Type 2 Diabetes: Living With the Disease

Topic Overview

Is this topic for you?

This topic is for adults who have had type 2 diabetes for more than a few months.

If this topic does not answer your questions, see:

If you are looking for information about type 1 diabetes, see the topic Type 1 Diabetes.

What is diabetes?

Type 2 diabetes is a lifelong disease that develops when the pancreas cannot produce enough insulin or when the body's tissues become resistant to insulin. Insulin is a hormone that helps the body’s cells use sugar (glucose) for energy. It also helps the body store extra sugar in muscle, fat, and liver cells.

How can you manage diabetes?

Taking care of your diabetes takes time and energy every day. The goal is to keep your blood sugar in a target range. It’s the best way to reduce your chance of having more problems from diabetes. These problems are called complications.

Just focus on one day at a time, and:

  • Make healthy food choices. Eat a balanced diet, and try to manage the amount of carbohydrate you eat by spreading it out over the day. If you're overweight, losing 10 to 20 pounds can improve your blood sugar levels. There are many ways to manage how much and when you eat. Your doctor, a diabetes educator, or a dietitian can help you find a plan that works for you.
  • Be active. Try to do moderate activity at least 2½ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week. Activity helps control your blood sugar by using glucose for energy during and after activity. It also helps you stay at a healthy weight, lower high cholesterol, and lower high blood pressure.
  • Test your blood sugar levels. Everything in your life can affect your blood sugar levels, from what you eat, to how you feel, to how much activity you get. You may not like having to check your blood sugar regularly and keep track of the results. But testing can really help you keep your diabetes under control.
  • Keep high blood pressure and high cholesterol under control. Doing so can lower your risk of heart and large blood vessel disease.
  • Take medicines, such as metformin (Glucophage) or insulin, if you need them. These can help you keep your blood sugar levels on target.

And if you smoke, quit. Quitting smoking can help you reduce your risk of heart disease and stroke.

How can you deal with high or low blood sugar?

Even when you are careful and do all the right things, you can have problems with high or low blood sugar. It is important to know what signs to look for and what to do if this happens.

High blood sugar (hyperglycemia) usually happens over a few days or weeks. Early symptoms include:

  • Feeling very thirsty.
  • Urinating more often than usual.
  • Feeling very hungry.
  • Having blurred vision.

People with diabetes can get high blood sugar for many reasons, including not taking their diabetes medicines, eating more than usual (especially sweets), not exercising, or being sick or under a lot of stress.

If you have high blood sugar, follow your treatment plan for lowering it. This may mean taking missed doses of insulin or medicine. Make sure to drink plenty of fluids so that you stay hydrated. Call your doctor if you don't know what to do. Treating high blood sugar is important. If it is left untreated, it can lead to hyperosmolar state, a dangerous condition.

You can get low blood sugar (hypoglycemia) if you take insulin or sulfonylurea pills for diabetes. Low blood sugar can happen suddenly. Early symptoms include:

  • Sweating.
  • Feeling weak.
  • Feeling shaky.
  • Feeling very hungry.

Symptoms of low blood sugar may vary over time. You may also have these symptoms if you have a sudden large drop in blood sugar, even though the level does not drop below your target range. Eat 1 tablespoon of sugar, ½ cup of orange juice, or another carbohydrate. Wait 15 minutes, and then check your blood sugar.

What are the complications of diabetes and their symptoms?

Over time, high blood sugar can cause complications such as problems with your eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes you more likely to get serious illnesses or infections. Complications can lead to blindness, kidney failure, removal of a limb (amputation), heart attack, stroke, and death. This is why it is so important to keep your blood sugar in your target range.

If you had the disease several years before you were diagnosed, you may already have a complication from diabetes. Even if you don't have problems now, the longer you have diabetes, the more likely you are to get one or more complications. And the better you manage your blood sugar levels, the lower your risk of complications.

Be sure to tell your doctor if you notice any new symptoms, such as vision problems, chest pain, numbness, or a shooting pain in your hands or feet.

How can you prevent complications?

You may be able to prevent, or at least delay, problems from diabetes by keeping your blood sugar level as close to your target range as you can. Treatment of high blood pressure or high cholesterol can also help. If you smoke, quit. Smoking increases your risk for complications.

