Patient information: Diabetes mellitus type 2: Overview (Beyond the Basics) Author David K McCulloch, MD Section Editor David

M Nathan, MD Deputy Editor Jean E Mulder, MD Disclosures All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Nov 2013. | This topic last updated: Aug 22, 2012. INTRODUCTION — Type 2 diabetes mellitus is a disorder that disrupts the way your body uses glucose (sugar). All the cells in your body need sugar to work normally. Sugar gets into the cells with the help of a hormone called insulin. If there is not enough insulin, or if the body stops responding to insulin, sugar builds up in the blood. This is what happens to people with diabetes mellitus. There are two different types of diabetes mellitus. In type 1 diabetes mellitus, the problem is that the pancreas (an organ in the abdomen) does not make enough insulin. In type 2 diabetes mellitus, the pancreas does not make enough insulin (figure 1), the body becomes resistant to normal or even high levels of insulin, or both. This causes high blood glucose (blood sugar) levels, which can cause problems if untreated. In the United States, Canada, and Europe, about 90 percent of all people with diabetes have type 2 diabetes. Type 2 diabetes is a chronic medical condition that requires regular monitoring and treatment throughout your life. Treatment includes lifestyle changes, self-care measures, and sometimes medications. Fortunately, these treatments can keep blood sugar levels close to normal and minimize the risk of developing complications. THE IMPACT OF DIABETES — Being diagnosed with type 2 diabetes can be a frightening and overwhelming experience, and you likely have questions about why it developed, what it means for your long-term health, and how it will affect your everyday life. For most people, the first few months after being diagnosed are filled with emotional highs and lows. If you have just been diagnosed with diabetes, you and your family should use this time to learn as much as possible so that caring for your diabetes (including testing your blood sugar, going to medical appointments, and taking your medications) becomes a part of your daily routine. (See "Patient information: Self-blood glucose monitoring in diabetes mellitus (Beyond the Basics)".) In addition, you should talk to your doctor or nurse about resources that are available for medical as well as psychological support. These may include group classes, meetings with a nutritionist, social worker, or nurse educator, and other educational resources such as books, web sites, or magazines. Several of these resources are listed below (see 'Where to get more information' below). Despite the risks associated with type 2 diabetes, most people can lead active lives and continue to enjoy the foods and activities that they previously enjoyed. Diabetes does not mean an end to "special occasion" foods like birthday cake, and most people with diabetes can enjoy exercise in almost any form. (See "Patient information: Type 2 diabetes mellitus and diet (Beyond the Basics)" and "Patient information: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics)".)

you can have blood drawn at any time throughout the day. A normal fasting blood sugar level is less than 100 mg/dL (5.    .  Random blood sugar test — For a random blood sugar test. Fasting blood sugar test — A fasting blood sugar test is a blood test done after not eating or drinking for 8 to 12 hours (usually overnight). or obesity.) Symptoms — Before being diagnosed with type 2 diabetes. (See "Clinical presentation and diagnosis of diabetes mellitus in adults". combined with genetic causes. called "gestational diabetes. high blood pressure. Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is a test that involves drinking a special glucose solution (usually orange or cola flavored). the most common include:    Needing to urinate frequently Feeling thirsty Blurred vision Laboratory tests — Several blood tests are used to measure blood glucose levels. the primary test for diagnosing diabetes. Normal values for A1C are 4 to 6 percent. affect the risk of developing type 2 diabetes. Your blood sugar level is tested before you drink the solution. The likelihood of developing type 2 diabetes is greater in certain ethnic groups. such as people of Hispanic. and then again one and two hours after drinking it. son." Gestational diabetes is similar to type 2 diabetes. African. Hemoglobin A1C test — The "A1C" blood test measures your average blood sugar level over the past two to three months. Environmental conditions — Environmental factors such as what you eat and how active you are. daughter) of a person with diabetes compared to a person with no family history of diabetes.55 mmol/L). brother. If your blood sugar is 200 mg/dL (11. but usually resolves after the woman delivers her baby.1 mmol/L) or higher and you have symptoms of high blood sugar (see 'Symptoms' above). The A1C test can be done at any time of day (before or after eating). most people have no symptoms at all. (See "Pathogenesis of type 2 diabetes mellitus" and "Risk factors for type 2 diabetes mellitus". Pregnancy — A small number (about 3 to 5 percent) of pregnant women develop diabetes during pregnancy. and Asian descent.) TYPE 2 DIABETES DIAGNOSIS — The diagnosis of diabetes is based upon your symptoms and the results of blood tests. regardless of when you last ate. Women who have gestational diabetes are at increased risk for developing type 2 diabetes later in life.CAUSES OF TYPE 2 DIABETES — Type 2 diabetes is thought to be caused by a combination of genetic and environmental factors. such as high cholesterol levels. The lifetime risk of developing type 2 diabetes is 5 to 10 times higher in first-degree relatives (sister. it is likely that you have diabetes. In those who do have symptoms. (See "Patient information: Gestational diabetes mellitus (Beyond the Basics)".) Genetic causes — Many people with type 2 diabetes have a family member with either type 2 diabetes or other medical problems associated with diabetes.

