Type 2 Diabetes




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Editors
Mark E. Molitch, MD
Guillermo Umpierrez, MD



Additional Resources
MedlinePlus
NIDDK (NIH)
Mayo Clinic

What is type 2 diabetes?

Diabetes is a disease in which levels of glucose (sugar) in the bloodstream are too high. The body produces glucose from the foods you eat. It also produces the hormone insulin, which allows glucose from the bloodstream to enter the body’s cells where it is used for energy. In type 2 diabetes, too little insulin is produced, or the body cannot use insulin properly, or both. This results in a build-up of glucose in the blood.

People with diabetes are at risk for developing serious health problems (complications). If your blood glucose level stays too high for too long, complications can include:

  • Blindness
  • Kidney disease and failure
  • Nerve damage that may result in amputation (loss of toes, fingers, or legs
  • Heart attack and stroke

Many people with type 2 diabetes can control their blood glucose levels with diet, exercise, and oral medications (pills). Others may need insulin shots.

How does type 2 diabetes differ from type 1 diabetes?

Both type 1 and type 2 diabetics have high blood glucose levels, the reason for those high levels differs.

Type 1 diabetics have high blood glucose levels because the body is attacking essential cells within the pancreas, the organ responsible for creating insulin. This attack results in the body's inability to create and/or use the insulin that is produced.

Type 2 diabetics have a pancreas that is able to produce insulin, but their bodies are unable to use or process the insulin that is produced. Over time, the pancreas may stop creating insulin altogether, but type 2 diabetes starts with the inability to process the insulin that is made.

Other differences between type 1 and type 2 diabetes include:

  • Age of diagnosis. Type 1 is typically diagnosed in children, while type 2 is diagnosed in adults and occasionally children.
  • Treatment options.
  • Hypoglycemia. Blood sugar levels can drop to dangerously low levels in type 1 diabetics, while type 2 diabetics rarely have to deal with this issue unless they are on certain medications or taking insulin.
  • Preventability. Type 1 diabetes cannot be prevented, type 2 diabetes can be prevented or symptoms delayed with lifestyle changes.

Who is at risk of developing type 2 diabetes?

Being older (over 45) and overweight are the greatest risk factors for developing diabetes. Other factors that increase your chances of developing high blood glucose include:

  • Having a parent or sibling with diabetes
  • Having an African American, Latino/Hispanic, or American Indian family background
  • Having had gestational diabetes (diabetes during pregnancy) or giving birth to a baby weighing more than 9 pounds
  • Having high blood pressure (140/90 mm Hg or higher)
  • Having low levels of HDL (good) cholesterol (below 35 mg/dL in men or 45 mg/dL in women) or high levels of triglycerides (above 250 mg/dL)
  • Having polycystic ovary syndrome (PCOS)
  • Being physically inactive

How is type 2 diabetes diagnosed and treated?

Your doctor will use blood tests to diagnose diabetes. An A1C test is a blood test used to diagnose diabetes and to help in its management. A level of 6.5% or more can indicate diabetes. The test measures your average blood glucose over the past two to three months and shows how well your treatment plan is working overall. For a person without diabetes, but at risk, it's recommended that A1C be drawn every 6 months. Healthy readings are less than 5.7%—prediabetes is defined as 5.7–6.4%.

The higher your A1C level is, the poorer your blood glucose control and the more likely you are to develop complications of diabetes.

For many patients with diabetes, a target A1C level of below 7% is appropriate. This can often be achieved by aiming for a pre-meal glucose reading of 80–130 mg/dL or a 2-hour post-meal glucose reading of less than 180 mg/dL. However, more or less specific A1c goals may be appropriate for certain people. It is important to speak with your diabetes healthcare professional about what A1C goal is right for you and the target should be individualized based on such factors as the duration of your diabetes, age/life expectancy, your other health conditions, whether you have heart disease or other complications of diabetes, and your risk of other complications.

What should you do if screening shows you have prediabetes or type 2 diabetes?

If tests show you have high blood glucose, you should talk with your doctor about the best way to manage your condition. The choice of treatment depends on whether you have diabetes or prediabetes and how well you respond to treatment. For many people, weight loss through diet and exercise is enough to bring blood glucose levels back to normal. If diet and exercise alone don’t work, several medications are available to manage the disease. Getting screened is an important first step. Knowing your blood glucose levels and working with your doctor to keep your levels as close to normal as possible will help you to enjoy a long and healthy life.

Tips for type 2 diabetes management

If you're living with diabetes, lifestyle is an important part of your care. It's very important to eat a good balance of foods every day and to get regular exercise. Managing your diabetes also means taking medicine, if needed, and testing your blood glucose levels each day.

If you need to take medicine, be sure to take it as directed. Don't change your dosage or how often you take your medicine unless your doctor tells you to. Take it as prescribed and on time every day. Be careful not to skip doses of insulin or other medicines.

Test your blood for glucose as directed by your doctor. Some people only test once a day. Those who take insulin or more than one medication may need to test four or more times a day. Talk to your doctor about how often you should test your blood glucose.

See your doctor for a hemoglobin A1C test every three to six months. This blood test gives your doctor a picture of your blood glucose levels over the past three months. Ask your doctor if you have questions about your A1C test results. You should have a normal result if most of your blood glucose levels are near 100 mg/dL.

The good news about being diagnosed with diabetes is it can be a wake-up call to make lifestyle changes, and with proper management, you can live a long, active, happy, healthy lifestyle despite diabetes. It's important to know that what you do does make a difference, and diabetes and related complications are not inevitable.

Questions to ask your doctor

  • Should I have my blood glucose level tested?
  • What are the results of my testing and what do they mean?
  • What can I do to bring my glucose levels back to normal?
  • Should I see a diabetes educator?
  • Should I see an endocrinologist for my care?