TYPE 2 DIABETES

What It Is
Everything you eat or drink — whether it’s a bowl of pasta, chicken, a piece of fruit or a glass of milk — is eventually broken down into glucose, a form of sugar the body uses for energy. When a person’s body is working as it should, the glucose enters the bloodstream, and the pancreas releases just the right amount of insulin needed to “unlock” the body’s cells so they can pull in the glucose and either burn it for energy or store it as fat to use later. When there’s not enough insulin or when the body no longer responds to insulin, the sugar sits in the bloodstream, raising blood sugar. Over time, this can lead to a host of horrible complications, including heart disease, kidney disease, and blindness.

Symptoms
Weight loss, increased thirst and urination, increased hunger, fatigue/lack of energy, blurred vision, sores that heal slowly, and frequent infections, especially bladder and vaginal infections in women.

Standard Treatments
Lifestyle changes
For most patients, the first step to treating type 2 diabetes is blood-sugar control achieved through diet, weight loss and exercise. “We always offer lifestyle intervention,” says Dr. Jabbour, who connects his patients with dieticians and diabetes educators. “Many studies show that if people lose five to 10 percent of their weight, they see an improvement in their sugars. However, not many people can make that happen. Weight loss can be difficult, and many people regain the weight over time. More than 90 percent of the time we give them an additional treatment.”

Metformin, brand name Glucophage
“It’s an oral medication that makes the pancreas secret more insulin. It’s a cheap option and is good for people with financial issues,” says Dr. Jabbour. “However, the extra insulin can make you gain weight and make you more hungry.” Some patients also experience low blood sugar, which happens when an overabundance of insulin robs the bloodstream of too much sugar.

Insulin injections
Insulin injections are taken once or multiple times a day to control blood sugar. “It’s generally an option after metformin fails,” says Dr. Jabbour. Weight gain, increased hunger and low blood sugar are also possible side effects.

Pioglitazone, brand name Actos
“This drug makes your body more sensitive to insulin, so the insulin works better at taking up sugar into the cells,” says Dr. Jabbour. The downside: weight gain and fluid retention are possible side effects, which means it’s not a good option for patients with underlying heart conditions.

Exenatide, brand name Byetta
These twice-daily injections cause the pancreas to produce more insulin, but it’s not like the constant drip caused by metformin. Instead, these injections cause the pancreas to produce more insulin only when needed to deal with whatever you just ate or drank. “It also shuts down the liver’s production of sugar, and it doesn’t cause low blood sugar, which is really great,” says Dr. Jabbour. “It also helps many patients lose weight by suppressing their appetite.”  The downside? It’s more expensive than other medications and may cause nausea in some patients.

Living With Diabetes
A diagnosis of type 2 is not a death sentence. Many patients live long, healthy, happy lives. It is, however, a huge adjustment and controlling blood sugar is often difficult. Your best bet? Take advantage of Philadelphia’s great local resources and assemble a team of specialists who will help you do everything from deal with your diagnosis to set help you achieve long-term management.