Glucose basics
Understanding type 2 diabetes: All your questions answered
By Dr. David M. Kayne
Nov. 26, 2024 • 5 min read
The content in this article should not be taken as medical advice. Please consult with your healthcare provider regarding your individual health needs.
Type 2 diabetes can feel overwhelming, especially when you’re trying to understand what’s going on in your body. But don’t worry—I’m here to break it down in a way that makes sense with simple answers to your questions. Let’s walk through what type 2 diabetes is, why it happens, and how you can manage it.
What exactly is type 2 diabetes?
Let’s start with the basics: glucose and insulin. Glucose is your body’s main source of energy—the fuel that powers all your cells. For glucose to do its job, it needs help from insulin, a hormone made by the pancreas. Insulin acts like a key, unlocking cells so glucose can enter and give your body the energy it needs.
Type 2 diabetes is a chronic condition where the body becomes resistant to insulin or doesn’t produce enough insulin, leading to elevated glucose levels in the blood (also known as blood glucose) due to not effectively being able to enter the cells.
What causes it?
Type 2 diabetes mainly happens because of two situations:
Insulin resistance
Your body becomes less sensitive to insulin, meaning it doesn’t unlock cells as efficiently. Insulin resistance is often genetic, so it can be something you’re born with. Over time, it can get worse, especially with weight gain and a sedentary lifestyle.
Beta cell dysfunction
The pancreas struggles to produce enough insulin to keep up with the body’s needs. As insulin production drops, blood sugar levels rise, especially after meals. Eventually, even your fasting glucose becomes elevated.
These are the two main culprits, but other factors also play a role. For example, hormones like glucagon and cortisol can raise blood sugar levels. Your gut hormones, which help regulate appetite and insulin, may also be out of balance. Even your kidneys, which normally filter out excess sugar, might hold on to more than they should. All these factors combine to create the perfect storm for type 2 diabetes.
How is it diagnosed?
There are four main ways doctors diagnose type 2 diabetes, and a combination of these may be used to confirm a diagnosis:
1. Fasting glucose
If your blood sugar is higher than 126 mg/dL after fasting (no eating for about 8 hours) on two separate occasions.
2. Random glucose
If your blood sugar is over 200 mg/dL along with common symptoms like frequent urination, excessive thirst, or unexpected weight loss.
3. Oral glucose tolerance test
A blood sugar level of over 200 mg/dL two hours after drinking a special sugary drink.
4. HbA1c
A blood test that shows your average blood sugar over the past 2-3 months. A level over 6.5% is considered diabetes.
Managing type 2 diabetes: The three-pronged approach
Now, let’s talk about what you can do to manage your diabetes. Treatment typically involves a combination of lifestyle changes and medication.
1. Diet
Adjusting what you eat is key. The goal is to reduce simple sugars and excess carbohydrates to keep your fasting glucose near 100 mg/dL and your post-meal glucose between 140-180 mg/dL. Using tools like continuous glucose biosensors (e.g., Stelo) can be a game-changer in tracking your levels 24/7.
2. Physical activity
Moving your body helps improve how it uses glucose and reduces insulin resistance. Aim for at least 150 minutes of moderate-intensity activity a week. Whether it's walking, biking, or even yard work, every bit counts.
3. Medications
There are several medications that target different aspects of type 2 diabetes, and your healthcare provider will work with you to find the right combination. Here’s a quick rundown of common medications:
- Metformin (biguanides): Reduces how much glucose your liver produces
- Sulfonylureas: Stimulates your pancreas to release more insulin
- Thiazolidinediones: Helps your body use insulin more effectively
- DPP-4 inhibitors: Boost natural gut hormones that help manage blood sugar
- SGLT2 inhibitors: Helps your kidneys get rid of excess glucose
- GLP-1 agonists: Lower blood sugar after meals, delay digestion, and help you feel full
- Insulin: Used when your body can’t produce enough insulin on its own
What should you do next?
Living with type 2 diabetes can feel like a lot to manage, but the good news is that there are more tools and treatments available today than ever before. Whether you’re adjusting your diet, ramping up your physical activity routine, or working with your healthcare provider to find the right plan for you, every step you take brings you closer to healthy glucose management. And remember, you’re not alone in this—there’s a whole community of people navigating diabetes right alongside you.
The production of this article was sponsored by Stelo by Dexcom.
Author profile
DD
Dr. David M. Kayne
David M. Kayne, MD, FACP, CDCES, former President of Medical Group of Encino, is presently a partner in Cedars Sinai Medical Group.