Type 2 diabetes can be a “silent” disease, which means that you may have it and not know you do. One of the most common things that occurs with type 2 diabetes is that you may begin to experience symptoms such as tingling in your fingers or toes (neuropathy), blurred vision, or chest pains or shortness of breath. Again, as with any troublesome symptoms, you should see your doctor. Diabetes is a condition that occurs when the pancreas fails to produce enough insulin. Some people are born with this condition or has the onset of diabetes at an early age. This is called juvenile diabetes or type 1. Type 1 diabetes usually requires insulin injections. The onset of diabetes later in life is called type 2. Type 2 diabetes can be treated and in most cases prevented with simple lifestyle changes. The chronic condition associated with the way the body metabolizes glucose (sugar) is called diabetes. When the disease surfaces in adults or involves non-insulin dependency, this form of the condition is known as type 2 diabetes. Although type 2 diabetes is often preventable, an increasing amount of people is developing diabetes symptom and signs, as a result of a growing obesity problem throughout the United States. Type 2 Diabetes Type 2 diabetes can develop at any age however is most common to appear during adulthood. Type 2 diabetes is caused by an insulin resistance; basically the body is unable to react properly to insulin. Causes of Type 2 Diabetes There are many causes for diabetes, which means that are many reasons why a person can develop diabetes type 2. The most common of all the factors that cause diabetes is genetics. Almost a half of the people who suffer from diabetes type 2 are brothers and sisters and one in three children of the same family will eventually suffer from diabetes. The second strongest cause of developing diabetes is obesity. Almost a third of all people that suffer from diabetes type 2 have antibodies to the islet cells, which produce insulin. These cells so vital in diabetes can be detected in the blood. Type 2 diabetes results from a combination of defective insulin secretion and insulin resistance or reduced insulin sensitivity. Although the exact cause for type 2 is unknown, it seems that central obesity predisposes people for insulin resistance, possibly because of hormone secretions that impair glucose tolerance. Fifty-five percent of individuals with type 2 diabetes are obese. Aging and family history also seem to play a role in the onset of this type. Type 2 diabetes is first treated by diet and exercise, which can restore insulin sensitivity. If the oral medications fail, insulin therapy will be implemented.

Diabetes interferes with the body’s ability to produce or properly use insulin, a hormone that is essential for the proper use of the energy contained in the food we eat. This results in a series of malfunctions, which include an excess of a type of sugar called glucose in tests on the blood and urine. Over time, diabetes can lead to life-threatening and debilitating complications.

Type 2 diabetes occurs when insulin continues to be produced but, for a variety of reasons, is not properly used in the body. Type 2 usually occurs later in life and affects 90 percent of people with diabetes (people are typically diagnosed with Type 2 after the age of 45).

Learn more about Symptoms of diabetes.

Frequent trips to the bathroom:

Are you visiting the bathroom much more lately? Does it seem like you urinate all day long? Urination becomes more frequent when there is too much glucose in the blood. If insulin is nonexistent or ineffective, the kidneys can’t filter glucose back to the blood. They become overwhelmed and try to draw extra water out of the blood to dilute the glucose. This keeps your bladder full and it keeps you running to the bathroom.

Unquenchable Thirst:

If it feels like you can’t get enough water and you’re drinking much more than usual, it could be a sign of diabetes, especially if it seems to go hand in hand with frequent urination. If your body is pulling extra water out of your blood and you’re running to the bathroom more, you will become dehydrated and feel the need to drink more to replace the water that you are losing.

Losing Weight Without Trying:

This symptom is more noticeable with Type 1 diabetes. In Type 1, the pancreas stops making insulin, possibly due to a viral attack on pancreas cells or because an autoimmune response makes the body attack the insulin producing cells. The body desperately looks for an energy source because the cells aren’t getting glucose. It starts to break down muscle tissue and fat for energy. Type 2 happens gradually with increasing insulin resistance so weight loss is not as noticeable.