People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases. 1 Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke.

See your doctor every 3 to 6 months. During these visits, your doctor will review your treatment and do tests and exams, such as an A1c test. These tests can show if your blood sugar is staying within your target range and if you have any complications.

It’s also important to have regular checkups with your eye doctor and dentist. Diabetes can cause vision and dental problems.

How can you cope with diabetes?

Trying to manage your diabetes isn't easy. Some days you may feel like it's just too much work to do everything you need to do.

If you're having trouble coping with your feelings, try talking with a counselor. A professional may make it easier to say things you wouldn't talk about with friends or family.

It might also help to:

  • Talk to your doctor. He or she can help you deal with your feelings.
  • Talk with friends and family about how you feel and any help you need.
  • Join a support group. You can find one through your doctor, your local hospital, or the American Diabetes Association.

Causes of High and Low Blood Sugar

Even if you've been careful to take care of yourself and manage your type 2 diabetes, there may still be times when your blood sugar is too high or too low.

Over time, high blood sugar can lead to serious problems or a medical emergency. When your blood sugar is too low, you can get shaky and weak. If your blood sugar gets very low, you could pass out (lose consciousness).

High blood sugar can happen if you:

  • Skip a dose of your diabetes medicine or skip a required dose of insulin.
  • Eat too much.
  • Are stressed or ill (such as with a bad case of the flu) or if you have an infection, especially if you are not eating or drinking enough.
  • Are taking medicines that raise blood sugar as a side effect, such as sleeping pills, some anti-inflammatory medicines (corticosteroids), and some decongestants.

Being pregnant can also make your blood sugar levels go up.

If you take insulin, you may have some mornings when your blood sugar level is very high, even if it was low when you went to bed. This called the Somogyi effect. Talk with your doctor if this happens. You may need to check your blood sugar during the night to find out why your levels are high in the morning.

You aren't likely to get low blood sugar unless you take insulin or some kinds of oral medicines. You may get low blood sugar if you:

  • Take too much oral medicine in a day, take your doses too close together, or take your full dose of medicine when you are not going to eat your usual amount of food.
  • Exercise too much without eating enough food.
  • Skip a meal.
  • Drink too much alcohol, especially on an empty stomach.
  • Take other medicines that can lower blood sugar levels, such as large doses of aspirin and medicines for mental health problems.
  • Have problems with your kidneys.
  • Start to have other problems with your glands and hormones, such as Addison's disease or hypothyroidism.

Symptoms

High blood sugar

When you have type 2 diabetes, your blood sugar can rise slowly over hours or days. You may not notice that anything is wrong. Symptoms of high blood sugar include:

  • Being very thirsty.
  • Urinating a lot.
  • Losing weight without trying.
  • Having blurry vision.

It's important to know these symptoms so you can treat them before they get worse and you need medical attention. If your blood sugar stays higher than your target range and you don't drink enough liquids, you can get dehydrated. This can make you feel dizzy and weak and can lead to an emergency called a hyperosmolar state.

Low blood sugar

When your blood sugar is too low, it can also cause problems. And it can happen suddenly. Quickly treating low blood sugar can help you avoid passing out (losing consciousness). You can pass out when your blood sugar gets very low. Low blood sugar can also lead to a heart attack. Symptoms of low blood sugar include:

  • Sweating.
  • Shakiness.
  • Weakness.
  • Hunger.
  • Confusion.

If you aren't able to tell when your blood sugar is too low, it's a good idea to test your blood sugar often. But you're not likely to get low blood sugar unless you take insulin or oral diabetes medicines.

Symptoms of complications

Talk with your doctor if you notice any of these signs:

  • Numbness, tingling, burning pain, or swelling in your feet or hands. This could be a sign of diabetic neuropathy. For more information, see the topic Diabetic Neuropathy.
  • Blurry or spotty vision or seeing flashes. This may be a sign of diabetic retinopathy. For more information, see the topic Diabetic Retinopathy.
  • Cuts or sores that won't heal or that look infected. This could mean damage to blood vessels.
  • Chest pain or shortness of breath. This may be a sign of heart disease or blood vessel problems (macrovascular disease).
  • Other symptoms of diabetic neuropathy, such as:
    • Frequent bloating, belching, constipation, nausea and vomiting, diarrhea, or belly pain after you eat (gastroparesis).
    • Heavy or reduced sweating.
    • Feeling weak or dizzy when you stand up quickly.
    • Not knowing when your bladder is full or having problems emptying it.
    • Erection problems or vaginal dryness.
    • Not being able to tell when your blood sugar is low (hypoglycemia unawareness).

