Diabetes Type 2

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

Education Topics

Activity

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

Gloria, 70
Read more about Gloria and how she manages her diabetes.
"Exercise really changed everything for me. The way I feel, my blood sugar, everything. It really works. I never felt better, stronger, healthier, or happier in my life."

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

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

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

Testing and tracking to stay in range

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

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

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

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

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

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

Activity makes a difference

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

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

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

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

Finding support and swapping recipes

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

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

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

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

Staying motivated with a long-term goal

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

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

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

Course

What can you expect with type 2 diabetes?

You’ll keep hearing about how important it is to keep your blood sugar within a target range. That’s because over time, high blood sugar can lead to serious problems. It can:

  • Harm your eyes, nerves, and kidneys.
  • Damage your blood vessels, leading to heart disease and stroke.
  • Reduce blood flow and cause nerve damage to parts of your body, especially your feet. This can cause slow healing and pain when you walk.
  • Make your immune system weak and less able to fight infections.

When people hear the word “diabetes,” they often think of problems like these. But daily care and treatment can help prevent or delay these problems. The goal is to keep your blood sugar in a target range. That’s the best way to reduce your chance of having more problems from diabetes.

Can type 2 diabetes be cured?

There is no known cure for type 2 diabetes. But it can be controlled. And in some cases, it goes into remission. Avoid products that promise a cure for type 2 diabetes.

Definition

Type 2 diabetes

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

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

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

Diagnostics

How is type 2 diabetes diagnosed?

If your doctor thinks that you may have diabetes, you will have blood tests to measure how much sugar is in your blood. A fasting blood sugar (glucose) test, an oral glucose tolerance test, and a hemoglobin A1c test are used. Your doctor will also ask you questions about your medical history and do a physical exam for type 2 diabetes.

Your doctor will use the test results and the American Diabetes Association (ADA) criteria to diagnose type 2 diabetes.

Two tests are used to confirm the diagnosis of diabetes.

Other possible tests

It may be hard to tell if you have type 2 or type 1 diabetes. If so, your doctor may do a C-peptide test or test for autoantibodies to help diagnose type 1 diabetes or a slowly developing form of type 1 diabetes called latent autoimmune diabetes in adults (LADA). Some rare forms of diabetes are caused by a genetic problem. You may need genetic testing to diagnose them. This includes maturity onset diabetes of the young (MODY). There are many types of MODY, depending on the gene that is affected.

Diet

How can healthy eating help you manage your blood sugar?

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

Goal Settings

How to create a plan to lower your A1c

Anytime you make a plan, it's a good idea to chip away at the things you need to do, one thing at a time. Here's how to create a plan to lower your A1c level.

  1. Pick one goal to focus on.

    To start your plan, think about what part of diabetes care you want to focus on first. Is it food or medicine? Is it being active? Or is it something else? Pick something that you feel you can do.

    For example, "I will start by making better food choices."

    Whatever your goal is, making a plan may help you get one step closer to lowering your A1c.

  2. Break down the goal into smaller steps.

    It could be something like, "I'll start by writing down everything I eat for a week."

    Each little change you make can help build your confidence and ability to make a bigger change. The secret is to think of smaller, easier steps that you know you can manage.

  3. Decide when you'll start and how you'll get ready.

    For example, "I'll get a notepad or phone app to record what I eat. I'll start Saturday when I have time to get rid of junk food and can plan and shop for healthy foods."

  4. Plan for success.

    Be sure to think about how you'll handle things that could get in your way. Then plan for how to get around them. Maybe you can ask someone for support.

    And think about how you might celebrate your success. Changing a routine is often not easy, so planning something special for when you meet your goal can give you something to look forward to.

  5. Post your plan.

    When you've completed your plan, think about where you want to post it. Seeing it every day can help you meet your goal.

How to set goals to prevent or manage type 2 diabetes

Losing weight, getting active, and eating better are the best things you can do to prevent or manage type 2 diabetes. The following steps can help you set a goal to make a change for your health.

  1. Know your reason for wanting to change.

    Before you set a goal, think about why you want to make a change. Your reason for wanting to change is important. If your reason comes from you—and not from someone else—it will be easier for you to make a healthy change for good. For example:

    • Maybe you want to avoid the hassles that come with type 2 diabetes, such as taking insulin or testing blood sugar.
    • Maybe you're worried about the health problems that diabetes brings.
    • You might simply want to enjoy your life and have more energy.
  2. Set long-term and short-term goals.

    Start by setting a big, or long-term, goal. Maybe you want to lose 10% of your body weight. If you weigh 200 lb (91 kg) , that means losing 20 lb (9 kg) .

