How is diabetes diagnosed?

Diabetes is diagnosed and managed by checking your glucose level in a

blood test. There are three tests that can measure your blood glucose level:
fasting glucose test, random glucose test and A1c test.

 Fasting plasma glucose test: This test is best done in the morning after
an eight hour fast (nothing to eat or drink except sips of water).
 Random plasma glucose test: This test can be done any time without
the need to fast.
 A1c test: This test, also called HbA1C or glycated hemoglobin test,
provides your average blood glucose level over the past two to three
months. This test measures the amount of glucose attached to
hemoglobin, the protein in your red blood cells that carries oxygen.
You don’t need to fast before this test.
 Oral glucose tolerance test: In this test, blood glucose level is first
measured after an overnight fast. Then you drink a sugary drink. Your
blood glucose level is then checked at hours one, two and three.
Normal Prediabetes Diabetes
Type of test
(mg/dL) (mg/dL) (mg/dL)
Less than 100
Fasting
100-125 126 or higher
glucose test
Less than 140
Random (anytime)
140-199 200 or higher
glucose test
Less than 5.7%
A1c test 5.7 - 6.4% 6.5% or higher

Oral glucose
Less than 140 140-199 200 or higher
tolerance test

Gestational diabetes tests: There are two blood glucose tests if you are
pregnant. With a glucose challenge test, you drink a sugary liquid and your
glucose level is checked one hour later. You don’t need to fast before this
test. If this test shows a higher than normal level of glucose (over 140 ml/dL),
an oral glucose tolerance test will follow (as described above).
Type 1 diabetes: If your healthcare provider suspects Type 1 diabetes, blood
and urine samples will be collected and tested. The blood is checked for
autoantibodies (an autoimmune sign that your body is attacking itself). The
urine is checked for the presence of ketones (a sign your body is burning fat
as its energy supply). These signs indicate Type 1 diabetes.
Who should be tested for diabetes?

If you have symptoms or risk factors for diabetes, you should get tested. The
earlier diabetes is found, the earlier management can begin and complications
can be lessened or prevented. If a blood test determines you have prediabetes,
you and your healthcare professional can work together to make lifestyle
changes (e.g. weight loss, exercise, healthy diet) to prevent or delay
developing Type 2 diabetes.

Additional specific testing advice based on risk factors:

 Testing for Type 1 diabetes: Test in children and young adults who

have a family history of diabetes. Less commonly, older adults may
also develop Type 1 diabetes. Therefore, testing in adults who come to
the hospital and are found to be in diabetic ketoacidosis is important.
Ketoacidosis a dangerous complication that can occur in people with
Type 1 diabetes.
 Testing for type 2 diabetes: Test adults age 45 or older, those between
19 and 44 who are overweight and have one or more risk factors,
women who have had gestational diabetes, children between 10 and 18
who are overweight and have at least two risk factors for type 2
diabetes.
 Gestational diabetes: Test all pregnant women who have had a
diagnosis of diabetes. Test all pregnant women between weeks 24 and
28 of their pregnancy. If you have other risk factors for gestational
diabetes, your obstetrician may test you earlier.

MANAGEMENT AND TREATMENT

Managing Diabetes
How is diabetes managed?
Diabetes affects your whole body. To best manage diabetes, you’ll need to
take steps to keep your risk factors under control and within the normal
range, including:

 Keep your blood glucose levels as near to normal as possible by

following a diet plan, taking prescribed medication and increasing your
activity level.
 Maintain your blood cholesterol (HDL and LDL levels) and
triglyceride levels as near the normal ranges as possible.
 Control your blood pressure. Your blood pressure should not be over
140/90 mmHg.

