Culturally appropriate education may help people with type 2 diabetes control their blood sugar levels, for up to 24 months.[93] If changes in lifestyle in those with mild diabetes has not resulted in improved blood sugars within six weeks, medications should then be considered.[23] There is not enough evidence to determine if lifestyle interventions affect mortality in those who already have DM2.[64] 

Vascular diseases that prevent blood flow to the small blood vessels are common if you have diabetes. Nerve damage may also occur with longstanding diabetes. Since restricted blood flow and nerve damage can affect the feet in particular, you should make regular visits to a podiatrist. With diabetes, you may also have a reduced ability to heal blisters and cuts, even minor ones. A podiatrist can monitor your feet for any serious infections that could lead to gangrene and amputation. These visits do not take the place of daily foot checks you do yourself.
A proper diet and exercise are the foundations of diabetic care,[23] with a greater amount of exercise yielding better results.[84] Exercise improves blood sugar control, decreases body fat content and decreases blood lipid levels, and these effects are evident even without weight loss.[85] Aerobic exercise leads to a decrease in HbA1c and improved insulin sensitivity.[86] Resistance training is also useful and the combination of both types of exercise may be most effective.[86]
Diabetes is a serious disease that you cannot treat on your own. Your doctor will help you make a diabetes treatment plan that is right for you -- and that you can understand. You may also need other health care professionals on your diabetes treatment team, including a foot doctor, nutritionist, eye doctor, and a diabetes specialist (called an endocrinologist).

Type 2 diabetes is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion.[11] The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 diabetes is the most common type of diabetes mellitus.[2] Many people with type 2 diabetes have evidence of "prediabetes" (impaired fasting glucose and/or impaired glucose tolerance) for many years before meeting the criteria for type 2 diabetes.[citation needed] Prediabetes and easy overt type 2 diabetes can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce the liver's glucose production.[citation needed]
In a 40-month study of 2977 middle-aged and older adults with long-standing type 2 diabetes, depression at baseline was associated with accelerated cognitive decline. [33, 34] The 531 subjects with scores of 10 or higher on the Patient Health Questionnaire Depression Scale at baseline had significantly lower scores on the Digit Symbol Substitution Test (DSST), the Rey Auditory Verbal Learning Test (RAVLT), and the modified Stroop test. Adjustment for other risk factors did not affect the association.
Type 1 diabetes is characterized by loss of the insulin-producing beta cells of the pancreatic islets, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which a T cell-mediated autoimmune attack leads to the loss of beta cells and thus insulin.[38] It causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Although it has been called "juvenile diabetes" due to the frequent onset in children, the majority of individuals living with type 1 diabetes are now adults.[39]
Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells, whereas others increase insulin resistance (especially glucocorticoids which can provoke "steroid diabetes"). The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization (WHO) when the current taxonomy was introduced in 1999.[57]
Patients using less frequent insulin injections or noninsulin therapies – Use SMBG results to adjust to food intake, activity, or medications to reach specific treatment goals; clinicians must not only educate these individuals on how to interpret their SMBG data, but they should also reevaluate the ongoing need for and frequency of SMBG at each routine visit.
For Candace Clark, bariatric surgery meant the difference between struggling with weight issues, including medical problems triggered by obesity, and enjoying renewed health and energy. "I felt like I was slowly dying," says Candace Clark, a 54-year-old Barron, Wisconsin, resident who had dealt with weight issues for years. "I was tired of feeling the way [...]

As of 2017, an estimated 425 million people had diabetes worldwide,[9] with type 2 diabetes making up about 90% of the cases.[17][18] This represents 8.8% of the adult population,[9] with equal rates in both women and men.[19] Trend suggests that rates will continue to rise.[9] Diabetes at least doubles a person's risk of early death.[2] In 2017, diabetes resulted in approximately 3.2 to 5.0 million deaths.[9] The global economic cost of diabetes related health expenditure in 2017 was estimated at US$727 billion.[9] In the United States, diabetes cost nearly US$245 billion in 2012.[20] Average medical expenditures among people with diabetes are about 2.3 times higher.[21]
Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by high blood sugar levels over a prolonged period.[10] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.[2] If left untreated, diabetes can cause many complications.[2] Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.[3] Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.[2]
When it comes to prediabetes, there are no clear symptoms—so you may have it and not know it. Here’s why that’s important: before people develop type 2 diabetes, they almost always have prediabetes—blood sugar levels that are higher than normal but not yet high enough to be diagnosed as diabetes. You may have some of the symptoms of diabetes or even some of the complications.
In a 40-month study of 2977 middle-aged and older adults with long-standing type 2 diabetes, depression at baseline was associated with accelerated cognitive decline. [33, 34] The 531 subjects with scores of 10 or higher on the Patient Health Questionnaire Depression Scale at baseline had significantly lower scores on the Digit Symbol Substitution Test (DSST), the Rey Auditory Verbal Learning Test (RAVLT), and the modified Stroop test. Adjustment for other risk factors did not affect the association. 

Agency for Healthcare Research and Quality. Comparative Effectiveness, Safety, and Indications of Insulin Analogues in Premixed Formulations for Adults With Type 2 Diabetes. AHRQ: Agency for Healthcare Research and Quality. Available at http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=108&pageaction=displayproduct.. Accessed: March 7, 2012.
Early, intensive, multifactorial (blood pressure, cholesterol) management in patients with type 2 diabetes mellitus was associated with a small, nonsignificant reduction in the incidence of cardiovascular disease events and death in a multinational European study. [73] The 3057 patients in this study had diabetes detected by screening and were randomized to receive either standard diabetes care or intensive management of hyperglycemia (target HbA1c < 7.0%), blood pressure, and cholesterol levels.

