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Do All Type 2 Diabetics Eventually Need Insulin?

Managing Type 2

Managing Type 2

In type 2 diabetes, your pancreas is still working but not as effectively as it needs to. This means your body is building insulin resistance and is unable to effectively convert glucose into energy leaving too much glucose in the blood. Type 2 diabetes can sometimes initially be managed through lifestyle modification including a healthy diet, regular exercise and monitoring your blood glucose levels. Eating well helps manage your blood glucose levels and your body weight Exercising helps the insulin work more effectively, lowers your blood pressure and reduces the risk of heart disease. Regular blood glucose monitoring tests whether the treatment being followed is adequately controlling blood glucose levels or whether you need to adjust your treatment. The aim of diabetes management is to keep blood glucose levels as close to the target range between 4 to 6 mmol/L (fasting), this will help prevent both short-term and long-term complications. Your healthcare team including your doctor, specialist, dietician and Credential Diabetes Educator, can help you with blood glucose monitoring, healthy eating and physical activity. However, sometimes healthy eating and exercise is not enough to keep the blood glucose levels down. Type 2 diabetes is a progressive condition. As time progresses, the insulin becomes more resistant and the pancreas is less effective converting glucose into energy. To help the pancreas convert glucose into energy, people with type 2 diabetes are often prescribed tablets to control their blood glucose levels. Eventually it may be necessary to start taking insulin to control blood glucose levels. This is when your body is no longer producing enough insulin of its own. Sometimes tablets may be continued in addition to insulin. If you require medication as Continue reading >>

Diabetes

Diabetes

High Blood Sugar, Hyperglycemia The Facts Diabetes is a condition where people don’t produce enough insulin to meet their body’s needs and/or their cells don’t respond properly to insulin. Insulin is important because it moves glucose, a simple sugar, into the body’s cells from the blood. It also has a number of other effects on metabolism. The food that people eat provides the body with glucose, which is used by the cells as a source of energy. If insulin isn’t available or doesn’t work correctly to move glucose from the blood into cells, glucose will stay in the blood. High blood glucose levels are toxic, and cells that don’t get glucose are lacking the fuel they need. There are two main kinds of diabetes: type 1 diabetes and type 2 diabetes. More than 90% of all people with diabetes have type 2. Overall, about 30 million people in North America have diabetes. Only about two-thirds of people with type 2 diabetes are aware of it and are receiving treatment because, for many people, early symptoms are not noticeable without testing. Type 1 diabetes occurs when the pancreas cannot make insulin. Everyone with type 1 diabetes requires insulin injections. Type 2 diabetes occurs when the pancreas does not make enough insulin or the body does not use insulin properly. It usually occurs in adults, although in some cases children may be affected. People with type 2 diabetes usually have a family history of this condition and are most often overweight. People with type 2 diabetes may eventually need insulin injections. This condition occurs most commonly in people of First Nations descent, Hispanics, and North Americans of African descent. Another less common form is gestational diabetes, a temporary condition that occurs during pregnancy. According to the Canadian Continue reading >>

Identifying And Addressing Barriers To Insulin Acceptance And Adherence In Patients With Type 2 Diabetes Mellitus

Identifying And Addressing Barriers To Insulin Acceptance And Adherence In Patients With Type 2 Diabetes Mellitus

Progressive hyperglycemia is a characteristic of type 2 diabetes mellitus (T2DM) that poses a challenge to maintaining optimal glycemic control. Achieving glycemic control early in the course of disease can minimize or prevent serious complications. Most patients with T2DM eventually require insulin replacement therapy to attain and preserve satisfactory glucose control. For decades, the use of insulin to address the primary defect of T2DM has been a cornerstone of diabetes therapy. Insulin is indicated for patients with T2DM presenting with clinically significant hyperglycemia, and it is mandatory for patients exhibiting signs of catabolism. Insulin should be considered for patients in whom hyperglycemia persists despite attempts to control the condition through diet and exercise modifications and the use of noninsulin therapies. Many physicians delay initiation of insulin until absolutely necessary, sometimes overestimating patient concerns about its use. Modern insulin analogs, treatment regimens, and delivery devices make insulin more user friendly, and physicians can promote patient acceptance of insulin by reviewing the benefits of controlled glycated hemoglobin levels and addressing patient concerns. Approximately 26 million Americans were living with diabetes in 2010.1 Data from a 2012 report2 indicated a substantial increase in the prevalence of diagnosed diabetes mellitus throughout the 50 states, Washington, DC, and Puerto Rico during a 16-year period (1995-2010), with the age-adjusted prevalence increasing by more than 50% in most states and by 100% or greater in 18 states. Figure 13 shows the areas of the United States that had the highest concentrations of diagnosed diabetes in 2009, whereas Figure 2 presents the lifetime risks of developing diabetes.4 In Continue reading >>

