Health Library Type 2 Diabetes: Living With the DiseaseFrom Healthwise

Is this topic for you?

This topic is for adults who have had type 2 diabetes for more than a few months. Before reading this topic, you may want to read Type 2 Diabetes: Recently Diagnosed.

If this topic does not answer your questions, see:

• Type 2 Diabetes, if you want to learn about type 2 diabetes but do not have the disease.
• Type 2 Diabetes: Recently Diagnosed, if you have been told recently that you have type 2 diabetes.
• Type 2 Diabetes in Children, if your child has been diagnosed with this disease.
• Type 2 Diabetes: Living With Complications, if you have eye, kidney, heart, nerve, or blood vessel disease caused by your diabetes.

If you are looking for information about type 1 diabetes, see the topic Type 1 Diabetes.

What is diabetes?

Type 2 diabetes is a lifelong disease that develops when the pancreas cannot produce enough insulin or when the body's tissues become resistant to insulin. Insulin is a hormone that helps the body’s cells use sugar (glucose) for energy. It also helps the body store extra sugar in muscle, fat, and liver cells.

How can you manage diabetes?

You play a major role in managing your diabetes. The most important thing is to control your blood sugar. To do this:

• Eat a balanced diet. If you are overweight, reduce your calorie intake to lose some weight. Losing as little as 10 to 20 pounds can improve your blood sugar levels. There are many ways to manage how much and when you eat. Your doctor, a diabetes educator, or a dietitian can help you find a plan that works for you.
• Exercise regularly. Get at least 30 minutes of exercise on most, preferably all, days of the week. Exercise helps control your blood sugar by using glucose for energy during and after activity. It also helps you stay at a healthy weight; lower high cholesterol; raise HDL, or "good," cholesterol; and lower high blood pressure.
• Take your medicine or insulin as directed, if prescribed by your doctor.
• Check your blood sugar levels regularly, as advised by your doctor.

The goal is to keep your blood sugar in a target range. You and your doctor may decide to keep your blood sugar as close to normal as possible. This is called tight control. It’s the best way to reduce your chance of having more problems from diabetes. These are called complications.

Taking care of your diabetes takes time and energy every day. But it will help you feel better and may prevent, or at least delay, complications.

How can you deal with high and low blood sugar?

Even when you are careful and do all the right things, you can have problems with high or low blood sugar. It is important to know what signs to look for and what to do if this happens.

High blood sugar (hyperglycemia) usually happens over a few days or weeks. Early symptoms include:

• Feeling very thirsty.
• Urinating more often than usual.
• Feeling very hungry.
• Having blurred vision.

People with diabetes can get high blood sugar for many reasons, including not taking their diabetes medicines, eating more than usual (especially sweets), not exercising, or being sick or under a lot of stress. If you have high blood sugar, follow your treatment plan for lowering it. This may mean taking missed doses of insulin or medicine. Call your doctor if you don't know what to do. Treating high blood sugar is important. If it is left untreated, it can lead to hyperosmolar state, a dangerous condition.

You can get low blood sugar (hypoglycemia) if you take insulin or a sulfonylurea pills for diabetes. It can happen suddenly. Early symptoms include:

• Sweating.
• Feeling weak.
• Feeling shaky.
• Feeling very hungry.

Symptoms of low blood sugar may vary over time. You may also have these symptoms if you have a sudden large drop in blood sugar, even though the level does not drop below the normal or near-normal range. Eat 1 tablespoon of sugar, ½ cup of orange juice, or another carbohydrate. Wait 15 minutes, and then check your blood sugar.

What are the complications of diabetes and their symptoms?

Over time, high blood sugar can cause complications such as problems with your eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes you more likely to get serious illnesses or infections. Complications can lead to blindness, kidney failure, removal of a limb (amputation), heart attack, stroke, and death. This is why it is so important to keep your blood sugar in your target range.

If you had the disease several years before you were diagnosed, you may already have a complication from diabetes. Even if you don't have problems now, the longer you have diabetes, the more likely you are to get one or more complications.

Be sure to tell your doctor if you notice any new symptoms, such as chest pain, numbness, or a shooting pain in your hands or feet.

How can you prevent complications?