With prolonged diabetes, atrophy of the pancreas may occur. A study by Philippe et al used computed tomography (CT) scan findings, glucagon stimulation test results, and fecal elastase-1 measurements to confirm reduced pancreatic volume in individuals with a median 15-year history of diabetes mellitus (range, 5-26 years). [13] This may also explain the associated exocrine deficiency seen in prolonged diabetes.
Diabetes is a serious disease that you cannot treat on your own. Your doctor will help you make a diabetes treatment plan that is right for you -- and that you can understand. You may also need other health care professionals on your diabetes treatment team, including a foot doctor, nutritionist, eye doctor, and a diabetes specialist (called an endocrinologist).
The 1989 "St. Vincent Declaration"[120][121] was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important not only in terms of quality of life and life expectancy but also economically – expenses due to diabetes have been shown to be a major drain on health – and productivity-related resources for healthcare systems and governments.
In the 10-year follow-up to the UKPDS, patients in the previously intensively treated group demonstrated a continued reduction in microvascular and all-cause mortality, as well as in cardiovascular events, despite early loss of differences in glycated hemoglobin levels between the intensive-therapy and conventional-therapy groups. [69] The total follow-up was 20 years, half while in the study and half after the study ended.
Rosiglitazone, a thiazolidinedione, has not been found to improve long-term outcomes even though it improves blood sugar levels.[97] Additionally it is associated with increased rates of heart disease and death.[98] Angiotensin-converting enzyme inhibitors (ACEIs) prevent kidney disease and improve outcomes in those with diabetes.[99][100] The similar medications angiotensin receptor blockers (ARBs) do not.[100] A 2016 review recommended treating to a systolic blood pressure of 140 to 150 mmHg.[101]

Treatment-related low blood sugar (hypoglycemia) is common in people with type 1 and also type 2 diabetes depending on the medication being used. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases.[26][27] rapid breathing and sweating, cold, pale skin are characteristic of low blood sugar but not definitive.[28][unreliable medical source?] Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.[29][unreliable medical source?]

Another diabetes-related sexual dysfunction symptom in men is reduced amounts of ejaculation, or retrograde ejaculation. Retrograde ejaculation is a condition in which the semen goes into the bladder, rather than out of the body through the urethra. Diabetes and damage to the blood vessels causes nerve damage to the muscles that control the bladder and urethra, which results in this problem.

Although the pathophysiology of the disease differs between the types of diabetes, most of the complications, including microvascular, macrovascular, and neuropathic, are similar regardless of the type of diabetes. Hyperglycemia appears to be the determinant of microvascular and metabolic complications. Macrovascular disease may be less related to glycemia.


Balducci S, Zanuso S, Nicolucci A, De Feo P, Cavallo S, Cardelli P, et al. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Arch Intern Med. 2010 Nov 8. 170(20):1794-803. [Medline].
The risk for coronary heart disease (CHD) is 2-4 times greater in patients with diabetes than in individuals without diabetes. Cardiovascular disease is the major source of mortality in patients with type 2 diabetes mellitus. Approximately two thirds of people with diabetes die of heart disease or stroke. Men with diabetes face a 2-fold increased risk for CHD, and women have a 3- to 4-fold increased risk.

Your primary care doctor can monitor you for diabetes at your regular checkups. Your doctor may perform blood tests to check for the disease, depending on your symptoms or risk factors. If you do have diabetes, your doctor may prescribe medication and manage your condition. They may also refer you to a specialist to help monitor your treatment. It’s likely that your primary care doctor will be part of a team of healthcare professionals who will work with you.
Vascular diseases that prevent blood flow to the small blood vessels are common if you have diabetes. Nerve damage may also occur with longstanding diabetes. Since restricted blood flow and nerve damage can affect the feet in particular, you should make regular visits to a podiatrist. With diabetes, you may also have a reduced ability to heal blisters and cuts, even minor ones. A podiatrist can monitor your feet for any serious infections that could lead to gangrene and amputation. These visits do not take the place of daily foot checks you do yourself.
In a cross-sectional study of 350 patients aged 55 years and older with type 2 diabetes and 363 control participants aged 60 years and older without diabetes, diabetic individuals were more likely to have brain atrophy than cerebrovascular lesions, with patterns resembling those of preclinical Alzheimer disease. [31, 32] Type 2 diabetes was associated with hippocampal atrophy; temporal, frontal, and limbic gray-matter atrophy; and, to a lesser extent, frontal and temporal white-matter atrophy.
^ Jump up to: a b c Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
Diabetes occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low- and middle-income countries,[104] where more than 80% of diabetic deaths occur.[108] The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030.[109] The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet).[104][109] The global number of diabetes cases might increase by 48% between 2017 and 2045.[9]
Treatment plans that include both very long-acting insulin and very short-acting insulin are frequently the most successful for controlling blood sugar. Very short-acting insulin is used with meals, to help control the spike in blood sugar levels that occur with a meal. If a person does not eat on a regular schedule, very short-acting insulin can be particularly helpful.
The United Kingdom Prospective Diabetes Study (UKPDS) was a clinical study conducted by Z that was published in The Lancet in 1998. Around 3,800 people with type 2 diabetes were followed for an average of ten years, and were treated with tight glucose control or the standard of care, and again the treatment arm had far better outcomes. This confirmed the importance of tight glucose control, as well as blood pressure control, for people with this condition.[89][135][136]
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