Type 2 Diabetes: A Beginner's Guide

Quick summary

Learning to deal with your parent's diagnosis of type 2 diabetes can be tough. There's a lot to help him manage: blood sugar, diet, exercise, medications, complications, mental health, care giving, and support. But while this is a serious, chronic disorder, there's plenty you and your parent can do to keep his diabetes under control and prevent or delay complications so he can live a relatively healthy, happy, and active life. Your first step: Get a good handle on this complex condition.

What is diabetes?

There are two main kinds of diabetes: type 1 and type 2. People with type 1 diabetes have a specific genetic makeup that causes their bodies to attack some of their own cells, which makes it an autoimmune disease. Those who suffer from type 1 diabetes usually develop severe symptoms over a short time and require regular insulin injections or infusions through a pump. This disorder is generally diagnosed in childhood, adolescence, or young adulthood; hence its former names, juvenile-onset diabetes or insulin-dependent diabetes mellitus .

Type 2 diabetes accounts for nearly 95 percent of all diabetes cases and is often, but not always, diagnosed in people over the age of 40; hence its former moniker, adult-onset diabetes . (It used to be known as noninsulin-dependent diabetes mellitus as well, but this term is also considered outdated.)

Type 2 diabetes strikes when a person's body doesn't produce and/or or loses the ability to properly use insulin. The result is too much sugar in the blood. Insulin (a hormone) is like a key that unlocks the door to cells, so that glucose -- a simple sugar and the primary energy source that fuels the body -- can enter. Without insulin, cells starve and blood glucose shoots dangerously above normal levels, which typically hover between 80 and 110 milligrams per deciliter of blood (mg/dL).

What causes diabetes?

The exact underlying causes of diabetes remain a mystery, though the question is the subject of extensive scientific study. What researchers do know is that both genetics (family history) and environment (such as excess weight and inactivity) appear to play significant roles.

What are the risk factors for diabetes?

The typical profile for a person with type 2 diabetes looks like this: someone age 45 or older who's overweight and sedentary, with a family history of the disease. People who have high blood pressure (hypertension) or heart disease are at increased risk as well.

Type 2 diabetes occurs more frequently in certain ethnic groups, including African Americans, Latin Americans, Asian and Pacific Islanders, and Native Americans. People with medical conditions such as high blood pressure or high cholesterol are also at greater risk for diabetes.

What are the symptoms of diabetes?

Warning signs include unusual thirst, appetite, or fatigue, frequent urination or infections, tingling or numbness in the hands or feet, and eye or vision problems. Repeated skin infections or cuts and wounds that don't heal well can also be clues to diabetes.

But many people with diabetes have no symptoms of the disease at all and often go many months or even years before they're diagnosed. That's because the symptoms may sneak up and develop slowly.

How is diabetes diagnosed?

There are two laboratory blood tests to diagnosis diabetes. One is called a fasting plasma glucose test and requires a blood sample after an overnight fast (no eating or drinking for eight hours). If your parent has symptoms and a fasting blood sugar reading above 126 mg/dL, diabetes is diagnosed. In another test, known as the oral glucose tolerance test, after an overnight fast a blood sample is taken immediately before and two hours after your parent drinks a sugary beverage. In this test, if your parent's fasting blood sugar reading is above 126 mg/dL and/or his two-hour test result is above 200 mg/dL, the diagnosis is diabetes.

What's the treatment for diabetes?

There's no silver bullet to make type 2 diabetes go away. This is, unfortunately, a long-term, progressive disease without a cure. In the early stages of the disorder, your parent may be able to put a damper on its development by controlling blood sugar levels through lifestyle changes (namely, diet, exercise, and weight loss), if that's necessary. As the disorder progresses, your parent may need to take medications to lower his blood sugar, and he may eventually need insulin injections as well.

Why do blood sugar levels matter?

In the short term, blood glucose levels that are either very high or very low can lead to serious medical problems, even emergencies. Your parent could become unconscious and go into a diabetic coma, called diabetic ketoacidosis , if his blood sugar numbers skyrocket. High blood sugar is known as hyperglycemia . On the other hand, if his numbers plummet to dangerously low levels, a condition called hypoglycemia , he can also lose consciousness.

In the long term, too much sugar in a person's blood can cause damage to nearly every major organ in the body. People with diabetes appear to be at increased risk for a host of other ailments, including Alzheimer's disease, dementia, heart disease, and stroke.

What kinds of complications can diabetes cause?

Left unchecked, elevated blood glucose levels can lead to a number of damaging complications, including eye diseases such as retinopathy (which can lead to blindness), nephropathy (a disease of the kidneys that can lead to kidney failure), and nerve damage (or neuropathy), particularly of the legs and feet, which can lead to injuries, infections, and limb loss. Diabetes also impacts other parts of the body's vascular system, increasing the risk of heart disease, stroke, and, in men, erectile dysfunction (impotence).

Are there any specific concerns for seniors with diabetes?

Many older people with diabetes are asymptomatic -- meaning they have no symptoms -- and so they may remain undiagnosed until serious complications from the disorder arise. Even with a proper diagnosis, however, seniors with diabetes may face special challenges:

• Making lifestyle changes can be more difficult for any senior. Mobility issues, for example, may make exercising a challenge -- even though regular exercise is important for controlling blood sugar levels.

• Physical or financial restrictions can it more challenging for seniors to meet dietary requirements.

• Quitting smoking may be harder after more years of indulging in the habit.

• Even if your parent isn't particularly sedentary or overweight, his body's inability to respond to and use the insulin it produces -- a condition known as insulin resistance -- increases with age.

• The elderly are particularly susceptible to hypoglycemia, which can be triggered by medications -- including medications such as insulin that are designed to treat diabetes.

In addition, many older people have other medical conditions along with diabetes, and this can impact diabetes management. For example, if your parent has diabetes, hypertension, and high cholesterol, this combination is likely to speed up the progression of common vascular complications, such as kidney, eye, foot, heart, and blood vessel problems. And taking the medications required for such coexisting conditions can lead to adverse drug interactions, a common problem among seniors.

What can I do to help my parent with diabetes?

Despite all these challenges, there's a lot you can do to help your parent manage diabetes:

• Learn all you can about the disease. The more you know, the more you can help. Take a diabetes education class with your parent and go to doctors' appointments together, if possible.

• Make sure your parent has the healthcare professionals he needs and gets regular health checkups.

• Make healthy changes together. If you live with or near your parent, eat nutritious meals together. Encourage him to exercise by helping him find an active pastime he enjoys, or start exercising together.

• Learn to recognize signs of problems. You'll want to know what to look for when your parent has high or low blood sugar, as well as symptoms that may indicate a potential diabetes-related complication.

• Offer your compassion and support. It's not easy dealing with diabetes every day. You'll need to be kind, sympathetic, and understanding as your parent copes with the denial, anger, depression, and fear that often accompany a diabetes diagnosis.