Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes cases.

It is generally characterized by insulin resistance, where the body does not fully respond to insulin. Because insulin cannot work properly, blood glucose levels keep rising, releasing more insulin. For some people with type 2 diabetes this can eventually exhaust the pancreas, resulting in the body producing less and less insulin, causing even higher blood sugar levels (hyperglycaemia).

Type 2 diabetes is most commonly diagnosed in older adults, but is increasingly seen in children, adolescents and younger adults due to rising levels of obesity, physical inactivity and poor diet.

The cornerstone of type 2 diabetes management is a healthy diet, increased physical activity and maintaining a healthy body weight. Oral medication and insulin are also frequently prescribed to help control blood glucose levels.

Risk factors

IDF risk factors T2D infographicSeveral risk factors have been associated with type 2 diabetes and include:

  • Family history of diabetes
  • Overweight
  • Unhealthy diet
  • Physical inactivity
  • Increasing age
  • High blood pressure
  • Ethnicity
  • Impaired glucose tolerance (IGT)*
  • History of gestational diabetes
  • Poor nutrition during pregnancy

*Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.

Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in the numbers of people living with type 2 diabetes.

Symptoms of type 2 diabetes

t2dsymptomsThe symptoms of type 2 diabetes are similar to those of type 1 diabetes and include:

  • Excessive thirst and dry mouth
  • Frequent urination
  • Lack of energy, tiredness
  • Slow healing wounds
  • Recurrent infections in the skin
  • Blurred vision
  • Tingling or numbness in hands and feet.

These symptoms can be mild or absent and so people with type 2 diabetes may live several years with the condition before being diagnosed.

Management of type 2 diabetes

The cornerstone of managing type 2 diabetes is a healthy lifestyle, which includes a healthy diet, regular physical activity, not smoking, and maintaining a healthy body weight.

Over time, a healthy lifestyle may not be enough to keep blood glucose levels under control and people with type 2 diabetes may need to take oral medication. If treatment with a single medication is not sufficient, combination therapy options may be prescribed.

When oral medication is not sufficient to control blood glucose levels, people with type 2 diabetes may require insulin injections.

Medications for type 2 diabetes

The most commonly used oral medications for type 2 diabetes include:

  • Metformin: reduces insulin resistance and allows the body to use its own insulin more effectively. It is regarded as the first-line treatment for type 2 diabetes in most guidelines around the world.
  • Sulfonylureas: stimulate the pancreas to increase insulin production. Sulfonylureas include gliclazide, glipizide, glimepiride, tolbutamide and glibenclamide.

Prevention of type 2 diabetes

There are a number of factors that influence the development of type 2 diabetes. The most influential are lifestyle behaviours commonly associated with urbanisation. Research indicates that a majority of cases, up to 80% according to some studies, of type 2 diabetes could be prevented through healthy diet and regular physical activity. A healthy diet includes reducing the amount of calories if you are overweight, replacing saturated fats (eg. cream, cheese, butter) with unsaturated fats (eg. avocado, nuts, olive and vegetable oils), eating dietary fibre (eg. fruit, vegetables, whole grains), and avoiding tobacco use, excessive alcohol and added sugar.

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of both aerobic (eg. jogging, swimming, cycling) exercise and resistance training, as well as reducing the amount of time spent being inactive.

Know your risk of type 2 diabetes

Risk assessment 966pxBrief questionnaires are simple, practical and inexpensive ways to quickly identify people who may be at a higher risk of type 2 diabetes and who need to have their level of risk further investigated.

The Finnish Type 2 Diabetes Risk Assessment Form, developed in 2001, is an example of an effective questionnaire that can be used as the basis for developing national questionnaires which take into account local factors. It has eight scored questions, with the total test score providing a measure of the probability of developing type 2 diabetes over the following 10 years. The reverse of the form contains brief advice on what the respondent can do to lower their risk of developing the disease, and whether they should seek advice or have a clinical examination. The test takes only a couple of minutes to complete and can be done online, in pharmacies or at various public campaign events.

IDF has developed a type 2 diabetes online diabetes risk assessment that aims to predict an individual’s risk of developing type 2 diabetes within the next ten years. The test is based on the Finnish Diabetes Risk Score (FINDRISC) developed and designed by Adj. Prof Jaana Lindstrom and Prof. Jaakko Tuomilehto from the National Institute for Health and Welfare, Helsinki, Finland. 

