What is type 2 diabetes and how do I prevent it ?

diabetes type 1 and type 2 diabetes

What is Type 2 Diabetes Mellitus (Non Insulin Dependent Diabetes)

There are two main types of diabetes. Type 1 diabetes usually develops in childhood or at a young age. Type 1 diabetes is a result of a damaged pancreas that leaves the organ producing either very little insulin or none at all.

Type 2 diabetes is quite different. It used to be referred to as “adult-onset” diabetes because it is often diagnosed later in life. In type 2 diabetes, it becomes increasingly difficult for the body’s cells to absorb and use the insulin. Type 2 diabetes is much more common than type 1 diabetes. About 90 % of people who have diabetes have type 2 diabetes. People who have type 2 diabetes are also at greater risk of developing cardiovascular diseases such as heart attack, stroke or problems with circulation in their legs and feet (peripheral artery disease). These are the “macrovascular” complications of diabetes. “Macrovascular” means that these complications affect the larger blood vessels. This risk is especially high in people who also have high blood pressure.

Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition characterized by high blood glucose levels caused by either a lack of insulin or the body’s inability to use insulin efficiently 1). Type 2 diabetes develops most often in middle-aged and older adults but can appear in children, teens, and young people. Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it!

With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn’t produce enough insulin to maintain a normal glucose level.

More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There’s no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren’t enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy.

The severity of diabetes can vary quite a bit: Some people only have to make minor changes to their lifestyle after they are diagnosed. Just losing a little weight and getting some more exercise may be enough for them to manage their diabetes.

It also important to note that not everyone with Type 2 diabetes is overweight, but weight gain and obesity are the most important risk factors for Type 2 diabetes and the reason why Type 2 has become a global epidemic that affects overweight people of all ages 2).

Other people who have type 2 diabetes need more permanent therapy that involves taking tablets or insulin. It is then especially important to have a good understanding of the disease and know what they can do to stay healthy 3).

 

Causes of Type 2 Diabetes:

Your metabolism converts food into energy for the body to use. One of the things your bodies need for this process is insulin.

Insulin is a hormone, a chemical that the body uses to send messages. Insulin is made by the pancreas. After you eat the sugar levels in your blood rise and it is released into the bloodstream. It then makes the cells in the liver and in muscle tissue absorb sugar from the blood. If insulin metabolism is not working properly, the sugar (glucose) in our blood cannot be used in the right way. This causes blood sugar levels to rise. If blood sugar levels are too high it is called hyperglycemia.

In people who have type 2 diabetes the pancreas does actually produce enough insulin, but it no longer has an effect on the body’s tissue and cells. This is what doctors refer to as “insulin resistance.” The pancreas can compensate for this temporarily by producing more insulin. But at some point the pancreas will not be able to keep up, and then blood sugar levels start to rise. Exactly why this happens is unknown, although genetics and environmental factors, such as excess weight and inactivity, seem to be contributing factors 4).

pancreas

How insulin works:

Insulin is a hormone that comes from the gland situated behind and below the stomach (pancreas).

  • The pancreas secretes insulin into the bloodstream.
  • The insulin circulates, enabling sugar (glucose) to enter your cells.
  • Insulin lowers the amount of sugar (glucose) in your bloodstream.
  • As your blood sugar (glucose) level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues.

  • Glucose comes from two major sources: food and your liver.
  • Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
  • Your liver stores and makes glucose.
  • When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

In type 2 diabetes, this process doesn’t work well. Instead of moving into your cells, sugar builds up in your bloodstream. As blood sugar levels increase, the insulin-producing beta cells in the pancreas release more insulin, but eventually these cells become impaired and can’t make enough insulin to meet the body’s demands.

(In the much less common type 1 diabetes, the immune system destroys the beta cells, leaving the body with little to no insulin.)

what is type 2 diabetes

Risk Factors for Type 2 Diabetes:

Researchers don’t fully understand why some people develop type 2 diabetes and others don’t. It’s clear, however, that certain factors increase the risk, including:

  1. Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to insulin. However, you don’t have to be overweight to develop type 2 diabetes.
  2. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs.
  3. Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
  4. Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes.
  5. Race. Although it’s unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are more likely to develop type 2 diabetes than whites are.
  6. Age. The risk of type 2 diabetes increases as you get older, especially after age 45. That’s probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
  7. Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
  8. Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.
  9. Polycystic ovarian syndrome. For women, having polycystic ovarian syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.

Symptoms and Signs of Type 2 Diabetes

People with type 2 diabetes may not always notice it at first. Type 2 diabetes can develop gradually over several years without any noticeable symptoms. Blood sugar levels that are continuously too high may cause the following symptoms:

  • Feeling very thirsty
  • Frequent urination
  • Tiredness and listlessness
  • Nausea
  • Dizziness

If someone has extremely high blood sugar levels, they may feel confused and drowsy or even lose consciousness (diabetic coma).

