Diabetes Melitis Type 2 (Non-Insulin-Dependent Diabetes)

Basic Information

Type 2 diabetes melitis or non-insulin-dependent diabetes is linked to insulin resistance -- glucose is not absorbed in a natural way from the blood into the body tissues as the tissues are resistant to insulin. The pancreas produces insulin and tries to make up for this additional blood glucose by increased production of insulin. Inevitably when the pancreas is unable to supply enough insulin that the body requires the blood sugars start to rise. This early rise is known as impaired glucose intolerance (IGT). Diabetes will occur in up to 5 percent of those persons who have impaired glucose tolerance. Unlike the Type 1 diabetic who has an absence of insulin, the Type 2 diabetic's hyperglycemia is caused by the ineffectiveness of insulin and postponed secretion from islet cells.

Type 2 diabetes melitis presents all the complications linked with hyperglycemia as Type 1 diabetes melitis but at a lesser risk and after an extended duration of the illness. These complications may include:

• nephropathy (weakness, uremic appearance)
• retinopathy
• neuropathy (burning pains in hands and feet)
• coronary artery disease
• peripheral vascular disease
• cataracts and glaucoma

At diagnosis a patient is classified as a Type 1 or Type 2 diabetic yet sometimes a Type 2 diabetic requires insulin if his or her diabetes is not well controlled but the patient remains classified as a type-2 diabetic and does not revert to a type-1 classification.

While 8 million adults in the United States have been diagnosed with Type 2 diabetes it is estimated that yet another 8 million have Type 2 diabetes but go undiagnosed. Thus the estimated cases in the United States ranges from 2.7 to 4.4%. Type 2 diabetes has a definite genetic basis with approximately 38% of children of parents with Type 2 diabetes exhibiting degrees of glucose intolerance. Diabetes Type 2 increases with age with obesity being a major factor. At the time of diagnosis more than two-thirds of patients are over the age of 40. Cases run at 230 per 100,000 from ages 40--49 and 939 cases per 100,000 between the ages of 70 and 79. At the time of diagnosis over 80% of patients are obese. Type 2 diabetes is the major cause of blindness in working adults in the U.S., and patients with Type 2 diabetes are at twice the risk for cardiovascular disease than non-diabetics.

Though Type 2 diabetes occurs in all races it is twice as likely to affect African Americans as Caucasians. This differs from Type 1 diabetes which mainly affects Northern Europeans. The aboriginal Pima Indians who live in Arizona show a prevalence of 40% or greater. Other races at risk include Mexican Americans, Polynesians and Melanesians.

Syndrome X refers to the many conditions that appear in adult-onset patients with non-insulin-dependent or nonautoimmune diabetes melitis. Because of insulin resistance there is a rise in insulin levels to try to compensate. This may lead to such vascular complications as hypertension and coronary artery disease. In fact, hypertension occurs in almost half of Type 2 diabetics. This stands in contrast to the rest of the U.S. population with a hypertension rate of 15--20%.

Obesity in particular is linked to insulin resistance often accompanied by hyperglycemia and in direct relation to the blood glucose level lessening as blood glucose is controlled either by diet or insulin.

Symptoms

Patients with diabetes Type 2 may present the following symptoms:

• frequent urination (usually at night)
• excessive thirst
• increased hunger
• numbness in extremities such as toes and fingers
• blurred vision

Many patients are asymptomatic, especially during the initial stages of the illness.

Diagnosis/Treatment

Type 2 diabetes melitis can be diagnosed by the following:

• a fasting blood sugar greater than 126mg/dL measured on at least 2 or more occasions
• two random blood sugar levels greater than 200mg/dL
• one blood sugar level greater than 200mg/dL in a patient with symptoms of diabetes

These detection methods are guidelines established by the American Diabetes Association in 1997. In addition, a glucose tolerance test (OGTT) may be an appropriate diagnostic tool, diabetes being diagnosed if there is a glucose level of 200mg/dL or more 2 hours following the drinking of 75g of glucose. Though new treatments appear each year, Type 2 diabetes melitis is not curable. Management and control of risk factors for diabetic-related illnesses is key. Complications of Type 2 diabetes can be quite serious -- for instance, it is one of the leading causes of amputations -- and the goal here is prevention.

