Medically Reviewed

Diabetes: Everything You Need to Know

All the info you need (and then some) on the causes, symptoms, and treatments of this chronic condition—plus how to keep living your best life with it.

Updated Nov 21, 2024

By

Sunny Sea Gold

Medical ReviewerRodrigo Barros, M.D., Ph.D.

Our Experts: Katherine Araque, M.D.; Stelios Mantis, M.D.; Peter Goulden, M.D.

Katherine Araque, M.D.Director of Endocrinology Pacific Neuroscience Institute at Providence Saint John’s Health Center Santa Monica, CA

Stelios Mantis, M.D.Pediatric Endocrinologist Rush University Medical Center Chicago, IL

Peter Goulden, M.D.Medical Director of the Division of Endocrinology and Metabolism Mount Sinai St. Luke's New York, NY

Whether you’ve just been diagnosed with diabetes or think you could have it, you’re probably nervous, confused, and maybe even a little scared. That’s normal, and everyone featured on HealthCentral with a chronic condition felt just like you do now. But we—and they—are here for you. On this page, you’ll discover not only the realities and challenges of this disorder of high blood sugar, but also the best treatments, helpful lifestyle changes, and expert-approved advice to help you not just manage, but thrive. We’re sure you’ve got a lot of questions ... and we’re here to answer them.

Everyone’s heard of diabetes. It’s one of the most common chronic diseases in the world, and rates are on the rise. Yet most people don’t fully understand what causes it or how it affects everyday life. Some people may think that because the disorder is so widespread, it isn’t serious. But if left untreated, diabetes can lead to heart disease, vision loss, and even limb amputation.

At its most basic, diabetes mellitus (the official name) is a group of disorders that cause people to have higher-than-normal levels of sugar—or glucose—in their blood. Glucose comes from the protein, carbohydrates, and fats that you eat and drink, as well as from your liver, which makes and stores the substance.

If everything is going according to plan, your pancreas releases a hormone called insulin that helps move glucose from the bloodstream into some of the cells of your body to be used for energy. But if your body is resistant to insulin, or doesn’t make enough of it, the glucose gets stuck hanging out in your blood. That’s when your doc will tell you that you have “high blood sugar.” As time goes on, the extra sugar in your blood causes inflammation and other major health problems.

More than 38 million people in the United States have diabetes, according to the American Diabetes Association, and nearly one quarter of them don’t know it.

There are several different types of diabetes, each with its own causes. It’s important to get an accurate diagnosis for which form of the disease you have, because treatment differs depending on type. The key forms of diabetes are:

Type 1 Diabetes

Also called “juvenile” diabetes because it’s often diagnosed in childhood, type 1 diabetes is an autoimmune disorder in which your immune system attacks and destroys insulin-making cells in the pancreas. Because of this, your body no longer produces its own insulin, so you need insulin injections every day. It’s thought that a combination of genetics and environmental factors may cause the disease to develop in the first place.

Most people with type 1 diabetes are diagnosed during childhood or young adulthood, but a small number of people may not develop the disease until their 30s, 40s, or even 50s.

Type 2 Diabetes

People with type 2 diabetes do produce their own insulin, but their bodies don’t use it very well. They are what’s known as insulin-resistant.

Type 2 diabetes is the most common form of the disease. Between 90% and 95% percent of all people with diabetes have type 2. It usually develops in adulthood, particularly middle age, but is increasingly being seen in children and teenagers, largely due to the obesity epidemic. Most people with type 2 don’t need to take insulin, but they may need other medications to help manage blood sugar.

Prediabetes

If your blood sugar is higher than normal, but not high enough to be diagnosed as full-blown diabetes, that’s considered prediabetes. More than one in three adults in the United States has prediabetes, and the majority of them don’t know it, according to the Centers for Disease Control and Prevention (CDC).

That’s a problem because people with prediabetes have an increased risk of developing type 2 diabetes. Luckily, prediabetes can be reversed: Exercise and diet changes are often prescribed to lower blood sugar and reduce the risk of progressing to diabetes. In some cases, a doctor may also prescribe metformin, a blood-sugar lowering drug.

Gestational Diabetes

Gestational diabetes refers to temporary high blood sugar that happens only in pregnancy. Doctors suspect that it’s related to hormonal changes that happen during this time. Every year, about 2% to 10% of pregnant women in the United States will experience gestational diabetes, according to the CDC.

Most pregnant women are screened for gestational diabetes during their second trimester with a glucose tolerance test, which involves drinking a glucose-containing beverage on an empty stomach and then having blood drawn to check sugar levels.

Gestational diabetes is usually treated with exercise and diet changes (such as eating less starch and more veggies, fruits, and protein). Some women may need insulin injections, too.

Most of the time, blood sugar levels return to normal once the baby is born; but if you have gestational diabetes during pregnancy, you are also at higher-than-average risk for developing type 2 diabetes later in life. In fact, about 50% of people with gestational diabetes end up getting type 2, according to the CDC.

