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What is type 2 diabetes and how do I prevent it ?

diabetes type 1 and type 2 diabetes
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What is Type 2 Diabetes Mellitus (Non Insulin Dependent Diabetes)

What is Type 2 Diabetes Mellitus (Non Insulin Dependent Diabetes)

Type 2 diabetes develops when your body does not use insulin efficiently and gradually loses the ability to make enough insulin. In type 2 diabetes, there are primarily two interrelated problems at work – 1) your pancreas does not produce enough insulin and 2) your body’s cells respond poorly to insulin and take in less sugar. When you eat, your body breaks down sugar and starches from food into glucose to use for energy. Your pancreas (an organ behind your stomach) makes a hormone called insulin that controls the amount of glucose (sugar) in your blood. Insulin helps glucose (sugar) produced by the digestion of carbohydrates move from the blood into your body’s cells where it can be used for energy. When you have type 2 diabetes, your body doesn’t make enough insulin or can’t use insulin well, so you end up with too much sugar in your blood. In type 2 diabetes, the body’s cells do not respond effectively to insulin. This is known as insulin resistance, it causes glucose (sugar) to stay in your blood, leading to a higher than normal level of glucose in your blood (also known as hyperglycemia, usually above 7 mmol/L [126 mg/dL] before a meal and above 8.5 mmol/L [153 mg/dL]  two hours after a meal) and not enough reaches your cells. The normal blood sugar level is between 4.0 mmol/L (72 mg/dL) and 5.5 mmol/L (99 mg/dL) when fasting (before meals), and less than 7.0 mmol/L [126 mg/dL] 2 hours after a meal. Eventually, high blood sugar levels can lead to serious health problems, like heart disease, kidney failure, blindness and disorders of the immune systems. People who have type 2 diabetes are also at greater risk of developing cardiovascular diseases such as heart attack, stroke or problems with circulation in their legs and feet (peripheral artery disease). These are the “macrovascular” complications of diabetes. “Macrovascular” means that these complications affect the larger blood vessels. This risk is especially high in people who also have high blood pressure.

Type 2 diabetes is the most common type of diabetes. More than 37 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them have type 2 diabetes 1. Type 2 diabetes most often develops in people over age 45, but more and more children, teens, and young adults are also developing it.

Type 2 diabetes used to be referred to as “adult-onset” diabetes or or noninsulin-dependent diabetes mellitus (NIDDM) because it is often diagnosed later in life most often in middle-aged and older adults, but type 2 diabetes can appear in children, teens, and young people. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. 

With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn’t produce enough insulin to maintain a normal glucose level.

There’s no cure for type 2 diabetes, but losing weight and maintaining a healthy weight, eating well and exercising can help you manage the disease. If diet and exercise aren’t enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy.

The severity of diabetes can vary quite a bit. Some people only have to make minor changes to their lifestyle after they are diagnosed. Just losing a little weight and getting some more exercise may be enough for them to manage their diabetes.

It also important to note that not everyone with type 2 diabetes is overweight, but weight gain and obesity are the most important risk factors for type 2 diabetes and the reason why type 2 has become a global epidemic that affects overweight people of all ages 2.

Other people who have type 2 diabetes need more permanent therapy that involves taking tablets or insulin. It is then especially important to have a good understanding of the disease and know what they can do to stay healthy 3.

Figure 1. Type 2 diabetes

type 2 diabetes

Figure 2. Blood sugar levels

Blood sugar levels
Blood sugar levels before meals

Footnotes: The images above show the general guidelines, but your individual target range for your blood sugar levels may be different. You’ll get different readings at different times of the day, depending on things like what you’ve eaten and how much you are moving around.

Figure 3. Type 2 diabetes blood sugar levels

Blood_Test_Levels_Chart_of_Diabetes_and_Prediabetes

Figure 4. Acanthosis nigricans

Acanthosis nigricans

Who is more likely to develop type 2 diabetes?

You can develop type 2 diabetes at any age, even during childhood. However, type 2 diabetes occurs most often in middle-aged and older people. You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight or have obesity. Diabetes is more common in people who are African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander.

Physical inactivity and certain health problems such as high blood pressure affect your chances of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant.

The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes in all adults age 35 or older and in the following groups:

  • People younger than 35 who are overweight or obese and have one or more risk factors associated with diabetes
  • Women who have had gestational diabetes
  • People who have been diagnosed with prediabetes
  • Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors

What is the difference between type 1 and type 2 diabetes?

The main difference between the type 1 and type 2 diabetes is that type 1 diabetes is a genetic condition that often shows up early in life, and type 2 is mainly lifestyle-related and develops over time. Type 1 diabetes is an auto-immune disease where your immune system is attacking and destroying the insulin-producing cells in your pancreas. In type 1 diabetes, people produce little or no insulin, as the insulin-producing cells have been destroyed by the body’s immune system. Approximately 5-10% of the people who have diabetes have type 1 diabetes. Currently, no one knows how to prevent type 1 diabetes.

In type 2 diabetes, the body may make enough insulin early in the disease, but doesn’t respond to it effectively. As type 2 diabetes progresses, the pancreas gradually loses the ability to produce enough insulin. Type 2 diabetes is associated with inherited factors and lifestyle risk factors such as being overweight or obese, poor diet, and insufficient physical activity. Type 2 diabetes most often develops in people over age 45, but more and more children, teens, and young adults are also developing it because the increase in the number of children with obesity.

Type 1 diabetes affects 8% of everyone with diabetes. While type 2 diabetes affects about 90% of people with diabetes.

Although type 1 and type 2 diabetes both have things in common, there are lots of differences. Like what causes them, who they affect, and how you should manage them.

A big difference between the two is that type 1 diabetes isn’t affected by your lifestyle. Or your weight. That means you can’t affect your risk of developing type 1 diabetes by lifestyle changes.

It’s different for type 2 diabetes. Scientists know some things put you at more risk:

  • If you’re overweight or obese. Being overweight or obese is a main risk.
  • Fat distribution. Storing fat mainly in your abdomen (waist size is too large) — rather than your hips and thighs — indicates a greater risk. Your risk of type 2 diabetes rises if you’re a man with a waist circumference above 40 inches (101.6 centimeters) or a woman with a measurement above 35 inches (88.9 centimeters).
    • How to measure your waist: Find the top of your hip bone and the bottom of your ribcage. In the middle of these two points is where you need to measure. For many people, the belly button is a good guide, but this might not be the case for you, so it’s best to find that midpoint between your ribcage and hip. If you’re still not sure, watch the video below.
    • What is a healthy waist size? This all depends on your gender and ethnicity. For a healthy measurement you need to aim to be less than:
      • 80 cm (31.5 in) for all women
      • 94 cm (37 in) for most men
      • 90cm (35in) for South Asian men. This is because you have a higher risk of type 2 diabetes if you are of black or South Asian background.
  • Inactivity. The less active you are, the greater your risk. Physical activity helps control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
  • Family history. The risk of type 2 diabetes increases if your parent, brother or sister has type 2 diabetes.
  • Race and ethnicity. Although it’s unclear why, people of certain races and ethnicities — including African Caribbean, Black African, Hispanic, Native American and Asian people (Indian, Pakistani, Bangladeshi or Chinese), and Pacific Islanders — are more likely to develop type 2 diabetes than white people are.
  • Blood lipid levels. An increased risk is associated with low levels of high-density lipoprotein (HDL) cholesterol — the “good” cholesterol — and high levels of triglycerides.
  • Age. You’re more at risk if you’re white and over 40, or over 25 if you’re African Caribbean, Black African, or South Asian (Indian, Pakistani or Bangladeshi).
  • Medical history. For example if you have a history of high blood pressure, heart attack or strokes, gestational diabetes or severe mental illness.
  • Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
  • Pregnancy-related risks. Your risk of developing type 2 diabetes increases if you developed gestational diabetes when you were pregnant or if you gave birth to a baby weighing more than 9 pounds (4 kilograms).
  • Polycystic ovary syndrome (PCOS). Having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
  • Smoking. Smoking is associated with a higher risk of type 2 diabetes, and also increases the risk of other health conditions such as heart disease and cancer.
  • Areas of darkened skin, usually in the armpits and neck. This condition, called acanthosis nigricans. This condition often indicates insulin resistance. Acanthosis nigricans is most common in those who are overweight, have darker skin, and have diabetes or pre-diabetic conditions. Acanthosis nigricans is not contagious. It is not harmful. Acanthosis nigricans is a warning sign of a health problem that requires medical attention.

Scientists also know that there are things you can do to reduce your risk of developing type 2 diabetes. Things like eating healthily, being active and maintaining a healthy weight can help you to prevent type 2 diabetes.

Some people still get confused between type 1 and type 2 diabetes. Below is a guide to some of the main differences between type 1 and type 2 diabetes. The main thing to remember is that both are as serious as each other. Having high blood glucose (or sugar) levels can lead to serious health complications, no matter whether you have type 1 or type 2 diabetes. So if you have either condition, you need to take the right steps to manage it.

Table 1. Type 1 and type 2 diabetes differences

Type 1 diabetes
Type 2 diabetes
What is happening?Your body attacks the cells in your pancreas which means it cannot make any insulin.Your body is unable to make enough insulin or the insulin you do make doesn’t work properly.
Risk factorsScientists don’t currently know what causes type 1 diabetes.Scientists know some things can put you at risk of having type 2 like weight and ethnicity.
SymptomsThe symptoms for type 1 appear more quickly.Type 2 symptoms can be easier to miss because they appear more slowly.
ManagementType 1 is managed by taking insulin to control your blood sugar.You can manage type 2 diabetes in more ways than type 1. These include through medication, exercise and diet. People with type 2 can also be prescribed insulin.
Cure and PreventionCurrently there is no cure for type 1 but research continues.Type 2 cannot be cured but there is evidence to say in many cases it can be prevented and put into remission. If you have obesity or overweight, your type 2 diabetes is more likely to go into remission if you lose a substantial amount of weight – 15kg (or 2 stone 5lbs) – as quickly and safely as possible following diagnosis. Type 2 diabetes remission is when your blood sugar levels are below the diabetes range and you don’t need to take diabetes medication anymore. Remission is when your HbA1c — a measure of long-term blood glucose levels — remains below 48mmol/mol or 6.5% for at least three months, without diabetes medication 4.

If I’m overweight, will I always develop type 2 diabetes?

Being overweight is a risk factor for developing diabetes, but other risk factors such as how much physical activity you get, family history, ethnicity, and age also play a role. Unfortunately, many people think that weight is the only risk factor for type 2 diabetes, but many people with type 2 diabetes are at a normal weight or only moderately overweight.

Do sugary drinks cause diabetes?

Research has also shown that drinking sugary drinks is linked to type 2 diabetes. The American Diabetes Association recommends that people avoid drinking sugar-sweetened beverages and switch to water whenever possible to help prevent type 2 diabetes.

Sugary drinks also raise blood sugar and can provide several hundred calories in just one serving. Just one 12-ounce can of regular soda has about 150 calories and 40 grams of sugar, a type of carbohydrate (carb). This is the same as 10 teaspoons of sugar.

Sugar-sweetened beverages include beverages like:

  • Regular soda
  • Fruit punch
  • Fruit drinks
  • Energy drinks
  • Sports drinks
  • Sweet tea
  • Sweetened coffee drinks
  • Other sugary drinks.

Is hyperinsulinemia a form of diabetes?

Hyperinsulinemia means the amount of insulin in your blood is higher than what’s considered healthy. On its own, hyperinsulinemia isn’t diabetes. But hyperinsulinemia often is associated with type 2 diabetes.

Insulin is a hormone that the pancreas makes. It helps control blood sugar. Hyperinsulinemia is connected to insulin resistance — a condition in which the body doesn’t respond as it should to the effects of insulin. In that situation, the pancreas makes more insulin in order to overcome the resistance, leading to higher levels of insulin in the blood. Type 2 diabetes develops when the pancreas can no longer make the large amounts of insulin needed to keep blood sugar at a healthy level.

Rarely, hyperinsulinemia is caused by:

  • A tumor of the cells in the pancreas that make insulin. These tumors are called insulinomas.
  • Too many cells in the pancreas that make insulin or too much growth of those cells. This condition is called nesidioblastosis.

Hyperinsulinemia usually doesn’t cause symptoms in people with insulin resistance. In people who have insulinomas, hyperinsulinemia may lead to low blood sugar, a condition called hypoglycemia.

Treatment of hyperinsulinemia is directed at the problem that’s causing it.

What are blood sugar levels?

Your blood sugar levels also known as blood glucose levels, are a measurement that show how much glucose (sugar) you have in your blood. Glucose is a sugar that you get from food and drink. Your blood sugar levels go up and down throughout the day and for people living with diabetes these changes are larger and happen more often than in people who don’t have diabetes.

Can I check my own blood sugar?

You can do blood sugar level check by doing a finger-prick test or by using an electronic blood sugar monitor called a flash glucose monitor. You can do this several times a day – helping you keep an eye on your levels as you go about your life and help you work out what to eat and how much medication to take. Find out your ideal target range.

Not everyone with diabetes needs to check their levels like this. You’ll need to if you take certain diabetes medication. Always talk to your healthcare team if you’re not sure whether that’s you – they’ll give you advice on whether to check them yourself and how often.

And there’s also something called an HbA1c, which is a blood test to measure your average blood sugar level over the last three months. Everyone with diabetes is entitled to this check.

High blood sugar levels increase your risk of developing serious complications. However you manage your diabetes, stay in the know about your blood sugar levels

Why test blood sugar levels?

Testing your blood sugar levels will help you stay healthy and prevent serious diabetes complications now and in the future. By complications, we mean serious problems in places like your feet and your eyes. This happens because too much sugar in the blood damages your blood vessels, making it harder for blood to flow around your body. This can lead to very serious problems like sight loss and needing an amputation.

Furthermore, if you take certain medication, like insulin or sulphonylureas, checking your blood sugars is a vital part of living with diabetes. It can help you work out when you need to take more medication, when you need to eat something or for when you want to get up and move around more.

Routine checks can help you know when you might be starting to go too low (called a hypoglycemia or hypo) or too high (called a hyperglycemia or hyper). It’s a way of getting to know your body and how it works. It can help you and your healthcare team spot patterns too. Do you write your results down? You might find that helpful.

What happens when my blood sugar levels are too high?

