabetes and Digestive and Kidney Diseases)

Type 2 Diabetes
A condition characterized by high blood glucose levels caused by either a
lack of insulin or the body's inability to use insulin efficiently. Type
2 diabetes develops most often in middle-aged and older adults but can
appear in children, teens, and young people.

Type 2 diabetes: Overview

Last Update: June 4, 2014; Next update: 2017.

Introduction
Type 2 diabetes (diabetes mellitus) is a metabolic disease that causes sugar to build
up in the bloodstream. The severity of diabetes can vary quite a bit: Some people
only have to make minor changes to their lifestyle after they are diagnosed. Just
losing a little weight and getting some more exercise may be enough for them to
manage their diabetes. Other people who have type 2 diabetes need more
permanent therapy that involves taking tablets or insulin. It is then especially
important to have a good understanding of the disease and know what you can
do to stay healthy.
There are two main types of diabetes. Type 1 diabetes usually develops in
childhood or at a young age. Type 1 diabetes is a result of a
damaged pancreas that leaves the organ producing either very little insulin or none
at all.
Type 2 diabetes is quite different. It used to be referred to as adult-onset
diabetes because it is often diagnosed later in life. In type 2 diabetes, it becomes
increasingly difficult for the bodys cells to absorb and use the insulin. Type 2
diabetes is much more common than type 1 diabetes. About 90 % of people who
have diabetes have type 2 diabetes.

Symptoms
If type 2 diabetes goes untreated, blood sugar levels stay high permanently. They
may not always notice it at first. Type 2 diabetes can develop gradually over
several years without any noticeable symptoms. Blood sugar levels that are
continuously too high may cause the following symptoms:
Feeling very thirsty
Frequent urination
Tiredness and listlessness
Nausea
Dizziness

If someone has extremely high blood sugar levels, they may feel confused and
drowsy or even lose consciousness (diabetic coma).

Causes
Our metabolism converts food into energy for the body to use. One of the things
our bodies need for this process is insulin.
Insulin is a hormone, a chemical that the body uses to send messages. Insulin is
made by the pancreas. After you eat the sugarlevels in your blood rise and it is
released into the bloodstream. It then makes the cells in the liver and
in muscle tissue absorb sugar from the blood. If insulin metabolism is not working
properly, the sugar (glucose) in our blood cannot be used in the right way. This
causes blood sugar levels to rise. If blood sugar levels are too high it is
called hyperglycemia.
In people who have type 2 diabetes the pancreas does actually produce
enough insulin, but it no longer has an effect on the body's tissue and cells. This is
what doctors refer to as insulin resistance. The pancreas can compensate for
this temporarily by producing more insulin. But at some point the pancreas will
not be able to keep up, and then blood sugar levels start to rise.
Risk factors
There are different factors that can favor the development of type 2 diabetes:
Being overweight and not getting enough physical exercise
Smoking
A low-fiber, high-fat and sugary diet
Some medications that affect the bodys sugar metabolism
Genetic factors: Some families are more likely to develop type 2 diabetes.

Effects
People who have type 2 diabetes are also at greater risk of developing
cardiovascular diseases such as heart attack, stroke or problems with circulation
in their legs and feet (peripheral artery disease, PAD). These are the
macrovascular complications of diabetes. Macrovascular means that these
complications affect the larger blood vessels. This risk is especially high in people
who also have high blood pressure.
If there is too much sugar in the blood for years at a time, the smaller blood
vessels in the eyes, nerves and kidneys can be damaged. These are called the
microvascular complications of diabetes. Microvascular means that the smaller
blood vessels are affected. The medical names for these kinds of complications
are retinopathy (damage to the retina), neuropathy (nerve damage),
and nephropathy (kidney damage). The later someone develops type 2 diabetes,
the less likely it is that they will develop these kinds of problems.

