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Type 2 Diabetes: Is It More Than Just Blood Sugar?

Posted Aug 24 2008 1:49pm
JACQUELINE SALAS-SPIEGEL, MD: Type 2 diabetes is a chronic illness that is defined as an abnormality in glucose metabolism where the body cannot effectively handle the carbohydrates that it consumes.

ANNOUNCER: At the heart of this disorder is a problem utilizing a hormone called insulin.

ASTRID ALMODOVAR, MD: If you think of insulin as a key to open the cell for the entrance of glucose, all of a sudden, mostly because of obesity and a sedentary lifestyle, the cells are indifferent to insulin. So we have a lot of insulin circulating, a lot of sugar circulating, but it's not going into the cells. That's what we call insulin resistance.

ANNOUNCER: An estimated 17 million Americans have Type 2 Diabetes. Most don't know it. Millions more are heading toward the disease.

ASTRID ALMODOVAR, MD: Type 2 diabetes is not a sudden illness. It is a process. It is the end product of a continuum of metabolic abnormalities. If you compare type 2 diabetes with a runaway train, you start, especially if you're a minority, you start with a ticket; you already have a ticket and a boarding pass. The moment you start getting sedentary and gaining weight, you start getting on the train and moving along the continuum of diabetes. We start with the metabolic syndrome, then we go prediabetes, and then we have full-blown diabetes.

ANNOUNCER: Doctors say there are five key metabolic abnormalities frequently found in the US population. These are: high blood pressure, poor blood levels of cholesterol and triglycerides, abdominal obesity, and insulin resistance. When a person has any three of these problems, they are said to suffer from metabolic syndrome, and they are at high risk for disease.

JACQUELINE SALAS-SPIEGEL, MD: The metabolic syndrome is definitely associated with an increased risk of cardiovascular mortality. That means an increased risk of heart attack, an increased risk of stroke and other vascular complications. It's also very strongly associated with diabetes.

ANNOUNCER: When a person has insulin resistance, leading to elevated blood sugar levels, but not yet to the point of diabetes, he or she is said to be prediabetic.

ASTRID ALMODOVAR, MD: Prediabetes would be the in-between. You are not normal, but you are not the full-blown diabetic yet. Prediabetes is just stage one or stage two of diabetes. It's part of a continuum, and we've just caught it at a different time.

ANNOUNCER: Prediabetes becomes diabetes when blood sugar levels reach certain defined values. The complications that follow can be serious.

JACQUELINE SALAS-SPIEGEL, MD: In patients with Type 2 diabetes, the major complications can really be put into two groups. There are microvascular and macrovascular complications; that means small-vessel complications and large-vessel complications.

The microvascular complications include: diabetic retinopathy, which is diabetic eye disease; diabetes nephropathy, which is diabetic kidney disease; and also diabetes neuropathy, which is the nerve damage that we see in type 2 diabetes. Macrovascular complications include: heart disease and stroke and other significant circulatory problems, such as peripheral vascular disease, meaning low circulation to the limbs.

ANNOUNCER: The complications of diabetes are not caused only by high blood glucose levels.

JACQUELINE SALAS-SPIEGEL, MD: For many patients, type 2 diabetes is more than just elevated blood sugar. They also have high cholesterol, high blood pressure and these things in combination can accelerate their development of complications.

The micro vascular complications, the small-vessel disease, I believe is significantly related to the high blood sugar. The large-vessel disease, which is the heart attack and the stroke and the peripheral vascular disease, do have a variety of causes, not just the blood sugar. And they are more related to characteristics of the metabolic syndrome, such as high cholesterol, high triglycerides, low HDL.

ANNOUNCER: Despite the prevalence of type 2 diabetes, doctors say complications can be prevented or controlled. The first steps are changes in diet and increased exercise. And when necessary, the use of many available medications.

ASTRID ALMODOVAR, MD: Fortunately, we have many medications to choose from nowadays. It's medications that help the body get more sensitive to insulin, what we call insulin sensitizers. These are medications like Metformin, Actos and Avandia.

JACQUELINE SALAS-SPIEGEL, MD: This class really addresses the basic problem that's going on in diabetes, which is insulin resistance. So what we're trying to do is to make the body more sensitive to insulin, less resistant to insulin and this class of drugs can really address that problem at the levels where the resistance takes place.

ASTRID ALMODOVAR, MD: The second class of medications, they've been in use for a long, long time, and they work by stimulating the pancreas to produce more insulin.

ANNOUNCER: There is also a new but similar group of drugs that also cause the pancreas to release insulin, but they do so very quickly, so they are taken at mealtime.

ASTRID ALMODOVAR, MD: Other medications that we use early on are the ones that are used to delay the absorption of carbohydrates.

ANNOUNCER: Delaying the absorption of carbohydrates gives the body's natural insulin production a better chance to keep blood glucose levels close to normal.

JACQUELINE SALAS-SPIEGEL, MD: If patients with Type 2 haven't achieved their blood sugar goal with a variety of oral treatments along with diet and exercise, the next step in their treatment is definitely insulin.

ASTRID ALMODOVAR, MD: The beauty of treating diabetes is that we can prevent the complications that I said, and this is not unavoidable. We know that with proper care and management of all the risk factors they can prevent, we can reverse and prevent the cardiovascular complications.

JACQUELINE SALAS-SPIEGEL, MD: The good news about Type 2 diabetes is that, with the current treatment modalities available to us today, which were certainly not available ten years ago, most, if not all, patients with Type 2 diabetes can be well-controlled.

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