Type 2 diabetes – Diagnosis and treatment

Diagnosis

Type 2 diabetes is usually diagnosed using the glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. Results are interpreted as follows:

• Below 5.7% is normal.
• 5.7% to 6.4% is diagnosed as prediabetes.
• 6.5% or higher on two separate tests indicates diabetes.

If the A1C test isn’t available, or if you have certain conditions that interfere with an A1C test, your doctor may use the following tests to diagnose diabetes:

Random blood sugar test. Blood sugar values are expressed in milligrams of sugar per deciliter (mg/dL) or millimoles of sugar per liter (mmol/L) of blood. Regardless of when you last ate, a level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially if you also have signs and symptoms of diabetes, such as frequent urination and extreme thirst.

Fasting blood sugar test. A blood sample is taken after an overnight fast. Results are interpreted as follows:

• Less than 100 mg/dL (5.6 mmol/L) is normal.
• 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is diagnosed as prediabetes.
• 126 mg/dL (7 mmol/L) or higher on two separate tests is diagnosed as diabetes.

Oral glucose tolerance test. This test is less commonly used than the others, except during pregnancy. You’ll need to fast overnight and then drink a sugary liquid at the doctor’s office. Blood sugar levels are tested periodically for the next two hours. Results are interpreted as follows:

• Less than 140 mg/dL (7.8 mmol/L) is normal.
• 140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) is diagnosed as prediabetes.
• 200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes.

Screening. The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes in all adults age 45 or older and in the following groups:

• People younger than 45 who are overweight or obese and have one or more risk factors associated with diabetes
• Women who have had gestational diabetes
• People who have been diagnosed with prediabetes
• Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors

After a diagnosis

If you’re diagnosed with diabetes, your doctor or health care provider may do other tests to distinguish between type 1 and type 2 diabetes — since the two conditions often require different treatments.

Your health care provider will repeat the test A1C levels at least two times a year and when there are any changes in treatment. Target A1C goals vary depending on your age and other factors. For most people, the American Diabetes Association recommends an A1C level below 7%.

You will also receive regular diagnostic tests to screen for complications of diabetes or comorbid conditions.

Treatment

Management of type 2 diabetes includes:

• Healthy eating
• Regular exercise
• Weight loss
• Possibly, diabetes medication or insulin therapy
• Blood sugar monitoring

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

Healthy eating

Contrary to popular perception, there’s no specific diabetes diet. However, it’s important to center your diet around:

• A regular schedule for meals and healthy snacks
• Smaller portion sizes
• More high-fiber foods, such as fruits, nonstarchy vegetables and whole grains
• Fewer refined grains, starchy vegetables and sweets
• Modest servings of low-fat dairy, low-fat meats and fish
• Healthy cooking oils, such as olive oil or canola oil
• Fewer calories

Your health care provider may recommend seeing a registered dietitian, who can help you:

• Identify healthy choices among your food preferences
• Plan well-balanced, nutritional meals
• Develop new habits and address barriers to changing habits
• Monitor carbohydrate intake to keep your blood sugar levels more stable

Physical activity

Exercise is important for losing weight or maintaining a healthy weight. It also helps with regulating blood sugar levels. Talk to your primary health care provider before starting or changing your exercise program to ensure that activities are safe for you.

Aerobic exercise. Choose an aerobic exercise that you enjoy, such as walking, swimming, biking or running. Adults should aim for 30 minutes or more of moderate aerobic exercise on most days of the week, or at least 150 minutes a week. Children should have 60 minutes of moderate to vigorous aerobic exercise daily.

Resistance exercise. Resistance exercise increases your strength, balance and ability to perform activities of daily living more easily. Resistance training includes weightlifting, yoga and calisthenics.

Adults living with type 2 diabetes should aim for two to three sessions of resistance exercise each week. Children should engage in activities that build strength and flexibility at least three days a week. This can include resistance exercises, sports and climbing on playground equipment.

Limit inactivity. Breaking up long bouts of inactivity, such as sitting at the computer, can help control blood sugar levels. Take a few minutes to stand, walk around or do some light activity every 30 minutes.

Weight loss

Weight loss results in better control of blood sugar levels, cholesterol, triglycerides and blood pressure. If you’re overweight, you may begin to see improvements in these factors after losing as little as 5% of your body weight. However, the more weight you lose, the greater the benefit to your health and disease management.

Your health care provider or dietitian can help you set appropriate weight-loss goals and encourage lifestyle changes to help you achieve them.

Monitoring your blood sugar

Your health care provider will advise you on how often to check your blood sugar level to make sure you remain within your target range. You may, for example, need to check it once a day and before or after exercise. If you take insulin, you may need to do this multiple times a day.

Monitoring is usually done with a small, at-home device called a blood glucose meter, which measures the amount of sugar in a drop of your blood. You should keep a record of your measurements to share with your health care team.

Continuous glucose monitoring is an electronic system that records glucose levels every few minutes from a sensor placed under your skin. Information can be transmitted to a mobile device such as your phone, and the system can send alerts when levels are too high or too low.

Diabetes medications

If you can’t maintain your target blood sugar level with diet and exercise, your doctor may prescribe diabetes medications that help lower insulin levels or insulin therapy. Drug treatments for type 2 diabetes include the following.

Metformin (Fortamet, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving your body’s sensitivity to insulin so that your body uses insulin more effectively.

Some people experience B-12 deficiency and may need to take supplements. Other possible side effects, which may improve over time, include:

• Nausea
• Abdominal pain
• Bloating
• Diarrhea

Sulfonylureas help your body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include:

• Low blood sugar
• Weight gain

Glinides stimulate the pancreas to secrete more insulin. They’re faster acting than sulfonylureas, and the duration of their effect in the body is shorter. Examples include repaglinide and nateglinide. Possible side effects include:

• Low blood sugar
• Weight gain

Thiazolidinediones make the body’s tissues more sensitive to insulin. Examples include rosiglitazone (Avandia) and pioglitazone (Actos). Possible side effects include:

• Risk of congestive heart failure
• Risk of bladder cancer (pioglitazone)
• Risk of bone fractures
• High cholesterol (rosiglitazone)
• Weight gain

DPP-4 inhibitors help reduce blood sugar levels but tend to have a very modest effect. Examples include sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). Possible side effects include:

• Risk of pancreatitis
• Joint pain

GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels. Their use is often associated with weight loss, and some may reduce the risk of heart attack and stroke. Examples include exenatide (Byetta, Bydureon), liraglutide (Saxenda, Victoza) and semaglutide (Rybelsus, Ozempic). Possible side effects include:

• Risk of pancreatitis
• Nausea
• Vomiting
• Diarrhea

SGLT2 inhibitors affect the blood-filtering functions in your kidneys by inhibiting the return of glucose to the bloodstream. As a result, glucose is excreted in the urine. These drugs may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Examples include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance). Possible side effects include:

• Risk of amputation (canagliflozin)
• Risk of bone fractures (canagliflozin)
• Risk of gangrene
• Vaginal yeast infections
• Urinary tract infections
• Low blood pressure
• High cholesterol

Other medications your doctor might prescribe in addition to diabetes medications include blood pressure and cholesterol-lowering medications, as well as low-dose aspirin, to help prevent heart and blood vessel disease.

Insulin therapy

Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it may be prescribed sooner if blood sugar targets aren’t met with lifestyle changes and other medications.

Different types of insulin vary on how quickly they begin to work and how long they have an effect. Long-acting insulin, for example, is designed to work overnight or throughout the day to keep blood sugar levels stable. Short-acting insulin might be used at mealtime.

Your doctor will determine what type of insulin is appropriate for you and when you should take it. Your insulin type, dosage and schedule may change depending on how stable your blood sugar levels are. Most types of insulin are taken by injection.

Side effects of insulin include the risk of low blood sugar (hypoglycemia), diabetic ketoacidosis and high triglycerides.

Weight-loss surgery

Weight-loss surgery changes the shape and function of your digestive system. This surgery may help you lose weight and manage type 2 diabetes and other conditions related to obesity. There are various surgical procedures, but all of them help you lose weight by limiting how much food you can eat. Some procedures also limit the amount of nutrients you can absorb.

Weight-loss surgery is only one part of an overall treatment plan. Your treatment will also include diet and nutritional supplement guidelines, exercise and mental health care.

Generally, weight-loss surgery may be an option for adults living with type 2 diabetes who have a body mass index (BMI) of 35 or higher. BMI is a formula that uses weight and height to estimate body fat. Depending on the severity of diabetes or comorbid conditions, surgery may be an option for someone with a BMI lower than 35.

Weight-loss surgery requires a lifelong commitment to lifestyle changes. Long-term side effects include nutritional deficiencies and osteoporosis.

Pregnancy

Women with type 2 diabetes will likely need to change their treatment plans and adhere to diets that carefully controls carbohydrate intake. Many women will need insulin therapy during pregnancy and may need to discontinue other treatments, such as blood pressure medications.

There is an increased risk during pregnancy of developing diabetic retinopathy or a worsening of the condition. If you are pregnant or planning a pregnancy, visit an ophthalmologist during each trimester of your pregnancy, one year postpartum or as advised.

Signs of trouble

Regularly monitoring your blood sugar levels is important to avoid severe complications. Also, be aware of signs and symptoms that may suggest irregular blood sugar levels and the need for immediate care:

High blood sugar (hyperglycemia). Eating certain foods or too much food, being sick, or not taking medications at the right time can cause high blood sugar. Signs and symptoms include:

• Frequent urination
• Increased thirst
• Dry mouth
• Blurred vision
• Fatigue
• Headache

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). This life-threatening condition includes a blood sugar reading higher than 600 mg/dL (33.3 mmol/L). HHNS may be more likely if you have an infection, are not taking medicines as prescribed, or take certain steroids or drugs that cause frequent urination. Signs and symptoms include:

• Dry mouth
• Extreme thirst
• Drowsiness
• Confusion
• Dark urine
• Seizures

Diabetic ketoacidosis. Diabetic ketoacidosis occurs when a lack of insulin results in the body breaking down fat for fuel rather than sugar. This results in a buildup of acids called ketones in the bloodstream. Triggers of diabetic ketoacidosis include certain illnesses, pregnancy, trauma and medications — including the diabetes medications called SGLT2 inhibitors.

