Nearly 26 million individuals are affected by diabetes in the United States each year, with about seven million people going undiagnosed. Diabetes is a chronic metabolic disease with no cure in which a person has high blood sugar because the body does not produce enough insulin (Type 1) or because cells do not respond to the insulin that is produced (Type 2).

The therapeutic combination in Type 2 may eventually include injected insulin as symptoms worsen.

Along with the presence of physical symptoms, a common blood test known as the A1C can test for the disease.

Often, people with type 2 diabetes have no symptoms at first. They may not have symptoms for many years.

The early symptoms of diabetes may include:

  • bladder, kidney, skin, or other infections that are more frequent or heal slowly
  • fatigue
  • hunger
  • increased thirst
  • increased urination

The first symptom may also be:

  • blurred vision
  • erectile dysfunction
  • pain or numbness in the feet or hands

Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.

Diabetes blood tests:

Fasting blood glucose level - diabetes is diagnosed if it is higher than 126 mg/dL two times

  • Hemoglobin A1c test
    • Normal: Less than 5.7%
    • Pre-diabetes: 5.7% - 6.4%
    • Diabetes: 6.5% or higher
  • Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours

Diabetes screening is recommended for:

  • overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
  • overweight adults (BMI greater than 25) who have other risk factors
  • adults over age 45 every 3 years

You should see your health care provider every 3 months. At these visits, you can expect your health care provider to:

  • check your blood pressure
  • check the skin and bones on your feet and legs
  • check to see if your feet are becoming numb
  • examine the back part of the eye with a special lighted instrument called an ophthalmoscope

The following tests will help you and your doctor monitor your diabetes and prevent problems:

  • blood pressure checks, done at least every year (blood pressure goals should be 130/80 mm/Hg or lower).
  • hemoglobin A1c test (HbA1c), checked every 6 months if your diabetes is well-controlled; otherwise every 3 months.
  • cholesterol and triglyceride levels, checked yearly (aim for LDL levels below 70-100 mg/dL).
  • kidney tests, which assess for microalbuminuria (protein in the urine above the normal level) and serum creatinine (a marker of kidney dysfunction)
  • eye tests, done either once a year or more often if you have signs of diabetic eye disease.

See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.

The goal of treatment at first is to lower high blood glucose levels. The long-term goals of treatment are to prevent problems from diabetes.

The main treatment for type 2 diabetes is exercise and diet.

If diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may prescribe medication. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one drug.

Some of the most common types of medication are listed below. They are taken by mouth or injection.

  • Alpha-glucosidase inhibitors (such as acarbose)
  • Biguanides (metformin)
  • Injectable medicines including exenatide (Byetta, Bydureon), pramlintide (Symlin), sitagliptin (Januvia), and saxagliptin (Onglyza)
  • Meglitinides (including repaglinide and nateglinide)
  • Sulfonylureas such as glyburide (Micronase, DiaBeta) and glipizide (Glucotrol)
  • Thiazolidinediones such as rosiglitazone (Avandia) and pioglitazone (Actos)

These drugs may be given with insulin, or insulin may be used alone. You may need insulin if you continue to have poor blood glucose control. It must be injected under the skin using a syringe or insulin pen device. It cannot be taken by mouth.

Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy.

When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy.

When sugar cannot enter cells, high levels of sugar build up in the blood. This is called hyperglycemia.

Type 2 diabetes usually occurs slowly over time. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way.

Type 2 diabetes can also develop in people who are thin. This is more common in the elderly.

Family history and genes play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your risk.

Call 911 right away if you have:

  • Chest pain or pressure
  • Fainting or unconsciousness
  • Seizure
  • Shortness of breath

These symptoms can quickly get worse and become emergency conditions (such as convulsions or hypoglycemic coma).

Call your doctor if you have:

  • Numbness, tingling, or pain in your feet or legs
  • Problems with your eyesight
  • Sores or infections on your feet
  • Symptoms of high blood sugar (being very thirsty, having blurry vision, having dry skin, feeling weak or tired, needing to urinate a lot)
  • Symptoms of low blood sugar (feeling weak or tired, trembling, sweating, feeling irritable, having trouble thinking clearly, fast heartbeat, double or blurry vision, feeling uneasy)

After many years, diabetes can lead to serious problems:

  • You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could become blind.
  • Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be removed. Infection can also cause pain and itching in other parts of the body.
  • Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, storke, and other problems. It can become harder for blood to flow to your legs and feet.
  • Nerves in your body can get damaged, causing pain, tingling, and a loss of feeling.
  • Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection.
  • High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well, and they may even stop working.

Infections of the skin, female genital tract, and urinary tract are also more common.

To prevent problems from diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.

Review Date: 
May 15, 2012
Overview Video: 
Type 2 Diabetes