Type 2 Diabetes
For even more, see our “Helpful Links” page below, with links to diaTribe articles focused on type 2 diabetes. These pages include helpful tips for living with type 2 diabetes, drug and device overviews, information about diabetes complications, nutrition and food resources, and some extras we hope you’ll find useful.
Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me, diaTribe senior editor Adam Brown's book, has hundreds of tips for better managing diabetes. Get it as a free PDF here or for $6 on Amazon.com.
What is type 2 diabetes and prediabetes? Behind type 2 diabetes is a disease where the body’s cells have trouble responding to insulin – this is called insulin resistance. Insulin is a hormone needed to store the energy found in food into the body’s cells. In prediabetes, insulin resistance starts growing and the beta cells in the pancreas that release insulin will try to make even more insulin to make up for the body’s insensitivity. This can go on for a long time without any symptoms. Over time, though, the beta cells in the pancreas will fatigue and will no longer be able to produce enough insulin – this is called “beta burnout.” Once there is not enough insulin, blood sugars will start to rise above normal. Prediabetes causes people to have higher-than-normal blood sugars (and an increased risk for heart disease and stroke). Left unnoticed or untreated, blood sugars continue to worsen and many people progress to type 2 diabetes. After a while, so many of the beta cells have been damaged that diabetes becomes an irreversible condition.
Is type 2 diabetes serious? Type 2 diabetes is not a death sentence, but it is a very serious disease that demands attention and careful monitoring. There is no such thing as ‘mild’ diabetes. Elevated glucose levels can damage the nervous system, blood vessels, eyes, heart, and kidneys. These complications really impact quality of life (through blindness, amputations, dialysis etc). They also significantly increase the chance of a stroke or heart attack. Managing blood glucose levels immediately, along with other health risk factors (e.g., cholesterol, blood pressure, weight), is necessary for preventing these complications. Losing even a small amount of weight and keeping it off can also improve glucose control as well as have other clinical benefits (read more tips on managing diet and exercise below for more on weight loss). Keep in mind that better diabetes management also has benefits in the here and now – mood and energy levels are adversely affected when your glucose levels are high.
What does the research say about proactive type 2 diabetes management? Research shows that proactive management can pay off in fewer complications down the road. In the landmark UKPDS study, 5,102 patients newly diagnosed with type 2 diabetes were followed for an average of 10 years to determine whether intensive use of blood glucose-lowering drugs would result in health benefits. Tighter average glucose control (an A1c of 7.0% vs. an A1c of 7.9%) reduced the rate of complications in the eyes, kidneys, and nervous system, by 25%. For every percentage point decrease in A1c (e.g., from 9% to 8%), there was a 25% reduction in diabetes-related deaths, and an 18% reduction in combined fatal and nonfatal heart attacks.
Can type 2 diabetes be prevented? It is possible to reduce the risk of developing type 2 diabetes, although the underlying risk of type 2 diabetes depends strongly on genetic factors. But there was less type 2 diabetes around some years ago when people had a more active life and didn’t eat a modern Western diet. So it is fair to say that risk of getting type 2 diabetes is based on a genetic predisposition that is aggravated by lifestyle. Type 2 diabetes is associated with obesity, as well as a variety of environmental factors. To lower the risk of developing type 2 diabetes (as well as other diseases), it is highly recommended to exercise often, eat healthily, and maintain a healthy weight.
Is it your fault for getting type 2 diabetes? No – type 2 diabetes is not a personal failing. It develops through a combination of factors that are still being uncovered and better understood. Lifestyle (food, exercise, stress, sleep) certainly plays a major role, but genetics play a significant role as well. Type 2 diabetes is often described in the media as a result of being overweight, but the relationship is not that simple. Many overweight individuals never get type 2, and some people with type 2 were never overweight, (although obesity is probably an underlying cause of insulin resistance). To make matters worse, when someone gains weight (for whatever reason), the body makes it extremely difficult to lose the new weight and keep it off. If it were just a matter of choice or a bit of willpower, we would probably all be skinny. At its core, type 2 involves two physiological issues: resistance to the insulin made by the person’s beta cells and too little insulin production relative to the amount one needs.
People with family members who have type 2 diabetes (see below)
People that are overweight or obese
Members of ethnic minority groups (Hispanic, Black, Native American, and Asian)
People who are aged 40 or older
People who are physically inactive
People with high blood pressure and/or cholesterol
According to the American Diabetes Association, a child has a 1 in 7 risk of getting type 2 diabetes if his/her parent was diagnosed with type 2 diabetes before the age of 50, and a 1 in 13 risk of developing it if the parent was diagnosed after the age of 50. To see if you may be at risk for diabetes, consider taking this short and simple Type 2 Diabetes Risk Test from the ADA.