Weakness and Fatigue:

It’s that bad boy glucose again. Glucose from the food we eat travels into the bloodstream where insulin is supposed to help it transition into the cells of our body. The cells use it to produce the energy we need to live. When the insulin isn’t there or if the cells don’t react to it anymore, then the glucose stays outside the cells in the bloodstream. The cells become energy starved and you feel tired and run down.

Tingling or Numbness in Your Hands, Legs or Feet:

This symptom is called neuropathy. It occurs gradually over time as consistently high glucose in the blood damages the nervous system, particularly in the extremities. Type 2 diabetes is a gradual onset, and people are often not aware that they have it. Therefore, blood sugar might have been high for more than a few years before a diagnosis is made. Nerve damage can creep up without our knowledge. Neuropathy can very often improve when tighter blood glucose control is achieved.

Other Signs and Symptoms That Can Occur:

Blurred vision, skin that is dry or itchy, frequent infections or cuts and bruises that take a long time to heal are also signs that something is amiss. Again, when these signs are associated with diabetes, they are the result of high glucose levels in the body. If you notice any of the above signs, schedule an appointment with your doctor. He or she will be able to tell you if you have reason to be concerned about a diagnosis of diabetes.

Diabetes interferes with the body’s ability to produce or properly use insulin, a hormone that is essential for the proper use of the energy contained in the food we eat. This results in a series of malfunctions, which include an excess of a type of sugar called glucose in tests on the blood and urine. Over time, diabetes can lead to life-threatening and debilitating complications. Type 2 diabetes occurs when insulin continues to be produced but, for a variety of reasons, is not properly used in the body. Type 2 usually occurs later in life and affects 90 percent of people with diabetes (people are typically diagnosed with Type 2 after the age of 45). Learn more about Symptoms of diabetes. Frequent trips to the bathroom: Are you visiting the bathroom much more lately? Does it seem like you urinate all day long? Urination becomes more frequent when there is too much glucose in the blood. If insulin is nonexistent or ineffective, the kidneys can’t filter glucose back to the blood. They become overwhelmed and try to draw extra water out of the blood to dilute the glucose. This keeps your bladder full and it keeps you running to the bathroom. Unquenchable Thirst: If it feels like you can’t get enough water and you’re drinking much more than usual, it could be a sign of diabetes, especially if it seems to go hand in hand with frequent urination. If your body is pulling extra water out of your blood and you’re running to the bathroom more, you will become dehydrated and feel the need to drink more to replace the water that you are losing. Losing Weight Without Trying: This symptom is more noticeable with Type 1 diabetes. In Type 1, the pancreas stops making insulin, possibly due to a viral attack on pancreas cells or because an autoimmune response makes the body attack the insulin producing cells. The body desperately looks for an energy source because the cells aren’t getting glucose. It starts to break down muscle tissue and fat for energy. Type 2 happens gradually with increasing insulin resistance so weight loss is not as noticeable. Weakness and Fatigue: It’s that bad boy glucose again. Glucose from the food we eat travels into the bloodstream where insulin is supposed to help it transition into the cells of our body. The cells use it to produce the energy we need to live. When the insulin isn’t there or if the cells don’t react to it anymore, then the glucose stays outside the cells in the bloodstream. The cells become energy starved and you feel tired and run down. Tingling or Numbness in Your Hands, Legs or Feet: This symptom is called neuropathy. It occurs gradually over time as consistently high glucose in the blood damages the nervous system, particularly in the extremities. Type 2 diabetes is a gradual onset, and people are often not aware that they have it. Therefore, blood sugar might have been high for more than a few years before a diagnosis is made. Nerve damage can creep up without our knowledge. Neuropathy can very often improve when tighter blood glucose control is achieved. Other Signs and Symptoms That Can Occur: Blurred vision, skin that is dry or itchy, frequent infections or cuts and bruises that take a long time to heal are also signs that something is amiss. Again, when these signs are associated with diabetes, they are the result of high glucose levels in the body. If you notice any of the above signs, schedule an appointment with your doctor. He or she will be able to tell you if you have reason to be concerned about a diagnosis of diabetes.

