Diabetes Information

Overview

Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It's also the brain's main source of fuel.

The main cause of diabetes varies by type. But no matter what type of diabetes you have, it can lead to excess sugar in the blood. Too much sugar in the blood can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes. Prediabetes happens when blood sugar levels are higher than normal. But the blood sugar levels aren't high enough to be called diabetes. And prediabetes can lead to diabetes unless steps are taken to prevent it. Gestational diabetes happens during pregnancy. But it may go away after the baby is born.

What type of diabetes do I have?

Type 1 diabetes
Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). This reaction stops your body from making insulin. If you have type 1 diabetes, you’ll need to take insulin every day to survive. Currently, no one knows how to prevent type 1 diabetes. Type 1 diabetes is usually diagnosed in children and young adults but can be diagnosed at any age, and symptoms often develop quickly.
Type 2 diabetes
With type 2 diabetes, your body doesn’t use insulin well and can’t keep blood sugar at normal levels. It develops over many years and is usually diagnosed in adults (but more and more in children, teens, and young adults). You may not notice any symptoms, so it's important to get your blood sugar tested if you're at risk.
Type 3c diabetes?

Type 3c diabetes develops when your pancreas experiences damage that affects its ability to produce insulin. Conditions like chronic pancreatitis and cystic fibrosis can lead to pancreas damage that causes diabetes

Gestational diabetes
Gestational diabetes develops in pregnant women who have never had diabetes. If you have gestational diabetes, your baby could be at higher risk for health problems. Gestational diabetes usually goes away after your baby is born. However, it increases your risk for type 2 diabetes later in life. Your baby is more likely to have Obesity as a child or teen and develop type 2 diabetes later in life.

No matter what type of diabetes you have, taking diabetes medicines every day can feel like a burden sometimes. New medications and improved delivery systems can help make it easier to manage your blood glucose levels. Talk with your doctor to find out which medications and delivery systems will work best for you and fit into your lifestyle.

What are the diabetes ABCs?

The diabetes ABCs can help you manage your blood glucose, blood pressure, and cholesterol levels. If you smoke, quitting is also important. Managing your ABCs may lower your chances of having health problems from diabetes, such as a heart attack, stroke, kidney disease, blindness, and foot or leg amputations.

A is for the A1C blood glucose test

The A1C test shows your average blood glucose level over the last 3 months. This test is done at a health care professional’s office or lab. For most people with diabetes, their goal is an A1C level below 7%.¹ Your A1C goal may be different if you have other health problems. Ask your health care team how often you should have the test and what your goal should be.

B is for blood pressure

High blood pressure can damage your heart, kidneys, brain, and eyes. Some people with diabetes have a blood pressure goal below 130/80 mm Hg. If you have heart disease or are at high risk for diabetes health problems, your goal may be lower. Ask your health care team what your goal should be.

C is for cholesterol

Cholesterol is a fat, also called lipid, that is produced by your liver. Unhealthy levels of cholesterol in your blood can build up and clog your blood vessels, which may result in a heart attack or a stroke. Ask your health care team how often you need a cholesterol test, also called a lipid panel, and what your cholesterol level should be. Some people may need to take a medicine called a statin, or another medicine, to lower their cholesterol for heart health.

S is for stop smoking

Not smoking is important for your health, especially if you have diabetes. Both smoking and diabetes can make your blood vessels narrow. E-cigarettes aren’t a safe option either. If you smoke, vape, or use other tobacco products, stop. Ask for help so you don’t have to do it alone.

Symptoms

Diabetes symptoms depend on how high your blood sugar is. Some people, especially if they have prediabetes, gestational diabetes or type 2 diabetes, may not have symptoms. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the symptoms of type 1 diabetes and type 2 diabetes are:

Feeling more thirsty than usual.

Urinating often.

Losing weight without trying.

Presence of ketones in the urine. Ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin.

Feeling tired and weak.

Feeling irritable or having other mood changes.

Having blurry vision.

Having slow-healing sores.

Getting a lot of infections, such as gum, skin and vaginal infections.

