Diabetes type 2 is a ‘lifestyle disease’ that is strongly associated with high blood pressure, high cholesterol and weight gain, particularly around the waist. Type 2 diabetes may be prevented, but it cannot be cured.
Diabetes is a condition where there is too much glucose, a type of sugar, in the blood. There are two main types of diabetes – type 1 and type 2. There is also gestational diabetes (GDM), which is diabetes that occurs in pregnancy and usually goes away after the baby is born. However, women with GDM are at higher risk of getting type 2 diabetes later on.
Around 7.4 per cent of Australians aged 25 years or older have diabetes. The risk of diabetes increases with age: from 2.5 per cent in people aged between 35 and 45 years to 23.6 per cent in those over 75. Aboriginal people have one of the highest rates of type 2 diabetes in the world.
Type 2 diabetes is sometimes described as a ‘lifestyle disease’ because it is more common in people who don’t do enough physical activity, and who are overweight or obese. It is strongly associated with high blood pressure, high cholesterol and an ‘apple’ body shape, where excess weight is carried around the waist.
Type 2 diabetes, the most common form of diabetes, affects 85 to 90 per cent of all people with diabetes. While it usually affects mature adults, younger people are also now being diagnosed in greater numbers as rates of overweight and obesity increase. Type 2 diabetes used to be called non-insulin dependent diabetes or mature onset diabetes.
Research shows that type 2 diabetes can be prevented or delayed with early lifestyle changes. However, there is no cure for type 2 diabetes.
Symptoms of type 2 diabetes
Type 2 diabetes often has no symptoms. About half of those who have type 2 diabetes have not yet been diagnosed. Even if symptoms are present, they are often not recognised or are attributed to other reasons, such as being busy or ‘getting older’.
In many cases, blood glucose levels can be very high by the time symptoms are noticed and medical treatment is sought. Common symptoms include:
- Being more thirsty than usual
- Passing more urine
- Feeling tired and lethargic
- Slow-healing wounds
- Itching and skin infections
- Blurred vision
- Mood swings.
How glucose is used in the body
The body uses glucose as its main source of energy. Glucose comes from foods that contain carbohydrates, such as potatoes, bread, pasta, rice, fruit and milk. After food is digested, the glucose is released and absorbed into the bloodstream.
The glucose in the bloodstream needs to move into body tissues so that cells can use it for energy. Excess glucose is also stored in the liver, or converted to fat and stored in other body tissues.
Insulin is a hormone made by the pancreas, which is a gland located just below the stomach. Insulin opens the doors (the glucose channels) that let glucose move from the blood into the body cells. It also allows glucose to be stored in the liver and other tissues. This is part of a process known as glucose metabolism.
In diabetes, either the pancreas can’t make insulin (type 1 diabetes), or the cells don’t respond to the insulin properly (insulin resistance) and the pancreas produces inadequate insulin for the body’s increased needs (type 2 diabetes).
If the insulin cannot do its job, the glucose channels cannot open properly. Glucose builds up in the blood instead of getting into cells for energy. High blood glucose levels cause the health problems linked to diabetes, often referred to as complications.
Pre-diabetes is a condition in which the blood glucose level is higher than normal but not high enough to be called diabetes. Pre-diabetic conditions include ‘impaired fasting glucose’ and ‘impaired glucose tolerance’. It is important that people with these conditions reduce their risk of developing diabetes by increasing their physical activity and seeing a dietitian to develop a healthy eating plan and assist them to lose weight.
If the insulin can’t do its job, the glucose channels can’t open properly and glucose builds up in the blood. High blood glucose levels cause the health problems linked to diabetes, often referred to as complications.
Risk factors for type 2 diabetes
While there is no single cause of type 2 diabetes, there are well-known risk factors. Those most at risk of developing type 2 diabetes include:
- People with pre-diabetes
- Aboriginal and Torres Strait Islander people aged 35 and over
- People aged 35 and over who are Pacific Islanders, Maori, Asian (including the Indian subcontinent, or of Chinese origin) Middle Eastern, North African or Southern European
- People aged 45 and over who are obese or overweight, have high blood pressure or have a first-degree relative with type 2 diabetes
- All people with cardiovascular disease such as heart attack, angina, stroke, or narrowed blood vessels.
- Women with polycystic ovarian syndrome who are overweight
- Women who have had gestational diabetes
- People aged 55 or over
- People with a first-degree relative with type 2 diabetes
- People taking certain antipsychotic medication or corticosteroid medication.
