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What is Type 2 Diabetes?


When we eat and drink our bodies break the food into chemicals that we can use as building blocks for growth.  The body uses everything that it can and anything that the body cannot use gets disposed of as waste in our urine, stool and sweat.  The chemicals from the food and drink are absorbed from our stomach and intestine into our bloodstream to be transported around our body to wherever they might be needed.  Once at their destination, the chemical leaves the blood stream to cross into a cell where it is used for growth or maintenance.  


One of the major building blocks taken from the things we eat and drink is glucose.  Soon after eating or drinking, the glucose level in our blood stream rises. However, before the glucose can become useful to our bodies it needs to move from the blood stream into a cell where it is utilised as an important source of energy.  



Type 2 diabetes mellitus is a disease where the body is no longer able to efficiently get glucose from the blood stream into the cells of the body.


When the glucose is in the blood stream, it cannot be used as energy and is poisonous.  


Patients who suffer from Type 2 Diabetes are called Diabetics.


If glucose stays in the blood stream at high levels for too long it damages everything it touches, like a poison.  It might be useful to imagine the organs in the body of a diabetic as irritated and fragile as it will help to understand why Diabetes pre disposes and accelerates other disease processes such as heart and kidney problems.  If an organ in the body is already damaged, irritating it further will make it worse.


The aim of the treatment for Diabetes is not just to reduce the blood sugar (poison) levels but also to reduce irritation of all the major organs and try to reduce the risk of other related problems.  In particular, it is important to have a healthy blood pressure and cholesterol level to reduce the heightened risk of heart attacks and strokes seen in Diabetics.


Glucose is carried around the body in the blood attached to red blood cells.  A spot test can tell us roughly how much sugar is being carried in the blood at any one time. This is often referred to as a BM an can easily be tested using a small device and a finger prick to get access to the blood.  Using laboratory tests and a blood sample we can also measure how much glucose has been attached to the red blood cells over their life span, which is around 120 days or 3 months.  We call this the HBA1C, or IFCC.





Treatment aims







Treatment options to reduce blood sugars


  1. Diet
  2. Exercise
  3. Tablets
  4. Injections


There is no one size fits all in Diabetes treatment.  There are multiple things to think of when deciding which treatment is best for you, but generally we consider the following points…  Think MOWA


Medical Problems

Not all medications are safe to use together and some medications worsen other medical conditions.  It is important to choose a treatment type that best suits your other medical problems.  Your Doctor or Pharmacist can help you understand which medicines will be safe options for you.


Occupation

Some diabetic medications increase the risk of low blood sugars or “hypo’s”.  As hypo’s impair your ability to think and be alert they may not be safe for occupations where alertness is critical.  Drug’s that cause hypo’s must also be used with caution with anyone who drives.  This is especially import with drivers who hold special licences, such as HGV drivers.


Age

The elderly are at increased risk of falls and are more susceptible to suffering the dangerous effects of low blood sugars or “hypos”.  The rapid correction of high blood sugars levels in the elderly can also be quite dangerous, so a more cautious approach is recommended.


Weight

Some diabetic medications increase body fat.  Given that higher levels of body fat makes it more difficult for for glucose to leave the blood and get into cells, it is usually not wise to use these types of drugs when you are struggling with excessive weight.

Metformin (Tablet)

Example - Metformin, Glucophage


Pros

Widely used for many years

Generally safe and well tolerated


Cons

Frequently known to cause diarrhoea and flatulence

Dangerous if used in severe kidney impairment or when seriously dehydrated

Gliptins (DPP4 inhibitors) (Tablet)

Example - Dapagliflozin, Empagliflozin


Pros

Dapagliflozin -

Secondary benefit of reduction in blood pressure

Secondary benefit of kidney protection

Secondary benefit of weight loss

Secondary benefit in heart failure (emerging evidence)



Cons

Can cause urinary tract infections

Risk of some serious but rare side effects - DKA and Pancreatitis

Gliflozins (SGLT2 inhibitors) (Tablet)

Example - Saxagliptin, Linagliptin, Sitagliptin, Anogliptin


Pros

Well tolerated

Weight neutral - don’t cause weight gain


Cons

None significant, yet!

GLP1 agonists (Injection)

Example - Exenatide, Liraglutide


Pros

Secondary benefit of weight loss


Cons

Injectable

Risk of some serious but rare side effects - DKA and Pancreatitis

Insulins (Injections)

Example - (There are lots!) Novorapid, Humulin


Pros

Very effective in controlling blood sugar levels

Can get a bit complicated without education


Cons

Risk of causing blood sugar levels to become too low - “hypo’s”

Causes weight gain

Increased amount needed over time

Sulphonlyureas (Tablet)

Example - Gliclazide


Pros

Used for many years

Very effective in reducing blood sugar levels


Cons

Risk of causing blood sugar levels to become too low - “hypo’s”

Causes weight gain

Increased amount needed over time


Glitazones (Tablet)

Example - Pioglitazone


Pros

Used for many years

Generally well tolerated


Cons

Can significantly worsen the function of the heart if it is already damaged

Type 2 Diabetes

Reviewed

August 2018 (Dr Eggitt)

Useful links


Table of Glycaemic index of common foods (Aston et al. Obesity Reviews 2010).


https://www.talkingtype2.co.uk/public/


http://www.diabetes.org.uk/


http://www.desmond-project.org.uk/