Gestational diabetes also puts your baby at risk of health problems. For example, babies with mothers who have gestational diabetes have a higher chance of low blood sugar, preterm birth (which can lead to breathing problems and other issues), being born greater than nine pounds (which can lead to difficult delivery or C-section), and getting type 2 diabetes later in life.

Other Types of Diabetes

Though rare, these types of diabetes can cause serious health issues if left untreated:

• Monogenic diabetes. Accounting for 1% to 5% of all diabetes cases, this rare type is caused by a mutation in a single gene. In most cases, the disease is due to a person’s pancreas not being able to make enough insulin; the condition is usually found in kids. If untreated, monogenic diabetes can lead to damage of the blood vessels in your eyes and kidneys.

• Secondary diabetes. Sometimes, diabetes is a side effect of another disease, such as Cushing’s syndrome or cystic fibrosis (more on this below). Certain medications, including niacin, diuretics, HIV medicines, anti-seizure drugs, and some antipsychotic drugs can also lead to high blood sugar. Secondary diabetes has a similar risk of complications to other types of diabetes.

• Cystic fibrosis-related diabetes. If you have cystic fibrosis, you are at risk of this type of diabetes. Basically, the scarring of the pancreas that occurs in cystic fibrosis can make it tough for your pancreas to make the insulin you need. Cystic fibrosis-related diabetes has some features of type 1 diabetes and some features of type 2 diabetes.

The causes of diabetes differ depending on what type you have. No matter what type it is, though, issues with making or using insulin are the core of the disease. With type 1 diabetes, it’s believed that a combination of environmental factors (like viruses) and your genes trigger the body to start attacking insulin-producing cells. With type 2, lifestyle factors and genes contribute to insulin problems. Typically, this starts with insulin resistance, in which your body simply doesn’t use insulin as well as it should.

Let’s take a closer look at the causes of each type of diabetes.

Causes of Type 1

Type 1 diabetes is primarily an autoimmune disorder. In this case, your immune system attacks your body in the same way it might attack invaders like bacteria or viruses, destroying certain cells in your pancreas in a misguided attempt to protect the body. These cells, called beta cells, are the ones that produce insulin. When your body attacks and destroys them, you can no longer make your own insulin.

Doctors believe that type 1 diabetes may be caused by a combination of genes and environmental factors. Type 1 diabetes is treatable with daily insulin injections but isn’t curable; and lifestyle changes like diet and exercise, while important for managing the condition, won’t reverse it.

Causes of Type 2

Type 2 diabetes is usually caused by a combination of factors. It tends to run in families, and certain genes make you more likely to develop it. It’s also more common in some ethnic groups, including Native Americans, African Americans, Pacific Islanders, Asians, and Latinos.

How you eat and how active you are also important. Carrying extra body fat, especially in your belly, can contribute to insulin resistance, a situation where your pancreas makes plenty of insulin, but your body doesn’t use it well, so sugar builds up in your blood rather than going into your cells for energy. Insulin resistance is a major cause of type 2 diabetes.

Sometimes, type 2 diabetes is caused by an underactive pancreas and your body doesn’t make enough insulin.

Causes of Gestational Diabetes

Genetics and hormonal changes during pregnancy are the culprits of this type of diabetes. You’re at increased risk of getting gestational diabetes if you:

• Have had it in a past pregnancy

• Are overweight prior to pregnancy

• Have polycystic ovary syndrome

• Have given birth to a baby over nine pounds

• Have a family history of type 2 diabetes

All women become insulin-resistant late in pregnancy, thanks to hormones released mostly by the placenta. Most of the time, the pancreas amps up production of insulin to make up the difference, but in cases where it can’t keep up, blood sugar levels rise and gestational diabetes develops.

Now that you know what causes diabetes to develop in the first place, you’re likely wondering what your odds are of developing the condition. It’s true that there are certain factors that can make you more likely to get diabetes. Knowing these risk factors arms you with knowledge that you can use to take steps to reduce your risk and stay as healthy as possible. Here’s what to know.

Type 1 Diabetes Risk Factors

Risk factors for type 1 diabetes are not as well-understood overall as risk factors for type 2, but there are a few established ones:

• Family history. If your parent or sibling has type 1 diabetes, you’re also more likely to develop the condition.

• Race. In the United States, you’re more likely to develop type 1 if you are white compared with if you are Black or Latino.

• Younger age. Children, teens, and young adults are the most likely to get type 1 diabetes (that’s why it used to be called “juvenile diabetes”). However, it’s possible to develop it at any age.

Type 2 Diabetes Risk Factors

Risk factors for developing type 2 diabetes include:

• Being overweight or obese. Having excess weight has been linked to increased risk of type 2 diabetes.

• Being 45 or older. Unlike type 1, which most commonly develops in childhood or early adulthood, type 2 diabetes is more common in middle-aged and older adults.

• Family history. Having a parent or sibling with type 2 diabetes makes you more likely to get the disease.

• History of gestational diabetes or delivering a large baby. If you were diagnosed with gestational diabetes during a pregnancy or had a baby over nine pounds in weight, you’re at higher risk of type 2 diabetes.

• Prediabetes. Having prediabetes greatly raises your chances of going on to develop type 2 diabetes.