If your blood sugar levels are slightly above your targets, there are usually no symptoms. But if your blood sugar levels become too high, you may experience some symptoms associated with a hyperglycemia (or hyper).

The blood sugar level at which symptoms begin to appear is different for everyone, but the common symptoms include passing more urine than normal, being very thirsty, having headaches and feeling tired and lethargic.

What happens when your blood sugar levels are too low?

If your blood sugar levels are too low, usually below 4 mmol/L, you may experience a hypoglycemia or hypo. Hypos need to be treated immediately, otherwise your blood sugar levels will drop further. If this happens, you may experience a severe hypo and need emergency treatment.

There are many different symptoms of a hypoglycemia, so it’s important that you are aware of the signs in case your blood sugar level gets too low.

Is there a cure for diabetes?

Unfortunately, there’s currently no permanent cure for either type 1 or type 2 diabetes, but scientists are working on a ground-breaking weight management study, to help people put their type 2 diabetes into remission. There’s evidence that some people with type 2 can put their diabetes into remission by losing weight. Following a very low-calorie diet under medical supervision, or having weight loss surgery (bariatric surgery) are some ways you can put your type 2 diabetes into remission. Remission is when blood glucose (or blood sugar) levels are in a normal range again. This doesn’t mean diabetes has gone for good. It’s still really important for people in remission to get regular healthcare checks. But being in remission can be life changing.

Is there a cure for type 1 diabetes?

In type 1 diabetes, insulin-producing beta cells in the pancreas are destroyed by the immune system. This means you can’t make the insulin you need to live. To stop type 1 diabetes scientists need to disrupt the immune system’s attack on beta cells. Currently scientists are working on it. They’re aiming to develop and test treatments – called immunotherapies – that target the immune system to stop it destroying beta cells.

Is diabetes a serious disease?

Yes. Diabetes causes more deaths per year than breast cancer and AIDS combined and having diabetes nearly doubles your chance of having a heart attack. The good news is that managing your diabetes can reduce your risk for diabetes complications.

Common diabetes health complications include heart disease, chronic kidney disease, nerve damage, and other problems with feet, oral health, vision, hearing, and mental health.

  • Heart and blood vessel (cardiovascular) disease. Diabetes majorly increases the risk of many heart problems. These can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you’re more likely to have heart disease or stroke.
  • Nerve damage (diabetic neuropathy). Too much sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
  • Kidney damage (diabetic nephropathy). The kidneys hold millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system.
  • Eye damage (diabetic retinopathy). Diabetes can damage the blood vessels of the eye (diabetic retinopathy). This could lead to blindness.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of many foot complications.
  • Skin and mouth conditions. Diabetes may leave you more prone to skin problems, including bacterial and fungal infections.
  • Hearing impairment. Hearing problems are more common in people with diabetes.
  • Alzheimer’s disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease.
  • Depression. Depression symptoms are common in people with type 1 and type 2 diabetes.

Do people with diabetes need to eat special foods?

No, you don’t need special food. Packaged foods with special “diabetes-friendly” claims may still raise blood glucose levels, be more expensive, and/or contain sugar alcohols that can have a laxative effect.

A healthy meal plan for people with diabetes is generally the same as healthy eating for anyone. In fact, there are a lot of different eating plans that can help you manage your diabetes. In general, a healthy eating plan for diabetes will include lots of non-starchy vegetables, limit added sugars, swap refined grains for whole grains and prioritize whole foods over highly processed foods when possible.

Type 2 diabetes and pregnancy

Preexisting diabetes also called pregestational diabetes means you have diabetes before you get pregnant. This is different from gestational diabetes, which is a kind of diabetes that some women get during pregnancy. In the United States, about 1 to 2 percent of pregnant women have preexisting diabetes. The number of women with diabetes during pregnancy has increased in recent years. High blood sugar can be harmful to your baby during the first few weeks of pregnancy when his brain, heart, kidneys and lungs begin to form. There is a chance that some of the potential complications of diabetes, like eye disease (diabetic retinopathy) and kidney disease (diabetic nephropathy), may develop while you are pregnant. Your doctors will keep an eye on this. If you are pregnant or planning a pregnancy, visit an ophthalmologist during each trimester of your pregnancy, one year postpartum or as advised. There is also a risk of developing pre-eclampsia, a condition involving high blood pressure during pregnancy, which can cause problems for the baby.

If you have type 1 or type 2 diabetes and are planning a family, you should plan your pregnancy as much as possible. Controlling your blood sugars before conception and throughout pregnancy gives you the best chance of having a trouble-free pregnancy and birth and a healthy baby. Most women with diabetes have a healthy baby.

Having diabetes means that you and your baby are more at risk of serious health complications during pregnancy and childbirth. The good news is that by planning ahead and getting support from your doctor and diabetes team, you can really reduce the risks involved. So you’re more likely to enjoy a healthy pregnancy and give birth to a healthy baby.

If you have diabetes and your pregnancy is unplanned, there’s still plenty you can do to give your baby the best start in life.

Women with type 2 diabetes will likely need to change their treatment plans and adhere to diets that carefully controls carbohydrate intake. Many women will need insulin therapy during pregnancy and may need to discontinue other treatments, such as blood pressure medications.

What is gestational diabetes?

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. As gestational diabetes is a condition that occurs during pregnancy, it is not the same as having pre-existing diabetes during your pregnancy. Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy. This leads to higher than normal levels of sugar in the blood, which can be unhealthy for both you and the baby. Typically, women with gestational diabetes have no symptoms. Your medical history and whether you have any risk factors may suggest to your doctor that you could have gestational diabetes, but you’ll need to be tested to know for sure. Most women are diagnosed after routine tests during pregnancy.

During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

Every year, 6 out of every 100 pregnancies in the United States are affected by gestational diabetes.

Babies born to women with diabetes are at risk of being born larger than average, or with a birth defect. They may also be born prematurely or even stillborn. They are also at risk of developing type 2 diabetes in the long term.

These risks are greatly reduced if you keep your blood sugars under good control.

Managing gestational diabetes will help make sure you have a healthy pregnancy and a healthy baby.

If I have gestational diabetes, how can I prevent getting diabetes later in life?

For most people, gestational diabetes goes away after giving birth. But having it makes you more likely to develop type 2 diabetes later in life. Type 2 diabetes is the most common kind of diabetes.

Here’s what you can do to help reduce your risk of developing type 2 diabetes after pregnancy:

  • Get tested for diabetes 4 to 12 weeks after your baby is born. If the test is normal, get tested again every 1 to 3 years.
  • Get to and stay at a healthy weight.
  • Talk to your provider about medicine that may help prevent type 2 diabetes.

What causes gestational diabetes?

When you are pregnant, your placenta produces hormones to help the baby grow. These hormones also block the action of insulin in your body (called insulin resistance). Women need 2 to 3 times more insulin when they are pregnant. If you already have insulin resistance, your body may not be able to cope with this extra demand for insulin. That will lead to blood glucose levels being too high.

You are at higher risk of developing gestational diabetes if you:

  • are overweight or obese and not physically active or gaining too much weight in the first half of pregnancy
  • are over the age of 35 years
  • have a family history (parent, brother or sister) of type 2 diabetes
  • come from a racial or ethnic group that has a higher prevalence of diabetes that isn’t entirely explained by race or ethnicity, such as Black, American Indian, Alaska Native, Asian, Hispanic/Latino or Pacific Islander
  • have had gestational diabetes before
  • have prediabetes. This means your blood glucose levels are higher than normal but not high enough to be diagnosed with diabetes.
  • have had polycystic ovary syndrome (PCOS). This is a hormone problem that can affect reproductive and overall health.
  • have had a large baby (macrosomia) in a past pregnancy
  • are taking some types of anti-psychotic or steroid medications
  • have high blood pressure or you’ve had heart disease

Can gestational diabetes increase your risk for problems during pregnancy?

Yes. If not treated, gestational diabetes can increase your risk for pregnancy complications and procedures, including:

  • Macrosomia. This means your baby weighs more than 8 pounds, 13 ounces (4,000 grams) at birth. Babies who weigh this much are more likely to be hurt during labor and birth, and can cause damage to his or her mother during delivery.
  • Shoulder dystocia or other birth injuries (also called birth trauma). Complications for birthing parents caused by shoulder dystocia include postpartum hemorrhage (heavy bleeding). For babies, the most common injuries are fractures to the collarbone and arm and damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm. They provide feeling and movement in the shoulder, arm and hand.
  • High blood pressure and preeclampsia. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Preeclampsia is when a pregnant person has high blood pressure and signs that some of their organs, such as the kidneys and liver, may not be working properly.
  • Perinatal depression. This is depression that happens during pregnancy or in the first year after having a baby (also called postpartum depression). Depression is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you think, feel, and act and can interfere with your daily life.
  • Preterm birth. This is birth before 37 weeks of pregnancy. Most women who have gestational diabetes have a full-term pregnancy that lasts between 39 and 40 weeks. However, if there are complications, your health care provider may need to induce labor before your due date. This means your provider will give you medicine or break your water (amniotic sac) to make your labor begin.
  • Stillbirth. This is the death of a baby after 20 weeks of pregnancy.
  • Cesarean birth also called C-section. This is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. You may need to have a c-section if you have complications during pregnancy, or if your baby is very large (also known as macrosomia). Most people who have gestational diabetes can have a vaginal birth. But they’re more likely to have a c-section than people who don’t have gestational diabetes.

Gestational diabetes also can cause health complications for your baby after birth, including:

  • Breathing problems, including respiratory distress syndrome. This can happen when babies don’t have enough surfactant in their lungs. Surfactant is a protein that keeps the small air sacs in the lungs from collapsing.
  • Jaundice. This is a medical condition in which the baby’s liver isn’t fully developed or isn’t working well. A jaundiced baby’s eyes and skin look yellow.
  • Low blood sugar (hypoglycemia)
  • Obesity later in life
  • Diabetes later in life

What are complications of gestational diabetes?

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can be caused by gestational diabetes, including:

  • Excess growth (also known as macrosomia). Extra glucose can cross the placenta. Extra glucose triggers the baby’s pancreas to make extra insulin. This can cause your baby to grow too large. It can lead to a difficult birth and sometimes the need for a C-section.
  • Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth. This is because their own insulin production is high.
  • Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
  • Death. Untreated gestational diabetes can lead to a baby’s death either before or shortly after birth.

Complications in the mother also can be caused by gestational diabetes, including:

  • Preeclampsia. Symptoms of this condition include high blood pressure, too much protein in the urine, and swelling in the legs and feet.
  • Gestational diabetes. If you had gestational diabetes in one pregnancy, you’re more likely to have it again with the next pregnancy.

How is gestational diabetes diagnosed?

All women are tested for gestational diabetes, usually at 24 to 28 weeks of pregnancy. If you are at higher risk, you may be tested earlier.

The test for gestational diabetes is called an ‘oral glucose tolerance test’ (OGTT). You need to fast for 10 hours (generally overnight, missing breakfast). A blood test is taken, followed by a 75g glucose drink and further blood tests at 1 and 2 hours later. You will be required to remain at the laboratory for the 2-hour test.

How is gestational diabetes treated?

If you are diagnosed with gestational diabetes, it’s important to follow your doctor’s advice. Managing the condition and keeping your blood glucose levels under control helps avoid complications for both you and your baby.

You may be referred to an obstetrician and dietitian and may need more frequent antenatal appointments and regular monitoring of your blood sugar levels.

If you have gestational diabetes, your prenatal care provider will want to see you more often at prenatal care checkups so they can monitor you and your baby closely to help prevent problems. You’ll probably have tests to make sure you and your baby are doing well. These include a nonstress test and a biophysical profile. The nonstress test checks your baby’s heart rate. The biophysical profile is a nonstress test with an ultrasound.

Your provider also may ask you to do kick counts (also called fetal movement counts). This is way for you to keep track of how often you can feel your baby move. Here are two ways to do kick counts:

  • Every day, time how long it takes for your baby to move 10 times. If it takes longer than 2 hours, tell your provider.
  • See how many movements you feel in 1 hour. Do this 3 times each week. If the number changes, tell your provider.

If you have gestational diabetes, your provider tells you how often to check your blood sugar, what your levels should be and how to manage them during pregnancy. Blood sugar is affected by pregnancy, what you eat and drink, and how much physical activity you get. You may need to eat differently and be more active. You also may need to take insulin shots or other medicines.

Treatment for gestational diabetes can help reduce your risk for pregnancy complications. Your provider begins treatment with monitoring your blood sugar levels, healthy eating, and physical activity. If this doesn’t do enough to control your blood sugar, you may need medicine. Insulin is the most common medicine for gestational diabetes. It’s safe to take during pregnancy.

Here’s what you can do to help manage gestational diabetes:

  • Go to all your prenatal care checkups, even if you’re feeling fine.
  • Follow your provider’s directions about how often to check your blood sugar. Your provider shows you how to check your blood sugar on your own. They tell you how often to check it and what to do if it’s too high. Keep a log that includes your blood sugar level every time you check it. Share it with your provider at each checkup. Most parents can check their blood sugar four times each day: once after fasting (first thing in the morning before you’ve eaten) and again after each meal.
  • Eat healthy foods. Talk to your provider about the right kinds of foods to eat to help control your blood sugar.
  • Do something active every day. Try to get 30 minutes of moderate-intensity activity at least 5 days each week. Talk to your provider about activities that are safe during pregnancy, like walking.
  • If you take medicine for diabetes, take it exactly as your provider tells you to. If you take insulin, your provider teaches you how to give yourself insulin shots. Tell your provider about any medicine you take, even if it’s medicine for other health conditions. Some medicines can be harmful during pregnancy, so your provider may need to change them to ones that are safer for you and your baby. Don’t start or stop taking any medicine during pregnancy without talking to your provider first.
  • Check your weight gain during pregnancy. Gaining too much weight or gaining weight too fast can make it harder to manage your blood sugar. Talk to your provider about the right amount of weight to gain during pregnancy.

Monitoring your blood glucose levels

Your medical team will give you a target range for your blood glucose levels. You will need to check these at home while you are pregnant.

You can purchase a blood glucose measuring kit from your local pharmacy or diabetes center.

To test your blood glucose levels, you prick your finger with a lancet and put a small drop of blood onto a testing strip. Then you insert the strip into a meter, which reads your blood glucose level.

