CARE GUIDE Type 2 Diabetes

Type 2 Diabetes

Type 2 diabetes (formerly adult-onset or noninsulin-dependent diabetes) is a chronic disease in which your body is unable to maintain a normal blood sugar (glucose) level. Abnormally high or low levels of glucose-- which is your body’s “fuel” or energy source--is a potentially serious threat to your health.

Regulation of blood sugar levels depends on a normal supply of insulin, a hormone made in the pancreas. When food is eaten, the pancreas releases insulin to move sugar from circulation into body cells for energy or storage in liver, muscle and fat for future energy usage. In untreated type 2 diabetes, your body is either blocking the sugar-regulating effects of insulin (called insulin resistance) or not producing enough insulin to keep your blood sugar at normal levels. Type 2 diabetes if different than type 1 diabetes, where your body does not produce insulin.

While the cause of Type 2 diabetes is unknown, risk factors include:

  • Obesity
  • Lack of regular exercise
  • Abdominal fat
  • Family history
  • Advancing age
  • Gestational (pregnancy) diabetes

7 Important Facts

1. No one knows what causes it: The exact cause of type 2 diabetes is unknown, but being overweight, not exercising, genetics, race, and age all seem to contribute to its development. If you develop gestational diabetes during pregnancy, you’re at a higher risk of developing type 2 as well.

2. There is no cure: That’s the bad news. The good news is that type 2 diabetes can be controlled by lifestyle changes like eating well, exercising, and maintaining a healthy weight; or with diabetes medication and/or insulin.

3. It can cause skin changes: Patches of dark, velvety skin can develop in body creases and folds, most often in the neck and armpits. This condition is called acanthosis nigricans, and treating the underlying condition can help to lessen symptoms.

4. You’re not alone: According to the CDC’s National Diabetes Statistics Report, an estimated 9.3% of the population has diabetes. That’s roughly 29.1 million people!

5. It might be linked to Alzheimer's: Studies have shown that deposits of a hormone called amylin in the brain may share a link with type 2 diabetes, Alzheimer’s disease and dementia. While there is no guarantee that you will develop additional conditions, it's a good reason to focus on proper blood sugar regulation.

6. If you smoke, quit: Smoking makes diabetes harder to manage. If you need help quitting, talk to your doctor about available options.

7. You're on the right track: Reading this list is the right first step. It's important to take the time to educate yourself about this condition. Knowledge is power!


Many people have type 2 diabetes and don't know it. Learn how to recognize the symptoms, and find out what causes them.

1. Being more thirsty than usual and urinating more often: Blood sugar buildup pulls fluid out of your tissues, which can make you thirsty. Drinking more leads to more frequent urination.

2. Being hungrier than usual: When insulin can’t move sugar into the muscle and organ cells, they become “starved” for energy, making you feel starved, too.

3. Weight loss: You may be losing weight even though you’re eating more.The excess glucose your body can’t use—along with the calories it represents—are eliminated in your urine instead of contributing to your body weight.

4. Feeling more tired and/or irritable than usual: This can happen when your body doesn’t have enough sugar for energy.

5. Blurry vision: High blood sugar levels can pull fluid from the lenses in your eyes so you can’t focus clearly.

6. Slow healing and/or frequent infections: Type 2 diabetes can cause immune system deficiency, making it harder to fight infections.

7. Patches of dark, velvety skin (called acanthosis nigricans) in body creases and folds, most often in the neck and armpits: This condition is often caused by obesity, which is commonly associated with type 2 diabetes.

If you have any of these symptoms and haven’t been diagnosed with type 2 diabetes, see your doctor. Type 2 diabetes develops most often in adults; however, with childhood obesity on the rise, it is becoming more common in children.

Type 2 diabetes can’t be cured, but eating well, exercising, and maintaining a healthy weight can help keep it under control. If these lifestyle choices aren’t enough, you may need to add diabetes medications and/or insulin treatment to your disease management program.

Tests and Diagnosis

Along with your medical and family history and the results of your physical examination, your doctor can use a variety of tests to arrive at a correct diagnosis of type 2 diabetes.