You can prevent or delay the development of complications from type 2 diabetes by keeping your blood sugar levels within a normal or near-normal range (tight control). Scientific evidence shows that tightly controlling blood sugar levels:

• Prevents the development and progression of small blood vessel (microvascular) disease and nerve disease (neuropathy).
• Slightly reduces your risk for heart and large blood vessel (macrovascular) disease from diabetes.

If you are age 30 or older, talk to your health professional about taking a low-dose, or baby, aspirin daily to help prevent heart attack, stroke, or other large blood vessel disease (macrovascular disease). People with diabetes are 2 to 4 times more likely than people who don’t have diabetes to die from heart and blood vessel diseases.

Prevention and early detection

To prevent and detect complications early:

• Don’t smoke. If you quit smoking, you will reduce your risk for developing early damage to the blood vessels caused by diabetes. For information on how to quit smoking, see the topic Quitting Tobacco Use.
• Inspect your feet daily, wear properly fitted shoes, do not go barefoot or use home remedies, and have yearly foot examinations. If you have poor vision, have someone else examine your feet daily and help you with foot and toenail care. Keep pathways in your home clear of objects that could cause a fall.
• Report blurred vision, floaters, or flashes of light to your doctor immediately, and have yearly eye exams by an ophthalmologist or optometrist.
• Have yearly urine tests for protein. At the first sign of small amounts of protein (microalbuminuria), talk with your doctor about whether you can take a high blood pressure medication, such as an angiotensin-converting enzyme (ACE) inhibitor or an angiotension II receptor blocker (ARB).
• Get effective treatment for high blood pressure and high cholesterol. You may take an ACE inhibitor, ARB, or other medications to keep your blood pressure consistently below 130/80 millimeters of mercury (mm Hg). You also may need to take cholesterol-lowering medications such as statins (for example, Lipitor, Zocor, or Pravachol) to reach your goals.
• Have yearly exams to test for touch and feeling sensations in your feet and legs and report any symptoms of digestive, sexual, or urinary problems or signs of hypoglycemia unawareness as soon as you notice them.

Other preventive measures

Keep your immunizations up to date. Diabetes affects your immune system, increasing your risk for having a serious case of the flu, pneumonia, or other infections. For the recommended immunization schedule, see the topic Immunizations.

Diabetes is the #1 reason for limb amputation in the United States. Since poor circulation resulted in these conditions leads to diminished sensation and ability to feel pain, many diabetics are unaware when they sustain foot injuries and are less likely to manage or treat the injury immediately. From playing sports on the beach and swimming, to walking in sandals or open toed shoes, many summer activities put patients with diabetes at risk for foot injuries that could lead to more serious diabetic complications – even amputation. These helpful tips are recommended by Dr. Riccardo Perfetti, Director of the Diabetes Outpatient Treatment and Education Center at Cedars-Sinai Medical Center, Los Angeles, California.

Maintain proper glucose levels. You should maintain a glucose level lower than 126 mg/dl on a consistent basis. You can do this through regular exercise and close attention to how often you eat and what types of foods you consume. See your physician or nutritionist to develop a diet plan that works for your individual needs and lifestyle.

If the shoes fit, wear them – all the time! Diabetics should never walk barefoot, even in-doors. Something as minor as stubbing a toe on a coffee table or bumping a soccer ball at the park can lead to a serious foot ulcer. While at the beach, seashells, glass or debris from the ocean can puncture the skin and cause serious infections that can be perpetuated by diabetes. For diabetics with circulation problems or neuropathy when sensation in the feet is diminished, walking barefoot on hot pavement is especially dangerous and can lead to severe burns and infection. There are a variety of closed-toe beach shoes on the market that help protect feet against these types of injuries. Invest in a couple of pairs for pool-side activities to make your own summer-time fashion statement.

