Turning Around Type 2

Type 2 diabetes does not have to be a permanent condition

/ Author:  / Reviewed by: Joseph V. Madia, MD

Type 2 diabetes may be the most common form, affecting millions of Americans. That doesn't mean it has to be a chronic condition. A healthy lifestyle can help you turn around the disease and live free of medication.

Though various factors can play a role in the development of type 2 diabetes, most who develop the condition are overweight, frequently with excess belly fat, and live a sedentary lifestyle that often includes poor diet choices.

But just as easily as you made a choice to skip a healthy lifestyle, you can make a decision to change your lifestyle, potentially ditching your type 2 diabetes treatment in the process. You'll still have diabetes.

Continuing to exercise and follow a healthy diet means your body can regulate its own glucose and free you from daily medication.

"The trajectory of their disease will change according to if they make those lifestyle changes," said Dr. Shahla Nader, an endocrinologist and professor of medicine at The University of Texas Health Science Center at Houston (UTHealth) Medical School and a member of the faculty at Memorial Hermann-Texas Medical Center.

"Some make the changes, and some don't."

Type 1 Vs. Type 2

Diabetes, also known as hyperglycemia, is a metabolism disorder because it is related to how the body uses and breaks down food. Most food is broken down into glucose, where the type of sugar in the blood enters the bloodstream.

It's used by cells for energy and growth with the aid of insulin produced by the pancreas. The pancreas does its part by releasing insulin to transport blood glucose to cells and lower blood sugar.

In patients with type 1 diabetes, mostly diagnosed in children and young adults and previously called juvenile diabetes, the body produces no insulin. According to the American Diabetes Association, only about 5 percent of those with diabetes have this form of the condition.

Alternatively about 90 percent of diabetics suffer from type 2 diabetes, which occurs when the body does not produce enough insulin or the insulin is ignored by the cells. It usually develops over a period of years, and some patients may find they are in a pre-diabetes phase before they are formally diagnosed type 2.

The symptoms of either type of diabetes remain the same. Common symptoms include hunger and thirst, fatigue, increased urination, and infections that may be more frequent or heal slowly. Blurry vision, pain or numbness in the hands or feet or erectile problems also can indicate diabetes, though those with the condition usually do not initially notice symptoms.

Doctors confirm diabetes when a patient's blood sugar level is higher than 200 mg/dL through one of several blood tests such as fasting blood glucose level, oral glucose tolerance, which involves drinking sweetened sugary drinks before blood testing, or the Hemoglobin A1c test.

Treating the Diabetes Epidemic

As Americans collectively get heavier and begin foregoing the gym in favor of evening television, the rate of type 2 diabetes has continued to climb.

"I see an enormous amount of obesity and sedentary lifestyle," said Dr. Nader. "Many will eventually need insulin over the years."

Though some patients with type 2 diabetes must immediately begin insulin injections to lower blood sugar, many have success with oral medication and a small percentage may be able to forego medication with lifestyle changes.

There are many choices among oral medications, including sulfonylureas, a type of drug that stimulates beta cells in the pancreas to release more insulin, such as chlorpropamide (Diabinese); meglitinides, such as repaglinide (Prandin) or nateglinide (Starlix), which work in a similar manner by urging the pancreas to release additional amounts of insulin, and biguanides like metformin (Glucophage), which decrease the amount of glucose produced by the liver.

Thiazolidinediones such as rosiglitazone (Avandia) and pioglitazone (Actos) work by lowering glucose production in the liver, while alpha-glucosidase inhibitors such as acarbose (Precose) and meglitol (Glyset) lower glucose by blocking the breakdown of starchy foods in the intestines.

DPP-4 Inhibitors are a newer class of drugs that prevent the breakdown of a naturally occurring compound in the body called GLP-1, which is capable of lowering blood glucose. Other options include combination drugs or injectable options.

Besides insulin, two injectable drugs are currently available to treat diabetes. For those with type 2 diabetes, injections are generally used only after patients have failed to get their diabetes under control with insulin injections alone.

Pramlintide (Symlin) is a synthetic form of hormone amylin, which the beta cells in the pancreas manufacture along with insulin. Amylin, insulin, and another hormone, glucagon, work together to maintain normal blood glucose levels.

Exenatide (Byetta), the other injectable drug, is part of a newer class of type 2 diabetes therapy called incretin mimetics. It is a synthetic version of exendin-4, a naturally-occurring hormone that helps lower blood glucose mostly by increasing insulin secretion. The drug was developed after the hormone was isolated from the saliva of the lizard called the Gila monster.

Some type 2 patients also take low-dose aspirin to reduce their risk of a heart attack.

Shaking Type 2

Though type 2 diabetes has become widespread, that doesn't mean it has to be permanent. Lifestyle changes such as weight loss and exercise can mean taking a pill instead of insulin injections, or even ridding yourself of the need for diabetes drugs altogether.

After diet changes and increased physical activity aid an individual with type 2 diabetes hit an ideal weight, the body's own insulin and a healthy diet can control blood sugar levels so that medication is no longer needed.

However, the main problem is that many type 2 patients pledge to make lifestyle changes, yet don't follow through, Dr. Nader said.

"It's only a very small percentage of patients (that follow through)," Dr. Nader said. "They pay lip service to it, but they don't actually do it."

Dr. Nader suggests patients start with simply reducing their portion sizes, which also will result in lower calorie consumption.

"You can't necessarily change the way people eat. They should eat less junk food, more fruits and vegetables and less carbs," she said. "There's only so much you can do to change what they eat, but a lot of it boils down to calories."

Diabetes can cause problems with the heart, kidneys, blood vessels, eyes, feet and other parts of the body. Diabetics also have a heart attack risk that is as high as a person that has already had a heart attack, according to the National Institutes of Health. Diabetics also are at a heightened risk of heart failure, stroke and dying.

The good news is that by improving your diet, losing weight and getting to a point where your body no longer requires medication, you can reverse those risks. Dr. Nader said all of the risks may not become as low as the risk before a person developed diabetes if they have had the condition for many years, but it still would lower substantially.

"It does depend on how long they've had diabetes, but broadly speaking the risk is lowered with lifestyle changes," said Dr. Nader.

Review Date: 
March 14, 2012