Healthy diet

Following a healthy eating plan is important in managing gestational diabetes. Eat small amounts often and try not to put on too much weight. A healthy diet for women with gestational diabetes includes:

  • a carbohydrate with every meal and snack (spread your carbohydrate intake over 3 small meals and 2 to 3 snacks each day)
  • a variety of foods that contain the nutrients you need during pregnancy
  • high-fiber foods
  • avoiding foods and drinks that contain a lot of sugar
  • limiting fat, especially saturated fats

Exercise

Moderate intensity physical activity — physical activity that raises your breathing or heart rate — can help you manage your blood glucose levels and reduces insulin resistance.

The best form of exercise if you have gestational diabetes is to build walking into your daily routine. Always check with your doctor first before you start exercising while you are pregnant.

Medication

If your blood sugar levels remain high despite changes to your diet and an exercise regime, you may need medication to lower your blood sugar levels.

Both insulin injections and metformin pills have been shown to be safe for the unborn baby. If you already have diabetes when you become pregnant, discuss with your doctor whether you will need to change any of your medicines.

If you are worried about taking medicines while you are pregnant, discuss the risks with your doctor. Remember, the risks of not treating your gestational diabetes could be much higher for both you and your baby.

Causes of Type 2 Diabetes

Type 2 diabetes is primarily the result of two interrelated problems:

  1. Cells in muscle, fat and the liver become resistant to insulin. Because these cells don’t interact in a normal way with insulin, they don’t take in enough sugar.
  2. The pancreas is unable to produce enough insulin to manage blood sugar levels.

Exactly why this happens is unknown, but being overweight and inactive are key contributing factors.

Glucose (a sugar) is a main source of energy for the cells that make up muscles and other tissues. The use and regulation of glucose includes the following:

  • Glucose comes from two major sources: food and your liver.
  • Glucose is absorbed into the bloodstream, where it enters cells with the help of insulin.
  • Your liver stores and makes glucose.
  • When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

In type 2 diabetes, this process doesn’t work well. Instead of moving into your cells, sugar builds up in your bloodstream. As blood sugar levels increase, the insulin-producing beta cells in the pancreas release more insulin. Eventually these cells become impaired and can’t make enough insulin to meet the body’s demands.

pancreas
insulin and prediabetes

How insulin works

Insulin is a hormone that comes from the gland situated behind and below the stomach (pancreas).

  • The pancreas secretes insulin into the bloodstream.
  • The insulin circulates, enabling sugar (glucose) to enter your cells.
  • Insulin lowers the amount of sugar (glucose) in your bloodstream.
  • As your blood sugar (glucose) level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues.

  • Glucose comes from two major sources: food and your liver.
  • Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
  • Your liver stores and makes glucose.
  • When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

In type 2 diabetes, this process doesn’t work well. Instead of moving into your cells, sugar builds up in your bloodstream. As blood sugar levels increase, the insulin-producing beta cells in the pancreas release more insulin, but eventually these cells become impaired and can’t make enough insulin to meet the body’s demands.

(In the much less common type 1 diabetes, the immune system destroys the beta cells, leaving the body with little to no insulin.)

Risk factors for developing type 2 diabetes

Some things can increase your chance of getting type 2 diabetes. Because the symptoms of type 2 diabetes are not always obvious, it’s really important to be aware of these risk factors. Factors that may increase your risk of type 2 diabetes include:

  • Weight. Being overweight or obese is a main risk.
  • Fat distribution. Storing fat mainly in your abdomen (waist size is too large) — rather than your hips and thighs — indicates a greater risk. Your risk of type 2 diabetes rises if you’re a man with a waist circumference above 40 inches (101.6 centimeters) or a woman with a measurement above 35 inches (88.9 centimeters).
    • How to measure your waist: Find the top of your hip bone and the bottom of your ribcage. In the middle of these two points is where you need to measure. For many people, the belly button is a good guide, but this might not be the case for you, so it’s best to find that midpoint between your ribcage and hip. If you’re still not sure, watch the video below.
    • What is a healthy waist size? This all depends on your gender and ethnicity. For a healthy measurement you need to aim to be less than:
      • 80 cm (31.5 in) for all women
      • 94 cm (37 in) for most men
      • 90cm (35in) for South Asian men. This is because you have a higher risk of type 2 diabetes if you are of black or South Asian background.
  • Inactivity. The less active you are, the greater your risk. Physical activity helps control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
  • Family history. The risk of type 2 diabetes increases if your parent, brother or sister has type 2 diabetes.
  • Race and ethnicity. Although it’s unclear why, people of certain races and ethnicities — including African Caribbean, Black African, Hispanic, Native American and Asian people (Indian, Pakistani, Bangladeshi or Chinese), and Pacific Islanders — are more likely to develop type 2 diabetes than white people are.
  • Blood lipid levels. An increased risk is associated with low levels of high-density lipoprotein (HDL) cholesterol — the “good” cholesterol — and high levels of triglycerides.
  • Age. You’re more at risk if you’re white and over 40, or over 25 if you’re African Caribbean, Black African, or South Asian (Indian, Pakistani or Bangladeshi).
  • Medical history. For example if you have a history of high blood pressure, heart attack or strokes, gestational diabetes or severe mental illness.
  • Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
  • Pregnancy-related risks. Your risk of developing type 2 diabetes increases if you developed gestational diabetes when you were pregnant or if you gave birth to a baby weighing more than 9 pounds (4 kilograms).
  • Polycystic ovary syndrome (PCOS). Having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
  • Smoking. Smoking is associated with a higher risk of type 2 diabetes, and also increases the risk of other health conditions such as heart disease and cancer.
  • Areas of darkened skin, usually in the armpits and neck. This condition, called acanthosis nigricans. This condition often indicates insulin resistance. Acanthosis nigricans is most common in those who are overweight, have darker skin, and have diabetes or pre-diabetic conditions. Acanthosis nigricans is not contagious. It is not harmful. Acanthosis nigricans is a warning sign of a health problem that requires medical attention.

Researchers don’t fully understand why some people develop type 2 diabetes and others don’t. It’s clear, however, that certain factors increase the risk, including:

  1. Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to insulin. However, you don’t have to be overweight to develop type 2 diabetes.
  2. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs.
  3. Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
  4. Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes.
  5. Race. Although it’s unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are more likely to develop type 2 diabetes than whites are.
  6. Age. The risk of type 2 diabetes increases as you get older, especially after age 45. That’s probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
  7. Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
  8. Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.
  9. Polycystic ovarian syndrome (PCOS). For women, having polycystic ovarian syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.

How to reverse type 2 diabetes?

The strongest evidence we have at the moment suggests that type 2 diabetes can be reversed or put into remission is by weight loss 5. If you have obesity or overweight, your diabetes is more likely to go into remission if you lose a substantial amount of weight – 15kg (or 2 stone 5lbs) – as quickly and safely as possible following diagnosis. Type 2 diabetes remission is when your blood sugar levels are below the diabetes range and you don’t need to take diabetes medication anymore. Remission is when your HbA1c — a measure of long-term blood glucose levels — remains below 48mmol/mol or 6.5% for at least three months, without diabetes medication 4. This definition has been agreed by a team of international experts at Diabetes UK, the American Diabetes Association and the European Association for the Study of Diabetes. Some people call this ‘reversing type 2 diabetes’, but experts use the term remission because your blood sugar levels can rise again and there’s no guarantee that your diabetes has gone forever. If your regular blood tests show your HbA1c remaining below 48 mmol/mol or 6.5%, talk to your healthcare team to discuss diabetes remission and how this applies to you. Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis. However, scientists do know of people who have put their diabetes into remission 25 years after diagnosis.

There is no such thing as a special diet for people with diabetes or those aiming for diabetes reversal. There are a lot of different ways to lose weight – but there’s no one-size-fits-all diet. Some people have lost a substantial amount of weight and put their diabetes into remission through lifestyle and diet changes or by having weight loss surgery (called bariatric surgery). Scientists do know that some people have put their diabetes into remission by losing weight through following the Mediterranean diet or a low-carb diet 6, 7, 8.

It’s important to know that not everyone who loses this much weight will be able to put their diabetes into remission. But losing 15kg comes with a lot of health benefits, even if you don’t lead to remission. Research shows that getting support to lose just 5% of your body weight can have huge benefits for your health. People with obesity have an increased risk of serious health conditions, including heart attack, stroke and certain cancers. Research has shown that losing just 5% of your body weight can lead to:

  • fewer medications
  • better blood sugar levels
  • lowering your blood pressure and cholesterol levels
  • a lower risk of complications.

Scientists believe that just as storing fat around the liver and pancreas affects how type 2 diabetes develops, losing fat affects remission.

To understand how losing weight can help someone go into remission, you need to understand why obesity or overweight can lead to type 2 diabetes. If someone’s carrying extra weight around their waist, fat can build up around important organs like the liver and pancreas. This makes it more difficult for those organs to work properly, leading to type 2 diabetes.

But not everyone who develops type 2 diabetes lives with obesity or overweight. There are other factors, like age, ethnicity and family history that play a role in our risk of type 2 too. These factors influence how well the liver and pancreas work, and also where you store your fat. You can’t change those things, but you can usually change your weight.

Diabetes remission is quite a new idea. A lot of research is needed before we fully understand it. Diabetes experts don’t have enough evidence that remission is permanent. It needs to be maintained and in many cases, blood sugar levels can rise again, which is why it is so important to continue your diabetes appointments while in remission, because there’s always a chance that your diabetes might return. So, you’ll need ongoing support to keep an eye on your weight, and if it starts to creep up again, ask for extra support to adjust your eating pattern and activity levels.

You’ll also want to ensure that your HbA1c levels stay below 48 mmol/L or 6.5%.

Be sure to have regular health checks with your healthcare team at least once a year, including retinal screening. That way, your healthcare team can follow up on existing complications, pick up on new complications and give you support as soon as possible if your HbA1c levels go up again.

Symptoms and Signs of Type 2 Diabetes

Many people with type 2 diabetes do not experience any symptoms at first and it may go undiagnosed for years. In fact, you can be living with type 2 diabetes for years and not know it.

Signs and symptoms of type 2 diabetes often develop slowly. When signs and symptoms are present, they may include:

  • Increased thirst or being very thirsty
  • Frequent urination (passing more urine). Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink and urinate more than usual.
  • Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger.
  • Unintended weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine.
  • Fatigue (feeling tired). If your cells are deprived of sugar, you may become tired and irritable.
  • Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus.
  • Slow-healing sores or having cuts that heal slowly.
  • Frequent infections. Type 2 diabetes affects your ability to heal and resist infections.
  • Numbness or tingling in the hands or feet (diabetic neuropathy). Diabetic neuropathy is when diabetes causes damage to your nerves. It can affect different types of nerves in your body, including in your feet, organs and muscles.
  • Areas of darkened skin, usually in the armpits and neck. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance.

Over time, diabetes can lead to complications, which can then cause other symptoms.

Blood glucose testing is important for detecting pre-diabetes and type 2 diabetes before complications arise.

Type 2 diabetes complications

Type 2 diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Also, factors that increase the risk of diabetes are risk factors for other serious chronic diseases. Managing diabetes and controlling your blood sugar can lower your risk for these complications or coexisting conditions (comorbidities).

Potential complications of type 2 diabetes and frequent comorbidities include:

  • Heart and blood vessel disease. Diabetes is associated with an increased risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).
  • Nerve damage (neuropathy) in limbs. High blood sugar over time can damage or destroy nerves, resulting in tingling, numbness, burning, pain or eventual loss of feeling that usually begins at the tips of the toes or fingers and gradually spreads upward.
  • Other nerve damage. Damage to nerves of the heart can contribute to irregular heart rhythms. Nerve damage in the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. For men, nerve damage may cause erectile dysfunction.
  • Kidney disease (diabetic nephropathy). Diabetes may lead to chronic kidney disease or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
  • Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness.
  • Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
  • Slow healing. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.
  • Hearing impairment. Hearing problems are more common in people with diabetes.
  • Sleep apnea. Obstructive sleep apnea is common in people living with type 2 diabetes. Obesity may be the main contributing factor to both conditions. It’s not clear whether treating sleep apnea improves blood sugar control.
  • Dementia. Type 2 diabetes seems to increase the risk of Alzheimer’s disease and other disorders that cause dementia. Poor control of blood sugar levels is linked to more-rapid decline in memory and other thinking skills.

Type 2 diabetes prevention

Healthy lifestyle choices can help prevent type 2 diabetes, and that’s true even if you have biological relatives living with diabetes. If you’ve received a diagnosis of prediabetes, lifestyle changes may slow or stop the progression to diabetes.

Prevention of diabetes through healthy lifestyle includes:

  • Eating healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains.
  • Getting active. Aim for 150 or more minutes a week of moderate to vigorous aerobic activity, such as a brisk walk, bicycling, running or swimming.
  • Losing weight. Losing a modest amount of weight and keeping it off can delay the progression from prediabetes to type 2 diabetes. If you have prediabetes, losing 7% to 10% of your body weight can reduce the risk of diabetes.
  • Avoiding inactivity for long periods. Sitting still for long periods can increase your risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes.

For people with prediabetes, metformin (Fortamet, Glumetza, others), an oral diabetes medication, may be prescribed to reduce the risk of type 2 diabetes. This is usually prescribed for older adults who are obese and unable to lower blood sugar levels with lifestyle changes.

How to reduce your waist size

Unfortunately, there are no quick fixes when it comes to reducing your waist size. It comes down to eating well and moving more. Start by setting some realistic, achievable changes to suit your lifestyle. You can become more active by making small changes to your lifestyle. You can fit them around your daily life and in your budget. Here are three top tips to help make your life more active:

  1. Set clear goals to move more – setting goals can help you break down what you need to do and how to do it. This could be aiming to walk more, taking up a new activity or learning a new skill such as swimming or running.
  2. Plan ahead – we all have busy lives, so try to plan what you’re going to eat and what activity you’re going to do this week, fitting it around your social life. You can always squeeze in an activity during your lunch hour or go for walk instead of getting another form of transport.
  3. Start by making small changes – it’s time to put your plan into action. Start small and do something you enjoy. Doing just a little bit more each day will still make a difference. It also means you’re more likely to stick to it. Just remember, small changes to your routine won’t have such a big impact, so start small and grow.

