# Diabetes

Source: https://ourhealthnetwork.com/conditions/diabetes
Last reviewed: 2026-05-05

## What is Diabetes?

Diabetes is a condition where the body cannot properly control blood sugar (glucose) levels. Glucose is the main energy source for your body's cells. In diabetes, the body either does not produce enough insulin, cannot use it effectively, or both. Insulin is a hormone made by the pancreas that allows glucose to enter cells and be used for energy. Without enough working insulin, glucose stays in the bloodstream and builds up to unhealthy levels.

## Overview

Diabetes is a condition where the body cannot properly control blood sugar (glucose) levels. Glucose is the main energy source for your body's cells. In diabetes, the body either does not produce enough insulin, cannot use it effectively, or both. Insulin is a hormone made by the pancreas that allows glucose to enter cells and be used for energy. Without enough working insulin, glucose stays in the bloodstream and builds up to unhealthy levels.

Diabetes comes in several distinct forms:

- **Type 1 diabetes:** The immune system mistakenly attacks and destroys insulin-producing cells in the pancreas. The body makes little or no insulin on its own. People with Type 1 require lifelong insulin therapy. It can develop at any age but is most commonly diagnosed in children, teens, and young adults.
- **Type 2 diabetes:** The body still produces insulin, but cells gradually stop responding to it well, a process called insulin resistance. The pancreas tries to compensate by making more insulin, but eventually cannot keep blood sugar in a normal range. Type 2 is by far the most common form, accounting for about 90 to 95% of all cases.
- **Gestational diabetes:** Develops during pregnancy in people who did not have diabetes beforehand. It typically resolves after delivery but raises the risk of Type 2 diabetes later in life.
- **Prediabetes:** Blood sugar is higher than normal but not yet high enough to meet the diagnostic threshold for Type 2 diabetes. Lifestyle changes can often prevent or slow progression.

Diabetes is among the most common chronic conditions in the United States. The CDC reports that approximately 37.3 million Americans had diabetes as of 2022, representing roughly 1 in 10 adults. An additional 96 million adults had prediabetes, with most unaware of it. Type 2 is most prevalent in people over 45, though diagnoses in younger adults and adolescents have increased in recent decades.

This condition, diabetes mellitus, is unrelated to diabetes insipidus, a rare disorder affecting water regulation in the kidneys. Despite the shared name, the two conditions have completely different causes, symptoms, and treatments.

## Symptoms and causes

The symptoms of diabetes can develop gradually or quickly, depending on the type. In Type 2, symptoms may be so mild that they go unnoticed for years. In Type 1, symptoms often appear suddenly and worsen over days or weeks. Both types share many of the same warning signs because both involve excess glucose remaining in the bloodstream.

**Common symptoms include:**

- **Frequent urination**, especially at night
- **Increased thirst** or persistent dry mouth
- **Unexplained weight loss** (particularly common in Type 1)
- **Blurry vision**
- **Unusual fatigue** or low energy throughout the day
- Slow-healing cuts, bruises, or sores
- Tingling, numbness, or burning in the hands or feet
- Frequent infections, such as urinary tract, skin, or gum infections

People typically contact their doctor when they notice unexplained rapid weight loss, extreme thirst that will not go away, or urination so frequent it disrupts sleep. Certain symptoms signal a medical emergency: confusion, difficulty breathing, fruity-smelling breath, or loss of consciousness. These can be signs of diabetic ketoacidosis (DKA), a serious complication most common in Type 1 diabetes that requires immediate emergency care.

In Type 1 diabetes, the immune system attacks and destroys the beta cells in the pancreas that produce insulin. Researchers believe this involves a combination of genetic susceptibility and environmental triggers such as certain viral infections, though the exact mechanism is not fully understood. In Type 2, the body's cells gradually become less responsive to insulin over time. The pancreas works harder to compensate, but eventually cannot maintain blood sugar in a normal range. Gestational diabetes occurs because hormones produced during pregnancy can interfere with normal insulin signaling.

