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.

What Is Hyperglycemia?

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

Hyperglycemia is the medical term for high blood glucose, or high blood sugar.

Did you know that you have sugar in your bloodstream at all times? In fact, your blood sugar levels fluctuate over the course of the day.
Levels are higher right after meals (as carbohydrates are broken down into glucose and enter the bloodstream through the small intestine) and lower after exercise (when glucose has been burned to fuel the activity).
In someone who doesn't have diabetes, blood sugar levels stay within a narrow range. Between meals, the concentration of sugar in the blood ranges from about 60 to 100 mg/dl (milligrams per deciliter).
After meals it may reach 120 to 130 mg/dl, but rarely goes higher than 140 mg/dl.
But if you have type 2 diabetes, blood sugar levels can go much higher — to 200, 300, or even 400 mg/dl and beyond — and will go much higher unless you take the necessary steps to bring them down.

Diagnosing Type 2 Diabetes

All types of diabetes are diagnosed on the basis of hyperglycemia. Several different types of blood tests may be used to make the diagnosis, including:

• fasting plasma glucose test
• random glucose test
• HbA1c test
• oral glucose tolerance test

When screening for diabetes in a person with risk factors for type 2 diabetes, doctors generally order either a fasting plasma glucose test (which requires fasting for 8 to 10 hours) or an HbA1c test (which does not require fasting).
A fasting plasma glucose test result of 126 mg/dl or higher indicates diabetes, as does an HbA1c test result of 6.5 percent or higher.
A fasting plasma glucose test result between 100 and 125 mg/dl and an HbA1c test result between 5.7 percent and 6.4 percent indicate prediabetes, which is associated with a high risk of developing type 2 diabetes in the future.
A random glucose test may be done if you have signs or symptoms of diabetes. A test result of 200 mg/dl or higher suggests diabetes and should be confirmed with another diagnostic test on another day. (In fact, all the tests noted above should be confirmed on another day before making a diagnosis of diabetes or prediabetes).

Causes of Hyperglycemia

Once you've been diagnosed with type 2 diabetes, a treatment plan is put in place to lower blood sugar and keep it as close to the normal range as possible.
But even after you start treatment, you may still develop hyperglycemia at times.
When you have diabetes, it's almost impossible not to have hyperglycemia — and high blood sugar can happen for no identifiable reason. Luckily, with enough detective work, a likely cause for high blood sugar can be found.
Some of the reasons blood sugar may go too high include:

• Missing prescribed medicines or taking medication at the wrong times or in the wrong amounts
• High food intake or larger consumptions of carbohydrate than expected or intended
• Lack of sleep
• Emotional stress
• Intense exercise

Illness is another important — and common — cause of hyperglycemia. The stress of an illness (cold or flu) or infection can cause your body to release stress hormones, which raise blood sugar.
So even if you aren't eating much because you feel sick, it's still necessary to check blood sugar levels and take diabetes medicines.
You should also ask your doctor about how to take your diabetes medications if you aren't eating properly. You may develop hypoglycemia (low blood sugar) if you keep taking your medication without eating right — especially sulfonylureas such as glipizide (Glucotrol), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl).
You may need to use insulin temporarily during an illness, even if it's not part of your usual diabetes regimen.
This is why it's especially important to work with your diabetes care team to develop a sick-day plan, which includes instructions and supplies for checking blood sugar levels, taking medicines and calling for help when necessary.

When Hyperglycemia Is a Medical Emergency

Extreme hyperglycemia can lead to hyperosmolar hyperglycemic state (HHS), which is a medical emergency that must be treated in a hospital.
In HHS, the blood sugar level exceeds 600 mg/dl and may reach as high as 2,000 mg/dl. The very high blood sugar level is accompanied by dehydration, and the blood literally becomes thick, as the sugar concentration rises and the water content decreases.

HHS usually develops over several days or even weeks. It can be prevented by checking your blood sugar level regularly and by treating very high levels by taking rapid-acting insulin and drinking water.