What are the symptoms of type 2 diabetes? Symptoms of type 2 diabetes often appear slowly, meaning that many people with the disease may not know they have it for years. According to the American Diabetes Association, the common symptoms of type 2 diabetes are:
Feeling very thirsty
Feeling very hungry - even though you are eating
Cuts/bruises that are slow to heal
Tingling, pain, or numbness in the hands/feet
How is it diagnosed? According to the ADA, diabetes can be diagnosed through any one of the following tests:
A glycated hemoglobin test, which is commonly referred to as an HbA1c, or simply A1c, test. This test measures the body’s average blood sugar levels from the past 3 months. An A1c of 6.5% or higher is considered a diagnosis of diabetes, 5.7% to 6.4% is considered prediabetes, and an A1c of under 5.7% is considered normal.
A fasting plasma glucose (FPG) test, which measures the body's glucose level after fasting (no caloric intake) for eight hours. An FPG result of 126 mg/dl or greater indicates a positive diagnosis of diabetes.
An oral glucose tolerance test (OGTT), which measures the body's blood glucose level two hours after the intake of 75-grams of glucose. An OGTT result of 200 mg/dl or greater indicates a positive diagnosis of diabetes.
In someone with classic symptoms of hyperglycemia (high blood sugar), a random plasma glucose test with a result of 200 mg/dl or greater indicates a positive diagnosis of diabetes.
How is it treated? There is no uniform therapy for type 2 diabetes treatment, which depends on the individual person and his or her stage of type 2 diabetes. To learn more about individualization of therapy, please read our patient guide. That said, the ADA and EASD have created treatment recommendation guidelines for type 2 diabetes progression. In all cases, healthy eating, exercise, and weight management are key to effective type 2 diabetes management. As type 2 diabetes progresses, patients may need to add one or more drugs to their treatment regimen.
A study in a leading journal found that metformin is the most effective first-line treatment for type 2 diabetes. Patients may also use other drugs such as GLP-1 agonists, DPP-4 inhibitors, SGLT-2 inhibitors, TZDs, sulfonylureas, or insulin to help manage their blood sugar.
What is hyperglycemia? A blood glucose level of over 180 mg/dl (10 mmol/l) is considered hyperglycemia (high blood sugar). To correct hyperglycemia, patients commonly use a dose of rapid-acting insulin. According to the Mayo Clinic, symptoms of hyperglycemia are:
Early signs and symptoms: frequent urination, increased thirst, blurred vision, fatigue, and headache
Later signs and symptoms: fruity-smelling breath, nausea and vomiting, shortness of breath, dry mouth, weakness, confusion, coma, and abdominal pain
What is hypoglycemia? A blood sugar level of under 70 mg/dl (3.9 mmol/l) is typically considered hypoglycemia (low blood sugar), and can result in irritability, confusion, seizures, and even unconsciousness for extreme lows. To correct hypoglycemia, patients commonly use fast-acting carbohydrates. In extreme cases of severe hypoglycemia, a glucagon injection pen can be used. According to the Mayo Clinic, symptoms of hypoglycemia are:
Early signs and symptoms: shakiness, dizziness, sweating, hunger, irritability or moodiness, anxiety or nervousness, and headache
Nighttime symptoms: damp sheets or bed clothes due to perspiration, nightmares, tiredness, and irritability or confusion upon waking
Severe symptoms: clumsiness or jerky movements, muscle weakness, difficulty speaking or slurred speech, blurry or double vision, drowsiness, confusion, convulsions or seizures, and unconsciousness
How does type 2 diabetes progress over time? Type 2 diabetes is a progressive disease, meaning that the body’s ability to regulate blood sugar gets worse over time, despite careful management. Over time, the body’s cells become increasingly less responsive to insulin (increased insulin resistance) and beta cells in the pancreas produce less and less insulin (called beta-cell burnout). In fact, when people are diagnosed with type 2 diabetes, they usually have already lost up to 50% or more of their beta cell function. As type 2 diabetes progresses, people typically need to add one or more different types of medications. The good news is that there are many more choices available for treatments, and a number of these medications don’t cause as much hypoglycemia, hunger and/or weight gain (e.g., metformin, pioglitazone, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and better insulin). Diligent management early on can help preserve remaining beta cell function and sometimes slow progression of the disease, although the need to use more and different types of medications does not mean that you have failed.