Although diabetic ketoacidosis is usually less severe in type 2 diabetes, the toxicity of the acids can be life-threatening. In addition to the signs and symptoms of hypoglycemia, such as frequent urination and increased thirst, ketoacidosis may result in:

• Nausea
• Vomiting
• Abdominal pain
• Shortness of breath
• Fruity-smelling breath

Low blood sugar. If your blood sugar level drops below your target range, it’s known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal, unintentionally taking more medication than usual or being more physical activity than usual. Signs and symptoms include:

• Sweating
• Shakiness
• Weakness
• Hunger
• Irritability
• Dizziness
• Headache
• Blurred vision
• Heart palpitations
• Slurred speech
• Drowsiness
• Confusion

If you have signs or symptoms of low blood sugar, drink or eat something that will quickly raise your blood sugar level — fruit juice, glucose tablets, hard candy or another source of sugar. Retest your blood in 15 minutes. If levels are not at your target, repeat the sugar intake. Eat a meal after levels return to normal.

If you lose consciousness, you will need to be given an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.

More Information

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Careful management of type 2 diabetes can reduce your risk of serious — even life-threatening — complications. Consider these tips:

• Commit to managing your diabetes. Learn all you can about type 2 diabetes. Make healthy eating and physical activity part of your daily routine.
• Work with your team. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.
• Identify yourself. Wear a necklace or bracelet that says you are living with diabetes, especially if you take insulin or other blood sugar-lowering medication.
• Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren’t meant to replace regular physicals or routine eye exams.
• Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year. Your health care provider may also recommend the pneumonia vaccine. The Centers for Disease Control and Prevention (CDC) also recommends the hepatitis B vaccination if you haven’t previously received this vaccine and you’re 19 to 59 years old.
• Take care of your teeth. Diabetes may leave you prone to more-serious gum infections. Brush and floss your teeth regularly and schedule recommended dental exams. Consult your dentist right away if your gums bleed or look red or swollen.
• Pay attention to your feet. Wash your feet daily in lukewarm water, dry them gently, especially between the toes, and moisturize them with lotion. Check your feet every day for blisters, cuts, sores, redness and swelling. Consult your health care provider if you have a sore or other foot problem that isn’t healing.
• Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Take medication as prescribed.
• If you smoke or use other types of tobacco, ask your health care provider to help you quit. Smoking increases your risk of various diabetes complications. Talk to your health care provider about ways to stop smoking tobacco.
• Use alcohol sparingly. Depending on the type of drink, alcohol may lower or raise blood sugar levels. If you choose to drink alcohol, only do so with a meal. The recommendation is no more than one drink daily for women and no more than two drinks daily for men. Check your blood sugar frequently after consuming alcohol.

Alternative medicine

Many alternative medicine treatments claim to help people living with diabetes. According to the National Center for Complementary and Integrative Health, studies haven’t provided enough evidence to recommend any alternative therapies for blood sugar management. Research has shown the following results about popular supplements for type 2 diabetes:

• Chromium supplements have been shown to have few or no benefits. Large doses can result in kidney damage, muscular problems and skin reactions.
• Magnesium supplements have shown benefits for blood sugar control in some but not all studies. Side effects include diarrhea and cramping. Very large doses — more than 5,000 mg a day — can be fatal.
• Cinnamon, in some studies, has lowered fasting glucose levels but not A1C levels. Therefore, there’s no evidence of overall improved glucose management. Most cinnamon contains a substance called coumarin that may cause or worsen liver disease.

Talk to your doctor before starting a dietary supplement or natural remedy. Do not replace your prescribed diabetes medication with alternative medicines.

Coping and support

Type 2 diabetes is a serious disease, and following your diabetes treatment plan takes round-the-clock commitment. To meet the demands of diabetes management, you may need a good support network.

Anxiety and depression are common in people living with diabetes. Talking to a counselor or therapist may help you cope with the lifestyle changes or stressors that come with a type 2 diabetes diagnosis.

Support groups can be good sources of diabetes education, emotional support, and helpful information, such as how to find local resources or where to find carbohydrate counts for a favorite restaurant. If you’re interested, your health care provider may be able to recommend a group in your area.

You can visit the American Diabetes Association website to check out local activities and support groups for people living with type 2 diabetes. The American Diabetes Association also offers online information and online forums where you can chat with others who are living with diabetes. You can also call the organization at 800-DIABETES (800-342-2383).

Preparing for your appointment

Keeping your annual wellness visits enables your health care provider to screen for diabetes and to monitor and treat conditions that increase your risk of diabetes — such as high blood pressure, high cholesterol or a high BMI.

If you are seeing your health care provider because of symptoms that may be related to diabetes, you can prepare for your appointment by being ready to answer the following questions:

• When did your symptoms begin?
• Does anything improve the symptoms or worsen the symptoms?
• What medicines do you take regularly, including dietary supplements and herbal remedies?
• What are your typical daily meals? Do you eat between meals or before bedtime?
• How much alcohol do you drink?
• How much daily exercise do you get?
• Is there a history of diabetes in your family?

If you are diagnosed with diabetes, your health care provider will begin a treatment plan. You may be referred to a doctor who specializes in hormonal disorders (endocrinologist). Your care team may also include the following specialists:

• Dietitian
• Certified diabetes educator
• Foot doctor (podiatrist)
• Doctor who specializes in eye care (ophthalmologist)

Talk to your health care provider about referrals to other specialists who will be providing care.

Questions for ongoing appointments

Before any appointment with a member of your treatment team, make sure you know whether there are any restrictions, such as fasting before taking a test. Questions that you should regularly review with your doctor or other members of the team include:

• How often do I need to monitor my blood sugar, and what is my target range?
• What changes in my diet would help me better manage my blood sugar?
• What is the right dosage for prescribed medications?
• When do I take the medications? Do I take them with food?
• How is management of diabetes affecting treatment for other conditions? How can I better coordinate treatments or care?
• When do I need to make a follow-up appointment?
• Under what conditions should I call you or seek emergency care?
• Are there brochures or online sources you recommend?
• Are there resources available if I’m having trouble paying for diabetes supplies?

What to expect from your doctor

Your provider is likely to ask you a number of questions at regularly scheduled appointments, including:

• Do you understand your treatment plan and feel confident you can follow it?
• How are you coping with diabetes?
• Have you experienced any low blood sugar?
• Do you know what to do if your blood sugar is too low or too high?
• What’s a typical day’s diet like?
• Are you exercising? If so, what type of exercise? How often?
• Do you sit for long periods of time?
• What challenges are you experiencing in managing your diabetes?

Jan. 20, 2021

Diabetes treatment: Medications for type 2 diabetes

Healthy lifestyle choices — including diet, exercise and weight control — provide the foundation for managing type 2 diabetes. However, you may need medications to achieve target blood sugar (glucose) levels. Sometimes a single medication is effective. In other cases, a combination of medications works better.

The list of medications for type 2 diabetes is long and potentially confusing. Learning about these drugs — how they’re taken, what they do and what side effects they may cause — will help you discuss treatment options with your doctor.

Diabetes treatment: Lowering blood sugar

Several classes of type 2 diabetes medicines exist. Each class of medicine works in different ways to lower blood sugar. A drug may work by:

• Stimulating the pancreas to produce and release more insulin
• Inhibiting the production and release of glucose from the liver
• Blocking the action of stomach enzymes that break down carbohydrates
• Improving the sensitivity of cells to insulin
• Inhibiting the reabsorption of glucose in the kidneys
• Slowing how quickly food moves through the stomach

Each class of medicine has one or more drugs. Some of these drugs are taken orally, while others must be injected.

Compare diabetes medications

Here’s an at-a-glance comparison of common diabetes medications. More medications are available depending on your needs and situation. Ask your doctor about your options and the pros and cons of each.

Oral medications

Meglitinides

Medications

Action

• Stimulate the release of insulin

Advantages

Possible side effects

• Low blood sugar (hypoglycemia)
• Weight gain
• Nausea or vomiting, when interacting with alcohol

Sulfonylureas

Medications

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

Action

• Stimulate the release of insulin

Advantages

• Low cost
• Effective in lowering blood sugar

Possible side effects

• Hypoglycemia
• Weight gain
• Skin rash

Dipeptidyl-peptidase 4 (DPP-4) inhibitors

Medications

• Saxagliptin (Onglyza)
• Sitagliptin (Januvia)
• Linagliptin (Tradjenta)
• Alogliptin (Nesina)

Action

• Stimulate the release of insulin when blood glucose is rising
• Inhibit the release of glucose from the liver

Advantages

• Don’t cause weight gain
• Don’t cause hypoglycemia (unless combined with insulin or a sulfonylurea)

Possible side effects

• Upper respiratory tract infection
• Sore throat
• Headache

Biguanides

Medications

• Metformin (Glumetza, Riomet, Fortamet)

Action

• Inhibit the release of glucose from the liver
• Improve sensitivity to insulin

Advantages

• Very effective
• May promote modest weight loss
• Low cost

Possible side effects

• Nausea
• Diarrhea
• Very rarely, the harmful buildup of lactic acid (lactic acidosis) when used in people with kidney or liver failure

Thiazolidinediones

Medications

• Rosiglitazone (Avandia)
• Pioglitazone (Actos)

Action

• Improve sensitivity to insulin
• Inhibit the release of glucose from the liver

Advantages

• May slightly increase high-density lipoprotein (HDL) cholesterol, the “good” cholesterol

Possible side effects

• Weight gain
• Heart failure
• Heart attack
• Fractures
• Possible increased risk of bladder cancer with pioglitazone

These medications shouldn’t be used in people with kidney disease or heart problems.

Alpha-glucosidase inhibitors

Medications

• Acarbose
• Miglitol (Glyset)

Action

• Slow the breakdown of starches and some sugars

Advantages

• Don’t cause weight gain
• Don’t cause hypoglycemia (unless combined with insulin or a sulfonylurea)

Possible side effects

• Stomach pain
• Gas
• Diarrhea

Sodium-glucose co-transporter 2 (SGLT2) inhibitors

Medications

• Canagliflozin (Invokana)
• Dapagliflozin (Farxiga)
• Empagliflozin (Jardiance)

Action

• Block glucose from being reabsorbed by the kidneys

Advantages

• May promote weight loss
• May lower blood pressure

Possible side effects

• Urinary tract infections
• Yeast infections
• Rare, serious genital infection

Bile acid sequestrants

Medications

Action

• Lower cholesterol and have a very modest effect in lowering blood glucose when used in combination with other diabetes medications

Advantages

• Likely safe for people with liver problems

Possible side effects

• Gas
• Constipation
• Indigestion

Injectable medications

Amylin mimetics

Medications

Action

• Help regulate glucose
• Slow food moving through the stomach
• Used with insulin injections

Advantages

• May suppress hunger
• May promote modest weight loss

Possible side effects

• Hypoglycemia
• Nausea or vomiting

Incretin mimetics (GLP-1 analogs)

Medications

• Albiglutide (Tanzeum)
• Dulaglutide (Trulicity)
• Exenatide (Byetta)
• Exenatide extended release (Bydureon)
• Liraglutide (Saxenda, Victoza)
• Lixisenatide (Adlyxin)
• Semaglutide (Ozempic, Rybelsus)

Action

• Stimulate the release of insulin
• Used with metformin, basal insulin or a sulfonylurea

Advantages

• May suppress hunger
• May promote modest weight loss

Possible side effects

• Nausea or vomiting
• Increased risk of inflamed pancreas (pancreatitis) and some thyroid tumors

How to choose your diabetes medication

No single diabetes treatment is best for everyone, and what works for one person may not work for another. Your doctor can determine how a specific medication or multiple medications may fit into your overall diabetes treatment plan and help you understand the advantages and disadvantages of specific diabetes drugs.

