Diabetes: Type 2
DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of type 2 diabetes.
Alternative NamesMaturity Onset Diabetes; Noninsulin-dependent Diabetes Mellitus
A simple heart-healthy diet with weight control may be sufficient for people with type 2 diabetes. In fact, a 2002 study reported that successful lifestyle changes were more effective than metformin -- a major drug used in type 2 diabetes -- in preventing type 2 diabetes in high-risk individuals. On the other hand, the so-called Western diet (higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts) poses a high risk for type 2 diabetes. Lifestyle changes are difficult to initiate and sustain, however. Patients should be certain to surround themselves with a solid network of doctors, dietitians, family, and friends who understand both their condition and their needs.
Currently, there is much controversy over the best balance of carbohydrates, fats, and protein. A number of dietary approaches for improving the heart are available:
Although all the major dietary approaches differ in important aspects, they have some recommendations in common:
[For detailed information, see Well-Connected Report #43 Heart-Healthy Diet]
The Diabetic Diet. The current state of the diabetic diet is in flux, and at this time, there is no single diet that meets all the needs of everyone with diabetes. Patients should meet with a professional dietitian to plan an individualized diet that takes into consideration all health needs. There are some constants, however:
[For detailed information, see Well-Connected Report #42 Diabetes Diet]
Weight Loss with Diet and Medications. Being overweight is the number one risk factor for type 2 diabetes. Even modest weight loss can help prevent type 2 diabetes from developing. It can also help control or even stop progression of type 2 diabetes in people with the condition. Unfortunately, not only is weight loss difficult to sustain, but many of the oral medications used in type 2 diabetes cause weight gain as a side effect. For obese patients who cannot control weight using dietary measures alone, weight-loss drugs, such as orlistat (Xenical) or sibutramine (Meridia), may be beneficial. Orlistat may have specific benefits for people with diabetes. It may not only achieve weight but also improved glucose, cholesterol, and lipid levels. Surgical procedures are proving to be extremely beneficial in selected cases. [For detailed information, see Well-Connected Report #53, Obesity.]
Sedentary habits, especially watching television, are associated with significantly higher risks for obesity and type 2- diabetes. Regular exercise, even of moderate intensity (such as brisk walking), improves insulin sensitivity and may play a significant role in preventing type 2 diabetes--regardless of weight loss. An important study reported a 58% lower risk for type 2 diabetes in adults who performed moderate exercise for as little as 2.5 hours a week.
In 2002, a well-conducted study on overweight adults confirmed previous research that reported beneficial changes in cholesterol and lipid levels, including lower LDL levels (the so-called bad cholesterol), even when people performed low amounts of moderate or high intensity exercise (e.g., walking or jogging 12 miles a week). However, more intense exercise is required to significantly change cholesterol levels, notably increasing HDL (the so-called good cholesterol). An example of such a program would be jogging about 20 miles a week. Such benefits in the study occurred even with very modest weight loss, suggesting that overweight people who have trouble losing pounds can still achieve considerable heart benefits by exercising.
Aerobic Exercises. Aerobic exercise is proving to have significant and particular benefits for people with both type 1 and type 2 diabetes. Regular aerobic exercise, even of moderate intensity, improves insulin sensitivity. People with diabetes are at particular risk for heart disease, so the heart protective effects of aerobic exercise are very important for this patient population. Moderate exercise, in fact, protects the heart in people with type 2 diabetes, even if they have no risk factors for heart disease other than diabetes itself. (In general, when exercising people with diabetes, should aim for a heart rate target of 55% to 75% of their maximum heart rate.)
Strength Training. Strength training, which increases muscle and reduces fat, may be particularly helpful for people with diabetes, but evidence is needed to confirm this.
Yoga. One study reported that yoga helped patients with type 2 diabetes reduce their need for oral medications.Studies have indicated that yoga and Tai Chi (an ancient Chinese exercise involving slow relaxing movements) may lower blood pressure almost as well as moderate-intensity aerobic exercises.
Some Precautions for People with Diabetes Who Exercise. The following are precautions for all people with diabetes, whether type 1 or 2:
Patients who are taking medications that lower blood glucose, particularly insulin, should take special precautions before embarking on a workout program.
Monitoring Glucose (Blood Sugar) and Hemoglobin A1C
In 2002, the American Heart Association revised its guidelines for preventing heart disease and recommended that people with diabetes should aim for fasting blood glucose levels of less than 110 mg/dl and hemoglobin A1C or less than 7%.
Measuring Blood Glucose. In patients being treated with insulin or insulin-producing or sensitizing drugs, it is important to monitor blood glucose levels carefully to avoid hypoglycemia. Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions.
Blood glucose levels are generally more stable in type 2 diabetes than in type 1, so experts usually recommend measuring blood levels only once or twice a day. For patients who have become insulin-dependent, more intensive monitoring is necessary. Usually, a drop of blood obtained by pricking the finger is applied to a chemically treated strip. The glucose level is read on a standard meter or a small, portable digital display device.
Measuring Hemoglobin A1C. Hemoglobin A1c (HbA1c), or glycated hemoglobin, is measured periodically to determine the average blood-sugar level over the life span of the red blood cell, which is about eight to 10 weeks. Home tests (DRx, Metrika A1c Now) are available for measuring HbA1c that may allow even better monitoring of glucose levels.
Some research suggests that not getting enough sleep may impair insulin use and increase the risk for obesity. More research is needed, but it is always wise to improve sleep habits.