What Is Type 2 Diabetes?

What Is Type 2 Diabetes?

Type 2 diabetes strikes people of all ages, and early symptoms are subtle. In fact, about one out of three people with type 2 diabetes don't know they have it. This chronic condition thwarts the body's ability to use the carbohydrates in food for energy. The result is elevated blood sugar. Over time, this excess sugar raises the risk for heart disease, loss of vision, nerve and organ damage, and other serious conditions.

Diabetes Warning Sign: Thirst

People with type 2 diabetes frequently have no symptoms. When symptoms do appear, one of the first may be an increase in thirst. This is often accompanied by additional problems, including dry mouth, increased appetite, frequent urination -- sometimes as often as every hour -- and unusual weight loss or gain.

Diabetes Warning Sign: Headaches

As blood sugar levels become more abnormal, additional symptoms may include headaches, blurred vision, and fatigue.

Diabetes Warning Sign: Infections

In most cases, type 2 diabetes is not discovered until it takes a noticeable toll on health. One red flag is troubling infections, such as:

• Cuts or sores that are slow to heal
• Frequent yeast infections or urinary tract infections
• Itchy skin, especially in the groin area

  Diabetes Warning Sign: Sexual Dysfunction

  Sexual dysfunction is common among people with diabetes. Diabetes can cause damage to blood vessels and nerve endings in the genitals, leading to a loss of feeling and making orgasm difficult. Other complications can include vaginal dryness and impotence in men. It's estimated between 35% and 70% of men with diabetes will have at least some degree of impotence in their lifetime. And about 1 in 3 women with diabetes will experience some form of sexual dysfunction.
  

  Risk Factors You Can Control

  Some health habits and medical conditions related to your lifestyle can increase the odds of developing type 2 diabetes, including:
  
• Being overweight, especially at the waist
• A sedentary lifestyle
• Smoking
• A diet high in red meat, processed meat, high-fat dairy products, and sweets
• Abnormal cholesterol and blood fats, such as HDL "good" cholesterol lower than 35 mg/dL or a triglyceride level over 250 mg/dL

  Risk Factors You Can't Control

  Other risk factors are out of your control, including:
  
• Race or ethnicity: Hispanics, African Americans, Native Americans, and Asians have a higher than average risk.
• Family history of diabetes: Having a parent or sibling with diabetes boosts your risk.
• Age: Being 45 and older increases your risk of type 2 diabetes.

The more risk factors you have, the greater your odds of developing type 2 diabetes.

Risk Factors for Women

Having gestational diabetes when you're pregnant puts you at higher risk for developing type 2 diabetes later on. Women who give birth to a baby weighing over 9 pounds are also at risk. Having a history of polycystic ovary syndrome can also cause insulin resistance that can lead to diabetes.

How Does Insulin Work?

In a healthy person, insulin helps turn food into energy -- in an efficient manner. The stomach breaks down carbohydrates from food into sugars, including glucose. Glucose then enters the bloodstream, which stimulates the pancreas to release insulin in just the right amount. Insulin, a hormone, allows glucose to enter cells throughout the body, where it is used as fuel. Excess glucose is stored in the liver.

Type 2 Diabetes: Metabolism Mishaps

In type 2 diabetes, the cells cannot absorb glucose properly. That means glucose levels in the blood become elevated. If you've developed a condition called insulin resistance, the body makes excess insulin, but the muscle, liver, and fat cells do not use or respond properly to the insulin. With long-standing uncontrolled type 2 diabetes, the pancreas will reduce the amount of insulin it produces.

Diagnosing Type 2 Diabetes

A simple blood test can diagnose diabetes. The A1C test gives a snapshot of your average blood glucose level over the past 2-3 months. An A1C level of 6.5% or higher may indicate diabetes. With a fasting plasma glucose test, a result above 126 is considered diabetes. Your doctor may order an oral glucose challenge test with a two-hour blood test. In people with classic symptoms of diabetes, a random blood glucose level of greater than 200 can help diagnosis diabetes.

Managing Diabetes: Diet

Fortunately, controlling blood sugar levels by changing diet can also cut your risk of complications. People with type 2 diabetes should carefully monitor carbohydrate consumption, as well as total fat and protein intake, and reduce calories. Ask your doctor for a referral to a registered dietitian to help you with healthy choices and an eating plan that will work for you.