• Race. Black Americans, Latino Americans, American Indians, and Alaska Natives are at higher risk of type 2 diabetes compared to other racial groups.

Risk Factors for Prediabetes

The risk factors for developing prediabetes are essentially the same as those for type 2 diabetes, including overweight or obesity, age, family history, history of gestational diabetes, and being Black, Latino, or of American Indian or Alaskan Native heritage. Having a sedentary lifestyle or being physically active less than three times per week are also risk factors.

A tricky truth about this disease: Sometimes, there are no symptoms or symptoms are so mild that they’re easy to miss. That’s why nearly all pregnant women are screened for gestational diabetes, and the U.S. Preventive Services Task Force recommends screening for prediabetes and type 2 diabetes in all asymptomatic adults ages 35 to 70 who are overweight or obese.

Other times, symptoms of diabetes are sudden and clear. Any of these signs merit a call to your doctor so you can get checked out:

• Blurry vision. High blood sugar can lead to a leaking of fluids into your eye, causing the lens to swell. That leads to trouble focusing.

• Fatigue. You may feel exhausted and weak because your brain, muscles, and other body systems aren’t getting the energy they need to work properly. If you’re dehydrated, that can make you tired, too.

• Increased infections. Having diabetes makes it harder for your immune system to fight off infections, including yeast infections or UTIs. It might also take longer for cuts to heal, because extra glucose prevents white blood cells from doing their repair work.

• Lots of pee. When there’s too much sugar in the blood, your kidneys try and filter it out. They dump it into your urine, creating more pee. In more advanced stages of the disease, damaged nerves around the bladder may cause some people to feel the urge to pee frequently, even if little or nothing comes out. You also have a higher risk of urinary tract infections (UTIs).

• Major thirst. When your blood has too much sugar in it, your body pulls water from surrounding tissues to try to dilute it. That leaves you dehydrated and thirsty. Some diabetics feel like no matter how much they drink, they can’t quench their thirst.

• The munchies. If you’re hungry all the time, even after a good meal, it could be a sign that your muscles and other tissues aren’t getting the energy—i.e. glucose—they need from the food you’re eating, because it’s hung up in your bloodstream. Your muscles tell your brain that they’re starving (even though you ate plenty), making you hungry again and continuing the cycle.

• Weight loss. Losing weight without changing your diet could be a sign of type 1 diabetes. If your body can’t get the glucose it needs from food, it will start to break down its own fat, muscles, and other tissues for fuel, leading to weight loss.

Type 1 Diabetes vs. Type 2 Diabetes Symptoms: Are They Different?

With the exception of weight loss, the symptoms listed above apply to both type 1 and type 2 diabetes. However, there are differences between the types in how fast symptoms come on: When you have type 1 diabetes, your symptoms may start fast, taking only a couple of weeks to ramp up. In contrast, type 2 diabetes develops much more gradually and can take several years. In fact, symptoms of type 2 may be so mild at first that you don’t even realize anything is off. That’s why it’s important to get regular checkups at your doctor—they may be able to catch changes early with blood tests so you can get started on treatment sooner.

Getting diagnosed with diabetes involves blood tests and potentially additional testing to figure out which type you have. Correct diagnosis is important since treatment differs depending on type. Diabetes may be diagnosed by your primary care provider or a doctor who specializes in hormonal disorders like diabetes, called an endocrinologist.

It’s normal to be nervous as you head to your doctor’s appointment to explore a potential diagnosis of diabetes, but knowing what you may expect during your appointment can help calm the nerves.

What to Expect at the Doctor’s Office

The doctor will likely do a physical exam and ask you questions about your symptoms and family history. Then, you’ll probably have one or more blood tests and possibly a urine test. Let’s take a closer look at those now.

A1C (or Glycated Hemoglobin) Test

This common blood test measures what percentage of your red blood cells have been coated with glucose over the past two to three months. The higher your blood sugar, the higher your A1C score. A1C results are given in percentages. A result below 5.7% is considered normal; 5.7% to 6.4% is considered prediabetes; and 6.5% or above suggests diabetes.

Fasting Blood Sugar Test

Blood will be drawn first thing in the morning before you eat or drink anything other than water. A result under 100 milligrams per deciliter (mg/dL) is normal; 100 to 125 mg/dL is prediabetic; and 126 mg/dL or above indicates diabetes. Your doctor will likely want to do the test twice before diagnosing you.

Glucose Tolerance Test

After getting your blood drawn on an empty stomach, you’ll drink a glucose beverage, then have blood drawn again after one or two hours. If your blood sugar is under 140 mg/dL two hours after downing the sugar drink, that’s normal; 140 to 199 mg/dL is prediabetic; and 200 md/dL or over indicates diabetes.

Random Blood Sugar Test

Blood is drawn at any time of day, whether you’ve eaten recently or not. A result of 200 mg/dL means you may have diabetes.

Antibody Test

To help differentiate between type 1 and type 2 diabetes, your doctor may also draw blood for an autoantibody test, which can show if your immune system is attacking your pancreas. People with type 1 often test positive for several specific autoantibodies, while those with type 2 (or the rare monogenic diabetes) won’t.