You won't have any symptoms of kidney damage (diabetic nephropathy) until the problem is severe. Then you may notice swelling in your feet or legs or all over your body. Having regular tests to check for protein in your urine is the only way to find diabetic nephropathy before symptoms start.

What Happens

Now that you have had type 2 diabetes diabetes for a while, you already know how important it is to keep your blood sugar as close to your target range as you can. Doing so can help you delay or prevent more serious health problems later.

If your diabetes gets worse, your pancreas may make less and less insulin, which can make it harder for you to control your blood sugar. When your pancreas makes too little or no insulin, you will need to give yourself shots of insulin.

It can be hard to find the right balance of insulin and blood sugar levels. So even if you take insulin or other diabetes medicines, there may still be times when your blood sugar is too high or too low. It's important to know the symptoms of both of these and to treat them early. For more information, see the Symptoms section of this topic.

High blood sugar emergencies

A hyperosmolar state is life-threatening and can occur when your blood sugar level is very high (400 to 500 mg/dL or higher) and you get dehydrated. You are more likely to have this problem if your blood sugar stays above 200 mg/dL.

Hyperosmolar state is treated in a hospital. You'll have frequent blood tests for glucose and electrolytes. Insulin will be given to you through a vein (intravenous, or IV) to lower your blood sugar level. You'll get fluids through the IV to get rid of the dehydration. The fluids will make you urinate, removing the excess sugar from your body.

Diabetes complications

Over time, high blood sugar that is not controlled can lead to problems with your:

If you have had high blood sugar levels for years, you may already have one or more of these complications. For more information, see Type 2 Diabetes: Living With Complications.

Other health problems

People with diabetes often already have other health problems, such as high blood pressure and high cholesterol. Or they may get them as diabetes gets worse. These health problems can make it harder to avoid complications from diabetes.

Living with diabetes

Uncontrolled high blood sugar is the main reason why complications occur. So if you work closely with your doctor to keep your blood sugar within your target range, you may be able to avoid or prevent these problems. You may also feel better and be more in control of your life. For more information, see the Preventing Complications section of this topic.

Even if you have done all you can to keep your blood sugar under control, you may still get a diabetes-related health problem. You may feel sad, angry, and confused that you have to deal with something new along with your diabetes.

Talking with others who have diabetes can help. Call your local hospital, and ask if it has a support group or classes for people with diabetes. Or visit the Web site of the American Diabetes Association, www.diabetes.org.

For more information, see the What Increases Your Risk of Complications section of this topic.

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One Man's Story:

Andy, 52

As a grocery manager, Andy is on his feet all day. He also likes to bowl and play basketball with his buddies. He started thinking about what he would do if he couldn't walk, work, or play. "It finally just hit me how serious this disease is. I couldn't keep ignoring it."—Andy

Read more about Andy and his diabetes routine.

What Increases Your Risk Of Complications

You are more likely to get complications from type 2 diabetes if:

  • Your blood sugar stays high over time. Your risk for complications increases if your blood sugar gets too high and stays high too long.
  • You have had the disease for a long time. The longer you have diabetes, the more likely you are to have some related health problems. This can happen even if your blood sugar levels are controlled.
    • Kidney disease (diabetic nephropathy) occurs in 20 to 30 people out of 100 who have type 2 diabetes.2
    • Eye disease (diabetic retinopathy) occurs within 20 years after diagnosis in more than 60 people out of 100 with type 2 diabetes.3
    • Most people with diabetes start to get some nerve damage (diabetic neuropathy) over the years. But only about half of the people who get neuropathy have noticeable symptoms.4
  • You already have one complication. If you have one diabetes-related problem, you are at a higher risk for getting another one.
  • You have other risk factors, such as:

People with untreated depression are also more likely to have complications. For more information, see the topic Depression.

For tips on how to reduce your risk, see the Home Treatment and Preventing Complications sections of this topic.

