Type 2 diabetes

    Type 2 diabetes


    Definition of Type 2 diabetes


    With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn’t produce enough insulin to maintain a normal glucose level. Untreated, type 2 diabetes can be life-threatening.

    More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There’s no cure for type 2 diabetes, but you can manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise don’t control your blood sugar, you may need diabetes medications or insulin therapy.

    Symptoms of Type 2 diabetes

    Type 2 diabetes symptoms may develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for:


    When to see a doctor

    See your doctor if you notice any type 2 diabetes symptoms.


    Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. Exactly why this happens is unknown, although excess weight and inactivity seem to be contributing factors.

    How insulin works


    • The pancreas secretes insulin into the bloodstream.
    • The insulin circulates, enabling sugar to enter your cells.
    • Insulin lowers the amount of sugar in your bloodstream.

    The role of glucose


    • Your liver stores and makes glucose.
    • When your insulin levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.


    In the much less common type 1 diabetes, the pancreas produces little or no insulin.

    Risk factors

    Researchers don’t fully understand why some people develop type 2 diabetes and others don’t. It’s clear, however, that certain factors increase the risk, including:

    • Age. The risk of type 2 diabetes increases as you get older, especially after age 45. That’s probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
    • Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of later developing type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.

    Complications of Type 2 diabetes



    • Heart and blood vessel disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure. The risk of stroke is two to four times higher for people with diabetes, and the death rate from heart disease is two to four times higher for people with diabetes than for people without the disease, according to the American Heart Association.
    • Alzheimer’s disease. Type 2 diabetes may increase the risk of Alzheimer’s disease and vascular dementia. The poorer your blood sugar control, the greater the risk appears to be. So what connects the two conditions? One theory is that cardiovascular problems caused by diabetes could contribute to dementia by blocking blood flow to the brain or causing strokes. Other possibilities are that too much insulin in the blood leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose.
    • Hearing problems. Diabetes can also lead to hearing impairment.

    Preparing for your appointment

    Your family doctor or primary care physician likely will diagnose your type 2 diabetes, then refer you to a doctor who specializes in hormonal disorders (endocrinologist). Your health care team also may include:

    • Dietitian
    • Certified diabetes educator
    • Foot doctor (podiatrist)
    • Doctor who specializes in eye care (ophthalmologist)


    It’s good to prepare for appointments with your health care team. Here’s some information to help you get ready for your appointment and know what to expect from your doctor.

    What you can do

    • Be aware of any pre-appointment restrictions. If your doctor is going to test your blood sugar, you’ll need to refrain from eating or drinking anything but water for eight hours for a fasting glucose test or four hours for a pre-meal test. When you’re making an appointment, ask if you should fast.
    • Write down any symptoms you’re experiencing, including any that may seem unrelated.
    • Ask a family member or friend to join you, if possible. Managing diabetes well requires retaining a lot of information. Someone who accompanies you may remember something you missed.
    • Bring a notebook and a pen or pencil to write down important information.
    • Write down questions to ask your doctor.


    Glucose monitoring

    • How often do I need to monitor my blood sugar?
    • What is my goal range?

    Lifestyle changes

    • What changes do I need to make to my diet?
    • How can I learn about counting carbohydrates in foods?
    • Should I see a dietitian to help with meal planning?
    • How much exercise should I get each day?


    • Do I need to take insulin?
    • I have other medical problems. How do I manage them together?


    • What are the signs and symptoms of low blood sugar?
    • How do I treat low blood sugar?
    • What are the signs and symptoms of high blood sugar?

    Medical management

    • Are there resources available if I’m having trouble paying for diabetes supplies?

    Don’t hesitate to ask any other questions.

    What to expect from your doctor


    • How are you coping with diabetes?
    • Have you experienced any low blood sugar?
    • What’s a typical day’s diet like?

    What you can do in the meantime

    If your blood sugar isn’t well controlled, or if you’re not sure what to do in a certain situation, contact your doctor or diabetes educator.

    Tests and diagnosis

    In June 2009, an international committee composed of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that type 2 diabetes testing include the:


    If the A1C test isn’t available, or if you have certain conditions — such as if you’re pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes:

    • Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. A level between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L) is considered prediabetes, which puts you at greater risk of developing diabetes. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal.

    The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you’re overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test. Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 135/80 millimeters of mercury (mm Hg).

    If you’re diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — which often require different treatments.

    After the diagnosis


    The American Diabetes Association has a formula that translates the A1C into what’s known as an estimated average glucose (eAG). The eAG more closely correlates with daily blood sugar readings. An A1C of 7 percent translates to an eAG of 154 mg/dL (8.5 mmol/L).

    Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication or meal plan.

    In addition to the A1C test, the doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important.

    Treatments and drugs

    Treatment for type 2 diabetes requires a lifelong commitment to:

    • Blood sugar monitoring
    • Healthy eating
    • Regular exercise
    • Possibly, diabetes medication or insulin therapy

    These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

    Monitoring your blood sugar

    Depending on your treatment plan, you may check and record your blood sugar level once a day or several times a week. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.


    • Alcohol. Alcohol and the substances you use to make mixed drinks can cause either high or low blood sugar, depending on how much you drink and whether you eat at the same time.

