`
`Diagnosis
`
`Type 2 diabetes is usually diagnosed using the glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past
`two to three months. Results are interpreted as follows:
`
`Below 5.7% is normal.
`5.7% to 6.4% is diagnosed as prediabetes.
`6.5% or higher on two separate tests indicates diabetes.
`
`If the A1C test isn't available, or if you have certain conditions that interfere with an A1C test, your health care provider may use the following tests to
`diagnose diabetes:
`Random blood sugar test. Blood sugar values are expressed in milligrams of sugar per deciliter (mg/dL) or millimoles of sugar per liter (mmol/L) of
`blood. Regardless of when you last ate, a level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially if you also have symptoms of
`diabetes, such as frequent urination and extreme thirst.
`Fasting blood sugar test. A blood sample is taken after you haven't eaten overnight. Results are interpreted as follows:
`
`Less than 100 mg/dL (5.6 mmol/L) is considered healthy.
`100 to 125 mg/dL (5.6 to 6.9 mmol/L) is diagnosed as prediabetes.
`126 mg/dL (7 mmol/L) or higher on two separate tests is diagnosed as diabetes.
`Oral glucose tolerance test. This test is less commonly used than the others, except during pregnancy. You'll need to not eat for a certain amount of
`time and then drink a sugary liquid at your health care provider's office. Blood sugar levels then are tested periodically for two hours. Results are
`interpreted as follows:
`
`Less than 140 mg/dL (7.8 mmol/L) after two hours is considered healthy.
`140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) is diagnosed as prediabetes.
`200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes.
`Screening. The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes in all adults age 35 or older
`and in the following groups:
`
`People younger than 35 who are overweight or obese and have one or more risk factors associated with diabetes.
`Women who have had gestational diabetes.
`People who have been diagnosed with prediabetes.
`Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors.
`After a diagnosis
`
`If you're diagnosed with diabetes, your health care provider may do other tests to distinguish between type 1 and type 2 diabetes because the two
`conditions often require different treatments.
`
`Your health care provider will test A1C levels at least two times a year and when there are any changes in treatment. Target A1C goals vary depending
`on age and other factors. For most people, the American Diabetes Association recommends an A1C level below 7%.
`
`You also receive tests to screen for complications of diabetes and other medical conditions.
`Treatment
`
`Management of type 2 diabetes includes:
`
`Healthy eating.
`Regular exercise.
`Weight loss.
`Possibly, diabetes medication or insulin therapy.
`Blood sugar monitoring.
`
`These steps make it more likely that blood sugar will stay in a healthy range. And they may help to delay or prevent complications.
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`Healthy eating
`There's no specific diabetes diet. However, it's important to center your diet around:
`
`A regular schedule for meals and healthy snacks.
`Smaller portion sizes.
`More high-fiber foods, such as fruits, nonstarchy vegetables and whole grains.
`Fewer refined grains, starchy vegetables and sweets.
`Modest servings of low-fat dairy, low-fat meats and fish.
`Healthy cooking oils, such as olive oil or canola oil.
`Fewer calories.
`
`Your health care provider may recommend seeing a registered dietitian, who can help you:
`
`Identify healthy food choices.
`Plan well-balanced, nutritional meals.
`Develop new habits and address barriers to changing habits.
`Monitor carbohydrate intake to keep your blood sugar levels more stable.
`Physical activity
`
`Exercise is important for losing weight or maintaining a healthy weight. It also helps with managing blood sugar. Talk to your health care provider before
`starting or changing your exercise program to ensure that activities are safe for you.
`Aerobic exercise. Choose an aerobic exercise that you enjoy, such as walking, swimming, biking or running. Adults should aim for 30 minutes or
`more of moderate aerobic exercise on most days of the week, or at least 150 minutes a week.
`Resistance exercise. Resistance exercise increases your strength, balance and ability to perform activities of daily living more easily. Resistance
`training includes weightlifting, yoga and calisthenics. Adults living with type 2 diabetes should aim for 2 to 3 sessions of resistance exercise each
`week.
`Limit inactivity. Breaking up long periods of inactivity, such as sitting at the computer, can help control blood sugar levels. Take a few minutes to
`stand, walk around or do some light activity every 30 minutes.
`Weight loss
`Weight loss results in better control of blood sugar levels, cholesterol, triglycerides and blood pressure. If you're overweight, you may begin to see
`improvements in these factors after losing as little as 5% of your body weight. However, the more weight you lose, the greater the benefit to your
`health. In some cases, losing up to 15% of body weight may be recommended.
`
`Your health care provider or dietitian can help you set appropriate weight-loss goals and encourage lifestyle changes to help you achieve them.
