Type 2 Diabetes : Diagnosis & Treatment

Diagnosis

To diagnose type 2 diabetes, you'll be given a:

Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent.

If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes:

Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate diabetes.

The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test.

Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 140/90 millimeters of mercury (mm Hg).

If you're diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — since the two conditions often require different treatments.

After the diagnosis

A1C levels need to be checked between two and four times a year. Your target A1C goal may vary depending on your age and other factors. However, for most people, the American Diabetes Association recommends an A1C level below 7 percent. Ask your doctor what your A1C target is.

Compared with repeated daily blood sugar tests, the A1C test is a better indicator of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication, meal plan or activity level.

In addition to the A1C test, your doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important.

Treatment

Management of type 2 diabetes includes:

Healthy eatingRegular exercisePossibly, diabetes medication or insulin therapyBlood sugar monitoring

These steps will facilitate keep your blood sugar level closer to normal, which can delay or prevent complications.

Healthy eating

Contrary to popular perception, there's no specific diabetes diet. Still, it's important to center your diet on these high-fiber, low-fat foods:

FruitsVegetablesWhole grains

You'll likewise need to eat fewer animal products, refined carbohydrates and sweets.

Low glycemic index foods also may be helpful. The glycemic index is a touchstone of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar rapidly. Low glycemic index foods may help you reach a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.

A registered dietician can help you put together a meal plan that fits your health goals, food preferences and lifestyle. He or she can also instruct you how to monitor your carbohydrate intake and let you know about how many carbohydrates you need to eat with your meals and snacks to keep your blood sugar levels more stable.

Physical activity

Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exclusion. Get your doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming and biking. What's most important is creating physical activity part of your daily routine.

Aim for at least 30 minutes of aerobic exercise five days of the workweek. Stretching and strength training exercises are helpful, too. If you haven't been active for a while, begin slowly and build up gradually.

A combination of exercises — aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week — often helps control blood sugar more effectively than either type of exercise alone.

Think of that physical activity lowers blood sugar. Control your blood sugar level before any activity. You might require to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar.

Monitoring your blood sugar

Depending on your treatment plan, you may need to find out and record your blood sugar level every now and then or, if you're on insulin, multiple times a day. Take your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only path to make sure that your blood sugar level remains within your target range.

Sometimes, blood sugar levels can be irregular. With assistance from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication.

Diabetes medications and insulin therapy

Some people who have type 2 diabetes can reach their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medicines are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different divisions to help you control your blood sugar in several different ways.

Cases of possible treatments for type 2 diabetes include:

Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medicine prescribed for type 2 diabetes. It operates by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively.

Metformin also lowers glucose production in the liver. Metformin may not lower blood sugar enough on its own. Your physician will also recommend lifestyle changes, such as losing weight and becoming more active.

Nausea and diarrhea are possible side effects of metformin. These side effects usually pass away as your body gets used to the medicineIf metformin and lifestyle changes aren't enough to hold in your blood sugar level, other oral or injected medications can be added.d.

SSulfonylureas. These medicines help your body secrete more insulin.Examples of medicines in this class include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Potential side effects include low blood sugar and weight gain.

Meglitinides. These medicines work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter.. They likewise have a risk of causing low blood sugar, but this risk is lower than with sulfonylureas.

Weight gain is a possibility with this class of medicines as well. Examples include repaglinide (Prandin) and nateglinide (Starlix).

Thiazolidinediones. Like metformin, these medications make the body's tissues more sensitive to insulin. This category of medications has been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and fractures. Because of these dangers, these medications generally aren't a first-choice treatment.

Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones.

DPP-4 inhibitors. These medicines help reduce blood sugar levels, but tend to have a modest effect. ThThey don't cause weight incrInstances of these medications are sitagliptin (Januvia), saxagliptin (Onglyza)yza) and linagliptin (Tradjenta).

GLP-1 receptor agonists. These medications slow digestion and help lower blood sugar levels, though not every bit much as sulfonylureas. Their function is often associated with some weight lThis category of medications isn't recommended for use by itself.

Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists. Potential side effects include nausea and an increased risk of pancreatitis.

SGLT2 inhibitors. These are the newest diabetes drugs on the marketplThey function by preventing the kidneys from reabsorbing sugar into the blood.lood. Instead, the sugar is excreted in the urine.

Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga). Side effects may include yeast infections and urinary tract infections, increased urination and hypotension.

Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was utilized as a last resort, but today it's often prescribed sooner because of its benefits.

Because normal digestion interferes with insulin taken by mouth, insulin must be put in. DeDepending on your needs, your doc may prescribe a mixture of insulin types to use throughout the day and night.

Frequently, people with type 2 diabetes start insulin use with one long-acting shot at nightInsulin injections involve using a fine needle and syringe or an insulin pen injector — a gimmick that looks similar to an ink pen, except the cartridge is filled with insulin.

Thither are many types of insulin, and they each work in a different way. Options include:

Insulin glulisine (Apidra)
Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glargine (Lantus)
Insulin detemir (Levemir)
Insulin isophane (Humulin N, Novolin N)

Talk about the pros and cons of different drugs with your doctor. Together you can determine which medication is best for you after considering many factors, including costs and other aspects of your healthIn gain to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.

Bariatric surgery

If you have type 2 diabetes and your body mass indicator (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the operation performed. Surgical procedures that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries.

Drawbacks to the surgery include its high cost, and there are risks involved, including a risk of dying. Additionally, drastic lifestyle modifications are required and long-term complications may include nutritional deficiencies and osteoporosis.

Pregnancy

Adult females with type 2 diabetes may need to alter their treatment during pregnancy. Many adult females will require insulin therapy during preCholesterol-lowering medications and some blood pressure drugs cannot be practiced during pregnancy.

If you experience signs of diabetic retinopathy, it may worsen during pregnancy. See your ophthalmologist during the first trimester of your pregnancy and at one year postpartum.

Signs of trouble

Because so many genes can affect your blood sugar, problems sometimes arise that require immediate care, such as:

High blood sugar (hyperglycemia). Your blood sugar level can develop for many reasons, including eating too much, being sick or not taking enough glucose-lowering medicationControl your blood sugar level often, and watch for signs and symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both.

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Signs and symptoms of this life-threatening condition include a blood sugar reading higher than 600 mg/DL (33.3 mmol/L), dry oral cavity, extreme thirst, fever greater than 101 F (38 C), drowsiness, confusion, vision loss, hallucinations and dark urine. Your blood sugar monitor may not be able to make you an exact reading at such high levels and may instead just read "high."

HHNS is caused by sky-high blood sugar that turns blood thick and syrupy. It inclines to be more common in older people with type 2 diabetes, and it's often preceded by an illness or infection. HHNS usually develops over days or weeks. Visit your doctor or seek immediate medical care if you have signs or symptoms of this condition.

Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your physical structure may begin to break down fat. This produces toxic acids known as ketones.

Look out for thirst or a very dry mouth, frequent urination, vomiting, shortness of breath, fatigue and fruity-smelling breatYou can hold your urine for excess ketones with an over-the-counter ketones test kit.it. IIf you have excess ketones in your urine, consult your doc right away or seek emergency care.This term is more common in people with type 1 diabetes but can sometimes occur in people with type 2 diabetes.

Low blood sugar (hypoglycemia). If your blood sugar level drops under your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can cast for many reasons, including skipping a meal, inadvertently taking more medication than usual or getting more physical activity than normal. Low blood sugar is most likely if you take glucose-lowering medications that boost the secretion of insulin or if you're taking insulin.

Control your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures.

If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a worry. DueDue to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the dawningIf you experience signs or symptoms of low blood sugar, drink or eat something that will quickly raise your blood sugar level — fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels have normalized.

If they haven't, treat again and retest in another 15 minutes. If you lose consciousness, a household member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.

Alternative medicine

Numerous alternative medicine centers have been shown to improve insulin sensitivity in some studies, while other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, no alternative therapies are recommended to help with blood sugar management.

If you settle to try an alternative therapy, don't stop taking the medications that your doctor has prescribed. Be certain to discuss the use of any of these therapies with your doctor to make sure that they won't cause adverse reactions or interact with your medicationsNo treatments — alternative or conventional — can heal diabetes.es. And then it's critical that people who are using insulin therapy for diabetes, don't stop using insulin unless directed to do so by their physicians.