Type 1 diabetes can start at any age. But it often starts during childhood or teen years. Type 2 diabetes, the more common type, can develop at any age. Type 2 diabetes is more common in people older than 40. But type 2 diabetes in children is increasing.

When to see a doctor

If you think you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your health care provider. The earlier the condition is diagnosed, the sooner treatment can begin.

If you've already been diagnosed with diabetes. After you receive your diagnosis, you'll need close medical follow-up until your blood sugar levels stabilize.

Causes

To understand diabetes, it's important to understand how the body normally uses glucose.

How insulin works

Insulin is a hormone that comes from a gland behind and below the stomach (pancreas).

The pancreas releases insulin into the bloodstream.

The insulin circulates, letting sugar enter the cells.

Insulin lowers the amount of sugar in the bloodstream.

As the blood sugar level drops, so does the secretion of insulin from the pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

Glucose comes from two major sources: food and the liver.

Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.

The liver stores and makes glucose.

When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose. This keeps your glucose level within a typical range.

The exact cause of most types of diabetes is unknown. In all cases, sugar builds up in the bloodstream. This is because the pancreas doesn't produce enough insulin. Both type 1 and type 2 diabetes may be caused by a combination of genetic or environmental factors. It is unclear what those factors may be.

Risk factors

Risk factors for diabetes depend on the type of diabetes. Family history may play a part in all types. Environmental factors and geography can add to the risk of type 1 diabetes.

Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes immune system cells (autoantibodies). If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes.

Race or ethnicity also may raise your risk of developing type 2 diabetes. Although it's unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are at higher risk.

Prediabetes, type 2 diabetes and gestational diabetes are more common in people who are overweight or obese.

Diabetes by the numbers

In the last 20 years, the number of adults diagnosed with diabetes has more than doubled.

In the United States:

38.4 million people of all ages had diabetes (11.6% of the population) in 2021. 38.1 million were adults ages 18 years or older

29.7 million people of all ages had been diagnosed with diabetes (8.9% of the population).

29.4 million were adults ages 18 years or older.

352,000 were children and adolescents younger than age 20, including 304,000 with type 1 diabetes.

Age-adjusted data from 2019 to 2021 showed that, for both men and women ages 18 years or older, the prevalence of diagnosed diabetes was highest among American Indian and Alaska Native adults (13.6%), followed by non-Hispanic Black adults (12.1%), adults of Hispanic origin (11.7%), non-Hispanic Asian adults (9.1%), and non-Hispanic White adults (6.9%).

Diabetes is the eighth leading cause of death.

8.7 million adults ages 18 years or older had diabetes but were undiagnosed (22.8% of adults with diabetes were undiagnosed).

Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes; type 1 diabetes accounts for about 5% to 10%

Another 84.1 million people are thought to have prediabetes. But most people with prediabetes do not know they have the condition.

Diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult blindness.

In the last 20 years, the number of adults diagnosed with diabetes has more than doubled.

Medical costs and lost work and wages for people with diagnosed diabetes total $413 billion yearly.

Medical costs for people with diabetes are more than twice as high as for people who don't have diabetes.

Prediabetes occurs when your blood glucose is higher than it should be but not high enough to be diabetes.

You’re more likely to develop diabetes if you have a family history of the disease.

Other risk factors for type 2 diabetes include:

having a sedentary lifestyle

living with extra weight or obesity

having had gestational diabetes or prediabetes

Complications

Complications of diabetes generally develop over time. Having poorly managed blood sugar levels increases the risk of serious complications that can become life threatening. Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. In fact, prediabetes can lead to type 2 diabetes.

Possible complications include:

Heart and blood vessel (cardiovascular) disease. Diabetes majorly increases the risk of many heart problems. These can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you're more likely to have heart disease or stroke.

Nerve damage from diabetes (diabetic neuropathy). Too much sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.

Kidney damage from diabetes (diabetic nephropathy). The kidneys hold millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system.

Eye damage from diabetes (diabetic retinopathy). Diabetes can damage the blood vessels of the eye. This could lead to blindness.

Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of many foot complications.

Skin and mouth conditions. Diabetes may leave you more prone to skin problems, including bacterial and fungal infections.