Diagnosis
Because type 2 diabetes develops so gradually, people will at first usually only
have minor symptoms or no symptoms at all. High blood sugar levels in the blood
or urine are often first detected during a routine check-up. If you are thought to
have type 2 diabetes your doctor will first ask about any symptoms and other
conditions that you may have. You will then also have a physical examination and
your blood sugar levels will be tested. To check your blood sugar levels before
your first meal and over the course of a day, several blood samples will be taken
and then analyzed in the laboratory. The HbA1c value will also be measured:
That reading shows the average blood sugar level over the last two to three
months.
If blood sugar levels are high enough to be causing typical symptoms, sugar can
usually be detected in the urine as well. Easy-to-use test strips to test for sugar in
the urine are available from pharmacies and doctor's practices in Germany and
many other countries.

Prevention
There are numerous recommendations for preventing type 2 diabetes. The main
ones have to do with lifestyle: eating a balanced diet, getting enough exercise and
watching your weight.
Diet changes or more exercise can actually delay diagnosis by a few years for
people at a greater risk of developing the condition. But it is still not clear whether
these kinds of changes can prevent diabetes altogether, as some experts hope.

Treatment
There are a number of factors that influence whether treatment for type 2
diabetes is a good idea and worthwhile: They include age, physical condition,
other diseases, lifestyle and the individual goals of the person who has diabetes.
Sometimes just changing your lifestyle can have a positive effect: Losing weight
and getting more exercise can make insulin more effective and lower blood
sugar levels. Quitting smoking helps to reduce the risk of cardiovascular disease.
Some people can manage the condition and the other associated risks just by
making these kinds of adjustments to their habits.
If people who are very overweight (obese) are unable to lose
weight, stomach reduction surgery may also be an option.
Some people depend on medication to regulate their blood sugar levels. Some
people take tablets, while others inject insulin or medication called incretin
mimetics (hormone-like substances that are designed to increase the body's
insulin production). It is also possible to combine tablets and injections. The most
common medications used to treat type 2 diabetes (antidiabetic drugs)
are metformin and sulfonylureas. Newer antidiabetic drugs are also available
but there are still many unanswered questions about their effects.
Depending on what other symptoms and illnesses a person has, there are
different kinds of medication available that can help to relieve specific symptoms
or lower particular risks. For example, many people who have type 2 diabetes also
have high blood pressure.
The main medications that can lower the risk of cardiovascular disease
lower blood pressure (antihypertensives),
prevent blood clotting (ASA), or
 reduce cholesterol levels (statins).

Everyday life
There are some things that people who have type 2 diabetes can do to get by
without medication. The most important thing is to lose at least a little weight
even though that may be difficult to achieve in practice. Even just a little more
physical activity can have a positive effect, for example getting into the habit of
walking more often.
If that is not enough, medication is an option, but that then has to be taken
regularly over a long period of time. It can be difficult to get used to the idea of
taking medication for the rest of your life especially if you do not feel ill and do
not notice any immediate benefit. Managing type 2 diabetes treatment can be a
real challenge, especially at first. But having the facts about diabetes can make
dealing with the condition a normal part of your daily routine that need not affect
quality of life.

Further information
No matter what type of treatment you end up choosing, the key to
managing diabetes is understanding the disease and knowing what you can do to
help protect your own health. It is also important to have the support of your
doctor and other specialists, including diabetes and diet consultants, and foot
specialists.
In Germany there is also a wide range of different services for individual
counseling and support if you are ill. Many of these offers vary greatly depending
where they are based, and they are not always easy to find. A list of points
of contact can help you to locate and make use of these services.
Another option is taking part in a disease management program
where diabetes specialists offer courses about the disease, counseling services
and comprehensive medical care.

Sources
Nationale Versorgungsleitlinie. Therapie des Typ-2-Diabetes. Version 1. August
2013.

American Diabetes Association. Standards of medical care in diabetes--

2014. Diabetes Care 2014; 37 Suppl 1: S14-80. [PubMed]
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