Overview
Diagnosis
The glycated hemoglobin test most often diagnoses type 2 diabetes. Also called the A1C test, it reflects the average blood sugar level for the past two to three months. Results mean the following:
• Below 5.7% is healthy
• 5.7% to 6.4% is prediabetes
• 6.5% or higher on two separate tests means diabetes
If there are no A1C tests or if you have certain conditions that affect A1C test results, your healthcare professional may use the following tests to diagnose diabetes:
Random blood sugar test. Blood sugar values show in milligrams of sugar per deciliter (mg/dL) or millimoles of sugar per liter (mmol/L). It doesn’t matter when you last ate. A level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially if you also have diabetes symptoms such as urinating often and being very thirsty.
Fasting blood sugar test. You give a blood sample after not eating overnight. Results are:
• Less than 100 mg/dL (5.6 mmol/L) is healthy
• 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is prediabetes
• 126 mg/dL (7 mmol/L) or higher on two tests is diabetes
Oral glucose tolerance test. This mainly tests the blood sugar of people who are pregnant and those who have cystic fibrosis. After fasting for a certain time, you drink a sugary liquid and blood sugar is tested over two hours. Results are:
• Less than 140 mg/dL (7.8 mmol/L) after two hours is healthy
• 140 to 199 mg/dL (7.8 to 11.0 mmol/L) is prediabetes
• 200 mg/dL (11.1 mmol/L) or higher suggests diabetes
Screening. The American Diabetes Association recommends routine tests for type 2 diabetes for all adults age 35 or older. Others who need screening include:
• People younger than 35 who are overweight or obese and have one or more diabetes risk factors
• Women who had gestational diabetes
• People 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 diagnosed with diabetes, your healthcare professional may run additional tests to determine whether you have type 1 or type 2 diabetes. Treatment depends on the type.
Your healthcare team tests A1C levels at least twice a year and whenever treatment changes. Target goals vary based on age and other factors, but for most people, an A1C below 7% is suggested.
You also undergo tests to screen for diabetes complications and other health conditions.
Treatment
Living with type 2 diabetes involves education, lifestyle changes and ongoing monitoring. Management includes healthy eating, regular exercise, weight loss if needed, diabetes medicine or insulin therapy if needed, and tracking blood sugar. These steps help keep blood sugar within a healthy range and may delay or prevent complications.
Healthy eating
There is no specific diabetes diet. It is best to focus on:
• A regular schedule for meals and healthy snacks
• Smaller portions
• 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 oils such as olive or canola oil
• Fewer calories
A registered dietitian can help you make healthy food choices, plan meals, build new habits, understand what keeps you from making changes and watch carbohydrate intake to help stabilize blood sugar.
Physical activity
Exercise is important for weight management and blood sugar control. Always talk with your healthcare team before starting or changing an exercise plan.
Aerobic activity. Choose enjoyable activities such as walking, swimming, biking or running. Aim for 30 minutes or more of moderate aerobic exercise on most days, or at least 150 minutes weekly.
Strength training. Strength training builds strength, balance and daily functioning. It can be done with free weights, resistance tubes, weight machines or body weight. Aim for at least two sessions per week.
Move more. Break up long periods of sitting. Stand, walk or do light activity every 30 minutes to help control blood sugar.
Weight loss
Losing weight can help manage blood sugar, cholesterol, triglycerides and blood pressure. Losing as little as 5% of your body weight can improve these factors. Your healthcare professional or dietitian can help you set realistic goals and make lifestyle changes.
Tracking your blood sugar
Your healthcare team will advise how often to check your blood sugar. You may need to check it daily, before or after exercise, or several times a day if you take insulin.
Use a blood glucose meter to measure sugar from a drop of blood and keep a record to share with your healthcare team.
Continuous glucose monitoring uses a sensor under the skin, often in the arm, to measure blood sugar every few minutes. Results can be sent to a mobile device and alert you when levels are too high or too low.
Diabetes medicines
If diet and exercise do not keep blood sugar within your target range, your healthcare team may prescribe medicines or insulin therapy.