**Risk factors:**

- **Family history** of diabetes in a parent or sibling
- **Overweight or obesity**, especially weight concentrated around the abdomen
- **Physical inactivity** or a sedentary lifestyle
- **Age 45 or older** (most relevant for Type 2)
- **History of prediabetes or gestational diabetes**
- Belonging to certain ethnic groups, including Black, Hispanic, Native American, and Asian American adults, who have statistically higher rates of Type 2 diabetes
- **High blood pressure** or abnormal cholesterol and triglyceride levels

When blood sugar remains elevated for years without proper treatment, it damages blood vessels and nerves throughout the body. This can lead to serious complications including heart disease, kidney failure, vision loss, peripheral nerve damage, and increased vulnerability to infection.

## Diagnosis

Diagnosing diabetes involves blood tests that measure glucose levels in the bloodstream. A primary care physician, internist, or endocrinologist can order these tests during a routine visit or when symptoms suggest high blood sugar. Some tests require fasting for at least eight hours beforehand, while others do not.

The most commonly used diagnostic tests include the A1C test, which reflects average blood sugar over the past two to three months and requires no fasting; the fasting plasma glucose test, measured after an overnight fast; the oral glucose tolerance test, which involves drinking a standardized sugary solution and checking blood sugar two hours later; and the random plasma glucose test, taken at any time of day and typically used when symptoms are clearly present. These are standard tests available at any primary care office or commercial lab.

Test results are compared against established diagnostic thresholds. An A1C of 6.5% or higher confirms diabetes; 5.7% to 6.4% indicates prediabetes. A fasting blood glucose reading of 126 mg/dL or higher on two separate occasions indicates diabetes. For the oral glucose tolerance test, a two-hour result of 200 mg/dL or more confirms the diagnosis. Doctors generally require two abnormal results on different days before making a diagnosis, unless symptoms are severe and classic.

At a diagnostic appointment, expect questions about symptoms, how long they have been present, family history, current medications, and lifestyle habits. A physical exam typically includes checking weight, blood pressure, and examining the feet for signs of nerve damage. If Type 1 is suspected, additional blood tests for autoantibodies may be ordered to distinguish it from Type 2, since the treatment approach differs significantly between the two.

## Treatment

Managing diabetes requires a combination of approaches tailored to the type and severity of the condition. For Type 1, insulin therapy is essential from the time of diagnosis. For Type 2, most people start with lifestyle changes and oral medications, with insulin added if needed later.

**Lifestyle changes**

For Type 2 diabetes, lifestyle modifications form the foundation of care and can produce dramatic improvements in blood sugar control. They also support better outcomes in people with Type 1.

Common changes recommended include:

- Following an eating plan that limits refined carbohydrates, sugary drinks, and heavily processed foods while emphasizing vegetables, whole grains, and lean proteins
- Getting regular physical activity, with most guidelines recommending at least 150 minutes of moderate-intensity exercise per week
- Losing 5 to 10% of body weight if overweight, which can measurably improve insulin sensitivity
- Quitting smoking, since tobacco use raises the risk of cardiovascular complications associated with diabetes
- Monitoring blood sugar regularly with a glucometer or continuous glucose monitor as directed by your care team
- Maintaining consistent sleep patterns, since poor sleep can worsen insulin resistance

**Medications**

Several medication classes are used to lower blood sugar in Type 2 diabetes. Doctors often start with metformin, an oral medication that reduces glucose production in the liver. Additional or alternative medications may be added based on individual response and other health factors.

SGLT2 inhibitors are a widely used newer class that cause the kidneys to excrete excess glucose through urine. Options include [Canagliflozin](/drugs/canagliflozin) (brand name Invokana) and [Dapagliflozin Propanediol](/drugs/dapagliflozin-propanediol) (brand name Farxiga). Both have demonstrated heart and kidney protective benefits in clinical research beyond blood sugar control alone. Combination formulations pairing these with metformin are also available, such as [Canagliflozin/Metformin Hcl](/drugs/canagliflozin-metformin-hcl) and [Dapaglifloz Propaned/Metformin](/drugs/dapaglifloz-propaned-metformin).

DPP-4 inhibitors help the body release more insulin in response to meals. [Alogliptin Benzoate](/drugs/alogliptin-benzoate) is one option in this class. It is also available as a combination tablet with metformin, [Alogliptin Benz/Metformin Hcl](/drugs/alogliptin-benz-metformin-hcl), or with a thiazolidinedione that improves insulin sensitivity, [Alogliptin Benz/Pioglitazone](/drugs/alogliptin-benz-pioglitazone).