How you can lower your chances of developing type 2 diabetes

Research such as the Diabetes Prevention Program shows that you can do a lot to reduce your chances of developing type 2 diabetes. Here are some things you can change to lower your risk:

  • Lose weight and keep it off. You may be able to prevent or delay diabetes by losing 5 to 7 percent of your starting weight.1 For instance, if you weigh 200 pounds, your goal would be to lose about 10 to 14 pounds.
  • Move more. Get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional about which activities are best. Start slowly to build up to your goal.
  • Eat healthy foods most of the time. Eat smaller portions to reduce the amount of calories you eat each day and help you lose weight. Choosing foods with less fat is another way to reduce calories. Drink water instead of sweetened beverages.

In 8 randomised clinical trials 5) with 2241 participants randomised to exercise and diet intervention and 2509 participants to standard recommendation. Furthermore, 178 participants were randomised to an exercise only intervention and 167 participants to a diet only intervention. The duration of the interventions in the trials ranged from one year to six years. Interventions varied between studies but mainly consisted of caloric restriction if the person was overweight, low fat content (especially saturated fat), high carbohydrate content and the increase of fibre intake. Physical activity varied but on average at least 150 minutes each week of brisk walking or other activities such as cycling or jogging were recommended. Interventions were mainly delivered by frequent individual counselling by a physiotherapist, an exercise physiologist and a dietitian. Interventions aimed at increasing exercise combined with diet are able to decrease the incidence of type 2 diabetes mellitus in high risk groups (people with impaired glucose tolerance or the metabolic syndrome) by 37% with exercise and diet. This had favourable effects on body weight, waist circumference and blood pressure 6).

Ask your health care professional about what other changes you can make to prevent or delay type 2 diabetes.

Most often, your best chance for preventing type 2 diabetes is to make lifestyle changes that work for you long term. Get started with Your Game Plan to Prevent Type 2 Diabetes.

how diabetes affects children

Your Game Plan to Prevent Type 2 Diabetes

The information below is based on the National Institute of Health sponsored Diabetes Prevention Program research study 7), which showed that people could prevent or delay type 2 diabetes even if they were at high risk for the disease.

Follow these steps to get started on your game plan.

  • 1) Set a weight loss goal

Calculate your BMI to learn whether you are overweight.

If you are overweight, set a weight-loss goal that you can reach. Try to lose at least 5 to 10 percent of your current weight within 6 months. For example, if you weigh 200 pounds, a 10-percent weight-loss goal means that you will try to lose 20 pounds. A good short-term goal is to lose 1 to 2 pounds per week.

The keys to preventing type 2 diabetes are to lose weight by choosing foods and drinks that are lower in calories, and to be more active.

Find your weight-loss goal

Find your current weight in the first column to see how much weight you would need to lose for a 5, 7 or 10 percent weight loss. For example, if you weigh 200 pounds and want to lose 5 percent of your current weight, then you would need to lose 10 pounds.

Your current weight in poundsPounds to lose 5 percent of your weightPounds to lose 7 percent of your weightPounds to lose 10 percent of your weight
15081115
17591218
200101420
225111623
250131825
275141928
300152130
325162333
350182535

Calculate your weight-loss goal

Use the example below to learn how to calculate your exact weight-loss goal. In this example, the goal is for a 240-pound person to lose 5 percent of his or her weight.

As shown in the example above, a 240-pound person who wants to lose 5 percent of his or her weight would lose 12 pounds and weigh 228 pounds.
Step NumberActionResult
Step 1Weigh yourself to get your current weight.“My weight is 240 pounds.”
Step 2Multiply your weight by the percent you want to lose.“I want to lose 5 percent of my weight.”
240 pounds (current weight)
x .05 (5 percent weight loss)
12 pounds to lose
Step 3Subtract the answer in Step 2 from your current weight.240 pounds (current weight)
– 12 pounds (amount to lose)
228 pounds (weight-loss goal)

 

Research shows that you can prevent or delay type 2 diabetes by losing weight by following a low-fat, reduced-calorie eating plan and by being more active each day. Following an eating plan can help you reach your weight-loss goal. There are many ways to do this. Remember that the key to losing weight and preventing type 2 diabetes is to make lifelong changes that work for you. Many popular weight-loss plans promise “quick fixes” and haven’t been proven to work long-term or to prevent type 2 diabetes.

The four most important steps to eating healthy for weight loss are:

  • Eat smaller portions than you currently eat of foods that are high in calories, fat, and sugar.
  • Eat healthier foods in place of less-healthy choices.
  • Choose foods with less trans fat, saturated fat, and added sugars.
  • Drink water instead of drinks with sugar such as soda, sports drinks, and fruit juice.

Pay attention to portion sizes

Using the plate method can help you manage your portion sizes. Fill half of your plate with fruits and vegetables. Fill one quarter with a lean protein, such as chicken or turkey without the skin, or beans. Fill one quarter with a whole grain, such as brown rice or whole-wheat pasta.

A portion is how much food you choose to eat at one time, whether in a restaurant, from a package, or at home. A serving, or serving size, is the amount of food listed on a product’s Nutrition Facts, or food label (see food serving sizes below).

food serving sizes

(Source 8)).

Different products have different serving sizes, which could be measured in cups, ounces, grams, pieces, slices, or numbers—such as three crackers. A serving size on a food label may be more or less than the amount you should eat, depending on your age, weight, whether you are male or female, and how active you are. Depending on how much you choose to eat, your portion size may or may not match the serving size.