Sources

• Christopher D. Saudek, Richard R. Rubin, and Thomas W. Donner (2014). The Johns Hopkins Guide To Diabetes.
• When You’re Sick; American Diabetes Association.
• Kitabchi et al. (2006). “Hyperglycemic Crises in Adult Patients With Diabetes.” Diabetes Care.

Type 2 Diabetes Symptoms

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

Fatigue, increased thirst, irritability, and hunger – type 2 diabetes causes many symptoms that can be mistaken for other conditions.

Because type 2 diabetes develops slowly, and symptoms generally come on gradually, they may go unnoticed for a long time, or they may be attributed to something else.
For example, increased thirst may be chalked up to a hot summer, or fatigue may be interpreted as a sign of aging or stress.
This is unfortunate, because even short-term high blood sugar diminishes your quality of life. And if high blood sugar persists for a long time, it can eventually cause complications such as eye or kidney disease that cannot be completely reversed with improved blood sugar control.
Type 2 diabetes can cause a wide range of signs and symptoms, including:

• Fatigue
• Dry mouth
• Thirst
• Excessive urination
• Hunger
• Weight loss
• Blurry vision
• Cloudy thinking
• Irritability
• Wounds that won't heal

Frequent infections may also be a sign of type 2 diabetes. In women, vaginal yeast infections are particularly common. Yeast infections can also occur on the skin and, in men, in the groin.
Other infections associated with undiagnosed type 2 diabetes include gum infections, urinary tract infections (particularly in women), slowly healing wounds with subsequent infections, and infections of the feet.

Symptoms in Men

Type 2 diabetes symptoms are generally the same for men and women.
However, urological problems such as erectile dysfunction (ED) — the inability to achieve or maintain an erection — have been associated with all forms of diabetes, including type 2.
According to the National Diabetes Information Clearinghouse, 20 to 75 percent of men with any type of diabetes have ED.
Researchers believe diabetes causes sexual function problems in men due to damage to the body's autonomic nervous system (ANS), which controls circulation.
If you have the symptoms of ED, it may be a sign you have diabetes.

Another urological problem associated with diabetes in men is retrograde ejaculation, or the release of semen into the bladder during ejaculation. Symptoms include reduced semen during ejaculation.

Symptoms in Women

Women with type 2 diabetes are at increased risk for vaginal yeast infections.
This is because type 2 diabetes has been associated with increased yeast in the vaginal area.
Experts believe these vaginal infections will also lead to urinary tract and bladder infections, as both yeast and bacteria multiply when blood sugar is elevated.

What Causes Type 2 Diabetes Symptoms?

All of the signs and symptoms of type 2 diabetes are caused by high blood sugar and/or insufficient insulin:

Excessive urination (polyuria): When the concentration of glucose in the blood rises above normal levels, your body attempts to dilute your blood by pulling fluid into your bloodstream. At the same time, the high level of glucose in the fluid entering your kidneys causes them to discharge large amounts of glucose as urine, rather than reabsorbing it into the body as they normally would. These two processes together result in large amounts of fluid being lost through urination.

Thirst (polydipsia): As the amount of urine being excreted increases, your body starts to feel
dehydrated, prompting you to feel thirsty and drink more. If you reach for sugary drinks to quench your thirst, the problem becomes worse.

Dry mouth: Dry mouth goes hand in hand with increased thirst, as high blood sugar and excessive urination dehydrate your body.

Fatigue: Normally insulin allows glucose into the cells, where it's used to fuel cellular functions and stored for future energy needs. If there is not enough insulin, not much glucose gets into your cells, and your body is literally “running on empty.” In addition, if excessive urination is interrupting your sleep, you may feel fatigued from lack of sleep.

Hunger (polyphagia): Similar to fatigue, hunger is caused when the glucose from food stays in your bloodstream rather than being transported to your cells where it's needed for fuel. Eating more food doesn't help and, in fact, makes things worse by raising your blood sugar levels even higher.