You hold the keys to managing your diabetes by:

 Planning what you eat and following a healthy meal plan. Follow
a Mediterranean diet (vegetables, whole grains, beans, fruits, healthy
fats, low sugar) or Dash diet. These diets are high in nutrition and fiber
and low in fats and calories. See a registered dietitian for help
understanding nutrition and meal planning.
 Exercising regularly. Try to exercise at least 30 minutes most days of
the week. Walk, swim or find some activity you enjoy.
 Losing weight if you are overweight. Work with your healthcare team
to develop a weight-loss plan.
 Taking medication and insulin, if prescribed, and closely following
recommendations on how and when to take it.
 Monitoring your blood glucose and blood pressure levels at home.
 Keeping your appointments with your healthcare providers and having
laboratory tests completed as ordered by your doctor.
 Quitting smoking (if you smoke).

You have a lot of control – on a day-to-day basis – in managing your

diabetes!
How do I check my blood glucose level? Why is this important?

Checking your blood glucose level is important because the results help guide
decisions about what to eat, your physical activity and any needed medication
and insulin adjustments or additions.
The most common way to check your blood glucose level is with a blood
glucose meter. With this test, you prick the side of your finger, apply the drop
of blood to a test strip, insert the strip into the meter and the meter will show
your glucose level at that moment in time. Your healthcare provider will tell
you how often you’ll need to check your glucose level.
What is continuous glucose monitoring?

Advancements in technology have given us another way to monitor glucose

levels. Continuous glucose monitoring uses a tiny sensor inserted under your
skin. You don't need to prick your finger. Instead, the sensor measures your
glucose and can display results anytime during the day or night. Ask your
healthcare provider about continuous glucose monitors to see if this is an
option for you.
What should my blood glucose level be?

Ask your healthcare team what your blood glucose level should be. They may
have a specific target range for you. In general, though, most people try to
keep their blood glucose levels at these targets:

 Before a meal: between 80 and 130 mg/dL.

 About two hours after the start of a meal: less than 180 mg/dL.

What happens if my blood glucose level is low?

Having a blood glucose level that is lower than the normal range (usually
below 70 mg/dL) is called hypoglycemia. This is a sign that your body gives
out that you need sugar.

Symptoms you might experience if you have hypoglycemia include:

 Weakness or shaking.
 Moist skin, sweating.
 Fast heartbeat.
 Dizziness.
 Sudden hunger.
 Confusion.
  Pale skin.
 Numbness in mouth or tongue.
 Irritability, nervousness.
 Unsteadiness.
 Nightmares, bad dreams, restless sleep.
 Blurred vision.
 Headaches, seizures.

You might pass out if your hypoglycemia is not managed.

What happens if my blood glucose level is high?

If you have too much glucose in your blood, you have a condition
called hyperglycemia. Hyperglycemia is defined as:

 A blood glucose level greater than 125 mg/dL while in the fasting state
(nothing to eat or drink for at least eight hours).

or

 A blood glucose level greater than 180 mg/dL one to two hours after
eating.
How is diabetes treated?

Treatments for diabetes depend on your type of diabetes, how well controlled
your blood glucose level is and your other existing health conditions.

 Type 1 diabetes: If you have this type, you must take insulin every
day. Your pancreas no longer makes insulin.
 Type 2 diabetes: If you have this type, your treatments can include
medications (both for diabetes and for conditions that are risk factors
for diabetes), insulin and lifestyle changes such as losing weight,
making healthy food choices and being more physically active.
 Prediabetes: If you have prediabetes, the goal is to keep you from
progressing to diabetes. Treatments are focused on treatable risk
factors, such as losing weight by eating a healthy diet (like the
Mediterranean diet) and exercising (at least five days a week for 30
 minutes). Many of the strategies used to prevent diabetes are the same
as those recommended to treat diabetes (see prevention section of this
article).
 Gestational diabetes: If you have this type and your glucose level is
not too high, your initial treatment might be modifying your diet and
getting regular exercise. If the target goal is still not met or your
glucose level is very high, your healthcare team may start medication
or insulin.

Oral medications and insulin work in one of these ways to treat your diabetes:

 Stimulates your pancreas to make and release more insulin.

