What do I need to know about type 2 diabetes?

There are three main types of diabetes: type 1, type 2 and gestational. In all cases, the body is struggling to manage blood sugar. Blood sugar, or glucose, is important. Sugars from the food we eat go into the bloodstream. They’re then distributed to cells throughout the body. Cells use that glucose for energy.

Insulin is a chemical made by the pancreas that helps the cells take up sugar from the blood. But sometimes the sugar stays in the blood. The cells might not react to insulin. Or the pancreas might not make enough insulin. When blood sugar is too high for too long, it can damage blood vessels and nerves. This can cause problems throughout your body.

Type 1 diabetes is an autoimmune disease. “Autoimmune” means that your immune system attacks and damages your own cells. (The immune system is supposed to fight germs and other invaders.) With type 1 diabetes, the immune system attacks the cells in the pancreas that make insulin. In this case, the body doesn’t make insulin at all. Type 1 diabetes is usually diagnosed in children and teens.

Type 2 diabetes happens when you still make insulin, but the cells don’t react as well to it. This is called “insulin resistance.” It means your body has a harder time lowering blood sugar. Your pancreas has to make more insulin to keep your blood sugar at a healthy level. But over time, this can damage the pancreas. Then, your pancreas will start to make less insulin. Type 2 is the most common type of diabetes. In fact, about 90% to 95% of diabetes cases are type 2.²

Gestational diabetes happens during pregnancy. It typically goes away after the person gives birth. But people who’ve had it are more likely to get type 2 diabetes later in life.

Prediabetes means your blood sugar is higher than normal. But it’s not high enough that you have diabetes.

Type 2 diabetes doesn’t have one direct cause and it doesn’t happen suddenly. Your genes play a major role. It’s also more common in Black and Hispanic people.

Many other factors can lead to insulin resistance and type 2 diabetes. You might be at risk if you³:

• Have a family history of diabetes
• Are 45 years or older
• Are overweight or have obesity (your doctor can help you know if you’re at a healthy weight)
• Have had gestational diabetes

Eating unhealthy foods and not exercising can also add to your risk. What’s important to remember is that getting diabetes isn’t your fault.

Type 2 diabetes develops slowly, and symptoms can be hard to notice. Symptoms might include⁴:

• Peeing often, especially at night
• Feeling very thirsty all the time
• Losing weight without trying
• Feeling very tired
• Very dry skin
• Blurry vision
• Numbness or tingling in your hands and feet

You may not have any symptoms at all. The best way to know if you have diabetes is to have your doctor test you for it. Screening is important to catch diabetes early.

Adults should start testing for diabetes at age 35.⁵ You may need to start testing earlier if you:

• Have family members with diabetes
• Are overweight
• Habits that raise your chances of getting diabetes

How do doctors test for diabetes?

Doctors check for diabetes with these two tests:

Fasting blood sugar test. This test is taken after not eating for at least eight hours. It measures your blood sugar at that moment. Here are the possible results⁶:

• Normal is 99 mg/dL or lower
• Diabetes is 126 mg/dL or higher
• Prediabetes is 99 to 126 mg/dL

A1C test. This blood test estimates your average blood sugar over the past two to three months. The possible results are⁶:

• Normal is below 5.7%
• Diabetes is 6.5% or higher
• Prediabetes is 5.7% to 6.5%

If you’re diagnosed with diabetes, there are many health care providers who can help you. Here are some of the people who might be on your team:

Your doctor or primary care provider. They will help care for your diabetes and check for problems. They will also send you to other specialists as needed.

Endocrinologist. Some people may also work with an endocrinologist. This is a doctor who specializes in diabetes. But you don’t always need to see an endocrinologist. “Most primary care doctors are well set up to help a patient manage prediabetes and type 2 diabetes,” says Dr. Salzberg.

Pharmacist. Your doctor will likely prescribe you one or more medications to manage your diabetes. So a pharmacist will be part of your care team as well.

Certified diabetes care and education specialist (CDCES). Much of diabetes management is up to you. Every day you’ll have to check your blood sugar, take medications and insulin as needed, stay active and eat well. 

