People usually develop type 2 diabetes after the age of 40 years, although people of South Asian origin are at an increased risk of the condition and may develop diabetes from the age of 25 onwards. The condition is also becoming increasingly common among children and adolescents across all populations. Type 2 diabetes often develops as a result of overweight, obesity and lack of physical activity and diabetes prevalence is on the rise worldwide as these problems become more widespread.


When you have diabetes, it’s important to avoid eating many packaged, processed snacks such as cookies, chips, cake, granola bars, and the like, in lieu of fresh, whole foods, like fiber-rich fruits, veggies, and whole grains. (27) Eating foods high in fiber can help keep blood sugar levels steady and fill you up, potentially promoting weight loss and improving insulin sensitivity. (28)
Although there are dozens of known type 1 genes, about half of the risk attributable to heredity comes from a handful that coordinate a part of the immune system called HLA, which helps the body recognize nefarious foreign invaders, such as viruses, bacteria, and parasites. Type 1 diabetes is an autoimmune disease, in which the body's own immune system destroys the cells in the pancreas that produce insulin, so perhaps it is no surprise that immunity genes are involved. Other autoimmune diseases share the HLA gene link, which may be why people with type 1 are more likely to develop additional auto­immune disorders.
Watch for thirst or a very dry mouth, frequent urination, vomiting, shortness of breath, fatigue and fruity-smelling breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes but can sometimes occur in people with type 2 diabetes.
Treatment of pituitary diabetes insipidus consists of administration of vasopressin. A synthetic analogue of vasopressin (DDAVP) can be administered as a nasal spray, providing antidiuretic activity for 8 to 20 hours, and is currently the drug of choice. Patient care includes instruction in self-administration of the drug, its expected action, symptoms that indicate a need to adjust the dosage, and the importance of follow-up visits. Patients with this condition should wear some form of medical identification at all times.

DKA usually follows increasing hyperglycemia and symptoms of osmotic diuresis. Users of insulin pumps, by virtue of absent reservoirs of subcutaneous insulin, may present with ketosis and more normal blood glucose levels. They are more likely to present with nausea, vomiting, and abdominal pain, symptoms similar to food poisoning. DKA may manifest as respiratory distress.


Know Your Numbers: Knowing your ABCs—A1c, blood pressure, and cholesterol—are important in reducing your risk for diabetes and keeping your diabetes in good control. If you are someone with diabetes who has elevated blood pressure or cholesterol, you are increasing your risk of heart attack and stroke. Your physician will give you your A1c, blood pressure, and cholesterol targets. Make sure you pay attention to them and understand what they mean and why they are important.

Type 2 diabetes was also previously referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult-onset diabetes mellitus (AODM). In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's needs, particularly in the face of insulin resistance as discussed above. In many cases this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells).
To explain what hemoglobin A1c is, think in simple terms. Sugar sticks, and when it's around for a long time, it's harder to get it off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die off. When sugar sticks to these hemoglobin proteins in these cells, it is known as glycosylated hemoglobin or hemoglobin A1c (HBA1c). Measurement of HBA1c gives us an idea of how much sugar is present in the bloodstream for the preceding three months. In most labs, the normal range is 4%-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0% (optimal is <6.5%). The benefits of measuring A1c is that is gives a more reasonable and stable view of what's happening over the course of time (three months), and the value does not vary as much as finger stick blood sugar measurements. There is a direct correlation between A1c levels and average blood sugar levels as follows.

Indigestion (dyspepsia) can be caused by diseases or conditions that involve the gastrointestinal (GI) tract, and also by some diseases and conditions that do not involve the GI tract. Indigestion can be a chronic condition in which the symptoms fluctuate infrequency and intensity. Signs and symptoms that accompany indigestion include pain in the chest, upper abdominal pain, belching, nausea, bloating, abdominal distention, feeling full after eating only a small portion of food, and rarely, vomiting.