Oct. 24, 2020

Show references

1. Papadakis MA, et al., eds. Diabetes mellitus and hypoglycemia. In: Current Medical Diagnosis & Treatment 2017. 56th ed. New York, N.Y.: McGraw-Hill Education; 2017. http://accessmedicine.mhmedical.com. Accessed Aug. 28, 2017.
2. McCulloch DK. Overview of medical care in adults with diabetes mellitus. https://www.uptodate.com/contents/search. Accessed Aug. 28, 2017.
3. What are my options? American Diabetes Association. http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/what-are-my-options.html?referrer=https://www.google.com/. Accessed Aug. 21, 2017.
4. McCulloch DK. Sulfonylureas and meglitinides in the treatment of diabetes mellitus. https://www. uptodate.com/contents/search. Accessed Aug. 28, 2017.
5. Melmed S, et al. Diabetes mellitus. In: Williams Textbook of Endocrinology. 13th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Aug. 28, 2017.
6. Castro MR (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 8, 2017.
7. FDA warns about rare occurrences of a serious infection of the genital area with SGLT2 inhibitors for diabetes. U.S. Food and Drug Administration. https://www.fda.gov/Drugs/DrugSafety/ucm617360.htm. Accessed Sept. 14, 2018.

See more In-depth

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GLP-1 agonists: Diabetes drugs and weight loss

Are there any type 2 diabetes drugs that can help people lose weight and lower their blood sugar? Are there side effects?

Answer From M. Regina Castro, M.D.

There’s a class of type 2 diabetes drugs that not only improves blood sugar control but may also lead to weight loss. This class of drugs is commonly called glucagon-like peptide 1 (GLP-1) agonists. Another class of medications associated with weight loss and improved blood sugar control is the sodium glucose cotransporter 2 (SGLT-2) inhibitors. These include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).

Weight loss can vary depending on which GLP-1 medication you use and your dose. But weight loss may average about 3 to 5.5 pounds (1.5 to 2.5 kilograms, or kg) when using these drugs.

If you’re actively trying to lose weight through lifestyle changes and add the use of one of these medications, research has shown that the drugs may lead to around 6 to 9 pounds (2.8 to 4.2 kg) of additional weight loss.

Diabetes drugs in the GLP-1 agonists class include:

• Dulaglutide (Trulicity), taken by injection weekly
• Exenatide extended release (Bydureon), taken by injection weekly
• Exenatide (Byetta), taken by injection twice daily
• Semaglutide (Ozempic), taken by injection weekly
• Semaglutide (Rybelsus), taken by mouth once daily
• Liraglutide (Victoza), taken by injection daily
• Lixisenatide (Adlyxin), taken by injection daily

These medications mimic the action of a hormone called glucagon-like peptide 1. When blood sugar levels start to rise after someone eats, these drugs stimulate the body to secrete more insulin. The extra insulin helps lower blood sugar levels.

Lower blood sugar levels are helpful for controlling type 2 diabetes, but it’s not exactly clear how the GLP-1 drugs lead to weight loss. Doctors do know that GLP-1s appear to help suppress appetite. These drugs also slow the movement of food from the stomach into the small intestine. As a result, you may feel full faster and longer, so you eat less.

Along with helping to control blood sugar and boost weight loss, GLP-1s and SGLT-2 inhibitors seem to have other significant benefits. Research has found that some drugs in these classes of medications may lower the risk of heart disease, including heart failure; stroke; and kidney disease. People taking these drugs have seen improvements in their blood pressure and cholesterol levels, though it’s not clear whether these benefits are from the medication or the weight loss.

The downside to GLP-1 drugs is that all but one has to be taken by injection. And, like any medication, there is a risk of side effects, some serious. More common side effects usually improve after you’ve taken the medication for a while.

Some of the more common side effects include:

Low blood sugar levels (hypoglycemia) are a more serious risk linked to the GLP-1 class of medications. But the risk of low blood sugar levels is usually only increased if you’re taking another medication known to lower blood sugar at the same time, such as sulfonylureas or insulin.

The GLP-1 class of drugs isn’t recommended if you have a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia. Laboratory studies have linked these drugs with thyroid tumors in rats, but until more long-term studies are completed, the risk to humans isn’t known. They’re also not recommended if you’ve had pancreatitis.

The drugs already discussed are designed for people who have type 2 diabetes. There is also a drug that contains a higher dose of liraglutide (Saxenda) that’s approved for the treatment of obesity in people who don’t have diabetes.

If you have diabetes and wonder if one of these drugs may be helpful for you, talk to your doctor.

With

M. Regina Castro, M.D.

• Diabetes: Does alcohol and tobacco use increase my risk?

June 23, 2020

Show references

1. American Diabetes Association. Standards of medical care in diabetes — 2020. Diabetes Care. 2020; doi:10.2337/dc20-SINT.
2. Dungan K, et al. Glucagon-like peptide 1 receptor agonists for the treatment of type 2 diabetes mellitus. https://www.uptodate. com/contents/search. Accessed April 10, 2020.
3. Goldman L, et al., eds. Diabetes mellitus. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 11, 2020.
4. Hu M, et al. Effect of hemoglobin A1c reduction or weight reduction on blood pressure in glucagon-like peptide-1receptor agonist and sodium-glucose cotransporter-2 inhibitor treatment in type 2 diabetes mellitus: A meta-analysis. Journal of the American Heart Association. 2020; doi:10.1161/JAHA.119.015323.
5. Boyle JG, et al. Cardiovascular benefits of GLP-1 agonists in type 2 diabetes: A comparative review. Clinical Science. 2018; doi:10.1042/CS20171299.
6. Bellastella G, et al. Glucagon-like peptide-1 receptor agonists and prevention of stroke systematic review of cardiovascular outcome trials with meta-analysis. Stroke. 2020; doi:10.1161/STROKEAHA.119.027557.
7. Perreault L. Obesity in adults: Drug therapy. https://www.uptodate.com/contents/search. Accessed April 10, 2020.

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Diabetes – Diagnosis and treatment

Diagnosis

Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be evident, the American Diabetes Association (ADA) has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes:

• Anyone with a body mass index higher than 25 (23 for Asian Americans), regardless of age, who has additional risk factors, such as high blood pressure, abnormal cholesterol levels, a sedentary lifestyle, a history of polycystic ovary syndrome or heart disease, and who has a close relative with diabetes.
• Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter.
• Women who have had gestational diabetes are advised to be screened for diabetes every three years.
• Anyone who has been diagnosed with prediabetes is advised to be tested every year.

Tests for type 1 and type 2 diabetes and prediabetes

• Glycated hemoglobin (A1C) test. This blood test, which doesn’t require fasting, indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.

  The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5% or higher on two separate tests indicates that you have diabetes. An A1C between 5. 7 and 6.4 % indicates prediabetes. Below 5.7 is considered normal.

If the A1C test results aren’t consistent, the test isn’t available, or you have certain conditions that can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:

• Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.
• Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

• Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.

  A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.

If type 1 diabetes is suspected, your urine will be tested to look for the presence of a byproduct produced when muscle and fat tissue are used for energy because the body doesn’t have enough insulin to use the available glucose (ketones). Your doctor will also likely run a test to see if you have the destructive immune system cells associated with type 1 diabetes called autoantibodies.

Tests for gestational diabetes

Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy:

• If you’re at high risk of gestational diabetes — for example, if you were obese at the start of your pregnancy; you had gestational diabetes during a previous pregnancy; or you have a mother, father, sibling or child with diabetes — your doctor may test for diabetes at your first prenatal visit.
• If you’re at average risk of gestational diabetes, you’ll likely have a screening test for gestational diabetes sometime during your second trimester — typically between 24 and 28 weeks of pregnancy.

Your doctor may use the following screening tests:

• Initial glucose challenge test. You’ll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you’ll have a blood test to measure your blood sugar level. A blood sugar level below 140 mg/dL (7.8 mmol/L) is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs.

  If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. Your doctor will order a follow-up test to determine if you have gestational diabetes.

• Follow-up glucose tolerance testing. For the follow-up test, you’ll be asked to fast overnight and then have your fasting blood sugar level measured. Then you’ll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for a period of three hours.

  If at least two of the blood sugar readings are higher than the normal values established for each of the three hours of the test, you’ll be diagnosed with gestational diabetes.

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Treatment

Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. Eating a healthy diet, maintaining a healthy weight and participating in regular activity also are important factors in managing diabetes.

Treatments for all types of diabetes

An important part of managing diabetes — as well as your overall health — is maintaining a healthy weight through a healthy diet and exercise plan:

• Healthy eating. Contrary to popular perception, there’s no specific diabetes diet. You’ll need to center your diet on more fruits, vegetables, lean proteins and whole grains — foods that are high in nutrition and fiber and low in fat and calories — and cut down on saturated fats, refined carbohydrates and sweets. In fact, it’s the best eating plan for the entire family. Sugary foods are OK once in a while, as long as they’re counted as part of your meal plan.

  Yet, understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This will likely include carbohydrate counting, especially if you have type 1 diabetes or use insulin as part of your treatment.

• Physical activity. Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by moving sugar into your cells, where it’s used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells.

  Get your doctor’s OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What’s most important is making physical activity part of your daily routine.

  Aim for at least 30 minutes or more of aerobic exercise most days of the week, or at least 150 minutes of moderate physical activity a week. Bouts of activity can be as brief as 10 minutes, three times a day. If you haven’t been active for a while, start slowly and build up gradually. It’s also a good idea to avoid sitting for too long — aim to get up and move if you’ve been sitting for more than 30 minutes.

Treatments for type 1 and type 2 diabetes

Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting. Treatment of type 2 diabetes primarily involves lifestyle changes, monitoring of your blood sugar, along with diabetes medications, insulin or both.

• Monitoring your blood sugar. Depending on your treatment plan, you may check and record your blood sugar as many as four times a day or more often if you’re taking insulin. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People with type 2 diabetes who aren’t taking insulin generally check their blood sugar much less frequently.

