Diabetes is a disease that's characterized by high blood sugar, which doctors refer to as hyperglycemia.
What makes type 2 diabetes different from type 1 diabetes, gestational diabetes, and other types of diabetes is the underlying cause of high blood sugar.
In type 2 diabetes, the two main contributors to high blood sugar are insulin resistance and reduced production of insulin by the pancreas.
Insulin resistance is a state in which the bodys cells do not use insulin efficiently. As a result, it takes more insulin than normal to transport glucose (the main type of sugar found in the bloodstream) into cells, where it can be used for fuel or stored for later use.
Its not entirely clear why some people develop insulin resistance and others dont. Obesity, which is the main risk factor for developing type 2 diabetes, is known to increase insulin resistance.
But not all people with type 2 diabetes are obese and not all obese people develop the condition so other issues such as genetics are contributing factors as well.
Insulin resistance develops over time, and as the body becomes more and more insulin resistant, the pancreas responds by releasing more and more insulin. This higher-than-normal level of insulin in the bloodstream is called hyperinsulinemia.
For a while, the pancreas may be able to keep up with the bodys increased need for insulin, and blood sugar levels may stay within the normal range about 70 to 100 mg/dl before meals and lower than 140 mg/dl after meals. Eventually, however, the pancreas can no longer keep up, and blood sugar levels begin to rise.
In the early stages, higher-than-normal blood sugar may cause no symptoms. But catching it early is important, because over time, high blood sugar can have negative effects on just about every part of the body.
Currently, the American Diabetes Association recommends that everyone get screened for diabetes beginning at age 45. People who have risk factors besides age (the risk of type 2 diabetes rises with age) should get screened earlier.
The two types of blood tests most commonly used to screen for type 2 diabetes: fasting plasma glucose test and the HbA1c test (also called the A1C test or the hemoglobin A1c test).
The fasting plasma glucose test requires fasting for 8 to 10 hours before blood is drawn. The test result shows the blood sugar level at the time the test was done. A result of 126 mg/dl or higher indicates diabetes. In a person with no other signs or symptoms of hyperglycemia, the test should be repeated on another day to confirm the diagnosis.
The HbA1c test does not require fasting before the test. The test result reflects the average blood sugar level in the blood over the previous two to three months. A test result of 6.5 percent or higher indicates diabetes.
Like the fasting plasma glucose test, in a person with no other signs or symptoms of hyperglycemia, the test should be repeated on another day to confirm the diagnosis.
Treatment for type 2 diabetes includes dietary changes, regular physical activity, and usually one or more blood-sugar-lowering drugs. Most people start with the oral diabetes drug metformin (Fortamet, Glucophage, Glucophage XR, Glumetza), then increase the dose of metformin or add other oral drugs as needed to maintain blood sugar control.
Several new injected drugs can also be effective at helping to control blood sugar.
Although type 2 diabetes used to be called non-insulin-dependent diabetes, many people with type 2 diabetes eventually need to use insulin for optimal blood sugar control. This occurs because the pancreas can no longer produce enough insulin to keep up, not because you dont try hard enough to control your blood sugar.
Everyones type 2 diabetes treatment is different and will likely change over time due to age and lifestyle choices.
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Because type 2 diabetes develops slowly, and symptoms generally come on gradually, they may go unnoticed for a long time, or they may be attributed to something else.
For example, increased thirst may be chalked up to a hot summer, or fatigue may be interpreted as a sign of aging or stress.
This is unfortunate, because even short-term high blood sugar diminishes your quality of life. And if high blood sugar persists for a long time, it can eventually cause complications such as eye or kidney disease that cannot be completely reversed with improved blood sugar control.
Type 2 diabetes can cause a wide range of signs and symptoms, including:
Frequent infections may also be a sign of type 2 diabetes. In women, vaginal yeast infections are particularly common. Yeast infections can also occur on the skin and, in men, in the groin.
Other infections associated with undiagnosed type 2 diabetes include gum infections, urinary tract infections (particularly in women), slowly healing wounds with subsequent infections, and infections of the feet.
All of the signs and symptoms of type 2 diabetes are caused by high blood sugar and/or insufficient insulin:
Excessive urination (polyuria): When the concentration of glucose in the blood rises above normal levels, your body attempts to dilute your blood by pulling fluid into your bloodstream. At the same time, the high level of glucose in the fluid entering your kidneys causes them to discharge large amounts of glucose as urine, rather than reabsorbing it into the body as they normally would. These two processes together result in large amounts of fluid being lost through urination.