Managing Diabetes: Exercise

Routine exercise, such as strength training or walking, improves the body's use of insulin and can lower blood sugar levels in people with type 2 diabetes. Being active also helps reduce body fat, lower blood pressure, and protect against heart disease. People with type 2 diabetes should try to get 30 minutes of moderate exercise on most days of the week.

Managing Diabetes: Stress Reduction

Stress can cause blood pressure to rise. It can also increase glucose levels in your blood as part of your "fight or flight" response. Or you may turn to food to cope with stress. All are bad when living with diabetes. Instead of letting stress take its toll, try practicing relaxation techniques such as deep breathing, meditation, or visualization. Sometimes talking to a friend, family member, counselor, or member of the clergy can help. If you're still battling stress, reach out to your doctor.

Managing Diabetes: Oral Medication

When people with type 2 diabetes are unable to control blood sugar sufficiently with diet and exercise, medication may be added. There are many types of diabetes pills available, and they are often used in combination. Some work by stimulating the pancreas to make more insulin, and others improve the effectiveness of insulin, or block the digestion of starches.

Managing Diabetes: Insulin

Your doctor may prescribe insulin early on in your treatment and in combination with pills. Insulin is also used in people with type 2 diabetes who develop "beta-cell failure." This means the cells in the pancreas no longer produce insulin in response to high blood sugar levels. In this case, insulin therapy -- injections or an insulin pump -- must become part of the daily routine.

Non-Insulin Injectables

New drugs are available for people with type 2 diabetes. Pramlintide (Symlin), exenatide (Byetta), and liraglutide (Victoza) are non-insulin injectable drugs. Whereas insulin pulls glucose into the cells, these medications cause the body to release insulin to control blood sugar levels.

Glucose Testing

Testing your blood glucose level will let you know how controlled your blood sugars are and if you need to take actions to change your treatment plan. How often and when you test will be based on how controlled your diabetes is, the type of therapy used to control your diabetes, and whether you are experiencing symptoms of fluctuating sugars. Talk with your doctor to find out how often you should use a glucose meter to check your blood sugar. Some common testing times may be when waking up, before and after meals and exercise, and at bedtime.
Continuous glucose monitor (GGM) may be useful to those with type 1 diabetes to help lower their blood glucose.

Long-Term Damage: Arteries

Over time, untreated type 2 diabetes can damage many of the body's systems. About two out of three people with diabetes die of heart disease. Having diabetes also puts you at a two to four times higher risk for stroke. People with diabetes are likely to develop plaque in their arteries, reducing blood flow and increasing risk of clots. This hardening of the arteries (atherosclerosis) raises the risk of heart attack and stroke.

Long-Term Damage: Kidneys

The longer you have diabetes, the greater the risk of developing chronic kidney disease. Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008. Controlling risk factors such as uncontrolled diabetes, high blood pressure, and high cholesterol reduces your risk of developing this complication. Annual screening for kidney disease and medications, which slow the development and progression of kidney disease, are used to reduce your risk of kidney failure.

Long-Term Damage: Eyes

High blood sugar can damage the tiny blood vessels that bring oxygen and nutrients to the retina, a critical part of the eye. This is known as diabetic retinopathy, and it can cause progressive, irreversible vision loss. It is the leading cause of new cases of blindness in people between the ages of 20 and 74. Pools of blood, or hemorrhages, on the retina of an eye are visible in this image.

Long-Term Damage: Nerve Pain

Over time, uncontrolled diabetes and elevated blood sugars create a very real risk for nerve damage. Symptoms can include tingling, numbness, pain, and a pins and needles sensation -- often in the fingers, hands, toes, or feet. The damage is not reversible, but treatments can help with the pain and numbness. And controlling your diabetes can help prevent further damage.

Long-Term Damage: Feet

Diabetic nerve damage can make it difficult to feel your feet and detect injury. At the same time, hardening of the arteries results in poor blood flow to the feet. Foot sores and gangrene can occur, even from small injury. In severe cases, infections can go unchecked and result in an amputation.