Urine Test

If your doctor suspects that you have type 1 diabetes, he or she may want to test your urine for ketones, chemicals your body produces when it breaks down fat for energy.

The test can be done at home or in a lab or doctor’s office by peeing into a specimen cup. Extremely high levels of ketones are a sign of ketoacidosis, a potentially fatal complication of diabetes that requires emergency treatment. (More on ketoacidosis below.)

Whatever your path of treatment, most likely you’ll start by checking your glucose every day, or even several times per day, in order to make decisions about insulin dosages, food, and exercise. Diabetes management is a whole lifestyle, so we’ll break it down in detail after we talk about other treatments. Beyond self-monitoring, here are the main treatments your doctor will consider, based on your diabetes type:

Type 1 Diabetes Treatment

The main treatment for type 1 diabetes is insulin. Because your body cannot make this hormone, you will need to take insulin daily to survive. There are a couple of different ways insulin can be delivered to the body:

• Injection. This is the most common method of taking insulin and involves using either a syringe or “pen.” This will be placed in your belly, upper arm, thigh, or buttocks.

• Insulin pump. People who need multiple injections per day or are at high risk of ketoacidosis may prefer an insulin pump, which automatically delivers insulin throughout the day through a tiny catheter that’s worn on your body.

• Insulin inhaler. Some adults with type 1 or type 2 diabetes can use inhaled insulin, a powder you breathe into your lungs through an inhaler. Inhaled insulin is a type of rapid-acting insulin and is taken before meals. People who use it will have to use an injectable, longer-acting insulin as well.

Dangers of Too Much Insulin

Accidentally getting too much insulin is dangerous—it can cause your blood sugar to plummet and lead to hypoglycemia. This can happen if you accidentally inject the wrong dose at the wrong time, or inject your insulin but then skip your scheduled meal afterward. If you’ve overdosed on insulin, it’s important to seek medical care right away. In the most severe cases, an insulin overdose can lead to seizures or coma.

Insulin Questions for Your Doctor

If your doctor prescribes insulin for your diabetes, it can feel overwhelming. It’s important to ask questions so you understand the ins and outs of your treatment. Some questions you may want to ask your doctor include:

• What are the details of my prescription? (Name, strength of dose, etc.)

• How do I safely store my insulin?

• How does insulin work?

• When should I first start taking it?

• How do I take my insulin? Do I need any other supplies?

• How long does it take to feel the effects?

• At what times should I take my insulin? How do I need to plan my meals and snacks around it?

• Are there any foods or drinks (including alcohol) I shouldn’t have while on this medication?

• What happens if I forget to take it?

• What should I do if my blood sugar levels are too high or too low?

• What side effects might I experience?

Type 2 Diabetes Treatment

The mainstays of type 2 diabetes treatment are lifestyle changes and oral or injectable medications, though some people with this form of diabetes will eventually require insulin, according to Mayo Clinic.

Oral Medications

Several pills (or liquids), used in combination with each other or with insulin, can help lower blood sugar in people with type 2 diabetes. These are some of the common meds:

• Metformin. Sold under brands names including Glucophage, Glumetza, Fortamet, and Riomet, metformin is a drug that slows the breakdown of carbohydrates you eat into sugar and reduces how much glucose your liver produces. It’s usually the first drug prescribed for type 2 diabetes. Potential side effects include vitamin B12 deficiency, for which you can take supplements, along with bloating, nausea, abdominal pain, and diarrhea.

• Thiazolidinediones. Actos (rosiglitazone) and Avandia (pioglitazone) are drugs that reduce circulating fat concentrations and improve sensitivity to insulin. Their possible side effects include a risk of bone fractures, weight gain, congestive heart failure, bladder cancer (pioglitazone), and high cholesterol (rosiglitazone).

• Sulfonylureas. This group includes Amaryl (glimepiride), Glucotrol (glipizide), and glyburide, which is sold under several brand names include DiaBeta, Glynase, and Micronase. They work by triggering the pancreas to produce more insulin and are effective in controlling blood glucose and lowering A1C levels. Side effects to watch out for on these meds include weight gain and, if you skip a meal, low blood sugar.

• Meglitinide. Like sulfonylureas, these meds—which include Prandin (repaglinide) and Starlix (nateglinide)—work by causing the pancreas to release more insulin. But they are shorter-acting and used mainly to keep your blood sugar at a healthy level during mealtimes. Potential side effects are similar to those of sulfonylureas.

• DPP-4 inhibitors. This group of medications includes Januvia (Sitagliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin) and works by triggering the pancreas to produce more insulin. However, DPP-4 inhibitors tend to only have a modest effect on blood-sugar levels and can come with side effects like joint pain and an increased risk of pancreatitis.

• SGLT2 inhibitors. Farxiga (dapagliflozin), Invokana (canagliflozin), and Jardiance (empagliflozi) are members of this drug class. They boost the amount of sugar the kidneys can remove from your blood. Another plus: They may help lower your risk of heart attack and stroke. Their potential side effects include vaginal yeast infections, low blood pressure, urinary tract infections, high cholesterol, and a risk of gangrene, amputation (canagliflozin), and bone fractures (canagliflozin).