Weight loss: When large amounts of glucose are being excreted in your urine, the calories that that glucose would have provided are being lost as well. The effect is the same as consuming fewer calories in the first place.

Blurry vision: Normally, the lens of your eye changes shape as you focus on objects that are nearby
or far away. But when your blood sugar is high, your lens becomes swollen and unable to change shape to focus.

Infections: The bacteria and fungi that cause infections thrive on sugar, so more sugar means more food for them. In addition, high blood sugar slows blood circulation, meaning infection-fighting white blood cells can't get to where they're needed as quickly.

Wounds that won't heal: High blood sugar impairs parts of your immune system that are needed for fighting infections and healing wounds. Wounds also need oxygen to heal, and any slowdown in your blood circulation slows oxygen delivery throughout your body.

Cloudy thinking: Your brain uses a lot of glucose to fuel its various functions, and when it can't get that glucose (because of insufficient insulin), the result can be difficulty thinking, remembering, and staying focused. You may even become disoriented.

The good news is that bringing blood sugar levels down to normal levels can alleviate all of these signs and symptoms. And the earlier these symptoms are noticed — and the earlier a person can be tested for type 2 diabetes — the better!

 

Sources

• Dubois (2012). “High Blood Glucose: What’s Behind the Symptoms?” Diabetes Self-Management.
• “Am I at risk for type 2 diabetes? Taking Steps to Lower Your Risk of Getting Diabetes.” National Diabetes Information Clearinghouse.
• Type 2 Diabetes; Mayo Clinic.
• Sexual and Urologic Problems of Diabetes; National Institute of Diabetes and Digestive and Kidney Diseases.

Type 2 Diabetes and Birth Control

By Marijke Vroomen-Durning, RN | Medically reviewed by Cynthia Haines, MD

Some methods of contraception can have an effect on your blood sugar. Learn about birth control options for women with type 2 diabetes.

A woman who has type 2 diabetes, formerly called adult-onset diabetes or non-insulin-dependent diabetes, has to face the same issues that confront most women, such as choosing a birth control method. However, unlike women who don’t have diabetes, she must take into account about how the form of contraception she chooses will affect her blood sugar levels, as well as the rest of her body.

Type 2 Diabetes and Birth Control Pills

In the past, birth control pills weren’t usually recommended for women with diabetes because of the hormonal changes the medication could cause. High doses of hormones can have a dramatic effect on blood sugar levels, making it harder for women to control their diabetes. However, research into new formulations has resulted in many different, lighter combinations of hormones. These new pills are safer for many women, not just those with diabetes.

According to Brian Tulloch, MD, endocrinologist at Park Plaza Hospital and Medical Center and clinical associate professor at the University of Texas Medical School at Houston, a woman with type 2 diabetes who chooses to use birth control pills should take the lowest possible dose that is still effective in order to help limit the effects the medication has on the diabetes.

One thing women taking birth control pills should remember is that there is still an increased risk for heart attack or stroke among women who use this form of contraception. Since people with diabetes also have an increased risk of heart disease, this is something that women should discuss with their doctors.

Type 2 Diabetes and Other Hormonal Contraception

Birth control pills aren’t the only way you can use hormones to prevent pregnancy. There are also injections, implants, rings, and patches.

Injections are becoming a popular choice because one shot of depot medroxyprogesterone acetate (Depo-Provera, or DMPA) can prevent pregnancy for three months. With this method, women only have to think about birth control four times a year. However, because the injection uses the hormone progestin, there can be side effects like weight gain, unwanted hair growth, dizziness, headaches, and anxiety.

If you don’t like the idea of having an injection every three months, you may want to try the contraceptive implant. This is a small plastic matchstick-sized rod that’s inserted under the skin of the upper arm. While the implant is in place, it releases progestin, the same hormone as the injection.