You can use everyday objects or your hand to judge the size of a portion. For example:

  • 1 serving of meat or poultry is about the size of the palm of your hand or a deck of cards
  • 1 3-ounce serving of fish is the size of a checkbook
  • 1 serving of cheese is like six dice
  • 1/2 cup of cooked rice or pasta is like a rounded handful or a tennis ball
  • 2 tablespoons of peanut butter is like a ping-pong ball

How you can manage food portions at home

You don’t need to measure and count everything you eat or drink for the rest of your life. You may only want to do this long enough to learn typical serving and portion sizes. Try these ideas to help manage portions at home:

  • Take one serving according to the food label and eat it off a plate instead of straight out of the box or bag.
  • Avoid eating in front of the TV, while driving or walking, or while you are busy with other activities.
  • Focus on what you are eating, chew your food well, and fully enjoy the smell and taste of your food.
  • Eat slowly so your brain can get the message that your stomach is full, which may take at least 15 minutes.
  • Use smaller dishes, bowls, and glasses so that you eat and drink less.
  • Eat fewer high-fat, high-calorie foods, such as desserts, chips, sauces, and prepackaged snacks.
  • Freeze food you won’t serve or eat right away, if you make too much. That way, you won’t be tempted to finish the whole batch. If you freeze leftovers in single- or family-sized servings, you’ll have ready-made meals for another day.
  • Eat meals at regular times. Leaving hours between meals or skipping meals altogether may cause you to overeat later in the day.
  • Buy snacks, such as fruit or single-serving, prepackaged foods, that are lower in calories. If you buy bigger bags or boxes of snacks, divide the items into single-serve packages right away so you aren’t tempted to overeat.

Resources to learn more about portion sizes

  • ChooseMyPlate.gov 9) —learn about portion sizes at meals
  • Just Enough for You: About Food Portions 10) —learn how much you need to eat and how to control food portions

Recommended daily calories and fat grams

The table below shows how many calories and fat grams to eat each day to lose weight. Your needs may be different, but these are good starting points. The amounts are based on the eating patterns used in the Diabetes Prevention Program research study.

*Eating less than 1,200 calories a day is not advised. Source: DPP Lifestyle Manual of Operations 11)
Current WeightCalories Per Day*Fat Grams Per Day
120-170 pounds1,20033
175-215 pounds1,50042
220-245 pounds1,80050
250-300 pounds2,00055

 

  • You can also use the Body Weight Planner 12) to make a calorie and activity plan that can help you reach your weight-loss goals within a set time frame. The Body Weight Planner 13) allows you to make personalized calorie and physical activity plans to reach a goal weight within a specific time period and to maintain it afterwards.
  • You can also the SuperTracker 14) to get a personalized meal plan based on your calorie results from the Body Weight Planner. SuperTracker is a free food, physical activity, and weight tracking tool from the United States Department of Agriculture Center for Nutrition Policy and Promotion 15). The SuperTracker is a free, award-winning, state-of-the-art, online diet and activity tracking tool available from the United States Department of Agriculture Center for Nutrition Policy and Promotion 16). Built and maintained by USDA’s Center for Nutrition Policy and Promotion, this free application empowers Americans to build a healthier diet, manage weight, and reduce risk of chronic diet-related disease. Users can determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.

Note: This information is for use in adults defined as individuals 18 years of age or older and not by younger people, or pregnant or breastfeeding women.

 

  • 3) Move more

When you move more every day, you will burn more calories. This can help you reach your weight-loss goal and keep the weight off. Even if you don’t lose weight, being more active may help you prevent or delay type 2 diabetes.

Find ways to be active for at least 30 minutes, 5 days a week. Start slowly and add more activity until you get to at least 30 minutes of physical activity, like a brisk walk, 5 days a week.Walking is recommended for most people. Check with your health care team about other exercise programs.

Use these tips to get started, and keep moving:

  • Dress to move. Wear walking shoes that fit your feet and provide comfort and support. Your clothes should allow you to move and should keep you dry and comfortable. Look for fabrics that take sweat away from your skin to keep you cool.
  • Start slowly. Start by taking a 5-10 minute walk (or doing another activity that you like) on most days of the week. Slowly, add more time until you reach at least 30 minutes of moderate-intensity activity 5 days a week. Moderate-intensity activity will increase your heart rate and breathing. To check your intensity, use the Talk Test: a person doing moderate-intensity activity is able to talk but not sing.
  • Add more movement to your day. There are many ways you can add more movement to your day. If you have a dog, take your dog for a brisk walk in the morning or evening. When going shopping, park further away from the store’s entrance to increase your walk time. If you ride the bus, get off one stop early and walk the rest of the way if it is safe.
  • Try to sit less in your day. Get up every hour and move. When you watch TV, walk or dance around the room, march in place, or stretch.
  • Move more at work. Take a “movement break” during the day. Go for a walk during lunchtime. Deliver a message in person to a coworker instead of sending an email. Walk around your workplace while talking on the telephone. Take the stairs instead of the elevator to your workplace. Use the alarm on your phone, watch, or other device to remind you to take “movement breaks.”
  • Count your steps. You may be surprised to learn how much walking you already do every day. Use a pedometer or other wearable device to keep track of your steps. A pedometer is a gadget that counts the number of steps you take. Work up to 7, 000-10,000 steps per day.
  • Keep your muscles strong. Do activities to strengthen your muscles, such as lifting weights or using resistance bands 2 or more days a week.
  • Stretch it out. If your body aches or is sore, you are less likely to move more. To reduce stiff or sore muscles or joints, consider stretching after being active. Don’t bounce when you stretch. Perform slow movements and stretch only as far as you feel comfortable.
  • Make it social. When you bring other people into your activities, you are more likely to stick to your plan. Make walking “dates” with friends or family members throughout the week. For family fun, play soccer, basketball, or tag with your children. Take a class at a local gym or recreation center to be active with other people. Start a walking group with your neighbors, at work, or where you worship.
  • Have fun. Being active doesn’t have to be boring or painful. Turn up the music and dance while cleaning the house. Go dancing with friends and family members. Play sports with your kids or grandkids. Try swimming, biking, walking, jogging, or any activity that you enjoy that gets you moving. Find different ways to be active so you won’t get bored.
  • Keep at it. Reward yourself with nonfood treats, such as watching a movie, to celebrate your small successes. The longer you keep at it, the better you’ll feel. Making changes is never easy, but being more active is one small step toward a big reward: a healthier life.

 

  • 4) Track your progress

Research shows that people who keep track of their weight and activity reach their goals more often than those who don’t. Weigh yourself at least once a week. Keep track of what you eat and drink, how many minutes of activity you get each day, and your weight. Use your phone, a printed log, online tracker, app, or other device to record your weight, what you eat and drink, and how long you are active.

The examples below show how to record your daily activity and food intake.

Daily Activity
Type of ActivityMinutes
Walking10
Stationary bike20
Daily Total30
Daily Steps
Number of Steps Taken7,450
Daily Food and Drink Intake
TimeAmountFood ItemCaloriesFat Grams
8:00 a.m.1 cupOatmeal1603.5
½ cupStrawberries250
6 oz.Light yogurt900
1 cupTea with sugar-free sweetener00
11:00 a.m.10Almonds706.0
12:30 p.m.2 slicesWheat bread1602.0
4 oz.Ham1253.0
2 tsp.Mustard50
1 oz. sliceCheese1109.0
1 oz.Potato chips16010.0
10Cherry tomatoes300
4:00 p.m.4 squaresGraham crackers1203.0
1 tbsp.Peanut butter958.0
6:30 p.m.3 oz. skinlessChicken breast1403.0
1 cupCooked broccoli550
½ cupBrown rice1101.0
1 cupPineapple chunks800
1 cupNonfat milk90.5
Daily Total1,625 calories49.0 grams

 

  • 5) Talk with your health care team

Ask your health care team about steps you can take to prevent type 2 diabetes. Learn about other ways to help reach your goal, such as taking the medicine metformin. Also, ask if your health insurance covers services for weight loss or physical activity.

  • 6) Get support for changing your lifestyle

It’s not easy to make and stick to lifelong changes in what you eat and how often you are active. Get your friends and family involved by asking them to support your changes. Join with a neighbor or coworker in changing your lifestyle. You can also join a diabetes prevention program to meet other people who are making similar changes.

Talk with your health care team to learn about programs that may help, such as the National Diabetes Prevention Program.

  • National Diabetes Prevention Program 17) —Led by the Centers for Disease Control and Prevention (CDC), the National Diabetes Prevention Program offers lifestyle change programs based on the Diabetes Prevention Program research study. Participants work with a lifestyle coach in a live group or online setting to receive a 1-year lifestyle change program that includes 16 core sessions (usually 1 per week) and 6 post-core sessions (1 per month).
  • Find a program near you 18).
  • Find a registered dietitian nutritionist 19) near you.
  • Find a diabetes educator 20) near you.
  • Local hospitals, health departments, libraries, senior centers, or faith-based organizations may offer additional programs or seminars about type 2 diabetes prevention.

 

How To Diagnose Type 2 Diabetes:

  • Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent.
* Any test for diagnosis of diabetes requires confirmation with a second measurement unless there are clear symptoms of diabetes.
Diagnosis*A1C Level
Normalbelow 5.7 percent
Diabetes6.5 percent or above
Prediabetes5.7 to 6.4 percent

Can the A1C test be used to diagnose type 2 diabetes and prediabetes ?

Yes. In 2009, an international expert committee recommended the A1C test as one of the tests available to help diagnose type 2 diabetes and prediabetes 21).  Previously, only the traditional blood glucose tests were used to diagnose diabetes and prediabetes.

Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes. However, some medical organizations continue to recommend using blood glucose tests for diagnosis.

If the A1C test isn’t available, or if you have certain conditions — such as if you’re pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes:

  • Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.
  • Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
  • Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate diabetes.
  • The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you’re overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test.Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 140/90 millimeters of mercury (mm Hg).If you’re diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — since the two conditions often require different treatments.

