Type 2 diabetes develops slowly and often has no symptoms for years. The early signs, the numbers used to diagnose it, how it’s treated and the 15-15 rule for low blood sugar.
What is type 2 diabetes?
In type 2 diabetes, the body doesn't respond properly to insulin – the hormone that moves sugar from the blood into the cells – and over time doesn't make enough of it. Blood sugar rises, and over years high blood sugar damages the heart, kidneys, eyes, nerves and feet.
It's the most common type of diabetes. It develops slowly, often over many years, and more than 1 in 3 US adults has prediabetes – blood sugar that is higher than normal but not yet diabetes. Most of them don't know it.
Early signs
Many people have no symptoms at first. When they do appear, they can include:
- Urinating often, especially at night
- Being very thirsty
- Feeling very hungry
- Losing weight without trying
- Blurred vision
- Numbness or tingling in the hands or feet
- Feeling very tired
- Cuts and sores that heal slowly
- More infections than usual, such as yeast infections or UTIs
- Dark, velvety patches of skin in the folds of the neck or armpits – a sign of insulin resistance
Who should be tested
Testing is recommended for all adults from age 35, and earlier if you're overweight and have other risk factors, such as:
- A parent, brother or sister with type 2 diabetes
- High blood pressure or high cholesterol
- Diabetes during a pregnancy, or polycystic ovary syndrome
- Little physical activity
The numbers used to diagnose diabetes
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| A1C (average blood sugar over about 3 months) | Below 5.7% | 5.7–6.4% | 6.5% or higher |
| Fasting blood sugar | Below 100 mg/dL | 100–125 mg/dL | 126 mg/dL or higher |
| 2-hour glucose tolerance test | Below 140 mg/dL | 140–199 mg/dL | 200 mg/dL or higher |
A result in the diabetes range is usually confirmed with a second test.
How type 2 diabetes is treated
Lifestyle comes first. For people with prediabetes, losing 5–7% of body weight and being active for 150 minutes a week cut the chance of developing type 2 diabetes by more than half in a large US study.
Metformin is usually the first medicine. It lowers the amount of sugar the liver releases and helps the body use insulin better. Take metformin with meals – stomach upset and diarrhea are common at first and usually settle. Your doctor checks your kidney function before and during treatment.
Other medicines include GLP-1 receptor agonists, SGLT2 inhibitors and insulin. Whatever your treatment, regular checks of your A1C, eyes, feet, kidneys, blood pressure and cholesterol help prevent complications. PharmacyFarm dispenses metformin after our pharmacist has verified your prescription.
Low blood sugar (hypoglycemia)
Low blood sugar mainly affects people who take insulin or medicines called sulfonylureas (such as glipizide or glyburide). Metformin on its own rarely causes it. Blood sugar below 70 mg/dL is low. Signs include:
- Shakiness, sweating and a fast heartbeat
- Hunger, irritability or anxiety
- Dizziness, confusion or blurred vision
Use the 15-15 rule:
- Eat or drink 15 grams of fast-acting sugar – for example 4 glucose tablets (4 g each), or half a cup of juice or regular soda.
- Check your blood sugar again after 15 minutes.
- If it's still below 70 mg/dL, repeat.
- Once it's back to normal, eat a meal or snack to keep it steady.
Call 911 if someone with diabetes is too drowsy to swallow safely, passes out or has a seizure. Don't give them food or drink – use glucagon if they have it prescribed.
When to see a doctor
See a doctor if you have any of the early signs above, or risk factors and haven't been tested. Get urgent care for very high blood sugar with vomiting, deep or fast breathing, a fruity smell on the breath, extreme thirst or confusion.