Hearing impairment. Hearing problems are more common in people with diabetes.

Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease.

Depression related to diabetes. Depression symptoms are common in people with type 1 and type 2 diabetes.

Chronic complications include:

vessel disease, which can lead to heart attack or stroke

eye problems (retinopathy)

infection or skin conditions

nerve damage (neuropathy)

kidney damage (nephropathy)

amputations due to neuropathy or vessel disease

Type 2 diabetes may increase the risk of developing Alzheimer’s disease, especially if your blood sugar is not well managed.

Complications of gestational diabetes

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can be caused by gestational diabetes, including:

Excess growth. Extra glucose can cross the placenta. Extra glucose triggers the baby's pancreas to make extra insulin. This can cause your baby to grow too large. It can lead to a difficult birth and sometimes the need for a C-section.

Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth. This is because their own insulin production is high.

Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing Obesity and type 2 diabetes later in life.

Death. Untreated gestational diabetes can lead to a baby's death either before or shortly after birth.

Birth Defects

Complications in the mother also can be caused by gestational diabetes, including:

Preeclampsia. Symptoms of this condition include high blood pressure, too much protein in the urine, and swelling in the legs and feet.

Gestational diabetes. If you had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy.

High blood pressure

Prevention

Prediabetes

In the United States, about 1 in 3 adults has prediabetes. More than 8 in 10 people with prediabetes don't know they have it. With prediabetes, blood sugar levels are higher than normal, but not high enough for a type 2 diabetes diagnosis. Prediabetes raises your risk for type 2 diabetes, heart disease, and stroke.

Prediabetes and type 2 diabetes can be prevented with lifestyle changes. Currently, no one knows how to prevent type 1 diabetes.

How you can prevent type 1 diabetes‎?

Type 1 diabetes can't be prevented. But the healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:

Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Eat a variety to keep from feeling bored.

Take care of your mental health. Feeling stressed, sad, or angry can be common for people with diabetes. Many people with chronic, or long-term, illnesses such as diabetes develop anxiety or other mental health conditions. Learn healthy ways to lower your stress, and ask for help from your health care team or a mental health professional.

Get enough sleep. Getting enough sleep may improve your mood, energy level, and blood glucose level. Most adults should aim for about 7 to 8 hours each night.5 Children and adolescents may need more sleep.

Get more physical activity. Physical activity may help you lower blood glucose, blood pressure, and cholesterol levels. Being active may also help you get better sleep and improve your mood. Try to get at least 150 minutes of moderate-intensity External link physical activity, such as brisk walking, each week. If you can, try to do muscle-strengthening activities, such as wall push-ups or seated arm raises, two days a week.

Lose excess pounds. If you are overweight or have obesity, ask your health care team how you can manage your weight. To lose weight, you may need to consume fewer calories or get more physical activity. Your health care team may also recommend medicines or surgery to help manage your weight.

But don't try to lose weight during pregnancy. Talk to your provider about how much weight is healthy for you to gain during pregnancy.

To keep your weight in a healthy range, work on long-term changes to your eating and exercise habits. Remember the benefits of losing weight, such as a healthier heart, more energy and higher self-esteem.

Sometimes drugs are an option. Oral diabetes drugs such as metformin (Glumetza, Fortamet, others) may lower the risk of type 2 diabetes. But healthy lifestyle choices are important. If you have prediabetes, have your blood sugar checked at least once a year to make sure you haven't developed type 2 diabetes.

How you can prevent type 2 diabetes‎
If you have prediabetes, learn how the lifestyle change program can help you take healthy steps to prevent or delay type 2 diabetes.

Diagnosis

Type 1 diabetes symptoms often start 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 easy to see, the American Diabetes Association (ADA) has developed 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. These factors include high blood pressure, non-typical cholesterol levels, an inactive lifestyle, a history of polycystic ovary syndrome or heart disease, and having a close relative with diabetes.

Anyone older than age 35 is advised to get an initial blood sugar screening. If the results are normal, they should be screened every three years after that.

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.

Anyone who has HIV is advised to be tested.

