Type 2 diabetes

What is type 2 diabetes?

Your body turns food into glucose, a sugar your cells use for energy. Insulin, a hormone made by the pancreas, moves that sugar from your blood into your cells.

In type 2 diabetes, your cells don’t respond to insulin as well as they should. This is called insulin resistance. Over time, the pancreas may not make enough insulin to keep up, and blood sugar stays higher than it should.

About 9 in 10 people with diabetes have type 2, and it usually develops slowly, over years. Prediabetes means blood sugar is higher than normal but not yet in the diabetes range.

What are the symptoms?

Many people have no symptoms at first, so type 2 diabetes is often found on a routine blood test. When symptoms do show up, they can include:

• Feeling very thirsty
• Peeing more often, including at night
• Feeling tired
• Blurry vision
• Cuts or sores that heal slowly
• Tingling or numbness in the hands or feet
• Losing weight without trying

What causes it, and who is at risk?

Type 2 diabetes comes from a mix of genes, body changes, and life circumstances, and it isn’t anyone’s fault. Your chance is higher if you:

• Have a parent, brother, or sister with type 2 diabetes
• Are 35 or older
• Have prediabetes
• Had diabetes during a pregnancy (gestational diabetes)
• Have polycystic ovary syndrome (PCOS)
• Have high blood pressure or high cholesterol
• Have a higher body weight, especially around the belly
• Are active fewer than 3 days a week

Type 2 diabetes is more common in people who are Black, Hispanic or Latino, American Indian, Alaska Native, Asian American, or Pacific Islander.

How is type 2 diabetes diagnosed?

Type 2 diabetes is diagnosed with blood tests. Your clinician may use one or more of these:

• A1C: your average blood sugar over about the past 3 months. You don’t need to fast. An A1C of 6.5% or higher points to diabetes. An A1C of 5.7% to 6.4% is in the prediabetes range.
• Fasting blood sugar: checked after at least 8 hours without food. A result of 126 mg/dL or higher points to diabetes.
• Oral glucose tolerance test: you drink a sweet liquid, and your blood sugar is checked 2 hours later. A result of 200 mg/dL or higher points to diabetes.
• Random blood sugar: checked at any time of day. A result of 200 mg/dL or higher, along with symptoms, points to diabetes.

Unless you have clear symptoms, a high result is usually confirmed with a second test.

How is type 2 diabetes treated?

Treatment aims to keep blood sugar in a safe range and lower the chance of heart, kidney, eye, and nerve problems. Most plans combine:

• Everyday habits: eating patterns that work for your life and culture, regular movement, sleep, and stress support.
• Medicines by mouth: metformin is often the first medicine. Other groups include SGLT2 inhibitors, DPP-4 inhibitors, and sulfonylureas.
• Injected medicines: GLP-1 receptor agonists and related medicines, and insulin. Some people start insulin early, and others add it years later.
• Home blood sugar checks: with a meter or a continuous glucose monitor (a small sensor worn on the skin)
• Protecting the rest of your body: blood pressure and cholesterol care, a yearly eye exam, kidney tests, and foot checks.

Some medicines, including some SGLT2 inhibitors and GLP-1 receptor agonists, may also help protect the heart or kidneys in certain people.

Living with type 2 diabetes and when to get care

Type 2 diabetes often changes over time, so most people’s plans change too. Request an appointment or call 646-389-0001 if:

• Your A1C or home readings are often above the goal you set with your clinician
• You have low blood sugar (below 70 mg/dL) more than once in a while
• You’re starting or stopping a medicine, planning a pregnancy, or getting ready for surgery
• You notice new numbness, vision changes, or a foot sore that isn’t healing
• Side effects or your schedule make your plan hard to keep up with

When to get emergency care

Call 911 or go to the nearest emergency room if you or someone with you has:

• Low blood sugar that doesn’t improve after eating or drinking fast-acting sugar, or confusion, passing out, or a seizure
• High blood sugar with vomiting, trouble breathing, fruity-smelling breath, deep confusion, or extreme sleepiness

If you’re not sure, call 911. Don’t drive yourself.

How Madison Medical Care helps

At your visit, Sona Shah, MD, goes over your blood sugar history, medicines, and goals with you, and explains your options in plain words.

Dr. Shah is board-certified in Endocrinology, Diabetes & Metabolism by the American Board of Internal Medicine and has practiced adult endocrinology for a decade. She did her internal medicine residency at St. Luke’s Roosevelt and her endocrinology fellowship at Weill Cornell. She has a particular interest in pairing lifestyle changes with evidence-based medicine, and in women’s health.

• Visits are in person at 30 E 23rd St, Floor 7, near Madison Square Park.
• Your first visit is 30 minutes. Follow-up visits are 15 minutes.
• Request an appointment online or call 646-389-0001. Our Patient Support Team will contact you within 2 business days.
• We’re a self-pay practice and don’t bill insurance for visits. Your labs, imaging, and prescriptions still go through your insurance.
• We can’t see patients who have Medicare or Medicaid.