• Alpha-glucosidase inhibitors. Glyset (miglitol) and Orecose (acarbose) slow the digestion and breakdown of starches into glucose and regulate how much glucose is absorbed by the small intestine. They can have digestive side effects including gas, diarrhea, abdominal cramping, and bloating.

Injectable Medications

A newer class of type 2 diabetes medications called glucagon‐like peptide‐1 (or GLP-1) receptor agonists work by helping your body use its insulin more efficiently, in turn lowering your blood sugar. The medications may lead to weight loss and decrease your risk of heart disease if you are at high risk. GLP-1 drugs are taken by daily or weekly injection with one exception: Rybelsus, an oral formulation of semaglutide. Injectable GLP-1s include Ozempic (semaglutide), Trulicity (dulaglutide), and Victoza (liraglutide). A related medication targets both GLP-1 and another hormone, gastric inhibitory polypeptide (GIP), yielding similar weight-loss effects. It is sold under the brand name Mounjaro (tirzepatide). Possible side effects of these injectable medications include nausea, vomiting, and, rarely, stomach paralysis or pancreatitis.

Diet and Exercise

Unlike type 1 diabetes, which can’t be treated or cured through lifestyle changes (no matter how well you eat, you can’t make your pancreas be able to produce insulin again), type 2 diabetes can be treated and in some cases even reversed by eating well and exercising. Here are some key diet and exercise tips experts recommend:

• Cut out sugary drinks. One of the most important diet changes someone with type 2 can make is to reduce or cut out sugary drinks like soda and sugar-sweetened juices or coffee drinks that may hike up blood sugar.

• Get moving. Regular exercise can reduce insulin resistance and improve the way your body uses insulin. Getting at least 30 minutes of exercise on at least five days per week is ideal to help with your diabetes. A mix of aerobic and strength-training exercises is the goal. Find an activity you enjoy, like riding your bike or hiking. Good old walking does the trick, too. Make sure you know the signs of low blood sugar—confusion, weakness, dizziness, and profuse sweating—and stop if you experience them. People with diabetes are at increased risk of foot problems, so make sure you’re wearing supportive shoes during exercise.

• Try a meal plan. Some people with diabetes may work with their doctor or a dietitian to come up with a personalized meal plan. This can help you make sure you’re staying on target with the foods you need to help balance your blood sugar. As part of your meal planning, you also may need to count your carbs since they affect your blood glucose more than other foods.

• Vary your food groups. It’s important to eat a range of healthy foods to get you the nutrients you need. For example, prioritize lean protein, low-starch vegetables, heart-healthy fats, and whole grains.

Gestational Diabetes Treatment

Like with type 2 diabetes, diet and exercise are often the first-line treatments for gestational diabetes. If that isn’t enough to help get your blood sugar to a healthy level, you may be prescribed diabetes medications like insulin or metformin while you are pregnant.

Having any type of diabetes puts you at risk for other health problems, especially if the condition is left untreated or if blood sugar is not well managed. Some possible complications include:

• Cardiovascular disease. People with diabetes are at increased risk of heart disease, stroke, and high blood pressure.

• Diabetic neuropathy. Over time, having high blood sugar can lead to nerve damage, called diabetic neuropathy. This manifests in symptoms of tingling, pain, numbness, or burning and affects about one-half of people with diabetes. Additionally, nerve damage that occurs in the feet can lead to poor blood flow that can result in increased risk of foot problems like major infections from cuts and blisters.

• Erectile dysfunction. For men, having diabetes triples your risk of getting erectile dysfunction (ED). Due to nerve damage from diabetes, you also may experience overactive bladder, incontinence, or a condition called retrograde ejaculation, which is when semen is released into your bladder.

• Eye problems. Your eyes are at increased risk of health problems with diabetes, such as glaucoma and cataracts. You also may experience damage to the blood vessels in the part of your eye called the retina, a condition known as diabetic retinopathy, which can result in loss of sight.

• Kidney disease (nephropathy). Having diabetes makes you more likely to develop chronic kidney disease. That’s because diabetes can damage the filtering system in your kidneys that removes waste from your blood.

• Skin problems. People with diabetes are more prone to skin infections and other disorders.

• Pregnancy complications. Type 1 diabetes can lead to problems for you and your baby if you are pregnant. For example, your risk of miscarriage, stillbirth, and birth defects are higher if your diabetes is unmanaged in pregnancy. For these reasons, getting your diabetes under control before getting pregnant is ideal.

• Urinary tract infections. Both men and women with type 2 diabetes are at increased risk of UTIs.

• Vaginal yeast infections. Yeast thrives off excess sugar, so the less controlled a woman’s blood sugar is in type 2 diabetes, the greater the susceptibility to excessive yeast growth.

Complications in Women vs. Men

The likelihood of some diabetes complications—or the severity with which you experience them—can vary depending on sex. For example, women with diabetes have double the increased heart disease risk compared to men, according to the CDC. Women also have a greater risk of experiencing blindness, kidney disease, and depression as a result of diabetes. And they’re more likely in general to experience severe complications than men.

