What Should You Do if You Are Diagnosed With Type 2 Diabetes?
Start by meeting with your healthcare team to set an A1C target, typically below 7 percent for most adults. Begin lifestyle changes immediately — even modest increases in physical activity and dietary improvements can lower blood sugar within days. Your doctor will likely prescribe metformin as a first medication and schedule follow-up tests within 3 months.
A new type 2 diabetes diagnosis can feel overwhelming, but early and consistent action makes a significant difference in long-term outcomes. The American Diabetes Association Standards of Care 2025 recommend a comprehensive initial evaluation including A1C measurement, lipid panel, kidney function tests (eGFR and urine albumin-to-creatinine ratio), dilated eye exam, comprehensive foot exam, and blood pressure assessment. These baseline measurements help your healthcare team identify any existing complications and set personalized treatment goals. Most adults should aim for an A1C below 7 percent, though targets may be adjusted based on age, comorbidities, and hypoglycemia risk.
Diabetes self-management education and support (DSMES) is a critical first step that the ADA recommends at diagnosis and annually thereafter. DSMES programs teach blood glucose monitoring techniques, medication management, meal planning using methods like carbohydrate counting or the diabetes plate method, physical activity guidelines, and strategies for coping with the emotional aspects of chronic disease. Studies published in Diabetes Care show that DSMES improves A1C by 0.5 to 1.0 percentage points and reduces diabetes-related hospitalizations. Ask your doctor for a referral to a certified diabetes care and education specialist.
Establishing regular monitoring routines is essential from day one. If prescribed medications that can cause hypoglycemia, learn to recognize and treat low blood sugar. Check your blood sugar as directed by your healthcare team, keep a log of results, and bring it to every appointment. The ADA recommends scheduling comprehensive diabetes check-ups every 3 to 6 months, including A1C testing, medication review, and screening for complications. Set reminders for annual eye exams, foot exams, and dental visits.
The ADA Standards of Care 2025 recommend a comprehensive initial evaluation at diagnosis including A1C, lipid panel, and kidney function tests
What Is Type 2 Diabetes and What Causes It?
Type 2 diabetes is a chronic metabolic condition where your body becomes resistant to insulin or does not produce enough insulin to maintain normal blood sugar levels. It develops through a combination of genetic predisposition and lifestyle factors including obesity, physical inactivity, and poor dietary patterns.
In type 2 diabetes, the cells in your muscles, fat tissue, and liver do not respond properly to insulin, a condition called insulin resistance. The pancreas initially compensates by producing more insulin, but over time the beta cells that produce insulin become exhausted and fail to keep up with the body's increased demand. This progressive beta cell dysfunction is a hallmark of type 2 diabetes and explains why many patients eventually need insulin therapy even though the disease begins with insulin resistance. The United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that beta cell function declines at approximately 4 percent per year regardless of treatment, making type 2 diabetes a progressive condition.
Genetics play a substantial role in type 2 diabetes risk. Having a first-degree relative with type 2 diabetes increases your risk two to three fold. Certain ethnic groups, including African American, Hispanic, Native American, Asian American, and Pacific Islander populations, face disproportionately higher risk. However, the dramatic global increase in type 2 diabetes prevalence, from 108 million in 1980 to 537 million in 2021 according to the International Diabetes Federation, is driven primarily by rising obesity rates, sedentary lifestyles, and dietary changes associated with urbanization. The World Health Organization projects that diabetes will become the seventh leading cause of death globally by 2030.
Obesity is the strongest modifiable risk factor, with approximately 80 to 90 percent of people with type 2 diabetes being overweight or obese. Visceral adipose tissue (fat stored around the organs) is particularly harmful because it releases inflammatory cytokines and free fatty acids that worsen insulin resistance. Other risk factors include age over 45, history of gestational diabetes, polycystic ovary syndrome, hypertension, dyslipidemia, and prediabetes. The CDC estimates that 38.4 million Americans have diabetes, with type 2 accounting for 90 to 95 percent of cases.