Your health care provider along with a medical management team of physician, dietician and diabetes educator should be utilized to diagnose, instruct, educate and motivate.

Home blood glucose monitoring should be put into use upon diagnosis since normalizing the serum glucose level is the patient's utmost goal. Initially the Type 2 diabetic should determine blood glucose level 4 times per day for the first few weeks at least. Before meals and at bedtime constitute the ideal schedule. Eventually after stabilization occurs home blood glucose monitored twice a day (in the morning and before dinner) is usually sufficient. Your health care team however will assess your individual requirements. Do not attempt to cure or treat yourself.

Diet is extremely important, one that is low in fat and calories. Reaching your normal weight is essential as is exercise. Many diabetics when first diagnosed are not used to getting much exercise. An ECG may be advised to see what kind of exercise is appropriate for you. Aerobic exercises prove to be beneficial. Periods of walking, slowly increasing in length, are especially recommended. But don't forget, whatever exercise program you institute must be medically supervised.

An eye exam is indicated once a year for Type 2 diabetic patients. Foot exams are also recommended to search for preliminary nerve damage.

If you are a smoker you must stop smoking,. and blood pressure and blood cholesterol levels should be brought within normal range.

There are new medications used to treat diabetes that in many cases have proven effective. Ask your health care provider about the expedience of using them. Insulin may be indicated at least on a temporary basis for patients whose diabetes is not controlled through diet and exercise. Diabetic pregnant women and their fetuses have special risks for both mother and child and must be followed carefully by an obstetrician and/or specialist in diabetes. Insulin resistance in pregnant women can cause elevated blood sugars called gestational diabetes melitis (GDM) which may return to normal at the end of pregnancy but put the woman at a greater risk for developing diabetes at a later period.

If you feel you may have Diabetes Melitis Type 2 please see your health care provider promptly.

Diabetes- Type 2 (Nutrition Management and Prevention)

Your diet should be lots of fiber and little fat. You should derive about 60% of calories from complex carbohydrates preferably high fiber, complex (unrefined) carbs such as whole grains, fruits, vegetables and beans. You should also get about 30% of calories from fat preferably monounsaturated olive oil or canola oil and 15% of your calories from protein.

High fat, high calorie diets increases you risk for obesity- the number one risk factor for type 2 diabetes. Refined carbohydrates that are rapidly absorbed, such as white bread, white rice, pasta, fruit juices and soda cause you blood sugar to shoot up, putting excessive stress on you pancreas to produce more insulin. If you are overweight and eating a poor diet, eventually your cells may become less sensitive to the effects of insulin (which helps them to use energy) and your pancreas will work less efficiently. Complex carbohydrates high in fiber, by contrast, are absorbed into your system more slowly, causing a gradual rise in blood sugar and a decreased need for insulin.

• Fiber

  You need at least 30-35 grams day. Start your day with fruit, whole grain cereals and breads, skim milk dairy or soy food. Lunch on legume based soups and salads, whole grain breads with lean meat or fish, low fat cheese or crunchy veggies and fruits, fruits and vegetables. Dine on whole grain pastas, brown rice, beans or white meat poultry or fish. Insoluble fiber: whole grain bread, brown rice, bran cereal and crunchy fruits and vegetables slow the breakdown of carbohydrate to glucose. Soluble fiber: oats, barley, apples, beans lowers blood sugar and binds with bile and prevents cholesterol from being absorbed into your blood stream during digestion.