Thirst (polydipsia): As the amount of urine being excreted increases, your body starts to feel dehydrated, prompting you to feel thirsty and drink more. If you reach for sugary drinks to quench your thirst, the problem becomes worse.
Dry mouth: Dry mouth goes hand in hand with increased thirst, as high blood sugar and excessive urination dehydrate your body.
Fatigue: Normally insulin allows glucose into the cells, where its used to fuel cellular functions and stored for future energy needs. If there is not enough insulin, not much glucose gets into your cells, and your body is literally running on empty. In addition, if excessive urination is interrupting your sleep, you may feel fatigued from lack of sleep.
Hunger (polyphagia): Similar to fatigue, hunger is caused when the glucose from food stays in your bloodstream rather than being transported to your cells where its needed for fuel. Eating more food doesnt help and, in fact, makes things worse by raising your blood sugar levels even higher.
Weight loss: When large amounts of glucose are being excreted in your urine, the calories that that glucose would have provided are being lost as well. The effect is the same as consuming fewer calories in the first place.
Blurry vision: Normally, the lens of your eye changes shape as you focus on objects that are nearby or far away. But when your blood sugar is high, your lens becomes swollen and unable to change shape to focus.
Infections: The bacteria and fungi that cause infections thrive on sugar, so more sugar means more food for them. In addition, high blood sugar slows blood circulation, meaning infection-fighting white blood cells cant get to where theyre needed as quickly.
Wounds that wont heal: High blood sugar impairs parts of your immune system that are needed for fighting infections and healing wounds. Wounds also need oxygen to heal, and any slowdown in your blood circulation slows oxygen delivery throughout your body.
Cloudy thinking: Your brain uses a lot of glucose to fuel its various functions, and when it cant get that glucose (because of insufficient insulin), the result can be difficulty thinking, remembering, and staying focused. You may even become disoriented.
The good news is that bringing blood sugar levels down to normal levels can alleviate all of these signs and symptoms. And the earlier these symptoms are noticed and the earlier a person can be tested for type 2 diabetes the better!
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Did you known that you have sugar in your bloodstream at all times? In fact, your blood sugar levels fluctuate over the course of the day.
Levels are higher right after meals (as carbohydrates are broken down into glucose and enter the bloodstream through the small intestine) and lower after exercise (when glucose has been burned to fuel the activity).
In someone who doesnt have diabetes, blood sugar levels stay within a narrow range. Between meals, the concentration of sugar in the blood ranges from about 60 to 100 mg/dl (milligrams per deciliter).
After meals it may reach 120 to 130 mg/dl, but rarely goes higher than 140 mg/dl.
But if you have type 2 diabetes, blood sugar levels can go much higher to 200, 300, or even 400 mg/dl and beyond and will go much higher unless you take the necessary steps to bring them down.
All types of diabetes are diagnosed on the basis of hyperglycemia. Several different types of blood tests may be used to make the diagnosis, including:
When screening for diabetes in a person with risk factors for type 2 diabetes, doctors generally order either a fasting plasma glucose test (which requires fasting for 8 to 10 hours) or an HbA1c test (which does not require fasting).
A fasting plasma glucose test result of 126 mg/dl or higher indicates diabetes, as does an HbA1c test result of 6.5 percent or higher.
A fasting plasma glucose test result between 100 and 125 mg/dl and an HbA1c test result between 5.7 percent and 6.4 percent indicate prediabetes, which is associated with a high risk of developing type 2 diabetes in the future.
A random glucose test may be done if you have signs or symptoms of diabetes. A test result of 200 mg/dl or higher suggests diabetes and should be confirmed with another diagnostic test on another day. (In fact, all the tests noted above should be confirmed on another day before making a diagnosis of diabetes or prediabetes).
Once youve been diagnosed with type 2 diabetes, a treatment plan is put in place to lower blood sugar and keep it as close to the normal range as possible.
But even after you start treatment, you may still develop hyperglycemia at times.
When you have diabetes, its almost impossible not to have hyperglycemia and high blood sugar can happen for no identifiable reason. Luckily, with enough detective work, a likely cause for high blood sugar can be found.
Some of the reasons blood sugar may go too high include:
Illness is another important and common cause of hyperglycemia. The stress of an illness (cold or flu), infection, or intense exercise can cause your body to release stress hormones, which raise blood sugar.
