Type 2 diabetes — Insulin is made but it doesn't work as it should. Nine out of 10 people with diabetes have type 2 diabetes. This type occurs most often in people who are over 40 years old and overweight.

How is diabetes managed?

Diabetes is managed through proper diet, exercise and, if needed, medication. People with diabetes must use home and office tests to monitor the levels of sugar, cholesterol, and triglycerides (a type of fat) in their blood. Steps are then taken to keep the levels of these substances as normal as possible. Type 1 diabetes is controlled with:

• Insulin shots
• Meal planning
• Exercise

Type 2 diabetes is controlled with:

• Diet and exercise
• Medicine taken by the mouth
• Insulin shots (less common)

What are the symptoms of diabetes?

Type 1 diabetes

The symptoms of type 1 diabetes are often severe and sudden. These symptoms include:

• Increased thirst
• Dry mouth
• A need to urinate often
• Weight loss (even though you are eating and feel hungry)
• Weak, tired feeling
• Blurred vision

Type 2 diabetes

The symptoms of type 2 diabetes often go unnoticed. These symptoms build up over time and include:

• Blurred vision
• Slow healing sores or cuts
• Itchy skin (usually in the vaginal or groin area)
• Yeast infections
• Increased thirst
• Dry mouth
• A need to urinate often

How can I know if I have diabetes?

Your health care provider can perform blood and urine tests to see if you have diabetes. Normal blood sugar is between 70 mg/dl and 100 mg/dl. The standard diagnosis of diabetes is made when two blood tests show that your fasting blood sugar level (blood sugar before you have eaten anything) is 126 mg/dl or greater.

Can diabetes be cured?

No. A cure for diabetes has not yet been found. However, diabetes can be treated and controlled. Most people with diabetes manage their disease and lead normal lives. Without proper care, diabetes can lead to:

• Heart disease
• Kidney disease
• High blood pressure
• Low blood pressure
• Eye damage and blindness
• Gum disease
• Serious infections in feet, sometimes requiring amputation
• Damage to nerves, resulting in pain or loss of sensation

What should my blood sugar level be?

Blood sugar ranges may be different for each person and can change throughout the day. Your health care provider will tell you what range is good for you. If your blood sugar is less than 70 mg/dl or more than 180 mg/dl for three days in a row, call your health care provider.

What are the symptoms of low blood sugar?

Most people have symptoms of low blood sugar (hypoglycemia) when their blood sugar is less than 60 mg/dl. (Your health care provider will tell you how to test your blood sugar level.) When your blood sugar is low, your body gives out signs that you need food. Different people have different symptoms. You will learn to know your symptoms. Common low blood sugar symptoms include the following:

Early symptoms

You may:

• Feel weak
• Feel dizzy
• Feel hungry
• Tremble
• Feel shaky
• Sweat
• Have a pounding heart
• Have pale skin
• Feel frightened or anxious

Late symptoms

You may:

• Feel confused
• Have a headache
• Feel cranky
• Have poor coordination
• Have bad dreams or nightmares
• Be unable keep your mind on one subject
• Feel a numbness in your mouth and tongue
• Pass out

Can I take both pills and insulin to control my blood sugar?

Yes. The combination of insulin and an oral medication, when taken as directed by your doctor, is very safe and effective in controlling blood sugar. A typical combination therapy consists of taking an oral medication during the day and insulin at night. Once you begin taking insulin, you will need to monitor your blood sugar more often to reduce the risk of low blood sugar reactions. Combination therapies are often helpful for people who have type 2 diabetes (adult onset diabetes). If you have been taking an oral medication, your doctor may change your treatment plan to include insulin injections. This change is often made to help people with type 2 diabetes gain better control of their blood sugar.

What are insulin pumps?

Insulin pumps are small, computerized devices, about the size of a beeper, that you wear on your belt or put in your pocket. They have a small flexible tube with a fine needle on the end. The needle is inserted under the skin of your abdomen and taped in place. A carefully measured, steady flow of insulin is released into the tissue. Insulin pumps can cost $6,000 to $10,000 for the pump. There are additional costs for necessary supplies to use the pump. Using a pump requires you to monitor your blood sugar level at least four times a day. You program doses and make adjustments to your insulin, depending on your food intake and exercise program. Some health care providers prefer the insulin pump over injections because its slow release of insulin mimics a working pancreas.

How can I monitor the development and progression of diabetic complications?

Eye disease (retinopathy)

All patients with diabetes should see an ophthalmologist yearly for a dilated eye examination -- beginning at diagnosis in people with type 2 diabetes, and after 5 years in people with type 1 diabetes after puberty. Patients with known eye disease, symptoms of blurred vision in one eye, or blind spots may need to see their ophthalmologist more frequently.

Kidney disease (nephropathy)

Urine testing should be performed yearly. Regular blood pressure checks are important, since control of hypertension (high blood pressure) is essential in slowing kidney disease. Generally, blood pressure should be maintained less than 130/80 in adults. Persistent leg or foot swelling may be a symptom of kidney disease and should be reported to your doctor.

Nerve disease (neuropathy)

Numbness or tingling in your feet should be reported to your doctor at your regular visits. You should check your feet daily for redness, calluses, cracks, or skin breakdown. If you notice these symptoms before your scheduled visit, notify your doctor immediately.