When you eat, your body changes most of the food you digest into glucose (a form of sugar). A hormone called insulin allows this glucose to enter all the cells of your body. There it is used for energy. Insulin is produced by the pancreas. In someone who has type 2 diabetes, the pancreas doesn’t make enough insulin or the body’s cells can’t use insulin properly (called insulin resistance). This causes glucose to build up in your blood instead of moving into the cells. Too much glucose in the blood can lead to serious health problems that damage the blood vessels, nerves, heart, eyes, and kidneys.

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]


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.

Weight loss surgery in those who are obese is an effective measure to treat diabetes.[103] Many are able to maintain normal blood sugar levels with little or no medication following surgery[104] and long-term mortality is decreased.[105] There however is some short-term mortality risk of less than 1% from the surgery.[106] The body mass index cutoffs for when surgery is appropriate are not yet clear.[105] It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.[107][108]


Women seem to be at a greater risk as do certain ethnic groups,[10][109] such as South Asians, Pacific Islanders, Latinos, and Native Americans.[23] This may be due to enhanced sensitivity to a Western lifestyle in certain ethnic groups.[110] Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in parallel with rising obesity rates.[10] Type 2 diabetes is now diagnosed as frequently as type 1 diabetes in teenagers in the United States.[13]
A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.[66] According to the current definition, two fasting glucose measurements above 7.0 mmol/l (126 mg/dl) is considered diagnostic for diabetes mellitus.
You have a higher risk of type 2 diabetes if you are older, have obesity, have a family history of diabetes, or do not exercise. Having prediabetes also increases your risk. Prediabetes means that your blood sugar is higher than normal but not high enough to be called diabetes. If you are at risk for type 2 diabetes, you may be able to delay or prevent developing it by making some lifestyle changes.
How long will diabetes stay away after weight loss? Long-term normal blood glucose control in previously diabetic individuals after bariatric surgery demonstrates that diabetes does not recur for up to 10 years, unless substantial weight gain occurs (86). These observations are consistent with the twin cycle hypothesis and the existence of a trigger level for adverse metabolic effects of fat in the pancreas. Hence, for a given individual with type 2 diabetes, reducing the liver and pancreas fat content below his or her personal trigger levels would be expected to result in a release from the fatty acid–mediated dysfunction. Individual tolerance of different degrees of fat exposure vary, and understanding this liposusceptibility will underpin the future understanding of genetically determined risk in any given environment. However, this should not obscure the central point: If a person has type 2 diabetes, there is more fat in the liver and pancreas than he or she can cope with.

Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 AD with type 1 associated with youth and type 2 with being overweight.[112] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus which is also associated with frequent urination.[112] Effective treatment was not developed until the early part of the 20th century when the Canadians Frederick Banting and Charles Best discovered insulin in 1921 and 1922.[112] This was followed by the development of the long acting NPH insulin in the 1940s.[112]
Gestational diabetes develops in pregnant women who have never had diabetes. If you have gestational diabetes, your baby could be at higher risk for health problems. Gestational diabetes usually goes away after your baby is born but increases your risk for type 2 diabetes later in life. Your baby is more likely to have obesity as a child or teen, and more likely to develop type 2 diabetes later in life too.
Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[2] As the disease progresses, a lack of insulin may also develop.[11] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes".[2] The most common cause is a combination of excessive body weight and insufficient exercise.[2]
For people with Type 1 diabetes, blood glucose monitoring and insulin administration is the standard of care. Patients need to check their blood sugar a number of times a day, then give themselves insulin to replace what would have been made in the pancreas. Treatment for Type 2 diabetes, however, doesn’t involve these critical calculations of insulin. It’s usually maintained with a pretty regular administration of the same drugs on a set schedule.
Dietary factors also influence the risk of developing type 2 diabetes. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.[33][34] The type of fats in the diet are important, with saturated fats and trans fatty acids increasing the risk, and polyunsaturated and monounsaturated fat decreasing the risk.[26] Eating a lot of white rice appears to play a role in increasing risk.[35] A lack of exercise is believed to cause 7% of cases.[36] Persistent organic pollutants may play a role.[37]
iSage – A prescription-only patient-facing iOS and Android app that works in conjunction with a web portal used by the doctor. The doctor sets target levels for insulin based on the patient’s glucose levels. Then the algorithm takes over. Patients can enter their blood glucose levels and iSage will change their insulin dosing levels based on the doctor’s plan and the entered values.
Heart disease and stroke. People who have diabetes are at greater risk for heart disease and stroke. The risk is even greater for people who have diabetes and smoke, have high blood pressure, have a family history of heart disease, or are overweight. Heart disease is easiest to treat when it is caught early. It is very important to see your doctor on a regular basis. He or she can test for early signs of heart disease. This includes checking cholesterol levels. If your cholesterol is higher than the recommended level, your doctor will talk to you about lifestyle changes and medicine to help get your cholesterol under control.
Carb Manager is the preferred food app for Pamala Moberly, 56, a retired missionary in Tifton, Georgia. “I like that it helps me keep track of total carbs, net carbs, fiber, proteins, and fats. I can even make my own recipes in this app, and it will calculate all of those numbers,” she says. She uses the free version, but adding the subscription service allows you to also enter blood glucose values. (The current subscription price is $8.49 per month or $39.99 per year.)
Diabetes Tracker –  The American Journal of Preventive Medicine ranked this app, which has no free version, No. 1. It boasts an intensive and easy-to-follow educational component in addition to features for monitoring blood glucose, carbs, net carbs and more. Easy to see the big picture with daily and weekly reports. For some, it may be worth the extra expense.
Type 2 diabetes is usually associated with being overweight (BMI greater than 25), and is harder to control when food choices are not adjusted, and you get no physical activity. And while it’s true that too much body fat and physical inactivity (being sedentary) does increase the likelihood of developing type 2, even people who are fit and trim can develop this type of diabetes.2,3
Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine.
Asian. Diabetes is the fifth-leading cause of death for Asian or Pacific Islander women in the United States.10 However, it may be more or less common for women of different Asian heritage groups to be diagnosed with diabetes. One in every 33 Chinese-American women is diagnosed with diabetes compared to 1 in every 10 Asian Indian women.1 It is also more common for Asian women to develop gestational diabetes compared to white women.11
Diabetes also can cause long-term complications in some people, including heart disease, stroke, vision impairment, and kidney damage. It also can cause other problems throughout the body in the blood vessels, nerves, and gums. While these problems don't usually show up in kids or teens who've had type 1 diabetes for only a few years, they can affect them in adulthood, particularly if their diabetes isn't well controlled.

