Type 2 Diabetes

Type 2 diabetes is a chronic disease that happens when you have too much sugar in your bloodstream. This condition typically develops slowly, sometimes as a partial consequence of lifestyle factors such as diet and exercise habits, and is common in people with obesity. Type 2 diabetes is very treatable, but it may require medical treatment and a commitment to new habits to avoid its dangerous complications.

Overview

What Is Type 2 Diabetes?

Type 2 diabetes is caused by problems with the way the body creates and uses the hormone insulin, which helps sugar access the cells that need it for energy. People with type 2 diabetes cannot use insulin properly, and often do not make enough of it. This can result from lifestyle choices such as poor diet and exercise habits, but other factors also play a significant role, including age and genetics.

The resulting high blood sugar concentrations damage many parts of the body, eventually increasing the risk of long-term complications like heart attack, kidney disease, blindness, and amputation. People with type 2 diabetes need to learn how to check and manage their own blood sugar levels using medicine, diet, exercise, and other healthy habits, all in an effort to keep blood sugar concentrations in a safe range.

Type 2 diabetes doesn’t always have symptoms, at least not initially. Many people are diagnosed with the disease during routine checkups and blood tests.

Type 2 diabetes is considered a multifactorial disease — it has multiple interrelated causes. Some of these risk factors can be altered through lifestyle changes, and some cannot.

Here are some of the most common risk factors for type 2 diabetes that can be improved with lifestyle modifications.

Overweight and Obesity Excess body weight causes dysfunction within the pancreas and insulin resistance throughout the body, and is highly associated with type 2 diabetes risk.
Poor Eating Habits A diet that's high in calorie-dense processed foods and beverages, and low in wholesome nutrient-rich foods, can significantly increase your risk of type 2 diabetes.
Lack of Exercise Too much time sitting down, whether for work or leisure, is highly associated with type 2 diabetes development — but physical activity of any intensity level greatly reduces the risk.
Poor Sleep Getting too little sleep, too much sleep, or irregular sleep can affect the body’s balance of insulin and blood sugar by increasing demands on the pancreas.
Smoking Smoking cigarettes increases the risk of type 2 diabetes by 30–40 percent, and also makes the disease more difficult to manage.
Steroids These common drugs provoke high blood sugars.

Some of the most significant risk factors, however, cannot be modified:

Genetics Type 2 diabetes has a powerful genetic component. If you have a strong family history of diabetes, you may be more likely to develop the condition.
Older Age The older you get, the more likely you are to develop type 2 diabetes.
Race or Ethnicity In the United States, people from minority communities (including American Indians, Latinos, Asians, and African Americans) are more likely to develop type 2 diabetes, though many experts believe that this is primarily due to socioeconomic rather than genetic factors.
Polycystic Ovarian Syndrome (PCOS) Women with PCOS, a hormone imbalance disorder experienced before menopause, often have insulin resistance, a root cause of type 2 diabetes.
Previous Gestational Diabetes Women who develop gestational diabetes during pregnancy are far more likely to later develop type 2 diabetes.

If you have some of these risk factors, it doesn’t necessarily mean you will develop type 2 diabetes.

At the same time, you don’t need to have every risk factor for type 2 diabetes to develop the condition. Children and teens can develop type 2 diabetes, as can people who are not overweight or who have no family history of the condition.

Tests for type 2 diabetes are straightforward, and can be part of a regular checkup. Two of the more common ways to test for diabetes are the A1C test, which estimates your average blood sugar level of the previous few months, and the fasting glucose test, which measures your current blood sugar level before you eat a meal or snack:

An A1C result of 6.5 percent or higher indicates that you have diabetes.
A fasting blood sugar level of 126 milligrams per deciliter (mg/dL) or higher indicates diabetes.

Clinicians have other testing options, too, including glucose tolerance tests and random blood sugar measurements. If you do not have any obvious symptoms of diabetes, your doctor may wish to run a second test to confirm a diagnosis.

Type 2 diabetes treatment always begins with lifestyle change. Even the most powerful diabetes drugs are prescribed to be used in addition to healthy behaviors such as improved nutrition and physical activity.

Type 2 Diabetes Diet: What Can You Eat?

There is no single recommended diabetes diet — many different eating patterns can work for people with diabetes. With that said, the American Diabetes Association has found that the best diabetes diets tend to agree on the following recommendations:

Eat plenty of nonstarchy vegetables.
Eat less sugar and refined grains.
Choose whole, minimally processed foods rather than packaged and processed foods.

There are a number of very different eating patterns that can be easily designed to fit the above recommendations, including the Mediterranean diet, low-carb and ketogenic diets, the DASH diet for hypertension, and vegan and plant-based diets.