Be a smart shopper! Wearing the right shoes and socks is particularly important for diabetics to reduce the risk of blistering, developing painful calluses and overall protection of the feet. One major trigger for amputation is bone infection among diabetics. This is more likely to happen with puncture wounds where bacteria are introduced deep in the tissue. It is very important to buy shoes that are a “perfect fit”. Shoes that are too big or too small can cause unnecessary blisters or calluses, so make sure to have your feet measured each time you buy shoes. Adult feet usually change another four or five times during the course of a lifetime – and weight fluctuations, changes in weather and poor circulation can change the shape and size of your foot. Since heat and activity through out the day can cause temporary swelling in the feet, it is usually best to do your shoe shopping at the end of the day.

Inspect your feet daily – especially during the summer! Inspect your feet every day before putting shoes and after taking them off. Using a magnifying mirror can be helpful for those who are not flexible enough to see underneath the foot. Check between the toes and at the heel. Before putting your shoes on, diabetics should always inspect the inside of the shoe for debris that may rub your feet the wrong way. Even a small pebble or sand can create a small sore that may not cause pain, but can lead to more serious infection if not treated promptly.

See a Podiatrist regularly. During the summer months, feet have the tendency to be at risk for more fungal infection and calluses because of heat. For diabetics, fungal infections like athlete’s foot and calluses can lead to dangerous complications if they are not treated appropriately. A callus is a thickening of the skin that may be yellow, layered or even scaly due to excessive dryness. Occasionally the skin cracks and forms a fissure – which can become infected and even bleed. Though there are many over the counter medications that can be used to treat these, it is best to seek the professional treatment of a podiatrist who can care for the special needs of diabetics so these minor infections don’t lead to major complications.

The most consistent symptom of diabetes mellitus (Type I and II) is elevated blood sugar levels. In Type I (insulin dependent / early onset) diabetes, this is caused by the body not producing enough insulin to properly regulate blood sugar. In Type II (non insulin dependent/adult onset) diabetes, it is caused by the body developing resistance to insulin, so it cannot properly use what it produces.

However, high blood sugar is not something you can see in the mirror at home, so it is useful to know the side-effects of high blood sugar, which are commonly recognized as the noticeable symptoms of diabetes.

If you find yourself experiencing many of these diabetes symptoms on a consistent, long term basis, you should visit a doctor to be tested for diabetes. Ignoring (or not recognizing) the symptoms of diabetes can lead to long-term serious health risks and complications from untreated diabetes. Some of the common ‘early warning’ signs of diabetes are:

1. The first symptom of diabetes is often excessive thirst (unrelated to exercise, hot weather, or short-term illness)
2. Excessive hunger (you know you’ve eaten “enough” but are still hungry all the time)
3. Frequent urination (often noticed because you must wake up repeatedly during the night)
4. Tiredness and fatigue (possibly severe enough to make you fall asleep unexpectedly after meals), one of the most common symptoms of diabetes.
5. Rapid and/or sudden weight loss (any dramatic change in weight is a sign to visit a doctor)

While many of the signs and symptoms of diabetes can also be related to other causes, testing for diabetes is very easy, and the constant/regular presence of one or more of these symptoms over an extended period of time should be cause for a visit to the doctor.

If diabetes is suspected, tested for, and diagnosed when those symptoms first start appearing, other more serious symptoms of advanced diabetes can often be prevented or have their onset significantly delayed through diet, exercise and proper blood sugar management.