So even if you arent eating much because you feel sick, its still necessary to check blood sugar levels and take diabetes medicines.
You should also ask your doctor about how to take your diabetes medications if you arent eating properly. You may become hypoglycemic if you keep taking your medication without eating rightespecially sulfonylureas such as glipizide (Glucotrol), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl).
You may need to use insulin temporarily during an illness, even if its not part of your usual diabetes regimen.
This is why its especially important to work with your diabetes care team to develop a sick-day plan, which includes instructions and supplies for checking blood sugar levels, taking medicines and calling for help when necessary.
Extreme hyperglycemia can lead to hyperosmolar hyperglycemic state (HHS), which is a medical emergency that must be treated in a hospital.
In HHS, the blood sugar level exceeds 600 mg/dl and may reach as high as 2,000 mg/dl. The very high blood sugar level is accompanied by dehydration, and the blood literally becomes thick, as the sugar concentration rises and the water content decreases.
HHS usually develops over several days or even weeks. It can be prevented by checking your blood sugar level regularly and by treating very high levels by taking rapid-acting insulin and drinking water.
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Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel.
Type 2 diabetes occurs when the pancreas doesn't make enough insulin, or the cells of the body become resistant to insulin.
It's not known for certain why some people develop type 2 diabetes and some do not. There are several factors, however, that can increase a person's risk of developing type 2 diabetes.
Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes, says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels.
While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.
Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.
An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes.
This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.
Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes.
A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.
Sleep disturbances have been shown to affect the bodys balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes.
An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.
Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.
Scientists are only beginning to understand the genetics of diabetes. One thing that is known: Type 2 diabetes has a stronger genetic component than type 1 diabetes.
For example, in a family where one person has type 1 diabetes, there is a 1 in 25 chance that another family member will develop it. (The degree of risk varies depending on the relationship between family members.)
And if one identical twin has type 2 diabetes, the other twin has a very high chance of developing it; estimates range from 75 percent to 90 percent or higher.
If one parent has type 2 diabetes, his or her children have about a 15 percent to 20 percent chance of developing it in adulthood. And if both parents have it, their children have a 50 percent chance of developing it.
Researchers have also observed that certain ethnic or racial groups have a higher risk of type 2 diabetes than others. For example, African-Americans and Hispanic/Latino Americans have a higher risk of type 2 diabetes than white, Caucasian Americans.
Certain Native American groups also have a very high risk of developing type 2 diabetes. Among the Pima Indians of Arizona, for example, about 50 percent of tribe members have type 2 diabetes. Researchers have studied this group extensively to gain a better understanding of what conditions (genetic and otherwise) puts a person or group at risk of type 2 diabetes and of diabetes complications.
But type 2 diabetes is now such a common condition that having one or more family members who have it may or may not indicate a genetic predisposition for getting it.
Even among genetically related groups with very high rates of type 2 diabetes, environment and behavior do play a role.
For example, when Japanese people move to the United States and are exposed to a Western diet and lifestyle, the incidence of type 2 diabetes rises among that group. Their peers and family members who stay in Japan do not experience a rise in rates of type 2 diabetes.
Spouses of people with type 2 diabetes also have a higher risk of developing it. While theres rarely a genetic link, spouses do often share similar diets and lifestyles.
The positive message: Being genetically predisposed to type 2 diabetes doesnt mean that youll necessarily get it. But at the same time, not having a genetic predisposition does not prevent it either.
Whether or not you have a family history of type 2 diabetes, its important to be aware of modifiable risk factors, such as being overweight or having a sedentary lifestyle.
The study of genetics involves examining the structure and function of individual genes, as well as what happens when a gene is abnormal in any way.
So far, the gene abnormalities, or mutations, that scientists have identified as contributing to type 2 diabetes are all associated with beta-cell development (beta cells are the cells in the pancreas that produce insulin), beta-cell survival, or insulin production.
In the future, it may be possible to identify individuals at particularly high risk of type 2 diabetes by examining their genes. Even better, it may be possible to somehow change the functioning of these genes so that your risk decreases.
But gene therapy is still in its infancy, and it will be a long time before type 2 diabetes can be treated or prevented at a genetic level.
In the meantime, the most effective way to reduce your risk of type 2 diabetes is to lower your body weight (if youre overweight) and to maintain a healthy body weight for life.