    Healthy eating

    Contrary to popular perception, there’s no diabetes diet. However, it’s important to center your diet on these high-fiber, low-fat foods:

    • Fruits
    • Vegetables
    • Whole grains

    You’ll also need to eat fewer animal products, refined carbohydrates and sweets.

    A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. Remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.

    Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.

    Physical activity

    Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor’s OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming or biking. What’s most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven’t been active for a while, start slowly and build up gradually.

    Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar.

    Diabetes medications and insulin therapy

    Some people who have type 2 diabetes can manage their blood sugar with diet and exercise alone, but many need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.

    • Diabetes medications. Often, people who are newly diagnosed will be prescribed metformin (Glucophage, Glumetza, others), a diabetes medication that improves your body tissues’ sensitivity to insulin and lowers glucose production in the liver. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active.

      When metformin is not enough to control your glucose level, other oral or injected medications can be added to treat type 2 diabetes. Medications lower glucose in different ways. Some diabetes medications stimulate your pancreas to produce and release more insulin. They include glipizide (Glucotrol), glyburide (Diabeta, Glynase) and glimepiride (Amaryl). Still others block the action of enzymes that break down carbohydrates in the intestine, such as acarbose (Precose), or make your tissues more sensitive to insulin, such as metformin (Glucophage) or pioglitazone (Actos).

    If you can’t take metformin, other oral drugs include:

    • Sitagliptin (Januvia)
    • Saxagliptin (Onglyza)
    • Repaglinide (Prandin)
    • Nateglinide (Starlix)

    Recently approved drugs given by injection are:

    • Exenatide (Byetta)
    • Liraglutide (Victoza)

    Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you considering many factors, including costs and other aspects of your health. Rosiglitazone (Avandia) has been linked to heart attacks, and its use has been restricted by the FDA.

    In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.

    • Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. Because normal digestion interferes with insulin taken by mouth, insulin must be injected.


      Types of insulin are many and include rapid-acting insulin, long-acting insulin and intermediate options. Examples include:

    • Insulin lispro (Humalog)
    • Insulin aspart (Novolog)
    • Insulin glargine (Lantus)
    • Insulin detemir (Levemir)
    • Insulin isophane (Humulin N, Novolin N)


    Bariatric surgery

    If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries. However, the surgery is expensive and there are risks involved, including a slight risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis.


    Women with type 2 diabetes will likely need to alter their treatment during pregnancy. Although there’s no evidence that metformin is harmful to a growing fetus, studies haven’t been done to definitively establish its safety in pregnancy. So, during pregnancy, you’ll likely be switched to insulin therapy. Also, many blood pressure and cholesterol-lowering medications can’t be used during pregnancy. If you have signs of diabetic retinopathy, it may worsen during pregnancy. Visit your ophthalmologist during the first trimester of your pregnancy and at one year postpartum.

    Signs of trouble


    • Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Signs and symptoms of this life-threatening condition include a blood sugar reading higher than 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever greater than 101 F (38 C), drowsiness, confusion, vision loss, hallucinations and dark urine. HHNS is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in older people with type 2 diabetes, and it’s often preceded by an illness or infection. HHNS usually develops over days or weeks. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition.

    Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures.


    If you have signs or symptoms of low blood sugar, eat or drink something that will quickly raise your blood sugar level — fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels are normal. If they’re not, treat again and retest in another 15 minutes. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.

    Lifestyle and home remedies


    • Keep your immunizations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and get a tetanus booster shot every 10 years. Your doctor will likely recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also currently recommends hepatitis B vaccination if you haven’t previously been vaccinated against hepatitis B and you’re an adult ages 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes and haven’t previously received the vaccine, talk to your doctor about whether it’s right for you.
    • If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage and kidney disease. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.


    Alternative medicine

    Although two naturally occurring substances — chromium and cinnamon — have been shown in some studies to improve insulin sensitivity, other studies have failed to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, neither substance is currently recommended for diabetes control.

    Coping and support

    Type 2 diabetes is a serious disease, and following your diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile because following your treatment plan can reduce your risk of complications.

    Talking to a counselor or therapist may help you cope with the lifestyle changes that come with a type 2 diabetes diagnosis. You may find encouragement and understanding in a type 2 diabetes support group. Although support groups aren’t for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences or helpful information, such as where to find carbohydrate counts for your favorite takeout restaurant. If you’re interested, your doctor may be able to recommend a group in your area.

    Or, you can visit the American Diabetes Association to check out local activities and support groups for people with type 2 diabetes. The American Diabetes Association also offers online information and online forums where you can chat with others who have diabetes. The phone number is 800-DIABETES (800-342-2383).


    Healthy lifestyle choices can help you prevent type 2 diabetes. Even if you have diabetes in your family, diet and exercise can help you prevent the disease. If you’ve already been diagnosed with diabetes, the same healthy lifestyle choices can help you prevent potentially serious complications. And if you have prediabetes, lifestyle changes can slow or halt the progression from prediabetes to diabetes.

    • Get physical. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride a bike. Swim laps. If you can’t fit in a long workout, spread 10-minute or longer sessions throughout the day.
    • Lose excess pounds. If you’re overweight, losing 5 to 10 percent of your body weight can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

    Sometimes medication is an option as well. Metformin (Glucophage, Glumetza, others), an oral diabetes medication, may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.