Categories of increased risk    Impaired fasting glucose is defined as a fasting blood sugar level between 100 and 125 mg/dL (5. A full discussion of diabetes in pregnancy is available separately. A1C — persons with 5. Even if they don't develop diabetes.1 mmol/L) or higher A fasting blood sugar level of 126 mg/dL (7. these people are at increased risk of heart disease. doctors often run additional blood tests. Impaired glucose tolerance is very common.6 to 6.4 percent are at highest risk. In such cases.5 percent or higher The blood tests must be repeated on another day to confirm the diagnosis of diabetes.Criteria for diagnosis — The following criteria are used to classify your blood sugar levels as normal.1 mmol/L) or higher two hours after an oral glucose tolerance test An A1C of 6. Type 1 versus type 2 diabetes — Doctors can usually tell whether a person has type 1 or type 2.9 mmol/L).) PREGNANCY AND DIABETES — Women with type 2 diabetes are usually able to become pregnant and have a healthy baby.) WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. but there are situations when the diagnosis is difficult to determine. Normal — Fasting blood sugar less than 100 mg/dL (5.0 mmol/L) or higher A blood sugar of 200 mg/dL (11.55 mmol/L). or diabetes. TYPE 2 DIABETES TREATMENT — A full discussion of the treatment for type 2 diabetes is available separately. At least 50 percent of people with impaired glucose tolerance eventually develop type 2 diabetes. Impaired glucose tolerance is defined as a blood sugar level of 140 to 199 mg/dL two hours after an oral glucose tolerance test. (See "Patient information: Care during pregnancy for women with type 1 or 2 diabetes mellitus (Beyond the Basics)". .7 to 6. increased risk (blood sugar levels that are higher than normal and indicate a risk of future diabetes). (See "Patient information: Diabetes mellitus type 2: Treatment (Beyond the Basics)" and "Patient information: Diabetes mellitus type 2: Insulin treatment (Beyond the Basics)" and "Patient information: Hypoglycemia (low blood sugar) in diabetes mellitus (Beyond the Basics)". although there is a continuum of increasing risk across the entire spectrum of subdiabetic A1C levels. Diabetes mellitus — A person is considered to be diabetic if he or she has one or more of the following:     Symptoms of diabetes (see 'Symptoms' above) and a random blood sugar of 200 mg/dL (11.) TYPE 2 DIABETES COMPLICATIONS — Complications of type 2 diabetes can be related to the disease itself or to the treatments used to manage diabetes. (See "Patient information: Preventing complications in diabetes mellitus (Beyond the Basics)". about 11 percent of all people between the ages of 20 and 74 have impaired glucose tolerance.