Can type 2 diabetes be cured? In the early stages of type 2 diabetes, it is possible to manage the diabetes to a level where symptoms go away and A1c reaches a normal level – this effectively “reverses” the progression of type 2 diabetes. According to research from Newcastle University, major weight loss can return insulin secretion to normal in people who had type 2 diabetes for four years or less. Indeed, it is commonly believed that significant weight loss and building muscle mass is the best way to reverse type 2 diabetes progression. However, it is important to note that reversing diabetes progression is not the same as curing type 2 diabetes – people still need to monitor their weight, diet, and exercise to ensure that type 2 diabetes does not progress. For many people who have had type 2 diabetes for a longer time, the damage to the beta cells progresses to the point at which it will never again be possible to make enough insulin to correctly control blood glucose, even with dramatic weight loss. But even in these people, weight loss is likely the best way to reduce the threat of complications.
Does having type 2 diabetes affect life expectancy? While continued improvements in therapies and care for type 2 diabetes may be helping patients live longer, the unfortunate reality is that type 2 diabetes has been shown to decrease life expectancy by up to ten years, according to Diabetes UK. There is still much to be done to ensure that all patients have access to appropriate healthcare and treatments to live a happier and healthier life with type 2 diabetes.
The diaTribe Patient's Guide to Individualizing Therapy – Some helpful questions you can ask yourself in preparation for a visit with your health care provider
Blood Pressure 101 – An explanation of why this simple health measurement is particularly relevant for people with diabetes.
Cholesterol 101 – An overview of the different types of cholesterol and how to keep yourself at healthy levels of each
The diaTribe Advisory Board on What Every Person with Diabetes Must Know – Our star-studded advisory board of diabetes educators, endocrinologists, and more, give their tips on managing diabetes
Dr. Anne Peter's Top Ten Actionable Tips – Some helpful tips regarding communicating and improving relationships with your healthcare provider.
Simple Tips for Better Blood Sugar, Eating, and Health – Adam shares some advice to help tackle any situation with you diabetes.
Top 10 Tips for People Newly Diagnosed with Type 2 Diabetes – Adam shares his top ten tips for new type 2 diabetes patients.
Diabetes Drugs Resource Page – Our comprehensive overview of the available diabetes drugs, explaining the pros and cons of each
Metformin: What is it? – An article describing the various effects of the drug metformin.
DPP-4: What is it? – A quick description of the DPP-4 class of drugs.
SGLT-2: What is it? – An article describing the function and science of SGLT-2 inhibitors.
GLP-1: What is it? – An overview of the GLP-1 class of drugs.
Insulins Unplugged – An overview of the different varieties of insulin available today.
TZD's: What are they? – Learn about the TZD class of drugs.
Diabetes Devices Resource Page – Our comprehensive overview of the various diabetes devices out there
Making the Most of Meter Data – Gary Scheiner (MS, CDE) provides an overview of how to use blood glucose meters and their data for maximum results
Avoiding Complications of Diabetes – Dr. Mark Yarchoan provides an overview of the various complications of diabetes and how to help prevent them.
Talking About Complications – Kerri Sparling (SixUntilMe) discusses the shame and guilt that can come with complications and how a strong support network can make all the difference.
How Much Do You Know about Diabetes and Kidney Disease? – Our overview of what all of us need to know about one of our most vital organs – our kidneys.
Expand Your Knowledge of Diabetic Macular Edema (DME) – An overview of this diabetes complication and the three steps everyone can take to prevent it.
Diabetic Neuropathy: Knowledge is Power – Neuropathy occurs when the nerves are damaged and it can result in pain or numbness, read our prevention and treatment overview here.
Diabetes and Depression: Seven Things to Know and Resources to Help You Take Action – We examine the mental burden of diabetes, including depression and diabetes distress.
10 Diet Commandments for Better Diabetes Management – The ten diet commandments Adam follows for healthy eating with diabetes, plus a guide to how to write your own and overcome obstacles.
Are All Carbs Created Equal? – An article on the carb and glucose contents of different foods.
The Philosophy: What Foods Should I Eat? – An article by Kerri Sparling on her mindset regarding her food eating habits.
How to Thrive in a Toxic Food Environment that Encourages Bad Choices – Adam gives some tips on how to become, and stay, a healthy eater.
The Step-by-Step Approach to Better Blood sugars and a Healthier 2013 – Adam investigates how exercise, primarily walking, can positively affect your health and blood sugar levels.
Ten Tips for Changing Habits, Adopting New Behaviors, and Achieving Your Goals – Some tips on mentality by Adam for people newly diagnosed with diabetes.
Six Ways to Stay Motivated to Manage Your Diabetes Well – Managing your diabetes can be a daunting task, but Adam shares his advice on how to stay motivated.
How Much Activity Do You Actually Get? Why Activity Tracking is Worth It, and Perhaps Needed More than Ever – Adam shares why he’s found fitness tracking to be valuable, gives an overview of the pros/cons of fitness trackers, and shares the perspectives of other fitness tracker users
*Please note, this page is not a comprehensive list of all of the available resources.