The following are some commonly used tests to help diagnose the condition:

  • HbA1c (A1C) test: This test determines a person’s average blood sugar (glucose) level during the previous 6 weeks to 3 months. An A1C level 6.5% or higher on two separate tests is diagnostic for diabetes. Blood is drawn from an arm vein for laboratory analysis. A finger stick test may also be used in a { physician or healthcare }provider's office.

If your A1C tests are inconsistent or not advised (for example, if you are pregnant), your doctor may order one or both of the following tests:

  • Random blood sugar test: This is a blood sampling for your sugar level irrespective of eating times or food intake. A random blood sugar level of 200 mg/dL (milligrams per deciliter*) or higher on two consecutive testsmeans you may have diabetes. At any time and without previous fasting, blood is drawn from your arm vein for laboratory analysis.
  • Fasting blood sugar test: This test determines if higher-than-normal blood sugar levels are present in your blood. A fasting blood sugar level of 126 mg/dL or above is diagnostic for diabetes. Blood is drawn from your arm vein for laboratory analysis after you fast for 8 hours.
  • Oral glucose tolerance test (OGTT): This test assesses how well your body breaks down sugar. Following an overnight fast, a sample of your blood is drawn from your arm vein. You then drink a sweet liquid that contains a specific amount of glucose. Your blood is drawn at one hour, two hours and three hours after fluid intake.

Doctors and Specialists

To effectively manage your type 2 diabetes, the following practitioners will likely be part of your care team:

  • Primary Care Doctor: Primary care doctors, also known as Primary Care Physicians (PCPs), are usually the first doctors patients visit, most often on an outpatient basis and in non-emergency situations.
  • Endocrinologist: An endocrinologist is a physician with extensive training in understanding, diagnosing and treating conditions that affect your glands and hormones along with how these hormones affect your body systems.
  • Registered Dietitian: Registered dietitians are nutrition experts who devise healthy meal plans and lifestyle changes.
  • Ophthalmologist: An ophthalmologist is a physician who is specially trained to maintain the health of the eyes, and diagnose and treat eye and vision disorders.
  • Podiatrist: Podiatrists, also known as a podiatric physicians, are medical professionals devoted to the study and medical treatment of the foot, ankle and lower extremities.
  • Dentist: A dentist is a doctor who diagnoses and treats oral health issues, and provides preventative and regular maintenance treatments of the teeth, gums and mouth.
  • Exercise Physiologist: Professionals who assess, plan, or implement fitness programs that include physical activities designed to improve health.
  • Psychologist: A psychologist is a licensed professional who specializes in the study of the mind as well as human behavior.
  • Pharmacy: It’s also important to find a pharmacy you like and trust. Once you do, make it your one source for all your type 2 medication needs. That way, the pharmacists will always have a complete and up-to-date record of your medications, allergies, and medical history.

Questions to Ask

Review the following lists of questions about type 2 diabetes before your doctor visit, or print them out to bring with you. You may want to highlight the ones most important to you, and make notes where necessary.

  • Do you think my symptoms mean I may have diabetes, or another medical condition?
  • What types of diagnostic tests do I need?
  • Will you give me written information or instructions for my tests?
  • Should I see additional doctors for their input on my condition?
  • How should I create a chart with symptoms, meals and urination times?
  • Which type of diabetes do I have?
  • Which treatments do you recommend for me?
  • Do I need to take any medication? If so, what kind, how much, and at what times? Do I need insulin treatment?
  • How often should I monitor my blood sugar?
  • What blood sugar range should I be aiming for?
  • How does low blood sugar feel? What should I do if it happens?
  • How does high blood sugar feel? What should I do if it happens?
  • Would you suggest that I make changes to my lifestyle or diet? Should I see a dietitian?
  • How much daily exercise do I need?
  • Would you recommend I see a diabetes educator?
  • I have additional health problems—how will my diabetes treatment affect them?
  • Is there a generic alternative to the medicine you’re prescribing for me?
  • How often should I come back for a diabetes check-up?
  • Can you give me any printed material about type 2 diabetes?
  • What websites do you recommend?