Lifestyle risk factors for type 2 diabetes include:
- Being overweight or obese, especially around the waist
- Low levels of physical activity, including more than two hours of television watching per day
- Unhealthy eating habits, such as regularly choosing high-fat, high-sugar, high-salt or low-fibre foods
- Cigarette smoking.
People at risk need to have a laboratory blood glucose test (not using a portable blood glucose meter) performed by their doctor to check if they have diabetes. It is important not to wait for symptoms to develop, as these may not appear until the blood glucose is quite high.
You can assess your risk of developing type 2 diabetes by completing the AUSDRISK assessment tool.
Diagnosis of diabetes
People at risk need to have a laboratory pathology blood glucose test (not using a portable blood glucose meter) ordered by their doctor to check if they have diabetes. This test is preferably done after fasting. It is important not to wait for symptoms to develop, as these may not appear until the blood glucose is quite high.
Diagnostic tests are also done routinely during pregnancy to identify diabetes in pregnancy (gestational diabetes).
Tests for diabetes
Tests to diagnose diabetes include:
- Fasting blood glucose test (most common) – blood glucose levels are checked after fasting for between 12 and 14 hours. You can drink water during this time, but should strictly avoid any other beverage. Patients with diabetes may be asked to delay their diabetes medication or insulin dose until the test is completed
- Random blood glucose test – blood glucose levels are checked at various times during the day, and it doesn’t matter when you last ate. Blood glucose levels tend to stay constant in a person who doesn’t have diabetes
- Oral glucose tolerance test – a high-glucose drink is given. Blood samples are checked at regular intervals for two hours.
Immediately after the diabetes test
The fasting blood glucose test will confirm that the person has diabetes if it shows that the level of glucose in their blood is higher than normal when they are fasting.
Sometimes, the test result of the fasting blood glucose test is borderline. If this is the case, a glucose tolerance test may be performed. This test will confirm diabetes if the person’s blood sugar levels stay high for a long time after the tests.
Accuracy of diabetes test results
Depending on the test used, the level of blood glucose can be affected by many factors including:
- Eating or drinking
- Taking medications that are known to raise blood sugar levels, such as oral contraceptives, some diuretics (water pills) and corticosteroids
- Physical illness or surgery that may temporarily alter blood sugar levels.
Gestational diabetes is diabetes that occurs in, and is diagnosed during, pregnancy. It usually goes away after the baby is born, but the mother and child are at increased risk of type 2 diabetes later in life.
Management of type 2 diabetes
The aim of diabetes treatment is to maintain blood glucose levels within the normal range If you are taking diabetes tablets or insulin, the recommended blood glucose levels are 6-8 mmol/L before meals, and 6-10mmol/L two hours after meals. Keeping your blood glucose levels under good control will help prevent possible long-term problems that can affect your heart, blood vessels, eyes, kidneys and nerves.
Keeping your blood pressure and cholesterol within the recommended range is very important to help prevent these long-term problems. Healthy eating, achieving and maintaining a healthy weight, and doing regular physical activity, including sitting less, can help you do this. Sometimes, tablets and then insulin may also be needed.
Your diabetes healthcare team
A lifelong condition like diabetes is best managed with the support of a diabetes healthcare team. You are the most important member of your diabetes team. Other members are your doctor, diabetes educator, dietitian and podiatrist. Depending on your needs, the team may also include medical specialists, exercise physiologists and counsellors.
Self-care of diabetes
Suggestions to manage your diabetes include:
- You can link up with the diabetes team in your area. Your doctor may need to refer you, but this isn’t always necessary. You can call Diabetes Australia – Vic to find health professionals in your local area.
- Check your blood glucose levels regularly.
- Use any medication strictly as prescribed. Don’t make changes to your diabetes tablets without talking to your doctor about it first.
- Be physically active as often as you can and sit less. Work out ways that you can keep this going.
- Have a healthy eating plan. Choose healthy foods as well as suitable amounts.
- Keep a positive mental attitude and seek advice if you are anxious or depressed from your doctor, or other organisations such as Beyond Blue or Lifeline.
- Seek medical advice if you feel unwell.
- Consider joining a support group.
Where to get help
- Your doctor
- Diabetes educator
- Dietitians Association of Australia Tel. 1800 812 942
- Diabetes Australia Victoria Tel. 13 RISK (13 7475)
- Baker IDI Heart and Diabetes Institute Tel. (03) 8532 1111
Things to remember
- Type 2 diabetes is strongly associated with being overweight and physically inactive.
- Type 2 diabetes may be prevented, but it cannot be cured.
- Lifelong management should include regular exercise, healthy eating, loss of excess body weight and, where appropriate, use of prescribed medications.
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Diabetes Australia Victoria
Last reviewed: April 2013
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