When to Call a Doctor

Call 911 or other emergency services immediately if you are:

Call a doctor immediately if you are vomiting and cannot keep down liquids and:

  • Your blood sugar is 300 mg/dL or higher.

Call a doctor if you:

  • Are sick for more than 2 days (unless it is a mild illness, such as a cold), and you:
    • Have been vomiting or had diarrhea for more than 6 hours.
    • Have followed the doctor's advice but it has not worked. Learn what to do when you are sick and have diabetes.
    • Have blood sugar levels that are often above 300 mg/dL, and urine tests for ketones show more than 2+ or moderate or higher ketones.
  • Have a blood sugar level that stays below the target range after you eat some quick-sugar food.
  • Have a blood sugar level that stays high after you take a missed dose of insulin or oral diabetes medicines or after you take an extra dose of insulin (if prescribed by the doctor).
  • Have frequent problems with high or low blood sugar levels. The insulin dose or schedule may need to be changed.
  • Are having trouble knowing when your blood sugar is low (hypoglycemia unawareness).
  • Have problems following the meal plan or getting physical activity, and you want help.

Who to See

Health professionals who may be involved in your treatment for type 2 diabetes include:

Exams and Tests

See your doctor about every 3 to 6 months to:

  • Check your blood sugar levels since your last visit and see if your treatment needs to be changed.
  • Check your blood pressure and start or adjust treatment if it's high.
  • Check your feet for signs of problems.
  • Have a hemoglobin A1c test . This test shows how steady your blood sugar levels have been over time. And it can show high blood sugar at times when you might not normally be checking, such as after meals and overnight. With this information, your doctor will know how well your treatment for type 2 diabetes is working.

Have these exams and tests every year:

As needed, you may have a blood glucose test. During this test, you'll be able to check your blood sugar meter to find out if your home blood sugar tests are reliable. This test may also be done if your doctor adjusts your diabetes medicine.

You can print out a list of tests to monitor diabetes to help you remember what to do and when.

Eye exams during pregnancy

If you get pregnant, you will need to have an eye exam sometime during the first 3 months. You'll also need close follow-up during your pregnancy and for 1 year after you have your baby. Pregnancy increases your risk for diabetic retinopathy.5 If you already have eye disease and get pregnant, the disease can quickly get worse.

Treatment Overview

Your treatment for type 2 diabetes will change over time to meet your needs. But the focus of your treatment will always be to keep your blood sugar levels within your target range. That will help prevent complications from diabetes, such as eye, kidney, heart, blood vessel, and nerve disease.

To help you stay on track with your treatment, you'll need regular tests. For more information, see the Exams and Tests section of this topic.

You play an important role in managing your condition. By learning about diabetes and working with your doctor to create a plan for treatment, you can improve your health and quality of life.

The keys to managing your diabetes are to:

Pregnancy and diabetes

If you get pregnant, your diabetes treatment may change. For example, some medicines could harm your baby. If your blood sugar gets too high while you're pregnant, your baby might have problems at birth. Talk with your doctor. For more information, see:

Click here to view an Actionset. Pregnancy and diabetes: Planning for pregnancy.

Staying motivated

You've likely already had to make some big changes in the way you live your life. It can be hard to stay motivated when you have diabetes. Just try to focus on one day at a time.

Remember that untreated type 2 diabetes can lead to serious health problems. People with diabetes have a higher risk of dying from heart and blood vessel diseases than people who don't have the disease.6

But also remember that you can prevent or delay these problems by taking care of yourself. Eating right, staying active, and keeping your blood sugar under control are all things you can do. You don't have to do it alone. For help and how-tos, see the Home Treatment section of this topic.

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One Man's Story:

Andy, 52

"I'm doing so much better than I was 2 years ago. I eat better, I take walks, and I feel pretty good. I talk to other people who have diabetes. But I have to remember that what works for them may not work for me. Diabetes is different for everybody."—Andy

Read more about Andy and his diabetes routine.

Preventing Complications

Because you've been managing your type 2 diabetes diabetes for a while now, you probably already know that keeping your blood sugar levels within your target range is the best way to reduce your risk of other health problems. The higher your blood sugar level, the greater your risk for developing eye, kidney, heart, blood vessel, and nerve disease.7

Just focus on one day at a time, and:

  • Make healthy food choices, and lose weight if you need to.
  • Be active.
  • Test your blood sugar levels.
  • Keep high blood pressure and high cholesterol under control.
  • Take medicines, such as metformin (Glucophage) or insulin, if you need them.

