You've had type 2 diabetes for a while, and suddenly you realize you don't feel as good as you had been feeling. You notice your vision has become blurry, you have frequent urination, you're more tired, and your blood glucose levels have climbed. Your diabetes is out of whack.

What happened? There are several possibilities that will need to be evaluated. And sometimes the problem is a combination of things, rather than one simple answer. It's time to check with your physician or diabetes nurse educator.

Maybe you have an acute illness, such as a respiratory or urinary or skin infection, which has caused your blood glucose to climb. Treating the acute illness should result in improvement in your diabetes control, but for the short time that the illness is active, you may need to increase your diabetes medications.

Or maybe you were started on a new medication for some other reason. Typically, the medications most likely to cause diabetes to go haywire are the "steroids" (also called "corticosteroids") which might have been prescribed for conditions ranging in severity from poison ivy to cancer. If you will be on the steroid for a prolonged time, your diabetes program will definitely need adjustment. And if you're on high doses for even a few days, you might need supplemental diabetes medication.

Or perhaps you've gone off your meal plan. If you're having problems sticking to a meal plan that seemed reasonable for you previously, you'll want to talk things over with a diabetes dietitian, and get back on track.

Or maybe you've decreased your exercise level. Exercise is great to hold down your blood glucose, if done regularly. But if you decrease your exercise level, you can anticipate your glucose levels to climb. And maybe the change in exercise level was due to worsening of some other disorder such as hypothyroidism, chronic lung disease, or congestive heart failure, that made you too tired to exercise.

Or maybe you quit your diabetes pills: because they didn't seem to be doing anything, or they cost too much, or you kept forgetting to take them, or you ran out. Whatever the reason, quitting these medications will almost inevitably cause your glucose levels to rise. It's rare that people with diabetes can safely quit these medications unless they've made substantial changes to their lifestyle, such as losing a ton of excess weight.

But maybe the reason you're again having symptoms is none-of-the-above. Maybe you've been sticking with your meal plan, exercising, taking your medications faithfully, and don't have any new illness or new medications. How to explain symptoms sneaking back in this case?

The answer is simple: type 2 diabetes is well-known to be a progressive disorder. Whether it progresses slowly, or more rapidly, or sometimes not at all, it's completely unsurprising to physicians that patients who seem to be doing everything right, and who previously had excellent control, may later have elevated glucose, and indeed symptoms may return. It's the nature of the beast.