Metformin is often the first medicine prescribed. It reduces glucose production by the liver and helps the body use insulin better. Some people may develop B-12 deficiency and need supplements. Common side effects include nausea, belly pain, bloating and diarrhea, which may improve over time.
Sulfonylureas help the body make more insulin. Examples include glipizide and glimepiride. Side effects may include low blood sugar and weight gain. Glyburide carries a higher risk of low blood sugar.
Glinides help the pancreas make more insulin and work faster than sulfonylureas, though for a shorter time. They include repaglinide and nateglinide. Side effects may include low blood sugar and weight gain.
Thiazolidinediones help tissues take in more insulin. Examples include pioglitazone and rosiglitazone. Side effects may include weight gain, bone fractures, fluid retention and heart failure.
DPP-4 inhibitors help lower blood sugar but have a mild effect. They include alogliptin, sitagliptin, saxagliptin and linagliptin. Side effects may include pancreatitis and joint pain.
GLP-1 receptor agonists are injections that slow digestion and lower blood sugar. They can contribute to weight loss and may lower the risk of heart attack and stroke. Examples include dulaglutide, exenatide, liraglutide and semaglutide. Side effects may include nausea, vomiting and diarrhea.
SGLT2 inhibitors affect kidney blood filtering by blocking glucose return to the bloodstream. Excess glucose leaves in the urine. These medicines may lower the risk of heart attack and stroke. Examples include canagliflozin, dapagliflozin and empagliflozin. Side effects may include yeast infections, urinary tract infections, low blood pressure, high cholesterol, gangrene, fractures and a risk of amputation.
You may also be prescribed medicines to lower blood pressure or cholesterol. Low-dose aspirin may help prevent cardiovascular conditions.
Insulin therapy
Some people with type 2 diabetes need insulin. It may be prescribed earlier if lifestyle changes and medicines do not manage blood sugar. Insulin types vary by how quickly they work and how long they last. Long-acting insulin helps keep blood sugar even throughout the day or night, while short-acting insulin is taken at mealtimes.
Your healthcare professional prescribes the right insulin type and advises when to take it. Your dosage and schedule may change based on blood sugar patterns. Most insulin types are taken by injection. A common side effect is low blood sugar.
Weight-loss surgery
Weight-loss surgery changes the digestive system and may help you lose weight and manage type 2 diabetes and other obesity-related conditions. Procedures limit food intake and, in some cases, nutrient absorption.
Surgery is only part of treatment and includes diet, supplements, exercise and mental health care. It may be an option for adults with type 2 diabetes who have a BMI of 35 or higher, or sometimes lower depending on the severity of diabetes or other conditions.
Lifestyle changes are required for life. Long-term side effects may include nutrient deficiencies and osteoporosis.
Pregnancy
People with type 2 diabetes often need to change treatment during pregnancy. Many require insulin therapy and may need to stop certain medicines. The risk of diabetic retinopathy increases during pregnancy, and symptoms may worsen.
See an ophthalmologist each trimester and one year after giving birth or as advised.
Signs of trouble
Tracking blood sugar helps prevent complications. Be aware of symptoms that need immediate care.
High blood sugar, or hyperglycemia, may occur from certain foods, eating too much, illness or missing medicines. Symptoms include urinating often, extreme thirst, dry mouth, blurred vision, tiredness and headache.
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) includes blood sugar higher than 600 mg/dL (33.3 mmol/L). It may result from infections, missed medicines or certain drugs. Symptoms include dry mouth, extreme thirst, drowsiness, confusion, dark urine and seizures.
Diabetic ketoacidosis happens when the body breaks down fat instead of sugar, causing ketones to build up. Triggers include illness, pregnancy or certain medicines. It can be life-threatening. Symptoms include nausea, vomiting, belly pain, shortness of breath and fruity-smelling breath.
Low blood sugar, or hypoglycemia, may occur from skipping meals, taking too much medicine or increased physical activity. Symptoms include sweating, shakiness, weakness, hunger, irritability, dizziness, headache, blurred vision, palpitations, slurred speech, drowsiness and confusion.
If symptoms occur, eat or drink something sugary and retest in 15 minutes. If still low, repeat. Eat a meal once levels return to normal. If you pass out, someone must give a glucagon shot to raise blood sugar.
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