How you can lower your chances of developing type 2 diabetes

Research such as the Diabetes Prevention Program shows that you can do a lot to reduce your chances of developing type 2 diabetes. Here are some things you can change to lower your risk:

  • Lose weight and keep it off. You may be able to prevent or delay diabetes by losing 5 to 7 percent of your starting weight.1 For instance, if you weigh 200 pounds, your goal would be to lose about 10 to 14 pounds.
  • Move more. Get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional about which activities are best. Start slowly to build up to your goal.
  • Eat healthy foods most of the time. Eat smaller portions to reduce the amount of calories you eat each day and help you lose weight. Choosing foods with less fat is another way to reduce calories. Drink water instead of sweetened beverages.

In 8 randomized clinical trials 9 with 2241 participants randomized to exercise and diet intervention and 2509 participants to standard recommendation. Furthermore, 178 participants were randomized to an exercise only intervention and 167 participants to a diet only intervention. The duration of the interventions in the trials ranged from one year to six years. Interventions varied between studies but mainly consisted of caloric restriction if the person was overweight, low fat content (especially saturated fat), high carbohydrate content and the increase of fiber intake. Physical activity varied but on average at least 150 minutes each week of brisk walking or other activities such as cycling or jogging were recommended. Interventions were mainly delivered by frequent individual counseling by a physiotherapist, an exercise physiologist and a dietitian. Interventions aimed at increasing exercise combined with diet are able to decrease the incidence of type 2 diabetes mellitus in high risk groups (people with impaired glucose tolerance or the metabolic syndrome) by 37% with exercise and diet. This had favorable effects on body weight, waist circumference and blood pressure 9.

Ask your health care professional about what other changes you can make to prevent or delay type 2 diabetes.

Most often, your best chance for preventing type 2 diabetes is to make lifestyle changes that work for you long term. Get started with Your Game Plan to Prevent Type 2 Diabetes.

how diabetes affects children

Your Game Plan to Prevent Type 2 Diabetes

The information below is based on the National Institute of Health sponsored Diabetes Prevention Program research study 10, which showed that people could prevent or delay type 2 diabetes even if they were at high risk for the disease.

Follow these steps to get started on your game plan.

1) Set a weight loss goal

Calculate your BMI to learn whether you are overweight.

If you are overweight, set a weight-loss goal that you can reach. Try to lose at least 5 to 10 percent of your current weight within 6 months. For example, if you weigh 200 pounds, a 10-percent weight-loss goal means that you will try to lose 20 pounds. A good short-term goal is to lose 1 to 2 pounds per week.

The keys to preventing type 2 diabetes are to lose weight by choosing foods and drinks that are lower in calories, and to be more active.

Find your weight-loss goal

Find your current weight in the first column to see how much weight you would need to lose for a 5, 7 or 10 percent weight loss. For example, if you weigh 200 pounds and want to lose 5 percent of your current weight, then you would need to lose 10 pounds.

Your current weight in poundsPounds to lose 5 percent of your weightPounds to lose 7 percent of your weightPounds to lose 10 percent of your weight
15081115
17591218
200101420
225111623
250131825
275141928
300152130
325162333
350182535

Calculate your weight-loss goal

Use the example below to learn how to calculate your exact weight-loss goal. In this example, the goal is for a 240-pound person to lose 5 percent of his or her weight.

Step NumberActionResult
Step 1Weigh yourself to get your current weight.“My weight is 240 pounds.”
Step 2Multiply your weight by the percent you want to lose.“I want to lose 5 percent of my weight.”
240 pounds (current weight)
x .05 (5 percent weight loss)
12 pounds to lose
Step 3Subtract the answer in Step 2 from your current weight.240 pounds (current weight)
– 12 pounds (amount to lose)
228 pounds (weight-loss goal)

2) Follow a healthy eating plan for weight loss

Research shows that you can prevent or delay type 2 diabetes by losing weight by following a low-fat, reduced-calorie eating plan and by being more active each day. Following an eating plan can help you reach your weight-loss goal. There are many ways to do this. Remember that the key to losing weight and preventing type 2 diabetes is to make lifelong changes that work for you. Many popular weight-loss plans promise “quick fixes” and haven’t been proven to work long-term or to prevent type 2 diabetes.

The four most important steps to eating healthy for weight loss are:

  • Eat smaller portions than you currently eat of foods that are high in calories, fat, and sugar.
  • Eat healthier foods in place of less-healthy choices.
  • Choose foods with less trans fat, saturated fat, and added sugars.
  • Drink water instead of drinks with sugar such as soda, sports drinks, and fruit juice.

Pay attention to portion sizes

Using the plate method can help you manage your portion sizes. Fill half of your plate with fruits and vegetables. Fill one quarter with a lean protein, such as chicken or turkey without the skin, or beans. Fill one quarter with a whole grain, such as brown rice or whole-wheat pasta.

A portion is how much food you choose to eat at one time, whether in a restaurant, from a package, or at home. A serving, or serving size, is the amount of food listed on a product’s Nutrition Facts, or food label (see food serving sizes below).

food serving sizes
[Source 11 ]

Different products have different serving sizes, which could be measured in cups, ounces, grams, pieces, slices, or numbers—such as three crackers. A serving size on a food label may be more or less than the amount you should eat, depending on your age, weight, whether you are male or female, and how active you are. Depending on how much you choose to eat, your portion size may or may not match the serving size.

You can use everyday objects or your hand to judge the size of a portion. For example:

  • 1 serving of meat or poultry is about the size of the palm of your hand or a deck of cards
  • 1 3-ounce serving of fish is the size of a checkbook
  • 1 serving of cheese is like six dice
  • 1/2 cup of cooked rice or pasta is like a rounded handful or a tennis ball
  • 2 tablespoons of peanut butter is like a ping-pong ball

How you can manage food portions at home

You don’t need to measure and count everything you eat or drink for the rest of your life. You may only want to do this long enough to learn typical serving and portion sizes. Try these ideas to help manage portions at home:

  • Take one serving according to the food label and eat it off a plate instead of straight out of the box or bag.
  • Avoid eating in front of the TV, while driving or walking, or while you are busy with other activities.
  • Focus on what you are eating, chew your food well, and fully enjoy the smell and taste of your food.
  • Eat slowly so your brain can get the message that your stomach is full, which may take at least 15 minutes.
  • Use smaller dishes, bowls, and glasses so that you eat and drink less.
  • Eat fewer high-fat, high-calorie foods, such as desserts, chips, sauces, and prepackaged snacks.
  • Freeze food you won’t serve or eat right away, if you make too much. That way, you won’t be tempted to finish the whole batch. If you freeze leftovers in single- or family-sized servings, you’ll have ready-made meals for another day.
  • Eat meals at regular times. Leaving hours between meals or skipping meals altogether may cause you to overeat later in the day.
  • Buy snacks, such as fruit or single-serving, prepackaged foods, that are lower in calories. If you buy bigger bags or boxes of snacks, divide the items into single-serve packages right away so you aren’t tempted to overeat.

Resources to learn more about portion sizes

Recommended daily calories and fat grams

The table below shows how many calories and fat grams to eat each day to lose weight. Your needs may be different, but these are good starting points. The amounts are based on the eating patterns used in the Diabetes Prevention Program research study.

Current WeightCalories Per Day*Fat Grams Per Day
120-170 pounds120033
175-215 pounds150042
220-245 pounds180050
250-300 pounds200055
[Source 12 ]

Note: This information is for use in adults defined as individuals 18 years of age or older and not by younger people, or pregnant or breastfeeding women.

3) Move more

When you move more every day, you will burn more calories. This can help you reach your weight-loss goal and keep the weight off. Even if you don’t lose weight, being more active may help you prevent or delay type 2 diabetes.

Find ways to be active for at least 30 minutes, 5 days a week. Start slowly and add more activity until you get to at least 30 minutes of physical activity, like a brisk walk, 5 days a week.Walking is recommended for most people. Check with your health care team about other exercise programs.

Use these tips to get started, and keep moving:

  • Dress to move. Wear walking shoes that fit your feet and provide comfort and support. Your clothes should allow you to move and should keep you dry and comfortable. Look for fabrics that take sweat away from your skin to keep you cool.
  • Start slowly. Start by taking a 5-10 minute walk (or doing another activity that you like) on most days of the week. Slowly, add more time until you reach at least 30 minutes of moderate-intensity activity 5 days a week. Moderate-intensity activity will increase your heart rate and breathing. To check your intensity, use the Talk Test: a person doing moderate-intensity activity is able to talk but not sing.
  • Add more movement to your day. There are many ways you can add more movement to your day. If you have a dog, take your dog for a brisk walk in the morning or evening. When going shopping, park further away from the store’s entrance to increase your walk time. If you ride the bus, get off one stop early and walk the rest of the way if it is safe.
  • Try to sit less in your day. Get up every hour and move. When you watch TV, walk or dance around the room, march in place, or stretch.
  • Move more at work. Take a “movement break” during the day. Go for a walk during lunchtime. Deliver a message in person to a coworker instead of sending an email. Walk around your workplace while talking on the telephone. Take the stairs instead of the elevator to your workplace. Use the alarm on your phone, watch, or other device to remind you to take “movement breaks.”
  • Count your steps. You may be surprised to learn how much walking you already do every day. Use a pedometer or other wearable device to keep track of your steps. A pedometer is a gadget that counts the number of steps you take. Work up to 7, 000-10,000 steps per day.
  • Keep your muscles strong. Do activities to strengthen your muscles, such as lifting weights or using resistance bands 2 or more days a week.
  • Stretch it out. If your body aches or is sore, you are less likely to move more. To reduce stiff or sore muscles or joints, consider stretching after being active. Don’t bounce when you stretch. Perform slow movements and stretch only as far as you feel comfortable.
  • Make it social. When you bring other people into your activities, you are more likely to stick to your plan. Make walking “dates” with friends or family members throughout the week. For family fun, play soccer, basketball, or tag with your children. Take a class at a local gym or recreation center to be active with other people. Start a walking group with your neighbors, at work, or where you worship.
  • Have fun. Being active doesn’t have to be boring or painful. Turn up the music and dance while cleaning the house. Go dancing with friends and family members. Play sports with your kids or grandkids. Try swimming, biking, walking, jogging, or any activity that you enjoy that gets you moving. Find different ways to be active so you won’t get bored.
  • Keep at it. Reward yourself with nonfood treats, such as watching a movie, to celebrate your small successes. The longer you keep at it, the better you’ll feel. Making changes is never easy, but being more active is one small step toward a big reward: a healthier life.

4) Track your progress

Research shows that people who keep track of their weight and activity reach their goals more often than those who don’t. Weigh yourself at least once a week. Keep track of what you eat and drink, how many minutes of activity you get each day, and your weight. Use your phone, a printed log, online tracker, app, or other device to record your weight, what you eat and drink, and how long you are active.

The examples below show how to record your daily activity and food intake.

Daily Activity
Type of ActivityMinutes
Walking10
Stationary bike20
Daily Total30
Daily Steps
Number of Steps Taken7450

 

Daily Food and Drink Intake
TimeAmountFood ItemCaloriesFat Grams
8:00 a.m.1 cupOatmeal1603.5
½ cupStrawberries250
6 oz.Light yogurt900
1 cupTea with sugar-free sweetener00
11:00 a.m.10Almonds706
12:30 p.m.2 slicesWheat bread1602
4 oz.Ham1253
2 tsp.Mustard50
1 oz. sliceCheese1109
1 oz.Potato chips16010
10Cherry tomatoes300
4:00 p.m.4 squaresGraham crackers1203
1 tbsp.Peanut butter958
6:30 p.m.3 oz. skinlessChicken breast1403
1 cupCooked broccoli550
½ cupBrown rice1101
1 cupPineapple chunks800
1 cupNonfat milk900.5
Daily Total1,625 calories49.0 grams

5) Talk with your health care team

Ask your health care team about steps you can take to prevent type 2 diabetes. Learn about other ways to help reach your goal, such as taking the medicine metformin. Also, ask if your health insurance covers services for weight loss or physical activity.

6) Get support for changing your lifestyle

It’s not easy to make and stick to lifelong changes in what you eat and how often you are active. Get your friends and family involved by asking them to support your changes. Join with a neighbor or coworker in changing your lifestyle. You can also join a diabetes prevention program to meet other people who are making similar changes.

Talk with your health care team to learn about programs that may help, such as the National Diabetes Prevention Program.

  • National Diabetes Prevention Program 13 —Led by the Centers for Disease Control and Prevention (CDC), the National Diabetes Prevention Program offers lifestyle change programs based on the Diabetes Prevention Program research study. Participants work with a lifestyle coach in a live group or online setting to receive a 1-year lifestyle change program that includes 16 core sessions (usually 1 per week) and 6 post-core sessions (1 per month).
  • Find a program near you 14.
  • Find a registered dietitian nutritionist 15 near you.
  • Find a diabetes educator 16 near you.
  • Local hospitals, health departments, libraries, senior centers, or faith-based organizations may offer additional programs or seminars about type 2 diabetes prevention.

How To Diagnose Type 2 Diabetes

The following table lists the blood test levels for a diagnosis of prediabetes and diabetes.

Blood_Test_Levels_Chart_of_Diabetes_and_Prediabetes

A1C or HbA1C test

Type 2 diabetes is usually diagnosed using the glycated hemoglobin (A1C or HbA1C) test. The A1C test measures your average blood glucose for the past two to three months. Results are interpreted as follows 17:

  • Below 5.7% is normal.
  • 5.7% to 6.4% is diagnosed as prediabetes.
  • 6.5% or higher on two separate tests indicates diabetes.

Can the A1C test be used to diagnose type 2 diabetes and prediabetes?

Yes. In 2009, an international expert committee recommended the A1C test as one of the tests available to help diagnose type 2 diabetes and prediabetes 18.  Previously, only the traditional blood glucose tests were used to diagnose diabetes and prediabetes.

Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes. However, some medical organizations continue to recommend using blood glucose tests for diagnosis.

If the A1C test isn’t available, or if you have certain conditions — such as if you’re pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes:

Random blood sugar test

Random blood sugar test also called casual plasma glucose test is a blood check at any time of the day when you have severe diabetes symptoms.

