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)".)

CAUSES OF TYPE 2 DIABETES Type 2 diabetes is thought to be caused by a combination of genetic and environmental factors. (See "Pathogenesis of type 2 diabetes mellitus" and "Risk factors for type 2 diabetes mellitus".) Genetic causes Many people with type 2 diabetes have a family member with either type 2 diabetes or other medical problems associated with diabetes, such as high cholesterol levels, high blood pressure, or obesity. The lifetime risk of developing type 2 diabetes is 5 to 10 times higher in first-degree relatives (sister, brother, son, daughter) of a person with diabetes compared to a person with no family history of diabetes. The likelihood of developing type 2 diabetes is greater in certain ethnic groups, such as people of Hispanic, African, and Asian descent. Environmental conditions Environmental factors such as what you eat and how active you are, combined with genetic causes, affect the risk of developing type 2 diabetes. Pregnancy A small number (about 3 to 5 percent) of pregnant women develop diabetes during pregnancy, called "gestational diabetes." Gestational diabetes is similar to type 2 diabetes, but usually resolves after the woman delivers her baby. Women who have gestational diabetes are at increased risk for developing type 2 diabetes later in life. (See "Patient information: Gestational diabetes mellitus (Beyond the Basics)".) TYPE 2 DIABETES DIAGNOSIS The diagnosis of diabetes is based upon your symptoms and the results of blood tests. (See "Clinical presentation and diagnosis of diabetes mellitus in adults".) Symptoms Before being diagnosed with type 2 diabetes, most people have no symptoms at all. In those who do have symptoms, 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. Random blood sugar test For a random blood sugar test, you can have blood drawn at any time throughout the day, regardless of when you last ate. If your blood sugar is 200 mg/dL (11.1 mmol/L) or higher and you have symptoms of high blood sugar (see 'Symptoms' above), it is likely that you have diabetes. 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). A normal fasting blood sugar level is less than 100 mg/dL (5.55 mmol/L). Hemoglobin A1C test The "A1C" blood test measures your average blood sugar level over the past two to three months. Normal values for A1C are 4 to 6 percent. The A1C test can be done at any time of day (before or after eating). Oral glucose tolerance test Oral glucose tolerance testing (OGTT) is a test that involves drinking a special glucose solution (usually orange or cola flavored). Your blood sugar level is tested before you drink the solution, and then again one and two hours after drinking it.

Criteria for diagnosis The following criteria are used to classify your blood sugar levels as normal, increased risk (blood sugar levels that are higher than normal and indicate a risk of future diabetes), or diabetes. Normal Fasting blood sugar less than 100 mg/dL (5.55 mmol/L). Categories of increased risk Impaired fasting glucose is defined as a fasting blood sugar level between 100 and 125 mg/dL (5.6 to 6.9 mmol/L). Impaired glucose tolerance is defined as a blood sugar level of 140 to 199 mg/dL two hours after an oral glucose tolerance test. A1C persons with 5.7 to 6.4 percent are at highest risk, although there is a continuum of increasing risk across the entire spectrum of subdiabetic A1C levels.

At least 50 percent of people with impaired glucose tolerance eventually develop type 2 diabetes. Even if they don't develop diabetes, these people are at increased risk of heart disease. Impaired glucose tolerance is very common; about 11 percent of all people between the ages of 20 and 74 have impaired glucose tolerance. 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 (11.1 mmol/L) or higher A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher A blood sugar of 200 mg/dL (11.1 mmol/L) or higher two hours after an oral glucose tolerance test An A1C of 6.5 percent or higher