but you should have the test done again to be sure •If your A1C is between 5.‖ People with diabetes can get different types of nerve damage. Some people need to aim for different A1C levels than others.7 and 6.4 (meaning you do not have diabetes but are at risk for it). you should have A1C tests every 3 months.uptodate. your A1C should probably be 7 or less. and you had an A1C test to see how well controlled your blood sugar is. •If your A1C is 6. you are at risk for getting diabetes. you should have A1C tests done every year. you should have A1C tests every 6 months.7 and 6.‖ ―HbA1C. This article covers the most common type of nerve damage caused by diabetes. your A1C should be 6 or less. Not everyone with diabetes is the same. Patient information: Nerve damage caused by diabetes (The Basics) View in SpanishWritten by the doctors and editors at UpToDate Can diabetes cause nerve damage? — Yes.4.5 or higher. it probably means you have diabetes. Can I do this test at home? — It is now possible to buy kits to test your A1C at home. you should have A1C tests done every 3 years. . ●If you had an A1C test to check for diabetes and your A1C was between 5. as well as selected articles written for healthcare professionals. People with diabetes (sometimes called ―diabetes mellitus‖) can get nerve damage if they have high blood sugar levels for a long time. ●If you do have diabetes and your blood sugar is well controlled.This article will be updated as needed on our web site (www.com/patients). are also available. How often should I have an A1C test? — That depends on whether you have diabetes and on what your last A1C test showed. Related topics for patients. But home testing of A1C is not usually necessary. Another word for nerve damage is ―neuropathy. ●If you have diabetes and you recently changed treatment plans or you are having trouble controlling your blood sugar. For example. Some of the most relevant are listed What is hemoglobin A1C? — Hemoglobin A1C is a blood test that shows what your average blood sugar level has been for the past 2 to 3 months (table 1). you should become more active and lose weight (if you are overweight).7 (meaning you do NOT have diabetes). You should probably start doing things that can help prevent diabetes. Doctors and nurses use this test for 2 reasons: ●To see whether a person has diabetes ●To see whether diabetes treatment is working the right way Other names for hemoglobin A1C are ―glycated hemoglobin.‖ What should my A1C numbers be? — That depends on why you have the test. ●When checking how treatment is working – If you already know you have diabetes. ●If you had an A1C test to check for diabetes and your A1C was less than 5. ●When checking for diabetes – If you had an A1C test to see if you have diabetes.‖ or just ―A1C. But you need to check with your doctor on what your level should be.

muscles. this can cause a person’s foot to have an abnormal shape. your doctor might prescribe another diabetes medicine or recommend that you take your diabetes medicine more often. and joints in the feet. Some people do not feel any symptoms. you can:   Wear shoes or slippers all the time. Wear shoes that fit well. so they might not treat it. an untreated cut can get infected and turn into an open sore.What are the symptoms of nerve damage caused by diabetes? — Nerve damage usually affects the toes and feet first. They might not even know that they have a cut. Problems that aren’t treated right away can get much worse. symptoms can move from the feet up the legs. Take care of your feet – Taking care of your feet can prevent future problems. use a mirror or ask another person to check. If you cannot see the bottoms of your feet. such as removing an ingrown toenail. Do not cut cuticles or pop blisters. but are not too tight (figure 3). Wash your feet with warm water and soap every day and pat them dry. Wear socks that are not too tight. But people with nerve damage might not feel any pain when their feet get hurt. This test is called ―electromyography. Never go barefoot. Once people feel symptoms in the middle of their lower legs. Your doctor can usually tell if you have nerve damage by talking with you and doing an exam. Sometimes. Put a moisturizing cream or lotion on the tops and bottoms of your feet. a doctor will do a test to check how well a person’s nerves are working. Cut straight across and file the nail (figure 1). blisters. Look for cuts. swelling. and change them every day. Is there a test for nerve damage caused by diabetes? — Yes. they might also start to feel symptoms in their hands. Check both feet every day (figure 2). people feel pain when they get a cut on their foot.      .‖ How does nerve damage lead to problems? — Nerve damage can lead to problems. To better control your blood sugar. Tingling Feeling light touches as bothersome or painful As nerve damage gets worse. Make sure to check all over your feet. Trim your toe nails carefully. To protect and take care of your feet. Normally. or redness. but other people can have symptoms that include:     Numbness or loss of feeling Burning or pain – Pain is often worse at rest or at night. because it can make people unable to feel pain in their feet. The pain tells them that they need to treat their cut so that it can heal. including in between your toes. Check inside your shoes before you put them on. Over time. Ask your doctor to do any procedures that could involve cutting the skin. Nerve damage can also lead to problems with the bones. It can also prevent a mild problem from turning into a serious one. Make sure there is nothing sharp inside. What can I do to protect my feet and manage my condition? — You can:  Control your blood sugar levels – Symptoms of pain and burning sometimes get better when blood sugar levels are under control. For example.