  • Diabetes is diagnosed at blood glucose of greater than or equal to 11.1 mmol/L (200 mg/dL)

Blood sugar values are expressed in milligrams of sugar per deciliter (mg/dL) or millimoles of sugar per liter (mmol/L) of blood. Regardless of when you last ate, a level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially if you also have signs and symptoms of diabetes, such as frequent urination and extreme thirst.

Fasting blood sugar test

A blood sample is taken after an overnight fast. Results are interpreted as follows:

  • Less than 100 mg/dL (5.6 mmol/L) is normal.
  • 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is diagnosed as prediabetes.
  • 126 mg/dL (7 mmol/L) or higher on two separate tests is diagnosed as diabetes.

Oral glucose tolerance test (OGTT)

Oral glucose tolerance test is less commonly used than the others, except during pregnancy. You’ll need to fast overnight and then drink a sugary liquid at the doctor’s office. Blood sugar levels are tested periodically for the next two hours. Results are interpreted as follows:

  • Less than 140 mg/dL (7.8 mmol/L) is normal.
  • 140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) is diagnosed as prediabetes.
  • 200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes.

After a diagnosis

If you’re diagnosed with diabetes, your doctor or health care provider may do other tests to distinguish between type 1 and type 2 diabetes — since the two conditions often require different treatments.

Your health care provider will repeat the test A1C levels at least two times a year and when there are any changes in treatment. Target A1C goals vary depending on your age and other factors. For most people, the American Diabetes Association recommends an A1C level below 7%.

You will also receive regular diagnostic tests to screen for complications of diabetes or comorbid conditions.

Why should a person be tested for diabetes?

Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1C and blood glucose tests are the best tools available to diagnose diabetes—a serious and lifelong disease.

Testing enables health care providers to find and treat diabetes before complications occur and to find and treat prediabetes, which can delay or prevent type 2 diabetes from developing.

Complications of Type 2 Diabetes

If there is too much sugar in the blood for years at a time, the smaller blood vessels in the eyes, nerves and kidneys can be damaged. These are called the microvascular complications of diabetes. “Microvascular” means that the smaller blood vessels are affected. The medical names for these kinds of complications are retinopathy (damage to the retina), neuropathy (nerve damage), and nephropathy (kidney damage). The later someone develops type 2 diabetes, the less likely it is that they will develop these kinds of problems.

Controlling your blood sugar levels can help prevent these complications. For example, many people who have type 2 diabetes also have high blood pressure.

Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include:

  • Cancer. Diabetes is linked to some types of cancer . Many risk factors for cancer and for diabetes are the same. Not smoking and getting recommended cancer screenings can help prevent cancer.
  • Heart and blood vessel disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue. According to high-quality evidence, enhanced glucose control significantly prevents the development of clinical neuropathy and reduces nerve conduction and vibration threshold abnormalities in type 1 diabetes mellitus. In type 2 diabetes mellitus, enhanced glucose control reduces the incidence of clinical neuropathy 19.
  • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which often eventually requires dialysis or a kidney transplant.
  • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.
  • Hearing impairment. Hearing problems are more common in people with diabetes.
  • Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
  • Alzheimer’s disease. Type 2 diabetes may increase the risk of Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. The exact connection between these two conditions still remains unclear.
  • Sexual and Urologic Problems. Sexual and urologic complications of diabetes occur because of the damage diabetes can cause to blood vessels and nerves. Men may have difficulty with erections or ejaculation. Women may have problems with sexual response and vaginal lubrication. Urinary tract infections and bladder problems occur more often in people with diabetes. People who keep their diabetes under control can lower their risk of the early onset of these sexual and urologic problems 20.
  • Gum Disease and Other Dental Problems. Glucose is present in your saliva—the fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath 21.
  • Sleep Apnea. People who have sleep apnea are more likely to develop type 2 diabetes. Sleep apnea also can make diabetes worse. Treatment for sleep apnea can help.

Diabetes and Cancer

Diabetes are greatest (about twofold or higher) for cancers of the liver, pancreas, and endometrium, and lesser (about 1.2 to 1.5 fold) for cancers of the colon and rectum, breast, and bladder 22, 23.

Epidemiological studies clearly indicate that the risk of several types of cancer (including pancreas, liver, breast, colorectal, urinary tract, and female reproductive organs) is increased in diabetic patients. Hyperinsulinemia most likely favors cancer in diabetic patients as insulin is a growth factor with pre-eminent metabolic but also mitogenic effects, and its action in malignant cells is favored by mechanisms acting at both the receptor and post-receptor level. Obesity, hyperglycemia, and increased oxidative stress may also contribute to increased cancer risk in diabetes 22, 24.

Glucose metabolism represents a complex system, and several components of the regulatory metabolic pathways may induce abnormalities in cellular growth and regulation. The strongest evidence of an association between glucose metabolism alterations and cancer derives from cohort studies, showing increased cancer incidence and mortality in the presence of diabetes 25. In particular, several studies clearly indicate an association between type 2 diabetes and the risk of colorectal, pancreatic, and breast cancer. An increased risk of liver, gastric, and endometrial malignancies has also been suggested. Type 1 diabetes is associated with an elevated risk of female reproductive organs and gastric cancers. The risk of malignancies is also increased at earlier stages of glucose metabolism abnormalities, with a linear relationship between cancer risk and plasma insulin levels, usually elevated in the presence of metabolic syndrome or diabetes. The prevalence of diabetes and obesity is rapidly increasing worldwide; if these conditions are associated even with a small increase in the risk of cancer, this will translate into important consequences for public health.

In conclusion, diabetes and cancer have a complex relationship that requires more clinical attention and better-designed studies.

How You Can Prevent Diabetes Complications and Problems

Diabetes, Heart Disease, and Stroke

Having diabetes means that you are more likely to develop heart disease and have a greater chance of a heart attack or a stroke. People with diabetes are also more likely to have certain conditions, or risk factors, that increase the chances of having heart disease or stroke, such as high blood pressure or high cholesterol. If you have diabetes, you can protect your heart and health by managing your blood glucose, also called blood sugar, as well as your blood pressure and cholesterol. If you smoke, get help to stop.

What is the link between diabetes, heart disease, and stroke?

Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop heart disease 26.

People with diabetes tend to develop heart disease at a younger age than people without diabetes. In adults with diabetes, the most common causes of death are heart disease and stroke. Adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes 27.

The good news is that the steps you take to manage your diabetes also help to lower your chances of having heart disease or stroke.

What else increases your chances of heart disease or stroke if you have diabetes?

If you have diabetes, other factors add to your chances of developing heart disease or having a stroke.

  • Smoking

Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking because both smoking and diabetes narrow blood vessels. Smoking also increases your chances of developing other long-term problems such as lung disease. Smoking also can damage the blood vessels in your legs and increase the risk of lower leg infections, ulcers, and amputation.

  • High blood pressure

If you have high blood pressure , your heart must work harder to pump blood. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

  • Abnormal cholesterol levels

Cholesterol is a type of fat produced by your liver and found in your blood. You have two kinds of cholesterol in your blood: LDL and HDL.

LDL, often called “bad” cholesterol, can build up and clog your blood vessels. High levels of LDL cholesterol raise your risk of developing heart disease.

Another type of blood fat, triglycerides, also can raise your risk of heart disease when the levels are higher than recommended by your health care team.

  • Obesity and belly fat

Being overweight or obese can affect your ability to manage your diabetes and increase your risk for many health problems, including heart disease and high blood pressure. If you are overweight, a healthy eating plan with reduced calories often will lower your glucose levels and reduce your need for medications.

Excess belly fat around your waist, even if you are not overweight, can raise your chances of developing heart disease.

You have excess belly fat if your waist measures

  • more than 40 inches and you are a man
  • more than 35 inches and you are a woman

Learn how to correctly measure your waist by going to –  Waist Hip Ratio.

  • Family history of heart disease

A family history of heart disease may also add to your chances of developing heart disease. If one or more of your family members had a heart attack before age 50, you may have an even higher chance of developing heart disease 28.

You can’t change whether heart disease runs in your family, but if you have diabetes, it’s even more important to take steps to protect yourself from heart disease and decrease your chances of having a stroke.

How you can lower your chances of a heart attack or stroke if you have diabetes?

Taking care of your diabetes is important to help you take care of your heart. You can lower your chances of having a heart attack or stroke by taking the following steps to manage your diabetes to keep your heart and blood vessels healthy.

Manage your diabetes ABCs

Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol. Stopping smoking if you have diabetes is also important to lower your chances for heart disease.

A is for the A1C test. The A1C test shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you do every day. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. High levels of blood glucose can harm your heart, blood vessels, kidneys, feet, and eyes.

The A1C goal for many people with diabetes is below 7 percent. Some people may do better with a slightly higher A1C goal. Ask your health care team what your goal should be.

B is for blood pressure. Blood pressure is the force of your blood against the wall of your blood vessels. If your blood pressure gets too high, it makes your heart work too hard. High blood pressure can cause a heart attack or stroke and damage your kidneys and eyes.

The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask what your goal should be.

C is for cholesterol. You have two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels. Too much bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels.

Ask your health care team what your cholesterol numbers should be. If you are over 40 years of age, you may need to take medicine such as a statin to lower your cholesterol and protect your heart. Some people with very high LDL (“bad”) cholesterol may need to take medicine at a younger age.

S is for stop smoking. Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels, so your heart has to work harder.

If you quit smoking

  • you will lower your risk for heart attack, stroke, nerve disease, kidney disease, eye disease, and amputation
  • your blood glucose, blood pressure, and cholesterol levels may improve
  • your blood circulation will improve
  • you may have an easier time being physically active

Developing or maintaining healthy lifestyle habits can help you manage your diabetes and prevent heart disease.

  • Follow your healthy eating plan.
  • Make physical activity part of your routine.
  • Stay at or get to a healthy weight.
  • Get enough sleep.

Learn to manage stress

Managing diabetes is not always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, meditation, talking to people who can provide emotional and other support, gardening, taking a walk, doing yoga, ask for help from friends, family, and community or organizations, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress.

Treatment of type 2 diabetes

Nutrition and physical activity are important parts of a healthy lifestyle when you have diabetes.

Management of type 2 diabetes includes:

  • Healthy eating
  • Regular exercise
  • Weight loss
  • Blood sugar monitoring
  • Possibly, diabetes medication or insulin therapy

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

Following a healthy meal plan and being active can help you keep your blood sugar level in your target range. To manage your blood glucose, you need to balance what you eat and drink with physical activity and diabetes medicine, if you take any. What you choose to eat, how much you eat, and when you eat are all important in keeping your blood glucose level in the range that your health care team recommends.

Becoming more active and making changes in what you eat and drink can seem challenging at first. You may find it easier to start with small changes and get help from your family, friends, and health care team.

Type 2 diabetes diet

There is no such thing as a ‘diabetic diet’ or a special diet exclusively for people with type 2 diabetes 5, 29. No two people with diabetes are the same. So there isn’t a one-size-fits-all way of eating for everyone with diabetes. In the past, people with type 2 diabetes were sent away after their diagnosis with a list of foods they weren’t allowed to eat, or often told to cut out sugar. But the best advice is to make healthier choices more often, and only have treats occasionally and in small portions. Because experts know that making healthier food choices is important to managing your diabetes and to reducing your risk of diabetes complications, like heart problems and strokes, and other health conditions including certain types of cancers.

To assess the effects of type and frequency of different types of dietary advice for adults with type 2 diabetes, researchers reviewed 36 articles reporting a total of eighteen trials following 1467 participants 30.

Dietary approaches assessed in this review were:

  • low‐fat/high‐carbohydrate diets,
  • high‐fat/low‐carbohydrate diets,
  • low‐calorie (1000 kcal per day) and
  • very‐low‐calorie (500 kcal per day) diets and modified fat diets.

Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low‐fat diets versus moderate fat or low‐carbohydrate diets. Two studies assessed the effect of a very‐low‐calorie diet versus a low‐calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioral approaches. The studies all measured weight and measures of glycemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance.

Conclusion of the review: The data available indicate that the adoption of exercise appears to improve glycated hemoglobin (HbA1c) at six and twelve months in people with type 2 diabetes. The results suggest that adoption of regular exercise is a good way to promote better glycemic control in type 2 diabetic patients, however all of these studies were at high risk of bias 30.

In another meta‐analysis shows that exercise significantly improves glycemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss 31.

Healthy eating centers around:

  • A regular schedule for meals and healthy snacks
  • Smaller portion sizes
  • More high-fiber foods, such as fruits, nonstarchy vegetables and whole grains
  • Fewer refined grains, starchy vegetables and sweets
  • Modest servings of low-fat dairy, low-fat meats and fish
  • Healthy cooking oils, such as olive oil or canola oil
  • Fewer calories

Your health care provider may recommend seeing a registered dietitian, who can help you:

  • Identify healthy choices among your food preferences
  • Plan well-balanced, nutritional meals
  • Develop new habits and address barriers to changing habits
  • Monitor carbohydrate intake to keep your blood sugar levels more stable

Try and make changes to your food choices that are realistic and achievable so you’ll stick with them. This will be different for everyone, depending on what you eat now and the goals you want to achieve.

Breakfast. Here are some healthy breakfast ideas to choose from:

  • a bowl of wholegrain cereal with milk
  • two slices of wholegrain toast with olive oil-based spread
  • a pot of natural unsweetened yogurt and fruit
  • two slices of avocado with a hardboiled egg.

Lunch. Here are some healthy lunch ideas to choose from:

  • a chicken or tuna salad sandwich
  • a small pasta salad
  • soup with or without a wholegrain roll
  • a piece of salmon or tuna steak and salad.

Think about having a piece of fruit or a pot of natural unsweetened yogurt afterwards too.

Dinner. Here are some healthy dinner ideas to choose from:

  • lasagne and salad
  • roast chicken and vegetables, with or without potatoes
  • beef stir-fry and vegetables, with or without brown rice
  • chicken tortillas and salad
  • salmon and vegetables, with or without noodles
  • curry with chickpeas and brown rice

Mediterranean diet

The Mediterranean Diet is a way of eating rather than a formal diet plan. The Mediterranean Diet features foods eaten in more than 20 countries bordering the Mediterranean Sea including Greece, Spain, southern Italy, Portugal, Morocco, Cyprus, Croatia and France and each has their own unique culture and cuisine. In reality there is no “one” Mediterranean Diet 32, which in 2010 was recognized by UNESCO as an intangible cultural heritage of humanity.  The “Mediterranean diet” encompasses all of them—it’s not one size fits all  33. Despite regional variations, common components and cultural aspects can be identified, namely olive oil as the main source of lipids, the consumption of large amounts of seasonal vegetables, fruits and aromatic herbs (some of them gathered from the wild), as well as small intakes of meat and fish, often replaced or complemented with pulses, as sources of protein.