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Obesity, or the state of having too much body fat, is a fast-growing problem: More than one-third of adults, almost 18 percent of children, and more than 20 percent of teenagers are now obese in the United States, according to the Centers for Disease Control and Prevention (CDC).
Obesity can also raise the risk of many health problems, including type 2 diabetes. In fact, its the number-one risk factor for type 2 diabetes.
Obesity is generally assessed using body mass index, or BMI, which takes both height and weight into account and is expressed in units of kg/m2 (kilograms per meter squared).
You can calculate your BMI by finding your weight in kilograms and your height in meters and plugging them into our online BMI calculator.
Note that children should use a different BMI calculator than adults. The CDC provides this calculator for children ages 2 through 19.
BMI levels for adults are categorized as follows:
BMI is fairly accurate at identifying adults as normal weight, overweight, or obese, with a few exceptions: It may overestimate body fat in muscular individuals such as athletes, and it may underestimate body fat in older people and others who have lost muscle mass.
The relative risk of developing type 2 diabetes begins to rise at a BMI of 25, and gets progressively higher as BMI increases.
However, in some ethnic groups, notably South Asians, the risk of type 2 diabetes has been found to start at a lower BMI than for the general American population. For this group, overweight and increased risk of type 2 diabetes begins at a BMI of 23.1.
BMI is not the only tool for assessing diabetes risk. In 2012, researchers in England reviewed data on more than 28,500 people enrolled in the EPIC (European Prospective Investigation into Cancer and Nutrition) study to see how waist circumference influenced the risk of developing type 2 diabetes.
Their findings included the following:
Unlike BMI, which reflects overall fatness, waist circumference gives a measure of the amount of visceral fat, or fat surrounding the abdominal organs. Abdominal fat (around the waistline) is strongly linked to type 2 diabetes.
Studies have shown that reducing body weight lowers the risk of type 2 diabetes. But obesity is a complex condition with genetic, environmental, and behavioral causes.
Losing weight and keeping it off is notoriously difficult. Its not impossible, though, and even a moderate amount of weight loss (such as 5 to 7 percent) has significant benefits. You can get started by reading about how to successfully lose weight.
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Type 2 diabetes is often called a lifestyle disease, because many of its risk factors are related to how people live. The good news: Those risk factors are modifiable, meaning you can take steps to change them.
One risk factor thats been getting attention lately is being sedentary, or spending prolonged amounts of time sitting.
Numerous studies have examined the effects of being sedentary. Some measure being sedentary by the daily number of hours spent sitting while others use the number of hours spent watching television every day.
In either case, the more hours spent being sedentary, the higher risk of chronic health problems, including higher blood sugar levels, higher levels of insulin resistance, obesity, type 2 diabetes, cardiovascular disease, cancer, and even an increased risk of death.
People who are sedentary also tend to spend less time outdoors, so they may have lower vitamin D levels than people who get out more. (The body makes its own vitamin D when skin is exposed to sunlight.)
Low vitamin D levels have been associated with a higher risk of type 2 diabetes, although it is not yet clear whether the vitamin D itself is the cause of the increased risk.
Physical activity is generally defined as any bodily movement produced by skeletal muscles that results in energy expenditure. Many health organizations currently recommend that most adults perform at least 30 minutes of physical activity daily.
The American College of Sports Medicine also recommends performing strength training (two to three times a week) and flexibility exercises and exercises that improve balance, such as tai chi (two to three times a week).
Following these recommendations may not be enough to improve health or prevent chronic disease, however, if you spend the rest of the day sitting. The simple solution:
Get up and move more.
Unfortunately, the American way of life encourages being sedentary with its increased use of computers, for both work and entertainment; fewer physically active jobs; and cities and rural areas that are difficult to navigate on foot or by bicycle.
So what should you do to push back against this trend and get more active?
People are more inclined to engage in activities they perceive as pleasurable, so get adventurous and find the ones you most enjoy. Youll likely love those mini-breaks and being more active, and youll be taking the right steps toward reducing your risk of type 2 diabetes and improving your overall health.
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According to the International Diabetes Federation, about 382 million people worldwide are currently living with diabetes, and the figure is projected to rise to 592 million in 2035.
In the United States alone, more than 24 million American adults are living with diabetes, and another 79 million have elevated blood sugar levels.
In the face of these growing numbers, you may be wondering what your personal type 2 diabetes risk is.
