Type 2 diabetes, sometimes known as type 2 diabetes mellitus, is a disorder that disrupts the way your body uses sugar.

All the cells in your body need sugar to work normally. Sugar gets into the cells with the help of a hormone called insulin which is produced by an organ in the body called a pancreas. If there is not enough insulin, or if the body cells stop responding to insulin normally, sugar builds up in the blood and higher than normal amounts of sugars in circulating blood have a harming effect on the body. That is what happens to people with diabetes.

There are mainly two different types of diabetes. In type 1 diabetes, the problem is that the body makes little or no insulin and this is common in children and this is usually due to a problem with the pancreas. In type 2 diabetes, the problem is that either the body’s cells do not respond to insulin or the body does not make enough insulin or even both and this type of diabetes is common in adults.

According to WHO, the number of people living with diabetes has risen from 108 million in 1980 to 422 million in 2014 worldwide (global prevalence increase from 4.7% to 8.5% in 1980 and 2014 respectively) and is more increasing rapidly in middle and low income countries. WHO projects that diabetes will be the 7th leading cause of death in 2030

Type 2 diabetes is disease with no known single cause, although evidence points to a combination of both genetic and environmental factors. Many people with type 2 diabetes have a family member with either type 2 diabetes or other medical problems associated with diabetes, such as high cholesterol levels, high blood pressure, or obesity.

The lifetime risk of developing type 2 diabetes is 5 to 10 times higher in first-degree relatives (sister, brother, son, daughter) of a person with diabetes compared to a person with no family history of diabetes.

Environmental factors such as what you eat and how active you are, combined with genetic causes, affect the risk of developing type 2 diabetes.

Being overweight or obese, especially if you carry your extra weight in your belly (as opposed to in your hips, thighs, and butt), not doing enough physical activity (sedentary life style) and Smoking are associated with a higher risk of developing diabetes mellitus type 2.A small number (about 3 to 5 percent) of pregnant women develop diabetes during pregnancy, called "gestational diabetes.” Gestational diabetes is similar to type 2 diabetes, but usually resolves after the woman delivers her baby. Women who have gestational diabetes are at increased risk for developing type 2 diabetes later in life.

Asians and blacks are at an increased risk of suffering from diabetes mellitus type 2 than the general white population.

Type 2 diabetes usually causes no symptoms initially. When symptoms do occur, they usually include; increased need to urinate often especially at night, excessive thirst, blurry vision. These symptoms are usually present in conditions of very higher levels of blood glucose and commonly resolve when the sugars are treated to normal levels. Hence one can live a normal life, with no symptoms if their diabetes is well controlled.

Even though type 2 diabetes may not make you feel sick initially, it can cause serious problems over time if it is not detected and managed early. The disorder can lead to coronary heart disease which can lead to a heart attack, Cerebrovascular disease which can lead to stroke, disease of the eye which can lead to blindness, disease of the kidney which can lead to kidney failure and the need for dialysis and disease of the nerves and blood vessels which can lead to, among other things, ulceration of the foot requiring amputation

It is important to understand that many of these complications produce no symptoms in the early stages, and most can be prevented or minimized with a combination of regular medical care and blood sugar monitoring if one is diagnosed and appropriate measures taken early.

Diagnosis

The diagnosis of diabetes is made through taking proper history of the person, physical examination for signs of diabetes complications and by lab investigations.

A blood sample is taken off and different tests are done to determine the individual’s blood glucose levels. One may be given an amount of glucose to consume and a sample of blood taken off and tested 2 hours after to determine how the body is able to handle the glucose, and another sample taken off at least 8 hours after the last meal to determine the fasting glucose blood levels.

Another test is usually done to determine how long ones blood sugars have been consistently elevated. The results from the above results in addition to the presence or absence of symptoms and signs for diabetes are then interpreted and grouped as; normal, pre-diabetic (elevated above normal but not as high in diabetes hence higher risk to developing diabetes) or diabetic.

Different tests can be done to determine or rule out the possibility of damage to various organs (e.g. Kidneys, heart, eyes, etc.) due to the elevated blood sugars.

The goals of treatment for type 2 diabetes are; to keep a person’s blood sugar at or near a normal level,and to prevent future health problems that can happen in people with diabetes.

There are some medicines that help control blood sugar. Some people need to take tabs that enable the body make more insulin or that increases the effectiveness of the body’s insulin, or a combination of these. Others might need insulin shots.

Sometimes, people with type 2 diabetes also need medicines to treat any associated conditions such as high blood pressure, high cholesterol levels.

Irrespective of the type of medicines prescribed to manage diabetes, diet and lifestyle should be part of one’s treatment plan, and this include; losing weight, eating healthy foods (choose a diet rich in fruits, proteins, vegetables, low-fat dairy products and avoid red meat, high carbohydrates, sweets, refined grains, sweet drinks like soda and sweetened beverages), getting regular exercise(at least 30 minutes a day) and quit smoking.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.