A Mediterranean-style diet typically includes:

  • plenty of fruits, vegetables, bread and other grains, potatoes, beans, nuts and seeds are eaten daily and make up the majority of food consumed;
  • olive oil as a primary fat source, may account for up to 40% of daily calories; and
  • small portions of cheese or yogurt are usually eaten each day, along with a serving of fish, poultry, or eggs.

Fish and poultry are more common than red meat in the Mediterranean diet. The Mediterranean diet also centers on minimally processed, plant-based foods. Wine may be consumed in low to moderate amounts, usually with meals. Fruit is a common dessert instead of sweets.

Main meals consumed daily should be a combination of three elements: cereals, vegetables and fruits, and a small quantity of legumes, beans or other (though not in every meal). Cereals in the form of bread, pasta, rice, couscous or bulgur (cracked wheat) should be consumed as one–two servings per meal, preferably using whole or partly refined grains. Vegetable consumption should amount to two or more servings per day, in raw form for at least one of the two main meals (lunch and dinner). Fruit should be considered as the primary form of dessert, with one–two servings per meal. Consuming a variety of colors of both vegetables and fruit is strongly recommended to help ensure intake of a broad range of micronutrients and phytochemicals. The less these foods are cooked, the higher the retention of vitamins and the lower use of fuel, thus minimizing environmental impact.

The Mediterranean Diet is characterized by 34:

  1. An abundance of plant food (fruit, vegetables, breads, cereals, potatoes, beans, nuts, and seeds);
  2. Minimally processed, seasonally fresh, locally grown foods;
  3. Desserts comprised typically of fresh fruit daily and occasional sweets containing refined sugars or honey;
  4. Olive oil (high in polyunsaturated fat) as the principal source of fat;
  5. Daily dairy products (mainly cheese and yogurt) in low to moderate amounts;
  6. Fish and poultry in low to moderate amounts;
  7. Up to four eggs weekly;
  8. Red meat rarely; and
  9. Wine in low to moderate amounts with meals.

Here are some things you can do to switch from a traditional Western-style diet to a more Mediterranean way of eating.

  • Dip bread in a mix of olive oil and fresh herbs instead of using butter.
  • Add avocado slices to your sandwich instead of bacon.
  • Have fish for lunch or dinner instead of red meat. Brush it with olive oil, and broil or grill it.
  • Sprinkle your salad with seeds or nuts instead of cheese.
  • Cook with olive or canola oil instead of butter or oils that are high in saturated fat.
  • Choose whole-grain bread, pasta, rice, and flour instead of foods made with white flour.
  • Add ground flaxseed to cereal, low-fat yogurt, and soups.
  • Cut back on meat in meals. Instead of having pasta with meat sauce, try pasta tossed with olive oil and topped with pine nuts and a sprinkle of Parmesan cheese.
  • Dip raw vegetables in a vinaigrette dressing or hummus instead of dips made from mayonnaise or sour cream.
  • Have a piece of fruit for dessert instead of a piece of cake.
  • Use herbs and spices instead of salt to add flavor to foods.

A Mediterranean-style diet can help you achieve the American Heart Association’s recommendations for a healthy dietary pattern that:

  • emphasizes vegetables, fruits, whole grains, beans and legumes;
  • includes low-fat or fat-free dairy products, fish, poultry, non-tropical vegetable oils and nuts; and
  • limits added sugars, sugary beverages, sodium, highly processed foods, refined carbohydrates, saturated fats, and fatty or processed meats.

This style of eating can play a big role in preventing heart disease and stroke and reducing risk factors such as obesity, diabetes, high cholesterol and high blood pressure. There is some evidence that a Mediterranean diet rich in virgin olive oil may help the body remove excess cholesterol from arteries and keep blood vessels open.

The traditional Mediterranean dietary pattern is of particular interest to healthcare providers and dietary scientists, because of observations from the 1960s that populations in countries of the Mediterranean region, such as Greece and Italy, had lower mortality from cardiovascular disease compared with northern European populations or the US, probably as a result of different eating habits.

However, adherence to the Mediterranean diet dietary pattern has been rapidly decreasing in the region since 2000, particularly in Greece, Portugal and Spain – due to the wide dissemination of the fast-food culture. These observations point to a nutrition transition period that encompasses considerable changes in diet and physical activity patterns, which may be leading to an increase in the incidence of chronic and degenerative diseases in the Mediterranean region.

Traditionally characterized by vegetables, legumes, beans, fruits, nuts, seeds, olives, lots of extra virgin olive oil, high-fiber breads and whole grains and fish, this way of eating not only involves a low consumption of processed food, processed carbohydrates, sweets, chocolate and red meat. The recommended foods are rich with monounsaturated fats, fiber, and omega-3 fatty acids.

The Mediterranean Diet is associated with a lower incidence of mortality from all-causes 35 and is also related to lower incidence of cardiovascular diseases 36, type 2 diabetes 37, certain types of cancer 38, and neurodegenerative diseases 39. The Mediterranean diet is now recognized as one of the most healthy food patterns in the world.

The Mediterranean diet is like other heart-healthy diets in that it recommends eating plenty of fruits, vegetables, and high-fiber grains. But in the Mediterranean diet, an average of 35% to 40% of calories can come from fat. Most other heart-healthy guidelines recommend getting less than 35% of your calories from fat. The fats allowed in the Mediterranean diet are mainly from unsaturated oils such as fish oils, olive oil, and certain nut or seed oils (such as canola, soybean, or flaxseed oil) and from nuts (walnuts, hazelnuts, and almonds). These types of oils may have a protective effect on the heart.

Mediterranean Diet Food List

There’s no one “Mediterranean diet food list” because there are more than 20 countries bordering the Mediterranean Sea. Diets vary between these countries and also between regions within a country. Many differences in culture, ethnic background, religion, economy and agricultural production result in different diets. But the common Mediterranean dietary meal plan (source 40) has these characteristics:

  • High consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
  • Olive oil is an important monounsaturated fat source
  • Dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
  • Eggs are consumed zero to four times a week
  • Wine is consumed in low to moderate amounts

Mediterranean Diet Meal Plan:

  • Eating a variety of fruits and vegetables each day, such as grapes, blueberries, tomatoes, broccoli, peppers, figs, olives, spinach, eggplant, beans, lentils, and chickpeas.
  • Eating a variety of whole-grain foods each day, such as oats, brown rice, and whole wheat bread, pasta, and couscous.
  • Choosing healthy (unsaturated) fats, such as nuts, olive oil, and certain nut or seed oils like canola, soybean, and flaxseed. About 35% to 40% of daily calories can come from fat, mainly from unsaturated fats. More than half the fat calories in a Mediterranean diet come from monounsaturated fats (mainly from olive oil). Monounsaturated fat doesn’t raise blood cholesterol levels the way saturated fat does. (source 40).
  • Limiting unhealthy (saturated) fats, such as butter, palm oil, and coconut oil. And limit fats found in animal products, such as meat and dairy products made with whole milk.
  • Eating mostly vegetarian meals that include whole grains, beans, lentils, and vegetables.
  • Eating fish at least 2 times a week, such as tuna, salmon, mackerel, lake trout, herring, or sardines.
  • Eating moderate amounts of low-fat dairy products each day or weekly, such as milk, cheese, or yogurt.
  • Eating moderate amounts of poultry and eggs every 2 days or weekly.
  • Limiting red meat to only a few times a month in very small amounts. For example, a serving of meat is 3 ounces. This is about the size of a deck of cards.
  • Limiting sweets and desserts to only a few times a week. This includes sugar-sweetened drinks like soda.
mediterranean diet meal plan

Low-carb diet

There are many different types of low-carb diets. Eating a low-carb diet means cutting down on the amount of carbohydrates (carbs) you eat to less than 130 grams a day 41, 42. A low-carb diet focuses on foods high in protein and fat. But low-carb eating shouldn’t be no-carb eating. Some carbohydrate foods contain essential vitamins, minerals and fiber, which form an important part of a healthy diet 43.

A low-carb diet is generally used for weight loss. Some low-carb diets may have health benefits beyond weight loss, such as lowering your risk of type 2 diabetes and metabolic syndrome.

There are three macronutrients, carbohydrates (4 kcal/g), fat (9 kcal/g), and protein (4 kcal/g) found in food. Therefore, studies have defined low carbohydrate as a percent of daily macronutrient intake or total daily carbohydrate load. This article will define it as 44:

  • Very low-carbohydrate (less than 10% carbohydrates) or 20 to 50 g/day
  • Low-carbohydrate (less than 26% carbohydrates) or less than 130 g/day
  • Moderate-carbohydrate (26% to 44%)
  • High-carbohydrate (45% or greater)

For reference, the institute of medicine proposes Americans obtain 45% to 65% of calories from carbohydrates 45.

To put this into context, a medium-sized slice of bread is about 15 to 20g of carbs, which is about the same as a regular apple. On the other hand, a large jacket potato could have as much as 90g of carbs, as does one liter of orange juice.

A low-carb diet limits the amount of carbohydrates you eat. Carbs are grouped as:

  • Simple natural, such as lactose in milk and fructose in fruit.
  • Simple refined, such as table sugar.
  • Complex natural, such as whole grains or beans.
  • Complex refined, such as white flour.

Common sources of natural carbohydrates include:

  • Grains.
  • Fruits.
  • Vegetables.
  • Milk.
  • Nuts.
  • Seeds.
  • Legumes, such as beans, lentils and peas.

In general, you digest complex carbs more slowly. Complex carbs also have less effect on blood sugar than refined carbs do. They also offer fiber.

Refined carbs such as sugar or white flour are often added to processed foods. Examples of foods with refined carbs are white breads and pasta, cookies, cake, candy, and sugar-sweetened sodas and drinks.

The body uses carbs as its main energy source. During digestion, complex carbs are broken down into simple sugars, also called glucose, and released into your blood. This is called blood glucose.

Insulin is released to help glucose enter the body’s cells, where it can be used for energy. Extra glucose is stored in the liver and in muscles. Some is changed to body fat.

A low-carb diet is meant to cause the body to burn stored fat for energy, which leads to weight loss 46, 47.

A low-carb diet isn’t for everyone. The evidence shows they can be safe and effective in helping people with type 2 diabetes manage their weight, blood glucose (sugar) levels and risk of heart disease in the short term 48. But the evidence also shows they can affect growth in children, and so should not be recommended for them. And there is little evidence to show the benefits of this type of diet in people with type 1 diabetes.

If you do decide to follow a low-carb diet, it’s important to know all the potential benefits and how to manage any potential risks.

One hypothesis of why low-carb diet produces rapid weight loss compared to other diets is that fats and protein increase the feeling of fullness (satiety) and produce less concomitant hypoglycemia. This increase in satiety and less rebound hypoglycemia reduces hunger and overall food intake and produces a caloric deficit 44. Another hypothesis contends that low-carb diets can produce a higher metabolic burn than high-carb diets. In recent studies, there appears to be a metabolic advantage of approximately 200 to 300 more calories burned compared to an iso-caloric high-carb diet 46, 49. However, these theories remain controversial 50.

Typical foods for a low-carb diet

In broad terms, a low-carb diet focuses on proteins and some nonstarchy vegetables 51. A low-carb diet generally limits grains, legumes, fruits, breads, sweets, pastas and starchy vegetables, and sometimes nuts and seeds. But some low-carb diet plans allow small amounts of fruits, vegetables and whole grains.

A daily limit of 0.7 to 2 ounces (20 to 57 grams) of carbohydrates is typical with a low-carb diet. These amounts of carbohydrates provide 80 to 240 calories. Some low-carb diets greatly limit carbs during the early phase of the diet. Then those diets allow more carbs over time.

In contrast, the Dietary Guidelines for Americans recommend that carbohydrates make up 45% to 65% of your total daily calorie intake 52. So if you eat or drink 2,000 calories a day, carbs would account for between 900 and 1,300 calories a day.

Side effects of low-carb diet

A sudden and large drop in carbs can cause short term side effects, such as:

  • Constipation.
  • Headache.
  • Muscle cramps.

Severe carb limits can cause your body to break down fat into ketones for energy. This is called ketosis. Ketosis can cause side effects such as bad breath, headache, fatigue and weakness.

It’s not clear what kind of possible long-term health risks a low-carb diet may pose. If you limit carbs in the long term, it may cause you to have too little of some vitamins or minerals and to have digestive issues.

Some health experts think that if you eat large amounts of fat and protein from animal sources, your risk of heart disease or certain cancers may go up.

If you opt to follow a low-carb diet, think about the fats and proteins you choose. Limit foods with saturated and trans fats, such as meat and high-fat dairy products. These foods may make your risk for heart disease go up.

Type 2 diabetes food list

You may worry that having diabetes means going without foods you enjoy. The good news is that you can still eat your favorite foods, but you might need to eat smaller portions or enjoy them less often. Your health care team will help create a diabetes meal plan for you that meets your needs and likes.

The key to eating with diabetes is to eat a variety of healthy foods from all food groups, in the amounts your meal plan outlines.

The food groups are:

  • Vegetables
    • nonstarchy: includes broccoli, carrots, greens, peppers, and tomatoes
    • starchy: includes potatoes, corn, and green peas
  • Fruits—includes oranges, melon, berries, apples, bananas, and grapes
  • Grains—at least half of your grains for the day should be whole grains
    • includes wheat, rice, oats, cornmeal, barley, and quinoa
    • examples: bread, pasta, cereal, and tortillas
  • Protein
    • lean meat
    • chicken or turkey without the skin
    • fish
    • eggs
    • nuts and peanuts
    • dried beans and certain peas, such as chickpeas and split peas
    • meat substitutes, such as tofu
  • Dairy—nonfat or low fat
    • milk or lactose-free milk if you have lactose intolerance
    • yogurt
    • cheese
  • Heart-healthy fats. Eat foods with heart-healthy fats, which mainly come from these foods:
    • oils that are liquid at room temperature, such as canola and olive oil
    • nuts and seeds
    • heart-healthy fish such as salmon, tuna, and mackerel
    • avocado

Use oils when cooking food instead of butter, cream, shortening, lard, or stick margarine.

