How do I know if I have diabetes?
A doctor may suspect diabetes if there is a risk of developing diabetes, or if blood glucose levels in the urine are too high. Blood glucose levels may be higher than normal if the pancreas produces little or no insulin (type 1 diabetes), or if the body does not respond normally to insulin (type 2 diabetes).
Getting a diagnosis can start with one of the following 3 tests. In most cases, your doctor will repeat the test for some tests that show high results to confirm the diagnosis.
- A fasting blood glucose test is a blood glucose level measured in the morning before you eat. 126 mg/dl or higher may mean you have diabetes.
- An oral glucose tolerance test (OGTT) involves drinking a drink containing glucose and then measuring the blood glucose level every 30 to 60 minutes for 3 hours. If the glucose level at 2 hours is 200 mg/dl or higher, you may have diabetes.
- The glycated hemoglobin (HbA1c) test is a simple blood test that shows the average blood glucose level over the past 2 to 3 months. an HbA1c level of 6.5% or higher may mean you have diabetes.
Your doctor may also recommend a zinc transporter 8 autoantibody (ZnT8Ab) test, a blood test that, in combination with other information and test results, can help determine if you have type 1 diabetes rather than another type of diabetes. The goal of the ZnT8Ab test is to establish a timely and accurate diagnosis so that treatment can be given in a timely manner.
What are the treatment options?
The doctor will help develop a treatment plan.
The doctor will help develop a diabetes treatment plan that is appropriate and understandable. There may be other people involved in the diabetes treatment team, including podiatrists, dietitians, ophthalmologists, and diabetes specialists (endocrinologists).
Diabetes treatment requires close monitoring of blood glucose levels (and keeping them in the target range), using a combination of medications, exercise, and diet. By paying close attention to what and when you eat, you can minimize or avoid the “see-saw effect” of rapid changes in blood glucose levels, which may require rapid dose adjustments, especially with insulin.
Diabetes medications
If you have type 1 diabetes, your pancreas no longer produces the insulin your body needs. Insulin needs to be given by injection or given dynamically. Learning to inject yourself or give it to your child may seem the most intimidating at first, but it is much easier than one might think.
Some people with diabetes use an insulin pump to deliver insulin as set. The patient and doctor program the pump to deliver a certain amount of insulin (basal dose) during the day. Alternatively, the pump can be programmed to deliver a certain amount of insulin (mealtime dose) based on blood glucose levels before eating.
There are 5 types of injectable insulin.
- Quick-acting insulin (works within minutes and lasts 2 to 4 hours);
- Regular or short-acting insulin (works within 30 minutes and lasts 3 to 6 hours);
- Medium-acting insulin (works within 30 minutes and lasts 3 to 6 hours)
- Medium-acting insulin (works within 1 to 2 hours and lasts up to 18 hours);
- Long-acting insulin (works within 30 minutes and lasts 3 to 6 hours);
- Long-acting insulins (work within 1 to 2 hours and last more than 24 hours);
- Extra-long-acting insulins (work within 1 to 2 hours and last more than 24 hours);
- Extra-long-acting insulin (works within 1 to 2 hours and lasts 48 hours).
Quick-acting inhaled insulin is also FDA-approved for use before meals. It must be used in combination with long-acting insulin in people with type 1 diabetes and should not be used in smokers or people with chronic lung disease. It is a single-dose cartridge. Premixed insulin is also available for patients who require more than one type of insulin.
Deguel insulin is a long-acting insulin that is injected once a day and provides a basal dose of insulin that lasts more than 42 hours (it is the only basal insulin approved for use in patients 1 year and older with type 1 and type 2 diabetes). This insulin is also available in combination with rapid-acting insulin.
Each treatment plan is tailored to the individual patient and can be adjusted based on diet and exercise levels, as well as when there is stress and illness.
By measuring your own blood glucose levels, you can track your body’s changing need for insulin and work with your doctor to determine the best insulin dose. People with diabetes measure their blood glucose several times a day using a device called a blood glucose meter. A glucometer measures the glucose level in a blood sample that is applied to a test strip. In addition, there are now devices called ambulatory glucose monitoring systems (CGMS) that attach to the body and measure blood glucose every few minutes for up to a week at a time. However, these devices detect glucose levels from the skin rather than the blood and are not as accurate as traditional glucose meters.
For some people with type 2 diabetes, diet and exercise are enough to keep the disease under control, while others need to use medications, which may include insulin and oral medications.
Medications for type 2 diabetes work in different ways to bring blood sugar levels back to normal. These medications include the following.
- Medications that increase the amount of insulin produced by the pancreas, including chlorosulfonylurea, glimepiride, glipizide, glibenclamide, nateglinide, and repaglinide;
- Medications that reduce intestinal absorption of sugar, such as acarbose and miglitol;
- Medications that improve the body’s use of insulin, such as pioglitazone and rosiglitazone;
- Medications that reduce the amount of sugar produced by the liver and improve insulin resistance, such as metformin;
- drugs that increase insulin production by the pancreas or its blood levels, and/or reduce hepatic glucose production, including alogliptin, dulaglutide, ligliptin, exenatide, liraglutide, lisinopeptide, saxagliptin, selegiline, and semaglutide;
- drugs that block renal reabsorption of glucose and increase urinary excretion of glucose, also known as sodium-glucose cotransport protein 2 (SGLT2) inhibitors, including canaglifozin, dagliflozin, and emgliflozin;
- Pramlinitide is an injectable synthetic hormone. In people with diabetes who use insulin, this medicine helps lower blood sugar after meals.