Diabetic ketoacidosis can be caused by infections, stress, or trauma, all of which may increase insulin requirements. In addition, missing doses of insulin is also an obvious risk factor for developing diabetic ketoacidosis. Urgent treatment of diabetic ketoacidosis involves the intravenous administration of fluid, electrolytes, and insulin, usually in a hospital intensive care unit. Dehydration can be very severe, and it is not unusual to need to replace 6-7 liters of fluid when a person presents in diabetic ketoacidosis. Antibiotics are given for infections. With treatment, abnormal blood sugar levels, ketone production, acidosis, and dehydration can be reversed rapidly, and patients can recover remarkably well.

This depends on the type of diabetes. Type 2 diabetes, and to a lesser extent type 1 diabetes, may run in families. If a parent has diabetes, their children will not necessarily get it but they are at an increased risk. In type 2 diabetes, lifestyle factors such as being overweight (obesity) and lack of exercise can significantly increase your risk of developing diabetes. Some rarer types of diabetes mellitus may be inherited.
What is hypoglycemia? A blood sugar level of under 70 mg/dl (3.9 mmol/l) is typically considered hypoglycemia (low blood sugar), and can result in irritability, confusion, seizures, and even unconsciousness for extreme lows. To correct hypoglycemia, patients commonly use fast-acting carbohydrates. In extreme cases of severe hypoglycemia, a glucagon injection pen can be used. According to the Mayo Clinic, symptoms of hypoglycemia are:
Knowledge is power. A certified diabetes educator can provide you with diabetes self-management education. They specialize in diabetes and can help you learn about complicated or easier things. For example, they can help you set up your glucose meter, teach you about how your medicines work, or help you put together a meal plan. You can meet with them one on one or in group setting.
Environmental factors are important, because even identical twins have only a 30-60% concordance for type 1 diabetes mellitus and because incidence rates vary in genetically similar populations under different living conditions. [25] No single factor has been identified, but infections and diet are considered the 2 most likely environmental candidates.
Large, population-based studies in China, Finland and USA have recently demonstrated the feasibility of preventing, or delaying, the onset of diabetes in overweight subjects with mild glucose intolerance (IGT). The studies suggest that even moderate reduction in weight and only half an hour of walking each day reduced the incidence of diabetes by more than one half.
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The glucose level at which symptoms develop varies greatly from individual to individual (and from time to time in the same individual), depending in part on the duration of diabetes, the frequency of hypoglycemic episodes, the rate of fall of glycemia, and overall control. (Glucose is also the sole energy source for erythrocytes and the kidney medulla.)
Patients with type 2 diabetes can still make insulin, but not enough to control their glucose levels. Type 2 diabetes is therefore initially treated with a combination of lifestyle changes (diet and exercise) which reduce the need for insulin and therefore lower glucose levels. If this is insufficient to achieve good glucose control, a range of tablets are available. These include metformin and pioglitazone, which, like diet and exercise, reduce insulin requirements; sulphonylureas (e.g. gliclazide), which stimulate insulin secretion; DPP4 inhibitors (e.g sitagliptin) and GLP-1 agonists (e.g. liraglutide), which stimulate insulin production and reduce appetite; and SGLT2 inhibitors (e.g. dapagliflozin), which lower blood sugar levels by causing sugar to pass out of the body in the urine. In many patients, particularly after several years of treatment, insulin production is so low or so insufficient compared with the patient's needs that patients with type 2 diabetes have to be treated with insulin injections, either alone or in combination with tablets.
In the exchange system, foods are divided into six food groups (starch, meat, vegetable, fruit, milk, and fat) and the patient is taught to select items from each food group as ordered. Items in each group may be exchanged for each other in specified portions. The patient should avoid concentrated sweets and should increase fiber in the diet. Special dietetic foods are not necessary. Patient teaching should emphasize that a diabetic diet is a healthy diet that all members of the family can follow.

Unlike many health conditions, diabetes is managed mostly by you, with support from your health care team (including your primary care doctor, foot doctor, dentist, eye doctor, registered dietitian nutritionist, diabetes educator, and pharmacist), family, and other important people in your life. Managing diabetes can be challenging, but everything you do to improve your health is worth it!
In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.
The beta cells may be another place where gene-environment interactions come into play, as suggested by the previously mentioned studies that link beta cell genes with type 2. "Only a fraction of people with insulin resistance go on to develop type 2 diabetes," says Shulman. If beta cells can produce enough insulin to overcome insulin resistance, a factor that may be genetically predetermined, then a person can stay free of diabetes. But if the beta cells don't have good genes propping them up, then diabetes is the more likely outcome in a person with substantial insulin resistance.