And if you smoke, quit. Quitting smoking can help you reduce your risk of heart disease and stroke.

For tips on how to do these things, see the Home Treatment section of this topic.

Get the tests you need

Make sure to schedule the important tests you need to monitor diabetes and watch for complications. These include:

Flu shots

Diabetes affects your immune system. This increases your risk for getting sick. It's important to keep your flu shots and other immunizations up to date. Getting sick can make your blood sugar harder to control, so avoid illness if you can. See the topic Immunizations for guidelines on these and other shots.

Daily aspirin

People with diabetes have a higher risk of dying from heart and blood vessel diseases than people who don't have diabetes.1 Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke.

Set a Goal to Prevent Complications

Losing weight, getting active, eating better, and quitting smoking are all important changes you can make for your health when you have type 2 diabetes. But you don't have to do them all at once. Just pick one to start. Maybe it's losing weight, or adding more activity to your life. Three steps can help you get started.

1. Know your reason. Before you set a goal, think about why you want to make a change. If your reason comes from you—and not from someone else—it will be easier for you to make a healthy change for good.

Maybe you want to prevent your diabetes from getting worse. Perhaps you're worried about losing your eyesight or even a limb. You might simply want to enjoy your life and have more energy for all the things you enjoy doing. Your reason for wanting to change is important.

2. Set long-term and short-term goals. Start by setting a big, or long-term goal. Maybe you want to lose 10% of your body weight to reduce your risk of health problems linked to type 2 diabetes. If you weigh 200 pounds, that means losing 20 pounds. Break down your big goal into smaller, short-term ones. These are the steps you'll take to reach your big goal.

Do what works best for you. It's important to set goals you can reach. For example:

  • Week 1: Set a goal to walk 15 minutes, 5 days a week.
  • Week 2: Continue to walk 15 minutes, 5 days a week. And this week, when you reach for a snack, make it carrot or celery sticks instead of potato chips or crackers.
  • Week 3: Keep up your walking program and eating healthy snacks. Pay attention to your hunger levels when eating meals. Stop eating when you feel full.

For help, see:

Click here to view an Actionset. Fitness: Adding activity to your life.
Click here to view an Actionset. Fitness: Walking for wellness.
Click here to view an Actionset. Healthy eating: Starting a plan for change.
Click here to view an Actionset. Healthy eating: Recognizing your hunger signals.

3. Prepare for slip-ups and barriers. Plan for setbacks. Use a personal action plan(What is a PDF document?) to write down your goals, any possible barriers, and your ideas for getting past them. By thinking about these barriers now, you can plan ahead for how to deal with them if they happen.

For help, see:

Click here to view an Actionset. Quitting smoking: Preventing slips and relapses.
Click here to view an Actionset. Healthy eating: Overcoming barriers to change.

Tips for staying on track

  • Get support. Tell family and friends your reasons for wanting to change. Tell them that their encouragement makes a big difference to you in your goal, whether it's losing weight or quitting smoking. Your doctor or a professional counselor can also provide support.
  • Pat yourself on the back. Don't forget to give yourself some positive feedback. If you slip up, don't waste energy feeling bad about yourself. Instead, think about how much closer you are to reaching your goal than when you started.

Home Treatment

Your treatment goals

When it comes to managing your type 2 diabetes, it's really up to you. You can learn how to take care of yourself, how to stay motivated, and how to find the support you need to do it.

For the best chance at a long, healthy life, you need to set goals for your treatment, including:

  • Making healthy food choices.
  • Being active.
  • Testing your blood sugar levels.
  • Keeping your high blood pressure and high cholesterol under control.
  • Taking medicines, such as metformin (Glucophage) or insulin, if you need them.
  • Quitting smoking, which can help you reduce your risk of heart disease and stroke.

Make a healthy eating plan

If you're overweight, losing 5% to 10% of your weight may help you reach normal blood sugar levels. For example, if you weigh 200 pounds, losing 10 to 20 pounds may lower your blood sugar.

