2. What is Type 2 Diabetes

Diabetes mellitus occurs when the body cannot produce insulin, or the body makes insulin but it does not work properly.

There are two main types of diabetes mellitus as well as some other less common forms, and the treatment required for each type of diabetes may differ:

• Type 1 diabetes

• Type 2 diabetes

• Cystic Fibrosis related diabetes 

• Steroid/ medication induced diabetes

What is insulin?

The pancreas is a gland which is located behind the stomach in the abdomen. Insulin is a hormone which is produced by cells known as beta cells in the pancreas.

When we eat food, it is digested in our stomach and small intestine and the nutrients from that food pass into the bloodstream. Any food that contains carbohydrates (sugar and starches) is changed into glucose during digestion, and the glucose then passes into the bloodstream. Insulin is produced by the pancreas, and assists the glucose to get from the blood into the cells of the body to be used for energy. Without insulin the glucose cannot get into the cells and the body cannot make the energy it needs to function.

Type 2 diabetes

Type 2 diabetes is when the body is unable to use insulin properly due to "resistance" to insulin. The cells in the pancreas that make insulin still produce insulin. However the insulin is not able to work properly because the cells in the body are "resistant" to its effects (so more insulin is needed to do the same job). Sometimes the insulin-making cells in the pancreas become exhausted which leads to not enough insulin being produced, in addition to the problem of insulin resistance.

Insulin is needed to allow the glucose to get from the blood into cells where it is used for energy. If there is not enough insulin in the body or it is not working properly, the glucose gets stuck in our blood. This results in the levels of glucose in the blood becoming too high.

• Type 2 diabetes is mostly found in adults but children can also develop type 2 diabetes.

• Type 2 diabetes can be prevented or delayed in some people by making lifestyle changes.

The following link takes you to a video produced by Diabetes UK that helps to explain diabetes in more detail.  https://www.diabetes.org.uk/Guide-to-diabetes/What-is-diabetes/Diabetes-and-the-body/

What are the symptoms of type 2 diabetes?

If the glucose level in the blood stays high it can cause serious health problems.

One of the first signs of type 2 diabetes is dark skin patches that appear anywhere on the body where there are folds of skin, such as around the neck, in the arm pits, behind the knees or in the groin area. This change in the skin is called Acanthosis Nigricans and it is caused by the body not being able to use the available insulin effectively. It is a sign of insulin resistance.

High blood glucose levels can also cause:

• Tiredness

• Low energy

• Blurry vision

• Significant thirst and passing urine frequently

• Weight loss

• Feeling sick

• Decreased concentration at school

• Mood changes

• Frequent infections or slow healing wounds.

• Long term can cause damage to the eyes, kidneys and heart.

As type 2 diabetes is slow to develop there may be no signs but your doctor might just have picked this up in a blood test. 

Who is at risk of developing type 2 diabetes?

Some children/young people are at a higher risk of developing type 2 diabetes especially if there is more than one of the following risk factors present:

• history of diabetes in the family (grandparents, parents, brothers or sisters)

• Maori, Asian, Middle Eastern or Pacific Island ethnicity  

• Obesity or being overweight

• Non-active lifestyle ( less than 60min a day exercise/activity most days)

Treatment of type 2 diabetes

Healthy lifestyle choices
The best support and help for children and young people with type 2 diabetes is around lifestyle changes, focusing on healthy eating and increasing activity levels.  These changes can make a big impact on the child/young person's overall health and wellbeing and will help the body to use insulin more effectively.  Changing behaviours and habits can be difficult but positive changes can be made when families/whanau come together to make goals and support each other.  Sometimes making small changes is easier than trying to change everything at once. Your diabetes team can help you and your family/whanau make a plan with clear, achievable goals.  

Metformin tablets  
Metformin tablets are another way of helping the body to use the insulin more efficiently.  

Some children/young people will need to take Metformin tablets once or twice a day.  Your diabetes team will provide information on a treatment plan using Metformin if it is required.

Metformin only works if it is taken regularly.  Sometimes it helps children/young people to remember, if families have put some regular routines in place, e.g. remembering to take it at the same time as a meal. Parents should always supervise the medication being given.

Metformin tablets should be stopped during vomiting illnesses and/or if any radiology tests are required (for example CT scan) but should be restarted when recovered. Drinking alcohol is not recommended when taking Metformin.  

Insulin Injections
In children with type 2 diabetes, sometimes the body cannot make enough insulin and insulin injections will be required.  Insulin injections may help to slow the progression of type 2 diabetes in children/young people. Insulin injections might be needed once a day or twice a day. Each child's treatment plan is created with the family/whanau taking into consideration any cultural and social needs.

How is type 2 diabetes diagnosed?

If symptoms of type 2 diabetes are present, or there are other risk factors present, a fingerprick blood test or urine test to check the level of glucose is done. Generally if the level of glucose is high further blood tests may be requested.  One of the tests is called HbA1c. This test measures the amount of glucose which sticks to the protein in red blood cells. This helps to give a picture of average blood glucose levels over the 3 month period before this. Additional blood and urine tests will be done to check kidneys and heart health. 

What is Type 2 Diabetes - an overview. Let's go over the main points we've just covered. Ready?

Think you've got it sorted now?

If you have read through the information above and watched the video, and you feel confident that you understand this module, print off and fill in the evaluation form below (you might need to ask someone to print this off for you) and return to the nurse on your ward. If you have any questions, note them down on this form and your diabetes nurse specialist will discuss them with you.

What is type 2 diabetes: Evaluation

After reading this teaching module and watching the Diabetes UK video, I feel confident that I can understand and describe:

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