or the pain can come and go. you can reduce your risk of getting nerve damage by:     Keeping your blood sugar levels as close to normal as possible Not smoking Losing weight. it can last months or years. Neuropathic pain is usually worse at rest and at night. Neuropathic pain can be severe and affect daily life. For instance. Your doctor or nurse will ask about your symptoms and do an exam. He or she should also do a quick check of your feet at every visit. neuropathic pain goes away on its own. But in other cases. In some cases. or stabbing. For example. He or she might do:   Blood tests Nerve tests to check whether your nerves are working normally .What other treatment might I have? — Some people might have other treatment for symptoms or problems caused by nerve damage. depending on how serious the problem is. Can nerve damage be prevented? — Yes. What causes neuropathic pain? — Different conditions can cause neuropathic pain. People can have the pain all the time. Neuropathic pain is usually burning. people feel a lot of pain when they are touched gently. If you have diabetes. Postherpetic neuralgia – This is a condition that can happen after people have a painful rash called ―shingles. tingling. But sometimes.‖ Stroke – A stroke is when part of the brain is injured because it goes without blood for too long. sharp. if you are overweight Making sure that your high blood pressure and heart disease are treated (if you have these conditions) More on this topic What is neuropathic pain? — Neuropathic pain is a type of pain caused by nerve damage or a problem with the nervous system. Foot problems – Doctors can treat foot problems that occur. They might have treatment for:   Pain – Doctors can prescribe different medicines to treat pain that is caused by nerve damage. There are different treatments. Sometimes. neuropathic pain can keep people from sleeping or eating well. doctors can’t figure out what’s causing a person’s neuropathic pain. People can have neuropathic pain after a stroke. This can lead to depression and anxiety. Will I need tests? — Maybe. a doctor might do one or more of the following to treat an open sore:  Clean the sore and remove any dead skin around it  Prescribe antibiotic medicines  Do surgery to remove a toe or part of the foot How often should my doctor check my feet? — Your doctor should do a complete check of your feet once a year. including:    Diabetic neuropathy – This is a form of nerve damage that can happen in people with diabetes.

Sometimes people have to try a few different things before they find the one that works best. because they work on areas of the brain that process pain. If you haven’t been active for a while.How is neuropathic pain treated? — Treatments for neuropathic pain include both medicines and activities. Some of these include:       Physical therapy Working with a counselor Relaxation therapy Massage therapy Acupuncture Devices that affect nerve signals To find the best treatment for you. because they help with overactive nerves. such as doing deep breathing exercises. No single treatment works for everyone. Other medicines doctors sometimes use to treat neuropathic pain include:    Prescription pain medicines called ―opioids‖ Pain-relieving or numbing medicines that go on the skin as a cream. and each can make the other worse. The medicines used most often to treat neuropathic pain are ones that are also used to treat other conditions. Relaxing your mind can help with how the body feels pain. start slowly and increase your activity slowly. . Is there anything I can do on my own to feel better? — Yes. Getting treatment for your depression can help you cope more easily with your pain. Tell your doctor or nurse if you feel depressed. You can:     Use a heating pad or cold pack on the painful area. Stay as active as possible. you should be open to trying new treatments or combinations of treatments. Your doctor or nurse will help you find the right mix of treatments for you. or spray Injections (shots) of numbing or pain-relieving medicines that go into the spine or the area with pain Other kinds of treatments can also help with neuropathic pain. Doctors also treat neuropathic pain with medicines that prevent seizures. patch. Check with your doctor before trying this to make sure it is OK for your individual condition. Neuropathic pain and depression often go together. Doctors treat neuropathic pain with medicines for depression. Learn ways to relax your mind and body.