Another new entry in the hormonal contraceptive group is the vaginal ring, which is worn for 21 days straight. This ring is placed in the upper vaginal area; when it’s in place, you shouldn’t feel it. The ring provides you with not only progestin, but estrogen as well, which means that women who use it may experience side effects much like those from the Pill.

Finally, there is the patch. Like other medication patches, such as those that help you stop smoking, the contraceptive patch works when applied to the skin. The patch releases estrogen and progestin for one week and is then replaced with a new one; this is done for a total of three weeks in a row. No patch is worn during the fourth week (during which you get your period), and the cycle then starts over. Again, the side effects can be similar to that of the Pill or the vaginal ring, plus there could be some skin irritation where you use the patch.

Like the Pill, other types of hormonal contraception can have an impact on blood sugar. If you choose to use one of these methods, you doctor may need to adjust your diabetes medication.

Type 2 Diabetes and Intrauterine Devices

Intrauterine devices (IUDs) are devices that are inserted into the uterus. An IUD stays in place for a set amount of time until a doctor removes it. For reasons that doctors do not completely understand, the IUD discourages fertilized eggs from implanting into the uterine wall and thus helps prevent pregnancy. Although an IUD is a fairly effective method of birth control, one of the risks of using the device is infection in the uterus.

Women with diabetes are already at a higher risk of developing infections because of their disease, so this type of birth control may not be the best choice if you have type 2 diabetes.

Type 2 Diabetes and Barrier Methods

With the concern over sexually transmitted diseases, barrier methods are becoming more popular among women. By preventing semen from reaching the uterus, the risk of pregnancy, as well as disease transmission, is lowered.

For most women, barrier methods can be an effective contraceptive choice, and condoms and diaphragms won’t affect blood sugar levels. It’s important, however, to understand that these barrier methods do have a failure rate higher than the Pill and must be used properly each and every time it’s possible for semen to enter the vagina. Also, women with diabetes may have a higher risk of getting yeast infections when using a diaphragm.

Type 2 Diabetes and Sterilization

Finally, perhaps the most secure method of birth control, outside of abstinence, is sterilization by means of a surgical procedure called a tubal ligation. This is, however, a permanent method of birth control unless a woman undergoes another surgery to reverse the sterilization procedure. The reliability of this method is the biggest “pro,” while the fact that it is permanent may be a “con” if you are not 100 percent sure you have finished growing your family.

Another point in favor of this method for women with type 2 diabetes is that sterilization doesn’t affect a woman’s blood sugar levels. Still, surgery is not without risk, including infection and other complications.

Whatever you choose, a reliable method of birth control is important for women with type 2 diabetes, since an unplanned pregnancy carries health risks for both mother and baby. Taking charge of your reproductive health puts you in the driver’s seat.

Type 2 Diabetes and Your Sexuality

By Marijke Vroomen-Durning, RN | Medically reviewed by Lindsey Marcellin, MD, MPH

People with diabetes often report lackluster sex lives, but sexual dissatisfaction can be treated.

Nerve damage or diabetic neuropathy is one of the most serious side effects of type 2 diabetes, damaging everything from your hands and feet, brain, heart, and more. There are four significant types of diabetic neuropathy, including autonomic neuropathy, which can cause sexual dysfunction. If you're experiencing poor sexual satisfaction with diabetes,autonomic neuropathy is likely to blame. Try these tips to reclaim your love live.

Why Nerve Damage Causes Sexual Dysfunction

Poor glucose control causes diabetic neuropathy, which affects the nerves of the sexual organs.

Explains Gerald Bernstein, MD, director of the Diabetes Management Program at Mount Sinai Beth Israel Medical Center in New York City: “Uncontrolled diabetes can cause damage in blood vessels and nerves, which affects sexual health. Human sexuality is extremely complex, and when you add in high blood sugars, this becomes a problem. Poor blood sugar control has a big impact on the person's sex life.”