Preventing Type 2 Diabetes

One of the most astonishing things about type 2 diabetes is that such a life-altering condition is often preventable. To lower your risk, follow the same guidelines for warding off heart disease:

• Eat a healthy diet.
• Exercise for 30 minutes, five days a week.
• Maintain a healthy weight.
• Talk to your doctor about being screened for prediabetes.

In people with prediabetes, lifestyle changes and medication can help prevent the progression to type 2 diabetes.

The Search for a Cellulite Fix

The Search for a Cellulite Fix

Cellulite gives a dimpled or lumpy look to the skin, usually on the thighs, abdomen, or buttocks in women -- and for some of us, it's an obsession. We'd like for these tiny lumps of fat to melt away. And we're willing to try almost anything -- creams, massage, lasers, and more. Browse the pictures ahead for WebMD's guide to cellulite -- who gets it, which remedies work, and what's a waste of money.

Signs of Cellulite

Cellulite is purely a cosmetic problem, not an illness or medical condition. It can look like faint dimples or an "orange peel" texture, and may only be seen when the skin is pressed. But for some people cellulite can be very conspicuous, forming large areas of lumpy skin, deep dimples, and creases. While it's most common on the thighs and backside, it occurs on the abdomen, upper arms, and breasts, too.

Causes of Cellulite

Cellulite is caused by fat deposits that sit side-by-side with tough collagen fibers that are anchored to the muscle beneath. When the fibers pull tight, or the fatty areas grow larger, the fat deposits may bulge out. Cellulite is much more common in women than in men.

Myth: Skinny People Don't Have Cellulite

Cellulite is related to the structures within the skin, so even slender women are likely to have some cellulite. And if thin skin runs in your family, the cellulite you have will be more visible.

Risk Factors You Can't Control

Genetics is destiny when it comes to cellulite. If your mother has cellulite, you probably will, too. White women are more likely to have cellulite than Asian women. Other risk factors include:

• Hormonal changes in pregnancy
• Aging
• 

  Risk Factors You Can Control

  Although you can't completely prevent cellulite, your lifestyle choices may affect its appearance. Factors that worsen the condition include:
  
• Yo-yo dieting
• An excessively high-carbohydrate diet
• An increase in total body fat
• Being inactive
• Fluid retention or being dehydrated

  Myth: Tanning Can Hide Cellulite

  Tanning may make the cellulite less obvious, but when the tan fades, the cellulite might look even worse. That's because frequent exposure to UV rays can damage the skin, making it thinner and less resilient, according to the International Academy of Cosmetic Dermatology.
  

  Treatment: Weight Loss

  If cellulite is caused by fatty deposits, it makes sense that losing weight would be a good strategy. In fact, in a small 2006 study, the appearance of cellulite improved for 17 women enrolled in medically supervised weight loss programs. (The average weight loss was 30 pounds.) However, for nine women, the cellulite actually appeared to worsen, especially if the skin was looser after they lost weight.
  
  

  Topical: Retinol Cream

  One study found that applying a 0.3% retinol cream to the area for six months improved the appearance of cellulite. The theory is that retinol stimulates skin tissues to create thicker skin that better covers the lumps and bumps of cellulite. Other studies have not shown differences in average skin thickness after retinol use.
  

  Topical: Methylxanthine Creams

  Some studies suggest improvement in cellulite with the use of creams containing methylxanthines, including caffeine, aminophylline and theophylline, but the extent of improvement is questionable. Other studies show no improvement. These creams are thought to act by breaking down fat, but it's not clear whether enough of the substance penetrates the skin. The American Society for Aesthetic Plastic Surgery warns that scientific proof for aminophylline products is still far in the distance.
  

  Topical: Herbal Creams

  Herbal creams containing a variety of ingredients, such as gingko biloba, sweet clover, and evening primrose oil, claim to reduce cellulite, perhaps by affecting circulation. But there aren't any scientific studies to back that up. In fact, one study of 32 anti-cellulite creams contained more than 260 different chemical ingredients. About one-quarter of those ingredients are known to cause allergic reactions in some people
  .
  