Tests for type 1 and type 2 diabetes and prediabetes

A1C test. This blood test, which doesn't require not eating for a period of time (fasting), shows your average blood sugar level for the past 2 to 3 months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. It's also called a glycated hemoglobin test.

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 means that you have diabetes. An A1C between 5.7% and 6.4% means that you have prediabetes. Below 5.7% is considered normal.

Random blood sugar test. A blood sample will be taken at a random time. No matter 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 you haven't eaten anything the night before (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.

Glucose tolerance test. For this test, you fast overnight. Then, the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested regularly 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 means you have diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have prediabetes.

If your provider thinks you may have type 1 diabetes, they may test your urine to look for the presence of ketones. Ketones are a byproduct produced when muscle and fat are used for energy. Your provider will also probably run a test to see if you have the destructive immune system cells associated with type 1 diabetes called autoantibodies.

Your provider will likely see if you're at high risk for gestational diabetes early in your pregnancy. If you're at high risk, your provider may test for diabetes at your first prenatal visit. If you're at average risk, you'll probably be screened sometime during your second trimester.

Treatment

Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral drugs may be part of your treatment. Eating a healthy diet, staying at a healthy weight and getting regular physical activity also are important parts of managing diabetes.

Treatments for all types of diabetes

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

Healthy eating. Your diabetes diet is simply a healthy-eating plan that will help you control your blood sugar. You'll need to focus your diet on more fruits, vegetables, lean proteins and whole grains. These are foods that are high in nutrition and fiber and low in fat and calories. You'll also 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. They must be counted as part of your meal plan.

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 activity. This includes people who have diabetes. Physical activity lowers your blood sugar level by moving sugar into your cells, where it's used for energy. Physical activity also makes your body more sensitive to insulin. That means your body needs less insulin to transport sugar to your cells.

Get your provider'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 moderate physical activity most days of the week, or at least 150 minutes of moderate physical activity a week. Bouts of activity can be a few minutes during the day. If you haven't been active for a while, start slowly and build up slowly. Also avoid sitting for too long. Try 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. For some people with type 1 diabetes, pancreas transplant or islet cell transplant may be an option.

Treatment of type 2 diabetes mostly involves lifestyle changes, monitoring of your blood sugar, along with oral diabetes drugs, 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 blood sugar testing 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 often.

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 lower the number of finger sticks 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 and stress. For women, you'll learn how your blood sugar level changes in response to changes in hormone levels.

Besides daily blood sugar monitoring, your provider will likely recommend regular A1C testing to measure your average blood sugar level for the past 2 to 3 months.

Compared with repeated daily blood sugar tests, A1C testing shows better how well your diabetes treatment plan is working overall. A higher A1C level may signal the need for a change in your oral drugs, 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 or your ability to feel when your blood sugar is low. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7%. Ask your provider what your A1C target is.

Insulin

People with type 1 diabetes must use insulin to manage blood sugar 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 provider may prescribe a mixture of insulin types to use during the day and night.

Insulin can't be taken orally to lower blood sugar because stomach enzymes interfere with insulin's action. Insulin is often 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 cell phone worn on the outside of your body. A tube connects the reservoir of insulin to a tube (catheter) that's inserted under the skin of your abdomen.

A continuous glucose monitor, on the left, is a device that measures blood sugar every few minutes using a sensor inserted under the skin. An insulin pump, attached to the pocket, is a device that's worn outside of the body with a tube that connects the reservoir of insulin to a catheter inserted under the skin of the abdomen. Insulin pumps are programmed to deliver specific amounts of insulin continuously and with food.

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 give out more or less insulin depending on meals, activity level and blood sugar level.

A closed loop system is a device implanted in the body that links a continuous glucose monitor to an insulin pump. The monitor checks blood sugar levels regularly. The device automatically delivers the right amount of insulin when the monitor shows that it's needed.

The Food and Drug Administration has approved several hybrid closed loop systems for type 1 diabetes. They are called "hybrid" because these systems require some input from the user. For example, you may have to tell the device how many carbohydrates are eaten, or confirm blood sugar levels from time to time.

A closed loop system that doesn't need any user input isn't available yet. But more of these systems currently are in clinical trials.