There are several risk factors that can affect the likelihood of your having type 2 diabetes at some point in your life. These include:
Metabolic syndrome is a disorder that typically involves a group of factors such as high blood pressure, obesity, and high blood sugar which are linked to an increased risk of heart disease and type 2 diabetes.
People with metabolic syndrome (also called insulin resistance syndrome or syndrome X) are twice as likely to develop heart disease and five times more likely to develop type 2 diabetes.
Metabolic syndrome is not well-defined, says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Its a little bit more than prediabetes, says Dr. Fonseca, but metabolic syndrome has several other components to it, including high blood pressure and cholesterol problems. "Much of it is linked with obesity, says Fonseca.
Metabolic syndrome is diagnosed when a patient has at least three of these risk factors:
Metabolic syndrome is linked to insulin resistance, which means that your body is not able to use insulin properly to remove blood sugar from your blood. This is what causes high blood sugar levels in many people who go on to develop type 2 diabetes.
Close to one in four adults in the United States has metabolic syndrome. However, the good news is that metabolic syndrome can be prevented by making changes in diet and exercise habits.
Furthermore, for people already diagnosed with metabolic syndrome, making appropriate lifestyle changes can prevent it from turning into diabetes.
Research in more than 1,500 people with high fasting blood sugar (but without actual diabetes) who participated in a study called the Diabetes Prevention Program (DPP) indicates that the same weight-reducing changes in diet and lifestyle that prevent type 2 diabetes also cut the risk of developing metabolic syndrome.
Study participants who ate a low-fat, calorie-controlled diet and got at least 30 minutes of exercise most days of the week cut their risk of developing metabolic syndrome by 41 percent.
One third of the subjects in the DPP study were given metformin (Glucophage), a medication that controls blood sugar. After three years, these patients were also at lower risk of developing metabolic syndrome, although lifestyle changes had a greater impact.
Fortunately, many of the factors that contribute to the development of diabetes and metabolic syndrome can be controlled. Here are five steps you can take to prevent diabetes and metabolic syndrome:
Prediabetes is a state in which blood sugar levels are higher than normal but not high enough for a diagnosis of diabetes.
Prediabetes is also referred to as impaired fasting glucose or impaired glucose tolerance, depending on the blood test used to make the diagnosis.
The Centers for Disease Control and Prevention (CDC) estimates that one of every three adults in the United States or 79 million Americans age 20 or older had prediabetes in 2010. And the majority of these people didnt even know they had it.
The risk factors for prediabetes are largely the same as those for type 2 diabetes:
Prediabetes generally has no signs or symptoms. One of the few possible signs is acanthosis nigricans, which is a darkening of the skin in places such as the neck, armpits, elbows, knees, and knuckles. If you notice such skin changes, its a good idea to get them checked out by a doctor.
Prediabetes may be discovered by chance if you undergo a routine blood test (at any age) or routine screening for type 2 diabetes (at age 45). Or it may be discovered if you have risk factors for prediabetes and type 2 diabetes and your doctor orders a screening test.
The tests used to screen for prediabetes are the same as those used to screen for type 2 diabetes: the fasting plasma glucose test and the A1C test (also called the HbA1c test or the hemoglobin A1c test).
A fasting plasma glucose test result between 100 and 125 mg/dl and an HbA1c test result between 5.7 percent and 6.4 percent indicate prediabetes.
The oral glucose tolerance test (OGTT), which involves fasting overnight, then drinking a glucose solution and having blood sugar measured one hour and two hours afterward, is sometimes used to diagnose prediabetes, though its generally used only to screen for gestational diabetes because its more time-consuming and expensive than other tests.
The goal of treating prediabetes is to prevent or delay the onset of type 2 diabetes - and its possible, according to the landmark Diabetes Prevention Program (DPP) study, which examined the effects of modest weight loss through dietary changes and increased physical activity on people who are overweight and have prediabetes.
The DPP study enrolled 3,234 adults from 27 clinical centers around the United States; 45 percent of participants were members of racial or ethnic minority groups. Participants who received intensive counseling and motivational support for improving their diets and being physically active reduced their risk of developing diabetes by 58 percent.
The methodology of the DPP has been adopted by the YMCAs Diabetes Prevention Program, which is currently being implemented at participating Ys across the United States, as well as other sites.
That means many of the 79 million Americans with prediabetes now have access to an affordable - and proven - way of managing their prediabetes and preventing or delaying type 2 diabetes.