Avoid eating packaged, processed starchy foods, such as cookies, cake, granola bars, and the like, and instead choose fresh, whole foods, like fiber-rich fruits, veggies, and whole grains. Replace bread or pasta made from refined white flour with whole-grain varieties. Foods high in fiber can help slow digestion, keeping blood sugar levels steady and helping you feel full sooner.

An additional factor to keep in mind is carbohydrate content. While most nutrition authorities agree that people with type 2 diabetes can and should enjoy healthier high-carbohydrate foods such as fresh fruit and whole grains, carbohydrate restriction may be the most reliable way to reduce blood sugar levels.
If you’re taking medications that carry a risk of hypoglycemia (low blood sugar), such as insulin and sulfonylureas, talk to your doctor before switching to a low-carb diet, as you may need to take smaller doses of your medications.

Food choices play a critical role in your blood sugar control. If you’re interested in a specific diet plan, consider working with a registered dietitian nutritionist (RDN) or a certified diabetes care and education specialist (CDCES) who can help you navigate the landscape.

Physical Activity and Type 2 Diabetes

There is a very strong link between physical activity and type 2 diabetes risk, and moving your body is one of the best ways to treat diabetes. With very few exceptions, almost everyone with type 2 diabetes, regardless of age or fitness level, is recommended to add physical activity to their treatment regimen.

The American Diabetes Association recommends engaging in at least 150 minutes of moderate exercise (such as jogging) or 75 minutes of vigorous exercise (such as strength or interval training) per week.
Every type of exercise improves insulin sensitivity, and has comprehensive health benefits — even when it does not lead to weight loss.

Even very light exercise, including walking, can have significant benefits, including improvements in A1C and blood pressure. Low-impact exercise such as tai chi or yoga can also help improve flexibility, balance, and physical function, all of which lead to improved fitness and quality of life. Small doses of exercise, just a few minutes here or there, can break up a sedentary day and have a direct positive effect on blood sugar metabolism.

If you’ve been diagnosed with type 2 diabetes, you have a number of medical treatment options at your disposal.

Type 2 Diabetes Medication Options

It’s important to note that all type 2 diabetes medicines are intended to be used alongside the first and most important diabetes therapy: lifestyle change. Diet and exercise are always paramount in the treatment of diabetes.

These are some of the more popular drugs used to lower glucose levels in type 2 diabetes:

Metformin is the first-line medication for the treatment of type 2 diabetes. This daily pill, which helps reduce blood sugar levels and resensitize the body to insulin, is almost always prescribed upon diagnosis.
GLP-1 Receptor Agonists have rapidly become the world’s most talked-about drugs because of their incredible weight loss potential. GLP-1 receptor agonists increase insulin secretion in response to glucose, and help people effortlessly eat less food, leading both to weight loss and blood sugar improvements.
GLP-1 drugs also help protect the long-term health of both the heart and the kidneys.
SGLT-2 Inhibitors cause the body to remove excess glucose from the body through the urine. SGLT-2 inhibitors drive blood sugar improvement, modest weight loss, and cardiovascular and kidney protection.
Sulfonylureas work by stimulating the pancreas to produce more insulin.
DPP-4 Inhibitors help digestive hormones which increase insulin secretion and slow glucose absorption in the gut.
Insulin is sometimes seen as a last line of defense when other therapies cannot keep blood sugar levels under control. Insulin is a powerful glucose-lowering drug, but it brings a significant risk of hypoglycemia (dangerously low blood sugar), and it involves a significant learning curve.

Bariatric Surgery and Type 2 Diabetes

Bariatric (weight loss) surgery is another treatment option for type 2 diabetes in people with obesity. There are several types of bariatric surgery, but they all involve changing the size of the stomach, restricting the amount of food that can be eaten comfortably. Some types of bariatric surgery also change the connections between the stomach and the intestines, causing your body to absorb less energy from the food you eat.

While bariatric surgery may seem like an extreme option, it is very effective. The different procedures have their own risks and benefits, but generally speaking, people with diabetes who receive weight loss surgery lose about 20 percent of their body mass, and enjoy significant blood sugar improvements, often achieving lasting diabetes remission.

Bariatric surgery can cost over $10,000, but insurers often cover much of the expense.
For some, it’s a far less costly option than using weight loss drugs such as GLP-1 drugs.

The fundamental goal of diabetes management is to keep blood sugar levels within a safe range. Because doctors are generally only able to evaluate blood sugar levels during checkups, people with type 2 diabetes are usually asked to be somewhat responsible for measuring and managing their own blood sugar levels. Depending on your situation, you may be asked to test your blood sugar with a meter several times a day, once a day, or only every once in a while.