You may be able to prevent, or at least delay, problems from diabetes by keeping your blood sugar level as close to normal as you can. Treatment of high blood pressure or high cholesterol can also help. If you smoke, quit. Smoking increases your risk for complications.

If you are age 40 or older, talk to your doctor about whether to take a low-dose aspirin each day to help prevent heart attack, stroke, or other large blood vessel disease. People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.¹

See your doctor every 3 to 6 months. During these visits, your doctor will review your treatment and do tests and exams to see if your blood sugar is staying within your target range and if you have any complications. It’s also important to have regular checkups with your eye doctor and dentist. Diabetes can cause vision and dental problems.

Will your treatment change over time?

The goal of treatment is to always keep your blood sugar as close to your target range as you can. At first, you may be able to treat diabetes with diet and exercise alone. At some point, you may need to use insulin or take pills to control your diabetes.

You always need to:

• Eat a balanced diet with enough calories to help you stay at a healthy weight. If you are overweight, reduce your calorie intake to lose some weight.
• Get regular exercise.
• Check your blood sugar regularly during the day, as advised by your doctor.

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	I have diabetes. Should I get pregnant now?
	Actionsets are designed to help people take an active role in managing a health condition.
	Diabetes: Checking your blood sugar
	Diabetes: Coping with your feelings about your diet
	Diabetes: Counting carbs if you don't use insulin
	Diabetes: Counting carbs if you use insulin
	Diabetes: Dealing with low blood sugar from insulin
	Diabetes: Dealing with low blood sugar from medicines
	Diabetes: Giving yourself an insulin shot
	Diabetes: Preventing high blood sugar emergencies
	Diabetes: Taking care of your feet
	Diabetes: Using a food guide
	Diabetes: Using a plate format for eating
	Pregnancy and diabetes: Planning for pregnancy

Even with careful treatment for type 2 diabetes, you may experience periods of high and low blood sugar.

High blood sugar may develop if you:

• Skip a dose of your oral medicine for diabetes or skip a required dose of insulin.
• Eat too much.
• Are feeling a lot of emotional stress or are ill (such as with a severe case of the flu) or have an infection, especially if you are not eating or drinking enough.
• Are taking medicines that can raise blood sugar levels as a side effect, such as sleeping pills, some anti-inflammatory medicines ( corticosteroids), and some decongestants.

If you take insulin, you may have some mornings when your blood sugar level is very high. This could happen because of the Somogyi effect. Talk with your health professional if this occurs.

Low blood sugar is not likely to develop unless you take insulin or some oral medicines for type 2 diabetes. Low blood sugar may develop if you:

• Take too many doses of your oral medicine in a day, take the doses too close together, or take your full dose of medicine when you are not going to eat your usual amount of food.
• Exercise too much without eating enough food.
• Skip a meal.
• Drink too much alcohol, especially on an empty stomach.
• Take other medicines that can lower blood sugar levels, such as large doses of aspirin and medicines for psychiatric disorders.
• Have reduced kidney function.
• Develop other endocrine problems, such as Addison's disease or hypothyroidism.

High blood sugar

Because you have type 2 diabetes, you should learn to recognize and treat symptoms of high blood sugar, which include increased thirst, frequent urination, and blurred vision. High blood sugar usually develops slowly over hours or days, so you can treat your symptoms before they become severe and require medical attention.

Low blood sugar

If you take insulin or oral diabetes medicines, such as glipizide (Glucotrol), glimepiride (Amaryl), or glyburide (DiaBeta, Glynase, or Micronase) you may experience low blood sugar (hypoglycemia). Glyburide stays in the body longer, so it is more likely than other medicines to cause low blood sugar.

Learn to recognize symptoms of low blood sugar, which include sweating, weakness, and hunger. Treating low blood sugar promptly will help avoid loss of consciousness, which can occur with severe low blood sugar.