A diabetes educator can help you learn how to better handle day-to-day life. You can get this help through a program called “diabetes self-management education and support (DSMES) services.” It’s covered by Medicare and many other health plans. Ask your doctor for more information.

Registered dietitian (RD/RDN). What you eat has a big impact on your blood sugar. A dietitian can help you make changes to what you eat and plan meals. Many dietitians are also diabetes educators.

Eye doctor. Diabetes can cause vision problems. You’ll need to get a yearly eye exam to check for damage to your eyes.

Your doctor may also suggest a group diabetes education program. “Many hospitals offer diabetes education classes. Patients should take advantage of them,” says Dr. Salzberg. They offer basic skills. Plus, they offer emotional support for people who are struggling.

If you’re having a hard time, check out the virtual mental health resources from Optum. You can work with someone one-on-one through AbleTo. Find support.

Almost all patients with type 2 diabetes are given metformin. “Metformin is a great first-line therapy,” says Dr. Salzberg. “It’s safe and most people can afford it. And it’s shown to help keep diabetes from getting worse.”

Metformin blocks the liver from making glucose. That’s how it lowers blood sugar. It also improves insulin sensitivity. Learn more about what to expect from metformin.

There are many other types of medications that may be given with metformin. Your doctor may make changes to your medications depending on your blood sugar levels. Don’t be afraid to ask questions about your medications. Your pharmacist can also help.

Do I need to take insulin for type 2 diabetes?

Many people associate insulin with diabetes. People with type 2 diabetes don’t always need to take insulin. But it may eventually be part of your diabetes management plan. Injecting insulin can be scary, but it’s perfectly safe. You’re just replacing the insulin that your pancreas doesn’t make. Your doctor, nurse or diabetes educator can teach you how to safely inject insulin.

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Besides medications, your doctor will also suggest changes to your habits to manage your diabetes. What you eat is particularly important. You may want to work with a dietitian or diabetes educator. That’s the best way to get a personalized plan. Ask your doctor for a referral.

How food affects blood sugar

Sugar in your blood comes from carbohydrates (carbs) in food. Carbs are broken down into sugar (glucose) during digestion. Then the sugar is absorbed into your bloodstream. Carbs are mostly found in these foods:

• Sugary foods and drinks such as candy, soda, juice and baked goods
• Whole grains and grain-based foods such as bread, pasta and cereal
• Beans and legumes
• Fruit
• Certain starchy vegetables, including potatoes, corn and winter squash

You may have heard that people with diabetes need to stop eating any foods that contain carbs and sugar. Even healthy ones like fruit. This is not true. Carb foods do raise blood sugar. But many of them have vitamins, minerals and fiber that are important for your health. Plus, carbs are very common. It’s hard (and not needed) to cut them out completely.

Instead, focus on cutting back on refined carbs and sugar. These are things like white bread and pasta and sugary foods and drinks. These foods raise your blood sugar the most without providing many nutrients.

You’ll also want to think about how much you’re eating at each meal. The more carbs you eat at once, the more they will raise your blood sugar. Pairing carb foods with fiber, protein and/or fat also lessens the blood sugar spike after meals. Fiber, protein and fat are nutrients that slow digestion. That means the sugar from carbs doesn’t go into your bloodstream as quickly. Your levels stay steadier.

Try the plate method for healthy eating.⁷ This is an easy way to make sure you eat the right amount of each food. It also helps make sure you’re getting fiber, protein and fat in your meals. You don’t have to measure portions or count carbs. Just use your plate as a guide:

• Fill half your plate with non-starchy vegetables.
• Fill one-quarter of your plate with lean protein.
• Fill the last quarter of your plate with carb foods.

How to make meals more diabetes friendly

Let’s put all of this into practice. We’ll see how we can make a typical burrito meal more diabetes friendly. You can make a burrito with a large tortilla (10-inch.) Fill it with rice, beans, cheese and chicken. Plus, you might have chips and salsa on the side and a soda to drink.