Some drugs contain more than one diabetes medication, such as engramliptin/ligliptin, which is a combination of an SGLT2 inhibitor (blocks renal reabsorption of glucose) and a dipeptidyl peptidase-4 (DPP-4) inhibitor (increases the hormone) to help the pancreas produce more insulin and the liver produce less glucose.
Nutrition and meal timing in diabetes
A balanced diet is critical for people with diabetes, so work with your doctor or dietitian to develop a meal plan. If you have type 1 diabetes, the timing of insulin dosing depends on activity and diet. The timing and amount of food eaten is as important as what you eat. Usually, doctors recommend eating 3 small meals and 3 to 4 extra meals a day to maintain the proper balance between sugar and insulin in the blood.
A healthy balance of carbohydrates, proteins, and fats in your diet helps keep your blood sugar within your target range. The amount of each depends on many factors, including weight and personal preference. Paying attention to carbohydrates (knowing how much is needed and how much is being eaten) is key to controlling blood sugar. If overweight, a low-carb, low-fat/low-calorie or Mediterranean diet can help reduce to target weight. The amount of saturated fat in the diet should not exceed 7% and trans fats should also be avoided as much as possible.
Exercise for diabetes
Another key element of a diabetes treatment plan is exercise. For any type of diabetes, consult your doctor before starting an exercise program. Exercise improves the body’s use of insulin and may lower blood sugar levels. To prevent blood sugar from dropping to dangerously low levels, measure your blood sugar about half an hour before you exercise and eat a snack containing carbohydrates if necessary. If you begin to feel symptoms of hypoglycemia, stop exercising and eat a snack or drink containing carbohydrates. Wait 15 minutes, then take another measurement. If it is still too low, eat another snack.
Exercise can help some people with type 2 diabetes lower their blood sugar levels and help prevent the disease in those at risk.
For people with either type of diabetes, exercise can lower the chance of a heart attack or stroke and can improve blood circulation. Exercise can also relieve stress. People with type 2 diabetes who need to lose weight can benefit from moderate exercise. Most people with diabetes are encouraged to get at least 150 minutes of moderate-intensity aerobic exercise, such as walking, each week. Strength training is usually recommended at least 2 times a week. Talk to your doctor about which types of exercise are more appropriate.
Lifestyle changes for diabetes
It’s a good idea to wear a medical alert bracelet or tag that indicates you have diabetes. It will let others know when you have a severe hypoglycemic episode and cannot make yourself understood, or if you have an accident and need emergency medical help. It is important to let others know that you have diabetes because hypoglycemic episodes can be mistaken for intoxication and because people with hypoglycemic episodes are often unable to take care of themselves. If not treated promptly, hypoglycemia can cause a coma or seizure. Also, in the event of illness or injury, the body will be under more stress and blood sugar levels will need to be measured by medical personnel providing emergency care.
Be sure to take care of your teeth and floss them regularly. Diabetes may aggravate gum disease.
Alternative medicine for diabetes
Vitamins and minerals
Alternative medicine alone should not be used to treat diabetes. However, certain things that can be done – in addition to medications, proper diet and exercise – may help control blood sugar and prevent diabetes complications.
While chromium does have an effect on insulin and glucose metabolism, there is no evidence that the use of chromium supplements can help treat diabetes. However, chromium is found in many healthy foods, such as green vegetables, nuts, and grains. Studies have shown that when used with chromium, biotin (also known as vitamin H) may improve glucose metabolism in people with diabetes. However, no studies have shown that biotin itself can help.
Supplementation with vitamin B6 and vitamin B12 may help treat diabetic nerve pain if the levels are low and therefore promote nerve pain, but otherwise there is no evidence that using these vitamins will help.
Vitamin C may compensate for low levels of insulin in the blood, and its mechanism of action is usually to help cells absorb the vitamin. Moderate amounts of vitamin C may help the body maintain good cholesterol levels and keep blood sugar levels under control. However, too much vitamin C can cause kidney stones and other problems. Check with your doctor to see if a vitamin C supplement is appropriate.
Vitamin E may help limit damage to blood vessels and help prevent kidney disease and eye disease. However, too much vitamin E may cause serious problems, such as a higher risk of stroke. Talk to your doctor before adding this supplement.
Magnesium helps control blood sugar levels. Some people with diabetes are severely deficient in magnesium. In this case, magnesium supplements may improve the action of insulin.
Mind-body medicine
Imagery guidance, biofeedback, meditation, hypnotherapy, and yoga can reduce stress hormones, which in turn may help stabilize blood sugar levels. Biofeedback may also help lower blood pressure, but more research is needed in exploring its role in treating diabetes and hypertension.
Herbal remedies
Capsaicin cream is a topical ointment made from cayenne pepper, and some patients have reported that this medicine can help reduce pain in the hands and feet caused by diabetic neuropathy. However, people with loss of sensation in their hands or feet should be cautious when using capsaicin, as they may not feel any burning sensation at all. If you are considering trying this product, consult your doctor.
Evening primrose oil is thought to help reduce diabetic nerve pain, but no conclusive evidence has been found.
Ginkgo, garlic, holy basil leaves, fenugreek seeds, ginseng, and hawthorn are other herbs that some people claim can treat diabetes symptoms. More research is needed to understand the possible effects, if any, of these herbs. Consult your doctor before trying any herbal products.