Symptoms of complications

Symptoms of diabetic complications include:

• Chest pain; shortness of breath with exercise or other exertion; heart attack; stroke; or tight or squeezing pain in the calf, foot, thigh, or buttock that occurs during exercise and causes changes in skin color, decreased sensation, and leg cramps. These are symptoms of large blood vessel complications, or macrovascular disease.
• Burning pain, numbness, or swelling in your feet or hands, which may indicate nerve damage (diabetic neuropathy). When only one nerve is involved (focal neuropathy), you may have symptoms in one part of your body. An example is double vision, which can happen when diabetes affects the nerves that control your eye muscles.
• A wound that won't heal or that looks infected, which may indicate damage to the blood vessels that supply that area.
• Blurred or distorted vision; seeing floaters or flashes of light, large floating red or black spots, or large areas that look like floating hair, cotton fibers, or spiderwebs; or pain in your eyes. These may indicate diabetic retinopathy.
• Frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain, which may indicate gastroparesis related to diabetic autonomic neuropathy.
• Profuse sweating or reduced sweating, feeling dizzy or weak when you sit or stand up suddenly, difficulty sensing when your bladder is full or difficulty emptying your bladder completely, erection problems or vaginal dryness, or hypoglycemia unawareness. These also may indicate diabetic neuropathy.

You will not have any symptoms of kidney damage (diabetic nephropathy) until the condition is severe. Then you may notice swelling in your feet, legs, and throughout your body. Having regular tests for protein in the urine is the only way to detect diabetic nephropathy before symptoms develop.

Although your experience with type 2 diabetes may be different from that of others with the disease, everyone with diabetes has to pay attention to eating a healthy, balanced diet and exercising regularly. Eating too much carbohydrate can cause your blood sugar levels to rise quickly. A plate format is a simple way to plan a balanced diet. For information, see:

Diabetes: Using a plate format for eating.

It is important to have a healthy eating lifestyle—including eating whole grains, lean meats, fish, and vegetables—and to reduce calorie intake if you need to lose weight. You may be able to keep your blood sugar levels within your target range with only these measures for a while, but you will likely need to take oral diabetes medicines as time goes on.

As diabetes progresses, your pancreas may produce less and less insulin. If your blood sugar level is persistently high, it also may cause your pancreas to produce less insulin. This is called glucose toxicity. When your pancreas produces too little or no insulin, you will have to give yourself shots of insulin.

Because it is difficult to achieve the perfect balance of insulin and blood sugar level that your body would have if you didn't have diabetes, you will experience high blood sugar levels from time to time. If you take insulin or certain oral diabetes medicines, you also may experience low blood sugar. Early treatment of high or low blood sugar can prevent a medical emergency.

What could happen if your blood sugar level is very high?

Symptoms of high blood sugar (hyperglycemia) usually develop gradually over a period of hours or days. Early symptoms are increased thirst, frequent urination, increased hunger, and blurred vision. But you may not have any early symptoms. If your blood sugar level continues to rise and you do not drink enough liquids, you can become dehydrated.

If you do not take your diabetes medicine (pills or insulin), or if you have a severe infection or other illness or become severely dehydrated, your blood sugar may rise to a dangerous level called a hyperosmolar state. Left untreated, the condition can lead to coma and death. Hyperosmolar state usually is treated in a hospital and often in the intensive care unit. There you are closely observed and receive frequent blood tests for glucose and electrolytes. You will receive insulin and other fluids through a vein (intravenous, or IV) to bring your blood sugar down and correct the dehydration.

Complications

Long-term diabetic complications are caused by persistently high blood sugar levels continuing over months or years. You may already have one or more complications, because you may have had the disease for several years before being diagnosed. There are four types of complications:

• Microvascular disease, which affects your eyes or kidneys. Diabetic retinopathy (eye disease) and diabetic nephropathy (kidney disease) develop without early noticeable signs. You are also at risk for other eye diseases, such as cataracts and glaucoma.
• Macrovascular disease, which affects your heart and the large blood vessels throughout your body. Diabetes damages the lining of large blood vessels and contributes to developing atherosclerosis. Atherosclerosis and a greater tendency toward blood clot formation can lead to peripheral arterial disease, heart attack, or stroke.
• Diabetic neuropathy, which affects the nerves in your body. Diabetic neuropathy can decrease or completely block the movement of nerve impulses or messages to organs, legs, arms, and other parts of your body. Nerve damage can affect both the functioning of internal organs, such as the stomach ( gastroparesis), and your ability to feel pain when injured. When blood vessels and nerves are affected, broken bones (fractures) and joint deformities can develop within weeks without noticeable pain, especially in your feet ( Charcot foot).
• Weakened immune system, which puts you at risk for difficult-to-treat and persistent infections and delayed healing of wounds, especially in your feet. Severe infections in your feet may lead to amputation.