Around 10% of all people with diabetes have type 1 diabetes.

Type 1 diabetes is caused by an autoimmune reaction where the body’s defence system attacks the cells that produce insulin. As a result, the body produces very little or no insulin. The exact causes of this are not yet known, but are linked to a combination of genetic and environmental conditions.

Type 1 diabetes can affect people at any age, but usually develops in children or young adults. People with type 1 diabetes need daily injections of insulin to control their blood glucose levels. If people with type 1 diabetes do not have access to insulin, they will die.

The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.

Symptoms of type 1 diabetes

t1d symptomsThe most common symptoms of type 1 diabetes include:

  • Abnormal thirst and dry mouth
  • Sudden weight loss
  • Frequent urination
  • Lack of energy, tiredness
  • Constant hunger
  • Blurred vision
  • Bedwetting

Diagnosing type 1 diabetes can be difficult so additional tests may be required to confirm a diagnosis.

Management of type 1 diabetes

People with type 1 diabetes require daily insulin treatment, regular blood glucose monitoring and a healthy lifestyle to manage their condition effectively.

Insulin

All people with type 1 diabetes need to take insulin to control their blood glucose levels. There are different types of insulin depending on how quickly they work, when they peak, and how long they last. Insulin is commonly delivered with a syringe, insulin pen or insulin pump.

Types of insulin include:

  • Rapid-acting: usually taken just before or with a meal. These insulins act very quickly to limit the rise in blood sugar, which follows eating. It is essential to avoid overdosage to minimize the risk of low blood sugar (hypoglycemia). Rapid-acting insulins include Asparat, Glulisine, Lispro.
  • Short-acting: usually taken before meals. These insulins are also called regular or neutral insulins. They do not act as quickly as rapid-acting insulins and therefore may be more appropriate in certain people. Short-acting insulins include Actrapid, Humulin R, Insuman Rapid.
  • Intermediate-acting: often taken together with a short-acting insulin. Intermediate-acting insulins start to act within the first hour of injecting, followed by a period of peak activity lasting up to 7 hours. Intermediate acting insulins include Humulin NPH, Protaphane, Insulatard.
  • Long-acting: insulins that are steadily released and can last in the body for up to 24 hours. They are commonly taken in the morning or in the evening, before going to bed. Long-acting insulins include Detemir, Glargine.

Two common insulin treatment plans include:

  • Twice-daily insulin: using both short-acting and intermediate-acting insulin.
  • Basal bolus regimen: short-acting insulin taken with main meals (usually three times a day) and intermediate-acting insulin given once or twice daily (evening or morning and evening).
Self-monitoring

People with diabetes who require insulin need to check their blood glucose levels regularly to inform insulin dosage. Self-monitoring of blood glucose (SBMG) is the name given to the process of blood glucose testing by people with diabetes at home, school, work or elsewhere. SMBG helps people with diabetes and their healthcare providers understand how their blood glucose levels vary during the day so that their treatment can be adjusted accordingly.

People with type 1 diabetes are usually advised to measure their blood glucose level at least four times a day. 

Healthy nutrition

Healthy nutrition — knowing what and when to eat — is an important part of diabetes management as different foods affect your blood glucose levels differently.

A healthy diet for all people with diabetes includes reducing the amount of calories if you are overweight, replacing saturated fats (eg. cream, cheese, butter) with unsaturated fats (eg. avocado, nuts, olive and vegetable oils), eating dietary fibre (eg. fruit, vegetables, whole grains), and avoiding tobacco use, excessive alcohol and added sugar.

Physical activity

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of both aerobic (eg. jogging, swimming, cycling) exercise and resistance training, as well as reducing the amount of time spent being inactive.

A glossary of terms commonly associated with diabetes.

Beta cells

Beta cells are found in the pancreas that produce, store and release insulin.

Cardiovascular disease (CVD)

Diseases and injuries of the circulatory system: the heart, the blood vessels of the heart and the system of blood vessels throughout the body and to (and in) the brain. CVD generally refers to conditions that involve narrowed or blocked blood vessels.

