Type 2 Diabetes - Symptoms, Diagnosis of Type 2 Diabetes Mellitus - How Is Type 2 Diagnosed?

People with diabetes and their families need to acquire detailed knowledge about the disease. Many people with diabetes experience a wide range of complications and secondary conditions. They must always be able to respond appropriately to these. Medical professionals classify complications as short-term and long-term.

Short-Term Complications

Short-term complications include, for example, hypoglycemia or blood sugar fluctuations. The latter can even lead to a coma. Hypoglycemia poses a significant risk. Hypoglycemic shock may also develop. Patients taking certain diabetes medications (e.g., sulfonylurea preparations) are particularly at risk. 

Causes of hypoglycemia include, for example:

• unusual physical exertion
• dietary mistakes, such as skipping meals
• alcohol consumption

Clinical signs of hypoglycemia include, for example:

• heart palpitations
• Pale skin
• Sweating
• Tremors
• Hunger
• Anxiety
• Restlessness
• Headaches
• Difficulty concentrating and
• Irritability

In cases of acute hypoglycemia, the patient needs sugar quickly. 

To do so, they can consume the following:

• 2–3 sugar cubes or glucose tablets
• 1 glass of fruit juice or sweetened tea, or
• 1–2 BE of fruit, bread, or cookies

A second short-term complication is the exact opposite: high blood sugar. In cases of severe high blood sugar (hyperglycemia), performance is usually impaired. Impaired consciousness or loss of consciousness (diabetic coma) may occur.

In addition, the following symptoms may occur:

• Nausea and vomiting
• Thirst
• Abdominal pain
• Dry skin
• Shallow breathing and
• smell of acetone on the breath

Sudden factors may be responsible for hyperglycemia:

• a sudden illness
• infections
• overeating
• other medications, or
• an interruption in diabetes treatment

It is important to identify the cause of the blood sugar spike in order to adjust treatment and prevent further spikes. Depending on the severity of the hyperglycemia, treatment with insulin is administered. The patient should also drink plenty of fluids.

Long-term complications

Possible long-term complications include damage to:

• Eyes
• Kidneys
• Nerves
• Heart and
• blood vessels

Complications and secondary conditions of diabetes mellitus can be life-threatening. They are responsible for reducing life expectancy in people with diabetes.

Poor blood sugar control over a prolonged period leads to changes in the:

• small (microangiopathy) and
• large blood vessels (macroangiopathy)

Microangiopathy particularly damages the kidneys (diabetic nephropathy) and the eyes (retinopathy).

It plays a crucial role in the development of:

• diabetic neuropathy (diabetic polyneuropathy) and
• Diabetic foot
• Diabetic retinopathy

The cause of these conditions is poor blood sugar control over many years. This damages the blood vessels in the retina of the eyes. Bulges (microaneurysms) form. In addition, fatty deposits may accumulate on the blood vessels. As a result, new blood vessels form that bleed easily and can lead to blindness. In Germany, approximately 8,000 people currently go blind each year as a result of diabetic complications. To treat diabetic retinal damage, good blood sugar control is essential. Regular checkups with an ophthalmologist are also necessary.

Diabetic Nephropathy

Poor blood sugar control over many years also causes damage to the blood vessels in the kidneys. This, in turn, leads to a progressive loss of kidney function. As a result, dialysis (blood filtration) becomes necessary after some time. In Germany, approximately half of all patients requiring dialysis are diabetic.

Nephropathy often manifests with the following symptoms:

• fluid buildup in the tissues (edema) or
• high blood pressure that is difficult to control with medication

Once these symptoms appear, it is usually no longer possible to restore normal kidney function. Treatment can only prevent the disease from progressing further. For this reason, close monitoring of blood sugar levels and regular checkups are absolutely essential.

Diabetic Foot

Various factors can contribute to the development of diabetic foot syndrome. 

These include, for example:

• Circulatory disorders and
• Peripheral neuropathy (nerve damage) resulting from long-standing diabetes mellitus

Nerve damage, in particular, often leads to abnormal or uneven weight distribution on the foot. The foot also loses some of its sensitivity, meaning that those affected no longer feel as much in their feet. This often results in unnoticed injuries, which can serve as a potential entry point for pathogens. In turn, infections can lead to chronic and poorly healing wounds. Inadequate or improper foot care can also play a significant role in the development of this serious condition.

If treatment is lacking or delayed, amputation may be necessary. In Germany, nearly 30,000 amputations are performed each year on people with diabetes. 

This high number can be reduced through the following measures:

• Good blood sugar control
• Regular checkups, as well as
• Timely and appropriate treatment

The diagnosis can be made using several methods. A clear indication is a consistently elevated blood glucose level measured repeatedly while fasting.

Long-term blood sugar levels can be expressed by the so-called HbA1c value. If this value is significantly elevated, it is also an indication of diabetes.

Most often, doctors diagnose diabetes mellitus using an oral glucose tolerance test. This test involves measuring blood glucose levels after the patient drinks a standardized glucose solution. The focus is on the progression of blood glucose levels over time.

There are standardized guidelines for the treatment of type 2 diabetes mellitus. Specialists in the treatment of diabetes are medical doctors in the field of diabetology.

The goal of treatment is to prevent short-term complications, such as:

• hypoglycemia and
• blood glucose fluctuations

It is also intended to counteract symptoms of poorly controlled diabetes, such as:

• reduced physical performance and
• susceptibility to infections

In the long term, the treatment is intended to prevent or delay the onset of complications. 

Typical complications include damage to:

• eyes
• Feet
• Kidneys
• blood vessels, and
• nerves

For the majority of people with type 2 diabetes, treatment consists solely of dietary changes.

Exercise and physical activity also aid in treatment. Working muscles can absorb and burn sugar independently of insulin. Therefore, with sufficient exercise, the body requires less insulin to regulate blood sugar levels.

Medications (pills or insulin) are used only when a healthy lifestyle is not sufficient. A proper and mindful diet is a lifelong companion for people with diabetes. Patients can learn more about proper and mindful eating in specialized training sessions.

Type 2 diabetes mellitus is one of the most common chronic metabolic disorders and results from a combination of various risk factors for diabetes, such as obesity, lack of physical activity, and genetic predisposition. The onset of diabetes, including type 2 diabetes, is usually gradual, so typical symptoms often do not appear until later. Many people with type 2 diabetes do not notice the condition until they already have elevated blood sugar levels or complications have developed.

Early diagnosis and treatment are crucial for preventing complications. Tests such as the oral glucose tolerance test and care provided by a doctor play an important role in this process. Organizations such as the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung) and the German Diabetes Society provide clear recommendations on diagnosis, treatment, and long-term care. International findings, such as those from *Diabetes Care*, also contribute to improving treatment.

In addition to oral antidiabetic medications, the treatment of diabetes also involves lifestyle changes. A balanced diet and a targeted nutritional plan for diabetes are key components of controlling blood sugar. People with diabetes should also ensure they get enough exercise to reduce the increased risk of complications. The risk of cardiovascular disease, in particular, is elevated in this condition.

Since many people have type 2 diabetes, prevention is particularly important. Measures to prevent type 2 diabetes can help delay the onset of the disease or even prevent it altogether. Nevertheless, type 2 diabetes cannot always be completely avoided, especially in cases of genetic predisposition. The course of type 2 diabetes varies from person to person, which is why personalized treatment is necessary. Overall, it is clear that a healthy lifestyle and early intervention are crucial for reducing the risk of developing type 2 diabetes and maintaining quality of life in the long term.