What is diabetes type 2?

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Type 2 diabetes: Overview

Type 2 diabetes is a disease that develops when the body's tissues cannot use insulin properly. Over time, the pancreas cannot make enough insulin. Insulin is a hormone that helps the body's cells use sugar (glucose) for energy. It also helps the body store extra sugar in muscle, fat, and liver cells.

Without insulin, the sugar cannot get into the cells to do its work. It stays in the blood instead. This can cause high blood sugar levels. A person has diabetes when the blood sugar stays too high too much of the time. Over time, diabetes can lead to diseases of the heart, blood vessels, nerves, kidneys, and eyes.

You may be able to control your blood sugar by losing weight, eating a healthy diet, and getting daily exercise. You may also have to take insulin or other diabetes medicine.

Type 2 diabetes

Type 2 diabetes is a disease that happens when your body can't use insulin the right way. Over time, your pancreas can't make enough insulin. It often affects people who are overweight and not physically active.

Insulin helps sugar (glucose) move from the blood into the body's cells, where it can be used for energy or stored. Without insulin, sugar can't get into the cells, and your blood sugar gets too high. Over time, high blood sugar can lead to problems with your eyes, heart, blood vessels, nerves, and kidneys.

You may be able to manage diabetes by eating healthy foods and getting regular exercise. But some people need medicines to help control their blood sugar levels.

Could your type 2 diabetes go into remission?

There's no way to know in advance if type 2 diabetes will go into remission. It happens for some people and not others, even if they have the same diet, exercise, weight loss, or weight-loss surgery. Experts don't fully understand why.

What are the symptoms of high or low blood sugar in type 2 diabetes?

Some people who have type 2 diabetes may not have any symptoms early on. Many people with the disease don't even know they have it at first. But with time, diabetes starts to cause symptoms. You have most symptoms of type 2 diabetes when your blood sugar is either too high or too low.

The most common symptoms of high blood sugar include:

Thirst.
Needing to urinate often.
Weight loss.
Blurry vision.

The symptoms of low blood sugar include:

Sweating.
Shakiness.
Weakness.
Hunger.
Confusion.

You're not likely to get symptoms of low blood sugar unless you take insulin or use certain diabetes medicines that lower blood sugar.

How is type 2 diabetes treated?

Treatment for type 2 diabetes will change over time to meet your needs. But the focus of your treatment will usually be to keep your blood sugar levels in your target range. This will help prevent problems such as eye, kidney, heart, blood vessel, and nerve disease.

Some people may need medicines to help their bodies make insulin or decrease insulin resistance. Some medicines slow down how quickly the body absorbs carbohydrates.

Treatment to manage type 2 diabetes includes:

Making healthy food choices and being active.
Losing weight, if you need to.
Seeing your doctor regularly.
Keeping your blood sugar in your target range.
Taking medicines, if you need them.
Quitting smoking, if you smoke.
Keeping your blood pressure and cholesterol under control.

How can you prevent type 2 diabetes when you have prediabetes?

Prediabetes can lead to type 2 diabetes. But not everyone who has prediabetes will get type 2 diabetes. Major lifestyle changes and the use of a medicine called metformin can help prevent type 2 diabetes in people who have prediabetes.

How is type 2 diabetes diagnosed?

If your doctor thinks that you have type 2 diabetes, he or she will order blood tests that measure the amount of sugar in your blood. Blood glucose tests and other tests are used. Your doctor will also ask you questions about your medical history and do a physical exam.

How is medicine used to treat type 2 diabetes?

Some people with type 2 diabetes need medicines to help their bodies make insulin, decrease insulin resistance, or slow down how quickly their bodies absorb carbohydrates.

You may take no medicine, one medicine, or a few medicines. Some people need to take medicine for a short time. Others always need to take medicine.
How much medicine you need depends on how well you can keep your blood sugar within your target range. You may need more medicine over time. This can happen even if you have good control of your blood sugar.
If you are having trouble controlling your blood sugar with pills, your doctor may suggest other medicines, such as insulin or a noninsulin medicine taken as shots.

Medicine choices

Medicines that may be prescribed include:

Noninsulin medicines.