  People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology hasn’t yet completely replaced the glucose meter, it can significantly reduce the number of fingersticks necessary to check blood sugar and provide important information about trends in blood sugar levels.

  Even with careful management, blood sugar levels can sometimes change unpredictably. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to food, physical activity, medications, illness, alcohol, stress — and for women, fluctuations in hormone levels.

  In addition to daily blood sugar monitoring, your doctor will likely recommend regular A1C testing to measure your average blood sugar level for the past two to three months.

  Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your oral medication, insulin regimen or meal plan.

  Your target A1C goal may vary depending on your age and various other factors, such as other medical conditions you may have. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7%. Ask your doctor what your A1C target is.

• Insulin. People with type 1 diabetes need insulin therapy to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy.

  Many types of insulin are available, including short-acting (regular insulin), rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

  Insulin can’t be taken orally to lower blood sugar because stomach enzymes interfere with insulin’s action. Often insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like a large ink pen.

  An insulin pump also may be an option. The pump is a device about the size of a small cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that’s inserted under the skin of your abdomen.

  A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

  In September 2016, the Food and Drug Administration approved the first artificial pancreas for people with type 1 diabetes who are age 14 and older. A second artificial pancreas was approved in December 2019. Since then systems have been approved for children older than 2 years old.

  An artificial pancreas is also called closed-loop insulin delivery. The implanted device links a continuous glucose monitor, which checks blood sugar levels every five minutes, to an insulin pump. The device automatically delivers the correct amount of insulin when the monitor indicates it’s needed.

  There are more artificial pancreas (closed loop) systems currently in clinical trials.

• Oral or other medications. Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells.

  Still others block the action of stomach or intestinal enzymes that break down carbohydrates or make your tissues more sensitive to insulin. Metformin (Glumetza, Fortamet, others) is generally the first medication prescribed for type 2 diabetes.

  Another class of medication called SGLT2 inhibitors may be used. They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine.

• Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. Islet transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy.

  But transplants aren’t always successful — and these procedures pose serious risks. You need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, which is why transplants are usually reserved for people whose diabetes can’t be controlled or those who also need a kidney transplant.

• Bariatric surgery. Although it is not specifically considered a treatment for type 2 diabetes, people with type 2 diabetes who are obese and have a body mass index higher than 35 may benefit from this type of surgery. People who’ve undergone gastric bypass have seen significant improvements in their blood sugar levels. However, this procedure’s long-term risks and benefits for type 2 diabetes aren’t yet known.

Treatment for gestational diabetes

Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin or oral medications.

Your doctor also will monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin — which can lead to low blood sugar right after birth.

Treatment for prediabetes

If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing about 7% of your body weight may prevent or delay type 2 diabetes.

Sometimes medications — such as metformin (Glucophage, Glumetza, others) — also are an option if you’re at high risk of diabetes, including when your prediabetes is worsening or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.

In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease if you’re at high risk. However, healthy lifestyle choices remain key.

Signs of trouble in any type of diabetes

Because so many factors can affect your blood sugar, problems may sometimes arise that require immediate care, such as:

• High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level as directed by your doctor, and watch for signs and symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you’ll need to adjust your meal plan, medications or both.

• Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and a sweet, fruity breath.

  You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes.

• Hyperglycemic hyperosmolar nonketotic syndrome. Signs and symptoms of this life-threatening condition include a blood sugar reading over 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever, drowsiness, confusion, vision loss and hallucinations. Hyperosmolar syndrome is caused by sky-high blood sugar that turns blood thick and syrupy.

  It is seen in people with type 2 diabetes, and it’s often preceded by an illness. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition.

• Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it’s known as low blood sugar (hypoglycemia). If you’re taking medication that lowers your blood sugar, including insulin, your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. Low blood sugar also occurs if you take too much insulin or an excess of a glucose-lowering medication that promotes the secretion of insulin by your pancreas.

  Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice or glucose tablets.

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment. Careful management of diabetes can reduce your risk of serious — even life-threatening — complications.

• Make a commitment to managing your diabetes. Learn all you can about diabetes. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.
• Choose healthy foods and maintain a healthy weight. If you’re overweight, losing just 5% of your body weight can make a difference in your blood sugar control if you have prediabetes or type 2 diabetes. A healthy diet is one with plenty of fruits, vegetables, lean proteins, whole grains and legumes, with a limited amount of saturated fat.

• Make physical activity part of your daily routine. Regular exercise can help prevent prediabetes and type 2 diabetes, and it can help those who already have diabetes to maintain better blood sugar control. A minimum of 30 minutes of moderate exercise — such as brisk walking — most days of the week is recommended. Aim for at least 150 minutes of moderate aerobic activity a week.

  It’s also a good idea to spend less time sitting still. Try to get up and move around for a few minutes at least every 30 minutes or so when you’re awake.

Lifestyle for type 1 and type 2 diabetes

In addition, if you have type 1 or type 2 diabetes:

• Identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency — and make sure your friends and loved ones know how to use it.
• Schedule a yearly physical and regular eye exams. Your regular diabetes checkups aren’t meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications and screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

• Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and your doctor may recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also currently recommends hepatitis B vaccination if you haven’t previously been vaccinated against hepatitis B and you’re an adult ages 19 to 59 with type 1 or type 2 diabetes.

  The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes, and haven’t previously received the vaccine, talk to your doctor about whether it’s right for you.

• Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes. Moisturize with lotion, but not between the toes. Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that doesn’t heal promptly on its own.
• Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.
• Take care of your teeth. Diabetes may leave you prone to more-serious gum infections. Brush and floss your teeth at least twice a day. And if you have type 1 or type 2 diabetes, schedule regular dental exams. Consult your dentist right away if your gums bleed or look red or swollen.
• If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications. Smokers who have diabetes are more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.

• If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation — one drink a day for women and two drinks a day for men — and always with food.

  Remember to include the carbohydrates from any alcohol you drink in your daily carbohydrate count. And check your blood sugar levels before going to bed.

• Take stress seriously. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which will raise your blood sugar and stress you even more. Set limits for yourself and prioritize your tasks. Learn relaxation techniques. And get plenty of sleep.

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Alternative medicine

Numerous substances have been shown to improve insulin sensitivity in some studies, while other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, there aren’t any alternative therapies that are currently recommended to help everyone with blood sugar management.

If you decide to try any type of alternative therapy, don’t stop taking the medications that your doctor has prescribed. Be sure to discuss the use of any of these therapies with your doctor to make sure that they won’t cause adverse reactions or interact with your current therapy.

Additionally, there are no treatments — alternative or conventional — that can cure diabetes, so it’s critical that people who are receiving insulin therapy for diabetes don’t stop using insulin unless directed to do so by their physicians.

Coping and support

Living with diabetes can be difficult and frustrating. Sometimes, even when you’ve done everything right, your blood sugar levels may rise. But stick with your diabetes management plan, and you’ll likely see a positive difference in your A1C when you visit your doctor.

Because good diabetes management can be time-consuming, and sometimes overwhelming, some people find it helps to talk to someone. Your doctor can probably recommend a mental health professional for you to speak with, or you may want to try a support group.

Sharing your frustrations and your triumphs with people who understand what you’re going through can be very helpful. And you may find that others have great tips to share about diabetes management.

Your doctor may know of a local support group, or you can call the American Diabetes Association at 800-DIABETES (800-342-2383) or the Juvenile Diabetes Research Foundation at 800-533-CURE (800-533-2873).

Preparing for your appointment

You’re likely to start by seeing your primary care doctor if you’re having diabetes symptoms. If your child is having diabetes symptoms, you might see your child’s pediatrician. If blood sugar levels are extremely high, you’ll likely be sent to the emergency room.

If blood sugar levels aren’t high enough to put you or your child immediately at risk, you may be referred to a doctor who specializes in diabetes, among other disorders (endocrinologist). Soon after diagnosis, you’ll also likely meet with a diabetes educator and a dietitian to get more information on managing your diabetes.

Here’s some information to help you get ready for your appointment and to know what to expect.

What you can do

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if you need to do anything in advance. This will likely include restricting your diet, such as for a fasting blood sugar test.
• Write down any symptoms you’re experiencing, including any that may seem unrelated.
• Write down key personal information, including major stresses or recent life changes. If you’re monitoring your glucose values at home, bring a record of the glucose results, detailing the dates and times of testing.
• Make a list of any allergies you have and all medications, vitamins and supplements you’re taking.
• Record your family medical history. In particular, note any relatives who have had diabetes, heart attacks or strokes.
• Take a family member or friend, if possible. Someone who accompanies you can help you remember information you need.
• Write down questions to ask your doctor. Ask about aspects of your diabetes management you’re unclear about.
• Be aware if you need any prescription refills. Your doctor can renew your prescriptions while you’re there.

Preparing a list of questions can help you make the most of your time with your doctor. For diabetes, some questions to ask include:

• Are the symptoms I’m having related to diabetes or something else?
• Do I need any tests?
• What else can I do to protect my health?
• What are other options to manage my diabetes?
• I have other health conditions. How can I best manage these conditions together?
• Are there restrictions I need to follow?
• Should I see another specialist, such as a dietitian or diabetes educator?
• Is there a generic alternative to the medicine you’re prescribing?
• Are there brochures or other printed material I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• Can you describe your symptoms?
• Do you have symptoms all the time, or do they come and go?
• How severe are your symptoms?
• Do you have a family history of preeclampsia or diabetes?
• Tell me about your diet.
• Do you exercise? What type and how much?

Oct. 30, 2020

Symptoms & Signs of Diabetes Mellitus & Insipidus

Images provided by:

1.iStockphoto

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Sources:

MedicineNet: Diabetes Mellitus
<https://www.medicinenet.com/diabetes_mellitus/article.htm>

WebMD: Symptoms of Type 2 Diabetes
<http://diabetes.webmd.com/guide/diabetes-warning-signs>

MedTerms: Insulin
<http://www.medterms.com/script/main/art.asp?articlekey=3989>

WebMD: Obesity Overview
<https://www.webmd.com/diet/tc/obesity-overview>

WebMD: Obesity – Health Risks of Obesity
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MedicineNet: Prediabetes – Could You Have It?
<https://www.medicinenet.com/script/main/art.asp?articlekey=57580>

MedicineNet: Type 2 Diabetes Pictures Slideshow
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WebMD: Diabetes Symptoms and Types
<http://diabetes.webmd.com/guide/diabetes_symptoms_types>

WebMD: Diabetes and Infection
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WebMD: Understanding Diabetes – The Basics
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MedicineNet: Diabetes Insipidus
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NIH: Diabetes Insipidus
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the MedicineNet Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

&copy 1996-2021 MedicineNet, Inc. All rights reserved.

