Below are some frequently asked questions around Type 2 diabetes.
What are the symptoms of diabetes?
High blood glucose can cause excessive thirst, increased urination, fatigue, weight loss, blurred vision, tingling nerve sensations and increased hunger. Often, in Type 2 diabetics, blood glucose levels are not high enough to cause any of these symptoms which explains why so many people are unaware that they have diabetes.
Should I be tested if I don't have symptoms of diabetes?
Yes. Many Type 2 diabetics have no symptoms for several years and remain undiagnosed. More importantly, diabetes complications start a few years before the diagnosis is made. Early diagnosis is important. Consider testing if you are over 45 years of age or you are overweight (BMI > 25 or a BMI > 23 in Asians) with any of the following:
You are physically inactive
You have a family history of diabetes
You have high cholesterol, high blood pressure or heart disease
You have polycystic ovaries
You had a history of diabetes during your pregnancy
How is diabetes diagnosed?
There are 3 ways to diagnose diabetes and these include a fasting plasma glucose test (FPG), an oral glucose tolerance test (OGTT) and a Hemoglobin A1c (HbA1c). The OGTT is more cumbersome but can yield important information. It involves drinking a glucose solution and sitting in the laboratory for 2 hours while your glucose is measured. The HbA1c is a measure of the amount of glucose that sticks to your red blood cells. Because these red blood cells have a lifespan of about 120 days, the HbA1c is a 120 day or 3 month average glucose indicator. Each of these tests have their pros and cons and a single test may not be sufficient to diagnose diabetes. Your doctor may need to request more than one test especially if the readings are in the pre-diabetic range. Measuring insulin levels is not useful and not recommended.
A diagnosis of diabetes can be made if:
the fasting glucose reading is > 7mmol/l or
the HbA1c is > 6.5% or
a random blood glucose is > 11mmol/l in someone who has diabetic symptoms
the OGTT 2-hour glucose reading is > 11mmol/l or
Will I need medication, or can I first try lifestyle changes?
Lifestyle changes namely diet, weight loss, exercise and stopping smoking are essential at any stage of diabetes to improve glucose control, manage weight and reduce complications. Most Type 2 diabetic patients will need medication from the outset, and many will need insulin over time. Diabetes is not curable, but studies have shown that a structured low calorie diet plan with resultant weight loss can induce diabetes remission in some patients. Remission is more likely where there is greater weight loss and a shorter duration of diabetes; this also depends on whether the diet and weight can be sustained over the longer term.
Do all Type 2 diabetic patients need insulin?
Insulin therapy is necessary where lifestyle measures and oral diabetic medications have failed to achieve glucose control. Where the body is unable to make enough insulin or where there is significant insulin resistance, injectable insulin from the outside is necessary for glucose control. Insulin therapy does require more glucose monitoring and patient support. New injection devices have made the administration of insulin much easier and new insulin formulations have improved the efficacy of insulin. At the same time, we are seeing many newer non-insulin diabetic medications becoming available and these can be used before insulin initiation if glucose control is within an achievable target. Where glucose levels are very high, insulin may be started much earlier and should not be delayed.
What are the dangers of untreated or uncontrolled diabetes?
Complications from uncontrolled Type 2 diabetes include damage to the eyes, heart, blood vessels, feet and nerves. About 50% of Type 2 diabetics die from cardiovascular disease (damage to the heart and blood vessels) and managing the glucose alone does not offer enough protection. It is imperative in a Type 2 diabetic patient to control the cholesterol and the blood pressure as well. About 11% of Type 2 diabetic patients die from kidney disease so monitoring and treating early signs of kidney disease is important. Fortunately, there are good medications to control blood pressure and cholesterol as well as new diabetes treatments that offer heart and kidney protection.
When should I see a doctor?
Because diabetes is a complex condition affecting multiple systems in the body, regular check-ups with your doctor are important. Patients with well-controlled diabetes may consult their doctor less frequently than patients with poorly controlled diabetes. Diabetes check-ups involve a physical examination, a urine test, a lifestyle review and blood tests to check glucose control, cholesterol levels and kidney function. Detecting signs of any early complications is important in order to prevent further deterioration. If you are monitoring your glucose at home, it is important to share this with your doctor as soon as possible and not wait until your next appointment, especially if you are concerned about the readings.
What can I expect from my healthcare team?
The diabetes care team includes your family doctor, a dietician, a podiatrist, an ophthalmologist, a diabetic nurse educator and a specialist physician/endocrinologist, if necessary. You are encouraged to consult a dietician to work out an individualised meal plan that suits your lifestyle and your goals for weight and glucose control. Podiatrists should be consulted annually for diabetic foot assessments. An ophthalmologist should do a diabetic eye screening every 1-2 years, although some opticians also offer retina screening tests. A diabetic nurse educator is valuable in guiding those patients who require insulin therapy. Although this entire team of practitioners is not always accessible to many patients, it is your family doctor who will coordinate the care process, and this is a good place to start.