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Experts believe the number of people living with diabetes will rise dramatically over the next 40 years.
If current trends continue, according to the Centers for Disease Control and Prevention (CDC), as many as one in three adults could have the disease by 2050.
And about 79 million American adults now have prediabetes, a condition marked by above-normal blood sugar levels that arent high enough to be diagnosed as type 2 diabetes.
If theres a silver lining to these alarming statistics, its that theres plenty you can do to prevent the disease or slow the progression, including eating a balanced diet.
Everyone can benefit from a healthy eating plan aimed at containing prediabetes, regardless of whether youre at high risk for developing type 2 diabetes, says Barbara Borcik, RD, LDN, CDE, of the Diabetes & Nutrition Center at Northwest Hospital in Randallstown, Md.
Here are seven sound diet principles that can keep your blood sugars from creeping upward, among other health benefits.
A prediabetes regimen also includes regular exercise, both aerobics and strength training, to help you get to a healthy weight and maintain it once youre there, says Borcik. Plan for at least 30 minutes a day.
Borcik also suggests sneaking exercise into your daily activities by parking farther from the entrance at the mall or your office building, using the stairs instead of elevators, and taking a walk around your workplace at lunchtime.
The best way to prevent type 2 diabetes is to follow a healthy lifestyle, which includes making smart food choices. If your diet could use a makeover, dont wait until your doctor sounds the prediabetes alarm to make changes. An ounce of prevention is worth a pound of cure.
Type 2 diabetes is present when your levels of blood sugar (glucose) are higher than normal. In order to test for diabetes, your doctor will send you to a lab so a blood sample can be tested.
There are three types of tests that can help determine whether you have diabetes.
This test is conducted on blood drawn after you have not eaten for about eight hours. The blood is normally drawn in the morning before breakfast.
This test can help diagnose diabetes and prediabetes a situation in which your glucose levels are high, but theyre not quite at diagnostic level.
How high your blood sugar levels are indicates whether you have diabetes:
The OGTT test is also performed after you have not eaten for about eight hours. The technician will take a sample of your blood and then give you a prepared sugary drink containing 75 mg of glucose. After you drink it, your blood will be taken again in two hours, to measure how your insulin responded to that drink.
This test also can diagnose diabetes and prediabetes. Possible results are:
This test may be done at any time to measure blood sugar levels. It is not accurate enough to diagnose prediabetes, but it can lead to a diabetes diagnosis if your blood sugar is at least 200 mg/dL and there are other symptoms such as:
Another type of blood sugar test that's used to diagnose type 2 diabetes is the hemoglobin A1C test. This test estimates how well your glucose levels have been controlled over a period of time.
The A1C is a good indicator of your average glucose over the past three months, says Vivian Fonseca, MD, chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
People with diabetes should get their A1C test results at least twice a year because this is the best measure of blood sugar control.
Your doctor may want you to repeat any of the above tests to confirm your results. People whose results indicate prediabetes have a 40 percent risk of developing diabetes within five years if they do not make changes to their lifestyle and overall health.
Unfortunately, you cannot feel your blood sugar levels rise. The only way to know whether you have prediabetes or diabetes for sure is to get a blood test.
The problem, says Dr. Fonseca, is that diabetes in its early stages has no symptoms, and can do continual damage over the years.
There are other tests you should have to find out about your risk factors for diabetes or the impact of high blood sugar on your health, including:
Getting tested to find out your blood sugar levels will give you the information you need to prevent or control type 2 diabetes.
The A1C test also referred to as the HbA1c test, the hemoglobin A1c test, and the glycated (or glycosylated) hemoglobin test is an important tool for diagnosing and managing diabetes.
The test measures the percentage of hemoglobin molecules in your blood that have glucose molecules attached to them.
That percentage provides an estimate of your average blood sugar level over the past two to three months, which can be used as an indicator of diabetes. The higher the percentage, the more likely you are to be diagnosed with diabetes.
The A1C test can be done with blood taken from a vein or a fingerprick.
Hemoglobin is the molecule in red blood cells that carries oxygen and causes those blood cells to look red.
Over the lifespan of a red blood cell, which is about four months, the hemoglobin in the cell binds to glucose molecules, or becomes glycated.
The higher the glucose concentration in the blood, the more hemoglobin that becomes glycated.
For monitoring diabetes control, the American Diabetes Association (ADA) makes these recommendations:
In 2009, an international expert committee recommended that the A1C test be used for the diagnosis of type 2 diabetes and prediabetes, and in 2010, the ADA adopted that recommendation.