Alpha-glucosidase inhibitors such as [Acarbose](/drugs/acarbose) slow the digestion of carbohydrates in the gut, helping to blunt blood sugar spikes after meals. Some patients are also prescribed bile acid sequestrants like [Colesevelam Hcl](/drugs/colesevelam-hcl), which can provide modest blood sugar lowering in addition to cholesterol management.

For Type 1 diabetes, insulin is the cornerstone of treatment. Multiple formulations exist, from rapid-acting types taken at mealtimes to long-acting types that provide steady background coverage. Some people with Type 2 diabetes also require insulin when oral medications are no longer sufficient.

**Monitoring bone health**

Diabetes, particularly Type 1, is associated with increased risk of bone density loss over time. Doctors may recommend a [Dexa Bone Density](/procedure-costs/dexa-bone-density) scan periodically to monitor bone strength. This low-radiation imaging test measures bone density and can detect early thinning before fractures occur, particularly in older patients or those with a long history of the condition.

**Advanced and emerging treatments**

Continuous glucose monitors (CGMs) have significantly changed diabetes management by providing real-time blood sugar readings throughout the day and night without frequent finger pricks. Closed-loop insulin delivery systems, sometimes called artificial pancreas devices, pair a CGM with an insulin pump to automatically adjust insulin delivery based on blood sugar trends. Research into islet cell transplantation and immune-based therapies for Type 1 diabetes is ongoing, with some approaches showing early promise in clinical trials.

## Costs and insurance

The cost of managing diabetes varies widely based on insurance coverage, which medications are needed, and how frequently specialist visits or monitoring supplies are required. For someone without insurance, monthly expenses can range from a few hundred to well over a thousand dollars, depending on whether insulin is required and what monitoring equipment is used. People with coverage typically pay copays for office visits and prescription medications, though high-deductible plans can still result in substantial out-of-pocket spending until the deductible is reached.

Key costs to plan for include endocrinologist visits (which can run $150 to $400 per visit without insurance), blood glucose testing supplies, oral medications (which vary from around $20 per month for older generics to several hundred dollars for newer branded options), insulin (which can be expensive, particularly newer analog formulations), and continuous glucose monitors, which have become more common but may carry ongoing sensor costs. If your care team recommends a bone density check, [see typical Dexa Bone Density scan costs](/procedure-costs/dexa-bone-density) to understand what that screening may cost in your area.

Diabetes care is covered by most major insurance plans including Medicare. Medicare Part B covers diabetes screenings for people at elevated risk, diabetes self-management training, and CGM devices for qualifying patients. Medicare Part D covers prescription diabetes medications. Medicaid programs generally include essential diabetes drugs and supplies, though specific formularies vary by state. People without adequate coverage may find assistance through manufacturer patient assistance programs, state pharmaceutical programs, or community health centers that offer income-based sliding-scale fees.

## Prevention and outlook

Whether diabetes can be prevented depends largely on the type. Type 1 diabetes is not currently preventable. It results from an autoimmune process that researchers do not yet fully understand, and no lifestyle intervention has been shown to stop it from developing. Type 2 diabetes, by contrast, is one of the most preventable chronic conditions in medicine. The landmark Diabetes Prevention Program trial found that lifestyle changes reduced the risk of progressing from prediabetes to Type 2 diabetes by about 58% in high-risk adults.

**Steps that reduce risk:**

- Reaching or maintaining a healthy body weight, since even a 5 to 7% weight reduction meaningfully lowers risk in overweight individuals
- Getting regular physical activity, such as brisk walking for 30 minutes on most days of the week
- Eating a diet rich in vegetables, legumes, whole grains, and lean proteins while limiting sugary beverages, processed foods, and refined carbohydrates
- Getting screened for prediabetes if you have risk factors, so changes can start before Type 2 diabetes develops
- Quitting smoking, which independently raises the risk of Type 2 diabetes and worsens its complications
- Managing blood pressure and cholesterol, which share lifestyle interventions with diabetes prevention

For people who already have diabetes, the long-term outlook depends heavily on how consistently blood sugar is kept in the target range. Many people with Type 2 diabetes live long, active lives when blood sugar, blood pressure, and cholesterol remain well controlled. Some achieve remission through significant weight loss, particularly following bariatric surgery or intensive dietary intervention, though sustained effort is required to maintain it. People with Type 1 diabetes require lifelong insulin therapy, but advances in continuous glucose monitoring and automated insulin delivery have dramatically improved quality of life and reduced the daily burden of management.

