Symptoms

Symptoms of Type 1 diabetes often appear suddenly, prompting immediate blood sugar testing. In contrast, symptoms of other types of diabetes and prediabetes tend to develop more gradually and may not be easily noticeable. To address this, the American Diabetes Association (ADA) has established screening guidelines, recommending that the following individuals be tested for diabetes:

• Anyone with a body mass index (BMI) over 25 (23 for Asian Americans), regardless of age, who also has additional risk factors. These include high blood pressure, abnormal cholesterol levels, a sedentary lifestyle, a history of polycystic ovary syndrome or heart disease, or a family history of diabetes.
• Anyone over the age of 35 should have an initial blood sugar screening. If the results are normal, screenings should be repeated every three years.
• Women who have had gestational diabetes should be screened for diabetes every three years.
• Individuals diagnosed with prediabetes should undergo annual testing.
• Anyone with HIV is advised to be tested for diabetes.

Tests for Type 1, Type 2 Diabetes, and Prediabetes

A1C Test: This blood test, also known as the glycated hemoglobin test, measures your average blood sugar level over the past 2 to 3 months. It does not require fasting. The test determines the percentage of blood sugar attached to hemoglobin, the protein in red blood cells that carries oxygen. Higher blood sugar levels result in more sugar attached to hemoglobin. An A1C level of 6.5% or higher on two separate tests indicates diabetes, while a level between 5.7% and 6.4% indicates prediabetes. Levels below 5.7% are considered normal.

Random Blood Sugar Test: A blood sample is taken at a random time, regardless of when you last ate. A blood sugar level of 200 milligrams per deciliter (mg/dL) or 11.1 millimoles per liter (mmol/L) or higher suggests diabetes.

Fasting Blood Sugar Test: This test requires fasting overnight before a blood sample is taken. A fasting blood sugar level below 100 mg/dL (5.6 mmol/L) is normal. Levels between 100 and 125 mg/dL (5.6 to 6.9 mmol/L) indicate prediabetes, and a level of 126 mg/dL (7 mmol/L) or higher on two separate tests indicates diabetes.

Glucose Tolerance Test: After fasting overnight, your fasting blood sugar level is measured. You then drink a sugary liquid, and your blood sugar levels are tested over the next two hours. A blood sugar level below 140 mg/dL (7.8 mmol/L) is normal, a reading above 200 mg/dL (11.1 mmol/L) indicates diabetes, and a reading between 140 and 199 mg/dL (7.8 to 11.0 mmol/L) suggests prediabetes.

If your healthcare provider suspects you have type 1 diabetes, they may perform a urine test to detect the presence of ketones, which are byproducts produced when the body uses muscle and fat for energy. Additionally, they may test for autoantibodies, which are immune system cells associated with type 1 diabetes.

During pregnancy, your provider will likely assess your risk for gestational diabetes early on. If you’re at high risk, testing for diabetes may occur at your first prenatal visit. For those at average risk, screening typically occurs during the second trimester.

Millimole – the amount of a substance equal to a thousandth of a mole (a measure of the amount of a substance). Also called mmol.

Treatment

Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral drugs may be part of your treatment. Eating a healthy diet, staying at a healthy weight and getting regular physical activity also are important parts of managing diabetes. An important part of managing diabetes — as well as your overall health — is keeping a healthy weight through a healthy diet and exercise plan:

• Healthy eating. Your diabetes diet is simply a healthy-eating plan that will help you control your blood sugar. You’ll need to focus your diet on more fruits, vegetables, lean proteins and whole grains. These are foods that are high in nutrition and fiber and low in fat and calories. You’ll also cut down on saturated fats, refined carbohydrates and sweets. In fact, it’s the best eating plan for the entire family. Sugary foods are OK once in a while. They must be counted as part of your meal plan.Understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This will likely include carbohydrate counting, especially if you have type 1 diabetes or use insulin as part of your treatment.
• Physical activity. Everyone needs regular aerobic activity. This includes people who have diabetes. Physical activity lowers your blood sugar level by moving sugar into your cells, where it’s used for energy. Physical activity also makes your body more sensitive to insulin. That means your body needs less insulin to transport sugar to your cells.Get your provider’s OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What’s most important is making physical activity part of your daily routine.Aim for at least 30 minutes or more of moderate physical activity most days of the week, or at least 150 minutes of moderate physical activity a week. Bouts of activity can be a few minutes during the day. If you haven’t been active for a while, start slowly and build up slowly. Also avoid sitting for too long. Try to get up and move if you’ve been sitting for more than 30 minutes.