    Break down your big goal into smaller, short-term goals. These are the steps you'll take to reach your big goal. Do what works best for you. It's important to set goals you can reach. For example:

    • Week 1: Set a goal to walk for 15 minutes, 5 days a week.
    • Week 2: Continue to walk for 15 minutes, 5 days a week. And this week, when you reach for a snack, make it carrots or celery sticks instead of potato chips or crackers.
    • Week 3: Keep up your walking program and eating healthy snacks. Bit by bit, increase your walks to 30 minutes for at least 5 days each week. Pay attention to your hunger levels when you eat meals. Stop eating when you feel full.
  3. Prepare for slip-ups and barriers.

    Plan for setbacks. Use a personal action plan to write down your goals, any possible barriers to success, and your ideas for getting past them. By thinking about these barriers now, you can plan ahead for how to deal with them if they happen.

Tips for staying on track:

  • Get support. Tell family and friends your reasons for wanting to change. Tell them that their encouragement makes a big difference to you in your goal to prevent type 2 diabetes. Your doctor or a professional counselor can also provide support.
  • Pat yourself on the back. Don't forget to give yourself some positive feedback. If you slip up, don't waste energy feeling bad about yourself. Instead, think about how much closer you are to reaching your goal than when you started.

How can you make a plan to lower your A1c?

Start by focusing on one goal, such as making healthier food choices. Break your goal down into smaller steps. You might start by writing down everything you eat for a week. Think about what might get in your way, and plan how you'll get past those barriers. Plan how you'll celebrate your success.

How can you set goals to prevent or manage type 2 diabetes?

When you're trying to make healthy changes, there are ways you can help yourself succeed. Think about your reasons for wanting to change. Then set long-term and short-term goals you can reach. And plan ahead for barriers and slip-ups. It also helps to ask for support from family and friends.

Medication Therapy

How do noninsulin medicines for diabetes work?

There are different types of noninsulin medicines for diabetes. Each type works in a different way to help you control your blood sugar. For example, some types of noninsulin medicines help your body make insulin to lower your blood sugar. Others lower how much insulin your body needs. Some types can slow how quickly your body digests sugars or can remove extra glucose through your urine.

How can you safely take noninsulin medicines for type 2 diabetes?

  • Eat a healthy diet. Get some exercise each day. This may help you to reduce how much medicine you need.
  • Do not take other prescription or over-the-counter medicines, vitamins, herbal products, or supplements without talking to your doctor first. Some medicines for type 2 diabetes can cause problems with other medicines or supplements.
  • Tell your doctor if you plan to get pregnant. Some of these drugs are not safe for pregnant women.
  • Be safe with medicines. Take your medicines exactly as prescribed. Meglitinides and sulfonylureas can cause your blood sugar to drop very low. Call your doctor if you think you are having a problem with your medicine.
  • Check your blood sugar often. You can use a glucose monitor. Keeping track can help you know how certain foods, activities, and medicines affect your blood sugar. And it can help you keep your blood sugar from getting so low that it’s not safe.

What are some cautions about noninsulin medicines for diabetes?

Cautions for noninsulin medicines for diabetes include the following:

  • It is important to check your blood sugar as your doctor says. If a medicine is not working well, you may need to try other medicines or combinations.

What are some examples of noninsulin medicines for diabetes?

Here are some examples of noninsulin medicines for diabetes.

Some of these medicines may be combined in one pill.

  • canagliflozin (Invokana)
  • exenatide (Byetta)
  • glimepiride (Amaryl)
  • glipizide (Glucotrol, Glucotrol XL)
  • metformin (Glucophage)
  • pioglitazone (Actos)
  • sitagliptin (Januvia)

This is not a complete list.

How is medicine used to treat type 2 diabetes?

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

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

Medicine choices

Medicines that may be prescribed include:

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

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

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

What noninsulin medicines are used for type 2 diabetes?

There are different types of noninsulin medicines for diabetes. Each works in a different way. They include metformin, sulfonylureas, thiazolidinediones, and others. You may need to take more than one medicine for diabetes. Two or more medicines may work better to lower your blood sugar level than just one does.

Overview

Type 2 diabetes: Overview

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

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

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

Prevention

Preventing type 2 diabetes

You can take steps to prevent type 2 diabetes. Even small changes can make a difference, and it's never too late to start making healthier choices.

  • Stay at a healthy weight.

    A healthy weight is one that is right for your body type and height and is based on your body mass index (BMI) and the size of your waist (waist circumference). Losing just 7% of your body weight can help reduce your risk for type 2 diabetes.

  • Exercise regularly.

    Do activities that raise your heart rate. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. Walking groups or programs are great ways to start exercising and to stay motivated.

    Try to do muscle-strengthening exercises at least 2 times a week. These exercises include push-ups and weight training. You can also use rubber tubing or stretch bands. You stretch or pull the tubing or band to build muscle strength. Be sure to work the major muscle groups: legs, hips, back, abdomen, chest, shoulders, and arms.