Controlling your blood sugar helps prevent serious complications involving major organs, including:

  • Heart and blood vessels: Increased risk of heart attack, stroke, and high blood pressure.
  • Nervous system: Damage to nerves (neuropathy)—particularly in the legs and feet, causing discomfort, pain and numbness.
  • Kidneys: Damage to the kidneys’ complex filtering system, kidney failure or irreversible end-stage kidney disease.
  • Eyes: Damage to retinal blood vessels (diabetic retinopathy) can lead to blindness, glaucoma and cataracts.
  • Feet: Nerve damage and poor blood flow raise the risk of serious infection and amputation.
  • Skin and mouth (gum) infections.
  • Bones: Low bone mineral density and increased risk of osteoporosis.
  • Mental state: Increased risk of Alzheimer's disease and dementia from poor circulation

Diabetes complications typically develop over time. Day to day, some problems may arise despite your best efforts at blood sugar control.

Controlling Abnormal Sugar States

  • Low blood sugar (hypoglycemia): Raise your blood sugar level quickly by drinking fruit juice or sucking on hard candy. If this happens frequently, contact your doctor.
  • High blood sugar (hyperglycemia): When this occurs, contact your doctor. Exercising may help bring your sugar level down temporarily, but if your sugar level is higher than 240 mg/dL, DO NOT EXERCISE, as this could actually raise the level higher. Ignoring high blood sugar levels can lead to diabetic coma (diabetic ketoacidosis from high levels of ketones, or toxic acids, in your urine), which can be life-threatening.
  • Hyperglycemic hyperosmolar nonketotic syndrome (HHNS): develops over time and is seen typically in older diabetics or the chronically ill. This is a life-threatening medical emergency with blood sugar levels higher than 600 mg/dL, and thickened blood, fever higher than 101oF (38oC), dark urine, confusion, vision loss, sleepiness, and hallucinations. Seek medical help immediately.

If you have type 2 diabetes, an important way to be sure you get the right care quickly in an emergency is to wear a medical ID (identification) bracelet or necklace.

Treatment Options

Type 2 diabetes can not be cured and you will need to commit to a lifelong care program that includes:

  • Monitoring your blood sugar as often as your doctor instructs: If abnormal, take appropriate action.
  • Maintaining a nutritional diet. Keep in mind that the highest blood sugar levels typically occur one to two hours after you eat a meal.
  • Getting regular exercise—under guidance of an exercise physiologist. The more exercise you get, the lower your blood sugar will be.
  • Taking prescribed medications if needed.

It’s also important to monitor daily routine and how it affects your blood sugar levels. Conditions affecting blood sugar includes:

  • Illness: During any illness, your body produces hormones that raise your blood sugar level.
  • Stress: Long-term stress can cause your body to produce hormones that keep insulin from working the way it should.
  • Drinking alcoholic beverages: This can cause fluctuations of blood sugar levels
  • Changing hormone levels in women: With menopause or menstruation, fluctuations of blood sugar mimic hormonal changes.



  • Repaglinide
  • Nateglinide

What are they? Meglitinides are insulin-secretion stimulators that help your pancreas release insulin.

How are they taken? Meglitinides are taken in tablet form and may also be combined with another antidiabetic medication.

What else should I know? To be sure the medication works properly, carefully follow the meal plan your doctor gives you.


  • Glipizide (Glucotrol)
  • Glimepiride (Amaryl)
  • Glyburide (DiaBeta, Glynase)

Sulfonylureas bind to pancreatic cell membranes, leading to increased insulin release. They are taken in tablet form and may also be combined with other antidiabetic medications.

Note: Sulfonylureas raise insulin levels regardless of whether you’ve eaten—and especially if you drink alcoholic beverages. Stay alert for symptoms of low blood sugar, such as confusion and blurred vision.

Dipeptidyl peptidase-4 (DPP-4) inhibitors

  • Saxagliptin
  • Sitagliptin
  • Linagliptin
  • Alogliptin
  • Vildagliptin

These medications block release of enzyme dipeptidyl peptidase-4, leading to a rise in gut peptide GLP-1 (C). They activate insulin release and may also limit sugar production and slow insulin clearance in the liver.

