Type 2 diabetes

In type 2 diabetes, cells respond less well to insulin, so the pancreas produces more of it to keep blood sugar levels normal. This balance holds for years. When insulin production can no longer keep up with demand, blood sugar starts to rise.

That is why the disease does not usually appear overnight. It develops slowly and is often discovered by chance, in a laboratory test for something else, at an examination before a procedure or at a routine health check. The preceding stage, when values are too high but have not yet reached the threshold for the disease, is called prediabetes.

Symptoms that are easy to overlook

When symptoms appear, they are often put down to tiredness or age: increased thirst, passing urine frequently, including at night, a dry mouth, marked tiredness, blurred vision that varies over the day, itchy skin and recurrent fungal infections.

Wounds that heal more slowly than before and recurrent urinary tract or skin infections are often the first warning sign in adults. Unexpected weight loss despite an unchanged appetite is among the signs that need to be checked quickly.

Many people have no symptoms at all despite raised blood sugar. That is exactly why, if you have risk factors, regular yearly monitoring of blood sugar makes sense, even when there are no signs or symptoms.

Who is at higher risk

The risk is increased by diabetes in close family members, excess body weight, especially fat around the waist, too little exercise, high blood pressure, abnormal blood fats and age over forty-five.

In women, important risk factors also include diabetes in pregnancy, giving birth to a baby with a high birth weight and polycystic ovary syndrome.

Despite a family history, regular exercise and weight control can help to successfully avoid diabetes, or even cure it when it is found early.

When to call 112

If very high blood sugar comes with vomiting, abdominal pain, deep and rapid breathing, fruity-smelling breath, marked drowsiness or confusion, call 112. These are signs of an urgent metabolic complication that requires hospital treatment.

The opposite complication is blood sugar that is too low in people who take medicines for it. It shows itself with shaking, sweating, hunger, irritability, confusion and paleness. If the person is conscious and can swallow, give them a sugary drink or sugar straight away, and then a meal with starch.

If the person is unconscious, having seizures or cannot swallow, do not put anything in their mouth. Turn them on their side and call 112.

A wound on the foot that does not heal, is red, swollen or smells needs to be seen within a few days, not watched. In diabetes, foot infections quickly go deeper.

How the diagnosis is made and what is monitored

The diagnosis is based on laboratory tests: fasting blood sugar, glycated haemoglobin HbA1c, which shows the average sugar level over the last two to three months, and, if needed, a glucose tolerance test. A single borderline value is usually checked by repeating the test.

At the endocrinology clinic, the whole picture is assessed alongside the values: blood pressure, blood fats, body weight, kidney function and current medicines. The examination is also used to assess the risk of complications affecting the eyes, kidneys, nerves and blood vessels.

If you measure your blood sugar at home or use a sensor, bring the records. The pattern of values over the day tells more than a single number, especially when deciding on a change of treatment.

Ongoing care often takes place with your personal doctor, and we agree on follow-ups with the endocrinologist according to how the disease develops and your results.

What treatment involves

The foundation of treatment is a change in diet and physical activity. Regular walking, cutting down on sugary drinks and white flour, and losing a few kilograms noticeably improve the values in many people. This complements drug treatment and reduces the need for it.

Among medicines, metformin is the most common first choice. Newer groups of medicines also have a favourable effect on body weight, the heart and the kidneys besides blood sugar, so the choice is also adjusted to other conditions and not just to the HbA1c value.

Some people achieve remission, that is, normal values without medicines. The likelihood is higher in the first years after diagnosis and with greater weight loss. The decision to reduce or stop medicines is made by the doctor on the basis of your results.