Oral or other drugs

Sometimes your provider may prescribe other oral or injected drugs as well. Some diabetes drugs help your pancreas to release more insulin. Others prevent the production and release of glucose from your liver, which means you need less insulin to move sugar into your cells.

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

Another class of medication called SGLT2 inhibitors may be used. They work by preventing the kidneys from reabsorbing filtered sugar into the blood. Instead, the sugar is eliminated 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. Because of this, transplants are usually reserved for people whose diabetes can't be controlled or those who also need a kidney transplant.

Bariatric surgery

Some people with type 2 diabetes who are obese and have a body mass index higher than 35 may be helped by some types of bariatric surgery. People who've had gastric bypass have seen major improvements in their blood sugar levels. But 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. It can also keep you from having complications during delivery. In addition to having a healthy diet and exercising regularly, your treatment plan for gestational diabetes may include monitoring your blood sugar. In some cases, you may also use insulin or oral drugs.

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

Treatment for prediabetes

Treatment for prediabetes usually involves healthy lifestyle choices. These habits can help bring your blood sugar level back to normal. Or it could keep it from rising toward the levels seen in type 2 diabetes. Keeping 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.

Drugs — such as metformin, statins and high blood pressure medications — may be an option for some people with prediabetes and other conditions such as heart disease.

Signs of trouble in any type of diabetes

Many factors can affect your blood sugar. Problems may sometimes come up that need care right away.

High blood sugar

High blood sugar (hyperglycemia in diabetes) can occur 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 provider. And watch for symptoms of high blood sugar, including:

Urinating often

Feeling thirstier than usual

Blurred vision

Tiredness (fatigue)

Headache

Irritability

If you have hyperglycemia, you'll need to adjust your meal plan, drugs or both.

Increased ketones in your urine

Diabetic ketoacidosis is a serious complication of diabetes. If your cells are starved for energy, your body may begin to break down fat. This makes toxic acids known as ketones, which can build up in the blood. Watch for the following symptoms:

Nausea

Vomiting

Stomach (abdominal) pain

A sweet, fruity smell on your breath

Shortness of breath

Dry mouth

Weakness

Confusion

Coma

You can check your urine for excess ketones with a ketones test kit that you can get without a prescription. If you have excess ketones in your urine, talk with your provider right away or seek emergency care. This condition is more common in people with type 1 diabetes.

Hyperglycemic hyperosmolar nonketotic syndrome

Hyperosmolar syndrome is caused by very high blood sugar that turns blood thick and syrupy.

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

Hallucinations

This condition is seen in people with type 2 diabetes. It often happens after an illness. Call your provider or seek medical care right away if you have 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 (diabetic hypoglycemia). If you're taking drugs that lower your blood sugar, including insulin, your blood sugar level can drop for many reasons. These include skipping a meal and getting more physical activity than normal. Low blood sugar also occurs if you take too much insulin or too much of a glucose-lowering medication that causes the pancreas to hold insulin.

Check your blood sugar level regularly and watch for symptoms of low blood sugar, including:

Sweating

Shakiness

Weakness

Hunger

Dizziness

Headache

Blurred vision

Heart palpitations

Irritability

Slurred speech

Drowsiness

Confusion

Fainting

Seizures

Low blood sugar is best treated with carbohydrates that your body can absorb quickly, such as fruit juice or glucose tablets.

Diabetes drugs and weight loss

Insulin Type	Onset	When It Peaks	Duration
rapid-acting/ ultra rapid-acting	15 mins	1 hr	2 to 4 hrs (rapid) 5 to 7 hrs (ultra)
rapid-acting, inhaled	10 to 15 mins	30 mins	3 hrs
regular, also called short-acting	30 mins	2 to 3 hrs	3 to 6 hrs
intermediate-acting	2 to 4 hrs	4 to 12 hrs	12 to 18 hrs
long-acting	2 hrs	does not peak	24 hrs
ultra long-acting	6 hrs	does not peak	36 hrs or longer

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

There are two main groups of type 2 diabetes medicines that lower blood sugar and also may lead to weight loss. The first group is glucagon-like peptide 1 (GLP-1) agonists. The second is sodium glucose cotransporter-2 (SGLT-2) inhibitors.