This meal has five carb foods in it: tortilla, rice, beans, chips and soda. To make it more diabetes friendly, we need to reduce the amount of carbs and add more vegetables. Here are some ideas about what to add to your burrito:

• Non-starchy vegetables: Let’s add bell pepper and onion to the burrito filling.
• Lean protein: Chicken is a great lean protein. We’ll leave that the same.
• Carbs: We have too many carbs in this meal.
  • Let’s use a smaller tortilla (8-inch) and switch to whole wheat. It has more fiber.
  • We’ll ditch the rice and fill the tortilla with a smaller amount of beans. This will make room for the veggies we’re adding.
  • We’ll also cut out the tortilla chips on the side. You could add the salsa to the burrito instead.
  • Replace the soda with water or unsweetened tea.
• Healthy fats: You can make the meal more filling. Just add sliced avocado or guacamole. Avocado is a great source of heart-healthy fats.

Remember, you can make these changes slowly. If this feels like too many changes to a favorite meal, start with just one or two of these suggestions. Even small changes will make a difference.

What is the best way to eat for type 2 diabetes?

There is no one way to eat that all people should follow.8 You don’t need to completely change the way you eat or give up your favorite foods. Instead, focus on making changes that fit with your life and make you feel good.

Research shows that several different eating patterns can be used to manage diabetes. These include:

• Low-carb
• Low-fat
• Mediterranean
• Vegetarian or vegan
• The DASH (Dietary Approaches to Stop Hypertension) diet

But you don’t have to follow one of these specific diets to see results. They all share very similar rules:

• Eat plenty of plant-based foods.
• Cut back on refined carbs and sugar.
• Include healthy fats.
• Get protein from lean meats, fish and plant sources.

The food choices should be right for you, says Dr. Salzberg. “There’s evidence-based, high-quality data. And then there’s the individual,” she says. Health care providers need to take what they know and adapt it to you and your life. In the end, the best eating pattern for you will be the one that you can stick with for a long time.

Do I need to lose weight to manage type 2 diabetes?

If you’re overweight or have obesity, your doctor may suggest losing weight. But you don’t have to lose much. “There’s really good data that shows losing just 5% can help,” says Dr. Salzberg.9 (That’s just 10 pounds for a 200-pound person.)

Losing this much weight can improve your insulin sensitivity. This can make it easier to keep your blood sugar at a healthy level. It can also prevent complications such as heart disease and lessen your need for medications.

If you have prediabetes, weight loss can stop or delay getting type 2 diabetes. Think about working with a dietitian or diabetes educator. They can help you lose weight and have a healthy blood sugar level.

Exercise is one of the best ways to stay healthy with type 2 diabetes. It can help you lose weight and improve insulin sensitivity. And, physical activity helps lower blood sugar. When you exercise, your muscles can take up sugar from the blood without the help of insulin. Walking after a meal is helpful.

The ADA⁹ suggests:

• At least 150 minutes of moderate activity each week.
• Strength training two to three days a week.
• You should do some activity most days of the week. Try not to go more than two days in a row without activity.
• You shouldn’t sit for long periods of time. Do you spend most of your day at a desk? Try to get up every 30 minutes to an hour. Walk around for a few minutes.

You don’t have to do all of this perfectly to start seeing benefits. Starting with just a 10-minute walk most days can make a big difference. A dietitian or a diabetes educator can help you work on being more active. They’ll look at your current activity levels and work with you to set realistic goals.

It can be hard to make time for exercise. But the benefits are more than worth it. Check out these fool-proof ways to boost your workout motivation.

Healthy eating and exercise can help you manage your diabetes. But they aren’t the only things that affect blood sugar. Managing stress, illness and sleep are also important.

Stress and illness

Stress and common illnesses, such as a cold, can make it harder to manage blood sugar. Your body releases hormones that can raise blood sugar when you’re stressed or sick. Stress and anxiety can create a vicious cycle. Managing diabetes is stressful, and added stress can raise blood sugar levels. If you’re feeling overly stressed or depressed, you might want to seek help. Self care tools, therapists or support groups can offer support and help you cope.