Diabetic Ketoacidosis: A Severe Complication of Diabetes

In severe cases, your diabetes—in particular, type 1 diabetes—may lead you to develop a condition called diabetic ketoacidosis (DKA). This can happen if your body doesn’t get enough insulin, which your cells need in order to use glucose for energy. Since it’s unable to use glucose, the body starts burning fat to get the energy it needs. This process produces chemicals called ketones. If ketones build up in the blood, it makes your blood more acidic, and high levels can actually poison you.

DKA can affect people with any type of diabetes, but it’s rare in type 2. The earliest warning signs of DKA include:

• Having to pee frequently

• Feeling very thirsty or having dry mouth

• Having high blood glucose levels (hyperglycemia)

• Having high levels of ketones in the urine

Full-blown DKA results in the following symptoms:

• Feeling tired all the time

• Dry, flushed skin

• Nausea, vomiting, or abdominal pain

• Breath that smells fruity

• Confusion or difficulty focusing

• Difficulty breathing

If you think you may have DKA, it’s important to get medical attention right away. DKA can lead to diabetic coma, which is when you pass out for a long time, and in the most severe cases, death.

After your diagnosis, you will work closely with your primary care doctor and/or endocrinologist to stay healthy and keep your diabetes in check. However, you might also work with a variety of other healthcare professionals to help manage different aspects of your condition. Your care team may include:

• Fitness professional. A physiologist, personal trainer, or physical therapist can help you come up with an appropriate exercise program and make sure you are doing it safely.

• Mental health professionals. Living with a chronic illness like diabetes can bring an emotional toll. Working with a psychiatrist, psychologist, or therapist may be helpful for safeguarding your mental health and managing issues like depression or anxiety.

• Ophthalmologist or optometrist. These are eye doctors who can help you diagnose and manage diabetes-related eye conditions.

• Pharmacist. A pharmacist is an expert in medications—working closely with one can be helpful when navigating your diabetes medications to make sure you know how to take them properly and know what may interact with them.

• Podiatrist. Podiatrists are foot doctors. When you have diabetes, you are at increased risk of having issues with blood flow to the feet, which can cause problems, so working with a podiatrist can be especially important.

• Registered dietitian nutritionist (R.D.N.). Dietitians are nutrition experts who can help you learn about the best ways to plan meals to better manage your diabetes.

Many diabetes symptoms area related to blood sugar levels being out of your target range, so monitoring your blood glucose to make sure it stays within these targets is the name of the game with diabetes. Your doctor will let you know whether you should be monitoring your blood glucose regularly at home—this is usually the case for people who are taking insulin or who are having trouble controlling their blood-glucose levels. They will likely want you to keep a strict log of your blood-sugar readings so they can review it with you during appointments.

Typical targets are 80 mg/dL to 130 mg/dL before a meal and under 180 mg/dL one to two hours after you start eating a meal. That said, these targets can vary depending on things like your age. Your doctor can let you know what your target blood-sugar range should be.

Self-Monitoring Your Blood Glucose

To monitor your blood glucose, you’ll likely use a home glucose meter to poke your fingertip with a specialized lancet “pen,” then drop the blood onto a test strip in the meter. In some cases, your doc might suggest a continuous glucose monitor, where a tiny sensor is inserted under the skin of your abdomen, arm, or thigh to check glucose levels regularly. The device will alert you if levels fall too low.

Self-monitoring your glucose is handy since you can do it anytime, anywhere—without the assistance of a doctor. But if you’re using test strips, it’s important to know that sometimes they can give inaccurate readings. This may happen if the test strips have been stored in a location that is too hot or too cold, or if they are expired. You also may have inaccurate readings if your glucose level is very high or very low. Always check with your doctor if you get a reading that’s way outside your normal range.

How to Check Your Blood Sugar

The main way to check your blood glucose levels is to use a blood glucose meter. Here’s how it works:

• Wash your hands and put a test strip into your blood-glucose meter.

• Use your lancing device to prick the side of your fingertip. This will produce a drip of blood to be tested.

• Hold the test strip to the blood. Your blood glucose reading will show up on the meter.

When to Test Your Blood Sugar

When you test your blood sugar is a more complicated question because it varies from person to person. If you have type 1 diabetes, typical times you may need to test your levels include:

• Before meals and snacks

• Before and after exercise

• Before going to bed

If you have type 2 diabetes, you may need to test your blood sugar before meals and at bedtime.

To get specific instructions on when and how often you should be checking your blood sugar, talk with your doctor. Factors including what kind of medication you are taking can also impact your reading schedule.

How to Use a Continuous Glucose Monitor (CGM)

Some people track their blood sugar levels with a continuous glucose monitor (CGM) instead of a meter with test strips. Typically, people who use a CGM have type 1 diabetes. With a CGM, there is a sensor inserted beneath your skin that automatically measures your blood glucose every few minutes. Usually, you need to change your sensor every week or two, although some types of CGMs have sensors that can be worn longer.