Ones that you take as pills include metformin, canagliflozin, glipizide, linagliptin, and pioglitazone.
Ones that you take as shots include dulaglutide, exenatide, and liraglutide.

Insulin.

It lets sugar (glucose) in the blood enter cells, where it is used for energy. Without insulin, the blood sugar level gets too high.

Insulin can be taken as a shot (injection), as a nasal spray, or through an insulin pump. Most people who take it use a combination of short-acting and long-acting insulin. This helps keep blood sugar within the target range.

Caring for yourself when you have type 2 diabetes

Making healthy choices is a big part of managing type 2 diabetes. Here are some important steps you can take.

Eat healthy foods.

Follow your meal plan to know how much carbohydrate to eat at each meal and snack. Carbohydrate affects blood sugar more than any other nutrient. It's in breads, cereals, vegetables, fruit, milk, yogurt, and sugary foods like candy and cake.
Check your blood sugar as often as your doctor recommends.

You can use your blood sugar results to adjust your food and activities to stay in your target range.
Try to do moderate activity for at least 2½ hours a week.

One way to do this is to be active 30 minutes a day, at least 5 days a week. Walking is a good choice. You also can try other activities, like running or playing team sports.
Limit alcohol.

The American Diabetes Association recommends that women with diabetes have no more than 1 drink a day and men with diabetes have no more than 2 drinks a day.
Do not smoke.

If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Get support.

You may be overwhelmed by how much you need to learn and change. Talk with your family and friends about your feelings, and ask for help if you need it.
Have hemoglobin A1c tests.

This blood test shows how steady your blood sugar levels have been over time. Your doctor may recommend that you get this test every 3 to 6 months.
Take steps to prevent problems that diabetes can cause.
Work with your doctor to manage your blood pressure and cholesterol, and talk to your doctor about foot exams and other tests. Tests to do every year may include:
- A complete eye exam by an ophthalmologist or optometrist. High blood sugar levels from diabetes can damage your eyes. This test can find problems early, such as diabetic retinopathy.
- A foot exam to check for signs of problems. Nerve damage in your feet makes it hard to feel an injury or infection.
- Blood and urine tests. These tests may be done regularly to check for kidney problems.
Take your diabetes medicine.

If you take diabetes medicine, take it exactly as prescribed. Do not stop or change your medicine without talking to your doctor first.
Have a sick-day plan.

Work with your doctor to make a plan for what to do when you are sick. Being sick can affect your blood sugar.

When is surgery done to treat type 2 diabetes?

Experts recommend weight-loss surgery (also called bariatric surgery) for people who have type 2 diabetes and whose:

Body mass index (BMI) is 40 or more, even if blood sugar is controlled with medicine or healthy habits.
BMI is 35 or more if blood sugar isn't controlled with medicine or healthy habits.

Some doctors may suggest surgery for people whose BMI is 30 or more if blood sugar isn't controlled with medicine or healthy habits.

If you are Asian, your doctor may recommend surgery with a lower BMI. Studies have shown that the risks from being overweight start at a lower BMI in people of Asian background.

What puts you at risk for type 2 diabetes?

If you're overweight, get little or no exercise, or have type 2 diabetes in your family, you're more likely to get type 2 diabetes.

Gloria's story: Adding activity to help control blood sugar

Gloria, 70

Read more about Gloria and how she manages her diabetes.

"Exercise really changed everything for me. The way I feel, my blood sugar, everything. It really works. I never felt better, stronger, healthier, or happier in my life."

Gloria hasn't always been an active person. Until she retired a few years ago, she didn't have time, she says. Her job at the local college as an administrative assistant kept her busy. And after work, she just didn't have enough energy—or interest—to do any exercise.

After she retired, there were other things to keep her busy—grandkids, volunteering at the library, and helping her husband, Al, with his tax business. About a year ago while doing some work for Al, Gloria had trouble reading the numbers on the checks she was filing. She cleaned her glasses and put them back on, but it didn't help.

"My eyes were all blurry. It was really scary," Gloria says. "It finally went away, but then it came back. My doctor tested me for diabetes. He said that the blurriness means my blood sugar is too high."

