Health

19 Facts Most People Don't Know About Type 2 Diabetes

Let's talk about one of the most common chronic illnesses in the world.

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Although type 2 diabetes is the most common form of diabetes, there are a lot of misconceptions about what it actually does to the body and why it happens. We reached out to diabetes expert Dr. Dorothy Fink, of NYU Langone Endocrine and Diabetes Center, to dispel the most common diabetes myths.

Before we talk about the myths, let's define type 2 diabetes.

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According to the American Diabetes Association (ADA), type 2 diabetes (T2D) is a chronic condition which causes blood glucose (sugar) levels to be higher than normal, also called "hyperglycemia." It's also known as adult-onset or noninsulin-dependent diabetes.

"It's defined as having a hemoglobin A1C higher than 6.5 — which is a measure of how much sugar has coated your red blood cells over the last 2-3 months," says Fink. When your A1C is high, that means your body isn't processing sugar correctly and too much glucose is in your blood. T2D is usually treated with lifestyle changes, oral medications, and insulin injection, but it varies by person.

1. There are many different risk factors associated with type 2 diabetes.

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No one thing causes diabetes, it's a multifaceted diagnosis. According to the Mayo Clinic, these are the known risk factors (although not all of these will apply to everyone with T2D):

* Weight: Being overweight or obese.

* Fat distribution: If your body stores fat primarily in your abdomen.

* Inactivity: Getting little or no physical activity.

* Family history: Having a parent or sibling with type 2 diabetes.

* Race: If you are Black, Hispanic, Native American, or Asian American.

* Age: Being 45 or older.

* Prediabetes: Having a high blood sugar but not high enough to be associated with diabetes, or an A1C between 5.7 and 6.4.

* Gestational diabetes: Having high blood sugar (diabetic hyperglycemia) during pregnancy.

* Polycystic ovarian syndrome: Being a woman with PCOS, which can cause irregular menstrual periods, excess hair growth, and obesity.

We'll talk more about some of these in a bit.

2. Type 2 diabetes is not a deficiency or absence of insulin.

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Unlike type 1 diabetes, where the body does not produce the hormone insulin so it can't metabolize sugar, T2D occurs when your body does not use the insulin properly.

When you eat, food is converted into glucose for energy. The pancreas releases insulin to regulate the movement of glucose from our blood into cells so they can use it to fuel processes in our body. When you overload the body with sugar, says Fink, our pancreas freaks out and first tries to compensate by making extra insulin. Eventually, it can't keep up and stops making enough insulin to keep blood sugar down, which is called "insulin resistance."

"Insulin is like a key that unlocks our cells so glucose can get inside, and people with T2D have the key but they just can't use it anymore," says Fink. As a result, the sugar just stays in your blood — which can cause nerve, eye, kidney, and heart problems. If left untreated, it only gets worse over time.

3. Insulin resistance isn't just caused by eating too many sweets.

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Yes, added sugar is one factor, but its just one part of the puzzle. First of all, sugar comes in many different forms (like starches and carbs) that all get broken down as glucose. "If you eat too many carbs, your body still gets overwhelmed with glucose and has to work extra hard to process all of it," says Fink. At some point, the pancreas gets so overworked that it can no longer use the insulin it produces and the pancreas makes less over time.

But it's more than just your diet that causes these physiological changes in the body. Exercise, weight, pregnancy, and genetic factors all contribute to the body's metabolism of glucose and contribute to the development of insulin resistance.

4. Genetics play a small role, but a family history doesn't mean you'll definitely develop T2D.

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"Yes, family history is an unfortunate reality and it will influence risk for T2D but so much prevention can be done in regards to lifestyle and food that are in your control," Fink says. So while you can't change your family history, the right lifestyle changes can help you lower your risk.

5. You don't have to be overweight to develop T2D.

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Yes, being overweight is a major risk factor, because the overconsumption of sugar and carbohydrates usually causes weight gain in addition to the pancreas and insulin problems.

But it's important to note that T2D can occur in anyone of any size. Being overweight isn't always a precursor to diabetes — sometimes the condition and the weight gain develop together, which is called comorbidity.

Being thin or having a fast metabolism doesn't make you immune, either. No matter your weight, you can still overload your body and pancreas with too much sugar and cause insulin resistance, Fink says. These cases aren't as common, but they definitely happen. It's important for this myth to be dispelled because thin people who rely on processed sugar and carbs might be in the prediabetic range or have early-stage T2D and not even be aware of it until they get very sick.

6. Type 1 and Type 2 diabetes aren't mutually exclusive. You can actually have both.

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Although there is a clear difference — one is the body having an autoimmune condition which kills insulin-producing cells and the other is the body not being able to use insulin — the diagnosis isn't always black and white. In some cases, type 1 can present itself as type 2, especially in adults. This is referred to as insulin-resistant type 1 diabetes or "double diabetes."

