Diagnosis of Type 2 Diabetes

Type 2 Diabetes is generally diagnosed with blood sugar measurements performed after appearance of findings or high blood sugar in routine blood tests in some cases.

Glucose Metabolism

Glucose is the most important source of energy for the body. All cells use glucose as energy source.  Glucose absorbed from intestines after the meals directly passes through the blood.  This increased blood sugar just after the meal.  This increase on blood sugar provides secretion of insulin hormone from beta cells in pancreas rapidly.  Insulin provides glucose to be received by the cells and used as energy source.  Thus, blood sugar levels are kept within normal limits.

Insulin-Glucose relation as Key-Lock Model


Solutions for OGTT








Glucose is a biological sugar available in the simplest form.   This simplest sugar is vital for our body.  Because especially brain works by using glucose (simple sugar) only.  However, in very long hunger periods, some kind of protein degradation products called ketone body may be used by the brain for very long hunger periods.

Glucose is such important for the brain as well as for the muscles.  All muscles in our body are the organs which use blood sugar (glucose) most.  Therefore, inability of the muscles to use sugar plays important role in blood sugar increase.  Blood sugar increase means accumulation of unnecessary glucose (simple blood sugar) in the blood.  We call this condition hyperglycemia (just like we call high blood sugar hypertension).  Hyperglicemia (high blood sugar) is caused by inability of the muscles to intake glucose (simple sugar) as a result of deficient or inefficient insulin.

There are some locks called receptors on the muscle cells.  These receptors recognize and fits insulin under normal conditions.  Insulin is bound onto these locks like a key, opens required gaps and allows glucose (simple sugar) to go into the muscle cell.  In other words, gaps need insulin as a key to be opened for glucose (simple sugar).  We call this model lock-key model.

Function of this model spoils in Type 2 Diabetes.  Muscle cells change their locks (receptors) which exist on themselves and opens with insulin.  Insulin is programmed to go to the muscles and open these locks when blood sugar increases.  However, since number of appropriate locks are decreased much, it can not open gaps to allow glucose to enter into the muscle cell.  Consequently, blood glucose level increases and hyperglycemia appears.

What are Findings of Type 2 Diabetes?

Type 2 Diabetes is a disease which progresses with high blood glucose level. When blood sugar increases and is not used by the muscles, its excretion via urine increases.  When sugar will be excreted more with urine, it passes into the urine much with sugar.  Patients urinate much and frequently.  Because much fluid is lost from the bodies of the people who urinate much, sense of thirst appears and they start to drink water much.  Salivary secretion also reduces due to fluid loss.  Mouth dryness appears. Skin dries when water which provides tension and freshness of the skin decreases.  Wounds and infections appear especially on feet as the skin dries and numbness develops due to nerve damage.  Although blood sugar is the main energy source, they can not be used by the muscles.  Because muscles can not find the energy required, they get exhausted easily.  Patients start to have symptoms such as exhaustion, easy fatigue.  Although excessive sugar is accumulated in the blood, muscles can not get energy from this source and their hunger feeling can not be relieved no matter how much they eat.  Appetite increases due to frequent sense of hunger, but, sudden weight loss occurs unless exercise is done.  This is caused by degradation of muscles and fats as energy source by the body which suffers from energy source.  Even though this progresses differently in each patient, the result does not change and diabetes becomes significant with all symptoms.  Sugar which increases gradually in the blood and can not be consumed by the cells start to give permanent damage to all organs.


Over thirst and drinking much water








Symptoms of Type 2 Diabetes

  • Frequent urination
  • Over thirst and drinking much water
  • Mouth dryness
  • Dryness and hardening on the skin
  • Over exhaustion and tiredness
  • Sudden and rapid weight losses
  • Over hunger and desire to eat
  • Nausea and vomiting
  • Blurry vision
  • Oral malodor
  • Frequent infection
  • Late recovery of wounds
  • Menstrual disorders in women
  • Impotence and decrease on sexual potency in men


Blood sugar (glucose) should be under 100 mg/dl under normal circumcitances.  Disruption of fasting blood glucose (FBG) is considered for the values between 100 and 125 mg/dl.  People in this group are called as pre-diabetic.  In other words, they have not diabetes yet.  However, the patient stands one step before diabetes and she/he will have Type 2 Diabetes soon.

Blood sugar level of 126 mg/dl and over is enough to diagnose Type 2 Diabetes.  In Oral Glucose Tolerance Test (OGTT) of these patients for 2 hours, blood sugar will be 200 mg/dl or over at 2nd hour.

In this case, one of the two criteria is enough for Type 2 Diabetes diagnosis:

  • FBG(fasting blood glucose) ≥ 126 mg/dl
  • OGTT 2nd hour ≥ 200 mg/dl

What is Pre-Diabetes?

Fasting blood glucose level between 100 and 125 mg/dl is called as Impaired Fasting Glucose (IFG).  In this case, OGTT 2nd hour value is under 140 mg/dl which is normal.  Another condition is Impaired Glucose Tolerance (IGT).  In this case, fasting blood glucose (FBG) of the patient is normal (≤ 100 mg/ml), however OGTT 2nd hour level is detected between 140 and 199 mg/dl.  These two conditions are called pre-diabetes.

