How to Manage Type 2 Diabetes

• By Ingrid Strauch
• Medically Reviewed by Sanjai Sinha, MD

Making smart, healthy choices every day is crucial to managing type 2 diabetes.

Managing type 2 diabetes involves many decisions — what to eat, when to eat, how and when to be physically active, when to take medications, and when to monitor blood sugar levels, to name just a few.
The American Association of Diabetes Educators (AADE) has organized the major components of diabetes management into a framework called the "AADE7 Self-Care Behaviors." This framework is helpful for remembering all of the necessary tasks and how to properly carry them out.

Healthy Eating

Making good food choices is one of the most important parts of managing type 2 diabetes — and it's often one of the hardest. What you eat (and how much you eat) has an effect on your weight and blood sugar, blood pressure, and blood cholesterol levels.
Here are some tips to help you figure out what and how much to eat:

• Work with a registered dietitian to design a meal plan that takes your needs and preferences into consideration.
• Check your blood sugar level before a meal and again two hours after it to see what effect the meal had on your blood sugar.

Being Active

Finding the time and motivation to be physically active is a challenge for many people. But it's essential for optimal type 2 diabetes management.
How can you succeed at being physically active?

• Set SMART goals for activity — goals that are specific, measurable, achievable, relevant, and time-based, or grounded within a time frame.
• Remember that any movement is better than none, and that you need to build up the intensity and duration of your activity gradually.

Monitoring

Monitoring your type 2 diabetes includes blood sugar monitoring as well as monitoring your weight and, for some people, your blood pressure, using a home monitor.

For the best results:

• Have your doctor or diabetes educator show you how to use your blood sugar meter and blood pressure monitor. Patients on insulin, in particular, need to monitor their blood sugar daily.
• Write down your monitoring results and bring them to your diabetes care visits. Discuss any patterns you've observed with your healthcare provider.

Taking Medication

Most people with type 2 diabetes take at least one medication, and many take several pills and/or injections per day.
To make sure you stay on track with your medications:

• Enlist the help of your pharmacist when you have questions about your medications or trouble taking them.
• If you often forget to take your pills, try using a weekly pill box, marked with the days of the week.

Problem Solving

Diabetes, like life, is unpredictable, and sometimes you have to think on your feet. How can you be more prepared to respond when the unexpected happens?

• Take a diabetes education class to learn the basics. Many hospital diabetes programs offer them for free.
• Talk to your health-care provider about what to do when you're sick, when you're traveling, or any other time your routine is different from usual.

Reducing Risks

Reducing risks means nixing any behaviors with negative health consequences (such as smoking).
It also includes having age-appropriate health screenings (such as cancer screenings and immunizations) and recommended screening tests for diabetes complications, including:

• An annual dilated eye exam to check for diabetic retinopathy (eye disease)
• An annual microalbuminuria test to check for kidney disease
• Daily self-performed foot exams to check for breaks in the skin or anything else that looks or feels unusual
• An annual foot exam by your doctor to check for any diabetes-related complications

Healthy Coping

Living with diabetes is challenging and sometimes stressful. In fact, many people report becoming frustrated, angry, overwhelmed, and discouraged when trying to perform all of the self-care tasks their healthcare providers set out for them.
That's why learning healthy coping techniques is so important when you have type 2 diabetes.

• Participate in online or in-person support groups.
• Practice a relaxation technique, such as meditating or using guided imagery.
• Speak to a mental healthcare professional if self-help efforts aren't helpful.

Sources

• AADE7 Self-Care Behaviors; American Association of Diabetes Educators.
• Standards of Medical Care in Diabetes — 2014; Diabetes Care.

Dietary Goals for Type 2 Diabetes

• Medically Reviewed by Niya Jones, MD, MPH

Create your healthy diabetes diet and healthier eating habits with these goals in mind.

The right diabetes diet is crucial to managing diabetes. A sensible eating plan can help people with type 2 diabetes maintain stable blood sugar levels and preserve their overall health. However, it's not as complex or out of the ordinary as you might expect.
A diabetes diet actually looks a lot like the healthy eating plan doctors recommend for everyone: plenty of fruits and vegetables, simple carbohydrates in moderation, and fats sparingly.

Count Calories to Manage Diabetes

People with type 2 diabetes need to watch their calories, since eating more food means higher blood sugar levels. The National Institutes of Health (NIH) recommends the following calorie guidelines for people who are managing diabetes:

• About 1,200 to 1,600 calories a day for small women who are physically active, small or medium-sized women interested in weight loss, or medium-sized women who are not physically active.
• About 1,600 to 2,000 calories a day for large women interested in weight loss, small men at a healthy weight, medium-sized men who aren't physically active, or medium-sized or large men interested in weight loss.
• About 2,000 to 2,400 calories a day for medium-sized or large men who are physically active, large men at a healthy weight or who are medium-sized, or large women who are very physically active.

Reach for the Right Carbohydrates

You can't avoid carbohydrates completely. They are our main source of energy, but they also lead to the biggest fluctuations in blood sugar levels. Choosing your carbohydrates wisely is critical to managing diabetes.
Complex carbohydrates, or those that are rich in fiber, should constitute between 45 and 65 percent of your daily caloric intake. To make the best choices, keep these guidelines in mind:

• Get most or all of your carbohydrates from high-fiber sources like vegetables, beans, fruits, and whole grains. High-fiber foods are digested more slowly, which helps keep your blood sugar levels stable.
• Avoid foods that contain sugar or refined flour, which are absorbed quickly and can cause your blood glucose to spike. Drink water rather than sugary juices and soft drinks. You should also limit sweets, like cookies and cake, since they're high in calories and not very nutritious.

Diabetes Diet: The Right Fats

Fats contain more than double the calories of either carbohydrates or proteins, so any healthy diet should limit fat intake. Fats should provide only about 25 to 35 percent of your daily calorie intake.

In particular, people with diabetes should limit or eliminate unhealthy saturated fats and trans fats. These fats raise your risk of heart disease, which is already elevated if you have diabetes.
Saturated fats include:

• Butter
• Cheese
• White "marbling" or solid fat in red meat

Any oil that is solid at room temperature is probably a saturated fat. Trans fats are produced when a liquid oil is turned into a solid fat through a process called hydrogenation; avoid hydrogenated and partially hydrogenated oils.
Healthy fats such as monounsaturated or polyunsaturated fats are good for your heart and can help raise your HDL or "good" cholesterol levels. They are still high in calories, however, so practice moderation. Good sources of unsaturated fat are:

• Nuts
• Avocados
• Canola oil
• Olive oil

Diabetes Diet: Other Goals

Protein can help stabilize your blood sugar since it takes time to digest. Even so, be sure to choose lean meats, fish, and non- or low-fat dairy products. Protein should provide about 12 to 20 percent of your daily calories.
As for salt intake, many people with diabetes also have high blood pressure. Salt directly contributes to hypertension, so you should cut back on the amount of sodium in your diet.
Eating fewer processed foods — for example, canned soups and microwave meals — as well as sauces and condiments will help lower your salt intake. Always look for foods marked salt-free, low-sodium, or unsalted.

While managing diabetes effectively does take some effort, a sensible eating plan — one built on the same healthy principles everyone should follow — can go a long way toward controlling your blood sugar. Remember to focus on high-fiber foods like fruits and vegetables and minimize your intake of sweets and saturated fats.

Exercise and Type 2 Diabetes

• By Ingrid Strauch
• Medically Reviewed by Sanjai Sinha, MD

Regular exercise is one of the most effective tools for managing type 2 diabetes.

Exercise has proven benefits — stronger muscles and bones, better mood, improved quality of life, more energy, and a longer life — and its benefits are particularly relevant to people living with type 2 diabetes.

Lower Blood Sugar

Any aerobic activity — even a simple walk around the block — can help lower blood sugar. You can check this out for yourself by monitoring your blood sugar level before and after aerobic activity. Most of the time, it will be lower afterward.
Combining aerobic activities with resistance training appears to be even more effective at lowering blood sugar.
Resistance training is any exercise that requires the muscles to move against a source of resistance, such as using free weights or resistance bands.

Better Heart Health

The number one cause of poor health and death among people with type 2 diabetes is cardiovascular disease. Regular exercise reduces cardiovascular risk factors and may also reduce the need to take drugs to lower blood pressure and blood cholesterol.

Weight Loss

Many people start exercising because they'd like to lose weight.
Exercise alone does not always bring about a lot of weight loss. However, when combined with dietary changes and sustained over time, exercise can be a very important part of your efforts to lose weight and keep it off.

As proof, 94 percent of members of the National Weight Control Registry, a national study of people who lost significant amounts of weight and kept it off, say they increased their physical activity as part of their plan to accomplish lasting weight loss.

Exercise Recommendations

The American Diabetes Association and the American College of Sports Medicine recommend the following for adults with type 2 diabetes:

• At least 150 minutes per week of moderate-intensity aerobic physical activity, spread over at least three days of the week with no more than two consecutive days without exercise
• In the absence of contraindications, resistance training at least twice per week on nonconsecutive days
• Increased daily movement, such as walking more

If you're not there yet, use these recommendations as your ultimate goals. Start slowly, and build up gradually. Increase the amount of time you exercise by no more than 10 percent a week.

Safety First

People with diabetes are advised to get their doctor's OK before starting a formal exercise program or intensifying their level of physical activity.
If you have uncontrolled high blood pressure, severe neuropathy (nerve damage), or proliferative retinopathy (diabetes-related eye disease), you may need to limit the types of exercise you perform or seek treatment before embarking on an exercise regimen.
If you take a diabetes medication that can cause hypoglycemia (low blood sugar), talk to your doctor about how to prevent hypoglycemia during exercise. It's also important to learn how to recognize the symptoms and treat low blood sugar.
Medications that commonly cause hypoglycemia include insulin and the class of oral drugs known as sulfonylureas. This class includes glipizide, glyburide, and glimepiride.

There is some form of exercise that is safe and beneficial for just about everyone, so if you haven't found the right exercise for you, keep looking!

Sources

• Geil (2005). “Physical Activity: The Magic of Movement.” Diabetes Self-Management.
• NWCR Facts. The National Weight Control Registry.
• “Exercise and Type 2 Diabetes: American College of Sports Medicine and American Diabetes Association: Joint Position Statement.” Medicine & Science in Sports and Exercise.

Glucose Monitoring and Type 2 Diabetes

• By Ingrid Strauch
• Medically Reviewed by Sanjai Sinha, MD

Monitoring your blood sugar can help keep your type 2 diabetes under control.

The goal of any diabetes management regimen is to maintain blood sugar levels in a near-normal range. Your blood sugar meter allows you to see, in real time, if you're meeting that goal.
It also shows you the effects of the daily decisions you make. For example, it can show you how a particular meal or activity or even how stress impacts your blood sugar levels.
And it can show you how well the medications you're taking are helping to control your blood sugar.

Blood Sugar Goals

You and your doctor should decide on individualized blood sugar goals that take into consideration your age and overall health, and whether you have any diabetes complications and/or other medical conditions.
The following are standard goals established by the American Diabetes Association (ADA) for most adults with diabetes:

• Before meals: blood sugar between 70 mg/dl and 130 mg/dl
• One to two hours after meals: blood sugar lower than 180 mg/dl
• A1C: lower than 7 percent

How to Monitor

To monitor your blood sugar levels, you'll need a meter, test strips, a lancing device, alcohol swabs, and lancets.
All blood sugar meters come with instructions for operation, and you should review those instructions before you use a new meter.
If you've never used a blood sugar meter, it's helpful to go over how to monitor with a certified diabetes educator or a nurse.

In most cases, you turn on the meter by inserting a test strip. You then have a limited amount of time to lance your fingertip and apply blood to the test strip.
Once an adequate amount of blood is applied, you wait — usually for no more than a few seconds — until your blood sugar reading appears on the meter display.
Record your readings in a paper or digital logbook.

When to Monitor

There's no single correct monitoring schedule for everyone with type 2 diabetes.
In part, it depends on how you control your diabetes: For example, people who use insulin to manage their type 2 diabetes will likely need to monitor more frequently than people who take only pills or who control their diabetes with diet and exercise.
That said, some common times to monitor are:

• First thing in the morning, before you eat breakfast
• Just before and two hours after eating a meal
• Just before and right after exercising
• At bedtime
• Before driving, particularly if you use insulin or any other drug that can cause (hypoglycemia) low blood sugar
• When you feel any symptoms of hypoglycemia, such as light-headedness
• When you're feeling sick

What to Do With Your Readings

If your blood sugar reading shows that you have hypoglycemia, usually defined as blood sugar lower than 70 mg/dl, you need to take immediate action to raise your blood sugar level by consuming carbohydrates.
If it is very high and you feel sick, consult your sick-day plan (if you have one) or call your doctor's office for advice.
Unless your blood sugar is particularly high or low, an individual reading doesn't tell you a whole lot. Look for patterns, such as high blood sugar nearly every morning or low blood sugar after your weekly yoga class. These patterns can help you determine if your diabetes regimen needs some adjustment.
In some cases, you may be able to adjust your regimen yourself, for example, by altering your meal schedule.

But if you don't know what's causing the patterns you're seeing or don't know what to do about them, don't hesitate to contact your doctor or diabetes educator for help.

Sources

• Blood sugar testing: Why, when and how; Mayo Clinic.
• Checking Your Blood Glucose; American Diabetes Association.
• Hypoglycemia; National Diabetes Information Clearinghouse.

Ketoacidosis and Type 2 Diabetes

• By Ingrid Strauch
• Medically Reviewed by Sanjai Sinha, MD

Diabetic ketoacidosis is preventable, but if it occurs, it’s a medical emergency.

Diabetic ketoacidosis (DKA) is a metabolic state characterized by high blood sugar, low insulin, and the presence of moderate to large amounts of ketones in the blood.
It is a medical emergency that requires treatment in a hospital. If not treated in a timely fashion, DKA can lead to coma and death.
While DKA is much more common among people with type 1 diabetes, it can also occur in people with type 2 diabetes, so ketone monitoring is something everyone with diabetes should understand.

What Are Ketones?

Ketones, or ketone bodies, are acidic byproducts of fat metabolism.
It's normal for everyone to have a small amount of ketones in the bloodstream, and after a fast of 12 to16 hours, there may be detectable amounts in the urine.
As is the case with glucose, if blood levels of ketones get too high, they spill over into the urine.
An elevated level of ketones in the blood is known as ketosis.
People who follow low-carbohydrate diets often speak of ketosis as a desirable state, because it is evidence that their bodies are burning fat, not carbohydrate.
The level of ketosis that results from low carbohydrate consumption is not harmful and is much lower than the level seen in DKA.

When Should Ketones Be Monitored?

Ketone monitoring is less of a concern for people with type 2 diabetes than for those with type 1 diabetes. This is because most people with type 2 diabetes still make some of their own insulin, making DKA less likely to develop.
Nonetheless, people with type 2 diabetes may be advised to check for ketones during an illness (such as the flu) and/or when blood sugar levels are very high.

The stress hormones that are released during an illness or infection counteract the blood-sugar-lowering effects of insulin, leading to elevated blood sugar levels.
When you are sick, therefore, your normal diabetes medication may not be enough to lower your blood sugar to target range, and if you forget your medicine or think you don't need to take it because you're not eating much, your blood sugar may rise to dangerous levels.
Everyone with diabetes — and particularly those who use insulin — should discuss ketone monitoring with their doctor.

How Are Ketones Monitored?

Most commonly, ketones are monitored with urine test strips. These plastic strips have an absorptive pad on one end that changes color in the presence of ketones. The pad can be held in the urine stream, or you can collect urine in a cup and dip in the pad.
The level of ketones is assessed by comparing the color of the pad to a color scale on the strip packaging.
There are also a few blood glucose meters that can measure blood ketones, using special blood ketone strips. The level of ketones is displayed as a number on the meter display.

Symptoms of Diabetic Ketoacidosis

Signs and symptoms of DKA include symptoms caused by high blood sugar and those caused by high ketones:

• Thirst or a very dry mouth
• Frequent urination
• Fatigue and weakness
• Nausea
• Vomiting
• Dry or flushed skin
• Abdominal pain
• Deep breathing
• A fruity breath odor

When to Seek Help

If you have moderate or large amounts of ketones in your blood or urine and your blood sugar is high — even if it is only moderately high — you should seek medical help quickly.

Treatment for Diabetic Ketoacidosis

In the hospital, DKA is treated with intravenous infusion of fluids and insulin to rehydrate the patient, lower the blood sugar level, and reverse the acidosis (acidity in the blood and body tissues).
The blood sugar level is lowered gradually to prevent hypoglycemia (low blood sugar) and hypokalemia (low potassium).
Throughout treatment, the patient is monitored frequently, and the intravenous fluids adjusted as necessary, to maintain blood sugar and electrolytes (in particular, potassium) in the desired range.
A rare and potentially fatal complication of DKA is cerebral edema, or swelling of the brain. It occurs almost exclusively in children, and usually at the onset of type 1 diabetes.

It's not known what causes cerebral edema, but symptoms typically appear during treatment of DKA. How best to treat cerebral edema is the subject of ongoing research.

Sources

• Diabetic ketoacidosis; Mayo Clinic.
• Diabetic Ketoacidosis; Diabetes Education Online.
• DKA (Ketoacidosis) & Ketones; American Diabetes Association.

Type 2 Diabetes Complications

• By Ingrid Strauch
• Medically Reviewed by Robert Jasmer, MD

With good diabetes control, long-term complications such as retinopathy, nephropathy, and neuropathy can often be prevented.

Long-term complications of type 2 diabetes can be divided into two main categories: macrovascular complications and microvascular complications.
Macrovascular complications involve the large blood vessels and include heart attack and other forms of cardiovascular disease.
Microvascular complications involve the small blood vessels and include diabetic retinopathy (eye disease), neuropathy (nerve disease), and nephropathy (kidney disease).
All of these complications can be prevented, and in some cases, reversed or slowed by a combination of:

• Blood sugar control
• Blood pressure control
• Blood cholesterol control

You should discuss your level of control (and how to maintain or improve it) with your doctor at every appointment.

Cardiovascular Disease

Cardiovascular disease is the number-one cause of poor health and death among people with type 2 diabetes.
While some degree of arteriosclerosis (hardening of the arteries) occurs in everyone with age, diabetes accelerates the rate at which it develops and progresses.
Lowering your risk of cardiovascular disease — or treating it, if you have it — includes a combination of lifestyle changes along with medication, including:

• Quitting smoking if you smoke
• Sticking to a low-fat diet
• Getting regular physical activity
• Taking prescribed medications to lower blood pressure and cholesterol
• Taking diabetes medications to lower blood sugar

Retinopathy (Eye Disease)

In diabetic retinopathy, high blood sugar weakens the capillaries (the tiny blood vessels) that supply the retina, the light-sensitive layer of tissue at the back of the inner eye.
The capillaries then swell, become blocked, or leak blood into the center of the eye, blurring vision.
In advanced stages, abnormal new blood vessels grow. When these new vessels leak blood, the result can be severe vision loss or blindness.
In some cases, fluid leaks into the center of the macula, the part of the eye responsible for detailed, central vision.
This is called macular edema, and it can also cause vision loss.
In its early stages, diabetic retinopathy does not cause noticeable symptoms, but it can be detected with a dilated eye exam.

That's why the American Diabetes Association (ADA) recommends that all people with type 2 diabetes get a dilated eye exam from a qualified eye doctor (an optometrist or ophthalmologist) at the time of diagnosis and yearly thereafter.
Both retinopathy and macular edema can be treated with laser surgery, and certain drugs can be used to treat macular edema.

Neuropathy (Nerve Damage)

Neuropathy associated with diabetes, or diabetic neuropathy, can affect any nerve in your body.
Most commonly, it affects the nerves in the feet, legs, hands, and arms; this condition is called peripheral neuropathy.
Peripheral neuropathy can cause tingling, burning, pain, or numbness in the affected areas.
The pain of peripheral neuropathy is difficult to control, though some find topical products that contain capsaicin to be helpful.
Prescription products that may help alleviate the pain caused by peripheral neuropathy include a variety of antidepressants and anticonvulsants.
Improving your blood glucose control may help to restore feeling if your feet or hands are numb.
If you have neuropathy in your feet, check your feet every day for breaks in the skin, areas of redness, or anything else that looks or feels unusual. Report any problems to your doctor promptly.
When neuropathy affects nerves in the body that regulate automatic functions, such as digestion or blood circulation, it's called autonomic neuropathy.
Probably the best-known sign of autonomic neuropathy is erectile dysfunction (ED), but it can also cause:

• Diarrhea
• Orthostatic hypotension, or a drop in blood pressure when rising from lying down or sitting
• Sexual dysfunction in women
• Slowed stomach emptying, resulting in indigestion and erratic blood sugar control
• Difficulty starting to urinate or emptying the bladder completely
• Sweating abnormalities

Treatment options depend on the area of the body affected.

Nephropathy (Kidney Disease)

In diabetic nephropathy, the nephrons (or filtering units) in the kidneys become damaged from chronic high blood sugar.
High blood pressure compounds the problem, and high cholesterol appears to contribute to it as well.
In the early stages of diabetic nephropathy, you may not notice any symptoms, but standard blood and urine tests can detect early signs of dysfunction, and early treatment can stop or slow its progression.
The ADA recommends that all people with type 2 diabetes have a microalbumin test — a urine test that measures the level of the protein albumin in the urine — at diagnosis and annually thereafter to look for kidney dysfunction.
However, because the microalbumin test misses some cases of reduced kidney function, the ADA also recommends that all adults with diabetes have a second kidney function test, the estimated glomerular filtration rate (eGFR) test, at least once a year.

Symptoms of diabetic nephropathy typically appear in the later stages of the disease and often include swollen ankles, fatigue, and elevated blood pressure.

Sources

• Standards of Medical Care in Diabetes—2014. Diabetes Care.
• Autonomic Neuropathy; Mayo Clinic.
• Christopher D. Saudek, Richard R. Rubin, and Thomas W. Donner (2014). The Johns Hopkins Guide To Diabetes.

What Causes Type 2 Diabetes?

• By Madeline R Vann, MPH
• Medically Reviewed by Christine Wilmsen Craig, MD

Eating too much and exercising too little can increase your risk for developing type 2 diabetes.

Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel.
Type 2 diabetes occurs when the pancreas doesn't make enough insulin, or the cells of the body become resistant to insulin.
It's not known for certain why some people develop type 2 diabetes and some do not. There are several factors, however, that can increase a person's risk of developing type 2 diabetes.

Primary Causes of Type 2 Diabetes

Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
"One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes," says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels.
While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.

Poor Eating Habits

Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.

Too Much TV Time

An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes.
This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.

Physical Inactivity

Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes.
A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.

Sleep Habits

Sleep disturbances have been shown to affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes.
An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.

Genetics

Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.