`Monitoring your blood sugar
`
`Your health care provider will advise you on how often to check your blood sugar level to make sure you remain within your target range. You may, for
`example, need to check it once a day and before or after exercise. If you take insulin, you may need to check your blood sugar multiple times a day.
`
`Monitoring is usually done with a small, at-home device called a blood glucose meter, which measures the amount of sugar in a drop of blood. Keep a
`record of your measurements to share with your health care team.
`
`Continuous glucose monitoring is an electronic system that records glucose levels every few minutes from a sensor placed under the skin. Information
`can be transmitted to a mobile device such as a phone, and the system can send alerts when levels are too high or too low.
`Diabetes medications
`If you can't maintain your target blood sugar level with diet and exercise, your health care provider may prescribe diabetes medications that help lower
`glucose levels, or your provider may suggest insulin therapy. Medicines for type 2 diabetes include the following.
`Metformin (Fortamet, Glumetza, others) is generally the first medicine prescribed for type 2 diabetes. It works mainly by lowering glucose production
`in the liver and improving the body's sensitivity to insulin so it uses insulin more effectively.
`
`Some people experience B-12 deficiency and may need to take supplements. Other possible side effects, which may improve over time, include:
`
`Nausea.
`Abdominal pain.
`Bloating.
`Diarrhea.
`Sulfonylureas help the body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol XL) and glimepiride (Amaryl).
`Possible side effects include:
`
`Low blood sugar.
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`Weight gain.
`Glinides stimulate the pancreas to secrete more insulin. They're faster acting than sulfonylureas. But their effect in the body is shorter. Examples
`include repaglinide and nateglinide. Possible side effects include:
`
`Low blood sugar.
`Weight gain.
`Thiazolidinediones make the body's tissues more sensitive to insulin. An example of this medicine is pioglitazone (Actos). Possible side effects
`include:
`
`Risk of congestive heart failure.
`Risk of bladder cancer (pioglitazone).
`Risk of bone fractures.
`Weight gain.
`DPP-4 inhibitors help reduce blood sugar levels but tend to have a very modest effect. Examples include sitagliptin (Januvia), saxagliptin (Onglyza)
`and linagliptin (Tradjenta). Possible side effects include:
`
`Risk of pancreatitis.
`Joint pain.
`GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels. Their use is often associated with weight
`loss, and some may reduce the risk of heart attack and stroke. Examples include exenatide (Byetta, Bydureon Bcise), liraglutide (Saxenda, Victoza)
`and semaglutide (Rybelsus, Ozempic, Wegovy). Possible side effects include:
`
`Risk of pancreatitis.
`Nausea.
`Vomiting.
`Diarrhea.
`SGLT2 inhibitors affect the blood-filtering functions in the kidneys by blocking the return of glucose to the bloodstream. As a result, glucose is
`removed in the urine. These medicines may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Examples include
`canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance). Possible side effects include:
`
`Vaginal yeast infections.
`Urinary tract infections.
`Low blood pressure.
`High cholesterol.
`Risk of gangrene.
`Risk of bone fractures (canagliflozin).
`Risk of amputation (canagliflozin).
`Other medicines your health care provider might prescribe in addition to diabetes medications include blood pressure and cholesterol-lowering
`medicines, as well as low-dose aspirin, to help prevent heart and blood vessel disease.
`Insulin therapy
`Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it may be prescribed
`sooner if blood sugar targets aren't met with lifestyle changes and other medicines.
`
`Different types of insulin vary on how quickly they begin to work and how long they have an effect. Long-acting insulin, for example, is designed to work
`overnight or throughout the day to keep blood sugar levels stable. Short-acting insulin generally is used at mealtime.
`
`Your health care provider will determine what type of insulin is right for you and when you should take it. Your insulin type, dosage and schedule may
`change depending on how stable your blood sugar levels are. Most types of insulin are taken by injection.
`
`Side effects of insulin include the risk of low blood sugar — a condition called hypoglycemia — diabetic ketoacidosis and high triglycerides.
`Weight-loss surgery
`
`Weight-loss surgery changes the shape and function of the digestive system. This surgery may help you lose weight and manage type 2 diabetes and
`other conditions related to obesity. There are several surgical procedures. All of them help people lose weight by limiting how much food they can eat.
`Some procedures also limit the amount of nutrients the body can absorb.
`
`Weight-loss surgery is only one part of an overall treatment plan. Treatment also includes diet and nutritional supplement guidelines, exercise and
`mental health care.
`
`Generally, weight-loss surgery may be an option for adults living with type 2 diabetes who have a body mass index (BMI) of 35 or higher. BMI is a
`formula that uses weight and height to estimate body fat. Depending on the severity of diabetes or the presence of other medical conditions, surgery
`may be an option for someone with a BMI lower than 35.