For women who experience this nerve damage, the vagina may not be able to produce enough lubrication to allow for easy intercourse and create a cascading number of problems. Sexual problems in women include decreased vaginal lubrication, painful intercourse, and decreased libido or desire, Bernstein explains. A recent study found that women who take insulin injections to treat diabetes are twice as likely to report dissatisfaction and difficulty achieving orgasm as women without the condition. Women who do not treat their diabetes with insulin are still 40 percent less satisfied with their sex lives than women without the condition, researchers reported in the journal Obstetrics and Gynecology.

For men, this may mean that not enough blood flows to the penis to maintain an erection, Bernstein explains. Called erectile dysfunction (ED), this condition is more prevalent in men with diabetes than the general public, and may occur at an earlier-than-average age, too.

Type 2 Diabetes and Sexuality: Finding Solutions

 Individuals who experience sexual dysfunction should speak to their health care provider to discuss treatment options, Bernstein advises. Although sexuality might be difficult to talk about, it’s an important part of a full and healthy life, and sexual problems that result from diabetes can often be helped.

If you are a woman with type 2 diabetes and you are having diabetes-related sexual problems, you can first try over-the-counter lubricants to help overcome vaginal dryness. Choose a water-based lubricant, one that is meant for sexual activity and that won’t erode condoms or a diaphragm. Other forms of artificial lubrication that may be helpful include vaginal suppositories.

If you are a man with erectile dysfunction, there are many options to help you enjoy an active sex life again, including one of the popular ED prescription medications, vacuum pumps to draw blood into the penis, or penile implants.

Type 2 Diabetes and Sexuality: Prevention Strategies

Since some of the problems associated with sexuality and diabetes are related to uncontrolled diabetes, people with type 2 diabetes may avoid developing such complications by keeping their blood glucose as even as possible. “Controlling diabetes through diet, exercise, and medications can help prevent sexual dysfunction,” Bernstein says.

The best way to control diabetes is to:

• Follow the diet recommended by your doctor, diabetes educator or dietitian
• Take medications as directed
• Exercise regularly
• Make sure your blood glucose levels are tightly controlled

Communication is the first step to understanding sexual changes caused by diabetes. If you’re having, or want to avoid, sexual problems because of your type 2 diabetes, talk to your doctor or diabetes educator — and remember that they help patients with these issues every day.

The Effects of Type 2 Diabetes on Women

By Marijke Vroomen-Durning, RN | Medically reviewed by Lindsey Marcellin, MD, MPH

Women experience a variety of challenges as they work to control their diabetes. Find out how type 2 diabetes can affect other aspects of your health as you move through life's stages.

Today, almost 10 million women in the United States have type 2 diabetes. This type of diabetes is up to four times as likely to affect women of African-American, Hispanic-Latino, American-Indian, and Asian-Pacific Islander descent as white women. Many people are diagnosed with type 2 diabetes at younger ages, with some women developing type 2 diabetes in their teens or early 20s. And with advancing age, the risk of your getting type 2 diabetes goes up, too, especially if you don’t change any of the diabetes risk factors you have control over, like your weight and physical activity level. Women who get type 2 diabetes are at greater risk than men of cardiovascular disease and of blindness, just two of the disease’s complications.

How Type 2 Diabetes Affects Women: The Teen and Young Adult Years

When hormones swing into action at the start of puberty, blood glucose levels might be harder to control, adding to the frustration of learning how to manage diabetes. A woman’s menstrual cycle can wreak havoc with her blood sugar levels in teen years and beyond. Hormone levels before and during menstruation can make diabetes management more difficult during those times even after your period becomes regular. Keeping a journal to track regular fluctuations and mood changes may help you know what to expect on a monthly basis, and sharing these entries with your doctor may enable her to give you better guidelines to follow at key times of the month.