  Massage/Suction

  Lipomassage devices knead the skin with a combination of massage and suction. Several different machines are in use at MediSpas and dermatology practices, and at least one has been approved by the FDA for a temporary reduction in the appearance of cellulite. Generally, the treatment requires 35-minute sessions twice a week for about 14 weeks. The cellulite is likely to return after the treatments stop
  .
  

  Radiofrequency

  Radiofrequency devices deliver heat -- sometimes combined with tissue massage -- to damage the underlying fat and connective tissue. This is designed to spur skin tightening and to smooth out the bulges. Small studies have shown some benefits, at least temporarily.
  

  Laser Devices

  Laser devices target the underlying connective tissue to build collagen and thicken the skin. They may also apply massage, suction, cooling, and/or radiofrequency to hit cellulite with 3-4 different methods at once. Some small studies have shown some benefits, at least temporarily.
  

  Liposuction

  Standard liposuction techniques could actually lead to more skin dimpling, because the fat that causes cellulite lies close to the surface of the skin. Laser-assisted liposuction, with short pulses of high power, has been used to destroy and remove fat under the skin. However, it's too soon to say if the results will be better than with traditional liposuction. There is a risk of scarring and burns from the laser treatment
  .
  

  Subcision

  In this invasive technique, a needle is used to snip the connective tissue beneath the skin that is causing the fat deposits to bulge. The long-term results aren't clear, and the procedure's effectiveness needs to be validated in scientific studies. The treatment is expensive ($3,500 to $4,000), takes about 90 minutes, and can cause some temporary swelling and bruising.
  

  Mesotherapy

  This controversial and unapproved procedure involves injections of fat-dissolving substances beneath the skin, such as phosphotidylcholine, which is soybean lecithin extract, and sodium deoxycholate, a detergent. The FDA has issued warnings related to "lipodissolve" products. Side effects include swelling, rash, or infection. The FDA says some products have caused "permanent scarring, skin deformation, and painful knots."
  

  Body Wraps

  Being wrapped in warm, aromatic, "slenderizing" bandages may feel good. It may even temporarily tighten skin or reduce inches through dehydration. But there's no scientific evidence that body wraps have a lasting effect on cellulite or fat, and the Federal Trade Commission has warned body-wrapping firms not to promise the selective reduction of fat in one part of the body.
  

  The Cellulite 'Cure'

  You may be able to minimize your cellulite through lifestyle changes and even products or procedures, but beware of promises to "rid" you of cellulite. The FDA and Federal Trade Commission have forced some companies to stop making such claims. Most treatments at best can improve the appearance of cellulite -- while you use them.
  

  The Bottom Line: A Healthy Lifestyle

  Diet and exercise won't get rid of cellulite, but they can improve your skin and muscle tone. A combination of strength training and aerobic exercise, such as jogging or walking, can build muscle and burn fat. Staying hydrated and avoiding a high-carbohydrate diet also can help.
  

Skin and Beauty

Skin Sins

Your skin is the largest organ in your body, and it takes a lot of abuse. Constantly exposed to the elements, your epidermis (and the layers beneath) really takes a beating, especially if you're guilty of skin sins.
Want to preserve your skin? The following slides show what not to do.

1. Get Overexposed

There was a time when people thought it was healthy to slather their bodies in baby oil and spend entire days baking in the sun in order to tan their skin. Over the years, dermatologists set us straight, telling us in no uncertain terms that sun worshipping will only put us on the path to premature aging -- and skin cancer.
"If there's one thing in the world that one can do to avoid the ravages of injury to the skin, it's avoid the sun," says Norman Levine, MD, a dermatologist in Tucson, Arizona Ariz., and the author of Skin Healthy: Everyone's Guide to Great Skin. "When the sun damages the cells and deeper skin tissues irreparably you get skin aging and you are more prone to skin cancer."

2. Skimp on Sunscreen

Your sunscreen probably isn't shielding you from sun damage because most of us don't apply the shot-glass-sized amount (1 ounce) of SPF 30 or higher sunscreen -- the minimum experts say we need to protect us.
"Most people under-apply by one-fourth. Whatever you're putting on is probably too little, so at least double it," says Jeffrey Dover, MD, FRCPC, associate clinical professor of dermatology at Yale University School of Medicine] and director of SkinCare Physicians in Chestnut Hill, Mass. Also, many people also don't apply sunscreen every two hours as dermatologists recommend.