Treatment for type 1 and type 2 diabetes

Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting. For some people with type 1 diabetes, pancreas transplant or islet cell transplant may be an option.

Treatment of type 2 diabetes mostly involves lifestyle changes, monitoring of your blood sugar, along with oral diabetes drugs, insulin or both.

Monitoring your blood sugar

Depending on your treatment plan, you may check and record your blood sugar as many as four times a day or more often if you’re taking insulin. Careful blood sugar testing is the only way to make sure that your blood sugar level remains within your target range. People with type 2 diabetes who aren’t taking insulin generally check their blood sugar much less often.

People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology hasn’t yet completely replaced the glucose meter, it can lower the number of fingersticks necessary to check blood sugar and provide important information about trends in blood sugar levels.

Even with careful management, blood sugar levels can sometimes change unpredictably. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to food, physical activity, medications, illness, alcohol and stress. For women, you’ll learn how your blood sugar level changes in response to changes in hormone levels.

Besides daily blood sugar monitoring, your provider will likely recommend regular A1C testing to measure your average blood sugar level for the past 2 to 3 months.

Compared with repeated daily blood sugar tests, A1C testing shows better how well your diabetes treatment plan is working overall. A higher A1C level may signal the need for a change in your oral drugs, insulin regimen or meal plan.

Your target A1C goal may vary depending on your age and various other factors, such as other medical conditions you may have or your ability to feel when your blood sugar is low. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7%. Ask your provider what your A1C target is.

Insulin

People with type 1 diabetes must use insulin to manage blood sugar to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy.

Many types of insulin are available, including short-acting (regular insulin), rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your provider may prescribe a mixture of insulin types to use during the day and night.

Insulin can’t be taken orally to lower blood sugar because stomach enzymes interfere with insulin’s action. Insulin is often injected using a fine needle and syringe or an insulin pen — a device that looks like a large ink pen.

An insulin pump also may be an option. The pump is a device about the size of a small cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a tube (catheter) that’s inserted under the skin of your abdomen.

A continuous glucose monitor is a device that measures blood sugar levels every few minutes using a sensor placed under the skin. An insulin pump, attached to the pocket, is worn outside the body and connects via a tube to a catheter inserted under the skin of the abdomen. These pumps are programmed to deliver specific amounts of insulin continuously and in response to food intake.

There is also a tubeless pump available that operates wirelessly. This pump is programmed to dispense insulin in specific amounts, which can be adjusted based on meals, activity levels, and blood sugar readings.

A closed-loop system is a device implanted in the body that connects a continuous glucose monitor to an insulin pump. The monitor regularly checks blood sugar levels, and the system automatically delivers the appropriate amount of insulin when needed.

The Food and Drug Administration has approved several hybrid closed-loop systems for managing type 1 diabetes. These systems are termed “hybrid” because they still require some user input, such as entering the number of carbohydrates consumed or occasionally confirming blood sugar levels.

Fully automated closed-loop systems that require no user input are not yet available, but several are currently undergoing clinical trials.

Prescriptions

Your healthcare provider may also prescribe additional oral or injectable medications. Some of these medications help your pancreas produce more insulin, while others reduce the production and release of glucose from your liver, decreasing the amount of insulin needed to move sugar into your cells.

Other medications work by blocking stomach or intestinal enzymes that break down carbohydrates, which slows their absorption. Some drugs increase your tissues’ sensitivity to insulin. Metformin (Glumetza, Fortamet, and others) is typically the first medication prescribed for type 2 diabetes.

Another class of medications, known as SGLT2 inhibitors, may also be used. These drugs prevent the kidneys from reabsorbing sugar back into the bloodstream, leading to the elimination of sugar through urine.

Treatment for gestational diabetes

Managing your blood sugar levels is crucial for your baby’s health and can help prevent complications during delivery. Along with maintaining a healthy diet and regular exercise, your treatment plan for gestational diabetes may involve monitoring your blood sugar levels. In some cases, insulin or oral medications may also be necessary.

During labor, your healthcare provider will keep an eye on your blood sugar levels. If your blood sugar rises, your baby may produce high levels of insulin, which can result in low blood sugar immediately after birth.

Treatment for prediabetes

Treatment for prediabetes typically focuses on making healthy lifestyle choices, which can help return your blood sugar levels to normal or prevent them from rising to levels associated with type 2 diabetes. Maintaining a healthy weight through regular exercise and a balanced diet is key. Engaging in at least 150 minutes of exercise per week and losing around 7% of your body weight may help prevent or delay the onset of type 2 diabetes.

For some individuals with prediabetes, especially those with other conditions like heart disease, medications such as metformin, statins, or blood pressure drugs may also be considered.