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Diabetes (Type 2 Diabetes)

Overview


Having diabetes means you have too much sugar — called glucose — in your blood. If untreated, diabetes can harm the body, particularly the heart and vascular system. In fact, people with diabetes are 2-4 times more likely to have heart disease or suffer a stroke than those who don’t have the disease. Experts say this risk is even greater for women with diabetes.

Diabetes can lead to heart attacks, strokes, kidney disease, blindness, dental disease, amputations, and other serious health problems. And the longer you have high levels of blood glucose traveling around your body, the more likely you are to have problems.

If you have diabetes, the best thing you can do is learn about how to manage your condition and prevent problems.

About Diabetes

Diabetes develops when the body either:

  • Does not make enough insulin or
  • Is unable to use insulin properly (called insulin resistance, generally the result of being overweight, not exercising and eating a poor diet, which can lead to metabolic syndrome) or
  • Both

Insulin is a hormone that is usually made in the pancreas. It helps your body use the sugars that are in the foods we eat. Glucose gives your body energy, and insulin helps carry glucose to your cells.

If the body doesn’t make or use insulin well, glucose builds up in the blood instead of being absorbed by cells in the body. The body’s cells are then starved of energy, despite high blood glucose levels.

How Many People Have Diabetes?

Diabetes affects a lot of people. More than 30 million adults in the United States are living with diabetes, yet about 1 in 4 don’t know they have it. A recent study estimates nearly half of U.S. adults have diabetes or prediabetes, a condition when blood sugar is elevated but is not yet high enough to be classified as diabetes.
There are three types of diabetes:

  • Type 1 diabetes, occurs when the body loses the ability to make insulin. Traditionally, this was thought to occur in children, but it can happen throughout life.
  • Type 2 diabetes is the most common form of diabetes — accounting for up to 95% of all cases. People with type 2 diabetes suffer from insulin resistance, which means their bodies don't respond to insulin properly. But they can make insulin early in the disease. Eventually, patients with type 2 diabetes stop making insulin. It most often occurs in adults, but more children are being diagnosed. This may be because more youth are overweight or less physically active than before.
  • Gestational diabetes occurs during pregnancy. After pregnancy, levels of blood sugar improve. But if you had diabetes during pregnancy, you are at risk for developing type 2 diabetes.

There is also growing concern over prediabetes. People with prediabetes are more likely to develop type 2 diabetes, as well as heart disease and stroke. The good news is that you can take steps to prevent or delay the onset of full-blown diabetes. 

Some studies find that losing weight — just 5% to 10% of your starting weight — can delay or even reverse prediabetes. For example, if you are 5-foot-11 inches and weigh 200 pounds , try losing 10 pounds as a first step.

Diabetes is a lifelong condition that needs to be managed to stay healthy. Over time, too much glucose in the blood can cause serious problems including:

  • Heart disease
  • Stroke
  • Damage to the blood vessels in your eyes, kidneys and nerves
  • Damage to the arteries of the legs that, in some cases, can lead to loss of a limb
  • Ulcers on the feet or legs that don’t heal well
  • Gum disease

Am I at Risk?

Several things can make someone more likely to develop type 2 diabetes. For example:

  • Being overweight or obese — the more weight you carry, especially around your midsection, typically the more resistant your body is to insulin
  • Having high blood pressure generally or during pregnancy (called preeclampsia)
  • Eating an unhealthy diet that is high in fat, calories, cholesterol and processed food
  • Not exercising regularly
  • Being older than 45, although it can occur in younger people
  • Having a parent, brother or sister who has diabetes

If you are a woman, a few more factors can increase your risk:

  • Being diagnosed with gestational diabetes
    • Up to 3 out of 5 women who had this during pregnancy will go on to develop diabetes within 15 years
  • Giving birth to a baby that weighed more than 9 pounds
  • Having polycystic ovarian syndrome (PCOS)

Type 2 diabetes is also more common among certain ethnic or racial groups including African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders.

It’s important to talk with your health care professional about all your personal risk factors.


What are the Signs and Symptoms?

According to the Centers for Disease Control and Prevention, about 7 million people in the U.S. have undiagnosed diabetes. While symptoms are often present, some people have no signs of the disease.

Common signs and symptoms include:

  • Extreme thirst
  • Urinating more than usual
  • Unexplained weight loss or losing weight without trying
  • Blurry vision
  • Wounds or blisters that don’t heal well
  • Tingling or numbness in your hands or feet, or both
  • Feeling very tired
  • Dry, itchy skin
  • Red, swollen, tender gums
  • Frequent infections

How is it Diagnosed?

Diabetes is diagnosed by taking a detailed medical history, including a report of symptoms, and blood tests that measure the amount of glucose in the blood or how your body handles it.

