What is Type 2 Diabetes? And What Causes It?

Diabetes is the term used to describe a group of diseases that result in persistent high blood sugar. Type 2 diabetes, (also called diabetes mellitus type 2) represents about 95% of what is generically called diabetes. 

In people who do not have diabetes, insulin is released from the pancreas to bring higher blood sugar levels down. During the development of Type 2 diabetes, the body becomes resistant to insulin, so higher and higher insulin levels are needed to control the blood sugars. Eventually the insulin resistance can reach the point where the blood sugars remain elevated despite high insulin levels. This is when Type 2 diabetes is diagnosed. After diagnosis, medications can be prescribed to improve the body's responsiveness to insulin, but eventually, the insulin-producing cells of the pancreas may "burn-out" and stop responding to diabetes medications that were previously helpful. When this happens, your doctor may add injected insulin to help keep the blood sugars under control..

Closely related to type 2 diabetes is prediabetes. Prediabetes is the term used to describe an earlier stage of insulin resistance with blood sugar levels that are elevated above normal, but are not high enough to be called type 2 diabetes. An American Diabetes Association expert panel estimated that up to 70% of individuals with prediabetes will eventually develop Type 2 diabetes in their lifetime. But because prediabetes has few obvious symptoms, 90% of people with prediabetes don’t know they have it.

Insulin resistance is associated with many health problems in addition to type 2 diabetes and prediabetes, including metabolic syndrome, polycystic ovary syndrome (PCOS), atherosclerotic heart disease, fatty liver disease, and more.

There is also type 1 diabetes, which has notable differences from type 2 diabetes. What is type 1 diabetes, and what is the difference between type 1 and type 2 diabetes? Whereas type 2 diabetes is caused by insulin resistance (more on this below), type 1 diabetes is caused by the pancreas not producing enough (or any) insulin. Unlike type 2 diabetes, type 1 diabetes is not associated with weight, age, or living a sedentary lifestyle. 

How common is it?

If you are an adult living in the United States, you are more likely than not to either have type 2 diabetes or prediabetes. 14.3% of US adults have type 2 diabetes, and 38.0% of US adults have prediabetes, meaning that 52.3% of the adult population in the US is suffering from metabolic disease.

Symptoms

Type 2 diabetes symptoms are related to very high blood glucose or to long-term and often irreversible complications from high blood glucose. It is important to note that it is possible to have Type 2 diabetes with no symptoms at all. 

Symptoms of very high blood sugars get better when the blood sugar is brought under control. The symptoms of high blood sugars may include:

• Fatigue
• Increased thirst and dry mouth
• Increased urination
• Frequent vaginal yeast infections or urinary tract infections
• Blurred vision
• Increased hunger
• Weight gain. Weight loss is also possible if the blood sugars are extremely high

The risk of developing irreversible complications from T2D is far lower when the blood sugar is controlled. Symptoms related to long-term damage from high blood sugars can include:

• Erectile dysfunction due to nerve damage and circulatory problems
• Vision problems, including difficulty seeing at night (due to diabetes-related cataracts), reduced vision, and blindness caused by damage to the retina.  
• Nerve damage, causing numbness, tingling and burning, particularly in your feet. Loss of sensation in the feet can allow for slow-healing wounds to develop. These wounds sometimes lead to amputations.
• Increased risk of stroke, heart attack and other circulation problems such as problems with the blood flow to the legs which can make walking very difficult. 
• Kidney damage that can end in kidney failure and dialysis. 
• Issues with your gut, leading to frequent belching, nausea and vomiting, and problems digesting your food properly, leading to loose bowel movements or constipation. 
• Depression. 
• Weakened immune system, allowing for more severe infections. 
• Irregular periods or no periods in females.
• Infertility. 
• Increased risk of dementia.

Prediabetes usually has no symptoms at all. Symptoms may include:

• Feeling tired and hungry all the time
• Poor sleep
• Difficulty focusing
• Neuropathy (numbness, tingling in feet and hands)1
• Neck skin darkens
• Developing many small skin tags
• Weight gain

Risk factors 

There are a number of factors that may increase your risk of developing type 2 diabetes, including age, weight, race, lifestyle, and more.

These risk factors include:

• Having prediabetes.
• Being overweight or obese.
• Being over 35 years old.
• Being the child of someone with gestational diabetes, or being born with a low or high birth weight.
• Being of African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander heritage.
• Living a sedentary lifestyle, or not being physically active.
• Having a history of gestational diabetes.
• Having a history of polycystic ovarian syndrome. 
• Certain medications. 

What is the main cause of type 2 diabetes? While all of these factors play a role, obesity and lack of physical activity are the most significant, as they can be managed through lifestyle changes.

