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What Is Type 2 Diabetes?

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Type 2 diabetes is a chronic disease that happens when you have too much sugar in your bloodstream. It’s often caused by problems with the way the body creates and uses the hormone insulin, which helps cells access sugar for energy.

Most often, type 2 diabetes stems from factors like poor diet, a sedentary lifestyle, obesity, age, and genetics. These factors and others exacerbate insulin resistance, where your pancreas (the organ that produces insulin) cannot keep up with your body’s insulin demands.

 This results in high blood sugar, which, if left untreated, can lead to long-term complications such as heart attack, amputation, blindness, kidney failure, and more.

While type 2 diabetes cannot be cured, it’s very treatable. Checking blood sugar levels often, implementing healthy habits, and taking certain medications can all help keep blood sugar concentrations within a safe range.

Signs and Symptoms of Type 2 Diabetes

Type 2 diabetes doesn’t always have symptoms, at least not initially. Many people are diagnosed with the disease during routine checkups and blood tests.

Still, you should be aware of the symptoms and warning signs of high blood sugar, including:

  • Frequent urination and extreme thirst
  • Unexplained weight loss (sometimes despite increased hunger)
  • Blurry vision
  • Confusion, irritability, or fatigue
  • Burning, tingling, or numbness in the hands or feet
  • Wounds that heal slowly or not al all
  • Recurrent yeast infections

These symptoms can develop quickly or gradually, and should be evaluated by a healthcare professional.

Causes and Risk Factors of Type 2 Diabetes

Type 2 diabetes is considered a multifactorial disease — it has multiple interrelated causes. Some of these risk factors can be altered through lifestyle changes, and some cannot.

Here are some of the most common risk factors for type 2 diabetes that can be improved with lifestyle modifications.

  • Overweight and Obesity Excess body weight can cause the pancreas to malfunction and lead to insulin resistance (the cell’s inability to use insulin properly) throughout the body, which is strongly associated with type 2 diabetes risk.

  • Poor Eating Habits A diet that's high in calorie-dense processed foods and beverages, and low in wholesome nutrient-rich foods, can significantly increase your risk of type 2 diabetes.

  • Lack of Exercise Too much time sitting down, whether for work or leisure, is associated with the development of type 2 diabetes, but physical activity of any intensity level greatly reduces the risk.

  • Poor Sleep Getting too little, too much, or irregular sleep can affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas.

  • Smoking Not only does smoking cigarettes increase the risk of type 2 diabetes by 30 to 40 percent, it also makes the disease more difficult to manage.

  • Steroids These common drugs provoke high blood sugar.

Some of the most significant risk factors, however, cannot be modified:

  • Genetics Type 2 diabetes has a powerful genetic component. If you have a strong family history of diabetes, you may be more likely to develop the condition.

  • Older Age The older you get, the more likely you are to develop type 2 diabetes.

  • Race or Ethnicity In the U.S., Indigenous people, Alaskan Natives, and people from Black and Hispanic communities are more likely to develop type 2 diabetes, though many experts believe this is primarily due to socioeconomic rather than genetic factors.

  • Polycystic Ovary Syndrome (PCOS) Women with PCOS, a hormone imbalance disorder experienced before menopause, often have insulin resistance, a root cause of type 2 diabetes.

  • Previous Gestational Diabetes Women who develop gestational diabetes during pregnancy are far more likely to later develop type 2 diabetes.

If you have some of these risk factors, it doesn’t necessarily mean you will develop type 2 diabetes. At the same time, you don’t need to have every risk factor for type 2 diabetes to develop the condition. Children and teens can develop type 2 diabetes, as can people who do not have overweight or obesity or who have no family history of the condition.

How Is Type 2 Diabetes Diagnosed?

Tests for type 2 diabetes are straightforward and can be part of a regular checkup. Two of the more common ways to test for diabetes are the A1C test, which estimates your average blood sugar level of the previous few months, and the fasting glucose test, which measures your current blood sugar level before you eat a meal or snack:

  • An A1C result of 6.5 percent or higher may indicate that you have diabetes.
  • A fasting blood sugar level of 126 milligrams per deciliter (mg/dL) or higher may indicate diabetes.
Clinicians have other testing options, too, including glucose tolerance tests and random blood sugar measurements. If you don’t have any obvious symptoms of diabetes, your doctor may wish to run a second test to confirm a diagnosis.

