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Ask the Doctors: What Type 2 diabetes is, understanding insulin’s role in treatment

Once seen mostly among middle-aged adults, it’s increasingly seen in young adults, adolescents and even children.

Some people can manage Type 2 diabetes with diet and exercise alone. Others might also need medication or insulin to keep their blood sugar in control.
Some people can manage Type 2 diabetes with diet and exercise alone. Others might also need medication or insulin to keep their blood sugar in control.
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Dear Doctors: We keep hearing about Type 2 diabetes, and I’m embarrassed to say, I don’t actually know what it is. What does it do, and how do I know if I have it?

A. To understand diabetes, we should first talk about glucose.

That’s the sugar our bodies make from the foods that we eat that our cells use as their main source of fuel. Glucose travels the body via the blood, which is why it’s also often referred to as blood sugar.

But it’s not immediately available to cells. That’s where insulin, a hormone the pancreas makes, comes into play. Insulin helps transport glucose from the blood into cells.

When someone has diabetes, it means the insulin part of that energy equation isn’t working properly. The body isn’t manufacturing enough — or any — insulin, or it isn’t responding properly to the insulin that’s present.

That leads to high blood-glucose levels, which, over time, are dangerous and can cause damage to the circulatory system, vision problems, nerve damage, stomach and intestinal problems, slow healing, kidney disease and a higher risk of heart disease and stroke. Extremely high levels can lead to coma and death.

With Type 1 diabetes, the pancreas makes little or no insulin. It often develops early in life but can occur at any age. This type of diabetes is managed with diet and exercise, plus medications and insulin.

Type 2 diabetes, once known as adult-onset diabetes, often develops later in life, when the body doesn’t make or use insulin well. It often begins as insulin resistance, a condition in which the body stops responding properly to the insulin in the blood.

Some people can manage Type 2 diabetes with diet and exercise alone. Others might need medication or insulin. Medication needs often change over time, so it’s important for everyone with diabetes to have medical care.

Symptoms of Type 2 diabetes often develop gradually. They include persistent fatigue, increased thirst and urination, blurry vision, frequent infections, slow healing and unintended weight loss.

Risk factors include being overweight, storing excess fat mainly in the abdomen, a family history of diabetes, inactivity and being over 45.

Once seen mostly among middle-aged adults, Type 2 diabetes increasingly has been seen in young adults, adolescents and even children.

If you suspect you have it, see your doctor. Diagnosis is usually via a blood test.

Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.