People with type 2 diabetes also may also have access to a more advanced device, the continuous glucose monitor (CGM), which tracks blood sugar levels around the clock. Two leading CGM manufacturers now sell their devices over-the-counter.

Blood sugar management success is usually evaluated by A1C, an estimate of your blood sugar levels over the previous several months. Your healthcare team will measure your A1C regularly.

The American Diabetes Association sets a target A1C of less than 7 percent for most nonpregnant adults — meeting this benchmark substantially slows, and may completely prevent, the development of diabetes complications.
Because blood sugar meters and CGMs do not measure A1C, your healthcare provider will also likely give you a range of blood sugar levels to try and stay within, such as 70–180 mg/dL.

Effective diabetes management is about more than just diet, exercise, and blood sugar control. People who thrive with type 2 diabetes take a well-rounded approach to their health:

Mental Health People with type 2 diabetes have a massively increased risk of mental health conditions, especially depression, and yet only half or fewer ever have their condition professionally diagnosed.
Depression Mental health struggles make it difficult to engage in diabetes management, which leads to worsening blood sugar levels.
People with diabetes should take depression, stress, anxiety, and related issues very seriously. Please speak to your healthcare provider if you think you may be experiencing one of these issues.
Sleep Habits There’s also a connection between diabetes and sleep — people with type 2 diabetes are more likely to experience sleep apnea, insomnia, and other sleep disturbances. Disordered sleep can spike insulin resistance, leading to worsening glycemic control, which means you should tell your doctor if you’re experiencing persistent fatigue or other sleep issues.
Smoking Nicotine causes insulin resistance directly, and can make diabetes significantly more difficult to manage.

Staying healthy with diabetes also means enhanced self-care — such as protecting your feet from cuts and sores, or prioritizing oral hygiene. Diabetes increases the risk of infections and slows wound healing all over the body; a clinician or diabetes educator can help you learn what to watch out for.

There's no surefire way to prevent type 2 diabetes, but maintaining a healthy weight, following a healthy diet, and exercising regularly can fend off the condition.

For over 20 years, researchers at the National Institutes of Health have been studying what behaviors prevent the development of type 2 diabetes. Study participants who took part in a lifestyle change program — dietary changes and physical activity goals — reduced the likelihood of developing diabetes by nearly 60 percent.

While diabetes prevention outreach usually concentrates on lifestyle factors, in the future it also may become more common for doctors to prescribe medicine specifically for diabetes prevention. Tirzepatide (Mounjaro, Zepbound), a diabetes and obesity medication in the GIP/GLP1 receptor agonist family, almost entirely prevents the progression from prediabetes to type 2 diabetes. Some doctors will also describe other type 2 diabetes drugs, such as metformin, to slow or halt diabetes progression.
Today, however, there is no drug approved by the U.S. Food and Drug Administration for type 2 diabetes prevention.

At the root of type 2 diabetes is a type of dysfunction known as insulin resistance, which interferes with the way the body converts food into energy.

Insulin Resistance and Prediabetes

The hormone insulin allows sugar within the blood to unlock and enter cells, providing your body with energy. Insulin resistance is a state in which the body’s cells do not respond properly to insulin, which requires your body to make extra insulin to harvest the energy from the food you eat. When the pancreas, the organ which creates insulin, cannot keep up with the body’s insulin demands, the result is a rising blood sugar level.

Insulin resistance shares the same risk factors as type 2 diabetes, including obesity, lack of physical activity, chronic stress, and family history. It can develop slowly over a matter of years or even decades.

People who have insulin resistance but have not yet developed type 2 diabetes generally don’t show symptoms — which means the condition may go unnoticed. Occasionally, people with insulin resistance will experience skin changes, such as skin tags and dark, velvety skin patches.
A routine blood sugar test can identify prediabetes, a state of insulin resistance that has not yet developed into type 2 diabetes.

If insulin resistance continues to worsen, blood sugar eventually rises to the level that officially defines diabetes.

Without proper treatment and management, the overworked pancreas may begin to lose its ability to create insulin over time, which spikes blood sugar levels even higher, a vicious cycle which generally causes the condition to worsen in the years and decades after diagnosis.

Type 2 diabetes is considered a chronic or lifelong condition. Although medication and changes to your diet and lifestyle can help manage type 2 diabetes, the body’s underlying tendency towards insulin resistance cannot be cured.

For many people, type 2 diabetes is a progressive disease, meaning that it gets more severe as time goes on. Many patients will need to add medication to maintain their blood sugar levels as they age, and some will experience health complications despite efforts to manage their condition.

This isn’t destiny. With healthier habits, it is possible to lower your blood sugar and actually reduce the amount of medicine you require. Some people have achieved diabetes “remission” — normal blood sugar levels without the use of any medicine.
Those results are not common, but they help demonstrate how potent lifestyle change can be as a type 2 diabetes therapy.

