Type 2 diabetes mellitus (DM) is the most common form of diabetes and in simple terms, means your body is not using insulin properly. More often than not, type 2 DM evolves from some state of insulin resistance, where cells are desensitized to the effects of insulin. This resistance causes the body a lot of difficulty when trying to regulate blood glucose and eventually leads into prediabetes and eventually type 2 DM.
Type 2 DM: A Global Health Issue
The World Health Organization estimated that 422million people have diabetes. The Centers for Disease Control Prevention estimates 37million Americans have diabetes and approximately 90-95% with type2 DM. Diabetes is also the seventh leading cause of death in the United States.
Insulin Resistance: A Metabolic Condition
Insulin resistance is the earliest indicator of progressing type 2 DM. With insulin resistance, tissues inappropriately respond to insulin. When cells no longer produce enough insulin, glucose rises and leads to prediabetes. On the other end of the spectrum, another sign of type 2 DM is hyperinsulinemia. Hyperinsulinemia is a condition where the amount of insulin your blood is higher than what’s considered normal. The combination of insulin resistance and hyperinsulinemia results in the “metabolic syndrome”, a cluster of abnormalities including obesity, hypertension, dyslipidemia, type2 DM, and cardiovascular diseases.
Identifying Insulin Resistance
Insulin resistance has no signs or symptoms that can be difficult to diagnose. However, certain signs include:
- Increased waist circumference (over 40” for men and 35” for women)
- Blood pressure readings above 130/80
- Fasting glucose level over 100 mg/dl
- History of type 2 DM in the family
- PCOS-menstrual irregularities, hirsutism, acne and alopecia
- Excess skin tags
- A HDL cholesterol level under 40 mg/dl for men and 50 mg/dl for women
- Extreme thirst or hunger even after drinking/eating
Treating Insulin Resistance
The National Diabetes Prevention Program certifies lifestyle-change programs including eating healthy, increasing physical activity, and setting goals to stay motivated that prevent insulin resistance. Southwest Family Physicians’ Oregon Medical Weight Loss Program offers a team of board-certified and specially trained providers who will partner with you to establish a lifestyle that is sustainable and successful!
Screening, Diagnosis, Management, and Complications of Type 2 DM
American Diabetes Association recommends people without risk factors to start screening for prediabetes/diabetes when they reach 45 years old. You should obviously see your PCP sooner if you believe you are at risk prior to turning 45 years old. If you are overweight or obese while showing no symptoms, the ADA recommends screening if you have one or more of the below risk factors:
- Age: greater than 45
- Race/ethnicity: African, Latino, Native American, Asian American
- Physically inactive: <10min/week
- High blood pressure: >140/90 mmHg
- Low HDL-cholesterol: <35 mg/dL
- High triglycerides: >250 mg/dL
- Family history of diabetes
- CVD, gestational diabetes, or PCOS
Diagnosis of DM and prediabetes based on laboratory test results:
- Fasting plasma glucose (FPG>126 mg/dl, diabetes, 100-125 mg/dl, prediabetes)
- Plasma glucose after (2-hour PG>200mg/dl, diabetes, 140-199mg/dl, prediabetes)
- Hemoglobin A1c (HbA1c >6.5% diabetes; 5.7% to 6.4%, prediabetes)
Knowledge of DM and risk factors are ways to meet glucose management. Prevention and DM management programs increase adherence to treatments and decrease the chance to develop DM. Please reach out to your PCP for lab testing if you feel you are at risk. Southwest Family Physicians’ Oregon Medical Weight Loss is also a resource for anyone in the Portland area to join and have support throughout their lifelong health journey.
Sources: Insulin Resistance and the Evolution of Type 2 Diabetes
Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers