The Progression of Type 2 Diabetes

Type 2 diabetes doesn’t begin as a problem with insulin production like type 1 diabetes. In fact, the beta cells at the insulin factory are often working overtime. The high blood glucose levels that define type 2 diabetes result from a problem getting glucose into the cells that need it.

With type 2 diabetes some of the locks have been changed, and the key (insulin) doesn’t work. Type 2 diabetes begins with what’s called insulin resistance — normal or above normal levels of insulin finding unresponsive cells leaves excess glucose stranded in the blood.

But this all begins in slow motion. In fact, there is a recognized condition known as prediabetes (or impaired glucose tolerance) that can be ringing the warning bell for years. Prediabetes is when blood glucose levels are higher than normal, but not high enough to be officially diagnosed as diabetes.

A famous study called the Diabetes Prevention Program (DPP) found that people with prediabetes who adopted a healthier diet, lost a modest amount of weight, and exercised regularly reduced their odds of progressing to type 2 diabetes by a whopping 58 percent.

The results were even better for participants who were over 60 years of age, and the lifestyle changes were more effective at holding off diabetes than the very effective diabetes medication metformin. Prediabetes is commonly one component of what’s called metabolic syndrome, a condition that also includes abnormal blood cholesterol levels.

Type 2 diabetes begins and progresses slowly, often without symptoms. If you’re overweight, don’t exercise, have a family history of diabetes, or belong to certain ethnic groups like African-Americans, Latinos, Asian-Americans or Native Americans, annual testing for diabetes is a must.

So, why don’t more people put a stop to type 2 diabetes before it starts? One reason is because they don’t get regular medical checkups that always include a blood glucose level; they don’t know there’s a problem. But even those who know aren’t reminded by symptoms. The symptoms of modest hyperglycemia can be unnoticeable, especially because some like frequent urination or fatigue tend to be a natural age-related inconvenience.

In time, however, insulin resistance may increase, and the pancreatic beta cells just get tired of trying to produce enough insulin and wear out.

Many people with type 2 diabetes go through a range of medications targeting different pathways for reducing blood glucose levels, and some will eventually end up taking the same kinds of insulin injections as people with type 1. Type 2 diabetes is considered, as this overview suggests, a progressive condition, where progressive actually means getting worse all the time.

It is essential, however, that you understand this progression (regression) to poorer and poorer health is not inevitable. Just as diet and exercise was amazingly effective at preventing diabetes among participants with prediabetes in the DPP study, so, too, can diet and exercise along with diabetes medication improve blood glucose control after the diagnosis.

Adopting and sticking with a healthy lifestyle can have a profound effect on insulin sensitivity and blood glucose balance. Type 2 diabetes, unlike type 1, can be put into remission.

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