Foods and drinks to limit include:

  • fried foods and other foods high in saturated fat and trans fat
  • foods high in salt, also called sodium
  • sweets, such as baked goods, candy, and ice cream
  • beverages with added sugars, such as juice, regular soda, and regular sports or energy drinks

Drink water instead of sweetened beverages. Consider using a sugar substitute in your coffee or tea.

If you drink alcohol, drink moderately—no more than one drink a day if you’re a woman or two drinks a day if you’re a man. If you use insulin or diabetes medicines that increase the amount of insulin your body makes, alcohol can make your blood glucose level drop too low. This is especially true if you haven’t eaten in a while. It’s best to eat some food when you drink alcohol.

Physical activity

Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Choose activities you enjoy, such as walking, swimming and biking. What’s most important is making physical activity part of your daily routine.

Aim for at least 30 minutes of aerobic exercise five days of the week. Stretching and strength training exercises are important, too. If you haven’t been active for a while, start slowly and build up gradually.

A combination of exercises — aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week — often helps control blood sugar more effectively than either type of exercise alone.

Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar.

In interventions aimed at increasing exercise combined with diet 53, eight clinical trials that had an exercise plus diet (2241 participants) are able to decrease the incidence of type 2 diabetes mellitus in high risk groups (people with impaired glucose tolerance or the metabolic syndrome).

In a review involving people with impaired glucose tolerance, comparing the effectiveness lifestyle interventions (interventions could be diet alone, physical activity alone, or the combination). There is a strong body of evidence that the combined effect dietary change to ensure weight loss, coupled with physical activity, is clinically effective in reducing the progression to diabetes by about half and are likely to be considered cost-effective 54. The benefits of the lifestyle intervention were greatest in those with the highest compliance and who achieved more of the targets (such as weight loss and dietary change). The key to success is sustained lifestyle change, especially weight loss.

Monitoring your blood sugar

Depending on your treatment plan, you may need to check and record your blood sugar level every now and then or, if you’re on insulin, multiple times a day. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

Sometimes, blood sugar levels can be unpredictable. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication.

Compared with repeated daily blood sugar tests, the A1C test is a better indicator of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication, meal plan or activity level.

In addition to the A1C test, your doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important.

Diabetes medications and insulin therapy

If you can’t maintain your target blood sugar level with diet and exercise, you may need type 2 diabetes medicines, which may include pills or medicines you inject under your skin, such as insulin. Over time, you may need more than one diabetes medicine to manage your blood glucose. Even if you don’t take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital. You also may need medicines in addition to diabetes medications for high blood pressure, high cholesterol, or other conditions, as well as low-dose aspirin, to help prevent heart and blood vessel disease.

Drug treatments for type 2 diabetes include the following.

Metformin

Metformin (Fortamet, Glumetza, others) is generally the first medication prescribed for most people with type 2 diabetes. Metformin comes as a liquid, a tablet, and an extended-release (long-acting) tablet to take by mouth. Metformin works primarily by lowering glucose production in the liver and improving your body’s sensitivity to insulin so that your body uses insulin more effectively. This drug may help you lose a small amount of weight.

Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1–2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working.

Some people on metformin may experience B-12 deficiency and may need to take supplements.

Other possible side effects of metformin, which may improve over time, include:

  • Nausea
  • Abdominal pain
  • Bloating
  • Diarrhea

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors pills help your body digest sugar more slowly by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. Acarbose (Precose) and miglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.

Sulfonylureas

Sulfonylureas help your body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl).

Possible side effects of sulfonylureas include:

  • Low blood sugar
  • Weight gain

Meglitinides

Meglitinides or glinides stimulate the pancreas to secrete more insulin. They’re faster acting than sulfonylureas, and the duration of their effect in the body is shorter. Examples include repaglinide (Prandin) and nateglinide (Starlix).

Possible side effects of meglitinides include:

  • Low blood sugar
  • Weight gain

Thiazolidinediones

Thiazolidinediones make the body’s tissues more sensitive to insulin. Examples include rosiglitazone (Avandia) and pioglitazone (Actos). Possible side effects include:

  • Risk of congestive heart failure
  • Risk of bladder cancer (pioglitazone)
  • Risk of bone fractures
  • High cholesterol (rosiglitazone)
  • Weight gain

DPP-4 inhibitors

DPP-4 inhibitors help reduce blood sugar levels but tend to have a very modest effect. Examples include sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). Possible side effects include:

  • Risk of pancreatitis
  • Joint pain

GLP-1 receptor agonists

GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels. Their use is often associated with weight loss, and some may reduce the risk of heart attack and stroke. Examples include exenatide (Byetta, Bydureon), liraglutide (Saxenda, Victoza) and semaglutide (Rybelsus, Ozempic). Possible side effects include:

  • Risk of pancreatitis
  • Nausea
  • Vomiting
  • Diarrhea

SGLT2 inhibitors

SGLT2 inhibitors affect the blood-filtering functions in your kidneys by inhibiting the return of glucose to the bloodstream. As a result, glucose is excreted in the urine. These drugs may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Examples include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance). Possible side effects include:

  • Risk of amputation (canagliflozin)
  • Risk of bone fractures (canagliflozin)
  • Risk of gangrene
  • Vaginal yeast infections
  • Urinary tract infections
  • Low blood pressure
  • High cholesterol

Dopamine-2 agonists

Dopamine-2 agonist bromocriptine (Cycloset and Parlodel) helps lower blood glucose levels after a meal. Dopamine-2 agonist affects a chemical called dopamine in your cells. It is not clear how this pill works for diabetes.

Common side effects of bromocriptine:

  • Nausea
  • Headache
  • Feel very tired
  • Feel dizzy
  • Vomiting

Bile acid sequestrants

Bile acid sequestrants colesevelam (Welchol) is a cholesterol-lowering medication that also reduces blood glucose levels in patients with diabetes. Bile acid sequestrants help remove cholesterol from the body, particularly LDL cholesterol (“bad cholesterol”), which is often elevated in people with diabetes. The medications reduce LDL cholesterol by binding with bile acids in the digestive system; the body in turn uses cholesterol to replace the bile acids, which lowers cholesterol levels. The mechanism by which colesevelam lowers glucose levels is not well understood. Because bile acid sequestrants are not absorbed into the bloodstream, they are usually safe for use by patients who may not be able to use other medications because of liver problems. Because of the way they work, side effects of bile acid sequestrants can include flatulence and constipation.

Oral combination therapy

Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.

Insulin therapy

Insulin is a naturally occurring hormone secreted by your pancreas. Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it may be prescribed sooner if blood sugar targets aren’t met with lifestyle changes and other medications.

There are many different types of insulin sold in the United States, which differ on how quickly they begin to work and how long they have an effect. Long-acting insulin, for example, is designed to work overnight or throughout the day to keep blood sugar levels stable. Short-acting insulin might be used at mealtime.

Here’s a quick look at the different types of insulin. If you need a mix of two types, you can talk to your doctor about getting a premixed supply.

  • Rapid-acting insulin begins to work about 15 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours
  • Regular or short-acting insulin usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3 to 6 hours
  • Intermediate-acting insulin generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours
  • Long-acting insulin reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over a 24-hour period

Your doctor will determine what type of insulin is appropriate for you and when you should take it. Your insulin type, dosage and schedule may change depending on how stable your blood sugar levels are. Most types of insulin are taken by injection.

When it comes to syringes, your doctor will advise on which capacity you need based on your insulin dose. In general, smaller capacity syringes can be easier to read and draw an accurate dose. Here are some tips:

  • If your largest dose is close to the syringe’s maximum capacity, consider buying the next size up in case your dosage changes
  • If you need to measure doses in half units, be sure to choose a syringe that has these markings
  • If you’re traveling outside of the United States, be certain to match your insulin strength with the correct size syringe

Side effects of insulin include the risk of low blood sugar (hypoglycemia), diabetic ketoacidosis and high triglycerides.

Bariatric surgery

Weight-loss surgery also known as bariatric surgery changes the shape and function of your digestive system. This surgery may help you lose weight and manage type 2 diabetes and other conditions related to obesity. There are various surgical procedures, but all of them help you lose weight by limiting how much food you can eat. Some procedures also limit the amount of nutrients you can absorb.

Weight-loss surgery is only one part of an overall treatment plan. Your treatment will also include diet and nutritional supplement guidelines, exercise and mental health care.

Generally, weight-loss surgery may be an option for adults living with type 2 diabetes who have a body mass index (BMI) of 35 or higher. BMI is a formula that uses weight and height to estimate body fat. Depending on the severity of diabetes or comorbid conditions, surgery may be an option for someone with a BMI lower than 35.

Weight-loss surgery requires a lifelong commitment to lifestyle changes. Long-term side effects include nutritional deficiencies and osteoporosis.

Chinese herbal medicines for type 2 diabetes mellitus

Although the use of herbal medicines for treatment of diabetes has a long history especially in the East, current evidence cannot warrant to support the routine use in clinical practice 55.

Alternative medicine

Many alternative medicine treatments claim to help people living with diabetes. According to the National Center for Complementary and Integrative Health, studies haven’t provided enough evidence to recommend any alternative therapies for blood sugar management. Research has shown the following results about popular supplements for type 2 diabetes:

  • Chromium supplements have been shown to have few or no benefits. Large doses can result in kidney damage, muscular problems and skin reactions.
  • Magnesium supplements have shown benefits for blood sugar control in some but not all studies. Side effects include diarrhea and cramping. Very large doses — more than 5,000 mg a day — can be fatal.
  • Cinnamon, in some studies, has lowered fasting glucose levels but not A1C levels. Therefore, there’s no evidence of overall improved glucose management. Consumption of cinnamon (short term) is associated with a notable reduction in systolic blood pressure and diastolic blood pressure. Although cinnamon shows hopeful effects on blood pressure-lowering potential, it would be premature to recommend cinnamon for blood pressure control because of the limited number of studies available. Thus, undoubtedly a long-term, adequately powered randomized clinical trials involving a larger number of patients is needed to appraise the clinical potential of cinnamon on blood pressure control among patients with type 2 diabetes mellitus 56. Most cinnamon contains a substance called coumarin that may cause or worsen liver disease.

Talk to your doctor before starting a dietary supplement or natural remedy. Do not replace your prescribed diabetes medication with alternative medicines.

Whole grain foods for the prevention of type 2 diabetes mellitus

The evidence from only prospective cohort trials is considered to be too weak to be able to draw a definite conclusion about the preventive effect of whole grain foods on the development of type 2 diabetes mellitus 57.

Omega‐3 polyunsaturated fatty acids for type 2 diabetes mellitus

Omega‐3 PUFA supplementation in type 2 diabetes lowers triglycerides and VLDL cholesterol, but may raise LDL cholesterol (although results were non‐significant in subgroups) and has no statistically significant effect on glycemic control or fasting insulin 58. Trials with vascular events or mortality defined endpoints are needed.

Ayurvedic treatments for type 2 diabetes mellitus

This review 59 examines the efficacy and safety of the use of various Ayurvedic treatments for diabetes mellitus. We found seven trials which included 354 participants (172 on treatment, 158 on control, 24 could not be classified). All these studies included adults with type 2 diabetes mellitus.

The duration of treatment ranged from three to six months. One study each of Diabecon, Inolter and Cogent DB (proprietary herbal mixtures) found significantly lower glycosylated haemoglobin A1c (HbA1C) levels at the end of the treatment period compared to controls. Two studies of Diabecon, and one study of Cogent DB (proprietary herbal mixtures) found significantly lower fasting blood sugar levels at the end of the study period in the treatment group. No deaths were observed in these trials and side effects did not differ significantly between intervention and control groups. One study of Pancreas tonic reported no significant change in health-related quality of life.

Although there were significant glucose-lowering effects with the use of some herbal mixtures, due to methodological deficiencies and small sample sizes the study authors were unable to draw any definite conclusions regarding their efficacy 59. Though no significant adverse events were reported, there is insufficient evidence at present to recommend the use of these interventions in routine clinical practice and further studies are needed.

Momordica charantia (bitter gourd or bitter melon) for type 2 diabetes mellitus

Mormordica charantia (bitter gourd or bitter melon) is a climbing perennial that is characterized by elongated, warty fruit-like gourds or cucumbers and is native to the tropical belt. This review 60 of trials found only four studies which had an overall low quality. Three trials showed no significant differences between momordica charantia and placebo or antidiabetic drugs (glibenclamide and metformin) in the blood sugar response. The duration of treatment ranged from four weeks to three months, and altogether 479 patients with type 2 diabetes mellitus participated.

The current evidence does not warrant using the plant in treating type 2 diabetes mellitus 60. Further studies are therefore required to address the issues of standardization and the quality control of preparations. For medical nutritional therapy, further observational trials evaluating the effects of momordica charantia are needed before RCTs are established to guide any recommendations in clinical practice.

Low Calorie Diet on Weight Loss and the Metabolic Profile of Obese Patients with Type 2 Diabetes Mellitus

A small study 61 with 60 patients (23 males and 37 postmenopausal females) who have type 2 diabetes and are obese, to compare the effects of low calorie diet (1800 kcal/day) plus intensive insulin therapy (4 insulin injections/day) versus low calorie diet (1800 kcal/day) plus conventional insulin therapy (2/3 insulin injections/day). At 6 months post-interventions, there were significant reductions were observed in the body weight, body mass index (BMI), HbA1c for all participants and cholesterol. At 1 year, median body weight reduction was 4.5 kg for patients on low calorie diet (1800 kcal/day) plus intensive insulin therapy and 4.8 kg for those on low calorie diet (1800 kcal/day) plus conventional insulin therapy. The conclusion was a 12-month 1800-kcal low calorie dietary intervention achieved significant body weight loss and HbA1c reductions irrespectively of insulin regimen. The  low calorie diet (1800 kcal/day) plus conventional insulin therapy was associated with body weight loss greater than 8.0%, whereas low calorie diet (1800 kcal/day) plus intensive insulin therapy was associated with higher rates of normoglycemia 61.