3. Head to the Tanning Bed

Think a tanning bed is safer than being outside in the sun? Think again.
Tanning beds give you a concentrated burst of ultraviolet light that causes skin aging and will increase your risk for melanoma skin cancer. "Never go into a tanning parlor," Levine says. "There couldn't be a worse thing to do to your skin."

4. Smoke

If the risk of lung cancer, emphysema, heart disease, and stroke aren't enough to scare you off cigarettes, how about all those wrinkles you'll get?
Study after study shows just how extensively smoking ages the skin. "It does a lot of what the sun does. It just does it inside (the body) instead of outside," Dover says. "It makes the skin weak, tired, and listless looking."
If that weren't enough, smoking also yellows the skin, interferes with its blood supply, and slows wound healing. "So if you injure your skin it may not heal as well if you're a smoker," Levine says

5. Use the Wrong Cleanser

A big mistake people make when they wash their face is using a harsh soap that's meant for their body. Keep the bar soap in the shower. Use only a mild cleanser for your face, especially if you have sensitive skin, Stein advises.
If your skin is acne-prone, make sure the cleanser you use is oil-free and noncomedogenic, which means it does not promote acne. People whose skin is on the dry side should follow up each wash by applying a layer of lotion (preferably one that contains sunscreen) to seal in the skin's moisture.

6. Scrub Your Skin

Washing your face is a good idea. Scrubbing it isn't.
"Scrubbing can be very irritating to the skin," cautions Stein. "A lot of times people who have acne will feel like they have to scrub the skin to make it better, but that can actually worsen the acne."
Be gentle to your skin. Wash your face using a soft, circular motion using your fingertips.

7. Pop Your Pimples

Whenever you feel tempted to pop a pimple, control the urge. "Picking will make the acne worse and lead to permanent scarring," Stein says. "Better to leave it alone."
Instead of popping pimples, try an over-the-counter pimple remedy containing benzoyl peroxide or salicylic acid. If that doesn't clear up your breakouts, call your dermatologist. If you use a magnifying mirror, give it to your worst enemy.

8. Stress Out

It's not your imagination. When you're stressed out, it really does show in your skin.
"It's not well understood, but it's clear that stress makes many skin conditions worse," Dover says.
Stress can flare up psoriasis and rosacea, as well as acne. It may also lower the skin's ability to keep out harmful irritants and infections. Plus, people who are wrapped up in their stress have less time to care for their skin properly.

9. Overdo It

Looking young and vibrant is highly prized, but the quest for it can have a price, especially if you trust your chemical peel to someone without an MD after his or her name. "I think they should be done under the guidance of a doctor because they can certainly be very irritating, particularly to sensitive skin or people who have skin conditions," Stein says. In the wrong hands, a chemical peel could leave you with an infection or permanent scars.
You also don't want to overdo home microdermabrasion and peels. Instead of making you look younger, they'll leave your skin red and irritated. Let your dermatologist guide you if you are going to try at-home skin procedures.

10. Overeat

Before you take another bite of that bacon double cheeseburger, consider this: When you gain a lot of weight, your skin has to stretch to accommodate your new girth. Lose the weight and you'll be left with flabby, saggy skin. If your skin isn't elastic enough to bounce back, you may have to resort to surgery to tighten it up.

11. Fall Short on Sleep

More than a quarter of us aren't getting the seven to nine hours of sleep we need nightly, and our exhaustion is as obvious as the pallor of our skin and the bags under our eyes.
"Your skin rejuvenates while you're sleeping," Dover says. He warns that a lack of sleep makes your face look "dull and listless" and can exaggerate the appearance of dark circles.

12. Ignore Warning Signs

A changing mole is one of the clearest signs of skin cancer. Spotting it early gives your doctor a chance to treat it before it has time to spread. But how will you ever know a mole is changing if you never look at your skin?
Once a month, you should be checking your skin from top to bottom, front to back in a full-length mirror. "You're looking for changes in the size, shape, and color of moles, or new moles," Dover says. If you spot anything, or if you've got a personal or family history of skin cancer, let your dermatologist do a full exam as well, Stein says.