Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss.[3] Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[4][5]

You know that your family medical history, along with what you eat and how much you weigh, can affect your risk of developing type 2 diabetes. But did you know that your sleep habits can also play a role? It’s true. In fact, sleep deprivation is an often overlooked but significant risk factor for type 2 diabetes, a disease that involves too much glucose (or sugar) in the blood and increases the risk of heart disease.


Type 2 diabetes is a disorder characterized by abnormally high blood sugar levels. In this form of diabetes, the body stops using and making insulin properly. Insulin is a hormone produced in the pancreas that helps regulate blood sugar levels. Specifically, insulin controls how much glucose (a type of sugar) is passed from the blood into cells, where it is used as an energy source. When blood sugar levels are high (such as after a meal), the pancreas releases insulin to move the excess glucose into cells, which reduces the amount of glucose in the blood.
Type 2 diabetes, the most common type of diabetes, is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes mainly from the food you eat. Insulin, a hormone made by the pancreas, helps glucose get into your cells to be used for energy. In type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well. Too much glucose then stays in your blood, and not enough reaches your cells.
A: Fasting plasma glucose and weight change 2 years after randomization either to gastric banding or to intensive medical therapy for weight loss and glucose control. Data plotted with permission from Dixon et al. (13). B: Early changes in fasting plasma glucose level following pancreatoduodenal bypass surgery. A decrease into the normal range was seen within 7 days. Reproduced with permission from Taylor (98).
An individual with type 2 diabetes has the same level of heart attack risk as someone who's already had a heart attack, according to the National Heart, Lung, and Blood Institute. There are numerous reasons for the link between diabetes and heart disease, Dr. Sullivan says, including a "group attack" from diabetes and other heart disease risk factors like high blood pressure and high cholesterol, which already affect many people with type 2 diabetes.
People with diabetes should have an individualized plan for activity and nutrition. Intensive, group-based behavioural interventions can help patients to achieve their goals. Patients should be encouraged to seek nutrition counseling from a registered dietitian; in some regions dietitian consultations are available free of charge (eg, Ontario [www.unlockfood.ca/en/default.aspx], British Columbia [www.healthlinkbc.ca/dietitian-services], and Manitoba [www.wrha.mb.ca/prog/nutrition/files/204DADStickerEnglish.pdf]).
This is a special edition of the iCookbook app just for people with diabetes. The app delivers new, free diabetes-friendly recipes every month. It also has built-in kitchen tools like conversion charts and timers and voice activation, so the user can proceed through a recipe even with messy hands. The user can save and share recipes or even pull up a random one by shaking the phone.
On top of tracking your blood glucose and meals (with a nutrition database and bar-code scanner), the Diabetes:M app will calculate insulin boluses for you. Through the Apple Health app, Diabetes:M will sync with other devices, including glucose meters, Fitbit, Garmin, and many others. You’ll need to pay extra for the subscription to access the full food database, sync multiple devices, and get rid of the ads. (The current subscription cost is $4.99 per month or $49.99 per year.)

The Winnipeg Regional Health Authority acknowledges that it provides health services in facilities located on the original lands of Treaty 1 and on the homelands of the Metis Nation. WRHA respects that the First Nation treaties were made on these territories and acknowledge the harms and mistakes of the past, and we dedicate ourselves to collaborate in partnership with First Nation, Metis and Inuit people in the spirit of reconciliation.
^ Santaguida PL, Balion C, Hunt D, Morrison K, Gerstein H, Raina P, Booker L, Yazdi H. "Diagnosis, Prognosis, and Treatment of Impaired Glucose Tolerance and Impaired Fasting Glucose". Summary of Evidence Report/Technology Assessment, No. 128. Agency for Healthcare Research and Quality. Archived from the original on 16 September 2008. Retrieved 20 July 2008.