Other health problems

People with diabetes often already have other health problems, such as high blood pressure and high cholesterol, or they develop them as diabetes progresses. These conditions can contribute to the development and worsening of complications from diabetes.

Can the progression of diabetes be prevented?

From the time you are diagnosed with diabetes, work closely with your health professional to keep your blood sugar levels within a normal or near-normal range. If you do so, you may slow the progression of any complication you already have and prevent or delay the development of others. You also may feel better and be more in control of your life.

Eat a balanced diet. If you are overweight, reduce your calorie intake to lose some weight. Losing as little as 10 to 20 pounds can improve your blood sugar levels. The American Diabetes Association recommends exercising for at least 30 minutes on most, preferably all, days of the week.²

You are more likely to develop complications from type 2 diabetes if you:

• Have persistently high blood sugar over time. The higher your blood sugar and the longer it remains too high, the greater your risk for developing complications.
• Have the disease for a long time. The longer you have diabetes, the more likely you are to develop complications, even if blood sugar levels are controlled.
  • Diabetic nephropathy (kidney disease) develops in 20% to 30% of people with type 2 diabetes.³
  • Diabetic retinopathy (eye disease) develops in more than 60% of people with type 2 diabetes by 20 years after diagnosis.⁴
  • Most people with diabetes develop some diabetic neuropathy (nerve damage) over the years, but only about 13% to 15% have noticeable symptoms.⁵
• Already have one complication. Having one complication from diabetes increases your risk for developing other complications.
• Have other risk factors. Smoking, psychiatric disorders (such as depression), high blood pressure, high cholesterol, and a family history of diabetic complications may increase your risk for developing a complication. Not having health insurance coverage for supplies and other medical expenses related to diabetes care can contribute to poorer control of the disease and the development of complications.

Call 911 or other emergency services immediately if you or your child is:

• Unconscious or becomes very sleepy unexpectedly. You or your child may have low blood sugar, called hypoglycemia. While you wait for emergency help, follow:
  • Emergency care for low blood sugar in people taking oral diabetes medicine.
  • Emergency care for low blood sugar.
  • Emergency care for low blood sugar in a child.
• Drowsy, confused, breathing fast, and your or your child’s breath smells fruity or like nail polish. You or your child may have high blood sugar, called hyperglycemia. A life-threatening condition called diabetic ketoacidosis could be present.

Call a doctor immediately if you or your child is vomiting and cannot keep down liquids and:

• Your blood sugar is 300 mg/dL or higher.
• Your child’s blood sugar is 250 mg/dL or higher.

Call a doctor if you or your child:

• Is sick for more than 2 days (unless it is a mild illness, such as a cold), and you or your child:
  • Has been vomiting or had diarrhea for more than 6 hours.
  • Has followed the doctor's advice but it has not worked. Learn what to do when you are sick and have diabetes.
  • Has blood sugar levels that are often above 300 mg/dL, and urine tests for ketones show more than 2+ or moderate or higher ketones.
• Has a blood sugar level that stays below the target range after you or your child eats some quick-sugar food.
• Has a blood sugar level that stays high after you or your child takes a missed dose of insulin or oral diabetes medicines or after you or your child takes an extra dose of insulin (if prescribed by the doctor).
• Has frequent problems with high or low blood sugar levels. The insulin dose or schedule may need to be changed.
• Is having difficulty knowing when blood sugar is low (hypoglycemia unawareness).
• Has problems following the meal plan or getting physical activity, and you want help.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without changing your treatment plan. Watchful waiting is not appropriate if you:

• Are having high or low blood sugar levels frequently.
• Begin to notice symptoms of complications from diabetes. Early treatment of complications can prevent or delay worsening of the condition.