Diabetes 101

Diabetes 101

Learning objectives Upon completion of this chapter, the technician should be able to do the following: 1. Differentiate between Type 1 and Type 2 Diabetes. 2. Explain the Criteria for the diagnosis of Diabetes. 3. Explain Insulin Resistance. 4. Discuss the importance of monitoring blood sugars. 5. Explain the purpose of the HbA1c blood test. 6. Differentiate between the 5 classes of oral medications. 7. Explain the role of insulin treatment in diabetes. 8. Discuss the importance of controlling blood glucose. What is Diabetes? Diabetes-the complete name is diabetes mellitus-is one of the oldest diseases known. It was first described by the ancient Greeks as early as 100 AD. The word diabetes originates from the ancient Greek word for “flow through,” since two of the most common symptoms are extreme thirst and a need to urinate frequently. Scattered throughout the pancreas are cells called islets of Langerhans . About 75% of these cells produce insulin and about 20% of these cells produce glucagon. Insulin decreases blood glucose (sugar) and glucagon increases blood glucose. During normal food metabolism, insulin is released in response to blood glucose, to cause the uptake and storage of glucose ( in the form of glycogen and fat). Without insulin, the body cannot use the glucose. Glucagon (from the pancreas) is released to oppose the actions of insulin An estimated 16 million people in the United States of America (USA) are known to have diabetes, with 40% not even knowing they have diabetes and about 1 million of these being insulin dependent. Diabetes is a metabolism disorder which will progress over time to more serious problems unless it is managed properly. In diabetes, the body can’t properly use the energy it gets from food. Normally, many foods we eat are Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Overview Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood There are two main types of diabetes: type 1 – where the pancreas doesn't produce any insulin type 2 – where the pancreas doesn't produce enough insulin or the body's cells don't react to insulin These pages are about type 2 diabetes. Read more about type 1 diabetes. Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear after birth. Symptoms of diabetes The symptoms of diabetes occur because the lack of insulin means glucose stays in the blood and isn't used as fuel for energy. Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine. Typical symptoms include: feeling very thirsty passing urine more often than usual, particularly at night feeling very tired weight loss and loss of muscle bulk See your GP if you think you may have diabetes. It's very important for it to be diagnosed as soon as possible as it will get progressively worse if left untreated. Causes of type 2 diabetes Type 2 diabetes occurs when the body doesn't produce enough insulin to function properly, or the body's cells don't react to insulin. This means glucose stays in the blood and isn't used as fuel for energy. Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. It's far more common than type 1 diabetes. Treating type 2 diabetes As type 2 diabetes usually gets worse, you may eventually need medication – usually tablets – to keep your blood glucose at normal levels. Complications of type 2 diabetes Diabetes can cause serious long-term heal Continue reading >>