"Often when someone isn't significantly overweight and they get type 2, it could be underlying type 1 diabetes or a combination of the two and result in very serious complications," Fink says. That's why it's important to talk to your doctor about your diet and blood sugar.

7. You can get T2D pretty much any time of your life.

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While it typically presents in adulthood over the age of 45 (caused by an insulin resistance that's been developing for years or even decades), it can also occur in childhood or teenage years if your body is overloaded with sugar and the pancreas has to overcompensate.

This is especially true for young people with risk factors such as being overweight, having a family history, being a person of color, and having PCOS. Unfortunately, rates of juvenile T2D are climbing in the U.S., says Fink. "We've found that children are filling themselves with highly processed, sugary foods earlier and earlier in life which just weren't around 50 years ago." Children might also be at risk if their parents are obese or have T2D, because this could influence the entire family's nutrition and approach to food, Fink says.

8. Many women develop diabetes during pregnancy, even if they didn't have it before.

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According to the ADA, gestational diabetes occurs in many women later in their pregnancies due the drastic weight gain and increase in blood sugar. Doctors aren't actually sure what causes gestational diabetes, but it might have something to do with the hormones released during pregnancy blocking the insulin so it can't use it and glucose builds up in the blood. "It's often secondary to being overweight but it can present itself at lower weights so it's actually uncovering a different genetic risk factor for gestational diabetes," says Fink.

While it typically goes away after birth, in some cases it may stick around. "It can really be like a 'stress test' on the body, and actually uncover risks for T2D or even type 1 diabetes that the women wouldn't ever know about otherwise," says Fink. It's important to monitor your blood glucose after birth if you had gestational diabetes to make sure your body is now using insulin properly.

9. For most people, the first line of treatment involves lifestyle changes.

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"People should never underestimate the power of food and exercise as medicine," Fink says. Losing weight is no easy task and takes a lot of time and effort, but it is a natural way to reduce your need for medication and insulin shots and improve your prognosis. Many patients with T2D will require pills or insulin over time no matter what, says Fink, but this doesn't mean it's too late to make drastic and long-term lifestyle changes as a part of treatment.

That said, T2D can progress to a very severe point and when it's combined with the complications of obesity, it can be a fatal disease. For this reason, gastric bypass can be a necessary and life-changing surgery for many late-stage, obese type two diabetes patients, says Fink. However, it should be seen as a last-resort. "I see so many patients who have to undergo this invasive, expensive surgery and I just think if we had seen them sooner we could've used medication and lifestyle changes to manage the diabetes," Fink says.

10. Tweaking your diet can really help with managing diabetes.

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Even if you're treating T2D with insulin or medication to help regulate blood sugar, making changes to your diet can help, too. “If you cut refined sugar and simple carbs out of your diet, you will see your A1C start to drop,” Fink says.

Even if you can’t completely reverse or cure T2D with drastic food adjustments, it can help with not having to take as many medicines and delay the time when you have to start taking insulin.

11. Exercise can actually help blood sugar and insulin requirements, too.

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In addition to helping patients lose weight, exercise can actually decrease your insulin requirements, says Fink, because it helps the muscles take up glucose more efficiently. Think of it as an extra edge to help your body process the sugar, so you'll need less insulin to do the job. "Burning calories and losing weight is just another benefit of working out, but patients should also see it as another effective way to manage blood sugar," Fink says.

12. Insulin shots don't instantly relieve symptoms or make it better.

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People with type 1 diabetes rely on insulin injections to help regulate their blood sugar, but this isn't the case in people with type 2. In fact, most people with T2D rely on oral medications to regulate their blood sugar, says Fink.

Each person's treatment will depend on the stage of their diabetes and how severe their symptoms are, but there's definitely a range. "The earlier you catch T2D, the more variety and flexibility you have in treatments to help reverse the diagnosis," says Fink. If it progresses, insulin shots may be necessary, but they're not the only answer to lowering blood sugar.

13. There isn't one strict diet for people with T2D.

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According to the ADA, an optimal diet will help improve blood glucose, blood pressure, and cholesterol. What that looks like will vary, but it should be made up of a variety of nutrient-rich food from these core groups: whole grains, lean meats like poultry or fish, beans, vegetables, fruits, and non-fat dairy products.

"You don't need to conform to one strict diet or meal plan because you will work within your cultural or ethnic norms," Fink says. So much of food is related to culture and how we are raised, and you shouldn't feel like you have to abandon that to get healthy. "If your new diet is going to be a lasting lifestyle change, you need to adapt it to you and your family so it works," says Fink.