  • Eat healthy foods.

    Eat a balanced diet, including whole grains, lean sources of protein, and vegetables. Get enough fiber.

    Eating fewer calories and exercising more can help you lose weight, if you need to.

  • Take medicine if you need it.

    Many people have prediabetes before they have type 2 diabetes. If exercise, eating healthy foods, and being at a healthy weight don't help lower your blood sugar, you may need to take medicine. For people who have prediabetes, the medicine metformin can help prevent type 2 diabetes.

How can you help prevent type 2 diabetes?

You can take steps to help prevent type 2 diabetes. Even small changes can make a difference.

Stay at a healthy weight.

A healthy weight is one that is right for your body type and height and is based on your body mass index (BMI) and the size of your waist. Losing just 7% of your body weight can help reduce your risk for type 2 diabetes.

Exercise regularly.

Try to do moderate activity that adds up to at least 2½ hours a week. Or try to do vigorous activity that adds up to at least 1¼ hours a week.

Eat healthy foods.

Eat a balanced diet, including whole grains, lean sources of protein, and vegetables. Get enough fiber.

Take medicine if you need it.

For people who have prediabetes, the medicine metformin can help prevent type 2 diabetes.

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

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

Risk Factors

What puts you at risk for type 2 diabetes?

You're more likely to get type 2 diabetes if you:

  • Are overweight.
  • Get little or no exercise.
  • Have type 2 diabetes in your family.
  • Eat a diet that isn’t healthy. Making healthy food choices is important to avoid diabetes.

Other things that may put you at risk for type 2 diabetes include:

Age.
The risk of getting prediabetes and type 2 diabetes increases with age. But the number of children with type 2 diabetes is increasing. Usually, children who get type 2 diabetes have a family history of the disease, are overweight, and aren't physically active.
Race and ethnicity.
African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders are at higher risk than whites for type 2 diabetes.
A history of gestational diabetes.
Women who have had gestational diabetes are at higher risk for getting type 2 diabetes later in life.

Other health problems can put you at risk for type 2 diabetes. These include:

Polycystic ovary syndrome (PCOS).
PCOS causes a hormone imbalance that interferes with normal ovulation. It can cause problems with a woman's periods and make it harder to get pregnant.
History of heart disease.

The risk factors for developing heart disease also increase the risk for developing type 2 diabetes.

High blood pressure.

Untreated high blood pressure can increase the risk for developing type 2 diabetes.

Low HDL cholesterol and high triglyceride level.

A low level of high-density lipoprotein (HDL) cholesterol and/or a high level of triglycerides can increase the risk for developing type 2 diabetes.

Conditions associated with insulin resistance.

For example, acanthosis nigricans, which is a skin condition.

Prediabetes.
Having prediabetes means that you are at risk for type 2 diabetes.

Self-care Treatment Options

How can you care for yourself when you have type 2 diabetes?

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

Keep your blood sugar at a target level.
You and your doctor will set your target.
  • Lose weight if you need to by eating fewer calories and exercising more.
  • Eat healthy foods, and try not to eat too many carbohydrates at any single meal or snack. Instead, spread your carbohydrates throughout the day. Carbohydrate affects blood sugar more than any other nutrient. It's in breads, cereals, vegetables, fruit, milk, yogurt, and sugary foods like candy and cake.
  • Aim for 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
Check your blood sugar as often as your doctor recommends.
You can use your blood sugar results to adjust your food and activities to help you stay in your target range.
Do not smoke.
If you need help quitting, talk to your doctor about stop-smoking programs and medicines. They can increase your chances of quitting for good.
Take your diabetes medicine.
If you take diabetes medicine, take it exactly as prescribed.

Caring for yourself when you have type 2 diabetes

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

  • Eat healthy foods.

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

  • Check your blood sugar as often as your doctor recommends.

    You can use your blood sugar results to adjust your food and activities to stay in your target range.

  • Try to do moderate activity for at least 2½ hours a week.

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

  • Limit alcohol.

    The American Diabetes Association recommends that women with diabetes have no more than 1 drink a day and men with diabetes have no more than 2 drinks a day.

  • Do not smoke.

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

  • Get support.

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

  • Have hemoglobin A1c tests.

    This blood test shows how steady your blood sugar levels have been over time. Your doctor may recommend that you get this test every 3 to 6 months.

  • Take steps to prevent problems that diabetes can cause.

    Work with your doctor to manage your blood pressure and cholesterol, and talk to your doctor about foot exams and other tests. Tests to do every year may include:

    • A complete eye exam by an ophthalmologist or optometrist. High blood sugar levels from diabetes can damage your eyes. This test can find problems early, such as diabetic retinopathy.
    • A foot exam to check for signs of problems. Nerve damage in your feet makes it hard to feel an injury or infection.
    • Blood and urine tests. These tests may be done regularly to check for kidney problems.
  • Take your diabetes medicine.

