Type 2 Diabetes: Symptoms and Causes

Type 2 Symptoms

When Type 2 begins:

  • None

10 Years later at diagnosis

  • Weight Gain
  • Tiredness
  • Irritability
  • Blurred vision
  • Numbness or tingling of the
    feet or legs
  • Infections
  • Slow Healing

Adapted from Using Insulin © 2003

Type 2 diabetes is a metabolic disorder in which the body has trouble using its own insulin to control the blood sugar. At the time of diagnosis, beta cells often are producing as much or more insulin as would be needed by someone else of equal weight. But changes in liver, fat, and muscle cells have created resistance to insulin. Fat cells are not responsive to insulin, so they begin releasing free fatty acids into the bloodstream and these worsen the response to insulin. The liver does not respond to insulin so it is less able to turn off its production and release of glucose, and the blood sugar rises further. Cells in the muscles would normally pick up glucose from the blood, but insulin resistance weakens this effort. All these cellular changes cause damaging fat and sugar levels to rise in the blood.

Those with Type 2 diabetes are actually a small part of a larger group that has metabolic syndrome or Syndrome X, which was first recognized in the early 1990s. This syndrome includes everyone who has insulin resistance. About 30% of those with insulin resistance eventually develop Type 2 diabetes. Type 2 diabetes occurs when the body can no longer produce enough insulin to overcome the resistance and keep up with the body’s increased need for insulin.

The insulin-resistance syndrome is associated with high triglycerides (over 200), low HDL (under 40 mg/dl), high blood pressure, and gout. Syndrome X is found in one out of every four Americans with signs that include insulin resistance, cholesterol problems (especially a low HDL and high triglycerides), and high blood pressure. Those with an apple figure who carry excess weight predominantly in their abdomen are at the highest risk to develop Syndrome X. The cholesterol and blood pressure problems associated with Syndrome X hasten cardiovascular disease, which is responsible for 70% of the deaths in this group.

By the time Type 2 diabetes is discovered, 10 to 15 years of high blood sugars often have passed. Symptoms in Type 2 diabetes often start gradually and can easily be confused with normal aging. There can be no symptoms or only mild ones. Symptoms may include tiredness, irritability, blurred vision or changes in vision, numbness, and tingling in the feet and legs, and frequent infections that don’t heal quickly.

Many people find out they have diabetes after a high blood sugar is found during a routine health exam. Early diagnosis and treatment are facilitated by having an annual physical exam that includes a blood sugar test. Because diagnosis is commonly delayed, serious complications may already be in progress at the time the disease is discovered. Therefore, a complete checkup for complications and associated diseases should be done as soon as diabetes is discovered.

For anyone with an apple figure, helpful tests include blood pressure measurement, a complete lipid panel for triglycerides, HDL, LDL, and total cholesterol; a microalbumin test of the urine to detect early kidney changes; examination of the eyes by an ophthalmologist for retinopathy; examination of the feet for nerve and vascular problems; and a careful evaluation of the heart. For those with diabetes, an additional test called the hemoglobin A1C should be done. This test shows the average blood sugar for the last three months. include Ask your health care provider for these tests if they aren’t automatically provided.

The Insulin Resistance Syndrome
A diagnosis of the Insulin Resistance Syndrome is established when 3 or more of these risk factors are present.
Risk Factor Defining Level
Abdominal obesity*

Waist circumference



Blood Pressure
Fasting Glucose


> 102 cm (> 40 in)
> 88 cm (> 35 in)

≥ 150 mg/dl

< 40 mg/dl
< 50 mg/dl

≥ 130 mm Hg or
≥ 85 mm Hg or
current use of BP med

≥ 110 mg/dl or
current use of diab. med.

*Abdominal obesity is more highly correlated with IRS than weight or BMI
Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults, JAMA: 285: 2486-2497, 2001

Adapted from Using Insulin © 2003

What Causes Type 2

People over 40 who are sedentary and overweight, especially with excess weight around the middle, are the most likely to develop Type 2 diabetes. People who have a family history of Type 2 diabetes and those with a Hispanic, Black, Native American, or Asian background are more likely to develop Type 2 when excess weight is gained.

People with Type 2 diabetes produce insulin but because of insulin resistance, the insulin does not work well. Over several years of having the disease, they gradually stop producing insulin. Some 85 to 90 percent of all diabetes is Type 2. Treatments for insulin resistance Type 2 diabetes revolves around varied combinations of diet, exercise, medications, or insulin. Insulin resistance is best treated with weight loss, a healthy diet, and exercise.

Therapy for Type 2 diabetes individuals a wide range of medications that can enhance insulin production, reduce the liver’s production of glucose, sensitize the cells to insulin, and slow the digestion of carbohydrates to minimize the rise of blood sugars after meals. Because insulin production gradually fails in Type 2 diabetes, insulin can become necessary as part of the treatment plan.

Why Apple Figures Are Unhealthy

Apples may be good for you, but an apple figure filled out with excess weight in the middle isn’t. The apple figure is almost universal in Type 2 diabetes and is occasionally encountered in adults with Type 1 diabetes. This cardiovascular risk for heart disease goes up two and a half times for men with diabetes and an apple figure. The risk rises eightfold for women with diabetes and this shape. Men and women with the apple figure share the same high risk for heart disease.

Before you blame your parents, realize that very controllable lifestyle factors are the cause of excess fat deposits in the middle. These factors include the use of alcohol (especially beer), smoking, stress, lack of exercise, gaining more than normal weight, eating fewer than three meals a day, and a diet high in fat or simple sugars.

Fat located within the abdomen can be thought of as “fast” fat. Fat cells in this location are able to release fat into the bloodstream much faster than fat cells located elsewhere. For instance, fat begins to be released from the abdomen three to four hours after the last meal compared to many more hours for fat cells in other areas of the body. This easy release was designed to provide rapid access to fuel for exertion needed for hunting and fleeing from danger. But with today’s sedentary lifestyle, the abdominal buildup of fat shows up as higher triglyceride (TG) and free fatty acid levels. The excess fat in the abdomen turns out to be a major cause of insulin resistance.

Excess heart risks accompany an apple figure in the form of higher triglyceride levels, lower HDL (protective cholesterol), higher blood pressure, Type 2 diabetes, and kidney disease. Often there is a family history of high blood pressure, heart disease, diabetes, and cholesterol problems.

Do You Have An Apple Figure?

To find out if you have an apple figure, use a tape measure to measure around your waist an inch above your navel. Next measure your hips at their widest point. Then divide your waist measurement by your hip measurement.

Ratios above 0.8 for women or above 1.0 for men suggest an unhealthy accumulation of fat in the middle. If you’ve got an apple figure, you can do the following to improve insulin sensitivity and to prevent health problems:

  • Eat fewer calories and less fat
  • Eat less at each meal and leave food on your plate
  • Eat small amounts of food more often
  • Keep blood sugars normal before breakfast and 2 hours after meals
  • Drink little or no alcohol
  • Exercise regularly
  • Don’t smoke
  • Reduce stress through lifestyle changes and stress management techniques

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