Living well with diabetes means building daily habits around monitoring, eating, movement, and medication. Many people find it helpful to work with a certified diabetes care and education specialist (CDCES), who provides personalized guidance on blood sugar management and medication use. Diabetes education programs, peer support communities, and mobile apps that track blood sugar and meals are widely used tools for self-management. Regular check-ins with a care team, including annual eye exams, foot exams, and kidney function tests, allow complications to be caught and addressed early.

## Common medications

- [Acarbose](https://ourhealthnetwork.com/drugs/acarbose)
- [Alogliptin Benz/Metformin Hcl](https://ourhealthnetwork.com/drugs/alogliptin-benz-metformin-hcl)
- [Alogliptin Benzoate](https://ourhealthnetwork.com/drugs/alogliptin-benzoate)
- [Alogliptin Benz/Pioglitazone](https://ourhealthnetwork.com/drugs/alogliptin-benz-pioglitazone)
- [Canagliflozin](https://ourhealthnetwork.com/drugs/canagliflozin)
- [Canagliflozin/Metformin Hcl](https://ourhealthnetwork.com/drugs/canagliflozin-metformin-hcl)
- [Colesevelam Hcl](https://ourhealthnetwork.com/drugs/colesevelam-hcl)
- [Dapagliflozin Propanediol](https://ourhealthnetwork.com/drugs/dapagliflozin-propanediol)
- [Dapagliflozin/Saxagliptin Hcl](https://ourhealthnetwork.com/drugs/dapagliflozin-saxagliptin-hcl)
- [Dapaglifloz Propaned/Metformin](https://ourhealthnetwork.com/drugs/dapaglifloz-propaned-metformin)
- [Desmopressin Acetate](https://ourhealthnetwork.com/drugs/desmopressin-acetate)
- [Desmopressin (Nonrefrigerated)](https://ourhealthnetwork.com/drugs/desmopressin-nonrefrigerated)

## Related procedures

- [Dexa Bone Density](https://ourhealthnetwork.com/procedure-costs/dexa-bone-density)

## Frequently asked questions

### Is Type 2 diabetes reversible?

Some people with Type 2 diabetes do achieve remission, meaning blood sugar returns to a normal range without medication. This is most often accomplished through significant weight loss, sometimes following bariatric surgery or a structured low-calorie dietary program. Remission is not a cure; blood sugar can rise again if lifestyle habits slip, and ongoing monitoring remains important. It is more likely in people who are newly diagnosed and achieve substantial weight loss. Not everyone will reach remission, but meaningful improvement in blood sugar control is possible for most people who make sustained changes to diet, activity, and weight.

### What is the difference between Type 1 and Type 2 diabetes?

Type 1 is an autoimmune condition where the immune system destroys the insulin-producing cells in the pancreas, so the body makes no usable insulin. People with Type 1 require insulin to survive. Type 2 is a metabolic condition where the body gradually becomes resistant to insulin and the pancreas cannot keep up with demand. Type 2 is far more common, accounting for about 90 to 95% of all diabetes cases, and is closely linked to lifestyle factors such as diet, physical inactivity, and excess body weight. Type 1 cannot currently be prevented, while Type 2 can often be delayed or avoided with lifestyle changes.

### Can you have diabetes without knowing it?

Yes, and it is quite common. Type 2 diabetes often develops gradually with few or no obvious symptoms for years. The CDC estimates that about 8.5 million Americans with diabetes are currently undiagnosed. Prediabetes is even more likely to be undetected; an estimated 80% of people who have it are unaware. Routine blood sugar screening is recommended for adults who are overweight, aged 35 or older, or have other risk factors such as a family history of diabetes. Finding the condition early gives the best opportunity to prevent or delay complications and begin effective management.