However, often the ‘minor’ symptoms of diabetes go unrecognized, and physical and neurological problems may arise, resulting in some of the following symptoms:

• Blurred vision (diabetes can lead to macular degeneration and eventual blindness)
• Numbness and/or tingling in the hands and feet (peripheral neuropathy, a symptom of diabetes, causes nerve damage in the extremities)
• Slow healing of minor scratches and wounds (diabetes often leads to impaired immune system function)
• Recurrent or hard-to-treat yeast infections in women (another sign of impaired immune function)
• Dry or itchy skin (peripheral neuropathy also affects circulation and proper sweat gland function)

If you are experiencing any of these symptoms on a regular basis, or you recognize these symptoms in a child or relative, they may be signs of untreated diabetes. A doctor’s appointment should be made as soon as possible, so the individual experiencing the symptoms can — if diabetes is diagnosed — take the steps needed to prevent more serious health problems

Nervous system disease

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.
• Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
• Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

A common side effect of diabetes is “peripheral neuropathy,” which causes loss of sensation in the extremities. Ill-fitting shoes which rub or pinch the feet excessively can lead to ulceration and foot injury, simply because the diabetic does not feel the injury until it is too late.

Properly fitted diabetic shoes are very important in preventing such injuries. Companies specializing in pedorthics — the design of footwear and specialty insoles to help alleviate and/or prevent foot pain and injury — manufacture special shoes and insoles for diabetics.

Diabetic shoes are often wider and deeper than regular shoes, to make room for special diabetic insoles. Pedorthic insoles for diabetics are generally custom made for the patient’s feet, to ensure proper fit and minimize rubbing and uneven weight distribution, preventing injury. It is also important for a diabetic to have shoes with good air circulation, meaning a lot of diabetic footwear features fabric or sandal-style uppers.

It is very important for a diabetic to have their shoes custom fitted by a trained professional, since they may not be able to feel an improper fit, due to peripheral neuropathy. By ensuring proper fit and good air circulation, properly designed diabetic shoes and insoles prevent pressure ulcers, encourage good blood circulation, and allow the skin to breathe.

Some things to look for in good shoe designs for diabetics are:

• Diabetic Shoes need to have a breathable construction – sandals and fabric shoes are good for this.
• Deep and wide designs that allow room for custom pedorthic insoles.
• Designs with no interior seams (or covered seams) to prevent rubbing injuries.
• Diabetic Shoes need a roomy “toe box” to prevent pinching or squeezing of the toes.
• Elastic or easily adjustable fit, to prevent the diabetic shoe from sliding around on the feet.

Shoes and custom insoles which are specially designed to meet the needs of diabetics’ feet will often be partially or fully covered by Medicare or private insurance, offsetting the cost of the customization.

Diabetes is diagnosed by means of a blood test measuring blood sugar and is administered by a physician or health care provider. Blood glucose levels vary with food intake, so the timing of this test in relation to meals is important. To help ensure that blood glucose readings are as accurate as possible, the test is classified in the following manner:

• a casual plasma glucose means the measurement is taken without regard to the time of the last meal;
• a fasting plasma glucose (FPG) means the blood sugar measurement is taken when the person has not eaten for at least eight hours;
• the oral glucose tolerance test (OGTT) means that the person fasts for at least eight hours, is then given a 75 g glucose load, and the blood sugars are measured at one- and/or two-hour intervals after the load.

Glucose meters help people with diabetes check their blood sugar. Blood glucose meters measure the amount of glucose in the blood and serve as an aid in monitoring the effectiveness of diabetes management at home or in a clinical setting. Checking blood glucose is a critical step in managing diabetes. Frequent testing and good record keeping give people the most accurate picture of diabetes control.

Glucose meters must be reliable because if diabetes is not well-controlled, complications such as kidney failure, amputations, and blindness can occur.

What to look for when buying a Blood Glucose Meter

• Testing area: Some blood glucose meters allow you to test on your finger, forearm or palm.
• Sample size: (A blood glucose meter may need between .3 and 1.5 microliters of blood)
• Speed: Some blood glucose meters give results in 5 seconds.
• Ease of Use
• Before and after mean averages: Some blood glucose meters can give you a before and after meal averages.
• Suitability for use by children under ten years old: Young kids may have a hard time opening foil-wrapped strips and often forget to write down the results. Meters that require smaller blood volumes are more suitable for young kids than meters that require larger blood volumes. .
• Suitability for use by children over ten years old: Older kids can take on the foil-wrapped strips and meters that require more blood. Meters lacking a data port require the user to write everything down, which some people forget.