There is evidence that certain emotions can promote type 2 diabetes. A recent study found that depression seems to predispose people to diabetes. Other research has tied emotional stress to diabetes, though the link hasn't been proved. Researchers speculate that the emotional connection may have to do with the hormone cortisol, which floods the body during periods of stress. Cortisol sends glucose to the blood, where it can fuel a fight-or-flight response, but overuse of this system may lead to dysfunction.

Type 2 diabetes is a progressive, chronic disease related to your body's challenges with regulating blood sugar. It is often associated with generalized inflammation. Your pancreas produces the hormone insulin to convert sugar (glucose) to energy that you either use immediately or store. With type 2 diabetes, you are unable to use that insulin efficiently. Although your body produces the hormone, either there isn't enough of it to keep up with the amount of glucose in your system, or the insulin being produced isn't being used as well as it should be, both of which result in high blood sugar levels.


Hypoglycemia means abnormally low blood sugar (glucose). In patients with diabetes, the most common cause of low blood sugar is excessive use of insulin or other glucose-lowering medications, to lower the blood sugar level in diabetic patients in the presence of a delayed or absent meal. When low blood sugar levels occur because of too much insulin, it is called an insulin reaction. Sometimes, low blood sugar can be the result of an insufficient caloric intake or sudden excessive physical exertion.
Patients with type 2 diabetes can still make insulin, but not enough to control their glucose levels. Type 2 diabetes is therefore initially treated with a combination of lifestyle changes (diet and exercise) which reduce the need for insulin and therefore lower glucose levels. If this is insufficient to achieve good glucose control, a range of tablets are available. These include metformin and pioglitazone, which, like diet and exercise, reduce insulin requirements; sulphonylureas (e.g. gliclazide), which stimulate insulin secretion; DPP4 inhibitors (e.g sitagliptin) and GLP-1 agonists (e.g. liraglutide), which stimulate insulin production and reduce appetite; and SGLT2 inhibitors (e.g. dapagliflozin), which lower blood sugar levels by causing sugar to pass out of the body in the urine. In many patients, particularly after several years of treatment, insulin production is so low or so insufficient compared with the patient's needs that patients with type 2 diabetes have to be treated with insulin injections, either alone or in combination with tablets.

Feeling famished all the time? Your body could be trying to tell you that something’s up with your blood sugar. Many people with diabetes experience extreme hunger when their condition is unmanaged, thanks to high blood sugar levels. When your body can’t effectively convert the sugar in your blood into usable energy, this may leave you pining for every sandwich or sweet you see. And if you’re looking for a filling snack that won’t put your health at risk, enjoy one of the 25 Best and Worst Low-Sugar Protein Bars!


Nerve damage from diabetes is called diabetic neuropathy and is also caused by disease of small blood vessels. In essence, the blood flow to the nerves is limited, leaving the nerves without blood flow, and they get damaged or die as a result (a term known as ischemia). Symptoms of diabetic nerve damage include numbness, burning, and aching of the feet and lower extremities. When the nerve disease causes a complete loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to properly protect them. Shoes or other protection should be worn as much as possible. Seemingly minor skin injuries should be attended to promptly to avoid serious infections. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating surgical amputation of toes, feet, and other infected parts.
Occasionally, a child with hypoglycemic coma may not recover within 10 minutes, despite appropriate therapy. Under no circumstances should further treatment be given, especially intravenous glucose, until the blood glucose level is checked and still found to be subnormal. Overtreatment of hypoglycemia can lead to cerebral edema and death. If coma persists, seek other causes.