There are several types of blood tests to check your sugar level:

  • Hemoglobin A1c (HbA1c or A1c), or simple A1c gives an overall picture of your blood sugar level over the past two to three months
  • Fasting glucose test measures the amount of glucose in your blood after you haven’t had anything to eat or drink for eight hours
  • Random blood glucose test measures the amount of glucose in your blood at any point during the day. Eating does not affect this test
  • Oral glucose tolerance test checks your blood glucose levels before and two hours after you drink a special sweet drink to show how well your body processes glucose

Managing Diabetes

There are a few things you can do to help manage your diabetes and live a healthier life. It’s very important to take steps that will help prevent high blood sugar levels. This is most often achieved through a combination of:


Treatment Goals

Diabetes treatments aim to:

  • Lower high blood glucose levels
  • Manage blood pressure, cholesterol and other health issues
  • Reduce the risk of cardiovascular disease and related deaths
  • Prevent problems such as nerve damage, high blood pressure, issues digesting food, or gum disease and others
The American Diabetes Association has set the following blood glucose targets for people with diabetes. Your health care team will work with you to set your personal blood glucose goals and map out a course of treatment that’s best for you.

Target Blood Glucose Levels for Most People with Diabetes
 
Before Meals
70 mg/dL to 130 mg/dL
1 to 2 Hours After Start of Meal
Less than 180 mg/dL

HbA1c/A1c is also used to give an average blood glucose level over the past three months. Target A1c for people with diabetes should be less than 7% for more people.

American Diabetes Association Guidelines

Result
A1c
Normal
Less than 5.7%
Prediabetes
5.7% to 6.4%
Diabetes
6.5% or higher


Your treatment plan will likely include:

❱❱ Making healthier choices overall
  • Get regular exercise
  • Maintain a healthy weight
  • Eat a healthy diet that is lower in salt, fat and refined carbohydrates; it’s also helpful to meal plan, read labels and to learn how to substitute saturated and trans fats for healthier fats
  • Avoid cigarettes and alcohol

❱❱ Taking medications

Several medications are used to help control your blood sugar levels. The type of medicine you take — insulin therapy and/or diabetes medications — will depend on your type of diabetes, as well as other health conditions.

Some medications are given by mouth; others may be given by injection or by using an insulin pen or pump. Many people with diabetes take multiple medications. Some of the newer diabetes medications also have been shown to lower the risk of heart disease, stroke and related deaths. 

❱❱ Ongoing care and monitoring
Taking care of yourself, going to necessary medical appointments, getting lab tests, including a yearly urine test, and knowing your blood glucose number are all important to managing diabetes.

As mentioned, maintaining a healthy weight, staying physically active and eating a healthy diet are also key to controlling blood sugar levels and lowering your risk of heart disease and stroke.

Talk with your doctor about:

❱❱ Checking your blood sugar level
Ask your care team how often you need to check and record your blood glucose, and if you should use a glucose meter at home. Knowing your glucose levels can help you and your doctor make decisions about your medicines, meals and exercise regimen.

If your glucose level is not where it should be, changes can be made to your treatment plan. Random blood sugar testing may also be done or recommended when you have symptoms.
 
❱❱ Controlling your blood pressure and cholesterol levels, if needed
 
❱❱ Knowing what to look for
Ask your doctor about possible complications from diabetes and what to watch for. For example:

  • Nerve damage (called diabetic neuropathy), which most often shows as a numbness, tingling or burning in your hands or feet
  • Eye problems such as blurry vision
  • Kidney issues
  • Cuts, blisters or sores on your feet
  • Heart disease and stroke

Call 911 if you have chest pain, fainting or shortness of breath.
❱❱ Getting immunizations

Ask your doctor about getting vaccinated to help prevent illnesses such as the flu, pneumococcal disease and shingles.

Download: Tips to Keep Diabetes in Check

Talking to Your Care Team

Managing diabetes is a team effort.

If you also have cardiovascular disease or a high risk of developing heart disease, you will likely be seen by several health professionals including your primary care doctor, an endocrinologist, nurse, dietitian or certified diabetes educator, dentist, eye doctor, foot doctor, pharmacist, and cardiologist.

Make sure to write down questions before each appointment. For example, you might want to ask:

  • How often should I be checking my blood sugar?
  • What is my target blood glucose level and HbA1c/A1c? How am I doing?
  • What is the best thing I can do to help control my diabetes?
  • What kind of exercise is best for me? How often should I be exercising?
  • What dietary guidelines should I follow?
  • Do I need medication?
  • What should my blood pressure be?
  • Should I be taking a low-dose aspirin?
  • What should I do if my blood sugar gets too low? How do I prevent this from happening?
  • What symptoms should I watch for and when should I call you? How do I know when my blood sugar is too low or too high, and what do I do?
  • Would it help to see a dietitian or nutritionist?
  • Should I be seeing a doctor to get my eyes or feet checked?

Helpful Resources

American Diabetes Association
www.diabetes.org

American Heart Association
www.heart.org

Centers for Disease Control and Prevention
http://www.cdc.gov/diabetes/prevention/index.htm

National Diabetes Information Clearinghouse
1–800–860–8747
www.diabetes.niddk.nih.gov

Last Reviewed: March 2019 | Medical Reviewers: John Bucheit, PharmD, BCACP, CDE; Deborah Croy, DNP, RN, ANP-BC, AACC
CardioSmart Editor-in-Chief: Martha Gulati, MD, FACC
Originally Published: November 2015 | Medical Reviewer: Alison Bailey, MD, FACC

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