The following table lists the blood test levels for a diagnosis of prediabetes and diabetes.

Blood_Test_Levels_Chart_of_Diabetes_and_Prediabetes

What To Look for:

  • Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink and urinate more than usual.
  • Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger.
  • Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine.
  • Fatigue. If your cells are deprived of sugar, you may become tired and irritable.
  • Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus.
  • Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections.
  • Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance.

Why should a person be tested for diabetes ?

Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1C and blood glucose tests are the best tools available to diagnose diabetes—a serious and lifelong disease.

Testing enables health care providers to find and treat diabetes before complications occur and to find and treat prediabetes, which can delay or prevent type 2 diabetes from developing.

Complications of Type 2 Diabetes

If there is too much sugar in the blood for years at a time, the smaller blood vessels in the eyes, nerves and kidneys can be damaged. These are called the microvascular complications of diabetes. “Microvascular” means that the smaller blood vessels are affected. The medical names for these kinds of complications are retinopathy (damage to the retina), neuropathy (nerve damage), and nephropathy (kidney damage). The later someone develops type 2 diabetes, the less likely it is that they will develop these kinds of problems.

Controlling your blood sugar levels can help prevent these complications. For example, many people who have type 2 diabetes also have high blood pressure.

Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include:

  • Cancer. Diabetes is linked to some types of cancer . Many risk factors for cancer and for diabetes are the same. Not smoking and getting recommended cancer screenings can help prevent cancer.
  • Heart and blood vessel disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue. According to high-quality evidence, enhanced glucose control significantly prevents the development of clinical neuropathy and reduces nerve conduction and vibration threshold abnormalities in type 1 diabetes mellitus. In type 2 diabetes mellitus, enhanced glucose control reduces the incidence of clinical neuropathy 22).
  • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which often eventually requires dialysis or a kidney transplant.
  • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.
  • Hearing impairment. Hearing problems are more common in people with diabetes.
  • Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
  • Alzheimer’s disease. Type 2 diabetes may increase the risk of Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. The exact connection between these two conditions still remains unclear.
  • Sexual and Urologic Problems. Sexual and urologic complications of diabetes occur because of the damage diabetes can cause to blood vessels and nerves. Men may have difficulty with erections or ejaculation. Women may have problems with sexual response and vaginal lubrication. Urinary tract infections and bladder problems occur more often in people with diabetes. People who keep their diabetes under control can lower their risk of the early onset of these sexual and urologic problems 23).
  • Gum Disease and Other Dental Problems. Glucose is present in your saliva—the fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath 24).
  • Sleep Apnea. People who have sleep apnea are more likely to develop type 2 diabetes. Sleep apnea also can make diabetes worse. Treatment for sleep apnea can help.

Diabetes and Cancer

Diabetes are greatest (about twofold or higher) for cancers of the liver, pancreas, and endometrium, and lesser (about 1.2 to 1.5 fold) for cancers of the colon and rectum, breast, and bladder 25), 26).

Epidemiological studies clearly indicate that the risk of several types of cancer (including pancreas, liver, breast, colorectal, urinary tract, and female reproductive organs) is increased in diabetic patients. Hyperinsulinemia most likely favors cancer in diabetic patients as insulin is a growth factor with pre-eminent metabolic but also mitogenic effects, and its action in malignant cells is favored by mechanisms acting at both the receptor and post-receptor level. Obesity, hyperglycemia, and increased oxidative stress may also contribute to increased cancer risk in diabetes 27), 28).

Glucose metabolism represents a complex system, and several components of the regulatory metabolic pathways may induce abnormalities in cellular growth and regulation. The strongest evidence of an association between glucose metabolism alterations and cancer derives from cohort studies, showing increased cancer incidence and mortality in the presence of diabetes 29). In particular, several studies clearly indicate an association between type 2 diabetes and the risk of colorectal, pancreatic, and breast cancer. An increased risk of liver, gastric, and endometrial malignancies has also been suggested. Type 1 diabetes is associated with an elevated risk of female reproductive organs and gastric cancers. The risk of malignancies is also increased at earlier stages of glucose metabolism abnormalities, with a linear relationship between cancer risk and plasma insulin levels, usually elevated in the presence of metabolic syndrome or diabetes. The prevalence of diabetes and obesity is rapidly increasing worldwide; if these conditions are associated even with a small increase in the risk of cancer, this will translate into important consequences for public health.

In conclusion, diabetes and cancer have a complex relationship that requires more clinical attention and better-designed studies.

How You Can Prevent Diabetes Complications and Problems

  • Diabetes, Heart Disease, and Stroke

Having diabetes means that you are more likely to develop heart disease and have a greater chance of a heart attack or a stroke. People with diabetes are also more likely to have certain conditions, or risk factors, that increase the chances of having heart disease or stroke, such as high blood pressure or high cholesterol. If you have diabetes, you can protect your heart and health by managing your blood glucose, also called blood sugar, as well as your blood pressure and cholesterol. If you smoke, get help to stop.

What is the link between diabetes, heart disease, and stroke ?

Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop heart disease 30).

People with diabetes tend to develop heart disease at a younger age than people without diabetes. In adults with diabetes, the most common causes of death are heart disease and stroke. Adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes 31).