Regardless of the blood glucose meter that you decide to use, you should have to pay almost nothing for it. Manufacturers often discount the meters. Always compare prices and features before you buy.

Safety Precautions

• Do not drop the meter (dropping, especially in water can lead to misinterpretations of glucose test results and dosage errors in insulin or in oral medication)
• Avoid jarring the meter
• Be careful when changing the meter’s day and time (be careful not to accidently change a unit of measure when changing the date and time)

Diabetes can and often does go undiagnosed because the symptoms can seem harmless and oftentimes normal.

Some diabetes symptoms include:

1. Frequent urination
2. Excessive thirst
3. Extreme hunger
4. Unusual weight loss
5. Increased fatigue
6. Irritability
7. Blurry vision

Type 1 Diabetes Symptoms

1. Frequent urination
2. Excessive thirst
3. Extreme hunger
4. Unusual weight loss
5. Increased fatigue
6. Irritability
7. Blurry vision

Type 2 Diabetes Symptoms

1. Blurry vision
2. Cuts or sores that are slow to heal
3. Itchy skin, yeast infections
4. Increased thirst
5. Dry mouth
6. Need to urinate often
7. Leg pain
8. repeating over time please see your doctor.

Make every effort to keep your blood sugar levels within a normal or near-normal range to slow the progression of your complication and reduce your risk for developing others. Eat a diet that spreads carbohydrate throughout the day, get regular physical exercise, and take your prescribed oral diabetes medication or insulin.

You can prevent or delay the development of complications from type 2 diabetes by keeping your blood sugar levels within a normal or near-normal range (tight control). Scientific evidence shows that tightly controlling blood sugar levels:

• Prevents the development and progression of small blood vessel (microvascular) disease and nerve disease (neuropathy).
• Slightly reduces your risk for heart and large blood vessel (macrovascular) disease from diabetes.

If you are age 30 or older, talk to your health professional about taking a low-dose, or baby, aspirin daily to help prevent heart attack, stroke, or other large blood vessel disease (macrovascular disease). People with diabetes are 2 to 4 times more likely than people who don’t have diabetes to die from heart and blood vessel diseases.

Prevention and early detection

To prevent and detect complications early:

• Don’t smoke. If you quit smoking, you will reduce your risk for developing early damage to the blood vessels caused by diabetes.  For information on how to quit smoking, see the topic Quitting Tobacco Use.
• Inspect your feet daily, wear properly fitted shoes, do not go barefoot or use home remedies, and have yearly foot examinations. If you have poor vision, have someone else examine your feet daily and help you with foot and toenail care. Keep pathways in your home clear of objects that could cause a fall.
• Report blurred vision, floaters, or flashes of light to your doctor immediately, and have yearly eye exams by an ophthalmologist or optometrist.
• Have yearly urine tests for protein. At the first sign of small amounts of protein (microalbuminuria), talk with your doctor about whether you can take a high blood pressure medication, such as an angiotensin-converting enzyme (ACE) inhibitor or an angiotension II receptor blocker (ARB).
• Get effective treatment for high blood pressure and high cholesterol. You may take an ACE inhibitor, ARB, or other medications to keep your blood pressure consistently below 130/80 millimeters of mercury (mm Hg). You also may need to take cholesterol-lowering medications such as statins (for example, Lipitor, Zocor, or Pravachol) to reach your goals.
• Have yearly exams to test for touch and feeling sensations in your feet and legs and report any symptoms of digestive, sexual, or urinary problems or signs of hypoglycemia unawareness as soon as you notice them.