What causes T2D?

Many people ask: “Is type 2 diabetes caused by sugar?” Eating too many sweets can certainly increase the chances of getting type 2 diabetes. However, the real cause of type 2 diabetes is insulin resistance, a condition in which cells stop responding properly to the signal of insulin. Insulin is a key hormone that assists in moving glucose from the bloodstream into cells in order to be used as energy. Insulin resistance prevents cells from responding to insulin in order to move glucose from the bloodstream into cells. This leads to higher than normal blood sugar levels. 

While the root causes of insulin resistance are not fully understood ,injecting insulin into your body does not fix the underlying problem of insulin resistance. While your insulin levels will still rise in response to eating carbohydrates, since your cells are not responding to its signal, your blood sugar cannot be moved into cells effectively. This leaves you with both high blood sugar and high insulin.

Over many years, trying to compensate for the chronically elevated blood sugar requires that your body pumps out insulin at a much higher rate than it’s supposed to. Once we reach adulthood, our ability to grow new insulin-producing cells in the pancreas is limited3, so when insulin production is over-stressed, these cells are lost and not replaced. That’s why long-term type-2 diabetes can lead to a loss of the ability to produce much insulin on your own. When you lose most of your ability to produce insulin on your own, that is called pancreatic burnout. At this stage in the progression of type 2 diabetes, injected insulin becomes necessary to replace your body’s dwindling supply.

Insulin resistance is associated with many health problems in addition to type 2 diabetes and prediabetes, including metabolic syndrome, polycystic ovary syndrome (PCOS), atherosclerotic heart disease, fatty liver disease, and more.

What causes uncontrolled type 2 diabetes?

‍Uncontrolled type 2 diabetes can be caused by:

• Not taking medications properly.
• Inadequate medical care or dosage.
• Eating too many starchy, or sugary foods (it’s not just the sweet snacks!).
• Not getting enough exercise. 

Short-term complications of uncontrolled diabetes

In the short term, uncontrolled unstable diabetes can cause symptoms like:

• Very high blood sugar (hyperglycemia)
• Very low blood sugar (hypoglycemia) due to overmedication, which can also cause nervousness, sweating, anxiety, and shaking.
• Frequent urination
• Intense thirst 
• Unexplained weight loss
• Fatigue
• Increased infections
• Blurry vision 
• Increased hunger
• Dizziness

Long-term complications of uncontrolled diabetes 

People who have been diagnosed with T2D should know that type 2 diabetes can be very serious if it is not controlled. Long-term problems from uncontrolled diabetes include:

• Vision problems, including difficulty seeing at night, sensitivity to light and blindness.  
• Nerve damage, causing numbness, tingling and burning, particularly in your hands and feet. It can also make it harder for males to achieve an erection. 
• Increased risk of stroke, heart attack and other circulation problems 
• Kidney damage that can end in kidney failure and dialysis. 
• Issues digesting your food properly, leading to loose bowel movements or constipation. 
• Sores and infections on the skin, potentially leading to amputations. 
• Depression. 
• Weakened immune system. 
• Irregular periods in females.
• Infertility. 
• Increased risk of dementia.
• Very dry skin.

Treatment & Reversing Type 2 Diabetes

Can type 2 diabetes be cured?  Type 2 diabetes is a chronic disease. Remission is possible however with bariatric surgery or through lifestyle change. Remission means that the blood sugars are controlled without the need for medication. Even short of remission, excellent blood sugar control through medications and lifestyle can change the course of disease, reduce symptoms, and protect against complications. There are many treatment options for type 2 diabetes, all of which are focused on blood sugar control, and on managing risk of heart disease. One of the most effective lifestyle treatments of T2D is is Virta where we see less need for diabetes medication, and sometimes diabetes remission.

Virta is a medically supervised and individualized treatment that guides patients to nutritional ketosis through real-food based carbohydrate restriction, moderate protein intake and high fat intake to achieve satiety. The Virta program is delivered through an online clinic and includes individualized intensive nutrition and behavioral counseling, biomarker monitoring, online peer support and medical provider-guided medication management.

Virta is incredibly effective. It has an efficacy rate at reducing or eliminating the amount of insulin used by patients by 87% in 10 weeks. In addition, 56% of patients were able to reverse their diabetes in 10 weeks, and 57% who began on diabetes medications were able to reduce or eliminate at least one of their prescriptions in that time. All with no serious long-term risk.

The Takeaway

If you are diagnosed with prediabetes or type 2 diabetes and want to live a healthier lifestyle, Virta Health may be able to help. By making healthy lifestyle changes in a medical setting with supportive resources like 1:1 virtual coaching, you can regain control of your health and feel like yourself again. See if you’re eligible for Virta Health here.

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