Today we also have access to powerful treatments — especially bariatric surgery and GLP-1 drugs — which may be enough to bring blood sugar concentrations down to healthy levels, halting or substantially delaying the progression of diabetes.

Blood sugar management is critical because it is the best way to reduce the odds of developing the chronic long-term complications of type 2 diabetes.

While high blood sugar levels often cause no immediate symptoms, that extra glucose is silently causing damage to almost every part of the body. Eventually, this damage can become symptomatic and dangerous.

Long-Term Health Problems Linked to Type 2 Diabetes

Type 2 diabetes raises the risk of the following serious conditions.

Cardiovascular disease, including heart disease, heart attack, and stroke. Cardiovascular disease is the number one cause of death in people with type 2 diabetes.
Diabetic retinopathy, which causes impaired vision and, in the most extreme cases, blindness.
Diabetic neuropathy is nerve damage that can affect the entire body. This condition can cause difficult-to-treat numbness, tingling, or pain in the extremities; it can also cause an uncomfortable stomach condition named gastroparesis.
Diabetic nephropathy occurs when high blood sugar levels damage the kidneys, leading to kidney disease.
Nephropathy can eventually lead to kidney failure, making either dialysis treatment or a kidney transplant necessary.

If you have diabetes, you may also deal with sexual issues, gum disease, hearing loss, sleep apnea, and skin conditions, among other issues.
Finally, the disease may also increase the risk of other conditions linked to insulin resistance, including Alzheimer’s disease, which has occasionally been called “type 3 diabetes.”

The bottom line is that people with type 2 diabetes have a lower life expectancy, especially when they develop the disease at younger ages.
But meeting your doctor’s blood sugar targets can add years to your life. A study published in 2022 found that reducing A1C from 9.9 percent to 7.7 percent was associated with a gain of 3.4 years of life expectancy.

Short-Term Type 2 Diabetes Complications

While the long-term complications described above are largely caused by chronic exposure to high blood sugar levels, having very high and low blood sugar levels can also cause immediate damage.

Extremely high blood sugar levels result in some of the same symptoms that often develop in untreated or undiagnosed diabetes, such as excessive thirst and urination. If left untreated, in rare cases this can progress to a potentially deadly state named diabetic ketoacidosis.

Dangerously low blood sugar, or hypoglycemia, is a side effect of certain diabetes drugs, particularly insulin and sulfonylureas. The warning signs of low blood sugar include intense hunger, shakiness, and dizziness.

Type 2 diabetes is one of the world’s most widespread chronic diseases. In the United States alone, some 36.4 million people have type 2 diabetes.
Worldwide, there are nearly half a billion.

It is possible to have type 2 diabetes for years before developing significant symptoms, which means that many cases have gone undiagnosed. In the United States, 28 percent of people with the condition — 8.7 million adults — may be unaware of it.
Type 2 diabetes is also increasingly common among children, adolescents, and young adults.

Perhaps as many as 100 million Americans have prediabetes — more than 1 in 3 adults.

In the United States, type 2 diabetes disproportionately impacts people from racial and ethnic minority communities.
Black, Asian, Hispanic, and American Indian people all have elevated diabetes risks, leading to higher rates of long-term health complications.

These disparities can be stark. Black Americans, for example, are three times as likely to develop end-stage kidney disease as white Americans, and are far more likely to require lower limb amputation.

Many experts believe that these differences are caused by disparities in the social determinants of health (nonmedical factors that affect health outcomes), including gaps in income, education, and access to health care.
Diabetes rates are also higher in rural areas and among people with lower incomes.

There are many potential ways for socioeconomic factors to impact diabetes risks. Low income and racism can be chronic stressors. People with less money may not be able to afford quality healthcare or wholesome food, and it may be more challenging to get adequate exercise.

Bias in our healthcare system, even when unintentional, also helps drive these health disparities. People from racial and ethnic minorities are less likely to be offered access to the latest diabetes management technology, and are also less likely to receive the newest diabetes medications.

It may be worthwhile to seek out organizations devoted to fixing diabetes disparities, such as the African American Diabetes Association, who may be able to specifically help someone in your situation.

The Takeaway

Type 2 diabetes is a disease of high blood sugar levels which is often related to unhealthy diet and exercise habits.
This is a lifelong condition that comes with a learning curve, as patients may be asked to learn how to measure and manage their own blood sugar.
Type 2 diabetes doesn’t necessarily have any symptoms at first, but it can lead to a number of debilitating complications.
Diabetes can substantially be treated with healthy lifestyle changes, and diabetes drugs have never been better. With the right care and attention, type 2 diabetes does not need to lead to negative health outcomes.

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