Who to See

Health professionals who may be involved in your treatment for type 2 diabetes include:

• A family medicine doctor, general practitioner, or internist.
• A certified diabetes educator (CDE).
• A registered dietitian.
• An endocrinologist.

If you have signs of diabetic complications, you may be referred to a specialist. For more information, see the topic Type 2 Diabetes: Living With Complications.

People with type 2 diabetes should see a health professional every 3 to 6 months throughout life for tests and exams to monitor the condition and adjust treatment. You also need yearly screening tests for eye problems ( diabetic retinopathy) and kidney problems (diabetic nephropathy).

Other possible tests

You may also need:

• A blood glucose test. This test may be used to check the accuracy of your blood sugar meter to see whether your home blood sugar tests are reliable. It also may be done if your health professional is adjusting your diabetes medicine.
• An electrocardiogram (ECG or EKG), if you have had a heart attack or have heart disease or high blood pressure. An EKG may be done after a diabetes diagnosis even if you have not had a heart attack, because people with diabetes have a higher-than-average risk of heart disease. The test also provides a baseline against which to compare future tests in case of chest pain.
• An exercise electrocardiogram (treadmill EKG test) before you begin a vigorous exercise program.
• An electromyogram (EMG) and nerve conduction study, if your health professional suspects that you may have diabetic neuropathy.
• An ankle-brachial index (ABI) measurement, which can be used to test for peripheral arterial disease if you are older than 50.

Eye exams during pregnancy

If you become pregnant, you need to have an ophthalmoscopy during the first 3 months and close follow-up throughout pregnancy and for 1 year after delivery, because pregnancy increases your risk for eye disease.⁷ If you already have eye disease and become pregnant, the eye disease can rapidly become worse.

Your treatment for type 2 diabetes will change over time to meet your individual needs. But the focus of your treatment will always be to keep your blood sugar levels within a normal or near-normal range to prevent complications from diabetes, such as eye, kidney, heart, blood vessel, and nerve disease. You play an important role in managing your condition. By learning about diabetes and working with your health professional to create a plan for treatment, you can improve your health and quality of life.

How can you manage your diabetes?

Follow your diet

It is important to follow a healthy, balanced diet that includes whole grains, lean meat, fish, and vegetables. To help control your blood sugar and reduce your risk for complications from diabetes, limit alcohol. And reduce calories if you need to lose weight.

Of the three major nutrients (carbohydrate, protein, and fat), carbohydrate has the greatest effect on blood sugar. Because you have diabetes, it's important that you include the proper amount of carbohydrate in your daily diet and that you space carbohydrate evenly throughout the day. You can use one of the following approaches:

Diabetes: Counting carbs if you don't use insulin (preferred)

Diabetes: Counting carbs if you use insulin (preferred)

Diabetes: Using a food guide

Diabetes: Using a plate format for eating

Planning meals to manage diabetes often means looking at food in a new way. Some people may have trouble accepting the changes they need to make in their lifestyle. You may find it helpful to read about how emotions influence what we eat, when we eat, and how much we eat:

Diabetes: Coping with your feelings about your diet

Take an aspirin daily

If you are age 40 or older, talk to your health professional about taking a low-dose aspirin daily to help prevent heart attack, stroke, and other large blood vessel disease ( macrovascular disease). People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.¹

Exercise regularly

Exercise helps control your blood sugar, because you use glucose for energy during and after activity. It also helps you stay at a healthy weight; lower high cholesterol; raise high-density lipoprotein (HDL), or "good," cholesterol; and lower high blood pressure. These benefits help prevent cardiovascular disease. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week. It may help to keep track of your exercise on an activity log (What is a PDF document?) . The American Diabetes Association suggests that you include resistance exercises in your exercise program.² Resistance exercises can include activities like weight lifting or even yard work. See the topic Fitness for ideas on how to add daily activity to your life. Work with your health professional to develop a safe exercise program.

Maintain blood sugar control

Diabetes: Checking your blood sugar

Diabetes: Preventing high blood sugar emergencies

Lower high blood pressure and high cholesterol

It's important to keep your blood pressure and cholesterol at recommended levels to reduce your risk of heart disease and large blood vessel disease.