Managing the amount of carbohydrate you eat is an important part of a healthy diet for diabetes. Carbohydrate is found in:

  • Sugar and sweets.
  • Bread, rice, and pasta.
  • Fruit.
  • Starchy vegetables, such as potatoes and corn.
  • Milk and yogurt.

The best diet is a balanced one. A healthy eating plan doesn't have to be complicated. Try to:

  • Limit how much fat you eat. Eat foods low in saturated fat and high in fiber.
  • Cut down on foods that are high in calories but low in nutrition, such as soda.
  • Limit sweets.

You may want to work with a dietitian or certified diabetes educator to help you plan menus that spread carbohydrate throughout the day. This will keep your blood sugar from rising sharply after meals.

It's normal to have some negative feelings about diabetes and how it's affecting your life, especially when it comes to how and what you eat. But try not to let those feelings get in the way of taking care of yourself. For help, see:

Click here to view an Actionset. Diabetes: Coping with your feelings about your diet.

For more ideas about healthy eating, try:

Quick Tips: Smart Snacking When You Have Diabetes.
Click here to view an Actionset. Diabetes: Using a plate format for eating.
Click here to view an Actionset. Diabetes: Counting carbs if you don't use insulin.
Click here to view an Actionset. Diabetes: Using a food guide.
Click here to view an Actionset. Diabetes: Eating a low glycemic diet.

Get active

The more active you are, the more sugar (glucose) your body uses for energy. This keeps the sugar from building up in your blood. Being active also:

Don't worry. You don't have to sign up for a gym membership or train for a marathon to get the activity you need to control your blood sugar. Even everyday activities can make a difference.

Try to get about 30 minutes of activity on most days of the week. You can even break it up into two 15-minute sessions or three 10-minute sessions.

Try to include resistance exercises in your program 3 times a week. 1 These activities can include things like weight lifting or yard work. See the topic Fitness for more ideas.

For more help, see:

Quick Tips: Getting Active at Home.
Click here to view an Actionset. Fitness: Adding more activity to your life.
Click here to view an Actionset. Fitness: Walking for wellness.
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One Woman's Story:

Gloria, 70

"Exercise really changed everything for me. The way I feel, my blood sugar, everything. It really works. I never felt better, stronger, healthier, or happier in my life."—Gloria

Read more about Gloria and how she manages her diabetes.

Test your blood sugar

Everything in your life can affect your blood sugar levels, from what you eat, to how stressed you feel, to how much activity you get. You may not like having to check your blood sugar regularly and keep track of the results over time. But it can really help you keep your diabetes under control.

  • Checking how your blood sugar rises or falls in response to certain foods, exercise, and other things can help you reduce symptoms, prevent blood sugar emergencies, and prevent complications.
  • Having a record of your blood sugar over time can help you and your doctor know how well your treatment is working and whether you need to make any changes.

For more information, see:

Click here to view an Actionset. Diabetes: Checking your blood sugar.
Click here to view an Actionset. Diabetes: Preventing high blood sugar emergencies.

Know what your results mean

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Rhonda O'Brien, certified diabetes educator

As important as regular testing is, you also need to know what the results mean and how to use them. "Look for patterns. If your blood sugar is always high before lunch, take a look at what you had for breakfast. Maybe you need to make some changes."—Rhonda

Learn blood sugar testing tips from Rhonda O'Brien.

Control blood pressure and cholesterol

Try to keep your blood pressure and cholesterol at healthy levels. Doing so can lower your risk of heart and large blood vessel disease.

Being active can help keep your blood pressure at the recommended level of less than 130/80 millimeters of mercury (mm Hg). In some cases, you may need to take medicines to help you reach your goal.

A low-fat diet, activity, and weight loss can also lower your cholesterol. Aim for a goal of less than 100 milligrams per deciliter (mg/dL) of low-density lipoprotein (LDL), the "bad" cholesterol. Try to get it even lower if you can.

Your doctor may suggest that you take cholesterol-lowering medicines called statins. For more information, see the topics High Blood Pressure (Hypertension) and High Cholesterol, or see:

Therapeutic lifestyle changes (TLC) for high cholesterol.
Click here to view an Actionset. High blood pressure: Checking your blood pressure at home.

Take medicines if you need them

You may need to take oral medicines, such as metformin (Glucophage) or insulin, to help you keep your blood sugar levels on target.