Testing and tracking to stay in range

Gloria started taking pills (metformin) to help lower her blood sugar levels. And she took a diabetes education class where she learned how diet and activity can help her manage her blood sugar.

"I got pretty motivated to take care of myself. I don't want anything to happen to my eyes," she says.

She expected to see results right away, but it took time. It was hard to get her blood sugar in the range that her dietitian asked her to aim for (80 to 130 mg/dL before meals, and less than 180 mg/dL after meals).

Gloria kept trying. She used a food log to keep track of everything she ate. She tested her blood sugar often to find out what kinds of foods made it spike.

"It took me about 6 months to get into the range. And I was doing everything right. So I guess the biggest message is that you have to be patient. If you keep track of your numbers, you will see them slowly going down. That is the direction you want to go!"

Since she started controlling her blood sugar, Gloria hasn't had any eye problems. But she gets an eye exam every year to check for problems she might not notice.

Activity makes a difference

Now Gloria makes activity the top priority of her day. When she first found out she had diabetes, she started walking laps at the mall with friends. These days Gloria climbs on a stationary bike in her den 4 times a day and cycles for 10 minutes. She does it once before each meal and again before she goes to bed.

"Exercise really changed everything for me," she says. "The way I feel, my blood sugar, everything. It really works. I'm 70 years old, and I've never felt better, stronger, healthier, or happier in my whole life."

There are days when Gloria doesn't meet her blood sugar range. She doesn't worry too much about it, but she does keep track when it happens.

"You can't be perfect all the time. Everybody slips up sometimes," she says.

Finding support and swapping recipes

Gloria meets once a week with her support group—women she met in her diabetes education class at the hospital.

"It's not a formal group. We get together for coffee every Wednesday morning and talk about how we're doing, what we're eating. And we swap recipes. It's really fun, and I learn a lot from them."

She loves trying out recipes for healthy eating and is always on the lookout for new ones. One of her favorites is a zucchini-crust pizza.

"It uses zucchini and egg whites for the crust. You add a little cheese, tomato, and spices. I just love that. And it's really low-carb," she says. "I used to eat regular pizza all the time. Now I can still enjoy it by making a few healthy changes."

Staying motivated with a long-term goal

Gloria has a long-term goal—to rely on diet and exercise to lower her blood sugar levels. First, her doctor asked her to take a stress test. She passed it.

"We have a deal. If I keep exercising and my numbers keep going down, he said I may be able to slowly decrease how much metformin I'm taking. I know it might not happen. But it feels good to me to be taking charge of my situation."

This story is based on information gathered from many people living with type 2 diabetes.

What is type 2 diabetes?

Type 2 diabetes is a condition in which you have too much sugar (glucose) in your blood. Glucose is a type of sugar produced in your body when carbohydrates and other foods are digested. It provides energy to cells throughout the body.

Normally, blood sugar levels increase after you eat a meal. When blood sugar rises, cells in the pancreas release insulin, which causes the body to absorb sugar from the blood and lowers the blood sugar level to normal.

When you have type 2 diabetes, sugar stays in the blood rather than entering the body's cells to be used for energy. This results in high blood sugar. It happens when your body can't use insulin the right way.

Over time, high blood sugar can harm many parts of the body, such as your eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems (complications).

What causes type 2 diabetes?

When your blood sugar stays too high for too long, it causes type 2 diabetes. It happens when your body can't use insulin the right way. Over time, your body cannot make enough insulin.

How can healthy eating help you manage your blood sugar?

Healthy eating is an important part of managing diabetes. It helps keep your blood sugar in your target range, which you set with your doctor. Carbohydrate counting, using the plate method, and watching portion sizes are three ways to help you manage your blood sugar.

Type 2 diabetes: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

You passed out (lost consciousness), or you suddenly become very sleepy or confused. (You may have very low blood sugar.)

Call your doctor now or seek immediate medical care if:

Your blood sugar is 300 mg/dL or is higher than the level your doctor has set for you.
You have symptoms of low blood sugar, such as:
- Sweating.
- Feeling nervous, shaky, and weak.
- Extreme hunger and slight nausea.
- Dizziness and headache.
- Blurred vision.
- Confusion.