The UKPDS demonstrated that beta cell function declines at approximately 4 percent per year regardless of treatment strategy
What Are the Symptoms of Type 2 Diabetes?
Type 2 diabetes symptoms develop gradually and include increased thirst, frequent urination, unexplained weight loss, blurred vision, slow-healing wounds, frequent infections, fatigue, and tingling or numbness in the hands and feet. Many people have no noticeable symptoms for years, which is why screening is critical.
The insidious nature of type 2 diabetes means that symptoms often develop so slowly that people do not recognize them. The CDC estimates that 8.7 million Americans have undiagnosed diabetes. Classic symptoms result from elevated blood glucose levels: excess glucose overwhelms the kidneys' ability to reabsorb it, causing glucose to spill into the urine and pulling water along with it, leading to polyuria (frequent urination) and polydipsia (excessive thirst). The body's inability to effectively use glucose for energy triggers polyphagia (increased hunger) and unexplained weight loss as the body breaks down fat and muscle for fuel.
High blood sugar also impairs immune function and wound healing. People with undiagnosed type 2 diabetes often report frequent urinary tract infections, yeast infections, or skin infections. Cuts and sores heal slowly because elevated glucose impairs white blood cell function and damages blood vessels that deliver oxygen and nutrients to tissues. Blurred vision occurs when high blood sugar causes the lens of the eye to swell, temporarily changing its shape and focal length. Tingling, numbness, or pain in the hands and feet may indicate that nerve damage has already begun.
The CDC estimates that 8.7 million Americans have undiagnosed diabetes
- Increased thirst and dry mouth
- Frequent urination, especially at night (nocturia)
- Unexplained weight loss despite increased appetite
- Fatigue and weakness
- Blurred or changing vision
- Slow-healing cuts, sores, or bruises
- Frequent infections (urinary, skin, or gum)
- Tingling, numbness, or pain in hands and feet
- Areas of darkened skin (acanthosis nigricans), often in the neck and armpits
How Is Type 2 Diabetes Diagnosed?
Type 2 diabetes is diagnosed using one or more blood tests: A1C of 6.5 percent or higher, fasting plasma glucose of 126 mg/dL or higher, or a 2-hour oral glucose tolerance test result of 200 mg/dL or higher. The ADA recommends screening all adults starting at age 35, or earlier for those with risk factors.
The A1C test is the most convenient diagnostic tool because it does not require fasting and reflects average blood glucose over the preceding two to three months. An A1C of 6.5 percent or higher on two separate occasions confirms diabetes, while 5.7 to 6.4 percent indicates prediabetes. The fasting plasma glucose test requires an 8-hour overnight fast and diagnoses diabetes at 126 mg/dL or higher, with 100 to 125 mg/dL indicating prediabetes. The oral glucose tolerance test, which measures blood sugar two hours after drinking a 75-gram glucose solution, is more sensitive but less practical for routine screening.
The ADA Standards of Care 2025 recommend screening all adults beginning at age 35 regardless of risk factors, and screening earlier for adults of any age who are overweight or obese with one or more additional risk factors. These risk factors include first-degree relative with diabetes, high-risk ethnicity, history of cardiovascular disease, hypertension, HDL cholesterol below 35 mg/dL, triglycerides above 250 mg/dL, polycystic ovary syndrome, physical inactivity, history of gestational diabetes, or prediabetes. Women who had gestational diabetes should be tested every three years for life. If results are normal, repeat testing every three years is recommended.
ADA Standards of Care 2025 recommend screening all adults beginning at age 35 regardless of risk factors
What Are the Best Medications for Type 2 Diabetes?
Metformin remains the recommended first-line medication for most people with type 2 diabetes. Additional options include GLP-1 receptor agonists like semaglutide and liraglutide, SGLT2 inhibitors like empagliflozin and dapagliflozin, DPP-4 inhibitors, sulfonylureas, and insulin when needed. Treatment choice depends on individual factors including cardiovascular and kidney health.