How Type 2 Diabetes Affects Women: The Reproductive Years

Diabetes can have an impact on many aspects of a woman’s health during these years. The following are among the most important issues to go over with your doctor or gynecologist:

• Yeast infections. Women with diabetes often experience yeast infections because the glucose in your body can trigger a yeast overgrowth. Once diagnosed, a yeast infection can be easily treated, often with over-the-counter remedies.
• Birth control. When choosing a contraceptive method, keep in mind that birth control pills may raise your blood glucose levels. According to the American Diabetes Association, your risk of complications from diabetes may increase if you stay on contraceptive pills for a year or more. Other alternatives might be better for you.
• Vaginal changes. Some women experience changes in their sexual health. Nerve damage from diabetes can lead to vaginal dryness and difficulty becoming sexually aroused. Using lubricants and getting diabetes under control can help.
• Pregnancy. Controlling blood glucose levels is important to avoid complications like high blood pressure, as well as birth defects or a baby with too high a birth weight. Some women who don’t have diabetes develop a form called gestational diabetes while they are pregnant. While 90 percent of women who develop gestational diabetes find that their blood glucose level goes back to its normal level after childbirth, 5 percent of women will develop type 2 diabetes and 15 percent will show signs of pre-diabetes at a post-delivery check-up.
• Infertility. Many women who have polycystic ovarian syndrome, or PCOS, the most common cause of infertility, also have diabetes. Researchers haven’t found the exact connection yet, but are looking at the role of insulin as a factor.

How Type 2 Diabetes Affects Women: The Transitional Years

Just as hormones during menstruation can alter blood sugar levels, perimenopause, the period during which a woman’s body is beginning the process toward menopause, may cause severe blood sugar swings in some women. This is also the time when many women begin to gain weight and become less physically active; both are risk factors for developing type 2 diabetes, or making blood sugar control harder if you already have diabetes.

The start of menopause may differ depending on which type of diabetes you have. Women with type 1 diabetes tend to begin menopause earlier than average and those with type 2, if they are overweight, later. This is the result of estrogen levels dropping more slowly.

As you age, the likelihood of getting other chronic illnesses related to diabetes increases, especially if your lifestyle choices haven’t improved.

How Type 2 Diabetes Affects Women: What It Means for You

Being a woman doesn’t increase your chances of developing type 2 diabetes, but your gender may affect the progression of the disease and how your body reacts to it. It’s very important to try to reduce your risk of developing type 2 diabetes by keeping your optimal body weight, eating well, and exercising. And if you’ve already been diagnosed with type 2 diabetes, these same healthy practices, along with controlling your blood sugar, will help you avoid some of the problems that may occur as a result of the disease and keep long-term complications at bay.

Type 2 Diabetes: Questions to Ask Your Doctor

By Jen Laskey | Medically reviewed by Asqual Getaneh, MD

Get the most out of your visit to the doctor by thinking about your questions in advance.

Being proactive during your next trip to the doctor can make a big difference in the way you're able to manage your type 2 diabetes. Your health is important — both to you and to your doctor — so don't hesitate to ask questions about your type 2 diabetes diagnosis, your diabetes medication, complementary or alternative therapies for type 2 diabetes, emotional issues, financial concerns about paying for your treatment, or diet or lifestyle modifications.

Engaging in a dialogue with your doctor will help you educate yourself about type 2 diabetes and the available treatment options, and it'll give your doctor a better sense of who you are and how diabetes is affecting your health and your life. With the lines of communication open, you and your doctor will be better able to develop a treatment plan that meets your needs.

But remember, your time with your doctor is limited, so be sure to arrive at your appointment prepared to ask the questions about type 2 diabetes that are important to you.

Start by:

• Researching type 2 diabetes.It's a good idea to get a better understanding of type 2 diabetes before your appointment. And your preliminary research may even provide answers to some of your questions. Visit the Everyday Health Type 2 Diabetes Center, Diabetes Center, theAmerican Diabetes Association, the National Institute of Diabetes and Digestive and Kidney Diseases, and MedlinePlus.
• Strategizing. Your family doctor may not be able to answer all of your questions about type 2 diabetes; some questions may be better addressed by a specialist, such as an internist, an endocrinologist, a vascular surgeon, an ophthalmologist, a podiatrist, or a dietitian. Discuss this with your primary care doctor, and follow up with visits to appropriate specialists, as directed by your doctor. You might also want to do additional research of your own.
• Keeping records. Consider keeping a journal of your diabetes concerns between visits to the doctor, and share any relevant information with your doctor, such as challenges you face in keeping your blood sugar levels under control, symptoms that could indicate brewing diabetes complications, and the effectiveness of your medications. Additionally, taking notes during your appointments will help you remember important details after your visit. Alternatively, you may consider bringing a recording device or inviting someone to accompany you and take notes for you.

