Type 2 Diabetes

Type 2 diabetes (T2D) happens when your body can’t use insulin properly and/or doesn’t make enough of it. This leads to high blood sugar (hyperglycemia). It’s a condition you have to manage for the rest of your life.

Healthy blood sugar (glucose) levels are 70 to 99 milligrams per deciliter (mg/dL). If you have undiagnosed Type 2 diabetes, your levels are typically 126 mg/dL or higher.

This condition is very common. About 1 in 10 people in the U.S. has diabetes. And about 90% to 95% of them have T2D. Researchers estimate that it affects about 6.3% of the world’s population.

Most people who have T2D are over 45. But people younger than 45 can have it as well, including children.

Symptoms of Type 2 diabetes

Type 2 diabetes symptoms tend to develop slowly. They can include:

• Increased thirst
• Peeing more frequently
• Feeling hungrier than usual
• Fatigue
• Slow healing of cuts or sores
• Tingling or numbness in your hands or feet
• Blurred vision
• Dry skin
• Unexplained weight loss

Females may experience frequent vaginal yeast infections and/or urinary tract infections (UTIs).

If you have these symptoms, see your healthcare provider. Blood tests can diagnose T2D.

Type 2 diabetes causes

The main cause of Type 2 diabetes is insulin resistance.

Insulin resistance happens when certain cells in your body don’t respond as they should to insulin. Insulin is a hormone your pancreas makes that keeps your glucose levels in range.

With this resistance to insulin, your pancreas must make more of it to overcome increasing glucose levels. If your cells become too resistant to insulin and your pancreas can’t make enough, it leads to T2D.

Several factors can contribute to insulin resistance, including:

• Genetics
• Excess body fat, especially in your belly and around your organs (visceral fat)
• Physical inactivity
• Eating highly processed, high-carbohydrate foods and saturated fats frequently
• Certain medications, like long-term corticosteroid use
• Hormonal disorders, like underactive thyroid and Cushing syndrome
• Chronic stress and a lack of quality sleep

Is Type 2 diabetes genetic?

The cause of T2D is complex. But researchers know that genetics plays a strong role. Your lifetime risk of developing T2D is 40% if you have one biological parent with T2D. It’s 70% if both of your biological parents have it.

Researchers have identified at least 150 DNA variations linked to the risk of developing T2D. Some raise your risk, and others lower it. Some of these variations may directly play a role in insulin resistance and production. Others may increase your risk by increasing your tendency to have overweight or obesity.

These gene changes likely act together with other factors to influence your overall risk of T2D.

Risk factors

You’re more likely to develop Type 2 diabetes if you:

• Have a family history of Type 2 diabetes (biological parent or sibling)
• Are older than 45
• Have overweight or obesity (a BMI greater than 25)
• Are physically active less than three times a week
• Had gestational diabetes while pregnant
• Have high blood pressure and/or high cholesterol
• Have prediabetes
• Have polycystic ovarian syndrome (PCOS)

T2D symptoms typically come on slowly. So, it’s important to see your primary care provider regularly if you have risk factors. This way, they can do screenings to check on your blood sugar levels. It’s better to catch T2D earlier rather than later.

Complications of this condition

Having undiagnosed or undermanaged Type 2 diabetes can damage several areas of your body. Long-term complications of T2D can include:

• Cardiovascular disease, like heart attack and stroke
• Eye conditions, like retinopathy, macular edema and glaucoma
• Kidney damage
• Nerve damage
• Skin conditions, like dry skin and bacterial and fungal infections
• Foot problems, including ulcers and gangrene
• Oral health issues
• Hearing loss
• Digestive problems, including gastroparesis
• Sexual dysfunction

An acute (sudden and severe) complication of T2D is hyperosmolar hyperglycemic state (HHS). It’s life-threatening. HHS happens when your glucose levels are very high for days to weeks, leading to severe dehydration and confusion.

How doctors diagnose this condition

The following blood tests help your healthcare provider diagnose Type 2 diabetes:

• Fasting plasma glucose test: You typically get this test in the morning after an eight-hour fast (nothing to eat or drink except water). A result of 126 mg/dL or higher means you have diabetes.
• Random plasma glucose test: You can get this test at any time without fasting. A result of 200 mg/dL or higher means you have diabetes.
• A1C test: This test measures your average blood sugar level over the past two to three months. A result of 6.5% or higher means you have the condition.

In some cases, your provider may order an autoantibody blood test to see if you have Type 1 Diabetes instead of T2D.

How is Type 2 diabetes treated?