Signs Of Type 2 Diabetes

Signs Of Type 2 Diabetes

What Is Type 2 Diabetes? Type 2 diabetes can affect all people, regardless of age. Early symptoms of type 2 diabetes may be missed, so those affected may not even know they have the condition. An estimated one out of every three people within the early stages of type 2 diabetes are not aware they have it. Diabetes interferes with the body's ability to metabolize carbohydrates for energy, leading to high levels of blood sugar. These chronically high blood sugar levels increase a person's risk of developing serious health problems. Potential Consequences of High Blood Sugar Nerve problems Vision loss Joint deformities Diabetic coma (life-threatening) Other diabetes complications from high blood pressure are listed further along in this slideshow Type 2 Diabetes Symptoms: Thirst Although people with type 2 diabetes may not have specific symptoms, an increase in thirst is one symptom that is characteristic of the condition. The increased thirst can accompany other symptoms like frequent urination, feelings of unusual hunger, dry mouth, and weight gain or loss. Type 2 Diabetes Symptoms: Headaches Other symptoms that can occur if high blood sugar levels persist are fatigue, blurred vision, and headaches. Type 2 Diabetes Symptoms: Infections Often, type 2 diabetes is only identified after its negative health consequences are apparent. Certain infections and sores that take a long time to heal are a warning sign. Other possible signs include frequent yeast infections or urinary tract infections and itchy skin. Type 2 Diabetes Symptoms: Sexual Dysfunction Sexual problems can occur as a result of type 2 diabetes. Since diabetes can damage the blood vessels and nerves in the sex organs, decreased sensation can develop, potentially leading to difficulties with orgasm. Vaginal dryne Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Diabetes, Type 2 Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood There are two main types of diabetes: type 1 – where the pancreas doesn't produce any insulin type 2 – where the pancreas doesn't produce enough insulin or the body's cells don't react to insulin These pages are about type 2 diabetes. Read more about type 1 diabetes . Another type of diabetes, known as gestational diabetes , occurs in some pregnant women and tends to disappear after birth. Symptoms of diabetes The symptoms of diabetes occur because the lack of insulin means glucose stays in the blood and isn't used as fuel for energy. Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine. Typical symptoms include: feeling very thirsty passing urine more often than usual, particularly at night feeling very tired weight loss and loss of muscle bulk Read more about the symptoms of type 2 diabetes . See your GP if you think you may have diabetes. It's very important for it to be diagnosed as soon as possible as it will get progressively worse if left untreated. Read about how type 2 diabetes is diagnosed . Causes of type 2 diabetes Type 2 diabetes occurs when the body doesn't produce enough insulin to function properly, or the body's cells don't react to insulin. This means glucose stays in the blood and isn't used as fuel for energy. Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. It's far more common than type 1 diabetes. Read about the causes and risk factors for type 2 diabetes . Treating type 2 diabetes As type 2 diabetes usually gets worse, you may eve Continue reading >>

7 Scary Things That Can Happen When You Don't Treat Your Diabetes

7 Scary Things That Can Happen When You Don't Treat Your Diabetes

Swallowing pills, checking your blood sugar all the time, or sticking yourself with needles full of insulin probably doesn't sound like your idea of a good time. But taking steps to keep your diabetes under control is your best shot at preventing a slew of frightening complications. If you don't take care of yourself, "diabetes complications typically start within 5 years; within 10 to 15 years, the majority of patients will progress to have multiple health issues," says Betul Hatipoglu, MD, an endocrinologist at Cleveland Clinic. Fortunately, eating a nutritious diet, exercising, and taking your medication may not only stop complications from progressing, but can also reverse them, she says. Need motivation to stick to your treatment plan? Here's what can happen when you slack off. With type 1 diabetes, your body stops producing insulin, a hormone that regulates blood sugar; with type 2 diabetes, your body can't properly use the insulin you do produce. In turn, your HDL (or "good") cholesterol lowers, and your levels of harmful blood fats called triglycerides rise. Insulin resistance also contributes to hardened, narrow arteries, which in turn increases your blood pressure. As a result, about 70% of people with either type of diabetes also have hypertension—a risk factor for stroke, heart disease, and trouble with thinking and memory. (Add these 13 power foods to your diet to help lower blood pressure naturally.) Failing to control high blood pressure and high cholesterol, either with diet and exercise alone or by adding medications, accelerates the rate at which all your other complications progress, says Robert Gabbay, MD, PhD, chief medical officer at Joslin Diabetes Center in Boston. More than 4 million people with diabetes have some degree of retinopathy, or dam Continue reading >>

How Can I Avoid Taking Insulin?

How Can I Avoid Taking Insulin?

Answer Everyone who is diagnosed with type 1 diabetes needs to take insulin because they stop producing insulin altogether. Those with type 2 diabetes continue to produce insulin, but are not as sensitive to it, causing blood sugar to rise. They may also not produce enough insulin to keep their blood sugar in the normal range. As blood sugar rises, the pancreas (the organ that makes insulin) tries to produce more insulin to counteract the high blood sugar. This process can continue for many years. It is thought that high blood sugar plus the constant overproduction of insulin may damage the cells that produce insulin and they eventually begin to wear out. Oral medications work in several ways, including making the cells of the body more sensitive to the insulin available and causing the pancreas to produce more insulin. Often, these medications are sufficient to keep blood sugar under control for many years. However, if the amount of insulin made by the body decreases too much or stops altogether, oral medications will not work as well and injected insulin will be needed to control blood sugar. Not everyone will need to take insulin. The number of people with type 2 diabetes who take insulin (with or without oral medication) is between 15 percent and 27 percent. Because high blood sugar is toxic to the cells that produce insulin, the best way to preserve their functioning is to keep blood sugar as close to normal as possible. Diet, exercise, proper medication, and working closely with your healthcare provider are all tools you can use to keep blood sugar under control. Well-controlled blood sugar not only helps to prevent the complications of diabetes, but also can slow the decline of insulin-producing cells and delay the need to take insulin. Type 2 diabetes is a serio Continue reading >>

Managing Diabetes Without Insulin – Is It Possible?

