Type 2 diabetes is a chronic condition where the body becomes resistant to insulin or the pancreas does not produce enough insulin, causing high blood sugar. It accounts for 90-95% of all diabetes cases.
Main risk factors are excess weight, physical inactivity, age over 45, family history, and history of gestational diabetes. Common symptoms include increased thirst, frequent urination, fatigue, blurred vision, and slow wound healing.
Diagnosis uses fasting glucose ≥126 mg/dL, HbA1c ≥6.5%, or 2-hour OGTT ≥200 mg/dL. Management includes lifestyle change, metformin as first-line drug, and other medications or insulin if needed.
Complications include heart disease, kidney failure, nerve damage, and vision loss.
Causes and Risk Factors of Type 2 Diabetes
Primary Mechanisms
- Insulin resistance: Muscle, fat, and liver cells do not respond well to insulin
- Beta-cell dysfunction: Pancreas cannot make enough insulin to overcome resistance
Key Risk Factors
- Overweight or obesity: Especially abdominal fat increases insulin resistance
- Physical inactivity: Less than 150 minutes exercise per week
- Age: Risk rises after age 45
- Family history: Parent or sibling with type 2 diabetes
- Race/ethnicity: Higher risk in African American, Hispanic, Native American, Asian American, Pacific Islander groups
- Prediabetes: HbA1c 5.7-6.4% or fasting glucose 100-125 mg/dL
- History of gestational diabetes or baby >9 lbs
- PCOS, hypertension, low HDL, high triglycerides
Symptoms of Type 2 Diabetes
Many people have no symptoms early. When symptoms appear they include:
- Polyuria: Frequent urination, especially at night
- Polydipsia: Excessive thirst
- Polyphagia: Increased hunger
- Fatigue and weakness
- Blurred vision
- Slow-healing sores or frequent infections
- Tingling or numbness in hands or feet
- Unintended weight loss
How Type 2 Diabetes Is Diagnosed
Test | Diabetes Cutoff | Prediabetes Range |
|---|---|---|
HbA1c | ≥6.5% | 5.7-6.4% |
Fasting plasma glucose | ≥126 mg/dL | 100-125 mg/dL |
2-hour OGTT | ≥200 mg/dL | 140-199 mg/dL |
Random glucose | ≥200 mg/dL + symptoms | Not used |
Diagnosis requires 2 abnormal test results on separate days unless symptoms and random glucose ≥200 mg/dL.
Treatment and Management of Type 2 Diabetes
1. Lifestyle Therapy
- Weight loss: 5-10% of body weight improves blood sugar, blood pressure, lipids
- Diet: Mediterranean, DASH, or low-carb. Focus on non-starchy vegetables, lean protein, whole grains, fiber. Limit added sugar and refined carbs
- Exercise: 150 min moderate aerobic activity + 2-3 days resistance training per week
- Sleep: 7-9 hours nightly. Treat sleep apnea
2. Medications
- First-line: Metformin reduces liver glucose production and improves insulin sensitivity
- Other classes: GLP-1 receptor agonists, SGLT2 inhibitors, DPP-4 inhibitors, sulfonylureas, TZDs. Choice depends on cardiovascular risk, kidney function, weight, cost
- Insulin: Added if HbA1c remains >7-9% despite oral meds or if symptomatic
3. Monitoring and Targets
- HbA1c goal: <7% for most adults. Individualize to <6.5% or <8% based on age and comorbidities
- Blood pressure: <130/80 mmHg
- LDL cholesterol: <70-100 mg/dL depending on CVD risk
- Self-monitoring: As needed based on meds and control
Complications of Type 2 Diabetes
- Cardiovascular: 2-4x higher risk of heart attack and stroke
- Microvascular: Retinopathy, nephropathy, neuropathy
- Diabetic foot: Ulcers and amputations from nerve damage and poor circulation
- Other: Fatty liver disease, cognitive decline, infections, periodontal disease
FAQs About Type 2 Diabetes in Malaysia
Can type 2 diabetes be reversed?
Type 2 diabetes can go into remission with significant weight loss of 10-15 kg, low-calorie diet, or bariatric surgery. Remission means HbA1c <6.5% without meds for 3+ months. It may return if weight is regained.What foods should type 2 diabetics avoid?
Avoid sugary drinks, white bread, white rice, pastries, processed snacks, fried foods, and high-sugar cereals. Limit saturated fat and sodium. These spike blood sugar and worsen insulin resistance.Is type 2 diabetes genetic?
Genetics increases risk of type 2 diabetes. Having a parent or sibling with it raises risk 2-6x. Lifestyle factors like diet, weight, and activity strongly influence whether genetic risk leads to diabetes.What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes is autoimmune destruction of insulin-producing cells, starts young, needs insulin. Type 2 diabetes is insulin resistance with relative insulin deficiency, linked to lifestyle, often managed with diet and oral meds first.How fast does type 2 diabetes develop?
Type 2 diabetes develops slowly over years. It starts with insulin resistance and prediabetes. Without intervention, 15-30% of people with prediabetes progress to type 2 diabetes within 5 years.