Friday, April 28, 2017

TYPE 2 DIABETES - Symptoms, causes and treats

Understanding Type 2 Diabetes

Diabetes is a chronic disease (chronic) that occurs when the pancreas (pancreas) does not produce enough insulin, or when the body does not effectively use the insulin. Diabetes is characterized by normal blood sugar levels above normal. While type 2 diabetes is diabetes that is caused by the body's ineffective use of insulin or insulin deficiency relative to blood sugar levels.

TYPE 2 DIABETES - Symptoms, causes and treats

Patients with Type 2 Diabetes in Indonesia

In 2015, people with diabetes in Indonesia is estimated to reach 10 million people with an age range 20-79 years (quoted from the International Diabetes Federation). However, only about half of them were aware of his condition.
The research result Riskesdas (Basic Health Research) of the Ministry of Health of Indonesia in 2013, approximately 12 million people in Indonesia who are over 15 years of suffering from diabetes type 2. This means that 6.9 percent of the total population aged over 15 years. But only 26 percent are already diagnosed, while the rest did not realize itself as type 2 diabetes.

Causes of Type 2 Diabetes

Cells in the human body need energy from sugar (glucose) to function properly. Which normally controls blood sugar is insulin. Insulin helps cells take and use glucose from the bloodstream. If the body lacks insulin relative, meaning that blood sugar levels are very much due to excessive intake so that insulin levels appear degraded; or emerging resistance to insulin in the body's cells, the sugar (glucose) of blood will increase dramatically. This is what triggers and become the cause of diabetes  (diabetes mellitus).
Type 2 diabetes usually occurs in people who are overweight and lack of physical movement. Usually an inactive lifestyle many leads to this disease. That is why since ancient type 2 diabetes commonly found in adults. But now, the number of patients with type 2 diabetes in children also began to increase.

Symptoms of Diabetes

Symptoms of diabetes type 2 is a classic symptom, meaning that this is a symptom that always exists in diabetes, both type 1 and type 2. Among them:
  • Frequent urination, especially at night.
  • Often feel thirsty.
  • Increased hunger often.
Other symptoms may also appear in type 2 diabetes, among others:
  • Fatigue.
  • Decreased muscle mass.
  • Weight loss.
  • Wounds that heal slowly or frequent infections.
  • Blurred vision.
Consult your doctor if you experience symptoms above so that diagnosis and early treatment can be done.

Treatment and Complications of Type 2 Diabetes

Although diabetes can not be cured, early diagnosis is very important that diabetes can be addressed. Early detection allows the blood sugar levels of diabetics to control.
The aim of treatment of diabetes is to maintain blood sugar levels and control of symptoms in order to prevent complications that may occur. Changing lifestyle can also control the symptoms of type 2 diabetes, for example by implementing a healthy diet, regular exercise, limiting alcohol consumption, and smoking cessation.
This type of diabetes is a progressive disease. Therefore, people with type 2 diabetes generally will require medication to keep their blood sugar levels.
Diabetes can lead to a number of complications if neglected. High blood sugar levels can cause damage to blood vessels, nerves, and organs.

Suffered Diabetes Pregnancy

Diabetes can also be experienced by pregnant women and is usually known as gestational diabetes. This happens because pregnant women who sometimes have blood sugar levels that exceed normal but still not including sugar levels in diabetes, but insulin also can not control it.
Gestational diabetes can increase the risk of health complications in the mother and fetus. Therefore, it is very important for people with diabetes who are pregnant to keep their blood sugar levels.

Symptoms Of Type 2 Diabetes

The classic symptoms of type 2 diabetes are the same as type 1 diabetes, namely:

  • Frequent urination, especially at night.
  • Often feel thirsty.
  • Increased hunger.
In addition, these symptoms can also accompany classic symptoms, among others:
  • Weight loss.
  • Slow wounds heal or often have an infection.
  • Itchy.
  • Vague views.
  • Often exhausted.
These symptoms occur after blood sugar rises in the blood for some time. Initially, symptoms of type 2 diabetes tend to be mild. Therefore, many sufferers are often not aware if they already have this disease.