The only universal thing about a diabetic-friendly diet is what you should cut out — highly processed carbohydrates and added sugars. But when it comes down to what you can eat, there's a lot of room to experiment with different cuisines.

14. But yes, most people with T2D will have to drastically reduce the amount of added sugar in their diets.

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Natural (as opposed to added) sugars are essential for the body and the brain to function — so there is no reason to see sugar as the enemy. That being said, it does matter where the sugar comes from, says Fink. "Someone with diabetes should definitely avoid eating refined white sugar and candies, or at least keep it a rare treat," says Fink. These will spike the blood sugar so a person feels sick and needs insulin.

Fruits and berries are fine to include in the diet because they are lower in natural sugars and have some fiber which is also part of a nutritious diet, says Fink. It’s also important to focus on how to include whole foods to create an overall balanced and nutritious diet, so it’s a positive change. Viewing a diabetic meal plan as simply cutting out all processed and sugary stuff can create a negative and restrictive mindset.

15. Ideally we would catch prediabetes before it progresses to T2D, but that's not always possible.

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Prediabetes is defined by the ADA as having a hemoglobin A1C level between 5.7 and 6.4, and a "fasting plasma glucose" (FGP) level of 126 or higher. "We know that you can catch T2D early enough to only require changes in diet and exercise so you can reverse it almost completely and never need medication," Fink says. Since prediabetes is also a major risk factor for heart disease, it's important to know if you fall into the category so you can work with your doctor to prevent further complications.

But despite the available tests, it's still difficult to diagnose. "There are additional tests we use because A1C and blood glucose aren't always accurate or sensitive enough to detect prediabetes," says Fink. Usually a person will get tested if they have enough risk factors or they experience symptoms like high blood pressure. However, the severity of prediabetes and the symptoms vary in each individual. Likewise, it develops differently depending on the person and their body, so there really isn't a known timeline or definite stages of prediabetes for reference, Fink says.

Take this quiz to find out if you are at risk for prediabetes.

16. You can't cure type 2 diabetes, but you can reverse it.

"You can reverse type two diabetes to the extent that you have regulated blood sugar and you don't need as much or any medication," Fink says. Unfortunately, that doesn't mean it's completely cured as people still have to monitor their diabetes status and health for the rest of their lives.

"Even if you somewhat reverse it, you are always at very high risk because you still technically have T2D and can develop serious symptoms again," Fink says. But a combination of medication and insulin, a diabetic-friendly diet, and exercise can help tremendously to lower blood glucose down to around normal from a hyperglycemic state. "It's not easy and takes a lot of hard work so every patient still needs to find the best lifestyle treatment option for their own needs and daily life," Fink says.

17. Even though it's a chronic and often unnoticed condition, T2D can still be very serious and even fatal.

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"A huge problem is that people think that just because it won't kill you tomorrow like stage four cancer, T2D isn't that serious and treatment can be put off," Fink says. But like any chronic illness, it can have serious complications, especially without proper treatment.

"Diabetes can affect every organ in the body and patients can end up on dialysis, having limbs amputated, dying from heart attacks, strokes, etc.," says Fink. T2D isn't just a side effect of obesity, it's a serious chronic disease which can decrease the quality and length of your life.

18. Socioeconomic factors can also affect your risk of developing T2D.

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Socioeconomic status is a huge factor for T2D, says Fink, because it determines which foods people have access to and whether they can afford it. Unfortunately, many poor families are limited to purchasing cheap, highly processed packaged products and fast food because these are the only budget-friendly options available. When fresh, healthy food is more difficult and expensive to eat, people are forced to rely on unhealthy options for their calories, says Fink, even if they are aware of the health consequences.

Diabetes also disproportionally affects people of color. Data shows that the rates of diagnosed diabetes by race/ethnic background are: 15.9% of American Indians/Alaskan Natives, 13.2% of non-Hispanic blacks, 12.8% of Hispanics, and 9.0% of Asian Americans, as compared to 7.6% of non-Hispanic whites. Researchers point to a combination of genetic and environmental factors such as lack of access to nutritious food or healthcare and low socioeconomic status which contributes to an increased risk.

19. T2D is a complex diagnosis — not something that's "your fault."

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Although diet and exercise play a big role in developing T2D, there are many situational factors which influence a person's risk. "People get pigeon-holed into situations where they're at much higher risk of developing T2D," says Fink.

That can include a perfect storm of risk factors including a genetic predisposition, a lack of knowledge about diet and exercise, and barriers to healthy food and care. Growing up with limited food choices or understanding of healthy options can make it incredibly difficult to change your habits as an adult. So while it's important to feel empowered about what you can do to mitigate your risk and receive the best care, it's also true that T2D is a growing public health problem worthy of closer consideration.