Lifestyle Changes and Prevention of Type 2 Diabetes

Type 2 diabetes treatment always begins with lifestyle change. Even the most powerful diabetes drugs are prescribed to be used in addition to healthy behaviors such as improved nutrition and physical activity. The same healthy habits are also critical for the treatment of prediabetes and the prevention of type 2 diabetes.

Type 2 Diabetes Diet: What Can You Eat?

There is no single recommended diabetes diet — many different eating patterns can work for people with diabetes. That said, the American Diabetes Association has found that the best diabetes diets tend to agree on the following recommendations:

  • Eat plenty of nonstarchy vegetables.
  • Eat less sugar and refined grains.
  • Choose whole, minimally processed foods rather than packaged and processed foods.
Several different eating patterns can be easily designed to fit the above recommendations, including the Mediterranean diet, low-carb and ketogenic diets, the DASH diet for hypertension, and vegan and plant-based diets.

Limit your consumption of packaged, ultra-processed starchy foods such as cookies, cake, and granola bars. Instead, choose fresh, whole foods rich in fiber, like fruits, vegetables, and whole grains. Replace bread and pasta made with refined white flour with whole-grain alternatives. Foods high in fiber can also help slow digestion, keeping blood sugar levels steady and helping you feel full sooner.

An additional factor to keep in mind is carbohydrate content. While most nutrition authorities agree that people with type 2 diabetes can and should enjoy nutritious high-carbohydrate foods such as fresh fruit and whole grains, carbohydrate restriction may be the most reliable way to reduce blood sugar levels.

If you’re taking medications that carry a risk of hypoglycemia (low blood sugar), such as insulin and sulfonylureas (such as glipizide, glimepiride, or glyburide), talk to your doctor before switching to a low-carb diet, as you may need to take smaller doses of your medications.

Food choices play a critical role in your blood sugar control. If you’re interested in a specific diet plan, consider working with a registered dietitian-nutritionist or a certified diabetes care and education specialist who can help you navigate the landscape.

Physical Activity and Type 2 Diabetes

There is a strong link between physical activity and type 2 diabetes risk, and moving your body is one of the best ways to treat diabetes. With very few exceptions, almost everyone with type 2 diabetes, regardless of age or fitness level, is recommended to add physical activity to their treatment regimen.

The American Diabetes Association recommends engaging in at least 150 minutes of moderate-intensity exercise per week, which can be divided into 30-minute sessions, five times per week. This can include things like jogging, walking, strength training, or lifting weights.

 Every type of exercise improves insulin sensitivity and has comprehensive health benefits — even when it does not lead to weight loss.

Even very light exercise, like walking, can have significant benefits, including improvements in A1C and controlled blood glucose.

 Low-impact exercise, such as tai chi or yoga, can also improve flexibility, balance, and physical function, all of which lead to improved fitness and quality of life.

Small doses of exercise, just a few minutes here or there, can break up a sedentary day and have a direct positive effect on blood sugar metabolism.

Self-Care and Type 2 Diabetes

Effective diabetes management is about more than just diet, exercise, and blood sugar control. People who thrive with type 2 diabetes take a well-rounded approach to their health and address the following:

  • Mental Health People with type 2 diabetes have an increased risk of mental health conditions, such as depression, and yet only half or fewer ever have their condition professionally diagnosed.

     Poor mental health can make it difficult to engage in proper diabetes management, which can lead to worsening blood sugar levels. Talk to your healthcare provider if you think you’re experiencing symptoms of anxiety, depression, or other related mental health conditions.

  • Sleep Habits There’s also a connection between diabetes and sleep — people with type 2 diabetes are more likely to experience sleep apnea, insomnia, and other sleep disturbances. Disordered sleep can spike insulin resistance, leading to worsening glycemic control, which means you should tell your doctor if you’re experiencing persistent fatigue or other sleep issues.