What is HbA1c?

Hemoglobin (Hb) is a protein which exist in the white blood cells and carries oxygen.  Some hemoglobin proteins are covered by sugar (glucose) according to the blood sugar level.  Like strawberries immersed in chocolate sauce, these hemoglobin are covered with glucose and they are called “glycosylated hemoglobin” or HbA1c.  This HbA1c molecule exist in blood of people who do not have diabetes, however, the percentage among all hemoglobin molecules is below 6.5%.  HbA1c levels provide an idea about progress of the blood sugar for last 3 months.  We monitor progress of blood sugar controls of diabetic patients and efficiency of the treatment applied by HbA1c levels.  If a person have HbA1c ≥ 6.5%, that person has diabetes.  If HbA1c value is between 5.7 and 6.5%, such individual is under a high risk for Type 2 Diabetes.

Facts for Type 2 Diabetes and Obesity:

  • If your fasting blood glucose is over 100 mg/dl, do not underestimate this.  “I had a heavy meal last night. That must be the cause” Don’t say this.  Immediately refer to a diabetes specialist and plan your life again.
  • Pre-Diabetes is just one step before Type 2 Diabetes.  If you do not change your lifestyle, it is inevitable that you will have Type 2 Diabetes soon.


Oral Glucose Tolerance Test








  • If you have Pre-diabetes and obesity, in other words, if you are fat which requires treatment, immediately loose weight.  Patients with a BMI value of ≥ 30 kg/m2 your fatness requires treatment.
  • Obesity is the most important cause for Type 2 Diabetes.  Pre-diabetes with obesity rapidly progresses to Type 2 Diabetes.
  • First stage treatment of obesity is diet and regular exercise.  Many patients may achieve a weight loss up to 10%.  Even this weight loss causes recovery in your health.
  • Weights lost by diet and calorie restriction are gained more in many patients within a year.  If you have obesity and pre-diabetes was added into this, you should provide a long term weight control.  Because frequent weight gaining and loosing overtaxes your body and spoils your metabolism (natural and healthy operation of the body).
  • We call this YO-YO diets and this causes earlier appearance or worsening or severe problems such as Type 2 Diabetes.
  • World Health organization reports that most efficient and permanent treatment of fatness which requires treatment is possible with obesity surgery.
  • If your BMI is ≥ 35 kg/m2 and you have Type 2 Diabetes, the MOST EFFICIENT, MOST RELIABLE and LONGEST treatment is possible with obesity surgery to remove your obesity.
  • International Diabetes federation (IDF) announced as a consensus decision that obesity surgery should be considered as an alternative treatment for the patients whose BMI is ≥ 30 kg/m2 and Type 2 Diabetes can not be controlled with traditional methods; who have Type 2 Diabetes induced hypertension and other severe cardiovascular complications.  (International Diabetes Federation Notification: Bariatric Surgical and Procedural Interventions in the Treatment of Obese Patients with Type 2 Diabetes. A position statement from the International Diabetes Federation Taskforce on Epidemiology and Prevention-2011)


Apparent Diabetes

Impaired Fasting Blood Glucose (IFG)

Impaired Glucose Tolerance (IGT)


High Risk of Diabetes

Fasting Blood Glucose

≥126 mg/dl

100-125 mg/dl

≤ 100 mg/dl

100-125 mg/dl


2nd hour blood sugar in oral glucose tolerance test

≥200 mg/dl

≤140 mg/dl

140-199 mg/dl

140-199 mg/dl


Blood Sugar in Any time

≥200 mg/dl +
Diabetes Findings






≥ % 6.5




% 5.7-6.4

Diabetes is caused by absence of insulin production congenitally or less production which is useless in 10% of the patients. This group is called Type 1 Diabetes.  Metabolic surgical methods are useless in these patients who do not have any insulin.  In fact, 90% of diabetes patients have Type 2 Diabetes.  Insulin production and function in these patients are normal.  Majority of these patients have a fatness which requires treatment (BMI ≥ 30 kg/m2).  We call this Obesity. If your obesity progresses and your body mass index is (BMI ≥ 40 kg/m2), this means you are on a stage where severe problems which may be fatal will start.  We call this Morbid Obesity.  These conditions create the most important triggering cause and the most suitable base for Type 2 Diabetes.  If you have these and diabetes (Type 2 Diabetes), Metabolic Surgery (or Obesity Surgery) is life saving for you.  Metabolic Surgery (or Obesity Surgery) is applied for your health problems.  Metabolic Surgery (or Obesity Surgery) is never an aesthetic surgical method.  Aesthetic recoveries appeared may be assessed as BONUS.  However, these aesthetic outcomes are never aimed while planning Metabolic Surgery (or Obesity Surgery).  We apply the most efficient and permanent treatment for your diabetes, hypertension, cardiovascular diseases and increased bad cholesterol (LDL) caused by obesity.