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`Weight-loss surgery requires a lifelong commitment to lifestyle changes. Long-term side effects may include nutritional deficiencies and osteoporosis.
`Pregnancy
`People living with type 2 diabetes often need to change their treatment plan during pregnancy and follow a diet that controls carbohydrates. Many
`people need insulin therapy during pregnancy. They also may need to stop other treatments, such as blood pressure medicines.
`
`There is an increased risk during pregnancy of developing a condition that affects the eyes called diabetic retinopathy. In some cases, this condition
`may get worse during pregnancy. If you are pregnant, visit an ophthalmologist during each trimester of your pregnancy and one year after you give
`birth. Or as often as your health care provider suggests.
`Signs of trouble
`
`Regularly monitoring your blood sugar levels is important to avoid severe complications. Also, be aware of symptoms that may suggest irregular blood
`sugar levels and the need for immediate care:
`High blood sugar. This condition also is called hyperglycemia. Eating certain foods or too much food, being sick, or not taking medications at the right
`time can cause high blood sugar. Symptoms include:
`
`Frequent urination.
`Increased thirst.
`Dry mouth.
`Blurred vision.
`Fatigue.
`Headache.
`Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). This life-threatening condition includes a blood sugar reading higher than 600 mg/dL
`(33.3 mmol/L). HHNS may be more likely if you have an infection, are not taking medicines as prescribed, or take certain steroids or drugs that cause
`frequent urination. Symptoms include:
`
`Dry mouth.
`Extreme thirst.
`Drowsiness.
`Confusion.
`Dark urine.
`Seizures.
`Diabetic ketoacidosis. Diabetic ketoacidosis occurs when a lack of insulin results in the body breaking down fat for fuel rather than sugar. This results
`in a buildup of acids called ketones in the bloodstream. Triggers of diabetic ketoacidosis include certain illnesses, pregnancy, trauma and medicines —
`including the diabetes medicines called SGLT2 inhibitors.
`
`The toxicity of the acids made by diabetic ketoacidosis can be life-threatening. In addition to the symptoms of hyperglycemia, such as frequent urination
`and increased thirst, ketoacidosis may cause:
`
`Nausea.
`Vomiting.
`Abdominal pain.
`Shortness of breath.
`Fruity-smelling breath.
`Low blood sugar. If your blood sugar level drops below your target range, it's known as low blood sugar. This condition also is called hypoglycemia.
`Your blood sugar level can drop for many reasons, including skipping a meal, unintentionally taking more medication than usual or being more
`physically active than usual. Symptoms include:
`
`Sweating.
`Shakiness.
`Weakness.
`Hunger.
`Irritability.
`Dizziness.
`Headache.
`Blurred vision.
`Heart palpitations.
`Slurred speech.
`Drowsiness.
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`Confusion.
`
`If you have symptoms of low blood sugar, drink or eat something that will quickly raise your blood sugar level. Examples include fruit juice, glucose
`tablets, hard candy or another source of sugar. Retest your blood in 15 minutes. If levels are not at your target, eat or drink another source of sugar. Eat
`a meal after your blood sugar level returns to normal.
`
`If you lose consciousness, you need to be given an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.
`Lifestyle and home remedies
`
`Careful management of type 2 diabetes can reduce the risk of serious — even life-threatening — complications. Consider these tips:
`Commit to managing your diabetes. Learn all you can about type 2 diabetes. Make healthy eating and physical activity part of your daily routine.
`Work with your team. Establish a relationship with a certified diabetes education specialist, and ask your diabetes treatment team for help when
`you need it.
`Identify yourself. Wear a necklace or bracelet that says you are living with diabetes, especially if you take insulin or other blood sugar-lowering
`medicine.
`Schedule a yearly physical exam and regular eye exams. Your diabetes checkups aren't meant to replace regular physicals or routine eye
`exams.
`Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year. Your health care provider also
`may recommend the pneumonia vaccine. The Centers for Disease Control and Prevention (CDC) also recommends the hepatitis B vaccination if
`you haven't previously received this vaccine and you're 19 to 59 years old. Talk to your health care provider about other vaccinations you may need.
`Take care of your teeth. Diabetes may leave you prone to more-serious gum infections. Brush and floss your teeth regularly and schedule
`recommended dental exams. Contact your dentist right away if your gums bleed or look red or swollen.
`Pay attention to your feet. Wash your feet daily in lukewarm water, dry them gently, especially between the toes, and moisturize them with lotion.
`Check your feet every day for blisters, cuts, sores, redness and swelling. Contact your health care provider if you have a sore or other foot problem
`that isn't healing.
`Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling
`high blood pressure and cholesterol. Take medication as prescribed.