GLP-1 agonists (Incretin Mimetics)

GLP-1 agonists for type 2 diabetes are generally taken by a shot, also called an injection. Most are taken once a day or once a week.

GLP-1 agonists include the following medicines.

Taken once a day by a shot:

Liraglutide (Victoza, Saxenda).

Lixisenatide (Adlyxin).

Taken twice a day by a shot:

Exenatide (Byetta).

Taken once a week by a shot:

Dulaglutide (Trulicity).

Exenatide extended release (Bydureon BCise).

Semaglutide (Ozempic).

Another form of semaglutide is available in a pill that's taken by mouth once a day. The brand name of that medicine is Rybelsus.

Tirzepatide (Mounjaro) is a similar kind of medicine called a dual-acting GLP-1/GIP agonist. It's also used to control blood sugar and can support weight loss. It is taken once a week by a shot.

All GLP-1 agonists can help with weight loss. But the amount of weight loss depends on the type of medicine and the dose. In general, studies have found that tirzepatide and semaglutide are the most effective for weight loss. Dulaglutide and liraglutide also have been found to be very effective. Other GLP-1 agonists appear to be somewhat less effective for weight loss. But people who take them still have better weight loss results than those who do not take the medicine.

GLP-1 agonists mimic the way a hormone called (glucagon-like peptide 1) works in the body. When blood sugar starts to rise after a person eats, these medicines cause the body to make more insulin. The extra insulin helps lower blood sugar.

Lower blood sugar helps control type 2 diabetes. But it's not clear exactly how GLP-1 agonists lead to weight loss. They appear to curb hunger. They also slow the movement of food from the stomach into the small intestine. That means you may feel full faster and longer, so you eat less.

As with any medicine, there is a risk of side effects when taking a GLP-1 agonist. Some side effects can be serious. More common side effects often improve after taking the medicine for a while.

Common side effects include:

Nausea.

Vomiting.

Diarrhea.

Headache.

Low blood sugar is a more serious risk linked to GLP-1 agonists. The medical term for that condition is hypoglycemia. But the risk of low blood sugar typically only goes up when a person also is taking another medicine that's known to lower blood sugar. Examples include sulfonylureas and insulin.

GLP-1 agonists aren't recommended for people who:

Have had medullary thyroid cancer or who have a family history of the disease.

Have had multiple endocrine neoplasia or who have a family history of the disease.

Have had pancreatitis.

Are pregnant or are actively trying to get pregnant.

Are breastfeeding.

Certain GLP-1 agonists may not be appropriate for people who have a health condition that affects the intestines, such as gastroparesis, or for people who have some types of kidney disease.

Studies have linked GLP-1 agonists with certain thyroid tumors in rats. But until more long-term studies are done, the risk to humans isn't known.

SGLT-2 inhibitors

SGLT-2 inhibitors come in a pill that's taken once a day. They include the following medicines:

Canagliflozin (Invokana).

Dapagliflozin (Farxiga).

Empagliflozin (Jardiance).

Ertugliflozin (Steglatro).

Bexagliflozin (Brenzavvy).

sotagliflozin systemic (Inpefa)

These medicines work in the kidneys where they help take extra sugar out of the blood that then goes out of the body in urine. This lowers blood sugar. It also can help with weight loss. The weight loss benefits of SGLT-2 inhibitors typically are less than those of GLP-1 agonists.

Side effects of SGLT-2 inhibitors may include:

Genital yeast infections.

Urinary tract infections.

Lightheadedness.

Dizziness.

Nausea.

Kidney injury.

Weaker bones and a higher risk of broken bones.

A higher risk of diabetic ketoacidosis.

Rarely, SGLT-2 may be linked to a higher risk of infection in the feet and lower legs. If an infection is serious, it could lead to the need for amputation. People who have had wounds on their feet or other problems with their feet or lower legs should talk with their healthcare professionals about the possible risks before taking an SGLT-2.

SGLT-2 inhibitors aren't recommended for people who have had diabetic ketoacidosis. They also may not be a good choice for people with certain types of kidney disease.