Managing Diabetes Without Insulin – Is It Possible?

It is widely believed that those with Type 2 diabetes may eventually need insulin if they have diabetes for long enough. However, only about 20-30 percent of people with Type 2 diabetes end up needing insulin injections. In this article, we will explore whether it is possible to manage your diabetes without insulin. If so, how can one do so and when they may eventually need insulin if other treatments do not work out? 1 Type 1 Diabetes disclaimer This article is not for people with Type 1 diabetes because it is imperative that people with Type 1 diabetes require insulin every day without question. A person with Type 1 diabetes produces very little, or no insulin. Without insulin, you cannot convert food into usable energy. Simply put, without insulin, a person with Type 1 diabetes cannot survive. 2 When Robert contacted TheDiabetesCouncil, he was concerned that one day he would have to take insulin shots for his Type 2 diabetes. He had heard a few of his friends with diabetes at church talking about how they had to take insulin injections. Robert was “afraid of needles,” and the thought of giving himself a shot scared him. Is Robert going to need to start taking insulin, or is there any way he can avoid it at this point? If he avoids it, what effects would this have on his health? Will he develop long term complications of diabetes if he doesn’t start giving himself shots of insulin? I suggest also reading these: At TheDiabetesCouncil, we decided to take a look at this particular question in depth, for Robert and for others with diabetes who might benefit from reading this information. Insulin isn’t the “bad guy.” Naturally, the fear of giving oneself an injection or “shot,” can increase anxiety and stress. But what if I told you that once you get past t Continue reading >>

Metformin And Insulin In Type 2 Diabetes

Metformin And Insulin In Type 2 Diabetes

the United Kingdom Prospective Diabetes Study Group (UKPDS) has pointed out that majority of type 2 diabetes patients will experience progressive pancreatic beta cell dysfunction even when their diabetes control is excellent (1) so type 2 diabetics may eventually require treatment with insulin when oral hypoglycaemic medication is no longer effective a straight swap to insulin treatment is usual if the maximal therapy with non-insulin treatments have been reached according to estimations in UK general practice, only 50% of patients who require insulin due to failure of oral medication will receive it within 5 years o the average time taken from beginning treatment with the last oral agent to beginning insulin therapy is around 8 years (2) in the case of overweight patients taking metformin, then treatment with metformin may be continued - this is because metformin may attenuate weight gain resulting from the introduction of insulin therapy insulin therapy and a sulphonylurea may decrease the amount of insulin actually required and enhance the use of a single night-time dose but overall the clinical advantages of this combination are small (3) the average weight gain resulting from introduction of insulin therapy is 4 kg - however some patients may have a marked increase in weight after onset of insulin therapy in a comprehensive review of combination therapies with insulin in type 2 diabetes Yki-Jarvinen suggests an algorithm for starting insulin in an insulin naive type 2 diabetic patient who is on maximal oral hypoglycaemic therapy. In this algorithm she suggests stopping sulphonylurea treatment and continuation of metformin at a dose of 2g per day in combination with insulin treatment (4). If the patient is not on a dose of 2g per day when conversion to insulin occur Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Print Overview Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's important source of fuel. With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy. Symptoms Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for: Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. Fatigue. If your cells are deprived of sugar, you may become tired and irritable. Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. Slow-healing sores o Continue reading >>