  • Smoking Nicotine can worsen insulin resistance and make diabetes significantly more difficult to manage.

Enhanced self-care, such as protecting your feet from cuts and sores and prioritizing oral hygiene, is also important for staying healthy with diabetes. A clinician or diabetes educator can help you identify infection risks, such as slow wound healing, a common side effect of diabetes.

Treatment and Medication Options for Type 2 Diabetes

If you’ve been diagnosed with type 2 diabetes, you have several medical treatment options at your disposal.

Type 2 Diabetes Medication Options

It’s important to note that all type 2 diabetes medicines are intended to be used alongside the first and most important diabetes therapy: lifestyle change. Diet and exercise are always paramount in the treatment of diabetes.

These are some of the more popular drugs used to lower glucose levels in type 2 diabetes:

  • Metformin is the first-line medication for the treatment of type 2 diabetes. This daily pill, which helps reduce blood sugar levels and resensitize the body to insulin, is almost always prescribed upon diagnosis.

  • GLP-1 receptor agonists have rapidly become the world’s most talked-about drugs because of their incredible weight loss potential. GLP-1 receptor agonists increase insulin secretion in response to glucose and help people manage appetite, leading to weight loss and blood sugar improvements.

     GLP-1 drugs may also help protect the long-term health of both the heart and the kidneys.

  • SGLT-2 inhibitors cause the body to remove excess glucose from the body through the urine. SGLT-2 inhibitors drive blood sugar improvement, modest weight loss, and cardiovascular and kidney protection.

  • Sulfonylureas work by stimulating the pancreas to produce more insulin.

  • DPP-4 inhibitors help digestive hormones that increase insulin secretion and slow glucose absorption in the gut.

  • Insulin is sometimes seen as a last line of defense when other therapies cannot keep blood sugar levels under control. Insulin is a powerful glucose-lowering drug, but it brings a significant risk of hypoglycemia (dangerously low blood sugar), and it involves a significant learning curve.

Bariatric Surgery and Type 2 Diabetes

Bariatric (weight loss) surgery is another treatment option for people with type 2 diabetes and obesity. There are several types of bariatric surgery, but they all involve changing the size of the stomach, restricting the amount of food that can be eaten comfortably. Some types of bariatric surgery also change the connections between the stomach and the intestines, causing your body to absorb less energy from the food you eat.

While bariatric surgery may seem like an extreme option, it’s very effective. The different procedures have their own risks and benefits, but generally speaking, people with diabetes who receive weight loss surgery lose about 20 percent of their body mass and have significant blood sugar improvements, often achieving lasting diabetes remission.

Bariatric surgery can cost over $10,000, but insurers often cover much of the expense.

 For some, it’s a far less costly option than using weight loss drugs such as GLP-1 drugs.

Diabetes and Blood Sugar Management

The fundamental goal of diabetes management is to keep blood sugar levels within a safe range. Because doctors are generally only able to evaluate blood sugar levels during checkups, people with type 2 diabetes are usually asked to be somewhat responsible for measuring and managing their own blood sugar levels. Depending on your situation, you may be asked to test your blood sugar with a meter several times a day, once a day, or only every once in a while.

People with type 2 diabetes may also have access to a more advanced device called a continuous glucose monitor (CGM), which tracks blood sugar levels around the clock. Two leading CGM manufacturers now sell their devices over the counter.

Blood sugar management success is usually evaluated by A1C, an estimate of your blood sugar levels over the previous several months. Your healthcare team will measure your A1C regularly.

The American Diabetes Association sets a target A1C of less than 7 percent for most nonpregnant adults — meeting this benchmark substantially slows, and may completely prevent, the development of diabetes complications.

Because blood sugar meters and CGMs do not measure A1C, your healthcare provider will also likely give you a range of blood sugar levels to try to stay within, such as 70 to 180 mg/dL.

How Long Does Type 2 Diabetes Last?

Type 2 diabetes is considered a chronic or lifelong condition. Although medication and changes to your diet and lifestyle can help manage type 2 diabetes, the body’s underlying tendency toward insulin resistance cannot be cured.