If blood sugar levels continue to rise and become too high (hyperglycemia), it will arise:
  • Dry mouth and feel very thirsty.
  • Frequent urination.
  • Recurrent infections, such as canker sores and bladder infections.
  • Fainting.
  • Low blood pressure.
Diagnosis and treatment of diabetes early can reduce the risk of complications. Consult a doctor as soon as possible if you have diabetes symptoms.

Causes Of Type 2 Diabetes

Type 2 diabetes occurs when the pancreas in a patient's body does not produce enough insulin relative to keep blood sugar levels within normal limits. Other causes are the cells of the body becomes less sensitive to insulin, or which is known as insulin resistance.

Blood sugar levels are normally controlled by the hormone insulin produced by the pancreas. Insulin serves to move sugar from the blood into body cells which will convert it into energy.
There are a number of factors behind the lack of insulin production in type 2 diabetes risk factors include:
  • The age factor. The risk of type 2 diabetes will be higher with age. It may be triggered by weight tends to increase and frequency of exercise decreases as we get older. This type of diabetes usually strikes people aged 40 years and over. The risk of an even higher Asian ethnicity, ie at the age of 25 years and above.
  • Influence Factors Heredity. Having a family member (especially a nuclear families such as father, mother, and siblings) who suffer from diabetes also increases your risk. Risks for children with a parent with type 2 diabetes are also third higher for developing diabetes.
  • The impact of Weight Loss. The risk of type 2 diabetes is higher in people who are overweight and obese. Measuring waist to check fat in this section is the fastest way to measure your diabetes risk. Higher risk is women with a waist size of 80 cm or more and most Asian men with a waist size of 90 cm or more.
  • Ethnic factors. Asian ethnicity has type 2 diabetes risk is higher.
  • Prediabetes, a condition in which blood sugar levels are always exceeding normal, but not yet reached the stage of diabetes. If you have this condition, then the risk of developing diabetes is also increasing.
  • Gestational diabetes. Women who have experienced this condition have an increased risk of type 2 diabetes is higher.

Diagnosis Of Type 2 Diabetes

Early diagnosis is essential so that diabetes can be treated as soon as possible. If you have diabetes symptoms, you should immediately consult a doctor. A number of checks that will generally be recommended are as follows:

HbA1c test

This examination will show the average sugar level in the patient's blood over the past 2-3 months. HbA1c levels of 6.5% or more will indicate that patients have type 2 diabetes. This test can also be used as a baseline for people at risk of developing diabetes.

Oral Glucose Tolerance Test

This test serves to evaluate the activity of insulin in the body. The patient's blood sample was taken twice for fasting glucose and two hours after meals.

Fasting glucose test will be done on the morning after you fast for 8 hours, only water is allowed to drink. You are also advised not to take certain medications that may affect the test results. Blood samples will be taken towards the end of the fasting phase.
Then, you will be asked to drink a syrup containing 75 grams of glucose (sugar). Exactly two hours later, your blood sample will again be taken for glucose testing to evaluate the activity of insulin in the body.

How To Know Your Test Results

Until your sugar is known from the results of an oral glucose tolerance test will determine whether you suffer from impaired glucose tolerance or diabetes.
Milligrams/deciliter or commonly abbreviated mg / dL is the unit of blood glucose used in general in Indonesia. Normal blood sugar levels are:
  • 80-100 mg / dL before meals.
  • 80-144 mg / dL after meals (checked exactly two hours after meals).
While the blood sugar doses of patients with impaired glucose tolerance are:
  • 108-126 mg / dL before meals.
  • 142-198 mg / dL after meals (checked exactly two hours after meals).
Lifestyle changes will be recommended if the test results show you suffer from impaired glucose tolerance. Your doctor may also give you medications to lower your blood sugar levels.
While the blood sugar doses for diabetics are:
  • More than 126 mg / dL before meals.
  • More than 198 mg / dL after meals (checked exactly two hours after meals).
If the test results show you have diabetes, your doctor will usually give you drugs to lower and maintain your blood sugar balance.

Type 2 Diabetes Treatment

Although diabetes can not be cured, early detection allows blood sugar levels of diabetics can be controlled. The goal of diabetes treatment is to maintain the balance of blood sugar levels and minimize the risk of complications. Here's a detailed description of the treatment of diabetes is generally recommended.