High Blood Sugar (Hyperglycemia)

When your blood sugar is too high, it’s called hyperglycemia. This can happen if your body doesn’t get the amount of insulin it needs or can’t use it efficiently. This can be caused by:

• Eating too much food or more carbs than usual

• Dehydration

• Not getting enough of your diabetes medications (insulin or oral/injectable medications)

• Side effects of other medications

• Not being physically active

• Stress, illness, or having your period

Signs that you may have high blood sugar include a high reading on your glucose monitor, high levels of sugar in the urine, having to urinate frequently, and feeling thirstier than usual.

It’s important to treat hyperglycemia because it can develop into ketoacidosis, which can lead to diabetic coma), as discussed above. Signs include shortness of breath, fruity odor on the breath, nausea and vomiting, and dry mouth.

Exercising can often be effective in lowering your blood-sugar level. That said, you don’t want to exercise if your urine has ketones because it can actually make things worse. So if your blood sugar is over 240 mg/dl, it’s important to check your urine for ketones before exercising. If you have ketones, check with your doctor about the best way to bring your blood sugar down. They may suggest eating less or adjusting your medication dose or timing.

Low Blood Sugar (Hypoglycemia)

When your blood sugar levels fall too low, it’s called hypoglycemia. When this happens, you need to take steps to get your levels back where they need to be. Signs of low blood sugar include:

• Blurred vision

• Confusion

• Headache

• Hunger

• Increased heart rate

• Irritability

• Lightheadedness or dizziness

• Nausea

• Nervousness or anxiety

• Nightmares

• Seizures

• Shakiness

• Sleepiness or weakness

• Sweating or chills

These symptoms are a sign to check your blood sugar and take action if it is low. Talk with your doctor: Along with diet, your physician may also suggest other methods, such as glucose tablets, to help you raise your levels.

Any medication has potential side effects, and those for diabetes are no exception. But none are as serious as the alternative effects of not treating it—effects like heart disease, vision loss, nerve pain, foot ulcers, and even amputations. These are some side effects of the most common diabetes treatments:

• Continuous glucose monitoring: Skin irritation, pain, sore muscles.

• Insulin: Low blood sugar, headaches, weight gain, flu-like symptoms. Infection of infusion site if using an insulin pump.

• Oral medications: Nausea, diarrhea, gas, sweating, feeling anxious or shaky, weight gain, swelling may be potential side effects.

How to Handle Low Blood Sugar From Insulin Overdose

If you have more insulin than you should, it can be dangerous and lead to insulin shock, which is a term for extremely low blood sugar. What to do in the event of an overdose depends on how serious it is.

If your blood sugar falls under 70 mg/dL and you are conscious, it can often be treated with the “15-15 Rule,” according to the American Diabetes Association. This means eating 15 grams of carbs (such as a small snack or glucose tablets) and then checking your blood sugar after 15 minutes. If after that time your blood sugar is still under 70 mg/dL, have another serving of 15 grams of carbs and repeat.

If your blood sugar is severely low and you have passed out, you should be treated with a glucagon kit. You should always have one of these on hand in case of an emergency—ask your doctor if they can prescribe it. This kit allows the person with you or a bystander to inject a synthetic version of glucagon, a hormone, into your body to release stored glucose and quickly increase your blood sugar. If a glucagon kit is not available, it’s necessary to call 911 or go to the ER right away. Emergency medics can give you medication to help bring your glucose level back up and revive you if you have passed out.

If you are with someone who has passed out from hypoglycemia and you don’t have a glucagon kit or know how to use it, call 911 right away.

Whether you had diabetes already before pregnancy or you develop gestational diabetes during pregnancy, diabetes can pose risks to both you and your baby. You can reduce these risks by getting your blood-sugar levels into your target range prior to getting pregnant.

Type 1 and Type 2 Diabetes and Pregnancy

If you have type 1 diabetes or type 2 diabetes and get pregnant, there are certain risks you should be aware of:

• Birth defects. Your baby is at risk of serious birth defects if your blood sugar is not in control when key organs of the baby are forming during the first two months of pregnancy.

• High birth weight. If your diabetes isn’t well managed, then your baby’s blood sugar can rise, too. That causes them to grow more. Having an extra-large baby can make delivery difficult and raise your risk of C-section.

• High blood pressure (preeclampsia). Having diabetes increases your risk of high blood pressure. High blood pressure in pregnancy can lead to a condition called preeclampsia, which is when you have high blood pressure, protein in the urine, and swollen fingers and toes. This can lead to complications for you and the baby, such as preterm birth and even risk of you having a seizure or stroke.

• Low blood sugar (hypoglycemia). If your blood sugar gets low during pregnancy due to taking diabetes medications, it can be dangerous for you and your baby. That’s why it’s important to monitor blood sugar closely during pregnancy. Plus, if your diabetes isn’t well-managed while you are pregnant, your baby can also get low blood sugar after they are born, which requires close monitoring.

• Miscarriage or stillbirth. Women with uncontrolled diabetes have an increased risk of losing their pregnancy before 20 weeks (miscarriage) or after 20 weeks (stillbirth).