The good news is that the steps you take to manage your diabetes also help to lower your chances of having heart disease or stroke.

What else increases your chances of heart disease or stroke if you have diabetes ?

If you have diabetes, other factors add to your chances of developing heart disease or having a stroke.

  • Smoking

Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking because both smoking and diabetes narrow blood vessels. Smoking also increases your chances of developing other long-term problems such as lung disease. Smoking also can damage the blood vessels in your legs and increase the risk of lower leg infections, ulcers, and amputation.

  • High blood pressure

If you have high blood pressure , your heart must work harder to pump blood. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

  • Abnormal cholesterol levels

Cholesterol is a type of fat produced by your liver and found in your blood. You have two kinds of cholesterol in your blood: LDL and HDL.

LDL, often called “bad” cholesterol, can build up and clog your blood vessels. High levels of LDL cholesterol raise your risk of developing heart disease.

Another type of blood fat, triglycerides, also can raise your risk of heart disease when the levels are higher than recommended by your health care team.

  • Obesity and belly fat

Being overweight or obese can affect your ability to manage your diabetes and increase your risk for many health problems, including heart disease and high blood pressure. If you are overweight, a healthy eating plan with reduced calories often will lower your glucose levels and reduce your need for medications.

Excess belly fat around your waist, even if you are not overweight, can raise your chances of developing heart disease.

You have excess belly fat if your waist measures

  • more than 40 inches and you are a man
  • more than 35 inches and you are a woman

Learn how to correctly measure your waist by going to –  Waist Hip Ratio.

  • Family history of heart disease

A family history of heart disease may also add to your chances of developing heart disease. If one or more of your family members had a heart attack before age 50, you may have an even higher chance of developing heart disease 32).

You can’t change whether heart disease runs in your family, but if you have diabetes, it’s even more important to take steps to protect yourself from heart disease and decrease your chances of having a stroke.

How you can lower your chances of a heart attack or stroke if you have diabetes ?

Taking care of your diabetes is important to help you take care of your heart. You can lower your chances of having a heart attack or stroke by taking the following steps to manage your diabetes to keep your heart and blood vessels healthy.

  • Manage your diabetes ABCs

Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol. Stopping smoking if you have diabetes is also important to lower your chances for heart disease.

A is for the A1C test. The A1C test shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you do every day. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. High levels of blood glucose can harm your heart, blood vessels, kidneys, feet, and eyes.

The A1C goal for many people with diabetes is below 7 percent. Some people may do better with a slightly higher A1C goal. Ask your health care team what your goal should be.

B is for blood pressure. Blood pressure is the force of your blood against the wall of your blood vessels. If your blood pressure gets too high, it makes your heart work too hard. High blood pressure can cause a heart attack or stroke and damage your kidneys and eyes.

The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask what your goal should be.

C is for cholesterol. You have two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels. Too much bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels.

Ask your health care team what your cholesterol numbers should be. If you are over 40 years of age, you may need to take medicine such as a statin to lower your cholesterol and protect your heart. Some people with very high LDL (“bad”) cholesterol may need to take medicine at a younger age.

S is for stop smoking. Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels, so your heart has to work harder.

If you quit smoking

  • you will lower your risk for heart attack, stroke, nerve disease, kidney disease, eye disease, and amputation
  • your blood glucose, blood pressure, and cholesterol levels may improve
  • your blood circulation will improve
  • you may have an easier time being physically active

Developing or maintaining healthy lifestyle habits can help you manage your diabetes and prevent heart disease.

  • Follow your healthy eating plan.
  • Make physical activity part of your routine.
  • Stay at or get to a healthy weight.
  • Get enough sleep.

Learn to manage stress

Managing diabetes is not always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, meditation, talking to people who can provide emotional and other support, gardening, taking a walk, doing yoga, ask for help from friends, family, and community or organizations, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress.

Preventing Type 2 Diabetes

Perhaps you have learned that you have a high chance of developing type 2 diabetes, the most common type of diabetes. You might be overweight or have a parent, brother, or sister with type 2 diabetes. Maybe you had gestational diabetes, which is diabetes that develops during pregnancy. These are just a few examples of factors that can raise your chances of developing type 2 diabetes.

Diabetes can cause serious health problems, such as heart disease, stroke, and eye and foot problems. Prediabetes also can cause health problems. The good news is that type 2 diabetes can be delayed or even prevented. The longer you have diabetes, the more likely you are to develop health problems, so delaying diabetes by even a few years will benefit your health. You can help prevent or delay type 2 diabetes by losing a modest amount of weight by following a reduced-calorie eating plan and being physically active most days of the week. Ask your doctor if you should take the diabetes drug metformin to help prevent or delay type 2 diabetes 33).

Treatment of type 2 diabetes :

  • Healthy eating
  • Regular exercise
  • Blood sugar monitoring
  • Possibly, diabetes medication or insulin therapy.