Starting a Healthy Lifestyle

This is an early treatment for people with type 2 diabetes while helping the treatment process and prevent complications. These simple steps can be:
  • Applying a healthy diet, such as increasing the consumption of fiber-rich foods, avoid fatty foods or high sugar content.
  • Regular exercise, at least for 2.5 hours a week.
  • Lose weight, especially for those who are overweight or obese  (weight index 30 or more).
  • Quitting smoking may increase the risk of cardiovascular disease in people with diabetes.
  • Limit or stop consuming alcoholic beverages. Alcohol content in liquor can increase the risk of hyperglycemia and hypoglycemia. Do not consume alcoholic beverages on an empty stomach.
  • Maintain foot condition. Foot ulcers are a common complication experienced by type 2 diabetics. Therefore, keep your foot condition and be wary of wounds that do not heal.
  • Check eye condition regularly. The recommended frequency of routine eye examination is once every 2 years.
The Right Drugs to Overcome Diabetes Type 2

The balance of blood sugar levels in diabetes can sometimes not be well preserved only through the application of a healthy diet and regular exercise. You may also need medication to deal with it.
There are several types of drugs (usually in tablet form) that can be used for type 2 diabetes. You may also be given a combination of two or more drugs to control your blood sugar levels.
Metformin to reduce blood sugar levels
Metformin works by reducing the sugar content that is channeled to the bloodstream and makes the body more responsive to insulin. This is the first drug that is often recommended for people with type 2 diabetes.
Unlike other drugs, metformin does not cause weight gain. Therefore, this drug is usually given to patients who are overweight.
But metformin can sometimes cause mild side effects, such as nausea and diarrhea. Doctors also do not recommend this drug for people with diabetes who have kidney problems.
Sulfonylureas to increase insulin production in the pancreas
Sulfonylurea serves to increase insulin production in the pancreas. Diabetics who can not take metformin or are not overweight may be given this drug. If metformin is less effective at controlling your blood sugar levels, your doctor may combine it with sulfonylureas. Examples of these drugs are glimepiride, glibenclamide, glipizide, gliclazide, and gliquidone.
Sulphonylureas will increase insulin levels in the body so that it can increase the risk of hypoglycemia if there is an error in its use. These drugs also have side effects such as weight gain, nausea, vomiting, and diarrhea.
Pioglitazone as a trigger for insulin
Pioglitazone is usually combined with metformin, sulfonylurea, or both. This drug will trigger the body's cells to be more sensitive to insulin so that more glucose is removed from the blood.
These drugs can cause weight gain and swelling of the ankles. You are not recommended to take pioglitazone if you have had heart failure or are at risk of fracture.
Gliptin ( inhibitor of  DPP-4  ) for the prevention of breakdown of GLP-1 
Gliptin or  DPP-4  inhibitors prevent the breakdown of the GLP-1 (glucagon-like peptide-1)  hormone. GLP-1  is a hormone that plays a role in the production of insulin when high blood sugar levels. Thus, gliptin helps to increase insulin levels as the sugar levels rise.
Gliptin (eg,  linagliptin, saxagliptin, sitagliptin, and vildagliptin ) may inhibit elevated high blood sugar levels without causing hypoglycemia. These drugs do not cause weight gain and are usually given if the patient can not take sulfonylureas or glitazone, or in combination with both.
SGLT -2 inhibitors that affect urine
SGLT -2 inhibitors will increase the sugar levels secreted through the urine. However, these drugs increase the risk of infection in the urinary and genital tract for people with diabetes.
This drug is recommended if metformin and DPP-4 are not suitable for use by the person. Examples of SGLT -2 inhibitors include dapagliflozin, canagliflozin, and empagliflozin.
Agonis GLP-1 as an insulin trigger without risk of hypoglycemia
The GLP-1 agonist has a similar performance to the natural GLP-1 hormone. These drugs are given by injection to stimulate insulin production when high blood sugar levels without triggering the risk of hypoglycemia.
Acarbose to slow digestion of carbohydrates
Acarbose will slow down the process of digesting carbohydrates into sugars. This drug prevents elevated blood sugar levels too soon after diabetics eat.
These drugs can cause side effects diarrhea and flatulence. Acarbose is also rarely used to treat type 2 diabetes unless the person is not fit to take another drug.
Nateglinide and repaglinide to release insulin into the bloodstream
Both of these drugs will stimulate the pancreas to release more insulin into the bloodstream. The function of nateglinide  and repaglinide  can not last long, but effective when taken before meals. Although rarely used, both are recommended if the patient has a meal schedule at unusual hours.
All drugs still have side effects, including nateglinide and repaglinide. Side effects of both drugs are hypoglycemia and weight gain.
Insulin Therapy As A Companion Other Drugs
Drugs in tablet form may be less effective to treat diabetes, so you need insulin therapy. Based on the dosage and how to use it, this therapy may be given to replace or be given in conjunction with the above medications.
Other Drugs Commonly Needed for Type 2 Diabetes Patients
People with type 2 diabetes have a higher risk of developing complications ( heart disease,  stroke, or kidney disease). Doctors will usually suggest the following medications reduce the risk of complications:

  • statins (eg. simvastatin ) to reduce high cholesterol levels.
  • Hypertension-lowering drugs.
  • ACE Inhibitor drugs, such as lisinopril, enalapril, or ramipril, if there are indications of diabetic kidney disease. The development of disease characterized by the presence of albumin protein in the urine can be cured if treated promptly.
    Blood Sugar Level Monitoring
    The risk of hypoglycemia (blood sugar levels are too low) generally accompanies people with type 2 diabetes who use certain insulin or tablets in controlling their blood sugar levels. Symptoms of mild hypoglycemia include weakness, trembling, and hunger.
    The initial treatment for diabetics with hypoglycemia is to consume a source of carbohydrates (sugary drinks or glucose tablets) that can be absorbed quickly. After that, the patient may consume carbohydrate sources that can last longer such as a piece of wafer, a piece of sandwich, or eat fruit.
    The steps above can generally increase blood sugar levels to return to normal. But this process can take several hours.
    Severe hypoglycemia will lead diabetics to feel dazed, drowsy, and even loss of consciousness. When experiencing this condition, people with diabetes should be given a glucagon injection (a hormone that can increase blood sugar levels quickly) directly on the muscles or veins.

    Type 2 Diabetes Complications

    Very high blood sugar levels can cause damage to blood vessels, nerves, and organs. Diabetes includes chronic disease that develops gradually until it can trigger a number of complications if not treated properly. Here are some of the complications commonly experienced by diabetics.
    • Cardiovascular DiseasePeople with diabetes have a higher risk for developing heart disease, stroke, after sclerosis, and high blood pressure.
    • Damage to nerves or neuropathy. Excess blood sugar levels can damage the nerves and blood vessels smooth. This condition can cause the emergence of a sensation of tingling or pain that usually starts from the fingertips of the hands and feet, then spread to other body parts. Neuropathy in the digestive system can trigger nausea, vomiting,  diarrhea, or constipation.
    • Damage to the leg organs. Neuropathy or blocked blood flow in the diabetic foot may increase the risk of foot health complications that are usually too late to realize. About 10 percent of diabetics suffer serious infections due to minor injuries or scratches on the feet. Symptoms of foot complications to watch out for are swelling, skin that feels hot to the touch, and wounds that do not heal.
    • Damage to the eye, especially the retina. Retinopathy occurs when there is a problem in the blood vessels in the retina that can lead to blindness if left alone. Glaucoma and cataracts also include complications that may occur in diabetics.
    • Kidney damage. The kidneys have millions of fine blood vessels that filter waste from the blood. If the blood vessels are clogged or leaky, your kidney's performance may decrease. Severe damage to the kidneys can lead to kidney failure requiring dialysis (the process of dialysis) or even kidney transplantation.
    • Sexual dysfunction. Damage to fine blood vessels and nerves in male diabetics (especially smokers) can lead to erectile dysfunction. In women with diabetes, these complications may include decreased sexual satisfaction, lack of sex drive, dry vagina, or failing to reach orgasm.
    • Skin disorders. Diabetes will make the sufferer susceptible to skin diseases such as fungal and bacterial infections.
    • Miscarriage or stillbirth. High blood sugar levels can harm the mother and fetus. The risk of miscarriage and stillbirth will increase if gestational diabetes is not treated promptly. Blood sugar levels are not maintained at the beginning of pregnancy can also increase the risk of birth defects. Pregnant women with diabetes are advised to monitor their blood sugar levels regularly.

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