Very Low Calorie Diet in Obese Type 2 Diabetes

A small study was conducted with fifty-one obese subjects (24 with diabetes and 27 obese without diabetes) to compare weight loss and change in body composition in obese subjects with and without type 2 diabetes mellitus during a very-low-calorie diet (VLCD) program 62. After 24 weeks of intervention, there was no difference in weight loss between the 2 groups. Both groups completing the study per protocol had near-identical weight change during the program, with similar weight loss at 24 weeks (diabetes: 8.5 ± 1.3 kg vs control: 9.4 ± 1.2 kg). Change in fat mass index correlated with change in body mass index (BMI) in both groups, but change in fat mass index per unit change in BMI was less in the diabetic group compared with controls, which persisted after adjusting for age, sex, and baseline BMI. Insulin concentrations remained higher and peak β-hydroxybutyrate concentrations were lower in the diabetic compared with the control group. The conclusion was while following a 24-week very-low-calorie diet program, obese subjects with and without diabetes achieved comparable weight loss; but the decrease in body fat per unit weight loss was less in diabetic subjects. Hyperinsulinemia may have inhibited lipolysis in the diabetic group; however, further investigation into other factors is needed 62.

Low Carbohydrate Low Calorie Diet in type 2 Diabetes

In a very small study 63 comparing the effects of low carbohydrate low calorie diet (1800 kcal for men and 1600 kcal for women, distributed as 20 % carbohydrates, 30 % protein and 50 % fat) and high carbohydrate low calorie diet (1600-1800 kcal for men and 1400-1600 kcal for women, consisted of approximately 60 % carbohydrates, 15 % protein and 25 % fat) in two groups of obese patients with type 2 diabetes. The diets were tested with regard to glycaemic control and bodyweight. A group of 16 obese patients with type 2 diabetes was advised on a low-carbohydrate diet,  Fifteen obese diabetes patients on a high-carbohydrate diet were control group. Positive effects on the glucose levels were seen very soon. After 6 months a marked reduction in bodyweight of patients in the low-carbohydrate diet group was observed, and this remained one year later. After 6 months the mean changes in the low-carbohydrate group and the control (high carbohydrate low calorie diet) group respectively were fasting blood glucose: -3.4 and -0.6 mmol/l; HBA1c: -1.4 % and -0.6 %; Body Weight: -11.4 kg and -1.8 kg; BMI: -4.1 kg/m2 and -0.7 kg/m2. In conclusion, a low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes 63.

References
  1. Type 2 Diabetes. https://www.cdc.gov/diabetes/basics/type2.html
  2. Diabetes UK. Research spotlight – low-calorie diet for Type 2 diabetes. https://www.diabetes.org.uk/Research/Research-round-up/Research-spotlight/Research-spotlight-low-calorie-liquid-diet/
  3. National Center for Biotechnology Information. PubMed Health. Type 2 Diabetes. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024703/
  4. Diabetes remission. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/type2-diabetes-remission
  5. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L, Uelmen S, Urbanski PB, Yancy WS Jr. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019 May;42(5):731-754. doi: 10.2337/dci19-0014
  6. Westman EC, Yancy WS Jr. Using a low-carbohydrate diet to treat obesity and type 2 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes. 2020 Oct;27(5):255-260. doi: 10.1097/MED.0000000000000565
  7. Gepner Y, Shelef I, Komy O, Cohen N, Schwarzfuchs D, Bril N, Rein M, Serfaty D, Kenigsbuch S, Zelicha H, Yaskolka Meir A, Tene L, Bilitzky A, Tsaban G, Chassidim Y, Sarusy B, Ceglarek U, Thiery J, Stumvoll M, Blüher M, Stampfer MJ, Rudich A, Shai I. The beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content. J Hepatol. 2019 Aug;71(2):379-388. doi: 10.1016/j.jhep.2019.04.013
  8. Kirkpatrick CF, Bolick JP, Kris-Etherton PM, Sikand G, Aspry KE, Soffer DE, Willard KE, Maki KC. Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force. J Clin Lipidol. 2019 Sep-Oct;13(5):689-711.e1. doi: 10.1016/j.jacl.2019.08.003
  9. Cochrane Review 16 July 2008. Exercise or exercise and diet for preventing type 2 diabetes mellitus. http://www.cochrane.org/CD003054/ENDOC_exercise-or-exercise-and-diet-for-preventing-type-2-diabetes-mellitus
  10. The Diabetes Prevention Program (DPP). https://dppos.bsc.gwu.edu/
  11. U.S. Food and Drug Administration. Changes to the Nutrition Facts Label. https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm
  12. https://dppos.bsc.gwu.edu/documents/1124073/1134992/LSMOP5.PDF/358c8d33-5bb8-4876-83d1-943d379be8b2
  13. https://www.cdc.gov/diabetes/prevention/index.html
  14. https://nccd.cdc.gov/DDT_DPRP/Programs.aspx
  15. http://www.eatright.org/find-an-expert
  16. https://www.diabeteseducator.org/patient-resources/find-a-diabetes-educator
  17. Understanding A1C. https://diabetes.org/diabetes/a1c/diagnosis
  18. The International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327–1334.
  19. Cochrane Review 13 June 2012. Enhanced glucose control for preventing and treating diabetic neuropathy. http://www.cochrane.org/CD007543/NEUROMUSC_enhanced-glucose-control-for-preventing-and-treating-diabetic-neuropathy
  20. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes & Sexual & Urologic Problems. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/sexual-urologic-problems
  21. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, Gum Disease, & Other Dental Problems. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/gum-disease-dental-problems
  22. Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R. Diabetes and cancer. Endocr Relat Cancer. 2009;16:1103–1123. https://www.ncbi.nlm.nih.gov/pubmed/19620249
  23. Nicolucci A. Epidemiological aspects of neoplasms in diabetes. Acta Diabetol. 2010;47:87–95. https://www.ncbi.nlm.nih.gov/pubmed/20376506
  24. Nicolucci A. Epidemiological aspects of neoplasms in diabetes. Acta Diabetol. 2010;47:87–95. http://erc.endocrinology-journals.org/content/16/4/1103.long
  25. Acta Diabetologica June 2010, Volume 47, Issue 2, pp 87–95. Epidemiological aspects of neoplasms in diabetes. https://link.springer.com/article/10.1007%2Fs00592-010-0187-3
  26. Huo X, Gao L, Guo L, et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. The Lancet Diabetes & Endocrinology. 2016;4(2):115–124.
  27. National Centers for Disease Control and Prevention. National diabetes statistics report, 2014. https://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
  28. Kolber MR, Scrimshaw C. Family history of cardiovascular disease. Canadian Family Physician. 2014;60(11):1016.
  29. Food for Thought. Key Takeaways from ADA’s Nutrition Consensus Report. https://diabetes.org/sites/default/files/2019-10/ADV_2019_Consumer_Nutrition_One%20Pager.pdf
  30. Cochrane Reviews 18 July 2007. Dietary advice for treatment of type 2 diabetes mellitus in adults. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004097.pub4/abstract
  31. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD002968. Exercise for type 2 diabetes mellitus. https://www.ncbi.nlm.nih.gov/pubmed/16855995
  32. Altomare, R., Cacciabaudo, F., Damiano, G., Palumbo, V. D., Gioviale, M. C., Bellavia, M., Tomasello, G., & Lo Monte, A. I. (2013). The mediterranean diet: a history of health. Iranian journal of public health, 42(5), 449–457. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684452
  33. Castro-Quezada, I., Román-Viñas, B., & Serra-Majem, L. (2014). The Mediterranean diet and nutritional adequacy: a review. Nutrients, 6(1), 231–248. https://doi.org/10.3390/nu6010231
  34. F.B. Hu. The Mediterranean Diet and mortality—olive oil and beyond. N Engl J Med, 348 (2003), pp. 2595-2596
  35. Sofi F., Macchi C., Abbate R., Gensini G.F., Casini A. Mediterranean diet and health. Biofactors. 2013;39:335–342. doi: 10.1002/biof.1096
  36. Estruch R., Ros E., Salas-Salvadó J., Covas M.I., Corella D., Arós F., Gómez-Gracia E., Ruiz-Gutiérrez V., Fiol M., Lapetra J., et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N. Engl. J. Med. 2013;368:1279–1290. doi: 10.1056/NEJMoa1200303
  37. Mitrou P.N., Kipnis V., Thiébaut A.C., Reedy J., Subar A.F., Wirfält E., Flood A., Mouw T., Hollenbeck A.R., Leitzmann M.F., et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: Results from the NIH-AARP Diet and Health Study. Arch. Intern. Med. 2007;167:2461–2468. doi: 10.1001/archinte.167.22.2461
  38. Couto E., Boffetta P., Lagiou P., Ferrari P., Buckland G., Overvad K., Dahm C.C., Tjønneland A., Olsen A., Clavel-Chapelon F., et al. Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br. J. Cancer. 2011;104:1493–1499. doi: 10.1038/bjc.2011.106
  39. Sofi F., Abbate R., Gensini G.F., Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: An updated systematic review and meta-analysis. Am. J. Clin. Nutr. 2010;92:1189–1196. doi: 10.3945/ajcn.2010.29673
  40. American Heart Association – Mediterranean Diet – http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Mediterranean-Diet_UCM_306004_Article.jsp
  41. Hite, A.H., Berkowitz, V.G. and Berkowitz, K. (2011), Low-Carbohydrate Diet Review. Nutrition in Clinical Practice, 26: 300-308. https://doi.org/10.1177/0884533611405791
  42. Adam-Perrot, A., Clifton, P. and Brouns, F. (2006), Low-carbohydrate diets: nutritional and physiological aspects. Obesity Reviews, 7: 49-58. https://doi.org/10.1111/j.1467-789X.2006.00222.x
  43. Freire R. Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets. Nutrition. 2020 Jan;69:110549. doi: 10.1016/j.nut.2019.07.001
  44. Oh R, Gilani B, Uppaluri KR. Low Carbohydrate Diet. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537084
  45. Trumbo P, Schlicker S, Yates AA, Poos M; Food and Nutrition Board of the Institute of Medicine, The National Academies. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc. 2002 Nov;102(11):1621-30. doi: 10.1016/s0002-8223(02)90346-9. Erratum in: J Am Diet Assoc. 2003 May;103(5):563.
  46. Ebbeling CB, Feldman HA, Klein GL, Wong JMW, Bielak L, Steltz SK, Luoto PK, Wolfe RR, Wong WW, Ludwig DS. Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. BMJ. 2018 Nov 14;363:k4583. doi: 10.1136/bmj.k4583. Erratum in: BMJ. 2020 Nov 3;371:m4264
  47. Raynor HA, Champagne CM. Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults. J Acad Nutr Diet. 2016 Jan;116(1):129-147. doi: 10.1016/j.jand.2015.10.031
  48. Shan Z, Guo Y, Hu FB, Liu L, Qi Q. Association of Low-Carbohydrate and Low-Fat Diets With Mortality Among US Adults. JAMA Intern Med. 2020 Apr 1;180(4):513-523. doi: 10.1001/jamainternmed.2019.6980
  49. Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E, Ludwig DS. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA. 2012 Jun 27;307(24):2627-34. doi: 10.1001/jama.2012.6607
  50. Hall KD, Bemis T, Brychta R, Chen KY, Courville A, Crayner EJ, Goodwin S, Guo J, Howard L, Knuth ND, Miller BV 3rd, Prado CM, Siervo M, Skarulis MC, Walter M, Walter PJ, Yannai L. Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity. Cell Metab. 2015 Sep 1;22(3):427-36. doi: 10.1016/j.cmet.2015.07.021
  51. Duyff RL. Carbs: Sugars, starches, and fiber. In: Academy of Nutrition and Dietetics Complete Food and Nutrition Guide. 5th ed. Houghton Mifflin Harcourt; 2017.
  52. 2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://health.gov/our-work/nutrition-physical-activity/dietary-guidelines
  53. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD003054. doi: 10.1002/14651858.CD003054.pub3. Exercise or exercise and diet for preventing type 2 diabetes mellitus. https://www.ncbi.nlm.nih.gov/pubmed/18646086
  54. Health Technology Assessment, No. 16.33Non-Pharmacological Interventions to Reduce the Risk of Diabetes in People with Impaired Glucose Regulation: A Systematic Review and Economic Evaluation. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0049546/
  55. Cochrane Review 22 July 2002. DOI: 10.1002/14651858.CD003642.pub2. Chinese herbal medicines for type 2 diabetes mellitus. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003642.pub2/abstract
  56. Nutrition. 2013 Oct;29(10):1192-6. doi: 10.1016/j.nut.2013.03.007. Epub 2013 Jul 16. Effect of short-term administration of cinnamon on blood pressure in patients with prediabetes and type 2 diabetes. https://www.ncbi.nlm.nih.gov/pubmed/23867208
  57. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD006061. doi: 10.1002/14651858.CD006061.pub2. Whole grain foods for the prevention of type 2 diabetes mellitus. https://www.ncbi.nlm.nih.gov/pubmed/18254091
  58. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003205. doi: 10.1002/14651858.CD003205.pub2. Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus. https://www.ncbi.nlm.nih.gov/pubmed/18254017
  59. Cochrane Review 7 December 2011. Ayurvedic treatments for diabetes mellitus. http://www.cochrane.org/CD008288/ENDOC_ayurvedic-treatments-for-diabetes-mellitus
  60. Cochrane Review 15 August 2012. Momordica charantia for type 2 diabetes mellitus. http://www.cochrane.org/CD007845/ENDOC_momordica-charantia-for-type-2-diabetes-mellitus
  61. Adv Ther. 2016 Mar;33(3):447-59. doi: 10.1007/s12325-016-0300-2. Epub 2016 Feb 17. Obese Patients with Type 2 Diabetes on Conventional Versus Intensive Insulin Therapy: Efficacy of Low-Calorie Dietary Intervention. https://www.ncbi.nlm.nih.gov/pubmed/26886777
  62. Metabolism. 2012 Jun;61(6):873-82. doi: 10.1016/j.metabol.2011.10.017. Epub 2011 Dec 5. Less fat reduction per unit weight loss in type 2 diabetic compared with nondiabetic obese individuals completing a very-low-calorie diet program. https://www.ncbi.nlm.nih.gov/pubmed/22146094?dopt=Abstract
  63. Ups J Med Sci. 2005;110(1):69-73. Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes–a brief report. https://www.ncbi.nlm.nih.gov/pubmed/15801687?dopt=Abstract
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