The ADA and European Association for the Study of Diabetes (EASD) consensus report recommends metformin as initial pharmacotherapy due to its effectiveness, safety profile, low cost, and weight neutrality. Metformin reduces A1C by 1.0 to 1.5 percentage points and has demonstrated cardiovascular benefits in the UKPDS trial. For patients who do not reach their A1C target with metformin alone, the choice of second-line agent should be individualized based on the presence of atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, need for weight loss, cost considerations, and hypoglycemia risk.
GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide, exenatide) have emerged as preferred second-line agents due to their potent glucose lowering, significant weight loss, and proven cardiovascular benefits. The SUSTAIN-6 trial demonstrated that semaglutide reduced major adverse cardiovascular events by 26 percent compared to placebo in patients with type 2 diabetes and high cardiovascular risk. SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin) lower blood sugar by blocking glucose reabsorption in the kidneys and have shown remarkable benefits for heart failure and kidney disease. The EMPA-REG OUTCOME trial showed empagliflozin reduced cardiovascular death by 38 percent.
For patients with established atherosclerotic cardiovascular disease or high cardiovascular risk, the ADA recommends a GLP-1 receptor agonist or SGLT2 inhibitor with proven cardiovascular benefit regardless of A1C level. For patients with heart failure, SGLT2 inhibitors are preferred. For patients with diabetic kidney disease, SGLT2 inhibitors with evidence of slowing kidney disease progression (such as dapagliflozin or empagliflozin) are recommended. Insulin therapy may be necessary when A1C is very high (above 10 percent), when there is evidence of ongoing catabolism, or when oral and injectable non-insulin medications do not achieve glycemic goals.
The SUSTAIN-6 trial showed semaglutide reduced major adverse cardiovascular events by 26 percent
How Do Lifestyle Changes Help Manage Type 2 Diabetes?
Lifestyle modifications are foundational to type 2 diabetes management and can reduce A1C by 1 to 2 percentage points. The ADA recommends at least 150 minutes per week of moderate-intensity aerobic activity, medical nutrition therapy with a registered dietitian, weight management targeting 5 to 10 percent body weight loss, and smoking cessation.
Physical activity improves insulin sensitivity, lowers blood glucose, and reduces cardiovascular risk. The ADA recommends 150 minutes per week of moderate-intensity aerobic exercise such as brisk walking, cycling, or swimming, spread over at least three days with no more than two consecutive days without activity. Resistance training at least two to three sessions per week is also recommended because it increases muscle mass, which improves glucose uptake. Research published in Diabetes Care shows that combining aerobic and resistance exercise produces greater A1C reductions than either type alone. Reducing sedentary time by taking brief movement breaks every 30 minutes also improves postprandial glucose levels.
Medical nutrition therapy delivered by a registered dietitian is effective in reducing A1C by 0.5 to 2.0 percentage points. No single dietary pattern is universally recommended; instead, the ADA endorses individualized meal plans that may include Mediterranean, DASH, plant-based, or low-carbohydrate eating patterns. The diabetes plate method is a practical approach: fill half your plate with non-starchy vegetables, one quarter with lean protein, and one quarter with complex carbohydrates. Limit sugar-sweetened beverages, refined grains, and processed foods. For overweight or obese individuals, achieving 5 to 10 percent weight loss significantly improves glycemic control, blood pressure, and lipid levels.
What Complications Can Type 2 Diabetes Cause?
Uncontrolled type 2 diabetes can damage blood vessels and nerves throughout the body, leading to serious complications including cardiovascular disease, kidney disease (nephropathy), eye damage (retinopathy), nerve damage (neuropathy), foot problems that may require amputation, and increased risk of infections and cognitive decline.
Cardiovascular disease is the leading cause of death in people with type 2 diabetes. Adults with diabetes are two to four times more likely to have heart disease or stroke than those without diabetes, according to the American Heart Association. Chronic hyperglycemia damages the endothelial lining of blood vessels, accelerates atherosclerosis, and promotes inflammation. The UKPDS and subsequent landmark trials have demonstrated that intensive glycemic control, blood pressure management, and statin therapy significantly reduce cardiovascular events. The ADA recommends statin therapy for most adults with diabetes aged 40 to 75, and aspirin for those with established cardiovascular disease.