For many people, type 2 diabetes is a progressive disease, meaning that it gets more severe as time goes on. Many patients will need to add medication to maintain their blood sugar levels as they age, and some will experience health complications despite efforts to manage their condition.

That said, with healthier habits, it is possible to lower your blood sugar and actually reduce the amount of medicine you require. Some people have achieved diabetes “remission” — normal blood sugar levels without the use of any medicine.

 Those results are not common, but they help demonstrate how crucial lifestyle change can be as a type 2 diabetes therapy.

Today we also have access to powerful treatments — especially bariatric surgery and GLP-1 drugs — that may be enough to bring blood sugar concentrations down to healthy levels, halting or substantially delaying the progression of diabetes.

Complications of Type 2 Diabetes

Blood sugar management is critical because it’s the best way to reduce the odds of developing chronic, long-term complications from type 2 diabetes. While high blood sugar doesn’t often cause immediate symptoms, the extra glucose can silently cause damage to almost every part of the body. Eventually, this damage can become symptomatic and dangerous.

Long-Term Health Problems Linked to Type 2 Diabetes

Type 2 diabetes raises the risk of the following serious conditions:

  • Cardiovascular disease, including heart disease, heart attack, and stroke. Cardiovascular disease is the number one cause of death in people with type 2 diabetes.

  • Diabetic retinopathy, which causes impaired vision and, in the most extreme cases, blindness.

  • Diabetic neuropathy, or nerve damage, can affect the entire body. This condition can cause difficult-to-treat numbness, tingling, or pain in the extremities; it can also cause an uncomfortable stomach condition called gastroparesis.

  • Diabetic nephropathy occurs when high blood sugar levels damage the kidneys, leading to kidney disease.

     Nephropathy can eventually lead to kidney failure, making either dialysis treatment or a kidney transplant necessary.

If you have diabetes, you may also deal with sexual issues, gum disease, hearing loss, sleep apnea, and skin conditions, among other issues.

 Finally, the disease may also increase the risk of other conditions linked to insulin resistance, including Alzheimer’s disease, which has occasionally been called “type 3 diabetes.”

People with type 2 diabetes may also have a lower life expectancy, especially when they develop the disease at a younger age.

 But meeting your doctor’s blood sugar targets can add years to your life. A study published in 2022 found that reducing A1C from 9.9 percent to 7.7 percent was associated with a gain of 3.4 years of life expectancy.

Short-Term Type 2 Diabetes Complications

While the long-term complications described above are largely caused by chronic exposure to high blood sugar levels, having very high and low blood sugar levels can also cause immediate damage.

Extremely high blood sugar levels result in some of the same symptoms that often develop in untreated or undiagnosed diabetes, such as excessive thirst and urination. If left untreated, in rare cases, this can progress to two deadly hyperglycemic emergencies: diabetic ketoacidosis and hyperosmolar hyperglycemic state.

Dangerously low blood sugar, or hypoglycemia, is a side effect of certain diabetes drugs, particularly insulin and sulfonylureas. The warning signs of low blood sugar include intense hunger, shakiness, and dizziness.

Disparities and Inequities in Type 2 Diabetes

In the U.S., type 2 diabetes disproportionately affects people from racial and ethnic minority communities.

 Black, Asian, Hispanic, and Indigenous Americans all have elevated diabetes risks, leading to higher rates of long-term health complications.

Black Americans, specifically, are more than twice as likely to develop kidney failure from diabetes as white Americans, and are far more likely to require lower limb amputation.

Many experts believe that these differences are caused by disparities in the social determinants of health (nonmedical factors that affect health outcomes), including gaps in income, education, and access to health care.

 Diabetes rates are also higher in rural areas and among people with lower incomes.

 Stress from these risk factors, lack of access to healthcare and nutritious food, and lack of time for exercise are also contributing factors.
Bias in our healthcare system, even when unintentional, also helps drive these health disparities. People from racial and ethnic minorities are less likely to be offered access to the latest diabetes management technology, and are also less likely to receive the newest diabetes medications.

It may be worthwhile to seek out organizations devoted to fixing diabetes disparities, such as the African American Diabetes Association, which may be able to specifically help someone in your situation.

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