Type 2 Diabetes
Type 2 diabetes is a condition where the body doesn’t make enough insulin (relative insulin deficiency) or the body is unable to use the insulin properly (insulin resistance), or both.
Type 2 diabetes is a progressive condition. Over time, the beta-cells (the cells in the pancreas that make insulin) are destroyed, thus producing less and less insulin. Insulin resistance is associated with overweight and obesity. Overweight and obesity are one of the possible causes for the beta-cell being destroyed over time.
Initially people with type 2 diabetes are treated with tablets only, but because less and less insulin is produced over time, most people with type 2 diabetes will need to start using insulin to control their blood sugar (glucose) levels.
It is important for people with type 2 diabetes to know and understand that the condition is progressive, and that extra medication needs to be added over time, as many people think that they have “failed” because they need extra / additional medication.
Weight loss and management, healthy eating and exercise are equally as important as taking medication in the treatment of type 2 diabetes.
Symptoms of Type 2 Diabetes
Type 2 diabetes develops over a few years, and many people with type 2 diabetes do not have any symptoms, or they may not recognize these symptoms. Worldwide, up to 50% of people living with type 2 diabetes have not been diagnosed.
Treating Type 2 Diabetes
Type 2 diabetes is a progressive condition, and therefore additional medication will need to be added to your treatment regimen over time. Most people with type 2 diabetes will start treatment with oral tablets in combination with healthy eating and exercise, but over time, the majority of people with type 2 diabetes will also need to inject insulin.
Sensitizers
Sensitizers (also known as insulin sensitizers): these are tablets that are used to treat insulin resistance. They help the body’s cells use the insulin properly. There are 2 types of sensitizers.
Secretagogues
Insulin Secretagogues: these are tablets that help the beta-cells in the pancreas (the cells that make and release insulin) to make more insulin. In type 2 diabetes, the beta-cells are destroyed over time so the cells do not make enough insulin to control blood sugar (glucose) levels. Insulin secretagogues help the beta-cells to make and release more insulin to help lower the blood sugar (glucose) levels.
SGLT2-inhibitors (SGLT2-i)
These are oral tablets that act directly on the kidneys. They inhibit the reabsorption of glucose from the blood circulating in the kidneys back into the blood circulating in the body, thereby reducing blood glucose levels. The excess glucose from the blood is then passed out of the urine. SGLT2i’s have a weight loss benefit, the have been proven to have significant protective effects on the kidneys and have no hypoglycaemic risk as they do not have any effect on insulin levels.
Insulin use in type 2 diabetes
In type 2 diabetes, insulin can be added into your treatment plan along with your oral tablets.
Basal-Oral Therapy
In type 2 diabetes, as the beta-cells produce less and less insulin, it is necessary to start injecting insulin to increase your body’s levels of insulin to control your blood sugar (glucose) levels, in combination with your oral tablets. You must not stop taking your oral tablets unless your doctor has advised you to do so.
Premix insulin
Premix insulin is insulin that contains both a short (bolus) acting component and a long (basal) acting component. This means that there is a component (usually 30%) that is short-acting and will cover the meal, and a long/basal acting component (usually 70%) that will work in the background between meals, and overnight.