Diabetes Tests | CDC

You’ll need to get your blood sugar tested to find out for sure if you have prediabetes or type 1, type 2, or gestational diabetes. Testing is simple, and results are usually available quickly.

Tests for Type 1 Diabetes, Type 2 Diabetes, and Prediabetes

Your doctor will have you take one or more of the following blood tests to confirm the diagnosis:

A1C Test

The A1C test measures your average blood sugar level over the past 2 or 3 months. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes, and 6.5% or higher indicates you have diabetes.

Fasting Blood Sugar Test

This measures your blood sugar after an overnight fast (not eating). A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. At 2 hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates you have diabetes.

Random Blood Sugar Test

This measures your blood sugar at the time you’re tested. You can take this test at any time and don’t need to fast (not eat) first. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.

*Results for gestational diabetes can differ. Ask your health care provider what your results mean if you’re being tested for gestational diabetes.
Source: American Diabetes Association

If your doctor thinks you have type 1 diabetes, your blood may also tested for autoantibodies (substances that indicate your body is attacking itself) that are often present in type 1 diabetes but not in type 2 diabetes. You may have your urine tested for ketones (produced when your body burns fat for energy), which also indicate type 1 diabetes instead of type 2 diabetes.

Tests for Gestational Diabetes

Gestational diabetes is diagnosed using blood tests. You’ll probably be tested between 24 and 28 weeks of pregnancy. If your risk is higher for getting gestational diabetes (due to having more risk factors), your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.

Glucose Screening Test

This measures your blood sugar at the time you’re tested. You’ll drink a liquid that contains glucose, and then 1 hour later your blood will be drawn to check your blood sugar level. A normal result is 140 mg/dL or lower. If your level is higher than 140 mg/dL, you’ll need to take a glucose tolerance test.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. Results can differ depending on the size of the glucose drink and how often your blood sugar is tested. Ask your doctor what your test results mean.

Prevent Type 2 Diabetes

If your test results show you have prediabetes, ask your doctor or nurse if there is a lifestyle change program offered through the CDC-led National Diabetes Prevention Program in your community. You can also search for an online or in-person program. Having prediabetes puts you at greater risk for developing type 2 diabetes, but participating in the program can lower your risk by as much as 58% (71% if you’re over age 60).

Diabetes Treatment Plan

If your test results show you have type 1, type 2, or gestational diabetes, talk with your doctor or nurse about a detailed treatment plan—including diabetes self-management education and support services—and specific steps you can take to be your healthiest.

Manage Blood Sugar | Diabetes

It’s important to keep your blood sugar levels in your target range as much as possible to help prevent or delay long-term, serious health problems, such as heart disease, vision loss, and kidney disease. Staying in your target range can also help improve your energy and mood. Find answers below to common questions about blood sugar for people with diabetes.

How can I check my blood sugar?

Use a blood sugar meter (also called a glucometer) or a continuous glucose monitor (CGM) to check your blood sugar. A blood sugar meter measures the amount of sugar in a small sample of blood, usually from your fingertip. A CGM uses a sensor inserted under the skin to measure your blood sugar every few minutes. If you use a CGM, you’ll still need to test daily with a blood sugar meter to make sure your CGM readings are accurate.

When should I check my blood sugar?

How often you check your blood sugar depends on the type of diabetes you have and if you take any diabetes medicines.

Typical times to check your blood sugar include:

• When you first wake up, before you eat or drink anything.
• Before a meal.
• Two hours after a meal.
• At bedtime.

If you have type 1 diabetes, have type 2 diabetes and take insulin, or often have low blood sugar, your doctor may want you to check your blood sugar more often, such as before and after you’re physically active.

What are blood sugar targets?

A blood sugar target is the range you try to reach as much as possible. These are typical targets:

• Before a meal: 80 to 130 mg/dL.
• Two hours after the start of a meal: Less than 180 mg/dL.

Your blood sugar targets may be different depending on your age, any additional health problems you have, and other factors. Be sure to talk to your health care team about which targets are best for you.

What causes low blood sugar?

Low blood sugar (also called hypoglycemia) has many causes, including missing a meal, taking too much insulin, taking other diabetes medicines, exercising more than normal, and drinking alcohol. Blood sugar below 70 mg/dL is considered low.

Signs of low blood sugar are different for everyone. Common symptoms include:

• Shaking.
• Sweating.
• Nervousness or anxiety.
• Irritability or confusion.
• Dizziness.
• Hunger.

Know what your individual symptoms are so you can catch low blood sugar early and treat it. If you think you may have low blood sugar, check it even if you don’t have symptoms. Low blood sugar can be dangerous and should be treated as soon as possible.

How can I treat low blood sugar?

If you’ve had low blood sugar without feeling or noticing symptoms (hypoglycemia unawareness), you may need to check your blood sugar more often to see if it’s low and treat it. Driving with low blood sugar can be dangerous, so be sure to check your blood sugar before you get behind the wheel.

Carry supplies for treating low blood sugar with you. If you feel shaky, sweaty, or very hungry or have other symptoms, check your blood sugar. Even if you don’t have symptoms but think you may have low blood sugar, check it. If your blood sugar is lower than 70 mg/dL, do one of the following immediately:

• Take four glucose tablets.
• Drink four ounces of fruit juice.
• Drink four ounces of regular soda, not diet soda.
• Eat four pieces of hard candy.

Wait for 15 minutes and then check your blood sugar again. Do one of the above treatments again until your blood sugar is 70 mg/dL or above and eat a snack if your next meal is an hour or more away. If you have problems with low blood sugar, ask your doctor if your treatment plan needs to be changed.

What causes blood sugar to be high?

Many things can cause high blood sugar (hyperglycemia), including being sick, being stressed, eating more than planned, and not giving yourself enough insulin. Over time, high blood sugar can lead to long-term, serious health problems. Symptoms of high blood sugar include:

• Feeling very tired.
• Feeing thirsty.
• Having blurry vision.
• Needing to urinate (pee) more often.

If you get sick, your blood sugar can be hard to manage. You may not be able to eat or drink as much as usual, which can affect blood sugar levels. If you’re ill and your blood sugar is 240 mg/dL or above, use an over-the-counter ketone test kit to check your urine for ketones and call your doctor if your ketones are high. High ketones can be an early sign of diabetic ketoacidosis, which is a medical emergency and needs to be treated immediately.

What are ketones?

Ketones are a kind of fuel produced when fat is broken down for energy. Your liver starts breaking down fat when there’s not enough insulin in your bloodstream to let blood sugar into your cells.

What is diabetic ketoacidosis?

If you think you may have low blood sugar, check it even if you don’t have symptoms.

When too many ketones are produced too fast, they can build up in your body and cause diabetic ketoacidosis, or DKA. DKA is very serious and can cause a coma or even death. Common symptoms of DKA include:

• Fast, deep breathing.
• Dry skin and mouth.
• Flushed face.
• Frequent urination or thirst that lasts for a day or more.
• Fruity-smelling breath.
• Headache.
• Muscle stiffness or aches.
• Nausea and vomiting.
• Stomach pain.

If you think you may have DKA, test your urine for ketones. Follow the test kit directions, checking the color of the test strip against the color chart in the kit to see your ketone level. If your ketones are high, call your health care provider right away. DKA requires treatment in a hospital.

DKA happens most in people with type 1 diabetes and is sometimes the first sign of type 1 in people who haven’t yet been diagnosed. People with type 2 diabetes can also develop DKA, but it’s less common.

How can I treat high blood sugar?

Talk to your doctor about how to keep your blood sugar levels within your target range. Your doctor may suggest the following:

• Be more active. Regular exercise can help keep your blood sugar levels on track. Important: don’t exercise if ketones are present in your urine. This can make your blood sugar go even higher.
• Take medicine as instructed. If your blood sugar is often high, your doctor may change how much medicine you take or when you take it.
• Follow your diabetes meal plan. Ask your doctor or dietitian for help if you’re having trouble sticking to it.
• Check your blood sugar as directed by your doctor. Check more often if you’re sick or if you’re concerned about high or low blood sugar.
• Talk to your doctor about adjusting how much insulin you take and what types of insulin (such as short-acting) to use.

How do carbs affect blood sugar?

Carbs in food make your blood sugar levels go higher after you eat them than when you eat proteins or fats. You can still eat carbs if you have diabetes. The amount you can have and stay in your target blood sugar range depends on your age, weight, activity level, and other factors. Counting carbs in foods and drinks is an important tool for managing blood sugar levels. Make sure to talk to your health care team about the best carb goals for you.

What is the A1C test?

The A1C test  is a simple blood test that measures your average blood sugar levels over the past 2 or 3 months. The test is done at a lab or your doctor’s office in addition to—not instead of—regular blood sugar testing you do yourself.

A1C testing is part of the ABCs of diabetes—important steps you can take to prevent or delay health complications down the road:

• A: Get a regular A1C test.
• B: Try to keep your blood pressure below 140/90 mm Hg (or the target your doctor sets).
• C: Manage your cholesterol levels.
• s: Stop smoking or don’t start.

The A1C goal for most adults with diabetes is between 7% and 8%, but your goal may be different depending on your age, other health conditions, medicines you’re taking, and other factors. Work with your doctor to establish a personal A1C goal for you.

What else can I do to help manage my blood sugar levels?

Eating a healthy diet with plenty of fruit and vegetables, maintaining a healthy weight, and getting regular physical activity can all help. Other tips include:

• Keep track of your blood sugar levels to see what makes them go up or down.
• Eat at regular times, and don’t skip meals.
• Choose foods lower in calories, saturated fat, trans fat, sugar, and salt.
• Track your food, drink, and physical activity.
• Drink water instead of juice or soda.
• Limit alcoholic drinks.
• For a sweet treat, choose fruit.
• Control your food portions (for example, use the plate method: fill half your plate with non-starchy vegetables, a quarter with lean protein, and a quarter with a grain or starchy food).

How can I pay for tests and diabetes supplies?

Medicareexternal icon, Medicaid, and most private insurance plans pay for the A1C test and fasting blood sugar test as well as some diabetes supplies. Check your plan or ask your health care team for help finding low-cost or free supplies, and see How to Save Money on Diabetes Care for more resources.

90,000 What is type 2 diabetes?

What are the causes of type 2 diabetes

It has been found that lifestyle, diet, and ethnicity can have a direct impact on how likely a person is to develop type 2 diabetes. Studies have shown that people of African and Creole descent have a 3 times higher risk of developing this disease, and in people from South Asia it is almost 6 times higher than ⁶ .