• Glycemic Index

  The glycemic index ranks foods on how they affect your blood sugar. It measures how much your blood sugar increases in 2-3 hours after eating. It?s the carbohydrates that increase blood sugar. The more refined the carbs the higher the index. Recent studies show that diabetics who keep their blood sugar under tight control avoid the complications of the disease. The recommendation is a high fiber diet that is low in saturated fat. (For more on foods and the glycemic index see The Glycemic Index Diet on this website.)

• Soy Protein

  Soy Protein may be especially helpful for diabetic in the prevention of nephropathy (kidney disease), a major contributor to death in this population. The reasons: amino acid composition, phytochemical content, lipid lowering and antioxidant effect. Try tofu, tempeh, soymilk, textured vegetable protein, etc. (See protein on this website)

  How you eat is as important as what you eat. To slow the glucose rush, have fruits or refined carbohydrates as part of the meal. Don?t wolf your food and don?t skip a meal. These habits throw your blood sugar out of whack and worsen hypoglycemia (low blood sugar) often a precursor to diabetes.

• Heart Disease and Small Vessel Disease

  Diabetics are at high risk for heart disease for many reasons- One is that cells do not respond to normal amounts of the hormone insulin so the body compensates by cranking out more, damaging heart vessels.

  Excess sugar damages blood vessels that carry oxygen and nutrient to the nerves. Nerve damage and decreased nutrient flow causes tissue damage in extremities- e.g. feet and legs.

• Blood Pressure

  if you have high blood pressure management is a must. High blood pressure inflames and injures arteries and veins. It constricts blood flow and creates an environment that lets plaque build up. This increases your risk for heart disease and cerebral hemorrhage. Low sodium, skim milk (calcium) and fruits and vegetables (high potassium foods) seem to work in concert to lower blood pressure

  Excess weight is the trigger that causes a sugar imbalance to show itself. If you are 20% over your desirable body weight you become at risk for adult onset DM.

• Stabilized Rice Bran

  (SRB) phytochemical that reduces harmful cholesterol levels and raises HDLs (good cholesterol). Stabilizes blood sugars.

• Alpha Lipoic Acid

  helps unlock energy from food and directs calories away from fat production stabilizes blood sugar. Alpha lipoic acid recycles the breakdown products of vitamins C and E to restore them to their full antioxidant power. Used for many years to improve nerve health, balance the sugar in blood and stop retinal degeneration.

• Chromium

  this mineral helps to make your cells more receptive to insulin. Chromium rich foods are peas, prunes, Brewer?s yeast, chicken breast, peanut butter, shredded wheat, and potatoes. Make sure you are getting 120-200mcg from your daily diet and MVI/mineral supplement.

• Magnesium

  Harvard researchers have found that the more magnesium in your diet the less likely you are to get diabetes. Good sources are whole grain cereals, spinach, black-eyed peas and beans. Your need 350mcg from your diet and daily supplement. If your diet is low in this mineral you may be resistant to insulin.

• Beta-carotene

  Beta-carotene (pumpkin, sweet potatoes, spinach, melon, etc.) and lycopene (tomatoes, watermelon, red grapefruit) may be helpful in management. Research shows low blood levels of these nutrients are found in NIDDM. Get your beta-carotene from food not supplements.

• Omega 3 Fatty Acids

  Omega 3 fatty acids in fish and flaxseed oil. Helps improve kidney function in diabetics. Being evaluated for its ability to lower blood glucose in diabetics. GLA (gamma linolenic acid) may also be of benefit. Most think you can take both of these supplements together safely. They work almost like a natural prednisone.

• Soluble Fiber

  Soluble fiber known as psyllium found in Metamucil can lower cholesterol and lower blood sugar. Mixing 1 tsp. of psyllium in 1 cup of water before each meal can drop blood sugar levels from 210 to 140mg/dl. Enough to eliminate the need for medication in some people with type 2 diabetes.