• Blood pressure should be less than 130/80 millimeters of mercury (mm Hg) in people with diabetes. Moderate exercise, such as 30 to 45 minutes of brisk walking most days of the week, can help lower blood pressure. But you may need to take one or more medicines, such as angiotensin-converting enzyme (ACE) inhibitors or thiazide diuretics, to achieve your goal.⁷
• A low-fat diet, exercise, and weight loss can lower your cholesterol. Your body needs insulin to process fats, as it does with carbohydrate. If your diabetes is poorly controlled, the fats in your blood (particularly triglycerides) can rise significantly. You should strive for a goal of less than 100 milligrams per deciliter (mg/dL) or aim for keeping it at 70 mg/dL, for low-density lipoprotein (LDL), or "bad," cholesterol. Adults with diabetes need to keep their HDL cholesterol level more than 40 mg/dL for men and more than 50 mg/dL for women. Triglycerides should be less than 150 mg/dL. You may need to take lipid-lowering medicines, such as statins, to reach your goals. Statins reduce LDL levels and the risk of heart disease in people with diabetes.⁸ They also have been shown to reduce the risk of heart attack and stroke by one-third in people with diabetes, even those who do not have high LDL levels or existing heart disease.⁹

Take care of yourself in other ways

• Don't smoke.
• Take care of your skin and your teeth and gums.
• Know what to do when you are sick.
• Grieve the things you feel you have lost because of diabetes.
• Wear identification to let medical personnel know that you have diabetes so they can give you appropriate care. You can buy medical identification in bracelets, necklaces, or other forms of jewelry at your local drugstore.
• Know why foot care is important, and take care of your feet daily. For information, see:

Diabetes: Taking care of your feet.

• Limit your alcohol intake to no more than 1 drink a day for women (none if you are pregnant) and 2 drinks a day for men.
• See your health professional regularly. For more information, see the Exams and Tests section of this topic.

If you take oral diabetes medicine

Take your medicine as directed. If you take one of the medicines with low blood sugar as a side effect, learn to deal with low blood sugar. For information, see:

Diabetes: Dealing with low blood sugar from medicines.

If you need to take insulin

If you become severely ill, have surgery, become pregnant, or breast-feed, you may need insulin injections temporarily even though you normally take only oral medicine. You should be able to return to your usual treatment after the situation is over.

As type 2 diabetes progresses, your pancreas may produce less and less insulin. This means that you have to take insulin for the rest of your life, usually by giving yourself a shot several times a day for the rest of your life.

If you take insulin, learn how to deal with low blood sugar and give yourself an insulin shot. See:

Diabetes: Dealing with low blood sugar from insulin.

Diabetes: Giving yourself an insulin shot.

Also, learn how to:

• Take precautions when you are driving. Do not drive if your blood sugar is below 70 milligrams per deciliter (mg/dL).⁷
• Take precautions to prevent problems while traveling.

Other issues

Talk with your health professional if you want to know about:

• Treatment changes to prepare for pregnancy. For more information see:

  Pregnancy and diabetes: Planning for pregnancy.

• Finding a support group.
• Immunizations. See the topic Immunizations for the recommended immunization schedule.

What to Think About

The United Kingdom Prospective Diabetes Study (UKPDS) showed that keeping blood sugar levels within a normal or near-normal range helps decrease a person's chances of developing complications from diabetes. Every effort you make to get your blood sugar level closer to a normal or near-normal range leads to some lowering of your risk for complications.

Keeping your blood sugar levels within a normal or near-normal range is the best way to reduce your risk of complications from type 2 diabetes. The higher your blood sugar level, the greater your risk for developing eye, kidney, heart, blood vessel, and nerve disease.¹⁰

Be sure you have:

• An exercise program. Exercise helps control your blood sugar, because you use glucose for energy during and after activity. It also helps you stay at a healthy weight; lower high cholesterol; raise HDL, or "good," cholesterol; and lower high blood pressure. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week. The American Diabetes Association suggests that you include resistance exercises in your program.² Resistance exercises can include activities like weight lifting or even yard work. See the topic Fitness for ideas on to how add daily activity to your life.
• A daily aspirin, if your doctor says it is okay. People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases. If you are 40 or older, talk to your health professional about taking a low-dose aspirin daily to help prevent heart attack, stroke, or other large blood vessel disease ( macrovascular disease).¹¹
• Adequate treatment for high blood pressure and high cholesterol. These conditions increase your risk for developing diabetic complications, especially heart and blood vessel diseases.¹²
• Yearly screening for protein in your urine. This is the only way to detect early kidney damage (diabetic nephropathy). If evidence of kidney damage is found, medicine can help slow, or possibly reverse, the damage.
• Yearly eye exams by an ophthalmologist or optometrist. This is the only way to monitor your eyes for signs of damage ( diabetic retinopathy).
• A plan to take care of your feet daily.

And two more important things to act on are:

• Don't smoke. If you don't smoke, you can slow down the damage to your blood vessels from diabetes¹³
• Keep your immunizations up to date. Diabetes affects your immune system, increasing your risk for developing a severe illness, such as influenza or pneumonia. See the topic Immunizations for the recommended immunization schedule.

You play a major role in treating your type 2 diabetes. Be sure to:

• Follow your diet.
• Exercise regularly.
• Maintain blood sugar control.
• Take an aspirin if recommended.
• Control blood pressure and cholesterol.

Follow your diet

Carbohydrate affects your blood sugar more than other nutrients. When you know how much carbohydrate is in your food, you can spread the amount throughout the day, which helps prevent high blood sugar after meals. Use one of the following methods for keeping track of carbohydrate in your daily diet:

Diabetes: Counting carbs if you don't use insulin (preferred)

Diabetes: Using a food guide

Diabetes: Using a plate format for eating

Exercise regularly

Exercise helps control your blood sugar, because you use glucose for energy during and after activity. It also helps you stay at a healthy weight; lower high cholesterol; raise HDL, or "good," cholesterol; and lower high blood pressure. These benefits help prevent cardiovascular disease, the main cause of death in people who have diabetes.

Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week. It may help to keep track of your exercise on an activity log (What is a PDF document?) . The American Diabetes Association suggests that you include resistance exercises in your program.² Resistance exercises can include activities like weight lifting or even yard work. See the topic Fitness for ideas on to how add daily activity to your life.

Walking, running, bike riding, and swimming are good activities for people with diabetes. But some activities can make complications more likely. For instance, weight lifting can increase the risk of retinal bleeding if you have eye disease ( diabetic retinopathy). If you have diabetic neuropathy, running may lead to foot problems. Check with your health professional before you begin an exercise program to find out what activities are best for you. Work with your health professional to develop a safe exercise program.

Maintain blood sugar control

• Check your blood sugar as often as prescribed by your doctor.

  Diabetes: Checking your blood sugar

• Prevent high blood sugar levels.

  Diabetes: Preventing high blood sugar emergencies

• Deal with low blood sugar levels, if you take insulin or certain oral diabetes medicines.

  Diabetes: Dealing with low blood sugar from medicines

Getting your blood sugar in a normal or near-normal range is very important if you are thinking about getting pregnant. For more information, see:

I have diabetes. Should I get pregnant now?

Take an aspirin daily

If you are 40 or older, talk to your health professional about taking a low-dose aspirin daily to help prevent heart attack, stroke, or other large blood vessel disease ( macrovascular disease). People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.¹

Control blood pressure and cholesterol

It's important to keep your blood pressure and cholesterol at recommended levels to reduce your risk of heart and large blood vessel disease. Exercise can help keep your blood pressure at the recommended level of less than 130/80 millimeters of mercury (mm Hg). In some cases, one or more medicines may be needed. For more information, see the Treatment Overview section of this topic.

A low-fat diet, exercise, and weight loss can lower your cholesterol. The body needs insulin to process fats, as it does with carbohydrate. If your diabetes is poorly controlled, the fats in your blood (particularly triglycerides) can rise significantly. You should strive for a goal of less than 100 milligrams per deciliter (mg/dL) or aim for keeping it at 70 mg/dL, for low-density lipoprotein (LDL), or "bad," cholesterol. Triglycerides should be less than 150 mg/dL. Adults with diabetes need to keep their HDL cholesterol level more than 40 mg/dL for men and more than 50 mg/dL for women. Your health professional may recommend cholesterol-lowering medicines called statins to cut your risk of heart disease even if you do not have high LDL levels or existing heart disease.