DPP-4 inhibitors are taken in tablet form and may also be combined with other antidiabetic medications.


  • Metformin

Biguanide works completely differently from all other antidiabetic medications. It was developed from the identification of guanidine and related glucose-lowering compounds found in the French lilac plant, Galega officinalis. Biguanide reduces sugar (glucose) release from the liver, improves insulin sensitivity (the body’s ability to use insulin), and may promote modest weight loss and modest decline in low-density lipoprotein (LDL), or “bad” cholesterol.

Biguanide is taken in tablet form and may also be combined with other antidiabetic medications.


  • Rosiglitazone
  • Pioglitazone

Thiazolidinediones (also called glitazones) are compounds containing nitrogen and sulfur. These medications reduce sugar (glucose) release from the liver and improve the body’s ability to use insulin. They may also cause a slight increase in high-density lipoprotein (HDL), or “good” cholesterol.

Thiazolidinediones are taken in tablet form and may also be combined with other antidiabetic medications.

Alpha-glucosidase inhibitors

  • Acarbose (Precose)
  • Miglitol (Glyset)

Alpha-glucosidase inhibitors are saccharides (carbohydrates) that block enzymes needed to digest carbohydrates. They slow the breakdown of starches and some sugars, reducing the speed of digestion.

Alpha-glucosidase inhibitors are taken in tablet form. To work properly, these medications must be taken at the start of each main meal.

Bile Acid Sequestrants

  • Colesevelam

Bile is a substance produced by the liver that aids in digestion by breaking down fats. Bile acid sequestrants are medications that reduce LDL--known as the "bad" cholesterol--by preventing bile acids from being absorbed into the blood. The liver must then use cholesterol from your blood to make more bile acid.

Bile acid sequestrants are also known to lower blood sugar levels in patients with type 2 diabetes.

Bile acid sequestrants are taken in tablet or liquid form and may also be combined with other antidiabetic medications..

Note: Follow your doctor’s instructions for taking this medication exactly. DO NOT take more of it, or take it more often, or take it for a longer time.


Insulin may be used to treat type 2 diabetes when diet, exercise, and oral medications do not work. As most people dealing with type 2 diabetes know, insulin is a hormone produced in the pancreas that regulates blood sugar levels. Insulin causes cells to absorb blood sugar, taking it out of the blood and reducing blood sugar production in the liver.

Insulin cannot be taken in pill form, because digestion would cause it to break down. Currently, type 2 diabetes patients can take insulin in one of the following ways:

  • Injection: The patient, caregiver, or healthcare provider injects specific dosage of insulin using a needle and syringe or insulin pen.
  • Pump: A wearable, computerized device is programmed to deliver either a continuous dose or a "surge" of insulin through a catheter (a thin, plastic tube) that is inserted through the patient's skin and taped securely in place on the body.
  • Inhaler: Recently approved by the Food and Drug Administration, a new medication called Afrezza comes in small cartridges that patients use to inhale insulin, which is then absorbed rapidly through the lungs.

Glucagon-like Peptide-1 (GLP-1) Receptor Agonists

  • Pramlintide
  • Exenatide
  • Liraglutide

GLP-1 Receptor Agonists are synthetic forms of naturally occurring hormones. Each of these medications works differently:

Pramlintide activates insulin release and slows down the passage of food through the body, which slows the rise in blood sugar level. Pramlintide also reduces sugar (glucose) production in the liver and increases feeling of fullness after eating, helping to reduce appetite and food intake.

Pramlintide is taken by injection, and is administered together with insulin.

Exenatide activates insulin release, slows stomach emptying, reduces sugar (glucose) production in the liver, and may cause weight loss.

Exenatide is taken by injection, and may be combined with other antidiabetic medications.

Liraglutide activates insulin release. When blood sugar levels are high, this medication helps the pancreas release the amount of insulin that the body needs. It also helps move sugar from blood to other body tissues, slows stomach emptying, and may reduce appetite.

Liraglutide is taken by injection, and may be combined with other antidiabetic medications.