Watch closely for changes in your health, and be sure to contact your doctor if:

You often have problems controlling your blood sugar.
You have symptoms of long-term diabetes problems, such as:
- New vision changes.
- New pain, numbness, or tingling in your hands or feet.
- Skin problems.

How can you make a plan to lower your A1c?

A plan can make your to-do list feel more manageable. Here are some ideas for making a plan to lower your A1c level.

Focus on one goal.: What part of diabetes care do you want to focus on first? Is it food or medicine? Being active? Example: "I'll start by making healthier food choices."
Break your goal into smaller steps you can manage.: Example: "I'll start by writing down everything I eat for a week."
Decide when you'll start and how you'll prepare.: For example, get a notepad or phone app to record what you eat. Choose a day to start when you have time to shop for healthy foods.
Plan for success.: Plan how you'll get around things that might get in your way. And think about how you'll celebrate success.

Andy's story: Finding your own routine when you have diabetes

Andy, 52

Read more about Andy and his diabetes routine.

"It finally just hit me how serious this disease is. I couldn't keep ignoring it."

Two years ago, when his doctor told him he had type 2 diabetes, Andy wasn't surprised or even that worried. His blood sugar had been creeping up for the past few years. His doctor had even warned him to make some changes—to lose some weight and get more active. But he felt okay. If he was sick, he couldn't tell.

"I just couldn't take it seriously," Andy says. "Even after I found out I had it, diabetes just didn't seem that big of a deal. I didn't think it was something I had to worry about."

But he admits that it did nag at him a little bit. So when the doctor's office called to remind him to take a diabetes education class, he finally signed up. At the class, he heard about the kinds of foot and nerve problems that can happen if blood sugar isn't controlled.

As a grocery manager, Andy is on his feet all day. He also likes to bowl and play basketball with his buddies. He started thinking about what he would do if he couldn't walk, work, or play.

He decided it was time to do something about managing his diabetes. Andy asked his doctor for help.

"It finally just hit me how serious this disease is," he says. "I couldn't keep ignoring it."

Andy worked with a diabetes educator to create a plan for healthy meals and snacks that he could make himself, instead of bringing home some fried chicken or macaroni and cheese from the store deli. He learned how to count carbs. But he struggled to get his blood sugar under control.

"I tried to eat better, but my levels just didn't come down. It's hard, because everyone who has diabetes is different. You just have to find out what works for you, and stay with it."

Test, don't guess

He started using his blood sugar tests to learn more about how his body was using the food he ate. Writing everything in a food log also helped.

"Probably the biggest thing I've learned is to test, don't guess," Andy says. "That's something my doctor told me, and it's really true. You can't know what your numbers are unless you test."

He tests in the morning before breakfast and again before lunch. He also checks his blood sugar a few hours after lunch and before he goes to bed.

Testing regularly was a big step, Andy says. "I knew I needed to get a routine. But testing is a hassle. The strips are expensive. And I just didn't like doing it," he says.

One testing tip he learned from a nurse is to prick the side of his finger, instead of the tip.

"That way, you're not always poking at the same spot and making it sore," he says.

Focus on feet

About 6 months ago, Andy found that if he took a short walk after lunch and dinner, his numbers got better. He looks forward to his walks at work and around his home neighborhood.

The walks give him a chance to work out some of the stress of his job. And they remind him how much he cares about his feet.

Checking his feet has become part of Andy's daily routine. He looks for sores, cuts, scrapes, or cracks on his feet and between his toes. It's hard for him to bend over, so he uses a mirror to look underneath each foot.

"I never even thought about my feet before. They're so far away," he says. "But your feet are too important not to take care of."

Andy says his life has changed a lot since he found out he has diabetes. But he still struggles sometimes.

"I'm doing so much better than I was 2 years ago," he says. "I eat better, I take walks, and I feel pretty good. I talk to other people I know who have diabetes. But I have to remember that what works for them may not work for me. Diabetes is different for everybody."