The Progression of Type 2 Diabetes – Symptoms and Signs

The figures do not lie, but they may be discouraging at first glance. Of the millions of people globally who have diabetes, the greatest percentage are type 2 diabetics (T2D). What is more disconcerting is that this group is continuing to grow in what has been termed “epidemic proportions.”[1]

Hyperglycemia – The Essential Issue of Diabetes

In diabetes, the essential issue is hyperglycemia – too much sugar in the blood. The difference between diabetes types lies in the cause of the hyperglycemia.

T2D is characterized by the failure of insulin to be effective. Although the beta cells residing in the islets of Langerhans in the pancreas are continuing to secrete the insulin, often at higher than normal levels, it is no longer being utilized effectively. The cells that use insulin to help transport glucose – the surfaces of the liver and muscles as well as the fat cells – have grown to be resistant to its action, so blood glucose levels get too high. Temporarily, the physical response is to increase actual production of insulin beyond what is considered normal. While the insulin remains sufficient, cell resistance to insulin makes production ineffectual.

Symptoms of T1DM and Possibly T2DM

The symptoms for either type of diabetes include the following:[2]

  • Polyuria – increased urination
  • Polydipsia  – increased or abnormal thirst

Overall, however, the symptoms of T2D tend to be mild, if not absent at first. They may include the following:

  • Fatigue
  • Recurring vaginal or yeast infections for a woman
  • Possible balanitis (irritation of the foreskin) and sexual dysfunction
  • Vision problems
  • Irritability
  • Numbness

Causal Factors and Disease Progression

Dietary habits may contribute to disease progression. A higher incidence of T2D is associated with a low intake of dietary fiber. Also a causal and associated factor with this type of diabetes is related to lifestyle in that your activity level may influence whether you develop and manage diabetes. If you don’t get adequate exercise, you have a higher risk of developing T2D.

The sedentary lifestyle results in increased weight gain. Research has indicated clearly that there is a link between obesity and T2D. This is not a singular event. It is a series of events that include gaining weight and becoming obese, defective insulin secretion and a rise in insulin resistance.[3]  In other words, it is not simply a matter of weight gain that will result in T2D, but it is a key factor.

Determining the Potential

There are several ways to determine whether you, or a family member, are at risk of developing T2D. While weight is definitely a causal factor, it is important to look at the specifics of the weight gain. In particular, you need to examine exactly where the weight is carried. Of particular concern is excessive weight located around the waist and abdomen.

The popular method used to determine if you are within the limits for normal weight is the Body Mass Index (BMI). However, the BMI is not helpful in determining where your weight is located. The BMI calculation uses body weight and height in a formula that measures body fatness. The BMI is a factor representing your weight in relationship to your height. You can use a chart provided on many internet sites or multiply your weight in pounds by a factor of 703. You then take this figure and divide it by your height in inches.

Instead of just calculating BMI, you should also measure your waist to determine if body fat is accumulating in an unhealthy place – around your waist. You can do a simple measurement and compare it to what your waist used to be when you were younger or even to what it was last year. You can also pinch an inch and see how much extra fat is present. In addition, there are instruments available like calipers that can measure body fat.

The upshot is that if you are carrying too much weight on your person and the weight is centralized around your waist, you need to take measures to reduce body fat. You need to find a new approach to your life. By adopting a new more active and healthy lifestyle, you can significantly reduce your chances of developing T2D.

Actual Diagnosis

A T2D diagnosis is often not the result of any apparent symptoms the individual is complaining about or is aware exist. It tends to be the product of a routine physical examination. For example, the doctor may order blood work out of concern for someone’s health due to the weight gain or a family history of diabetes.

At the same time, lifestyle factors may be reviewed as potentially leading to a higher T2D risk. Family patterns regarding eating and life style habits, for example, may suggest a high risk of developing T2D. If there is a family history of T2D, it is recommended that all family members age 25 and over be tested periodically. If there are obese children within the family, they too should be tested. If T2D is not present in the overweight members, medical monitoring for diabetes is recommended with repeat testing at least once every 3 years.

T2D is not a disease that rapidly progresses, declaring its presence swiftly and openly. It may take years and even decades before it appears.[4]

Potential Complications

While it is true that T2D can appear to be a mild form of diabetes, do not be fooled. Diabetes, including T2D, is the number one cause of blindness, kidney failure, and ambutations, and it is also a key factor in heart attacks and strokes. It certainly has the potential to be deadly. With this type of diabetes come certain risks and complications. Among them is Non-Ketotic Hyperglycemic-Hyperosmolar Coma (NKHHC) which is referred to as a diabetic coma. It is also commonly called Hyperglycemic Hyperosmolar State (HHS).

It has a fatality rate of approximately 50%. It may start out as a complication due to an infection, e.g. pneumonia. Other potential causes may include:

  • Certain medications
  • Undiagnosed diabetes
  • Substance abuse
  • Coexisting disease

It may also be set off by dialysis for renal failure. Indications of the onset of a coma include convulsions. With the growing numbers of T2D, it is feared incidences may increase.[5]

Conclusion

The signs of T2D may not be as overt as those present in T1D. Nevertheless, they are there. Many are cloaked in health issues relating to causal factors. These include weight gain, obesity and poor diet. It is important that the individual does not wait for a formal diagnosis of diabetes by the doctor, but rather takes the initiative to reduce risks. Talk to your doctor. Take the blood test if you suspect your health is threatened by your weight. Lose the excess pound and increase the amount of exercise you get. The good news is that T2D is preventable.

References

[1] Warshaw, HS; and Pape, J (2009). Real-Life Guide To Diabetes. Alexandria, VA: ADA.

[2] American Diabetes Association (2009). Type 2 Diabetes. Your Healthy Living Guide. Alexandria, VA: ADA.

[3] Golay, A; and Ybarra, J (2005). “Link between Obesity and Type 2 Diabetes.” Best Practice & Research Clinical Endocrinology & Metabolism, 19 (4): 649-663.

[4] Meltzer, SJ; and Belton, AB (2009). Diabetes in Adults. Toronto: Key Porter Books.

[5] Stoner, GD (2005). “Hyperosmolar Hyperglycemic State.” American Family Physician, 71(9):1723-1730.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.