But for most people with Type 2 diabetes not on insulin, testing is inappropriate most of the time. That message is not getting through. At the end of last year, another study was published in JAMA Internal Medicine that quantified the prevalence of glucose testing in adults. Researchers examined a database that contained data on more than 370,000 commercial health insurance and Medicare Advantage beneficiaries who had Type 2 diabetes.
^ Jump up to: a b c Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S, Iheozor-Ejiofor Z (November 2015). "Treatment of periodontal disease for glycaemic control in people with diabetes mellitus". The Cochrane Database of Systematic Reviews (11): CD004714. doi:10.1002/14651858.CD004714.pub3. PMID 26545069.
The treatment of low blood sugar consists of administering a quickly absorbed glucose source. These include glucose containing drinks, such as orange juice, soft drinks (not sugar-free), or glucose tablets in doses of 15-20 grams at a time (for example, the equivalent of half a glass of juice). Even cake frosting applied inside the cheeks can work in a pinch if patient cooperation is difficult. If the individual becomes unconscious, glucagon can be given by intramuscular injection.
Gestational diabetes is high blood sugar that develops during pregnancy. Most of the time, you can control gestational diabetes through diet and exercise. It also typically resolves after the baby is delivered. Gestational diabetes can increase your risk for complications during pregnancy. It can also increase risk of type 2 diabetes development later in life for both mother and child.
Prediabetes is a condition in which blood glucose levels are higher than normal, but a person does not yet have diabetes. Prediabetes and high blood glucose levels are a risk factor for developing diabetes, heart disease, and other health problems. Other warning signs prediabetes may include increased urination, feeling you need to urinate more often, and/or increased thirst.
Research has shown that there are some ways of preventing type 2 diabetes, or at least delaying its onset. Lifestyle changes such as becoming more active (or staying active, if you already engage in regular physical activity) and making sure your weight stays in a healthy range are two ways to help ward off type 2 diabetes, but talk to your doctor about what else you can do to prevent or manage the disease.
The United Kingdom Prospective Diabetes Study (UKPDS) was a clinical study conducted by Z that was published in The Lancet in 1998. Around 3,800 people with type 2 diabetes were followed for an average of ten years, and were treated with tight glucose control or the standard of care, and again the treatment arm had far better outcomes. This confirmed the importance of tight glucose control, as well as blood pressure control, for people with this condition.[86][132][133]
Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization (WHO) when the current taxonomy was introduced in 1999.[52]
Diabetes mellitus is a disease in which a person's blood sugar (blood glucose) is either too high (hyperglycemia) or too low (hypoglycemia) due to problems with insulin regulation in the body. There are two main types of diabetes mellitus, type 1 and type 2. Type 1 diabetes usually occurs during childhood, while type 2 diabetes usually occurs during adulthood, however, rates of both types of diabetes in children, adolescents, and teens is increasing. More men than women have diabetes in the US, and the disease can affect men differently than women.
With gestational diabetes, risks to the unborn baby are even greater than risks to the mother. Risks to the baby include abnormal weight gain before birth, breathing problems at birth, and higher obesity and diabetes risk later in life. Risks to the mother include needing a cesarean section due to an overly large baby, as well as damage to heart, kidney, nerves, and eye.
Lack of blood flow can eventually affect your hands and feet and cause pain while you’re walking. This is called intermittent claudication. The narrowed blood vessels in your legs and feet may also cause problems in those areas. For example, your feet may feel cold or you may be unable to feel heat due to lack of sensation. This condition is known as peripheral neuropathy, which is a type of diabetic neuropathy that causes decreased sensation in the extremities. It’s particularly dangerous because it may prevent you from noticing an injury or infection.
A proper diet and exercise are the foundations of diabetic care,[23] with a greater amount of exercise yielding better results.[82] Exercise improves blood sugar control, decreases body fat content and decreases blood lipid levels, and these effects are evident even without weight loss.[83] Aerobic exercise leads to a decrease in HbA1c and improved insulin sensitivity.[84] Resistance training is also useful and the combination of both types of exercise may be most effective.[84]
Threshold for diagnosis of diabetes is based on the relationship between results of glucose tolerance tests, fasting glucose or HbA1c and complications such as retinal problems.[10] A fasting or random blood sugar is preferred over the glucose tolerance test, as they are more convenient for people.[10] HbA1c has the advantages that fasting is not required and results are more stable but has the disadvantage that the test is more costly than measurement of blood glucose.[51] It is estimated that 20% of people with diabetes in the United States do not realize that they have the disease.[10]

