4.19.4 Lesson: Diabetes, Part II

DIABETES

Part II: Type 2 Diabetes

Objectives:

G.2 – Students will analyze personal risk factors for diabetes, heart disease, and stroke.

G.5 – Students will identify health-related decisions that contribute to heart disease, stroke, diabetes, and other chronic diseases and conditions.

Diabetes

Diabetes is a problem with the body that causes blood glucose (sugar) levels to rise higher than normal.  This is also called hyperglycemia.

When you eat your body breaks food down into glucose and sends it into the blood.  Insulin then helps move the glucose from the blood into your cells.  When glucose enters your cells, it is either used as fuel for energy right away or stored for later use.  In a person with diabetes, there is a problem with insulin.  But, not all people with diabetes have the same problem.

As you learned yesterday, the types of diabetes are type 1, type 2, and a condition called gestational diabetes, which happens when pregnant.  If you have diabetes, your body either doesn’t make enough insulin, it can’t use the insulin it does make very well, or both.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes.

In type 2 diabetes, the body does not use insulin properly.  This is called insulin resistance.  At first, the pancreas makes extra insulin to make up for it.  But, over time the pancreas is not able to keep up and can’t make enough insulin to keep blood glucose levels normal.  Type 2 diabetes is treated with lifestyle changes, oral medications (pills), and insulin.

When glucose builds up in the blood instead of going into cells, it can cause two problems:

Right away, cells may be starved for energy.

Over time, high blood glucose levels may hurt the eyes, kidneys, nerves, or heart.

Some people with type 2 can control their blood glucose with healthy eating and by being active.  But, a doctor may need to also prescribe oral medications or insulin to help ensure target blood glucose levels are met.  Type 2 usually gets worse over time – even if medications are not needed at first, they may be needed later on.

There are several complications of diabetes.  Long-term complications of diabetes develop gradually.  The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications.  Eventually, diabetes complications may be disabling or even life-threatening.  Possible complications include:

• Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, and narrowing of arteries (atherosclerosis).  If you have diabetes, you are more likely to have heart disease or stroke.
• Nerve damage (neuropathy).  Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs.  This can cause tingling, numbness, burning, or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.  Left untreated, you could lose all sense of feeling in the affected limbs.  Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea, or constipation. For men, it may lead to erectile dysfunction.
• Kidney damage (nephropathy).  The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood.  Diabetes can damage this delicate filtering system.  Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage (retinopathy).  Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness.  Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage.  Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications.  Left untreated, cuts and blisters can develop serious infections, which often heal poorly.  These infections may ultimately require toe, foot or leg amputation.
• Skin conditions.  Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Hearing impairment.  Hearing problems are more common in people with diabetes.
• Alzheimer’s disease.  Type 2 diabetes may increase the risk of Alzheimer’s disease.  The poorer your blood sugar control, the greater the risk appears to be.  Although there are theories as to how these disorders might be connected, none has yet been proved.

Risk Factors

Scientists do not know the exact cause of type 2 diabetes.  However, development of type 2 diabetes has been associated with several risk factors.  These risk factors include:

• History of hyperglycemia, prediabetes, and/or gestational diabetes – Having a history of hyperglycemia (high blood sugar levels), prediabetes (high blood sugar levels, but not high enough to be considered diabetes), or gestational diabetes increases the risk of developing type 2 diabetes.
• Overweight and obesity – The more fatty tissue you have, the more resistant your cells become to insulin.
• Physical inactivity – The less active you are, the greater your risk.  Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
• Family history – Your risk increases if a parent or sibling has type 2 diabetes.
• Race and ethnicity – Although it is unclear why, people of certain races — including blacks, Hispanics, American Indians, and Asian-Americans — are at higher risk.
• Age – Your risk increases as you get older.  This may be because you tend to exercise less, lose muscle mass and gain weight as you age.  But type 2 diabetes is also increasing dramatically among children, adolescents, and younger adults.
• High blood pressure – Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
• Abnormal cholesterol and triglyceride levels – If you have low levels of high-density lipoprotein (HDL), or “good,” cholesterol, your risk of type 2 diabetes is higher.  Triglycerides are another type of fat carried in the blood.  People with high levels of triglycerides have an increased risk of type 2 diabetes.
• Polycystic ovary syndrome – Women who have polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — are at increased risk for developing diabetes.

As you have done for the other lessons in this module, you need to determine your own risk factors for diabetes, and you will answer questions related to your risks.  Before starting the question portion of this lesson, discover your risk factors for diabetes.