Several studies have suggested that process indicators such as foot exams, eye exams, and measurement of A1c may not be sensitive enough to capture all aspects of quality of care that ultimately result in reduced morbidity. New diabetes quality-of-care indicators are currently under development and may help determine whether appropriate, timely, evidence-based care is linked to risk factor reduction. In addition, the scientific evidence that type 2 diabetes can be prevented or delayed has stimulated new research into the best markers and approaches for identifying and referring high-risk individuals to prevention programs in community settings.
This evidence, while the best to date, confirmed what previous work had shown. A 2012 Cochrane review assessed all the randomized controlled trials through 2011 that had investigated how testing for blood glucose at home improved outcomes. It included 12 trials involving more than 3,200 patients. By 12 months, the overall benefit to testing, with respect to lab values, was statistically insignificant. There were never any benefits with respect to patient satisfaction.

Mechanism of interaction between excess amounts of fatty acids, diacylglycerol, and ceramide and insulin action within the hepatocyte. Diacylglycerol activates PKCε and inhibits activation of IRS-1 by the insulin receptor. Ceramides cause sequestration of Akt2 by PKCζ and inhibit insulin control of gluconeogenesis. These mechanisms have recently been reviewed (99). FFA, free-fatty acid; TG, triacylglycerol.
In obese young people, decreased β-cell function has recently been shown to predict deterioration of glucose tolerance (4,78). Additionally, the rate of decline in glucose tolerance in first-degree relatives of type 2 diabetic individuals is strongly related to the loss of β-cell function, whereas insulin sensitivity changes little (79). This observation mirrors those in populations with a high incidence of type 2 diabetes in which transition from hyperinsulinemic normal glucose tolerance to overt diabetes involves a large, rapid rise in glucose levels as a result of a relatively small further loss of acute β-cell competence (3). The Whitehall II study showed in a large population followed prospectively that people with diabetes exhibit a sudden rise in fasting glucose as β-cell function deteriorates (Fig. 5) (80). Hence, the ability of the pancreas to mount a normal, brisk insulin response to an increasing plasma glucose level is lost in the 2 years before the detection of diabetes, although fasting plasma glucose levels may have been at the upper limit of normal for several years. This was very different from the widely assumed linear rise in fasting plasma glucose level and gradual β-cell decompensation but is consistent with the time course of markers of increased liver fat before the onset of type 2 diabetes observed in other studies (81). Data from the West of Scotland Coronary Prevention Study demonstrated that plasma triacylglycerol and ALT levels were modestly elevated 2 years before the diagnosis of type 2 diabetes and that there was a steady rise in the level of this liver enzyme in the run-up to the time of diagnosis (75).
Choosing Wisely, an educational campaign aiming to reduce unnecessary medical tests and procedures, advises against routine home glucose monitoring for patients with Type 2 diabetes who are not on insulin. It says there is no benefit, and that there are potential harms (a study has shown an association with increased anxiety and depression). This argument is supported by the American Academy of Family Physicians, the Society of General Internal Medicine and the Endocrine Society.
Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations.[75] Management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight loss, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes).

People with type 1 diabetes are unable to produce any insulin at all. People with type 2 diabetes still produce insulin, however, the cells in the muscles, liver and fat tissue are inefficient at absorbing the insulin and cannot regulate glucose well. As a result, the body tries to compensate by having the pancreas pump out more insulin. But the pancreas slowly loses the ability to produce enough insulin, and as a result, the cells don’t get the energy they need to function properly.


Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine.
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