No major organization recommends universal screening for diabetes as there is no evidence that such a program improve outcomes.[55][56] Screening is recommended by the United States Preventive Services Task Force (USPSTF) in adults without symptoms whose blood pressure is greater than 135/80 mmHg.[57] For those whose blood pressure is less, the evidence is insufficient to recommend for or against screening.[57] There is no evidence that it changes the risk of death in this group of people.[56] They also recommend screening among those who are overweight and between the ages of 40 and 70.[58]
Diabetes can also affect your skin, the largest organ of your body. Along with dehydration, your body’s lack of moisture due to high blood sugar can cause the skin on your feet to dry and crack. It’s important to completely dry your feet after bathing or swimming. You can use petroleum jelly or gentle creams, but avoid letting these areas become too moist.
Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes, and "other specific types".[10] The "other specific types" are a collection of a few dozen individual causes.[10] Diabetes is a more variable disease than once thought and people may have combinations of forms.[36] The term "diabetes", without qualification, usually refers to diabetes mellitus.
Formal recommendations on how to reverse type 2 diabetes in clinical practice must await further studies. In the meantime, it will be helpful for all individuals with newly diagnosed type 2 diabetes to know that they have a metabolic syndrome that is reversible. They should know that if it is not reversed, the consequences for future health and cost of life insurance are dire, although these serious adverse effects must be balanced against the difficulties and privations associated with a substantial and sustained change in eating patterns. For many people, this may prove to be too high a price to pay, but for those who are strongly motivated to escape from type 2 diabetes, the new understanding gives clear direction. Physicians need to accept that long-term weight loss is achievable for a worthwhile proportion of patients (96). In the United States, diabetes costs $174 billion annually (97), and in the United Kingdom, it accounts for 10% of National Health Service expenditure. Even if only a small proportion of patients with type 2 diabetes return to normal glucose control, the savings in disease burden and economic cost will be enormous.
In fact, high blood pressure is very common with diabetes, as two in three adults with diabetes also have high blood pressure, according to the American Diabetes Association (ADA). High blood pressure doesn't always have noticeable symptoms and you may not know you have it unless your doctor checks. Still, it can lead to serious complications including heart attack, stroke, eye problems, and kidney disease.
In this simple app, you can record your blood sugar, meals, insulin, and medications. If there’s a feature in the app you don’t need, you can switch it off to keep the interface as clean as possible. The app syncs across multiple devices and creates clear graphs and reports so you can see the big picture of your data. If simplicity is your goal, this may be the right app for you.
That’s because when your blood sugar isn’t under control, the excess glucose in your body can increase your chance of developing serious related health conditions. Heart disease, kidney disease, vision issues, and nerve damage are among the problems that can result from poorly managed diabetes, says William Sullivan, MD, a senior physician at the Joslin Diabetes Center and an assistant professor of medicine at Harvard Medical School in Boston.
Effect of an 8-week very-low-calorie diet in type 2 diabetes on arginine-induced maximal insulin secretion (A), first phase insulin response to a 2.8 mmol/L increase in plasma glucose (B), and pancreas triacylglycerol (TG) content (C). For comparison, data for a matched nondiabetic control group are shown as ○. Replotted with permission from Lim et al. (21).
This summary tries to organize information from the full guideline relevant for FPs, but we understand that each practice and each patient is unique. The recommendations prioritized for emphasis in this document might not match the needs of each practice, and the needs of each patient must be assessed through shared decision making. Many patients with type 2 diabetes might not have coverage for medications, and the newer agents might be prohibitively expensive for such patients. It is also plausible that emergent evidence based on real-world data will identify issues with the newer agents that lead to changes in the guideline recommendations. We further recognize that access to supports to implement best practices is not equitably distributed.20,21 For example, some patients have more ready access to allied health professionals than others. These factors (and others) undoubtedly affect diabetes care and outcomes. While many clinical activities are appropriate and advisable in the primary care of a patient with diabetes, the starting point for this summary was the text of the Diabetes Canada clinical practice guidelines. Many other guidelines related to the care of patients who have diabetes exist. The Diabetes Canada guidelines are aligned with the Canadian Cardiovascular Society guidelines for lipids16 and the Hypertension Canada guidelines for blood pressure targets.22 However, not all guidelines have the same recommendations, likely owing to variable weighting of the importance of different outcomes in the evidence base. For instance, recent guidelines from the American College of Physicians encourage higher HbA1c targets owing to the lack of evidence that lower targets are associated with reduced risk of cardiovascular outcomes.23 Additionally, simplified lipid guidelines for FPs de-emphasize targets for low-density lipoprotein to focus on use of evidence-based medications (eg, statins).24 Finally, it is important to note that this manuscript seeks only to summarize Diabetes Canada guideline recommendations deemed most relevant for the primary care management of adults with type 2 diabetes by a selected, albeit multidisciplinary, group; further information about prevention and management of all types of diabetes can be accessed at guidelines.diabetes.ca.
Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with the disease.[2] Type 1 DM must be managed with insulin injections.[2] Type 2 DM may be treated with medications with or without insulin.[12] Insulin and some oral medications can cause low blood sugar.[13] Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM.[14] Gestational diabetes usually resolves after the birth of the baby.[15]

Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can’t make enough insulin, and blood glucose levels rise.
One of the key factors in Joslin’s treatment of diabetes is tight blood glucose control, so be certain that your treatment helps get your blood glucose readings as close to normal as safely possible. Patients should discuss with their doctors what their target blood glucose range is. It is also important to determine what your goal is for A1C readings (a test that determines how well your diabetes is controlled over the past 2-3 months). By maintaining blood glucose in the desired range, you’ll likely avoid many of the complications some people with diabetes face.

^ Jump up to: a b Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, Clegg AJ (September 2009). "The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation". Health Technology Assessment. 13 (41): 1–190, 215–357, iii–iv. doi:10.3310/hta13410. PMID 19726018.


People who are obese -- more than 20% over their ideal body weight for their height -- are at particularly high risk of developing type 2 diabetes and its related medical problems. Obese people have insulin resistance. With insulin resistance, the pancreas has to work overly hard to produce more insulin. But even then, there is not enough insulin to keep sugars normal.
In adults with type 2 diabetes with clinical CVD in whom glycemic targets are not achieved with existing antihyperglycemic medication, an antihyperglycemic agent with demonstrated CV outcome benefit should be added to reduce the risk of major CV events (grade A, level IA for empagliflozin; grade A, level IA for liraglutide; grade C, level II for canagliflozin) Flow sheets:
Hemoglobin A1c or HbA1c is a protein on the surface of red blood cells. The HbA1c test is used to monitor blood sugar levels in people with type 1 and type 2 diabetes over time. Normal HbA1c levels are 6% or less. HbA1c levels can be affected by insulin use, fasting, glucose intake (oral or IV), or a combination of these and other factors. High hemoglobin A1c levels in the blood increases the risk of microvascular complications, for example, diabetic neuropathy, eye, and kidney disease.
In people without clinical CVD in whom glycemic targets are not achieved with existing antihyperglycemic medication, incretin agents (DPP4Is or GLP1RAs) or SGLT2Is should be considered as add-on medication over insulin secretagogues, insulin, and TZDs to improve glycemic control, if lower risk of hypoglycemia or weight gain are priorities (grade A, level IA). Acarbose and orlistat can also be considered as add-on medication to improve glycemic control with a low risk of hypoglycemia and weight gain (grade D, consensus)
There’s no cure for type 1 diabetes. People with type 1 diabetes don’t produce insulin, so it must be regularly injected into your body. Some people take injections into the soft tissue, such as the stomach, arm, or buttocks, several times per day. Other people use insulin pumps. Insulin pumps supply a steady amount of insulin into the body through a small tube.