If your diabetes get worse, your pancreas may make less and less insulin, which can make it harder for you to control your blood sugar. When your pancreas makes too little or no insulin, you will need to give yourself shots of insulin.

If you get sick, have surgery, get pregnant, or breast-feed, you may need insulin shots for a short time, even if you normally only take pills. You should be able to go back to your regular treatment after the situation is over.

If you take diabetes medicines, you need to know how to deal with low blood sugar. If you use insulin, you need to know how to give yourself a shot. For help, see:

Click here to view an Actionset. Diabetes: Dealing with low blood sugar from medicines.
Click here to view an Actionset. Diabetes: Dealing with low blood sugar from insulin.
Click here to view an Actionset. Diabetes: Giving yourself an insulin shot.

For more information, see the Medications section of this topic.

Daily aspirin

People with diabetes have a higher risk of dying from heart and blood vessel diseases than people who don't have diabetes.1 Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke.

Take care of yourself in other ways

Be aware of other things you can do to help yourself stay healthy.

How to cope with your feelings

Trying to manage your diabetes isn't easy. Some days you may feel like it's just too much work to do everything you need to do. There will be times when you just don't feel like testing and tracking your blood sugar.

It's normal to feel sad or even angry sometimes when you have a health problem. Even though you've had a while to get used to the idea of having diabetes, you may still have trouble adjusting. You may find it hard to stay motivated.

When you feel sad, give yourself time to grieve your losses. If you feel overwhelmed, just try to focus on one day at a time. Do the best you can. You don't have to be perfect.

For more help, see:

Click here to view an Actionset. Depression: Using positive thinking.

Get the support you need

If you're having trouble coping with your feelings, try talking with a counselor. A professional may make it easier to say things you wouldn't talk about with friends or family.

If you have symptoms of depression, such as a lack of interest in things you used to enjoy, a lack of energy, or trouble sleeping, talk with your doctor. For more help, see the topic Depression.

You might also want to:

  • Talk with friends and family about how you feel and any help you need.
  • Ask a friend or family member to come to counseling with you.
  • Talk to your spiritual advisor if you belong to a church or spiritual group. He or she will have experience helping people deal with their feelings.
  • Join a support group. You can find one through your doctor, your local hospital, or the American Diabetes Association.

Medications

How medicine helps manage diabetes

Some people with type 2 diabetes need pills (oral medicines) to help their bodies make insulin, decrease insulin resistance, or slow down how quickly their bodies absorb carbohydrate.

You may take no medicine, one medicine, or a few medicines. Some people need to take medicine for a short time, while others always need to take medicine. How much medicine you need depends on how well you can keep your blood sugar within your target range. You may need more medicine over time, even if you have good control of your blood sugar.

Taking two or more medicines may work better to lower your blood sugar level than taking one medicine alone. Also, taking two or more medicines may mean fewer side effects if you are taking a lower dose of each.

Medicine choices

  • Oral medicines that help your body make insulin. These include:
    • Sulfonylureas, such as glipizide (Glucotrol), glyburide (DiaBeta, Glynase, and Micronase), glimepiride (Amaryl), and other medicines that work in combination (Glucovance, Metaglip).
    • Meglitinides, such as repaglinide (Prandin), nateglinide (Starlix), and a combination medicine (Prandimet).
    • DPP-4 inhibitors, such as sitagliptin (Januvia) and a combination medicine (Janumet).
  • Oral medicines that lower insulin resistance. These include:
    • Biguanides, such as metformin (Glucophage) and other medicines that are combined with metformin (Prandimet, Avandamet).
    • Thiazolidinediones, such as pioglitazone (Actos) and rosiglitazone (Avandia).
  • Oral medicines that slow down absorption of carbohydrates. These include:
  • Medicines that help lower blood sugar. If you are having trouble controlling your blood sugar with pills, your doctor may suggest one of these medicines:
    • Incretin mimetics, such as exenatide (Byetta). You take this medicine as a shot 2 times a day.
    • Amylinomimetics, such as pramlintide (Symlin). This medicine works with insulin and glucagon to help control blood sugar. It is given as a shot before meals.
  • Insulin . Insulin lets sugar (glucose) in the blood enter cells, where it is used for energy. Without insulin, the blood sugar level gets too high. Most of the time, people who take insulin use a combination of short-acting and long-acting insulin. This helps keep blood sugar within your target range. You may want to learn more about when insulin is needed for type 2 diabetes.