`If you smoke or use other types of tobacco, ask your health care provider to help you quit. Smoking increases your risk of diabetes
`complications. Talk to your health care provider about ways to stop using tobacco.
`Use alcohol sparingly. Depending on the type of drink, alcohol may lower or raise blood sugar levels. If you choose to drink alcohol, only do so
`with a meal. The recommendation is no more than one drink daily for women and no more than two drinks daily for men. Check your blood sugar
`frequently after drinking alcohol.
`Make healthy sleep a priority. Many people with type 2 diabetes have sleep problems. And not getting enough sleep may make it harder to keep
`blood sugar levels in a healthy range. If you have trouble sleeping, talk to your health care provider about treatment options.
`Alternative medicine
`
`Many alternative medicine treatments claim to help people living with diabetes. According to the National Center for Complementary and Integrative
`Health, studies haven't provided enough evidence to recommend any alternative therapies for blood sugar management. Research has shown the
`following results about popular supplements for type 2 diabetes:
`Chromium supplements have been shown to have few or no benefits. Large doses can result in kidney damage, muscle problems and skin
`reactions.
`Magnesium supplements have shown benefits for blood sugar control in some but not all studies. Side effects include diarrhea and cramping. Very
`large doses — more than 5,000 mg a day — can be fatal.
`Cinnamon, in some studies, has lowered fasting glucose levels but not A1C levels. Therefore, there's no evidence of overall improved glucose
`management.
`
`Talk to your health care provider before starting a dietary supplement or natural remedy. Do not replace your prescribed diabetes medicines with
`alternative medicines.
`Coping and support
`
`Type 2 diabetes is a serious disease, and following your diabetes treatment plan takes commitment. To effectively manage diabetes, you may need a
`good support network.
`
`Anxiety and depression are common in people living with diabetes. Talking to a counselor or therapist may help you cope with the lifestyle changes and
`stress that come with a type 2 diabetes diagnosis.
`
`Support groups can be good sources of diabetes education, emotional support and helpful information, such as how to find local resources or where to
`find carbohydrate counts for a favorite restaurant. If you're interested, your health care provider may be able to recommend a group in your area.
`
`You can visit the American Diabetes Association website to check out local activities and support groups for people living with type 2 diabetes. The
`American Diabetes Association also offers online information and online forums where you can chat with others who are living with diabetes. You also
`can call the organization at 800-DIABETES (800-342-2383).
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`Preparing for your appointment
`
`At your annual wellness visit, your health care provider can screen for diabetes and monitor and treat conditions that increase your risk of diabetes,
`such as high blood pressure, high cholesterol or a high BMI.
`
`If you are seeing your health care provider because of symptoms that may be related to diabetes, you can prepare for your appointment by being ready
`to answer the following questions:
`
`When did your symptoms begin?
`Does anything improve the symptoms or worsen the symptoms?
`What medicines do you take regularly, including dietary supplements and herbal remedies?
`What are your typical daily meals? Do you eat between meals or before bedtime?
`How much alcohol do you drink?
`How much daily exercise do you get?
`Is there a history of diabetes in your family?
`
`If you are diagnosed with diabetes, your health care provider may begin a treatment plan. Or you may be referred to a doctor who specializes in
`hormonal disorders, called an endocrinologist. Your care team also may include the following specialists:
`
`Dietitian.
`Certified diabetes education specialist.
`Foot doctor, also called a podiatrist.
`Doctor who specializes in eye care, called an ophthalmologist.
`
`Talk to your health care provider about referrals to other specialists who may be providing care.
`Questions for ongoing appointments
`
`Before any appointment with a member of your treatment team, make sure you know whether there are any restrictions, such as not eating or drinking
`before taking a test. Questions that you should regularly talk about with your health care provider or other members of the team include:
`
`How often do I need to monitor my blood sugar, and what is my target range?
`What changes in my diet would help me better manage my blood sugar?
`What is the right dosage for prescribed medications?
`When do I take the medications? Do I take them with food?
`How does management of diabetes affect treatment for other conditions? How can I better coordinate treatments or care?
`When do I need to make a follow-up appointment?
`Under what conditions should I call you or seek emergency care?
`Are there brochures or online sources you recommend?
`Are there resources available if I'm having trouble paying for diabetes supplies?
`What to expect from your doctor
`Your health care provider is likely to ask you questions at your appointments. Those questions may include:
`
`Do you understand your treatment plan and feel confident you can follow it?
`How are you coping with diabetes?
`Have you had any low blood sugar?
`Do you know what to do if your blood sugar is too low or too high?
`What's a typical day's diet like?
`Are you exercising? If so, what type of exercise? How often?
`Do you sit for long periods of time?
`What challenges are you experiencing in managing your diabetes?
`
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