Type 2 Diabetes: Causes And Symptoms

Type 2 Diabetes: Causes And Symptoms

Type 2 is the most common form of diabetes, accounting for over 90% of all diabetes cases.1,2 The number of adults diagnosed with diabetes in the US has risen significantly in the past 30 years, almost quadrupling from 5.5 million cases in 1980 to 21.3 million in 2012.1 Type 2 diabetes used to be known as adult-onset diabetes and noninsulin-dependent diabetes mellitus (NIDDM), but the disease can have an onset at any age, increasingly including childhood.2 What is type 2 diabetes? Type 2 diabetes mellitus most commonly develops in adulthood and is more likely to occur in people who are overweight and physically inactive.3 Unlike type 1 diabetes which currently cannot be prevented, many of the risk factors for type 2 diabetes can be modified. For many people, therefore, it is possible to prevent the condition.4 The International Diabetes Foundation highlight four symptoms that signal the need for diabetes testing:5 Frequent urination Weight loss Lack of energy Excessive thirst. To learn more, visit the Knowledge Center articles about symptoms or diagnosis. Causes of type 2 diabetes Insulin resistance is usually the precursor to type 2 diabetes - a condition in which more insulin than usual is needed for glucose to enter cells.3 Insulin resistance in the liver results in more glucose production while resistance in peripheral tissues means glucose uptake is impaired.2 The impairment stimulates the pancreas to make more insulin but eventually the pancreas is unable to make enough to prevent blood sugar levels from rising too high.3 Genetics plays a part in type 2 diabetes - relatives of people with the disease are at a higher risk, and the prevalence of the condition is higher in particular among Native Americans, Hispanic and Asian people.2 Obesity and weight gain are impo Continue reading >>

Facts About Diabetes And Insulin

Facts About Diabetes And Insulin

Diabetes is a very common disease, which, if not treated, can be very dangerous. There are two types of diabetes. They were once called juvenile-onset diabetes and adult diabetes. However, today we know that all ages can get both types so they are simply called type 1 and type 2 diabetes. Type 1, which occurs in approximately 10 percent of all cases, is an autoimmune disease in which the immune system, by mistake, attacks its own insulin-producing cells so that insufficient amounts of insulin are produced - or no insulin at all. Type 1 affects predominantly young people and usually makes its debut before the age of 30, and most frequently between the ages of 10 and 14. Type 2, which makes up the remaining 90 percent of diabetes cases, commonly affects patients during the second half of their lives. The cells of the body no longer react to insulin as they should. This is called insulin resistance. In the early 1920s, Frederick Banting, John Macleod, George Best and Bertram Collip isolated the hormone insulin and purified it so that it could be administered to humans. This was a major breakthrough in the treatment of diabetes type 1. Insulin Insulin is a hormone. Hormones are chemical substances that regulate the cells of the body and are produced by special glands. The hormone insulin is a main regulator of the glucose (sugar) levels in the blood. Insulin is produced in the pancreas. To be more specific, it's produced by the beta cells in the islets of Langerhans in the pancreas. When we eat, glucose levels rise, and insulin is released into the bloodstream. The insulin acts like a key, opening up cells so they can take in the sugar and use it as an energy source. Sugar is one of the top energy sources for the body. The body gets it in many forms, but mainly as carbohydr Continue reading >>

A Timely Transition To Insulin: Identifying Type 2 Diabetes Patients Failing Oral Therapy

A Timely Transition To Insulin: Identifying Type 2 Diabetes Patients Failing Oral Therapy

Abstract Although oral antidiabetic medications initially may be effective for controlling hyperglycemia, these agents often fail to maintain adequate glycemic control as the disease progresses, and insulin eventually is required in most patients. This review explores strategies for identifying patients with type 2 diabetes who are failing to maintain glycemic control on oral agents and for transitioning these patients to insulin. Based on available data, patients are not reaching recommended glycemic goals due to delays in and reluctance towards intensification of therapy, resulting in an increased risk of complications. Patients who are failing therapy with≥1 oral agents and who require insulin can be identified by monitoring A1C, daily blood glucose, and duration of oral antidiabetic therapy. Patient concerns about insulin may be addressed through education and the implementation of easy-to-follow titration regimens such as those recently proposed for basal insulin. Such approaches may simplify treatment while improving glycemic control in patients with type 2 diabetes. (Formulary. 2005;40:114–130.) Type 2 diabetes is a progressive disease characterized by the dual defect of gradual declines in insulin secretion and insulin resistance.1 Both of these defects are present at the outset of disease in those destined to have type 2 diabetes. Insulin resistance is a disorder in which the body does not respond to or utilize insulin appropriately.2 While insulin resistance generally remains constant throughout the course of the disease, the β-cells of the pancreas gradually become unable to secrete enough insulin to overcome the degree of insulin resistance.2,3 As pancreatic β-cell function progressively deteriorates, some degree of absolute insulin deficiency develops Continue reading >>

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