The blood tests must be repeated on another day to confirm the diagnosis of diabetes. Type 1 versus type 2 diabetes Doctors can usually tell whether a person has type 1 or type 2, but there are situations when the diagnosis is difficult to determine. In such cases, doctors often run additional blood tests. TYPE 2 DIABETES TREATMENT A full discussion of the treatment for type 2 diabetes is available separately. (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)".) 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)".) PREGNANCY AND DIABETES Women with type 2 diabetes are usually able to become pregnant and have a healthy baby. A full discussion of diabetes in pregnancy is available separately. (See "Patient information: Care during pregnancy for women with type 1 or 2 diabetes mellitus (Beyond the Basics)".) WHERE TO GET MORE INFORMATION Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. 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). 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, HbA1C, or just A1C. What should my A1C numbers be? That depends on why you have the test. When checking for diabetes If you had an A1C test to see if you have diabetes, your A1C should be 6 or less. If your A1C is 6.5 or higher, it probably means you have diabetes, but you should have the test done again to be sure If your A1C is between 5.7 and 6.4, you are at risk for getting diabetes. You should probably start doing things that can help prevent diabetes. For example, you should become more active and lose weight (if you are overweight). When checking how treatment is working If you already know you have diabetes, and you had an A1C test to see how well controlled your blood sugar is, your A1C should probably be 7 or less. But you need to check with your doctor on what your level should be. Not everyone with diabetes is the same. Some people need to aim for different A1C levels than others. Can I do this test at home? It is now possible to buy kits to test your A1C at home. But home testing of A1C is not usually necessary. How often should I have an A1C test? That depends on whether you have diabetes and on what your last A1C test showed. If you had an A1C test to check for diabetes and your A1C was less than 5.7 (meaning you do NOT have diabetes), you should have A1C tests done every 3 years. If you had an A1C test to check for diabetes and your A1C was between 5.7 and 6.4 (meaning you do not have diabetes but are at risk for it), you should have A1C tests done every year. If you do have diabetes and your blood sugar is well controlled, you should have A1C tests every 6 months. If you have diabetes and you recently changed treatment plans or you are having trouble controlling your blood sugar, you should have A1C tests every 3 months.

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. People with diabetes (sometimes called diabetes mellitus) can get nerve damage if they have high blood sugar levels for a long time. Another word for nerve damage is neuropathy. People with diabetes can get different types of nerve damage. This article covers the most common type of nerve damage caused by diabetes.

What are the symptoms of nerve damage caused by diabetes? Nerve damage usually affects the toes and feet first. Some people do not feel any symptoms, 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. Tingling Feeling light touches as bothersome or painful

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

What other treatment might I have? Some people might have other treatment for symptoms or problems caused by nerve damage. They might have treatment for: Pain Doctors can prescribe different medicines to treat pain that is caused by nerve damage. Foot problems Doctors can treat foot problems that occur. There are different treatments, depending on how serious the problem is. For example, 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. He or she should also do a quick check of your feet at every visit. Can nerve damage be prevented? Yes. If you have diabetes, 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, 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. Neuropathic pain is usually burning, tingling, sharp, or stabbing. People can have the pain all the time, or the pain can come and go. Neuropathic pain is usually worse at rest and at night. Sometimes, people feel a lot of pain when they are touched gently. Neuropathic pain can be severe and affect daily life. For instance, neuropathic pain can keep people from sleeping or eating well. This can lead to depression and anxiety. In some cases, neuropathic pain goes away on its own. But in other cases, it can last months or years. What causes neuropathic pain? Different conditions can cause neuropathic pain, including: Diabetic neuropathy This is a form of nerve damage that can happen in people with diabetes. Postherpetic neuralgia This is a condition that can happen after people have a painful rash called shingles. Stroke A stroke is when part of the brain is injured because it goes without blood for too long. People can have neuropathic pain after a stroke.

But sometimes, doctors cant figure out whats causing a persons neuropathic pain. Will I need tests? Maybe. Your doctor or nurse will ask about your symptoms and do an exam. He or she might do: Blood tests Nerve tests to check whether your nerves are working normally

How is neuropathic pain treated? Treatments for neuropathic pain include both medicines and activities. No single treatment works for everyone. Your doctor or nurse will help you find the right mix of treatments for you. The medicines used most often to treat neuropathic pain are ones that are also used to treat other conditions. Doctors treat neuropathic pain with medicines for depression, because they work on areas of the brain that process pain. Doctors also treat neuropathic pain with medicines that prevent seizures, because they help with overactive nerves. 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, patch, 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. 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, you should be open to trying new treatments or combinations of treatments. Sometimes people have to try a few different things before they find the one that works best. Is there anything I can do on my own to feel better? Yes. You can: Use a heating pad or cold pack on the painful area. Check with your doctor before trying this to make sure it is OK for your individual condition. Learn ways to relax your mind and body, such as doing deep breathing exercises. Relaxing your mind can help with how the body feels pain. Stay as active as possible. If you havent been active for a while, start slowly and increase your activity slowly. Tell your doctor or nurse if you feel depressed. Neuropathic pain and depression often go together, and each can make the other worse. Getting treatment for your depression can help you cope more easily with your pain.