Type 2 Diabetes results from any combination of the below defects.
It is a complex disease which often requires a mix of medications, in addition to lifestyle changes, to manage. Interventions should be started early to prevent or slow progressive β-cell failure that is characteristic of Type 2 Diabetes.
What's happening in your body?
- Decreased Insulin Secretion – your pancreas is not releasing enough insulin for the current demand
- Increased Glucagon Secretion – higher levels of glucagon (a hormone) trigger the production of glucose (sugar)
- Increased Hepatic Glucose Production — your liver dumps out too much glucose (sugar)
- Decreased Incretin Effect – gut hormones that normally stimulate insulin secretion in response to food are less effective and produced at lower quantities
- Increased Lipolysis – increased fat breakdown raises triglycerides in the blood which can impair insulin secretion
- Increased Glucose Reabsorption – in an attempt to conserve glucose as an energy source, the kidneys hold onto more of it which keeps blood levels high
- Decreased Glucose Uptake – the receptors on your liver and muscle cells do not function properly to take up glucose, causing glucose to remain in the bloodstream
- Neurotransmitter Dysfunction – altered neurotransmitter function in your brain which does not properly trigger the sensation of feeling full (appetite)
Therapies to address each defect
Common brand names
- Biguanides - Metformin
- GLP-1RA - Bydureon, Victoza, Trulicity, Ozempic, Rybelsus
- SGLT-2i - Invokana, Farxiga, Jardiance, Steglatro
- DPP-4i - Januvia, Onglyza, Tradjenta
- TZD - Avandia, Actos
- Sulfonylureas/Meglitinides – Glipizide, Glyburide, Amaryl, Prandin
Due to the natural progression of β-cell failure, many people will eventually need the assistance of medication to keep their blood sugars in a safe range. This does not necessarily reflect a failure on one’s part to manage their diabetes, but rather an indicator that one’s body is ever changing, and inevitably with Type 2 diabetes, treatments will need to change over time.
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