Diabetes complications

Acute and chronic conditions caused by diabetes. Acute complications include diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar syndrome (HHS), hyperglycaemic diabetic coma, seizures or loss of consciousness and infections. Chronic microvascular complications include retinopathy (eye disease), nephropathy (kidney disease), neuropathy (nerve disease) and periodontitis (inflammation of the tissue surrounding the tooth), whereas chronic macrovascular complications are cardiovascular disease (disease of the circulatory system), diabetic encephalopathy (brain dysfunction) and diabetic foot (foot ulceration and amputation).

Diabetes (mellitus)

A condition that arises when the pancreas does not produce enough insulin or when the body cannot effectively use insulin. The three most common types of diabetes are: type 1, type 2, and gestational. 

Diabetic foot

A foot that exhibits any disease that results directly from diabetes or a complication of diabetes.

Gestational diabetes mellitus (GDM)

Hyperglycaemia (high blood glucose level) that is first detected during pregnancy is classified as either gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy. Women with slightly elevated blood glucose levels are classified as having GDM and women with substantially elevated blood glucose levels are classified as women with diabetes in pregnancy. 

Glucagon

A hormone produced in the pancreas. If blood glucose levels decrease, it triggers the body to release stored glucose into the blood stream.

Glucose

Also called dextrose or blood sugar. The main sugar the body produces to store energy from proteins, fats and carbohydrates. Glucose is the major source of energy for living cells and is carried to each cell through the bloodstream. However, the cells cannot use glucose without the help of insulin.

Glycogen

A form of glucose that is used for storing energy in the liver and muscles. If blood glucose levels decrease, the hormone glucagon triggers the body to convert glycogen to glucose and release it into the blood stream. 

Glycosylated haemoglobin A1c (HbA1c)

Haemoglobin to which glucose is bound. Glycosylated haemoglobin is tested to determine the average level of blood glucose over the past two to three months.

Hyperglycaemia

A raised level of glucose in the blood. It occurs when the body does not have enough insulin or cannot use the insulin it does have to turn glucose into energy. Signs of hyperglycaemia include excessive thirst, dry mouth and need to urinate often.

Hypoglycaemia

A lowered level of glucose in the blood. This occurs when a person with diabetes has injected too much insulin, eaten too little food, or has exercised without extra food. A person with hypoglycaemia may feel nervous, shaky, weak, or sweaty, and have a headache, blurred vision and hunger.

Impaired fasting glucose (IFG)

Blood glucose that is higher than normal blood glucose, but below the diagnostic threshold for diabetes after fasting (typically after an overnight fast).

Impaired glucose tolerance (IGT)

Blood glucose that is higher than normal blood glucose, but below the diagnostic threshold for diabetes after ingesting a standard amount of glucose during an oral glucose tolerance test. 

Insulin

A hormone produced in the pancreas. If blood glucose levels increase, insulin triggers cells to take up glucose from the blood stream and convert it to energy, and the liver to take up glucose from the blood stream and store it as glycogen. 

Monogenic diabetes

A less common type of diabetes, which arises as a result of a genetic mutation.  Examples include Maturity-Onset Diabetes of the Young (MODY) and Neonatal Diabetes Mellitus. 

Nephropathy

Damage, disease, or dysfunction of the kidney, which can cause the kidneys to be less efficient or to fail.

Neuropathy

Damage, disease, or dysfunction of the peripheral nerves, which can cause numbness or weakness.

Pancreas

An organ located behind the stomach that produces several important hormones, including insulin and glucagon.

Periodontitis 

Also known as gum disease. Inflammatory disease that affects the tissues that surround and support the teeth.

Retinopathy

A disease of the retina of the eye, which may cause visual impairment and blindness.

Secondary diabetes

A less common type of diabetes, which arises as a complication of other diseases (e.g. hormone disturbances or diseases of the pancreas).

Type 1 diabetes 

People with type 1 diabetes cannot produce insulin. The disease can affect people of any age, but onset usually occurs in children or young adults. 

Type 2 diabetes

People with type 2 diabetes cannot use insulin to turn glucose into energy. Type 2 diabetes is much more common than type 1, and occurs mainly in adults although it is now also increasingly diagnosed in children and young adults.