Basic Questions About Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes. If you have type 2 diabetes, it means that your body either doesn't make insulin or doesn't use it efficiently. However, type 2 diabetes can be managed by decreasing insulin demand, by means of dietary changes, exercise, and medication, for example, as well as with treatments that increase insulin supply, including medications like sulfonylureas and meglitinides, as well as insulin itself.

If you haven't yet been diagnosed with type 2 diabetes but think you may have symptoms, talk to your doctor about arranging a diabetes evaluation.

Once you have a formal diagnosis, your doctor will give you information about type 2 diabetes and recommend a course of treatment. You may have some questions or concerns about your diagnosis and how type 2 diabetes will affect your health and your life. Consider asking your doctor the following:

• What is type 2 diabetes? Is it curable?
• What kinds of tests determined that I have type 2 diabetes?
• Are there any pre-appointment restrictions I need to know about for future visits? For example, do I need to fast if I'm going to have a blood sugar test?
• What caused my type 2 diabetes? Did I do something to cause it? Is it a hereditary condition?
• Does eating carbohydrates cause type 2 diabetes?
• I have a family history of heart attack and/or stroke; how might that affect my health?
• Does type 2 diabetes put me at risk for complications such as heart disease, blindness (retinopathy), nerve damage (neuropathy), or kidney damage (nephropathy)? How can I avoid such complications?
• What is the difference between hyperglycemia and hypoglycemia?
• How can I tell if my blood sugar is too high or too low? Will I have to test my own blood sugar at home? What should I do about either high or low blood sugar?
• What are urine ketones? Will I have to measure those too?
• What are the best treatments for type 2 diabetes?
• What are the risks of not treating type 2 diabetes?
• How will type 2 diabetes affect me over the long term?
• How can I keep my diabetes from worsening?
• What should I do if my symptoms worsen, or if I experience new symptoms?
• Is it possible for type 2 diabetes to go away on its own?

Medications and Treatments for Type 2 Diabetes

Different medications for type 2 diabetes work in different ways. Your doctor may prescribe injectable insulin or one or more oral medications to control your blood sugar. It's important to understand the medications your doctor prescribes. Ask your doctor about each medication, read the inserts the pharmacy includes with your prescriptions, and take each medication as directed. Knowing how your medication is supposed to work will help you evaluate its effectiveness and whether or not it's the right medication for you. Here are some questions you may want to ask your doctor about type 2 diabetes medications:

• Do I need insulin at this time? If I don't need insulin now, is it possible that I'll need it in the future?
• Do I need oral medication, or can I be treated effectively without it?
• What type of drug are you prescribing for me, and how does it work?
• How often and for how long will I need to take this medication?
• Where can I get more information about this drug?
• How will the medication make me feel, and how will I know if it's effective?
• When can I expect an improvement in my condition?
• What are the risks if I don't take my medication as directed, or if I forget to take it?
• Has this medication been tested in people with type 2 diabetes? Are there any recent research studies on it?
• Are there any side effects I should be aware of?
• What should I do if I experience any side effects? Are there any that may require me to call a doctor? Are there any that may require me to stop taking the medication immediately?
• Is this drug habit-forming?
• Can I take this on an empty stomach, or should it be taken with food?
• Could this medication interact negatively with other medications I'm taking?
• Will I always have to take medicine for type 2 diabetes?
• Are there any foods, drinks (such as alcohol), vitamins, herbal supplements, over-the-counter drugs, or other products that might affect my blood sugar level and that I should avoid while taking this medication?
• Can other conditions interfere with or be affected by my medication?
• Should cut down on my sugar or carbohydrate intake?
• Should I see other specialists, such as an internist, an endocrinologist, a vascular surgeon, an ophthalmologist, a podiatrist, or a dietitian, for type 2 diabetes or possible complications?

