TYPE 2 DIABETES
Type 2 Diabetes Mellitus (T2D) is the more common form of diabetes, affecting around 85% of people with diabetes worldwide. It is characterised by insulin resistance (when the insulin does not work properly – affecting the quality of the insulin) and/or insulin deficiency (when there is not enough active insulin being produced – the quantity is affected), and is strongly genetic in origin. Although lifestyle factors such as excess weight, inactivity, high blood pressure and poor diet are also major risk factors for the development of type 2 diabetes.
Type 2 used to be referred to as Mature-Onset Diabetes, as it tends to occur more in older people (over the age of 40) and becomes more and more common with age. In Australia the incidence of type 2 diabetes is around 25% in those over the age of 75. As obesity is becoming more common place, even in children, type 2 diabetes is also becoming more common, and an earlier age; hence we moved away from the term ‘maturity-onset diabetes’.
T2D was once also referred to as Non-Insulin Dependent Diabetes Mellitus or NIDDM, as patients often do well on oral agents (tablets) and hence do not need insulin treatment, at least not for the first few years. The term NIDDM was done away with in the 90’s as it became evident that most people with type 2 diabetes eventually will need insulin treatment to assure good glycaemic (blood glucose) control, if they live long enough with the disease. A person with type 2 diabetes can therefore become insulin requiring, though the diabetes itself doesn’t really change.
Not everyone who develops type 2 diabetes develops symptoms, or these symptoms may not show for many years, and hence regular screening for diabetes through your General Practitioner (GP, or family doctor) is strongly recommended, particularly for people over the age of 50 and those of certain ethnic backgrounds (in Australia this is in particular Aboriginal or Torres Strait Islander people, and those from the Middle East, India and Asia).
People with type 2 diabetes are at higher risk of cardiovascular disease, such as heart attacks and strokes, and in some cases these complications may even have formed before the diagnosis of diabetes has been made.
People with T2DM are recommended to make the dietary changes to lose some excess weight (if there is any), incorporate regular exercise into their life and most of the time tablets are needed to control the glucose levels. As mentioned above, the natural progression of the disease is an ongoing decline in beta cell function over time, hence most people with type 2 diabetes will require insulin treatment after about 5-10 years. This event is highlighted in the Figure 1.
The red dotted line in the table shows the increase in insulin requirements over time. The green solid line shows how the actual insulin production by the β-cells of the pancreas (also coined endogenous insulin) decreases as we get older. You can see that this creates a gap between what the body can produce and what is required. We aim to bridge this gap with tablets but as the b-cell function continues to decline, glycaemic control tends to get worse over time and an increase in the medication will be required. In due course tablets alone won’t be enough to warrant good glycaemic control and the need for additional insulin from outside becomes necessary. Needing to start insulin treatment is therefore not necessarily the person’s fault; this phenomenon is often referred to as “secondary failure”.
Carolien is a very experienced Credentialled Diabetes Educator, and she can help you understand better how type 2 diabetes can impact on your life and what you can do to minimise this impact. Carolien is also a Clinical Somatic Psychotherapist, a type of counsellor, and can help you or your family members.
Carolien has worked with people with diabetes for many, many years and understands how difficult it can be to have to live with this disease. Carolien says: “I found that sometimes the medical system does not take in consideration certain related factors such as the patient’s social situation, and the importance of stress on physical and emotional well-being. By remaining stuck in a dichotomy of thinking, of mind and body as 2 separate entities rather than one body-mind, many people (possibly including your doctor) don’t understand what it’s like to be ‘you’ and how difficult it is to go for a walk when you are suffering from depression, anxiety or high blood glucose levels. Even though they seem to think they know what is best for you, only you know what you can do or are willing to put in to get there.”
With the combination of her nursing background, her knowledge of diabetes (in all its types) and her somatic psychotherapy training Carolien is able to help you break through some of the barriers that you may face along the way.