The key parts of managing Type 2 diabetes include:

• Lifestyle changes, like more exercise and eating adjustments
• Medication
• Glucose monitoring

You mainly manage T2D on your own with medical guidance and support from your healthcare team. This could include your:

• Primary care physician (PCP) or endocrinologist
• Registered dietitian
• Certified diabetes care and education specialist (CDCES)
• Eye doctor
• Dentist

Your team should also include family members and other important people in your life. Managing T2D can be challenging — you must make several decisions every day for it. Loved ones can help carry this mental load.

Physical activity

Regular physical activity is helpful for managing T2D because it:

• Lowers your blood sugar level in the short term and long term
• Improves blood flow and blood pressure
• Helps with stress management
• May help with weight loss
• Increases your energy level and boosts your mood

Talk to your provider before starting an exercise program. You may need to take special steps before, during and after physical activity. Especially if you take insulin. The general goal is to get at least 150 minutes per week of moderate-intensity physical activity.

Diet changes

Together, you and your healthcare provider or a dietitian will form a meal plan that works for you. What and when you eat impact your blood sugar.

Most providers recommend eating a variety of nutritious foods. In general, the following types of foods can help support healthy glucose levels:

• Lean proteins
• Non-starchy vegetables
• Sources of monounsaturated and polyunsaturated fats
• Complex carbohydrates

Medications

Your provider may recommend taking medication for Type 2 diabetes. These include:

• Oral diabetes medications: You take these by mouth to help manage blood sugar. There are several types that work in different ways. The most common one is metformin. Your provider may prescribe more than one medication at a time.
• GLP-1 and dual GLP-1/GIP agonists: These are injectable medications. Some GLP-1 agonists can also help treat obesity.
• Insulin: Synthetic insulin directly lowers blood sugar levels. There are several types of insulin. You may inject it with syringes or pens or use an insulin pump.
• Other medicines: You may take other medicines to treat coexisting conditions, like high blood pressure and high cholesterol.

Glucose monitoring

Monitoring your glucose helps you know how well your current treatment plan is working. It can help you make decisions about food, physical activity and medication needs.

Several things can affect your blood sugar. You can learn to predict some of these impacts with time and practice. But others are very difficult or impossible to predict. That’s why it’s important to check your glucose regularly if your healthcare provider recommends doing so. Your provider will also give you a goal glucose range.

The two main ways you can monitor your glucose at home are with a glucose meter and/or a continuous glucose monitor (CGM).

Can Type 2 diabetes be reversed?

Type 2 diabetes is a chronic (long-term) disease. This means you must manage it for the rest of your life. There’s no cure for T2D. But you can manage it in a way that keeps your blood sugar levels in a healthy range. If you stop managing it or undermanage it, your blood sugar levels will go back up.

When should I see my healthcare provider?

You’ll need regular appointments with your healthcare team to be sure you’re on track with your T2D management plan. As your body, life and routines change, your management will change, as well. Your healthcare team can provide new strategies tailored to your needs.

If you develop symptoms of any complications, see your provider as soon as possible.

What can I expect if I have this condition?

With Type 2 diabetes, you must make decisions every day to stay healthy. It’s a complex condition that requires a lot of effort and changes. This can be tough. But it’s also very doable with the right education and healthcare providers by your side. Getting support from your family and friends is a big help, too.

You’ll need to prioritize both your physical and mental health to stay healthy long-term. Maintaining in-range blood sugar levels is key to preventing serious complications.

In general, your outlook depends on several factors, like:

• Your age at diagnosis
• How often your blood sugar level is in range
• If you have other conditions, like high blood pressure or high cholesterol
• Your access to healthcare, management tools, medication and nutritious foods

Is there anything I can do to feel better?

Aside from getting proper medical care and guidance, the following can help you thrive with T2D:

• Stay educated: Don’t hesitate to ask your provider questions about T2D. The more you know about it and your management, the more likely you’ll be able to live healthily and prevent complications.
• Find community: Connecting with other people who have T2D — whether in person or online — can help you feel less alone.
• Take care of your mental health: People with diabetes are two to three times more likely to have depression. They’re 20% more likely to be diagnosed with anxiety. See a mental health professional if you have signs of these conditions.

Can Type 2 diabetes be prevented?

Certain strategies can help lower your risk of getting Type 2 diabetes or delay its onset, like:

• Getting physical activity regularly (at least 150 minutes a week)
• Maintaining a weight that’s healthy for you
• Eating nutritious food
• Not smoking

Some people have such strong genetic risk factors that even lifestyle changes aren’t enough to prevent developing T2D.