Diabetes currently affects over 425 million people worldwide. Hypoglycaemia is a common and serious complication of diabetes, particularly affecting people with diabetes on insulin treatment. It is characterised by abnormally low blood sugar levels, which can lead to cognitive impairment and in some severe cases, seizures, loss of consciousness, coma and even death.

Hypoglycaemia can be caused by too much insulin in the body, a low intake of carbohydrate, unplanned exercise and activities, and missed or delayed meals/snacks.

Typical symptoms include:

  • Anxiety
  • Blurred vision
  • Dizziness
  • Fast Heartbeat
  • Headache
  • Hunger
  • Irritability
  • Shakiness
  • Weakness/fatigue

For people with diabetes, the generally accepted cut-off point to define hypoglycaemia is a blood glucose level below 3.9mmol/L (70 mg/dl), although people may experience symptoms associated with hypoglycaemia at a higher level or have no symptoms at that level.

Hypoglycaemia can have a profound effect on the everyday lives of people with diabetes and their carers. Research has found that 70% of people with type 1 diabetes feel tired the day after a night-time hypoglycaemic event and that over 60% of family members of people with diabetes are worried about the risk of hypoglycaemia to their loved one.

HypoResolve

Hyporesolve 400pxAs much about hypoglycaemia remains unknown, the International Diabetes Federation (IDF) has joined the HypoResolve (Hypoglycaemia – Redefining SOLutions for better liVEs) consortium to help gain a better understanding of hypoglycaemia’s impact on the lives of people with diabetes and their carers and families, and ultimately improve their lives. HypoResolve comprises of 23 partners from nine European countries and the US, and includes leading academic experts, pharmaceutical and device manufacturers, as well as patient organisations.

HypoResolve aims to provide researchers and clinicians with more validated data about the condition by:

  • Creating a sustainable clinical database;
  • Conducting studies to better understand the underlying mechanisms of hypoglycaemia;
  • Conducting a series of statistical analyses to define predictors and consequences of hypoglycaemia;
  • Calculating the financial cost in European countries.

The project has an initial duration of 48 months and is divided into eight individual work packages:

  • Work package 1 deals with all aspects of project management to ensure all contractual commitments are met.
  • Work package 2 aims to identify the molecular/cellular and pathophysiological mechanisms and the consequences of hypoglycaemia through clinical and non-clinical studies.
  • Work package 3 will collate, harmonise and structure data from a range of clinical trial datasets for use by other work packages for statistical analysis.
  • Work package 4 aims to provide a classification of hypoglycaemia, beyond currently-used definitions, and to develop a standardised approach for the collection of clinical and laboratory data to be used primarily in clinical trials.
  • Work package 5 strives to understand the predictors and the impact of hypoglycaemia in terms of its biological and health-economic outcomes, and general outcomes for people living with diabetes.
  • Work package 6 aims to provide a comprehensive assessment of the impact of hypoglycaemia on the quality of life (QoL) of people with diabetes and their family members.
  • Work package 7 will assess the economic consequences of hypoglycaemia, the value of prevention and patient impact.
  • Work package 8 will engage with regulators and other stakeholders to develop a consensus guideline on agreed definitions of hypoglycaemia and data collection methods for the standardisation of clinical investigations.

HypoResolve consists of three advisory committees, including a Patient Advisory Committee (PAC), which inputs into all work packages and ensures that the insights, opinions and wishes of people with diabetes are taken into account across the multiple components of the project. The PAC is led jointly by IDF and the Juvenile Diabetes Research Foundation (JDRF), with Novo Nordisk acting as co-lead.

Current PAC Members include:

  • Mohammed Hamid, Morocco
  • Bastian Hauck, Germany
  • Simon O’Neil, UK
  • Rachel Portelli, Malta
  • Renza Scibilia, Australia
  • Phil Riley, Belgium

Funding

HypoResolve is supported with a grant of € 26.8 million from the Innovative Medicines Initiative (IMI), a joint undertaking of the European Commission and the European Federation of Pharmaceutical Industries and Associations (EFPIA), T1D Exchange, JDRF, IDF and the Leona M. and Harry B. Helmsley Charitable Trust.

For more information on HypoResolve, visit the project website.

Articles on hypoglycaemia in DRCP

Diabetes Research and Clinical Practice (DRCP) is the official journal of the International Diabetes Federation (IDF).

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