Understanding Type 2 Diabetes

By Gerald Bernstein, MD, FACP

By Gerald Bernstein, MD, FACP

Type 2 diabetes results from the body’s failure to keep your blood glucose level normal. Glucose (sugar) comes into our bloodstream as a result of what we eat and what the liver produces. Insulin produced in the pancreas allows glucose to enter different cells for growth and energy. With Type 2 diabetes, the insulin-producing cells secrete less insulin than is needed, the liver produces more glucose than it should, and the muscles don’t respond to insulin normally, resulting in insulin resistance. Chronically elevated blood glucose levels increase the risk of complications, such as blindness, kidney failure, and loss of limbs.

Type 2 diabetes is best treated with nutritional control and physical activity. There are also a variety of medications used to treat the disease.

  • Metformin - This helps control the amount of glucose (sugar) in your blood. It decreases the amount of glucose made by your liver and the amount of glucose you absorb from food. 
  • Sulphonylureas (glyburide, glimeparide) and Meglitinaides (prandin) - Stimulate the cells in the pancreas to make more insulin.
  • TZDs, rosiglitazone, and Pioglitazone - Sensitize the muscles to be more reactive to insulin.
  • Incretins Byetta, Bydureon, Victoza and Januvia - Make the pancreatic cells more sensitive to glucose.

What should my first step be after receiving a diabetes diagnosis?

Ask your doctor if a diabetes educator would be helpful. They can assist you in understanding your diagnosis, and getting proper food and exercise advice.

How can I use my pharmacist to help?

Most people are going to be on combination therapy, the use of more than one medication or other therapy, as well as lipid and blood pressure-lowering medications. Your pharmacist can help you know what risks there are and what to be mindful of.

Why do I need to do everything necessary to control my blood glucose level if I don’t feel bad?

There is extensive information showing that people with a more normal blood glucose level function better in all aspects of life. It has also been shown that persistently elevated blood glucose increases the risk of complications, such as blindness, kidney failure, and loss of limbs. There is also an increased risk for coronary artery disease and heart attack. 

My doctor and educator tell me my A1c is good. But I still don't understand what an A1c is…

An A1c is a marker of average blood glucose over the last 90 days. It is also a reflection of what happens in the tissues. Glucose is sticky in the body and sticks to blood vessels, cells, and the hemoglobin molecules in the red blood cells. A high A1c means more glucose on the tissues, which puts you at risk for complications.

I have Type 2 diabetes and I am 42 years old. I am overweight and have a sedentary job. What can I do to make my diabetes disappear? 

The good news is there is plenty you can do. The bad news is that Type 2 diabetes is a progressive disease that starts very early and shows up when the body is stressed, such as by increased weight and decreased activity. See a diabetes educator. They will teach you about the disease and get you onto a weight-loss diet. Also, they will start you on an exercise program appropriate for your health. If you do this, you can greatly reduce your chances of having Type 2 diabetes.

How do I get reliable information about diabetes?

The best thing to do is look to the major organizations, such as the American Diabetes Association (ADA) or the Juvenile Diabetes Research Foundation (JDRF). Join one of these organizations and read up. You will learn a lot very fast.

Do I need to check my finger-stick glucose more than once a day?

My response is: "Do you close your eyes when you cross the street?” The more you test, the more you understand your body and can respond. If your blood glucose is high before lunch, reduce the carbohydrates you consume at that meal. It will help you achieve a more normal A1c and reduce your risk for complications.

Article written by Gerald Bernstein, MD, FACP