Overview

Diagnosis

Type 1 diabetes is usually diagnosed after a sudden onset of symptoms such as excessive thirst, frequent urination, unexplained weight loss, fatigue, and blurred vision. These symptoms often prompt blood sugar testing. Because the signs of other types of diabetes or predicates may develop slowly, screening guidelines by the American Diabetes Association (ADA) are used to identify people at risk.

Screening is recommended for:

  • Anyone with a body mass index above 25 (23 for Asian Americans) who has additional risk factors such as high blood pressure, abnormal cholesterol, an inactive lifestyle, or a family history of diabetes

  • Adults older than 35, with follow-up screenings every three years if initial results are normal

  • Women with a history of gestational diabetes, who should be screened every three years

  • People diagnosed with predicates, who should be tested yearly

  • People living with HIV

Tests for diabetes

  • A1C test: This blood test reflects average blood sugar levels over the past 2 to 3 months. An A1C of 6.5% or higher on two separate tests indicates diabetes.

  • Random blood sugar test: A result of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.

  • Fasting blood sugar test: After fasting overnight, a result of 126 mg/dL (7 mmol/L) or higher on two occasions confirms diabetes.

  • Glucose tolerance test: After fasting and drinking a sugary liquid, a blood sugar level above 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes.

If type 1 diabetes is suspected, urine tests may be done to detect ketones, which are produced when fat is broken down for energy. Blood tests can also identify autoantibodies, which signal immune system activity against insulin-producing cells.

Pregnant women at high risk for gestational diabetes are tested during their first prenatal visit, while others are screened during the second trimester.

Treatment

Treatment for diabetes depends on its type, but all forms focus on maintaining healthy blood sugar levels through medication, diet, exercise, and monitoring.

Treatments for all types of diabetes

  • Healthy eating: A balanced diet emphasizing fruits, vegetables, whole grains, lean proteins, and limited refined carbohydrates helps control blood sugar. Sugary foods can be eaten occasionally as part of a planned diet.

  • Physical activity: Regular aerobic exercise helps lower blood sugar by moving glucose into cells for energy. It also improves insulin sensitivity. Aim for at least 150 minutes of moderate exercise per week.

  • Weight management: Maintaining a healthy weight reduces the risk of complications and supports overall blood sugar control.

Treatments for type 1 and type 2 diabetes

  • Type 1 diabetes: Managed with insulin therapy, frequent blood sugar checks, and carbohydrate counting. Some may be eligible for pancreas or islet cell transplants.

  • Type 2 diabetes: Focuses on lifestyle changes, oral medications, and sometimes insulin therapy.

Monitoring your blood sugar

Monitoring is essential to ensure blood sugar stays within the target range.

  • People on insulin may check their levels multiple times daily or use a continuous glucose monitor (CGM).

  • A1C testing every 2 to 3 months helps track long-term control.

  • Most adults aim for an A1C below 7%, though this can vary based on age and other conditions.

Insulin therapy

Insulin is required for type 1 diabetes and sometimes for type 2 or gestational diabetes. Various insulin types include short-acting, rapid-acting, long-acting, and intermediate-acting. Insulin is usually injected using:

  • Syringes or insulin pens

  • Insulin pumps that deliver insulin continuously through a catheter under the skin

  • Tubeless or wireless pumps for convenience

Newer closed-loop systems connect insulin pumps to continuous glucose monitors, automatically adjusting insulin delivery based on glucose readings. These hybrid systems still require user input, such as entering carbohydrate amounts.

Oral or other medications

Some diabetes drugs help the pancreas produce more insulin, reduce glucose production in the liver, or make the body more sensitive to insulin.
Metformin is the most commonly prescribed drug for type 2 diabetes. Other options include SGLT2 inhibitors, which help the body eliminate excess glucose through urine.

Transplantation

In select cases, people with type 1 diabetes may consider a pancreas or islet cell transplant. Successful transplants can eliminate the need for insulin therapy, but they come with risks, such as the need for lifelong immune-suppressing drugs to prevent organ rejection. Because of these risks, transplantation is typically reserved for those with uncontrolled diabetes or concurrent kidney failure.

Bariatric surgery

People with type 2 diabetes and a body mass index over 35 may benefit from bariatric surgery, such as gastric bypass. This surgery can significantly improve blood sugar levels, although long-term effects are still being studied.

Treatment for gestational diabetes

Controlling blood sugar during pregnancy is vital for both mother and baby. Treatment includes healthy eating, exercise, and monitoring blood sugar levels. In some cases, insulin or oral medications may be needed. During labor, blood sugar levels are closely monitored to prevent complications.

Treatment for prediabetes

Prediabetes management focuses on lifestyle changes to prevent progression to type 2 diabetes.

  • Exercise at least 150 minutes per week

  • Lose about 7% of body weight

  • Eat a balanced diet and avoid excessive sugar intake

In some cases, medications like metformin or statins may be prescribed, especially if there are additional risk factors such as heart disease.

Signs of complications

Certain conditions related to diabetes require immediate medical attention.

High blood sugar (hyperglycemia)
Symptoms include:

  • Frequent urination

  • Excessive thirst

  • Blurred vision

  • Fatigue

  • Headache

  • Irritability

Diabetic ketoacidosis (DKA)
When cells are starved of glucose, the body breaks down fat, producing ketones that can be toxic. Symptoms include:

  • Nausea and vomiting

  • Abdominal pain

  • Fruity-smelling breath

  • Shortness of breath

  • Weakness and confusion

Hyperglycemic hyperosmolar syndrome
Usually seen in type 2 diabetes, this life-threatening condition is marked by:

  • Blood sugar above 600 mg/dL

  • Extreme thirst

  • Fever

  • Drowsiness or confusion

  • Vision loss and hallucinations

Low blood sugar (hypoglycemia)
Caused by skipping meals, taking too much insulin, or exercising more than usual. Symptoms include:

  • Sweating and shakiness

  • Weakness and dizziness

  • Hunger

  • Blurred vision

  • Heart palpitations

  • Slurred speech or confusion

Low blood sugar is treated with fast-absorbing carbohydrates such as fruit juice or glucose tablets.

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