### What foods should I avoid with diabetes?

People with diabetes typically work with a registered dietitian to build a personalized eating plan rather than following a strict list of forbidden foods. Foods that tend to raise blood sugar quickly and are often reduced include sugary drinks like soda and juice, white bread, white rice, pastries, candy, and heavily processed snacks. Saturated fats found in fatty cuts of meat and full-fat dairy can also worsen insulin resistance over time. A consistent, balanced approach that emphasizes fiber-rich vegetables, whole grains, and lean proteins, while keeping portions in check, generally produces better long-term blood sugar control than eliminating entire food groups.

### Is diabetes hereditary?

Genetics plays a role in both Type 1 and Type 2, but the pattern differs. For Type 2, having a parent or sibling with the condition meaningfully increases risk, yet lifestyle factors largely determine whether that genetic tendency results in disease. For Type 1, having a first-degree relative with the condition does raise risk, but most people who develop Type 1 have no family history of it. The genetic architecture of Type 1 is complex and involves multiple gene variants interacting with environmental triggers. Having a genetic predisposition does not make diabetes inevitable, especially for Type 2, where consistent lifestyle habits can substantially reduce risk.

### What is the first sign of diabetes?

The most commonly noticed early signs are increased thirst and frequent urination. These occur because the kidneys work overtime to filter and excrete excess glucose from the blood, drawing water with it and triggering thirst. Unusual fatigue is another frequent early complaint. In Type 1, symptoms can escalate quickly over days and may include unintentional weight loss and nausea in addition to thirst and urination. In Type 2, early symptoms are often mild enough that many people do not notice them until a routine blood test reveals elevated blood sugar. Persistent thirst, frequent bathroom trips, and unexplained tiredness are all worth raising with a doctor.

### What is the most effective treatment for diabetes?

There is no single best treatment because the right approach depends on the type of diabetes, how long it has been present, and individual health factors. For Type 1, insulin therapy is essential and cannot be substituted. For Type 2, a combination of lifestyle changes and medication tends to produce the best results. Losing excess weight, eating a balanced diet, and exercising regularly can significantly lower blood sugar, sometimes enough to reduce reliance on medication. Newer drug classes including SGLT2 inhibitors and GLP-1 receptor agonists offer blood sugar benefits alongside heart and kidney protection in certain patients. An endocrinologist or diabetes care team is best positioned to recommend a personalized plan.

### What doctor should I see for diabetes?

An endocrinologist is the specialist with the deepest training in diabetes and other hormone-related conditions. They are generally the right choice for anyone with Type 1 diabetes, anyone with Type 2 that is difficult to control, or anyone managing complex medication regimens. Many people with Type 2 diabetes are managed effectively by a primary care physician or internal medicine doctor, particularly in the earlier stages. A certified diabetes care and education specialist (CDCES) is another important member of the care team, focusing on day-to-day management including blood sugar monitoring, nutrition, and using devices like continuous glucose monitors.

### Can diabetes cause other health problems?

Yes. Persistently high blood sugar over time damages blood vessels and nerves throughout the body. The most common long-term complications include cardiovascular disease such as heart attack and stroke, chronic kidney disease, diabetic retinopathy (vision damage that can lead to blindness), and peripheral neuropathy (tingling, numbness, or pain in the feet and hands). Foot complications are a particular concern because nerve damage and poor circulation can allow small wounds to progress to serious infections. People with diabetes also have higher rates of gum disease and certain bacterial or fungal infections. Keeping blood sugar, blood pressure, and cholesterol well controlled substantially reduces the risk of all of these complications.

### How long does it take for diabetes complications to develop?

Complications from diabetes typically develop over years or decades of poorly controlled blood sugar, not weeks or months. Research has found that early changes in the nerves, kidneys, and eyes can begin within five to ten years of diagnosis when blood sugar remains consistently elevated. However, the timeline varies considerably based on how well blood sugar is managed, genetic factors, and the presence of other conditions like high blood pressure. Early and consistent management is the most effective way to delay or prevent serious complications from developing, and regular screening allows any early changes to be caught and addressed before they progress.

## Sources

- OurHealthNetwork: https://ourhealthnetwork.com/conditions/diabetes
- Primary source: llm-original
- Methodology: https://ourhealthnetwork.com/methodology
- Data sources: https://ourhealthnetwork.com/data-sources

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