Staff endocrinologist in the Department of Medicine at St Michael’s Hospital in Toronto, Chair of the Clinical Practice Guidelines Dissemination and Implementation Committee at the Canadian Diabetes Association, Associate Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael’s Hospital, and Assistant Professor in the Department of Medicine at the University of Toronto.
Insulin can be used at any time in the course of type 2 diabetes (grade D, consensus) (see link in Relevant Tools column for examples of insulin initiation and titration in people with type 2 diabetes). In people not achieving glycemic targets with existing non-insulin antihyperglycemic medication, the addition of a once-daily basal insulin regimen should be considered over premixed insulin or bolus-only regimens to reduce weight gain and hypoglycemia (grade B, level II)
Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
That’s because when your blood sugar isn’t under control, the excess glucose in your body can increase your chance of developing serious related health conditions. Heart disease, kidney disease, vision issues, and nerve damage are among the problems that can result from poorly managed diabetes, says William Sullivan, MD, a senior physician at the Joslin Diabetes Center and an assistant professor of medicine at Harvard Medical School in Boston.
Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down. It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body's needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycemia).
On top of tracking your blood glucose and meals (with a nutrition database and bar-code scanner), the Diabetes:M app will calculate insulin boluses for you. Through the Apple Health app, Diabetes:M will sync with other devices, including glucose meters, Fitbit, Garmin, and many others. You’ll need to pay extra for the subscription to access the full food database, sync multiple devices, and get rid of the ads. (The current subscription cost is $4.99 per month or $49.99 per year.)
Diabetes in Check, from the recently-IPO'd Everyday Health is a type 2 diabetes management app that features a wide range of tools. It includes diabetes coaching designed by a certified diabetes educator, trackers for blood glucose and medication, reminders, and tools for healthy eating, including a food tracker with a barcode scanner and a recipe database. For a $3.99 subscription, users can get daily personalized food recommendations.
^ Jump up to: a b c Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
People with type 1 diabetes are unable to produce any insulin at all. People with type 2 diabetes still produce insulin, however, the cells in the muscles, liver and fat tissue are inefficient at absorbing the insulin and cannot regulate glucose well. As a result, the body tries to compensate by having the pancreas pump out more insulin. But the pancreas slowly loses the ability to produce enough insulin, and as a result, the cells don’t get the energy they need to function properly.
To explain what hemoglobin A1c is, think in simple terms. Sugar sticks, and when it's around for a long time, it's harder to get it off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die off. When sugar sticks to these hemoglobin proteins in these cells, it is known as glycosylated hemoglobin or hemoglobin A1c (HBA1c). Measurement of HBA1c gives us an idea of how much sugar is present in the bloodstream for the preceding three months. In most labs, the normal range is 4%-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0% (optimal is <6.5%). The benefits of measuring A1c is that is gives a more reasonable and stable view of what's happening over the course of time (three months), and the value does not vary as much as finger stick blood sugar measurements. There is a direct correlation between A1c levels and average blood sugar levels as follows.
The GoMeals “Today’s Plate” feature helps monitor each day’s calorie intake, as well as the distribution of carbohydrates, fats and proteins. These three nutrient categories are also represented in a pie chart on the touch screen. A restaurant locator feature helps users locate restaurants based on their current location and the type of cuisine they prefer, as well.
Type 2 diabetes does not have a clear pattern of inheritance, although many affected individuals have at least one close family member, such as a parent or sibling, with the disease. The risk of developing type 2 diabetes increases with the number of affected family members. The increased risk is likely due in part to shared genetic factors, but it is also related to lifestyle influences (such as eating and exercise habits) that are shared by members of a family.
Diabetes Tracker helps users take control of type 1 and 2 diabetes as well as prediabetes and gestational diabetes. Document exercise and food intake so you can monitor your weight, and view stats and food grades for different foods. It also allows you to keep tabs on water intake, weight, HbA1c, cholesterol, net carbs, and other health factors. Virtual coaching can assist you in managing your health in addition to the analytical tools. This app delivers diabetes management that is truly at your fingertips.