Your Emotional Health and Living Type 2 Diabetes

In addition to affecting your body, type 2 diabetes can take a toll on your emotional health. Because it's a chronic condition, diabetes can cause denial, depression, frustration, anger, helplessness, and low self-esteem. Your doctor can help you find ways to cope with the emotional stress of diabetes, manage your feelings, and handle the impact type 2 diabetes is having on your life and relationships. Ask for a referral to a counselor, psychotherapist, or support group, and find out what else you can do to improve your emotional health while living with type 2 diabetes. Here are some questions to ask your doctor:

• How do I know if depression and stress are adversely affecting my health?
• Should I seek help from a counselor, a psychotherapist, or a support group?
• How should I explain my condition to my spouse, family, and friends? What, if anything, should I say to my boss and co-workers?
• How is my condition likely to affect my relationships, and what can I do to improve my situation?
• How can my family help me cope with type 2 diabetes?
• What should I do if I feel I'm being discriminated against at work or school?

Complementary and Alternative Therapies for Diabetes

You may want to consider complementary or alternative treatments for your diabetes, such as yoga, Reiki therapy, or herbal and other dietary supplements. Ask your doctor if any of these options might be beneficial for you:

• Are there any complementary or alternative therapies I should consider?
• Is yoga helpful for people with type 2 diabetes?
• Can Reiki therapy benefit diabetic neuropathy?
• Are there any herbs or other supplements — like alpha-lipoic acid, chromium, coenzyme Q10, polyphenols, magnesium, ginseng, cinnamon, garlic, or omega-3 fatty acids — that you would recommend?
• Has any medical research supported these complementary or alternative therapies?

Health and Lifestyle Concerns

Participating in a physical fitness regimen, following a balanced diet, getting adequate rest and sleep, quitting smoking, moderating your alcohol consumption, and avoiding substance abuse of any kind can all contribute to your overall health. This type of healthy lifestyle is especially important for people with type 2 diabetes who are trying to keep their blood sugar levels in balance. Check with your doctor to find out whether you need to make any lifestyle changes or whether there's anything he or she recommends that you do at home, work, or school that would help you better manage your type 2 diabetes:

• Do I need to make any changes in diet or exercise or how much I rest?
• Will exercising more make my condition worse, or would it help improve it? Are there exercises I should avoid? What precautions should I take when I exercise?
• Would losing weight improve my condition?
• Can drinking alcohol, smoking (or being exposed to secondhand smoke), or using drugs affect my condition? Will stopping smoking help prevent type 2 diabetes complications?
• Should I make any special accommodations for school, home, or work?
• Should I have a diabetes action plan, in case my blood sugar gets out of control? Can you work with me to develop one?
• Should I keep a diabetes emergency supply kit? If so, what should I put in it?
• Can you recommend any books, magazines, organizations, or online resources that focus on type 2 diabetes?

Financial Health and Type 2 Diabetes

The costs associated with your type 2 diabetes treatment will affect your overall finances. It's crucial to find ways to balance your physical health with your financial health. Ask your doctor about ways in which you may be able to offset the cost of your treatment, and follow up with a representative from your insurance company, as necessary:

• How much will my medication cost, and will it be covered by my health insurance plan?
• Is there a generic version of the medication that would be more affordable? If not, are other, equally effective medications available as generics?
• Do you have any samples or discounted coupons for my prescription?
• If I choose a complementary or alternative therapy, is it likely to be covered by my insurance? If not, what kind of out-of-pocket costs can I expect?
• What are my options if I don't have any health insurance coverage?