In its new diagnostic role, the A1C test is not intended to completely replace the fasting plasma glucose test or the oral glucose tolerance test (OGTT), which still may be preferred in certain circumstances.
However, some of the benefits of using the A1C test for diagnosis include the following:
The A1C test also has certain limitations as a diagnostic test:
When the A1C test is used to diagnose diabetes, the results are interpreted as follows:
When the A1C test is used to monitor diabetes control, the general recommendation for adults is to aim for an A1C lower than 7 percent. This level has been associated with a lower risk of long-term diabetes complications. The risk of these complications rises significantly with an A1C above 9 percent.
However, each persons A1C target should be individualized. For example, hypoglycemia (low blood sugar) can be particularly dangerous for an elderly person, so a higher AIC level may be recommended.
Discuss your A1C target and how to best achieve it with your healthcare provider.
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The random plasma glucose test is a blood test that measures the amount of glucose in your blood at a random time, without regard to when you last ate.
Also called a casual plasma glucose test, the procedure measures blood glucose in milligrams per deciliter (mg/dl), a useful measurement when checking for diabetes.
A doctor is most likely to order a random plasma glucose test when a person has signs or symptoms of diabetes, including:
The random plasma glucose test is done by drawing blood from a vein, then sending the blood sample to a lab for processing.
In the lab, the sample is spun in a centrifuge to separate the blood cells and platelets from the liquid part of the blood, called the plasma. The concentration of glucose is then measured in the plasma.
How quickly test results are ready depends on where the test is done. If its done in a hospital, the results may be ready within an hour or two. If blood is drawn at a doctors office, then sent to a laboratory, results may not be available for a day or two.
People who dont have diabetes rarely have blood glucose concentrations higher than 140 mg/dl, even after eating.
A random plasma glucose test result of 200 mg/dl or higher in a person who also has signs or symptoms of diabetes usually means the person has diabetes.
However, the diagnosis is generally confirmed with a fasting plasma glucose test, an oral glucose tolerance test (OGTT), or a hemoglobin A1C test. (Diagnosis by A1C is now commonplace, since the OGTT is too cumbersome for patients and doctors in primary care.)
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A fasting plasma glucose (FPG) test measures the concentration of glucose in the blood following an eight-hour (or longer) fast. The test is used to screen for diabetes and prediabetes.
The FPG is not generally used to screen for gestational diabetes. For that condition, the oral glucose tolerance test (OGTT) is preferred. However, a pregnant woman may be screened with the FPG at her first prenatal visit to see whether she has prediabetes or type 2 diabetes.
For the FPG test, blood is drawn from a vein and the sample is then spun in a centrifuge to separate the blood cells and platelets from the plasma, or liquid portion of the blood. The concentration of glucose is then measured in the plasma.
For accurate results, you must fast for at least eight hours before blood is drawn. Eating or drinking will change the test results, possibly indicating a problem where there isnt one.
The results of an FPG test, expressed in milligrams per deciliter (mg/dl), are interpreted as follows:
In a person with no signs or symptoms of diabetes, a test result of 126 mg/dl or higher should be confirmed with another FPG test on another day.
Similarly, in a person with signs or symptoms of diabetes and a normal FPG result, an OGTT may be ordered to see if that person may be experiencing high blood sugar after meals.
The FPG does not differentiate between types of diabetes. For that, a doctor typically relies on the signs, symptoms, typical characteristics of people with type 1 or type 2 diabetes, and family history.
Your healthcare provider may also order other blood tests to detect whether an autoimmune process is taking place, which is an indicator of type 1 diabetes.
Since 1997, an FPG result of 126 mg/dl or higher has been the diagnostic threshold for diabetes. But from 1979 until 1997, the diagnostic threshold was 140 mg/dl. Why the change?
The change from 140 mg/dl to 126 mg/dl stemmed largely from research studies showing that the incidence of retinopathy a form of diabetes-related eye disease increased at a fasting blood sugar level of 126 mg/dl (though doctors generally use the A1C test as a marker for potential complications such as retinopathy, neuropathy and kidney impairment).
The point at which high blood sugar causes noticeable symptoms varies from person to person, but symptoms typically include:
As researchers continue to conduct studies that examine when high blood sugar begins to have damaging effects, its possible that the diagnostic standards will change again.
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