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

Ask your health care team about your goals for A1C, blood pressure, and cholesterol, and what you can do to reach these goals.
Develop or maintain healthy lifestyle habits

A) Healthy eating

Contrary to popular perception, there’s no specific diabetes diet. However, it’s important to center your diet on these high-fiber, low-sugar foods:

  • Proteins
  • Vegetables
  • Whole grains

You’ll also need to eat fewer animal products, refined carbohydrates and sweets.

Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic index foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.

A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. He or she can also teach you how to monitor your carbohydrate intake and let you know about how many carbohydrates you need to eat with your meals and snacks to keep your blood sugar levels more stable.

B) Physical activity

Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Choose activities you enjoy, such as walking, swimming and biking. What’s most important is making physical activity part of your daily routine.

Aim for at least 30 minutes of aerobic exercise five days of the week. Stretching and strength training exercises are important, too. If you haven’t been active for a while, start slowly and build up gradually.

A combination of exercises — aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week — often helps control blood sugar more effectively than either type of exercise alone.

Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar.

In interventions aimed at increasing exercise combined with diet 34), eight clinical trials that had an exercise plus diet (2241 participants) are able to decrease the incidence of type 2 diabetes mellitus in high risk groups (people with impaired glucose tolerance or the metabolic syndrome).

In a review involving people with impaired glucose tolerance, comparing the effectiveness lifestyle interventions (interventions could be diet alone, physical activity alone, or the combination). There is a strong body of evidence that the combined effect dietary change to ensure weight loss, coupled with physical activity, is clinically effective in reducing the progression to diabetes by about half and are likely to be considered cost-effective 35). The benefits of the lifestyle intervention were greatest in those with the highest compliance and who achieved more of the targets (such as weight loss and dietary change). The key to success is sustained lifestyle change, especially weight loss.

To assess the effects of type and frequency of different types of dietary advice for adults with type 2 diabetes, researchers reviewed 36 articles reporting a total of eighteen trials following 1467 participants 36).

Dietary approaches assessed in this review were:

  • low‐fat/high‐carbohydrate diets,
  • high‐fat/low‐carbohydrate diets,
  • low‐calorie (1000 kcal per day) and
  • very‐low‐calorie (500 kcal per day) diets and modified fat diets.

Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low‐fat diets versus moderate fat or low‐carbohydrate diets. Two studies assessed the effect of a very‐low‐calorie diet versus a low‐calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioural approaches. The studies all measured weight and measures of glycaemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance.

Conclusion of the review: The data available indicate that the adoption of exercise appears to improve glycated haemoglobin (HbA1c) at six and twelve months in people with type 2 diabetes. The results suggest that adoption of regular exercise is a good way to promote better glycaemic control in type 2 diabetic patients, however all of these studies were at high risk of bias 37).

In another meta‐analysis shows that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss 38).

C) Monitoring your blood sugar

Depending on your treatment plan, you may need to check and record your blood sugar level every now and then or, if you’re on insulin, multiple times a day. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

Sometimes, blood sugar levels can be unpredictable. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication.

Compared with repeated daily blood sugar tests, the A1C test is a better indicator of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication, meal plan or activity level.

In addition to the A1C test, your doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important.

D) Diabetes medications and insulin therapy

Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.

E) Bariatric surgery

If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries.

Drawbacks to the surgery include its high cost, and there are risks involved, including a risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis.

F) Chinese herbal medicines for type 2 diabetes mellitus

Although the use of herbal medicines for treatment of diabetes has a long history especially in the East, current evidence cannot warrant to support the routine use in clinical practice 39).

G) Whole grain foods for the prevention of type 2 diabetes mellitus

The evidence from only prospective cohort trials is considered to be too weak to be able to draw a definite conclusion about the preventive effect of whole grain foods on the development of type 2 diabetes mellitus 40).

H) Omega‐3 polyunsaturated fatty acids for type 2 diabetes mellitus

Omega‐3 PUFA supplementation in type 2 diabetes lowers triglycerides and VLDL cholesterol, but may raise LDL cholesterol (although results were non‐significant in subgroups) and has no statistically significant effect on glycemic control or fasting insulin 41). Trials with vascular events or mortality defined endpoints are needed.

I) Effect of short-term administration of cinnamon on blood pressure in patients with prediabetes and type 2 diabetes

Consumption of cinnamon (short term) is associated with a notable reduction in systolic blood pressure and diastolic blood pressure. Although cinnamon shows hopeful effects on blood pressure-lowering potential, it would be premature to recommend cinnamon for blood pressure control because of the limited number of studies available. Thus, undoubtedly a long-term, adequately powered randomised clinical trials involving a larger number of patients is needed to appraise the clinical potential of cinnamon on blood pressure control among patients with type 2 diabetes mellitus 42).

J) Ayurvedic treatments for type 2 diabetes mellitus

This review 43) examines the efficacy and safety of the use of various Ayurvedic treatments for diabetes mellitus. We found seven trials which included 354 participants (172 on treatment, 158 on control, 24 could not be classified). All these studies included adults with type 2 diabetes mellitus.