For more information, see the Type 2 Diabetes Causes page.

Prevention of type 2 diabetes

The most important thing is to maintain a positive attitude and be ready for change. Try to wean yourself from potential bad habits and think about what gives you pleasure – this will help you move towards a healthier lifestyle. You can start walking more or try new, healthier recipes – whatever you want, as long as you do it with enthusiasm.

If you are in an age group with a higher risk of developing diabetes, or if you have a poor family history, this is not cause for concern.Just check out this article and try to enjoy a healthy lifestyle.

What are the symptoms and signs of type 2 diabetes?

Another important factor that distinguishes type 1 and type 2 diabetes is that type 1 diabetes appears within a few weeks, and type 2 diabetes develops slowly over a longer period of time. In this regard, gradually manifesting symptoms are often overlooked.

For more information, see the Type 2 Diabetes Symptoms page.

Side effects of type 2 diabetes

People with this condition can have short-term and long-term complications that affect various organs — the heart, blood vessels, nerves, and eyes — which, over time, can lead to more serious complications. Effectively controlling blood sugar levels with a pen or insulin pump can help prevent the effects of diabetes to a large extent.

Some of the most common complications of type 2 diabetes are:

• Damage to the heart and blood vessels
  Diabetes dramatically increases the risk of a variety of cardiovascular problems, including coronary heart disease and hypertension, which can ultimately lead to heart attack.
• Injury to eyes and feet
  Diabetes can have a significant effect on the blood vessels of the eyes, which can lead to cataracts and glaucoma, and in severe cases even blindness. The feet also often suffer from nerve damage and poor blood flow. Because diabetic patients have slower wound healing processes, any small damage to the foot can quickly develop into severe damage.
• Nerve damage
  High blood sugar (glucose) levels over long periods of time can damage the capillaries that are responsible for nerve endings in the extremities, such as the legs.As a result, tingling or numbness may occur, which ultimately leads to loss of sensation in the affected areas.

If you have any questions about complications of type 2 diabetes, please contact the Medtronic MiniMed Care team

Blood sugar level in type 2 diabetes

Understanding what blood sugar should be is a difficult but necessary part of living with diabetes. As you gain experience, you will begin to recognize the warning signals before a bout of high (hyperglycemia) or low (hypoglycemia) blood sugar, but if you or someone you love has been diagnosed recently, it is advisable to become familiar with the acceptable range of blood sugar levels in advance.

The average blood sugar level in type 2 diabetes usually changes depending on the following factors:

1. Age
2. Floor
3. Time of day
4. Period before or after meals

Before a meal, a person with type 2 diabetes should have a sugar level in the range of 4-7 mmol / L (72-126 mg / dL). After eating (after 90 minutes) – do not exceed 8.5 mmol / l (153 mg / dl).

For a more accurate individual range table, contact the Medtronic MiniMed Care team.

Type 2 diabetes treatment

If traditional approaches – diet, exercise, or antidiabetic medications – do not work to achieve the desired effect and improve your diabetes, alternative methods may be used. Currently, a significant decrease in the level of hemoglobin HbA1c in patients with type 2 diabetes when using an insulin pump ⁷ has already been clinically proven.

90,000 Topic 1. What is diabetes mellitus?

Key questions:
Definition and concept of SD.
Normal blood glucose numbers.
Glucose in urine.
Glycated hemoglobin and fructosamines.
C-peptide and other assays.

Diabetes mellitus is a group of diseases in which chronically blood glucose levels rise. Normal blood glucose levels are maintained on an empty stomach from 3.3 to 5.5; after meals – up to 7.8 mmol / l.

There are other units of blood glucose measurement: mg / dl. To convert to mmol / l, the indicator in mg / dl must be divided by 18.90 100

In the body, the blood glucose level is reduced by the hormone insulin , which is produced in the pancreas.

If little insulin is produced, or it is not produced at all, or low-quality insulin is produced, or a person has had the pancreas removed, etc., the level of glucose in the blood rises and the person is diagnosed with diabetes mellitus.

Depending on the cause of the disease, the type of diabetes is established (type 1, type 2, pancreatogenic, etc.).

In type 1 diabetes, insulin is not produced at all, or very little is produced.

In type 2 diabetes mellitus at the initial stage of the disease, insulin can be produced even in excessive amounts, but its effect is weakened (due to a decrease in the body’s sensitivity to insulin or “low-quality” insulin).

In pancreatogenic diabetes, insulin is not produced after suffering from pancreatitis or removal of the pancreas.

These are the most common types of diabetes, but not all.

A separate condition is gestational diabetes mellitus, which develops in pregnant women and disappears after pregnancy.

Outcome one: high blood glucose levels.

How are types 1 and 2 diabetes different?

Type 1 diabetes develops more often in young people, most often it is an autoimmune disease. Symptoms of diabetes often appear suddenly (thirst, dry mouth, high urine output, sudden weight loss).However, more than 90% of the pancreatic beta cells have already died. This type of diabetes is treated only with insulin.

type 2 develops in older people (although recently more and more young people with type 2 diabetes), overweight, obese people. It often develops without any symptoms and therefore is late detected. For the timely diagnosis of type 2 diabetes, a glucose screening test is carried out for people from risk groups. Type 2 diabetes is treated with a diet, normalization of body weight and pills, i.e.because at the beginning of the disease, insulin is produced. But in the future, the depletion of the pancreas occurs, insulin ceases to be produced and then insulin is prescribed.

Sometimes situations arise when it is difficult to determine what type of diabetes a person has. For example, there is type 1 diabetes mellitus with a slowly progressive course, when the disease is detected at a more mature age, but the patient is not obese and insulin is immediately required.

What is the basis for the diagnosis of diabetes mellitus?

Diabetes mellitus is established on the basis of blood glucose measurements. The upper limit of the normal blood glucose level from finger on an empty stomach is 5.5 mmol / L , in the blood from a vein – 6.0 mmol / L .

If fasting glucose level ≥ 6.1 mmol / L in blood from a finger , or ≥ 7.0 mmol / L in blood from a vein, or after eating ≥ 11.1 mmol / L in any blood is diagnosed diabetes.

It should be noted that, although blood is taken from a finger when determining blood glucose with a glucometer, most modern glucometers are calibrated for plasma, therefore, when determining blood glucose with a glucometer, one should be guided by the indicators for plasma.

The level of fasting blood glucose in the blood from a finger from 5.6 to 6.0 mmol / L (in the blood from a vein from 6.1 to 6.9 mmol / L) is an intermediate state between normal and diabetes mellitus (“prediabetes”) …

The term “prediabetes” is used as an informal name.

The official name of this condition includes two diagnoses: impaired glucose tolerance and impaired fasting glycemia.

A glucose test can be assigned to the patient to clarify these conditions.BUT! If the fasting glucose level is ≥ 6.1 mmol / L in the blood from a finger, or ≥ 7.0 mmol / L in the blood from a vein, or after meals ≥ 11.1 mmol / L – DO NOT PERFORM THE GLUCOSE TEST!

A very important indicator is glycated hemoglobin. Glycated hemoglobin shows the average blood glucose level over the last 3 months.

Blood glucose binds to hemoglobin, which is contained in the erythrocyte (erythrocyte is an insulin-independent blood cell).When there is a lot of glucose in the blood, then it binds more to hemoglobin. The erythrocyte lives for 120 days, so glycated hemoglobin shows what the average blood glucose level was over the last 3 months.

The level of glycated hemoglobin up to 5.7-6.0% is normal. A glycated hemoglobin level ≥6.5% is a criterion for the diagnosis of diabetes mellitus.

With a glycated hemoglobin level of 5.7-6.4%, one can speak of “prediabetes” (in the absence of criteria for diagnosing diabetes mellitus by blood glucose levels).

Glycated hemoglobin is used not only as a criterion for diagnosing diabetes mellitus, but also as a criterion for compensating for diabetes mellitus (assessment of compensation for the last 3-4 months).

To assess compensation for the last 3 weeks, an analysis for fructosamines is assigned.

Glucose in urine. Normally, there is no glucose in the urine, because when urine is formed, the kidneys reabsorb all glucose. Glucose in urine occurs when blood glucose levels exceed a certain level (renal threshold) and the kidneys cannot reabsorb all of the glucose.The “renal threshold” for blood glucose is 8-10 mmol / L. Those. when the blood glucose is above this level, the kidneys begin to pass glucose into the urine. If there is glucose in the urine, then during the period during which this portion of urine was collected in the bladder, the blood glucose level exceeded the renal threshold. If you measured blood glucose in the morning and it is 5 mmol / l, but there is glucose in the urine, then the glucose level was high at night.

To assess the secretion of insulin by the pancreas, immunoreactive insulin in the blood and C-peptide can be determined.

If a person is receiving insulin therapy, then the immunoreactive insulin will show a false value, so in such cases only the C-peptide is detected. C-peptide is part of the insulin molecule.

C-peptide shows how much insulin is produced by the pancreas. Its definition is important in cases where there are doubts whether a given patient needs insulin therapy. Determination of C-peptide is not included in standard examination protocols.

If the C-peptide is reduced, then insulin is indispensable.But with type 1 diabetes, as a rule, it makes no sense to determine the C-peptide, because clinical manifestations usually leave no doubt about the need for insulin therapy.

Among other analyzes, one can stop at antidiabetic antibodies . They are detected in patients with type 1 diabetes several years before the onset of the disease, but usually disappear within a few years after the person becomes ill. In the majority of patients, their definition has no practical meaning.

Diabetes mellitus Q&A

Diabetes mellitus is a disease caused by a complete or relative lack of insulin (a hormone of the pancreas), as a result of which the blood sugar level rises and energy metabolism disorders occur, sometimes very significant.

Diabetes mellitus is a group of diseases that manifest themselves in a similar way, but have different causes. Type 1 diabetes mellitus occurs in childhood or young age, proceeds violently, is characterized by a strong feeling of thirst, carries the danger of a significant violation of energy metabolism, is treated with insulin. Type 2 diabetes mellitus is more common in old age, is often accompanied by obesity, its symptoms are not as obvious as in type 1 diabetes, treatment can be started with diet or taking antidiabetic drugs – in the form of pills.Diabetes mellitus can also be caused by other diseases (the so-called specific types of diabetes), for example, diseases of the pancreas, it can be caused by treatment with corticosteroids.

How is diabetes mellitus manifested?