 Slows down the release of glucose from your liver (extra glucose is
stored in your liver).
 Blocks the breakdown of carbohydrates in your stomach or intestines
so that your tissues are more sensitive to (better react to) insulin.
 Helps rid your body of glucose through increased urination.

What oral medications are approved to treat diabetes?

Over 40 medications have been approved by the Food and Drug

Administration for the treatment of diabetes. It’s beyond the scope of this
article to review all of these drugs. Instead, we’ll briefly review the main
drug classes available, how they work and present the names of a few drugs
in each class. Your healthcare team will decide if medication is right for you.
If so, they’ll decide which specific drug(s) are best to treat your diabetes.

Diabetes medication drug classes include:

 Sulfonylureas: These drugs lower blood glucose by causing the

pancreas to release more insulin. Examples include glimepiride
(Amaryl®), glipizide (Glucotrol®) and glyburide (Micronase®,
DiaBeta®).
 Glinides (also called meglitinides): These drugs lower blood glucose
by getting the pancreas to release more insulin. Examples include
repaglinide (Prandin®) and nateglinide (Starlix®).
 Biguanides: These drugs reduce how much glucose the liver produces.
It also improves how insulin works in the body, and slows down the
 conversion of carbohydrates into sugar. Metformin (Glucophage®) is
the example.
 Alpha-glucosidase inhibitors: These drugs lower blood glucose by
delaying the breakdown of carbohydrates and reducing glucose
absorption in the small intestine. An example is acarbose (Precose®).
 Thiazolidinediones: These drugs improve the way insulin works in the
body by allowing more glucose to enter into muscles, fat and the liver.
Examples include pioglitazone (Actos®) and rosiglitazone (Avandia®).
 GLP-1 analogs (also called incretin mimetics or glucagon-like
peptide-1 receptor agonists): These drugs increase the release of
insulin, reduce glucose release from the liver after meals and delay
food emptying from the stomach. Examples include exenatide
(Byetta®), liraglutide (Victoza®), albiglutide (Tanzeum®),
semaglutide (Rybelsus®) and dulaglutide (Trulicity®).
 DPP-4 inhibitors (also called dipeptidyl peptidase-4
inhibitors): These drugs help your pancreas release more insulin after
meals. They also lower the amount of glucose released by the liver.
Examples include alogliptin (Nesina®), sitagliptin (Januvia®),
saxagliptin (Onglyza®) and linagliptin (Tradjenta®).
 SGLT2 inhibitors (also called sodium-glucose cotransporter 2
inhibitors): These drugs work on your kidneys to remove glucose in
your body through your urine. Examples include canagliflozin
(Invokana®), dapagliflozin (Farxiga®) and empagliflozin
(Jardiance®).
 Bile acid sequestrants: These drugs lower cholesterol and blood sugar
levels. Examples include colestipol (Colestid®), cholestyramine
(Questran®) and colesevelam (Welchol®).
 Dopamine agonist: This medication lowers the amount of glucose
released by the liver. An example is bromocriptine (Cyclocet®).

Many oral diabetes medications may be used in combination or with insulin

to achieve the best blood glucose control. Some of the above medications are
available as a combination of two medicines in a single pill. Others are
available as injectable medications, for example, the GLP-1 agonist
semaglutide (Ozempic®) and lixisenatide (Adlyxin®).
Always take your medicine exactly as your healthcare prescribes it. Discuss
your specific questions and concerns with them.
What insulin medications are approved to treat diabetes?

There are many types of insulins for diabetes. If you need insulin, you
healthcare team will discuss the different types and if they are to be combined
with oral medications. To follow is a brief review of insulin types.