Sleep

More researchers are paying attention to the link between sleep and diabetes. Studies show that poor sleep is linked to higher blood sugar in people with diabetes or prediabetes. It might be both a cause and an effect. High blood sugar can disrupt sleep by causing you to pee more often at night. It can also cause headaches and thirst that may keep you awake.¹⁰

Lack of sleep can lead to higher blood sugar levels. It can also derail your attempts to eat healthier. Sleep deprivation increases hunger hormones in your body. This leads to food cravings, particularly for foods that are high in sugar and carbs. Getting at least seven hours of sleep at night can make it easier to manage diabetes. If you're not getting enough rest, these sleep strategies can help. 

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Your bloodstream always has some sugar flowing through it. But having too much too often can lead to complications. Too much blood sugar can damage small blood vessels and nerves. This damage can lead to heart disease, nerve damage, vision problems and kidney disease. (The kidney filters your blood to help keep it healthy.)

• Heart disease. Having diabetes doubles your chances of having heart disease or a stroke.¹¹ If you have diabetes, your doctor should keep an eye on your blood pressure and cholesterol. (Cholesterol is a type of fat in your blood.) 
   
• Kidney disease. Damage to blood vessels and filters in the kidneys can cause chronic kidney disease. This happens slowly over time with little or no symptoms. Your doctor should check your kidney health with yearly blood and urine tests. 
   
• Nerve damage. Damage to nerves can cause tingling or numbness in your hands and feet. Numbness in your feet can lead to serious foot problems such as ulcers and blisters that don’t heal. In severe cases, this can even lead to amputation. Keep your feet protected by always wearing shoes and socks or slippers. Your doctor should check your feet at each visit.¹²
   
• Vision problems. Damage to blood vessels and nerves in the eye can cause vision loss and even blindness. People with diabetes should get a dilated eye exam every year. Special eyedrops will widen your pupil so that your doctor can better see the back of your eye.

These problems aren’t inevitable. Medications and habit changes can help you keep your blood sugar in a healthy range. This will keep damage to blood vessels and nerves from happening in the first place.

The short answer is "no.” Type 2 diabetes can’t be cured or reversed. But if you can keep your blood sugar level normal for a long time, it can be in “remission.” Remission is an A1C of less than 6.5% without medications for at least three months.¹³ But this does not mean the diabetes is cured. Your doctor will still watch your A1C. And to stay as healthy as possible, you’ll still need to:

• Eat healthy
• Be active
• Keep your weight at a healthy level
• Keep your A1C normal

Prediabetes, on the other hand, is reversible. You can get your blood sugar levels back to normal and prevent diabetes from ever happening.

1. Centers for Disease Control and Prevention. National diabetes statistics report. Last reviewed January 18, 2022. Accessed July 7, 2022.
2. Centers for Disease Control and Prevention. What is diabetes? Last reviewed December 16, 2021. Accessed July 7, 2022.
3. Centers for Disease Control and Prevention. Diabetes risk factors. Last reviewed April 5, 2022. Accessed July 7, 2022.
4. Centers for Disease Control and Prevention. Diabetes symptoms. Last reviewed April 27, 2021. Accessed July 7, 2022.
5. American Diabetes Association. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2022. Published December 16, 2021. Accessed July 7, 2022.
6. Centers for Disease Control and Prevention. Diabetes tests. Last reviewed August 10, 2021. Accessed July 7, 2022.
7. American Diabetes Association. What is the diabetes plate method? Published February 2020. Accessed July 7, 2022.
8. American Diabetes Association. Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Published April 15, 2019. Accessed July 7, 2022.
9. American Diabetes Association. Anaerobic exercise and diabetes. N.D. Accessed July 12, 2022.
10. Centers for Disease Control and Prevention. Sleep for a good cause. Last reviewed December 10, 2020. Accessed July 7, 2022.
11. Centers for Disease Control and Prevention. Diabetes and your heart. Last reviewed May 7, 2021. Accessed July 7, 2022.
12. Centers for Disease Control and Prevention. Diabetes and your feet. Last reviewed May 7, 2021. Accessed July 7, 2022.
13. American Diabetes Association. Consensus report: Definitions and interpretations of remission in type 2 diabetes. Published August 30, 2021. Accessed July 7, 2022.