Being too heavy gets the bulk of the blame for triggering type 2 diabetes. According to the National Institutes of Health, about 85 percent of people with type 2 diabetes are overweight or obese. But consider that the remaining 15 percent are not. Consider, too, that roughly two-thirds of overweight people and a third of those who are obese will never develop diabetes. In other words, normal-weight and thin people also develop type 2, while heavy people won't necessarily. Clearly, there is more to the connection between lifestyle and type 2 diabetes than just body size.
Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, the insulin their pancreas secretes is either not enough or the body is unable to recognize the insulin and use it properly (insulin resistance). When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells and builds up in the bloodstream instead. When glucose builds up in the blood instead of going into cells, it causes damage in multiple areas of the body. Also, since cells aren't getting the glucose they need, they can't function properly.
Type 2 diabetes (formerly named non-insulin-dependent) which results from the body's inability to respond properly to the action of insulin produced by the pancreas. Type 2 diabetes is much more common and accounts for around 90% of all diabetes cases worldwide. It occurs most frequently in adults, but is being noted increasingly in adolescents as well.

Persons with diabetes are prone to infection, delayed healing, and vascular disease. The ease with which poorly controlled diabetic persons develop an infection is thought to be due in part to decreased chemotaxis of leukocytes, abnormal phagocyte function, and diminished blood supply because of atherosclerotic changes in the blood vessels. An impaired blood supply means a deficit in the protective defensive cells transported in the blood. Excessive glucose allows organisms to grow out of control.
The Diabetes Control and Complications Trial (DCCT) was a clinical study conducted by the United States National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that was published in the New England Journal of Medicine in 1993. Test subjects all had diabetes mellitus type 1 and were randomized to a tight glycemic arm and a control arm with the standard of care at the time; people were followed for an average of seven years, and people in the treatment had dramatically lower rates of diabetic complications. It was as a landmark study at the time, and significantly changed the management of all forms of diabetes.[86][130][131]

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Jump up ^ Haw, JS; Galaviz, KI; Straus, AN; Kowalski, AJ; Magee, MJ; Weber, MB; Wei, J; Narayan, KMV; Ali, MK (6 November 2017). "Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials". JAMA Internal Medicine. 177 (12): 1808–17. doi:10.1001/jamainternmed.2017.6040. PMID 29114778.
When you have diabetes, your body becomes less efficient at breaking food down into sugar, so you have more sugar sitting in your bloodstream, says Dobbins. “Your body gets rid of it by flushing it out in the urine.” So going to the bathroom a lot could be one of the diabetes symptoms you’re missing. Most patients aren’t necessarily aware of how often they use the bathroom, says Dr. Cypess. “When we ask about it, we often hear, ‘Oh yeah, I guess I’m going more often than I used to,’” he says. But one red flag is whether the need to urinate keeps you up at night. Once or twice might be normal, but if it’s affecting your ability to sleep, that could be a diabetes symptom to pay attention to. Make sure you know these diabetes myths that could sabotage your health.

Jump up ^ Picot, J; Jones, J; Colquitt, JL; Gospodarevskaya, E; Loveman, E; Baxter, L; Clegg, AJ (September 2009). "The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation". Health Technology Assessment. Winchester, England. 13 (41): iii–iv, 1–190, 215–357. doi:10.3310/hta13410. PMID 19726018.


1. Monitoring of blood glucose status. In the past, urine testing was an integral part of the management of diabetes, but it has largely been replaced in recent years by self monitoring of blood glucose. Reasons for this are that blood testing is more accurate, glucose in the urine shows up only after the blood sugar level is high, and individual renal thresholds vary greatly and can change when certain medications are taken. As a person grows older and the kidney is less able to eliminate sugar in the urine, the renal threshold rises and less sugar is spilled into the urine. The position statement of the American Diabetes Association on Tests of Glycemia in Diabetes notes that urine testing still plays a role in monitoring in type 1 and gestational diabetes, and in pregnancy with pre-existing diabetes, as a way to test for ketones. All people with diabetes should test for ketones during times of acute illness or stress and when blood glucose levels are consistently elevated.
A type 2 diabetes diet or a type 2 diabetic diet is important for blood sugar (glucose) control in people with diabetes to prevent complications of diabetes. There are a variety of type 2 diabetes diet eating plans such as the Mediterranean diet, Paleo diet, ADA Diabetes Diet, and vegetarian diets.Learn about low and high glycemic index foods, what foods to eat, and what foods to avoid if you have type 2 diabetes.
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