It is manifested by fatigue, thirst, excretion of large amounts of urine, weight loss, inflammation of the bladder and kidneys, furunculosis can be observed. If diabetes is not treated for a long time, it can lead to a complete disruption of the basic functions of the human body, dehydration, loss of consciousness and even death.Type 1 diabetes mellitus is characterized by a sharp manifestation and development of all symptoms of the disease. Type 2 diabetes mellitus develops more slowly, its symptoms are less pronounced, they may not appear outwardly at all until late complications of diabetes appear.

Can diabetes mellitus go on without symptoms?

Diabetes mellitus type 2 at the onset of the disease often does not appear at all and can be detected during a routine examination by an increase in blood glucose levels and the appearance of sugar in urine.

Is diabetes mellitus hereditary?

Yes, both types of diabetes mellitus, especially type 2 diabetes, can be inherited in a certain way, more precisely, a predisposition to this disease is transmitted, and it depends on external influences whether a particular person will develop diabetes or not.

Can drugs or other diseases cause diabetes?

This type of diabetes is called secondary diabetes mellitus (or specific type of diabetes).The development of this diabetes can be triggered by certain medications, such as corticosteroids used in the treatment of rheumatic diseases, asthma, a number of non-specific intestinal diseases, skin diseases and other autoimmune diseases. Diabetes mellitus can appear as a symptom of a pancreatic disease, with some endocrine diseases, severe infectious diseases. Some diseases, more often of a viral nature, prolonged stress can provoke diabetes or a worsening of the course of existing diabetes.

What is impaired glucose tolerance?

Previously, this condition was called “latent” (dormant, asymptomatic) diabetes mellitus. It is found only in laboratory analysis, with the so-called glucose tolerance test, when the patient drinks a glucose solution (75 g in 100 ml of water) and the level of glucose in the blood after 2 hours reveals how fully his body is able to assimilate this glucose. This test shows the ability of the pancreas to produce the required amount of insulin per meal.In case of violation of glucose tolerance, medical supervision, adherence to a diet, and sufficient physical activity are necessary.

When is diabetes mellitus diagnosed?

If the patient has symptoms typical of diabetes mellitus (thirst, strong urination, weight loss), a blood sugar test is sufficient. If its level in capillary blood on an empty stomach is more than 6.1 mmol / l (two-fold definition), it is diabetes mellitus. If the patient does not have symptoms typical of diabetes, but there is only a suspicion of diabetes mellitus, a glucose tolerance test is performed, the principle of which is described above.According to the body’s response to this load (the glycemic level after 2 hours is more than 11.1 mmol / l), it is determined whether it is really about diabetes mellitus or only about impaired glucose tolerance (the level of glycemia after 2 hours is more than 7.8 mmol / l) …

Is it possible to plan a pregnancy with a diagnosis of diabetes mellitus?

Yes. However, before pregnancy (about 1 year) and throughout pregnancy, it is necessary to strictly control the compensation of the disease and adequately treat diabetes.During pregnancy, it is necessary to inject insulin, tablets are not used so as not to harm the fetus and not endanger its life. To assess the compensation of the disease, it is necessary to control the level of glycated hemoglobin once every 3 months.

Can I go in for sports, work with diabetes mellitus?

With diabetes mellitus, you can go in for sports, do physical work. Physical education and increased physical activity are usually desirable.This increases the sensitivity of the tissues to insulin and helps maintain an optimal weight. With heavy loads, it is necessary to consult a doctor, prescribe a diet and doses of insulin or antihyperglycemic drugs, taking into account the load so as not to cause hypoglycemia (a strong decrease in sugar levels). With regard to work, the patient should choose a type of activity with the ability to maintain a correct diet, with uniform physical activity throughout the week. For patients with diabetes and the danger of hypoglycemia, professions where the patient could harm himself or others are unsuitable – work at heights, associated with high voltage currents, driving a car, construction machines, etc.p.

How is diabetes treated?

The main task of treatment is to achieve a normal blood sugar level and maintain this level throughout life. This is necessary to prevent complications of diabetes mellitus. Treatment is based on changing the optimal exercise and diet. It is necessary to achieve weight loss in excess of it. If physical activity and diet are not enough to achieve normal sugar levels, antidiabetic drugs (pills or insulin) must be added.In type 1 diabetes, insulin treatment is necessary from the beginning of the diagnosis, as it is associated with primary damage to the cells of the pancreas.

What should be the diet for diabetes mellitus?

Diabetes diet is not only about eliminating sugar, sweets and sugary foods from food. Each patient should have an individually designed diet with a certain amount of carbohydrates, fats, proteins and calories so that blood sugar levels are normal, fat metabolism is not disturbed, the patient has an ideal weight and maintains it.Simple sugars should be eliminated from the diet, which are quickly absorbed, causing a sharp rise in blood sugar. The total amount of carbohydrates should be 55-60%, with a predominance of coarse fiber, fats – 25-30% (with a predominance of vegetable fats), proteins – 15-20%.

Do I need to follow a diet if I take pills or insulin?

Yes, it is necessary! Diet (good nutrition) is necessary for every patient, even if he must take pills or insulin.

What if I don’t follow the diet?

If the diet is not followed, there is a risk of poor compensation with the risk of complications. If you do not follow a diet and increase the dose of drugs or insulin doses, the patient may gain weight, worsen the sensitivity of cells to insulin, and treat diabetes will fall into a vicious circle. The only way to avoid these complications is to adjust your diet in such a way as to normalize and maintain weight.

Why can some patients take pills while others need insulin right away?

It depends on the type of diabetes mellitus.In patients with type 1 diabetes, the pancreas does not produce insulin and therefore insulin must be used from the onset of the disease. In patients with type 2 diabetes, the lack of insulin is only relative, often at the initial stage of the disease, it is enough to follow a diet and take medications that improve the body’s sensitivity to insulin or increase its secretion by the cells of the pancreas. If pill treatment stops working, insulin should be started.

How many times a day do you need to “inject” insulin?

When treating diabetes, we strive to match blood sugar levels with those of healthy people.Various insulin delivery regimens are used, which depend on the type of diabetes and the course of the disease. Often in young patients

Type 2 diabetes mellitus – non-infectious epidemic XXI

Every 10th inhabitant of the Earth today is sick with diabetes, but half of the patients do not yet know about their illness. Every minute another case of diabetes is revealed on earth, and every minute two people die from its complications.

The rapid spread of the incidence of diabetes mellitus (DM) in the world has acquired the character of a “non-infectious epidemic”: thus, according to WHO experts, in 2025about 500 million patients with diabetes will be registered. However, already in 2011, the number of cases approached this value, reaching 366 million people, and about 90% of them suffer from type 2 diabetes. In Russia, there are about 3.376 million people with type 2 diabetes, in the Khanty-Mansiysk Autonomous Okrug there are 43.2 thousand people, in the city of Nyagan this figure is 2340 people. From year to year, the increase in incidence is 5-7%.

GENERAL

All forms of diabetes are caused by an inability to adequately utilize glucose, the body’s main source of energy.This is due to a disruption in the production or use of insulin in the body, a hormone that is produced in the cells of the pancreas and which is necessary for the conversion of sugar, starches and other food components into energy.

In people with type 2 diabetes, the pancreas may not produce enough insulin or the body may not be able to use it adequately. As a result, blood glucose rises, causing damage to blood vessels and other organs.

This form of diabetes occurs in middle-aged and older people. Type 2 diabetes is diagnosed based on high blood glucose and urinary glucose levels.

REASONS

It is believed that when type 2 diabetes occurs, genetic predisposition to the disease plays a role. Poor ecology, a sedentary lifestyle, fast food, frequent stress and a combination of risk factors such as age and overweight also affect the development of the disease.The most important predisposing factor, however, was obesity. It has been found that more than 80% of those with type 2 diabetes are overweight. Excess fat is believed to interfere with the body’s ability to utilize insulin.

SYMPTOMS OF DIABETES MELLITUS TYPE 2

Intense thirst, dry mouth, frequent urination, increased hunger, rapid weight loss, weakness and fatigue, irritability.

COMPLICATIONS

In the case of insufficient control of type 2 diabetes mellitus, the risk of myocardial infarction, stroke, kidney disease, neurological disorders, impotence, visual impairment (including blindness), gangrene increases.Type 2 diabetes mellitus is a dangerous disease. In the absence of effective therapy, a lethal outcome is possible, which is associated with complications due to high blood glucose or pathological changes in organs and systems.

WHAT CAN YOU DO

For any symptoms of diabetes mellitus, you should immediately undergo a medical examination. Even if there are no symptoms of diabetes mellitus, blood sugar and urine should be monitored, especially for people with a family history of diabetes mellitus, over 40 years old and / or overweight.
Once a diagnosis of diabetes mellitus is made, regular medical supervision and monitoring of blood glucose levels are necessary to avoid the development of complications.
For effective treatment of diabetes mellitus, you should carefully monitor your condition.

People with type 2 diabetes should:

– control the content of glucose and cholesterol, as well as body weight, by including in your diet low-calorie foods low in sugar, fat and high in complex carbohydrates and plant fibers;
– exercise regularly to reduce the need for insulin and increase body weight loss;
– to determine blood glucose at home using a glucometer, which helps a person adjust their diet and exercise regime and prevent the development of complications of diabetes.Self-monitoring of glucose also allows you to observe how blood glucose decreases as you lose weight.

People with diabetes should take preventive measures to avoid colds, it is recommended to practice foot hygiene.
The course of type 2 diabetes is highly dependent on self-control. In most cases, type 2 diabetes mellitus can be controlled through diet and exercise, and taking hypoglycemic drugs.

WHAT YOUR DOCTOR CAN DO

If you suspect diabetes mellitus, your doctor should order appropriate blood tests to diagnose the disease. If the diagnosis is made, the doctor should prescribe a special diet or refer the patient to a dietitian consultation. Diet and exercise are the mainstays of type 2 diabetes treatment. Several studies have found that 80% or more of type 2 diabetes can be controlled through weight loss and exercise.If these methods are not effective and the blood glucose level does not normalize, then the doctor should prescribe oral hypoglycemic drugs. Depending on your blood sugar and your response to diet therapy, your doctor may prescribe medications that increase the body’s ability to use its own insulin effectively or increase its production.

Subsequently, the doctor determines the frequency of visits, depending on the need for various tests, the general condition of the patient and the risk of complications that require special additional treatment.

In some cases, insulin injections may be required.

PREVENTIVE MEASURES

To avoid type 2 diabetes mellitus, a balanced diet high in plant fiber should be used; exercise regularly; avoid excess body weight and a sharp decrease in it; regularly monitor blood glucose, especially if you have a family history of diabetes mellitus or if you are overweight.

Norms of blood sugar for adults and children

Norms of blood sugar for adults and children

Norms of blood sugar for adults and children. International tables.