The duration of treatment ranged from three to six months. One study each of Diabecon, Inolter and Cogent DB (proprietary herbal mixtures) found significantly lower glycosylated haemoglobin A1c (HbA1C) levels at the end of the treatment period compared to controls. Two studies of Diabecon, and one study of Cogent DB (proprietary herbal mixtures) found significantly lower fasting blood sugar levels at the end of the study period in the treatment group. No deaths were observed in these trials and side effects did not differ significantly between intervention and control groups. One study of Pancreas tonic reported no significant change in health-related quality of life.

Although there were significant glucose-lowering effects with the use of some herbal mixtures, due to methodological deficiencies and small sample sizes the study authors were unable to draw any definite conclusions regarding their efficacy 44). Though no significant adverse events were reported, there is insufficient evidence at present to recommend the use of these interventions in routine clinical practice and further studies are needed.

K) Momordica charantia (bitter gourd or bitter melon) for type 2 diabetes mellitus

Mormordica charantia (bitter gourd or bitter melon) is a climbing perennial that is characterized by elongated, warty fruit-like gourds or cucumbers and is native to the tropical belt. This review 45) of trials found only four studies which had an overall low quality. Three trials showed no significant differences between momordica charantia and placebo or antidiabetic drugs (glibenclamide and metformin) in the blood sugar response. The duration of treatment ranged from four weeks to three months, and altogether 479 patients with type 2 diabetes mellitus participated.

The current evidence does not warrant using the plant in treating type 2 diabetes mellitus 46). Further studies are therefore required to address the issues of standardization and the quality control of preparations. For medical nutritional therapy, further observational trials evaluating the effects of momordica charantia are needed before RCTs are established to guide any recommendations in clinical practice.

Low Calorie Diet on Weight Loss and the Metabolic Profile of Obese Patients with Type 2 Diabetes Mellitus

A small study 47) with 60 patients (23 males and 37 postmenopausal females) who have type 2 diabetes and are obese, to compare the effects of low calorie diet (1800 kcal/day) plus intensive insulin therapy (4 insulin injections/day) versus low calorie diet (1800 kcal/day) plus conventional insulin therapy (2/3 insulin injections/day). At 6 months post-interventions, there were significant reductions were observed in the body weight, body mass index (BMI), HbA1c for all participants and cholesterol. At 1 year, median body weight reduction was 4.5 kg for patients on low calorie diet (1800 kcal/day) plus intensive insulin therapy and 4.8 kg for those on low calorie diet (1800 kcal/day) plus conventional insulin therapy. The conclusion was a 12-month 1800-kcal low calorie dietary intervention achieved significant body weight loss and HbA1c reductions irrespectively of insulin regimen. The  low calorie diet (1800 kcal/day) plus conventional insulin therapy was associated with body weight loss greater than 8.0%, whereas low calorie diet (1800 kcal/day) plus intensive insulin therapy was associated with higher rates of normoglycemia 48).

Very Low Calorie Diet in Obese Type 2 Diabetes

A small study was conducted with fifty-one obese subjects (24 with diabetes and 27 obese without diabetes) to compare weight loss and change in body composition in obese subjects with and without type 2 diabetes mellitus during a very-low-calorie diet (VLCD) program 49). After 24 weeks of intervention, there was no difference in weight loss between the 2 groups. Both groups completing the study per protocol had near-identical weight change during the program, with similar weight loss at 24 weeks (diabetes: 8.5 ± 1.3 kg vs control: 9.4 ± 1.2 kg). Change in fat mass index correlated with change in body mass index (BMI) in both groups, but change in fat mass index per unit change in BMI was less in the diabetic group compared with controls, which persisted after adjusting for age, sex, and baseline BMI. Insulin concentrations remained higher and peak β-hydroxybutyrate concentrations were lower in the diabetic compared with the control group. The conclusion was while following a 24-week very-low-calorie diet program, obese subjects with and without diabetes achieved comparable weight loss; but the decrease in body fat per unit weight loss was less in diabetic subjects. Hyperinsulinemia may have inhibited lipolysis in the diabetic group; however, further investigation into other factors is needed 50).

Low Carbohydrate Low Calorie Diet in type 2 Diabetes

In a very small study 51) comparing the effects of low carbohydrate low calorie diet (1800 kcal for men and 1600 kcal for women, distributed as 20 % carbohydrates, 30 % protein and 50 % fat) and high carbohydrate low calorie diet (1600-1800 kcal for men and 1400-1600 kcal for women, consisted of approximately 60 % carbohydrates, 15 % protein and 25 % fat) in two groups of obese patients with type 2 diabetes. The diets were tested with regard to glycaemic control and bodyweight. A group of 16 obese patients with type 2 diabetes was advised on a low-carbohydrate diet,  Fifteen obese diabetes patients on a high-carbohydrate diet were control group. Positive effects on the glucose levels were seen very soon. After 6 months a marked reduction in bodyweight of patients in the low-carbohydrate diet group was observed, and this remained one year later. After 6 months the mean changes in the low-carbohydrate group and the control (high carbohydrate low calorie diet) group respectively were fasting blood glucose: -3.4 and -0.6 mmol/l; HBA1c: -1.4 % and -0.6 %; Body Weight: -11.4 kg and -1.8 kg; BMI: -4.1 kg/m2 and -0.7 kg/m2. In conclusion, a low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes 52).

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