 Rapid-acting insulins: These insulins are taken 15 minutes before

meals, they peak (when it best lowers blood glucose) at one hour and
work for another two to four hours. Examples include insulin glulisine
(Apidra®), insulin lispro (Humalog®) and insulin aspart (NovoLog®).
 Short-acting insulins: These insulins take about 30 minutes to reach
your bloodstream, reach their peak effects in two to three hours and last
for three to six hours. An example is insulin regular (Humulin R®).
 Intermediate-acting insulins: These insulins reach your bloodstream
in two to four hours, peak in four to 12 hours and work for up to 18
hours. An example in NPH.
 Long-acting insulins: These insulins work to keep your blood sugar
stable all day. Usually, these insulins last for about 18 hours. Examples
include insulin glargine (Basaglar®, Lantus®, Toujeo®), insulin
detemir (Levemir®) and insulin degludec (Tresiba®).

There are insulins that are a combination of different insulins. There are also
insulins that are combined with a GLP-1 receptor agonist medication (e.g.
Xultophy®, Soliqua®).
How is insulin taken? How many different ways are there to take insulin?

Insulin is available in several different formats. You and your healthcare

provider will decide which delivery method is right for you based on your
preference, lifestyle, insulin needs and insurance plan. Here’s a quick review
of available types.

 Needle and syringe: With this method, you’ll insert a needle into a vial
of insulin, pull back the syringe and fill the needle with the proper dose
of insulin. You’ll inject the insulin into your belly or thigh, buttocks or
 upper arm – rotating the injection spots. You may need to give yourself
one or more shots a day to maintain your target blood glucose level.
 Insulin pen: This device looks like a pen with a cap. They come
prefilled with insulin or with insulin cartridges that are inserted and
replaced after use.
 Insulin pump: Insulin pumps are small, computerized devices, about
the size of a small cell phone that you wear on your belt, in your
pocket, or under your clothes. They deliver rapid-acting insulin 24
hours a day through a small flexible tube called a cannula. The cannula
is inserted under the skin using a needle. The needle is then removed
leaving only the flexible tube under the skin. You replaces the cannula
every two to three days. Another type of insulin pump is attached
directly to your skin and does not use tubes.
 Artificial pancreas (also called a closed loop insulin delivery
system): This system uses an insulin pump linked to a continuous
glucose monitor. The monitor checks your blood glucose levels every
five minutes and then the pump delivers the needed dose of insulin.
 Insulin inhaler: Inhalers allow you to breath in powdered inhaler
through an inhaler device that you insert into your mouth. The insulin is
inhaled into your lungs, then absorbed into your bloodstream. Inhalers
are only approved for use by adults with Type 1 or Type 2 diabetes.
 Insulin injection port: This delivery method involves the placement of
a short tube into tissue beneath your skin. The port is held in place with
an adhesive patch. You use a needle and syringe or insulin pen and
inject the insulin through this port. The port is changed every few days.
The port provides a single site for injection instead of having to rotate
injection sites.
 Jet injector: This is a needleless delivery method that uses high
pressure to send a fine spray of insulin through your skin.
Are there other treatment options for diabetes?

Yes. There are two types of transplantations that might be an option for a
select number of patients who have Type 1 diabetes. A pancreas
transplant is possible. However, getting an organ transplant requires taking
immune-suppressing drugs for the rest of your life and dealing with the side
effects of these drugs. However, if the transplant is successful, you’ll likely
be able to stop taking insulin.

Another type of transplant is a pancreatic islet transplant. In this transplant,

clusters of islet cells (the cells that make insulin) are transplanted from an
organ donor into your pancreas to replace those that have been destroyed.

Another treatment under research for Type 1 diabetes is immunotherapy.

Since Type 1 is an immune system disease, immunotherapy holds promise as
a way to use medication to turn off the parts of the immune system that cause
Type 1 disease.

Bariatric surgery is another treatment option that’s an indirect treatment for

diabetes. Bariatric surgery is an option if you have Type 2 diabetes, are obese
(body mass index over 35) and considered a good candidate for this type of
surgery. Much improved blood glucose levels are seen in people who have
lost a significant amount of weight.

Of course other medications are prescribed to treat any existing health

problems that contribute to increasing your risk of developing diabetes. These
conditions include high blood pressure, high cholesterol and other heart-
related diseases.

PREVENTION