You may also need to take:

Managing your medicines

Medicines can help you manage your diabetes and other health problems, but only if you take them correctly. It can be hard to keep track of when and how to take your medicine, especially if you are taking more than one. Maybe you aren't sure why you are taking a medicine or if it is working. Or you might have trouble paying for your medicine. For help, see:

Surgery

There are no surgeries to treat type 2 diabetes.

Studies show that the large weight loss provided by stomach surgery (bariatric surgery) improves blood sugar control in people who are very overweight. 1 But the surgery can be risky. It's not a good choice for everyone with diabetes. And keep in mind that there is more than one kind of weight-loss surgery. It's not known for sure which one is best.

If you are very overweight, talk with your doctor about whether stomach surgery would be right for you. For more information, see the topic Obesity.

Other Treatment

Avoid products that promise a “cure” for diabetes. There is no cure.

If you have questions about a diet product for diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator. Talk with a dietitian before choosing a meal plan for your diabetes diet.

Complementary therapies

Some complementary therapies may help relieve stress and muscle tension. They might help you feel better in general. But they should not be used alone to treat your diabetes.

Talk with your doctor if you are using any of these treatments:

Other Places To Get Help

Organizations

American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA  22311
Phone: 1-800-DIABETES (1-800-342-2383)
E-mail: AskADA@diabetes.org
Web Address: www.diabetes.org
 

The American Diabetes Association (ADA) is a national organization for health professionals and consumers. Almost every state has a local office. ADA sets the standards for the care of people with diabetes. Its focus is on research for the prevention and treatment of all types of diabetes. ADA provides patient and professional education mainly through its publications, which include the monthly magazine Diabetes Forecast, books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also provides information for parents about caring for a child with diabetes.


National Diabetes Education Program (NDEP)
1 Diabetes Way
Bethesda, MD  20814-9692
Phone: 1-800-438-5383 to order materials
(301) 496-3583
E-mail: ndep@mail.nih.gov
Web Address: http://ndep.nih.gov
 

The National Diabetes Education Program (NDEP) is sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers for Disease Control and Prevention (CDC). The program's goal is to improve the treatment of people who have diabetes, to promote early diagnosis, and to prevent the development of diabetes. Information about the program can be found on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC (www.cdc.gov/team-ndep).


National Diabetes Information Clearinghouse (NDIC)
1 Information Way
Bethesda, MD  20892-3560
Phone: 1-800-860-8747
Fax: (703) 738-4929
TDD: 1-866-569-1162 toll-free
E-mail: ndic@info.niddk.nih.gov
Web Address: http://diabetes.niddk.nih.gov
 

This clearinghouse provides information about research and clinical trials supported by the U.S. National Institutes of Health. This service is provided by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).


References

Citations

  1. American Diabetes Association (2009). Standards of medical care in diabetes. Clinical Practice Recommendations 2009. Diabetes Care, 32(Suppl 1): S13–S61.
  2. American Diabetes Association (2004). Nephropathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79–S83.
  3. American Diabetes Association (2004). Retinopathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84–S87.
  4. American Diabetes Association (2005). Diabetic neuropathies. Position statement. Diabetes Care, 28(4): 956–962.
  5. American Diabetes Association (2008). Standards of medical care in diabetes. Clinical Practice Recommendations 2008. Diabetes Care, 31(Suppl 1): S3–S110.
  6. American Diabetes Association (2004). Aspirin therapy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72–S73.
  7. Gerstein HC (2001). What is diabetes? In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 62–67. Hamilton, ON: BC Decker.

Other Works Consulted

  • American Diabetes Association (2004). Influenza and pneumococcal immunization in diabetes. Position statement. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S111–S113.
  • Riddle MC, Genuth S (2007). Type 2 diabetes mellitus. In DC Dale, DD Federman, eds., ACP Medicine, section 9, chap. 2. New York: WebMD.

Credits

Author Judy Dundas
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer David C.W. Lau, MD, PhD, FRCPC - Endocrinology & Metabolism
Last Updated July 22, 2009

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