Endocrinology is the specialty of medicine that deals with hormone disturbances, and both endocrinologists and pediatric endocrinologists manage patients with diabetes. People with diabetes may also be treated by family medicine or internal medicine specialists. When complications arise, people with diabetes may be treated by other specialists, including neurologists, gastroenterologists, ophthalmologists, surgeons, cardiologists, or others.
Founded in 1953, the Canadian Diabetes Association (CDA) is a registered charity that works toward a world free from diabetes. They lead the fight against diabetes by helping those affected by diabetes to live healthy lives, preventing the onset and consequences of diabetes, and discovering a cure. Dr. Charles Best, co-discoverer of insulin, helped create the Diabetes Association of Ontario in the 1940s—which became the CDA in 1953. Diabetes is a chronic, often debilitating and sometimes fatal disease, in which the body either cannot produce insulin or cannot properly use the insulin it produces. Insulin is a hormone that controls the amount of glucose (sugar) in the blood. Diabetes leads to high blood sugar levels, which can damage organs, blood vessels and nerves. The body needs insulin to use sugar as an energy source.
Yes. Once you get a new kidney, you may need a higher dose of insulin. Your appetite will improve so your new kidney will break down insulin better than your injured one. You will use steroids to keep your body from rejecting your new kidney. If your new kidney fails, dialysis treatment can be started while you wait for another kidney. To learn more about kidney transplant click here.
As of 2017, an estimated 425 million people had diabetes worldwide,[8] with type 2 DM making up about 90% of the cases.[16][17] This represents 8.8% of the adult population,[8] with equal rates in both women and men.[18] Trend suggests that rates will continue to rise.[8] Diabetes at least doubles a person's risk of early death.[2] In 2017, diabetes resulted in approximately 3.2 to 5.0 million deaths.[8] The global economic cost of diabetes related health expenditure in 2017 was estimated at US$727 billion.[8] In the United States, diabetes cost nearly US$245 billion in 2012.[19]
The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.[23] Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue.[13] Many people, however, have no symptoms during the first few years and are diagnosed on routine testing.[13] A small number of people with type 2 diabetes mellitus can develop a hyperosmolar hyperglycemic state (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).[13]
Other technology devices, like physical activity trackers, are being integrated with some continuous glucose monitor (CGM) systems to help demonstrate how activity impacts blood glucose levels. In the fall of 2017, Fitbit partnered with Dexcom to bring CGM data to Fitbit Ionic. Some health-care programs, like UHC Medicare Advantage plans, are even providing piloting programs in which participants who use CGM technology, like Dexcom, are receiving Fitbit activity trackers.
In type 2 diabetes, the pancreas still makes insulin but the body doesn't respond to it normally. Glucose is less able to enter the cells and do its job of supplying energy (a problem called insulin resistance). This raises the blood sugar level, so the pancreas works hard to make even more insulin. Eventually, this strain can make the pancreas unable to produce enough insulin to keep blood sugar levels normal.

Diabetes Canada is a health charity and advocacy organization that produces comprehensive national guidelines for the prevention and management of diabetes in adults and children, with a focus on special populations (those with renal failure, Indigenous peoples, women of child-bearing age, etc). Following a rigorous methodology,9,10 a guideline writing committee, composed of interprofessional diabetes experts, posed then answered clinically relevant questions, resulting in a series of recommendations.10 The evidence supporting the recommendations ranges from levels I to IV and grades A to D.8 The Diabetes Canada guideline committee includes primary care practitioners, endocrinologists, diabetes educators, other specialists, and people living with diabetes from across Canada. The resulting diabetes guideline is reviewed and launched in a 5-year cycle, with interim revisions in the event of important practice-changing evidence and treatment options. For the 2018 guidelines, 9 of the 10 authors responsible for developing recommendations for pharmacologic management of type 2 diabetes had no conflicts of interest with industry. In the case of disagreement about conflicts or outright conflicts of interest, committee members removed themselves from discussions. This article does not attempt to revise or critique the Diabetes Canada guideline recommendations but presents a family medicine–oriented approach to applying relevant recommendations in practice.
Anything that makes life with type 1 diabetes or type 2 diabetes easier is a win, and research shows that using a diabetes app can improve your health. For example, a review published online in March 2018 in the journal Diabetes, Obesity and Metabolism combined the results of 16 trials of type 2 diabetes apps and found that, on average, using a diabetes app led to a drop in hemoglobin A1C of 0.57 percent.
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