Benefits beyond weight loss

Along with helping to control blood sugar and boosting weight loss, GLP-1 agonists and SGLT-2 inhibitors seem to have other health benefits.

Research has found that some of these medicines may lower the risk of certain serious health conditions, such as kidney disease, heart disease, heart failure and stroke. Many people who take these medicines also see their blood pressure improve. But it's not clear whether these benefits are from the medicine or a result of weight loss.

If you have type 2 diabetes and you want to find out if these medicines might be useful for you to lose weight, talk with your diabetes care team. They can help you decide what's best for your situation.

Lifestyle and home remedies

Diabetes is a serious disease. Following your diabetes treatment plan takes total commitment. Careful management of diabetes can lower your risk of serious or life-threatening complications.

Commit to managing your diabetes. Learn all you can about diabetes. Build a relationship with a diabetes educator. Ask your diabetes treatment team for help when you need it.

Choose healthy foods and stay at a healthy weight. If you're overweight, losing just 7% 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. And limit how much food with saturated fat you eat.

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

Getting regular aerobic exercise along with getting at least two days a week of strength training exercises can help control blood sugar more effectively than does either type of exercise alone. Aerobic exercises can include walking, biking or dancing. Resistance training can include weight training and body weight exercises.

Also try 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 recommendations for type 1 and type 2 diabetes

Also, 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. 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 provider will look for any diabetes-related complications and screen for other medical problems. Your eye care specialist will check for signs of eye damage, including retinal damage (retinopathy), cataracts and glaucoma.

Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year. Your provider may recommend the pneumonia and COVID-19 vaccines, as well.

The Centers for Disease Control and Prevention (CDC) also currently recommends hepatitis B vaccination if you haven't previously had it and you're an adult ages 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines suggest vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have been diagnosed with diabetes, and haven't previously received the vaccine, talk to your provider 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. Talk to your provider if you have a sore or other foot problem that doesn't heal quickly on its own.

Control your blood pressure and cholesterol. Eating healthy foods and exercising regularly can help control high blood pressure and cholesterol. Drugs 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. Talk to your dentist right away if your gums bleed or look red or swollen.

If you smoke or use other types of tobacco, ask your provider to help you quit. Smoking increases your risk of many diabetes complications. Smokers who have diabetes are more likely to die of cardiovascular disease than are nonsmokers who have diabetes. Talk to your provider 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. This depends 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 up to 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 make in response to long-term stress may prevent insulin from working properly. This 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.

Alternative medicine

Many substances have been shown to improve the body's ability to process insulin in some studies. 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 to manage blood sugar.

If you decide to try any type of alternative therapy, don't stop taking the drugs that your provider has prescribed. Be sure to discuss the use of any of these therapies with your provider. Make sure that they won't cause bad reactions or interact with your current therapy.

Also, no treatments — alternative or conventional — can cure diabetes. If you're using insulin therapy for diabetes, never stop using insulin unless directed to do so by your provider.

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 provider.

Good diabetes management can take a great deal of time and feel overwhelming. Some people find that it helps to talk to someone. Your provider 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 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 provider may know of a local support group. You can also call the American Diabetes Association at 800-DIABETES or the Juvenile Diabetes Research Foundation at 800-533-CURE.

Preparing for your appointment

You're likely to start by seeing your health care provider if you're having diabetes symptoms. If your child is having diabetes symptoms, you might see your child's health care provider. If blood sugar levels are very 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 provider trained in diagnosing and treating diabetes (endocrinologist). Soon after diagnosis, you'll also likely meet with a diabetes educator and a registered 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. Be sure to note any relatives who have had diabetes, heart attacks or strokes.

Bring a family member or friend, if possible. Someone who accompanies you can help you remember information you need.

Write down questions to ask your provider. Ask about aspects of your diabetes management you're unclear about.

Be aware if you need any prescription refills. Your provider can renew your prescriptions while you're there.

Preparing a list of questions can help you make the most of your time with your provider. 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 provider is likely to ask you many 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?

Medical IDs

Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.

In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves.

Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency.

** Good Luck with your Diabetic Situation **

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