Several oral medicines are available to treat type 2 diabetes. These medicines increase insulin production, decrease insulin resistance, or slow intestinal absorption of carbohydrate.

You may need more than one medicine to adequately control your diabetes. Together, two or more medicines may work more effectively than a single medicine to lower blood sugar level. Taking two medicines together may reduce side effects by allowing lower doses of each. But in some cases, taking two medicines can increase the risk of side effects, such as low blood sugar (hypoglycemia).

You may need to take insulin temporarily if you have surgery or are severely ill, pregnant, or breast-feeding. You also may need to take insulin daily as a shot if lifestyle and pills (oral medicines) are not controlling your blood sugar, or if your pancreas stops producing insulin.

Medicines also may be needed to prevent or slow the development of complications.

Medication Choices

Aspirin may be recommended to prevent heart attack, stroke, or other large blood vessel disease ( macrovascular disease).¹ If you are age 40 or older, talk to your health professional about whether you should take a low-dose aspirin daily.

Medicines that increase insulin production are:

• Sulfonylureas, such as glipizide (Glucotrol), glyburide (DiaBeta, Glynase, or Micronase), glimepiride (Amaryl), the combination medicine glyburide and metformin (Glucovance), the combination of sitagliptin and metformin (Janumet), or the combination of glipizide and metformin (Metaglip).
• Meglitinides, such as repaglinide (Prandin) and nateglinide (Starlix).

Medicines that decrease insulin resistance are:

• Biguanides, such as metformin (Glucophage or Glucophage XR) , the combination medicine glyburide and metformin (Glucovance), or the combination of metformin and glipizide (Metaglip).
• Thiazolidinediones, such as rosiglitazone (Avandia), pioglitazone (Actos), or the combination of rosiglitazone and metformin (Avandamet).

Medicines that slow intestinal absorption of carbohydrate are:

• Alpha-glucosidase inhibitors, such as acarbose (Precose) or miglitol (Glyset).

New medicines recently approved by the U.S. Food and Drug Administration (FDA) include:

• Incretin mimetics, such as exenatide (Byetta). Exenatide lowers both fasting blood sugar and blood sugar after you eat. Your doctor may recommend Byetta if you have not been able to control your blood sugar with oral medicines such as metformin or a sulfonylurea. Byetta may be taken by itself or with other oral medicines. It is given as a shot 2 times a day, before morning and evening meals.
• Amylinomimetics, such as pramlintide (Symlin). Pramlintide lowers blood sugar after you eat. Your doctor may recommend pramlintide if you already take insulin but still cannot control your blood sugar. Pramlintide is only used with insulin. You take it as a shot before meals.
• Dipeptidyl peptidase IV (DPP-4) inhibitors, such as sitagliptin (Januvia). Sitagliptin lowers blood sugar. It does this by allowing the body to release insulin for longer than usual after blood sugar rises.

Insulin

• Insulin

Medications to control blood pressure and cholesterol

You may need medicines to lower your blood pressure and cholesterol, reducing your risk for heart disease and large blood vessel disease.

• Angiotensin-converting enzyme (ACE) inhibitors or thiazide diuretics may be used to lower your blood pressure to the goal of less than 130/80 millimeters of mercury (mm Hg).
• Cholesterol-lowering medicines known as statins reduce LDL levels and the risk of heart disease in people with diabetes.⁸ They also have been shown to reduce the risk of heart attack and stroke by one-third in people with diabetes, even those who do not have high LDL levels or existing heart disease.⁹

What to Think About

You will need to take ACE inhibitors or ARBs if you have protein in your urine, a sign of diabetic nephropathy. Effective control of your blood sugar also is essential to prevent progression of nephropathy.

The U.S. Food and Drug Administration (FDA) has announced a possible safety issue with the drug rosiglitazone (Avandia). A new study shows that people who take Avandia may raise their chance of having a heart attack. They may also raise their chance of death from heart disease.

Manufacturers of rosiglitazone (Avandia), pioglitazone (Actos), rosiglitazone and glimepiride (Avandaryl),