Diabetic kidney disease affects approximately 40 percent of people with diabetes and is the leading cause of end-stage kidney disease in the United States. Early detection through annual urine albumin-to-creatinine ratio testing and estimated glomerular filtration rate monitoring is critical because kidney damage is initially reversible. Diabetic retinopathy is the most common cause of new blindness in working-age adults, affecting approximately one-third of people with diabetes. Annual dilated eye exams allow early detection and treatment with laser therapy or anti-VEGF injections before vision loss occurs.
Diabetic neuropathy affects up to 50 percent of people with diabetes over time. Peripheral neuropathy causes numbness, tingling, and pain in the feet and hands and is the leading cause of non-traumatic lower limb amputations. Autonomic neuropathy can affect the heart, digestive system, urinary tract, and sexual function. The DCCT and its follow-up EDIC study conclusively showed that intensive glycemic control significantly reduces the risk of all microvascular complications, reinforcing the importance of achieving and maintaining A1C targets.
The UKPDS demonstrated that each 1 percent reduction in A1C was associated with a 37 percent decrease in microvascular complications
How Often Should You Monitor Blood Sugar With Type 2 Diabetes?
Monitoring frequency depends on your treatment regimen. People on insulin should check blood sugar multiple times daily. Those on oral medications may need less frequent monitoring, but the ADA recommends checking as needed to guide treatment decisions. Continuous glucose monitors are increasingly used for type 2 diabetes management.
Self-monitoring of blood glucose (SMBG) provides real-time information that helps you understand how food, activity, stress, and medications affect your blood sugar. For people on multiple daily insulin injections or insulin pump therapy, the ADA recommends checking blood sugar before meals and snacks, at bedtime, before exercise, when suspecting low blood sugar, after treating low blood sugar, and before driving. Continuous glucose monitoring (CGM) systems like the Dexel G7, FreeStyle Libre 3, and Abbott Lingo provide glucose readings every 1 to 5 minutes, revealing patterns that intermittent finger-stick testing cannot capture.
For people managed with oral medications that do not cause hypoglycemia, such as metformin alone, routine daily blood sugar testing may not be necessary. However, periodic structured SMBG — checking fasting glucose and post-meal glucose for several days — helps assess glycemic control and guide medication adjustments. The ADA recommends that A1C be measured at least twice a year for patients meeting treatment goals and quarterly for those whose therapy has changed or who are not meeting glycemic goals. Time in range, the percentage of time glucose is between 70 and 180 mg/dL, is an increasingly important metric provided by CGM.
When Should You See a Doctor About Type 2 Diabetes Concerns?
See your doctor if you have risk factors and experience symptoms like increased thirst, frequent urination, or unexplained fatigue. If already diagnosed, schedule regular visits every 3 to 6 months. Seek urgent care if you experience blood sugar above 300 mg/dL, signs of dehydration, confusion, or symptoms of diabetic ketoacidosis or hyperosmolar syndrome.
Regular diabetes management requires a coordinated care team. The ADA recommends comprehensive diabetes evaluations every 3 to 6 months with your primary care provider or endocrinologist, including A1C testing, medication review, blood pressure check, foot inspection, and assessment of self-management goals. Annual screenings should include a dilated eye exam by an ophthalmologist, comprehensive foot exam with monofilament testing, urine albumin-to-creatinine ratio and eGFR for kidney function, lipid panel, and dental examination. Women of reproductive age should discuss contraception and preconception counseling.
Certain situations require prompt medical attention. Blood sugar consistently above 250 to 300 mg/dL despite taking medications as prescribed may indicate the need for treatment adjustment. Symptoms of hyperglycemic emergency including excessive thirst, very frequent urination, nausea, vomiting, abdominal pain, fruity-smelling breath, confusion, or extreme fatigue require immediate emergency care. Hypoglycemia (blood sugar below 70 mg/dL) that does not resolve with glucose tablets or juice, or hypoglycemia with loss of consciousness, requires emergency treatment with glucagon and a call to emergency services.