    If you take diabetes medicine, take it exactly as prescribed. Do not stop or change your medicine without talking to your doctor first.

  • Have a sick-day plan.

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

Signs and Symptoms

What are the symptoms of type 2 diabetes?

Some people who have type 2 diabetes may not have any symptoms early on. You may have the disease for many years before you have symptoms of high blood sugar.

Symptoms of high blood sugar may include:

  • Feeling thirsty all the time.
  • Needing to urinate often.
  • Feeling hungrier than usual.
  • Losing weight for no clear reason.
  • Feeling tired all the time.
  • Having blurry vision.
  • Having infections, cuts, and bruises that heal slowly.

The higher your blood sugar rises, the more likely you are to have symptoms. High blood sugar can also make you dehydrated if you're not drinking enough liquids. This can make you feel dizzy and weak, and it can lead to an emergency called a hyperosmolar state.

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

  • Sweating.
  • Feeling weak.
  • Feeling shaky.
  • Feeling very hungry.
  • Feeling confused.

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

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

The most common symptoms of high blood sugar include:

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

The symptoms of low blood sugar include:

  • Sweating.
  • Shakiness.
  • Weakness.
  • Hunger.
  • Confusion.

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

Story

Hear from an expert: Testing tips from a diabetes educator

Rhonda O'Brien, Registered Dietitian and Certified Diabetes Educator
Learn blood sugar testing tips from Rhonda O'Brien.
"Look for patterns. If your blood sugar is always high before lunch, take a look at what you had for breakfast. Maybe you need to make some changes."

Taking charge of your type 2 diabetes means managing your blood sugar. But to manage your blood sugar, you have to test it, says Rhonda O'Brien, a registered dietitian and certified diabetes educator.

A big part of O'Brien's work is teaching people how to check their blood sugar, find their target blood sugar range, and create an eating plan that helps keep sugar levels stable.

"A lot of people who find out that they have type 2 diabetes think, 'Well, at least it's not the "bad kind" of diabetes [type 1].' But they still need to test. Type 2 diabetes is just as serious as type 1," O'Brien says.

The need to test your blood sugar never goes away, she says. "You need to keep up with it every day."

Look for patterns in test results

It's important to know what your test results mean and how to use them, O'Brien says. Testing helps you learn what things affect your blood sugar—like your activity level, your stress, and what, when, and how much you eat.

"Look for patterns," O'Brien says. "If your blood sugar is always high before lunch, take a look at what you had for breakfast. Maybe you need to make some changes."

You can work with your doctor, a diabetes educator, or a dietitian to create a plan that works for you.

Healthy eating and activity help you manage blood sugar

"You don't have to follow a strict diet. Focus on healthy eating," O'Brien says. "There's no 'good food' or 'bad food' for diabetes. Learn about the amount of carbohydrate in different foods. Then test your blood sugar to see how different foods and amounts of foods affect your blood sugar."

"Activity plays a part too. Even taking a walk after a meal can help you keep your blood sugar stable," O'Brien says.

"Some people get overwhelmed by the idea of having to start a vigorous exercise program. But you don't have to do that," O'Brien says. "Walking can work, but like everything else with diabetes, you need to monitor it and how it affects your blood sugar."

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

Andy, 52
Read more about Andy and his diabetes routine.
"It finally just hit me how serious this disease is. I couldn't keep ignoring it."

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

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

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

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

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

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

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

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

Test, don't guess

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

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

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

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

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

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

Focus on feet

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

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

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

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

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

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

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

Surgical Treatment

When is surgery done to treat type 2 diabetes?

Weight-loss surgery may be done if BMI is 40 or more, even if blood sugar is controlled with medicine or healthy habits. It may also be done if BMI is 35 or more if blood sugar isn't controlled. Some doctors may suggest surgery if BMI is 30 or more if blood sugar isn't controlled.

Treatment Options

How is type 2 diabetes treated?

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

Treatment to manage type 2 diabetes includes:

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

Medicines

Some people with type 2 diabetes may need medicines to help their bodies make insulin or decrease insulin resistance. Some medicines slow down how quickly the body absorbs carbohydrates. Medicines for treating type 2 diabetes may include metformin or insulin.

You may also take other medicines to control or prevent other health problems, such as high cholesterol, high blood pressure, and diabetic kidney disease.

Weight-loss surgery

Experts recommend weight-loss surgery for people who have type 2 diabetes and whose:

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

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

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

What Causes It

What causes type 2 diabetes?

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

What It Is

What is type 2 diabetes?

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

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

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

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

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