The following glucose ranges are given in the UK’s National Institute for Health and Care Excellence (NICE) guidelines, but each person should check with their healthcare provider or diabetes educator.

Table 1.NICE Recommended Blood Glucose Target Ranges:

* Non-diabetic glucose values ​​are provided for informational purposes only, but are not part of NICE guidelines.

For most healthy people, normal blood sugar values ​​are as follows:

4.0-6.0 mmol / l (72-108 mg / dl) – on an empty stomach;

up to 7.8 mmol / l (140 mg / dl) – 2 hours after eating.

For people with diabetes, the target blood sugar values ​​are as follows:

Before meals: 4-7 mmol / L for people with type 1 or 2 diabetes;

After meals: to 9 mmol / L for people with type 1 diabetes and to 8.5 mmol / L for people with type 2 diabetes

Table 2. Blood sugar levels in the diagnosis of diabetes

Measurement of fasting plasma glucose.

This test is performed after a minimum of eight hours of fasting (usually in the morning). According to NICE guidelines, a fasting plasma glucose of 5.5 mmol / L indicates an increased risk of type 2 diabetes, especially when combined with other risk factors for type 2 diabetes.

Oral glucose tolerance test .

First, three days before the study, you should eat as usual, not excluding “fast” carbohydrates, for example, sweets.Secondly, the beginning of the study is carried out on an empty stomach, therefore, after the evening meal before the morning test, there should be a time interval of at least 10 hours. Better yet, if it is 16 hours. The first blood sample is taken from a finger on an empty stomach. Then the patient drinks a saturated sugar solution (75 g of glucose is dissolved in 300 ml of water). Sometimes lemon juice is added to the solution to make it more pleasant to drink. If, 2 hours after exercise, the blood sugar level does not exceed 7.8 mmol / l, this is normal.A decrease in tolerance is diagnosed if this indicator is between 7.8 and 11.1 mmol / l.

Measurement of HbA1c level for the diagnosis of diabetes mellitus

Glycosylated hemoglobin is one of the most important laboratory parameters in diabetes mellitus. The rate of binding of hemoglobin to glucose is the higher, the higher the glycemic parameters, i.e. blood sugar levels. And since erythrocytes, on average, “live” only 90-120 days, then the degree of glycation can be observed only during this period.In simple terms, by determining the level of glycosylated hemoglobin, the degree of saturation of the body with glucose is assessed for three months. With this test, you can determine your average daily blood glucose level over the past three months. Indicators of glycosylated hemoglobin: up to 6.0% – the norm; 6.0 to 6.5% – increased risk of developing diabetes; more than 6.5% – diabetes mellitus.

Diabetes Surgery ⋆ Prof Dr Alper Celik

What is Diabetes Surgery?

Diabetes is a disease caused by a sedentary lifestyle, unbalanced diet or genetic causes.Although insulin is not produced by the body in type 1 diabetes, insulin is produced by the body in patients with type 2 diabetes, but the patient’s body cannot use it. This is why blood sugar is always high. This leads to organ damage. In diabetes, the classic treatment is to lower blood sugar levels. Diabetes surgery is also a method of treating the disease. This operation, called metabolic surgery, is performed on people with type 2 diabetes. Thus, the insulin present in the body is used without problems.As a result, high blood sugar levels are reduced.

Purpose of diabetes surgery

The prerequisite for diabetes management is the elimination of insulin resistance in the body. Thus, the amount of hormones increases. If type 1 diabetes, insulin therapy is the treatment. If type 2 and changes in lifestyle, diet, medications have been tried, but organ damage has begun, then it is necessary to turn to surgery.

Diabetes surgery is performed on those with type 2 diabetes, overweight, high blood sugar, despite the medications used and insulin, the blood sugar is above the limit.Diabetes surgery is performed as a closed operation, through small incisions. 50% of the stomach is removed, changes are made in the small intestine. After this change, a signal is sent from the pancreas for insulin secretion and the efficiency is increased. In this way, type 2 diabetes will go away completely. Also, people get rid of obesity after this operation. The advantage of this operation consists of details such as not as painful as open surgery, no lung problems, quick return to normal life, no traces of the operation.

Can type 1 diabetics be operated on?

Type 1 diabetics do not have insulin in their bodies. Therefore, they cannot perform this operation. In patients with type 2 diabetes, it is important that the pancreas is active because the goal is to use the existing insulin correctly and adequately. This is possible with surgery.

In type 2 diabetes, factors such as disease progression, organ damage are taken into account when deciding on an operation after thorough examinations.All analyzes and examinations of the patient should be carried out. Because every operation is a risk. Sometimes, if classical methods are unsuccessful and ultimately result in organ loss, surgery may be the only remedy. If patients do not follow a diet and are inattentive to their lifestyle, then their lives can go into a problem period. Despite treatment with medication, the disease cannot be cured. And surgery becomes inevitable.

Metabolic Surgery

This operation, known as diabetes surgery, is used to treat type 2 diabetes caused by a patient’s eating habits and quality of life.The goal is to remove insulin resistance. With the surgical procedure, the amount of food consumed decreases and hormones become much more active, thus the problem of diabetes and obesity is solved. After stomach reduction in diabetes mellitus, the patient’s weight loss is accelerated after surgery. For metabolic operations it is necessary to have insulin in the body, otherwise it does not work.

What Happens After Diabetes Surgery

After diabetes surgery, you will not feel as often as you used to.Due to lack of appetite, you will face malnutrition. When these troubles go away, the body gets used to the normal order and the patient will feel much better. After surgery for diabetes, you should drink plenty of water. The body needs water. Water intake is important, as lack of food and water intake will contribute to the patient’s feeling of lethargy. Since eating habits are under the supervision of a physician for about 6 months after surgery, the smallest disturbance in the diet will promote the return of sugar.For this reason, diabetes surgery is ideal for a diabetic.

Diabetes mellitus

Diabetes

Diabetes mellitus is a chronic disease characterized by a constant increase in blood glucose levels. It manifests itself with the following symptoms: thirst, increased urination, weight loss.

The following types of diabetes are distinguished.

• Type 1 diabetes mellitus.
• Type 2 diabetes mellitus.
• Gestational diabetes mellitus (diabetes mellitus during pregnancy).
• Specific types of diabetes mellitus – LADA-diabetes and MODY-diabetes.

This disease is currently considered incurable (apart from gestational diabetes). Nevertheless, careful implementation of the recommendations of the attending physician is able to keep the course of the disease under control and allows the patient to lead a full life.

Russian synonyms

Sugar disease, sugar diabetes.

English synonyms

Diabetes Mellitus, Diabetes.

Symptoms

• Thirst.
• Frequent urination.
• Weight loss (in some cases).
• Increased appetite.
• Constant fatigue.
• Increased fatigue.
• Blurred vision.

General disease information

Glucose is the main source of energy in the human body.The transport of glucose from the blood to organs and tissues is carried out with the help of insulin, a hormone produced in the beta cells of the pancreas.

Normal fasting blood glucose should not exceed 6.1 mmol / L (according to the World Health Organization). Eating food leads to a temporary increase, but after a while, under the influence of stimulated insulin, it returns to normal values.

Values ​​greater than 6.1 and less than 7 mmol / L indicate that there is an impaired glucose tolerance – a pre-diabetic condition.A value greater than 7.0 mmol / L taken on an empty stomach will indicate the presence of diabetes mellitus.

A change in glucose levels (an increase in blood levels and a decrease in tissues and organs) leads to the occurrence of the above symptoms. Also, diabetes mellitus can cause numerous complications from the cardiovascular and nervous systems, kidneys, and eyes.

Type 1 diabetes usually develops at a young age (up to thirty years). In people of mature age, in the overwhelming majority of cases, type 2 diabetes is detected.

• Type 1 diabetes mellitus is characterized by the cessation of insulin production. Under the influence of various factors (genetic defect, viral exposure), the patient’s immune system perceives the beta cells of the pancreas as a foreign element and begins to produce antibodies against them. This leads to the death of beta cells and the cessation of insulin production. The symptoms of type 1 diabetes mellitus are usually acute, so that the patient can even give the exact day of the onset of the disease.
• Type 2 diabetes mellitus develops in connection with the emerging tissue insensitivity to the action of insulin, which is facilitated by the following risk factors: obesity, low physical activity, the presence of relatives with type 2 diabetes. In this case, the symptoms of the disease appear gradually, over a long period of time.
• Gestational diabetes mellitus develops during pregnancy. Symptoms may be mild or absent. After childbirth, the symptoms of the disease usually disappear, the patient recovers.Gestational diabetes is a significant risk factor for a woman to develop type 2 diabetes in the future.
• LADA-diabetes (from the first letters of the English. Latent autoimmune diabetes in adults – “latent autoimmune diabetes in adults”). Its occurrence is associated with the production of antibodies by the immune system against the beta cells of the pancreas (the same as in type 1 diabetes), but this process takes a long time, and therefore the duration of the manifestation of symptoms corresponds to type 2 diabetes.
• MODY-diabetes (from the first letters of the English. Maturity onset diabetes of the young – “diabetes mellitus of an adult type in young”). Caused by genetic defects in beta cells. It occurs at a young age, but its symptoms are similar to those of type 2 diabetes.

Who is at risk?

There are many factors leading to the development of diabetes mellitus. The most significant of them are:

• the presence of relatives with type 1 or 2 diabetes mellitus,
• overweight (for type 2 diabetes),
• decreased physical activity (for type 2 diabetes),
• high blood pressure (for type 2 diabetes).

Diagnostics

To detect diabetes mellitus, studies are carried out to determine the level of glucose in the blood (at the moment / for several weeks / for several months), to assess the body’s response to an increase in glucose levels, to identify the level of insulin produced by the body:

• Plasma glucose,
• glucose tolerance test,
• glycated hemoglobin (HbA1c),
• fructosamine,
• general urinalysis,
• insulin,
• C-peptide in daily urine, C-peptide in serum.

To determine the type of diabetes mellitus:

• determination of antibodies to insulin,
• Determination of antibodies to pancreatic islet cells.

The Genetic Risk of Hyperglycemia Study can be performed to assess the susceptibility to diabetes.

Consultations and examinations with a cardiologist, ophthalmologist, neuropathologist are also required for the timely detection of complications of the disease.

Treatment

At the moment, diabetes mellitus of both types is an incurable disease.To prevent complications and maintain a normal lifestyle, you need:

• Continuous treatment with insulin preparations – for patients with type 1 diabetes mellitus,
• Strict Blood Glucose Monitoring,
• Quitting high glucose foods (sugar and sugar-containing foods) and controlling the amount of carbohydrates consumed,
• physical activity,
• weight normalization, smoking cessation, alcohol.