Type 2 diabetes, which is sometimes called adult-onset diabetes, is a chronic health condition characterized by high levels of blood sugar. There are many serious complications that can arise from living with this condition, including heart disease, nerve damage, and vision loss. When treated, type 2 diabetes can be controlled and even reversed.
While lifestyle factors play a huge role in contributing to, causing, and treating type 2 diabetes, medications are also often used by patients. These medications can help lower blood sugar and reduce the risk of complications, but they can also cause serious and dangerous side effects, like pancreatitis, pancreatic cancer, ketoacidosis, thyroid cancer, and bladder cancer.
What is Type 2 Diabetes?
Type 2 diabetes is a condition that is related to how the body metabolizes glucose, or sugar. The pancreas is an organ that makes and excretes a hormone called insulin in response to high blood sugar levels. Insulin regulates blood sugar levels by going into action when levels get too high. In someone with type 2 diabetes the body has become resistant to the effects of insulin with the result being that levels of sugar in the blood remain chronically high.
The effects of type 2 diabetes are similar to those of type 1 diabetes, but the underlying cause of high blood sugar is different. Whereas in most cases of type 2 diabetes, enough insulin is produced, in people with type 1 diabetes, the pancreas does not produce enough of the hormone. Type 1 diabetes usually begins in childhood and is much less common.
Type 2 Diabetes on the Rise
The incidence of type 2 diabetes has risen along with the rates of obesity. According to the Centers for Disease Control and Prevention (CDC), one in three people currently living will eventually develop type 2 diabetes. Type 2 diabetes is much more common than type 1 and accounts for up to 95 percent of all cases of diabetes. Although this is known as adult-onset diabetes, with obesity rising among children, young people are being diagnosed with type 2 diabetes at alarming rates.
Causes and Risk Factors
Type 2 diabetes is caused by the body becoming resistant to insulin or the pancreas not producing enough insulin, but why this happens is not fully understood. There may be multiple contributing factors including genetics, environment, and lifestyle. What is known with certainty is that being overweight or obese and inactive are major risk factors for developing diabetes. Other risk factors include having excess fat in the midsection, having a family history of type 2 diabetes, being non-Caucasian, and being older than 45.
Another serious risk factor is having prediabetes. This is a condition that is characterized by blood sugar levels that are too high, but not high enough to be classified as diabetes. People with prediabetes have a chance to turn things around with lifestyle changes. Changing the diet, exercising more, and losing weight can reverse high blood sugar levels and prevent the onset of diabetes.
One in four people with diabetes do not know they have the condition. It is important, especially for people with risk factors, to know what the symptoms are and to be screened regularly for blood sugar levels. Symptoms include excessive thirst and frequent urination, increased hunger, fatigue, frequent infections, slow healing sores, darkened skin patches, and weight loss. Even when diabetes causes someone to eat more, weight loss may occur because the body is unable to metabolize sugar and turns to body fat and muscle instead.
Diagnosis of type 2 diabetes is simple. It only requires that a small amount of blood be drawn and tested. At a regular check up with a blood test, most patients will be fasting and will be tested for fasting blood sugar levels. If blood sugar while fasting is higher than 126 milligrams, a diagnosis of diabetes will be made. Diabetes can also be diagnosed with an A1C test, which measures the average blood sugar over two or three months. A result of over 6.4 for this test is considered diabetes.
Treating type 2 diabetes is crucial because the complications of the condition are serious and life-threatening. When left untreated, high blood sugar levels can to heart and blood vessel problems like atherosclerosis, the hardening of blood vessels, high blood pressure, heart attack, and stroke. Diabetes also causes nerve damage, which can cause tingling and numbness in the legs and eventually total loss of feeling. Because of this loss of feeling, a patient may get a wound that doesn’t heal, which can result in gangrene and the need to amputate a toe or foot.
Complications of type 2 diabetes may also include vision loss, glaucoma and cataracts, hearing loss, and skin infections. Untreated diabetes can cause sufficient damage to kidneys to lead to kidney disease that can be fatal. Type 2 diabetes has also been shown to contribute to the risk of developing Alzheimer’s disease.
Type 2 Diabetes and Lifestyle
Type 2 diabetes is a serious illness, but it is one that in most people responds very well to lifestyle changes. While medications may be necessary for some patients, others can slow down and even reverse the course of the disease by changing habits. Regular testing of blood sugar is important, as is setting goals for lowering that number. Many people will meet these goals by eating better, exercising, and losing weight.
Type 2 Diabetes Medications
With type 2 diabetes on the rise, drug companies are keeping up with new medications all the time. These medications use various strategies to reduce blood sugar levels. Most patients with diabetes will be directed by their doctors to lose weight, eat better, get exercise, and use a medication to control blood sugar. Unfortunately, while these drugs can lower blood sugar levels, they can also cause serious side effects and complications.
One class of drugs is called thiazolidinedione. These drugs include Avandia and Actos and work by increasing the effectiveness of insulin and by reducing the amount of glucose produced in the liver. DPP-4 inhibitors include Tradjenta, Onglyza, and Januvia, and work by preventing the breakdown of a molecule called GLP-1. GLP-1 lowers blood glucose, so preventing it from breaking down lowers blood sugar levels. SGLT2 inhibitors take effect in the kidneys helping to excrete more glucose in urine.
Medication Side Effects
The use of these medications must be weighed against the risks. There are side effects caused by them, which range from mild to serious. Actos and Avandia for instance may cause infections, muscle pain, headaches, and liver damage. DPP-4 drugs may cause infections, diarrhea, joint pain, and hypoglycemia. SGLT2 inhibitors, like Jardiance, may cause urinary tract infections because they cause more sugar to be excreted in the urine.
Congestive Heart Failure
Some type 2 diabetes drugs, like Actos and Avandia, have been found to contribute to the risk of congestive heart failure. Some of these drugs now carry black box warnings, the most serious warning given by the U.S. Food and Drug Administration (FDA). The risk comes from the fact that the drugs cause the body to retain fluid. Those at greatest risk are patients who already have congestive heart failure or are at risk for it. GlaxoSmithKline, the maker of Avandia has faced lawsuits over this and even went before a Senate Finance Committee to face accusations that it knew about these risks while promoting the medication and before the black box warning.
Pancreatitis and Pancreatic Cancer
Many of the newer type 2 diabetes drugs, like Januvia for instance, have been connected to a risk of pancreatitis and pancreatic cancer. Acute pancreatitis can come on suddenly and quickly become fatal. Pancreatic cancer is an aggressive type of cancer and the FDA is currently investigating how big the risk of it is with taking type 2 diabetes drugs. In the meantime, lawsuits have been filed against Merck and other drug companies over these very serious consequences of using the drugs.
Several type 2 diabetes drugs have been implicated in causing bladder cancer in patients. These include Actos and Oseni, both made by Takeda, for which the FDA issued a special warning about the risk of bladder cancer. Patients who have sued Takeda have already received settlements and the company agreed in 2015 to release nearly $3 billion to cover all settlements in about 9,000 cases.
Byetta, Bydureon, Januvia, and Victoza have all been implicated in an increased risk for thyroid cancer in type 2 diabetes patients. Some of the warning labels even warn that patients with a family history of thyroid cancer should not take the drug. Victoza now carries an FDA black box warning about this risk. Most of the research that shows these drugs can cause thyroid cancer was done in lab animals, but the evidence was clear and there is also some evidence that humans are at risk as well.
Type 2 diabetes is a very serious and chronic condition that affects millions of people. As obesity increases so does the incidence of this condition. Without treatment it can lead to devastating complications and even death. Medications can help, but these are not without their own serious risks.