• Metamucil helps if:

  1. Your diabetes is newly diagnosed,
  2. you have mildly elevated blood sugar <240mg/dl
  3. you don?t get 35g/fiber from food every day.

  Don't Exceed 40g/Day, Drink Lots Of Fluids.

CAUTION: The use of psyllium in insulin dependent diabetes is contraindication as it decreases the absorption of insulin. There have also been reports of allergic reaction. Before embarking on any new OTC remedy always consult with you private healthcare provider.

Source: Journal of Diabetes and Its Complications Sept-Oct 1998

Some Fats Are Better Than Others

Monounsaturated fats are the healthiest for your body. Nuts such asalmonds, cashews, hazelnuts, and peanuts contain this type of fat, asdoes avocado. Choose olive, canola or peanut oil for cooking. Avoidsaturated fats like butter, lard and meat fat, bacon, and shortening.There are lower-fat versions of saturated fats like sour cream, yogurtand cream cheese. A healthy diet includes less than 30% of caloriesfrom fat, with less than 10% of these from saturated fat. Remember allfats are 9 calories per gram. If you are Type 2, weight management isthe number one treatment for blood sugar control.

Omega 3 fatty acids in fish and flaxseed oil help to improve kidneyfunction in diabetics. They are also being evaluated for their abilityto lower blood glucose in diabetics. GLA (gamma linolenic acid) mayalso be of benefit. Most think you can take both of these supplementstogether safely. They work almost like a natural prednisone.

Cutting Fat

Stir-fry foods that have been marinated in tinyamounts of oil and lots of seasonings. Choose nonfat or low-fatselections, but stick to the correct portion size. Avoid fried foods -bake, broil, or roast vegetables and meat instead. (See Trimmingthe Fat on this website).

Artificial Sweeteners

Artificial sweeteners are safe for everyone except pregnant or breastfeeding women (who should not use saccharin). People with phenylketonuria should not use aspartame. Calorie-free sweeteners like aspartame (Equal), saccharin (Sweet & Low), and acesulfame-K (Sweet One) won't increase your blood glucose level. The sugar alcohols (xylitol, mannitol, and sorbitol) have some calories and do slightly increase blood glucose level. Eating too much of any of these can cause gas and diarrhea. Look for Stevia on the market (available in health food stores) and Splenda coming out soon. Both can be used in place of sugar for baking, cup for cup and will maintain sweetness. See more about Sugar Substitutes

Exercise

People who exercise and eat well are less likely to get diabetes. Those that have the disease and exercise regularly have an easier time managing their diabetes while living longer. A Harvard study shows that brisk walking for one hour a day and/or any other type of leisure activity of moderate intensity reduces the risk of Type 2 diabetes by 46%, compared to those who exercised the least. Physical activity improves insulin sensitivity, in addition to helping reduce body weight. EXCESS WEIGHT is the trigger that causes a sugar imbalance to show itself. If you are 20% over your desirable body weight, you become at risk for adult onset DM.

The Bottom Line

If you are overweight, lose it! The number one cause of Type 2 diabetes is obesity. Weight loss can reverse it!

Limit fat, avoid saturated and trans fat. Use monounsaturated fat and omega 3 exclusively.

Avoid sugar and refined carbohydrates, concentrate on whole grains. Foods like whole wheat bread and brown rice can actually slow down the absorption of sugars in food and help you manage your diabetes. You need 25-35 grams of fiber (found in whole foods like these) every day.

Eat a variety of colored vegetables and fruits on a daily basis.

Donna Tinnerello, MS, RD, CDN March 2000

Donna Tinnerello MS, RD, CD/N is registered dietitian with more than 10 years experience in HIV and nutrition. She works in lower Manhattan at Cabrini Medical Center, the community and in private practice.. Her subspecialties are cardiovascular, renal, gastrointestinal disease, diabetes and weight loss. Donna is available for private consultation by referral only.

Additional Resource(s)

• American Diabetes Association 1-800-232-3472