• Preterm birth. Diabetes raises the chances that your baby will be born too early. This can lead to issues in the baby such as breathing problems, heart problems, intestinal problems, bleeding in the brain, and vision problems.

Because of these risks, it’s super important that you take steps to get your diabetes under control before you conceive—and all throughout your pregnancy, too. Doing so can help increase your chances of a healthy pregnancy. This means that ideally, you would work with your doctor before you get pregnant and come up with a plan together to get your blood sugar under control before you conceive. Before and during pregnancy, you should see your doctor regularly so they can closely monitor you for any issues that may arise and treat them promptly. It’s also important for women with diabetes to eat a healthy diet and get enough physical activity, which can increase their chances of a healthy pregnancy and birth.

Gestational Diabetes

Gestational diabetes is when you develop diabetes for the first time while you are pregnant. Women with gestational diabetes are at risk of many of the pregnancy complications above, including having an extra-large baby with higher risk of C-section, high blood pressure, and low blood sugar.

Many women with gestational diabetes find success in treating their gestational diabetes by eating healthy foods and exercising regularly. It will also be important to watch your blood sugar closely and take any medications your doctors prescribe you.

About six to 12 weeks after your baby is born, you should be tested for diabetes, since gestational diabetes raises your risk of developing type 2 diabetes.

Kids and teenagers can be affected not just by type 1 diabetes, the type traditionally associated with childhood, but increasingly by type 2 diabetes. This info can help you detect each type.

Type 1 Diabetes in Children

Type 1 diabetes is sometimes referred to as juvenile diabetes because it usually develops in childhood. First signs that a child may be developing type 1 include:

• Being very thirsty and hungry

• Increase in tiredness

• Urinating more frequently, with possible bedwetting even after being potty trained

• Weight loss

If your child is showing any of these signs, it’s important to get them checked out, since leaving type 1 diabetes untreated can lead to major health problems.

Type 2 Diabetes in Children

Type 2 diabetes can occur at any age, including in children, even though it used to be called “adult onset” diabetes. Over the years, it’s become more common in kids as rates of childhood obesity have gone up. As noted above, risk factors for type 2 include being overweight, having a family member who also has type 2, or being born to a mom who had gestational diabetes.

Early signs of type 2 diabetes are similar to those listed above for type 1. Additionally, your child may also have darkening of parts of their skin, such as around their armpits or neck.

Diabetes is a disease, and living with it can be stressful. Some people in your life might not understand the condition and can’t grasp what you’re going through. But because diabetes is so common, there are a lot of people who do understand and can help make life a little easier.

One of the biggest challenges of living with diabetes can be the amount of “self-management” you need to do, like checking your blood sugar, giving yourself injections, taking medications correctly, and sticking to a healthy diet.

For this reason, many people find it useful to work with a certified diabetes care and education specialist (CDCES), formerly known as a certified diabetes educator (CDE). These healthcare providers, often registered nurses or registered dietitians, know the ins and outs of diabetes treatment and are able to come up with systems and solutions that work in real life.

If you find yourself feeling depressed and overwhelmed in the face of your diabetes diagnosis, don’t hesitate to tell your doctor. You are far from alone in feeling this way, and working with a diabetes educator, support group, and/or mental health professional can get you back on track.

Talking to people who know exactly what you’re going through can be just as important as finding a treatment plan that works. Here are some places to start to make connections, find resources, and meet friends.

Top Diabetes Instagrammers

There’s no shortage of influencers from the #T1D and #T2D communities on Instagram. Here’s a sprinkling of some of our favorites who are sharing diabetes-friendly recipes and stigma-squashing real talk:

• Mila Clarke Buckley, @thehangrywoman

  Follow because: She turns her lifestyle with diabetes (diagnosed with type 2 in 2016) into digital storytelling, sharing how to live with diabetes and still enjoy the finer things in life, like cheeseburgers and travel.

• Michelle Laine, APRN-BC, @diabadassaprn

  Follow because: This Yale University grad, family nurse practitioner, and Muay Thai kickboxing enthusiast is also a type 1 diabetes patient. Laine doesn’t sugarcoat (pardon the pun) her disease, but she does promise to never let it hold her back.

• Carrie Lane, @officialcarrielane

  Follow because: As a mama-to-be, Laine, who has type 1 diabetes, shares all about prepping to get pregnant, your ideal A1C levels during pregnancy, and how your body (and mind) change throughout. She’ll no doubt keep sharing through motherhood, so there’s no better time to go ahead and give her a follow.

• Carl Franklin and Carrie Brown, @2ketodudes

  Follow because: It’s no surprise to anyone that a lot of these 'grammers talk about food, because diabetes—especially type 2—is managed, in large part, with how you fuel your body. Their recipes range from gourmet eye candy to “hey, I can make that!”

• Christel Oerum, @diabetesstrong_ig

  Follow because: She turned a personal blog about exercise and nutrition for type 1 diabetes into one of the largest diabetes health websites, and created the ebook Fit With Diabetes to inspire anyone who is insulin-dependent.

Top Diabetes-Related Podcasts

If you’re an audiophile, you’re in luck—there is a plethora of podcasts about living with diabetes to help you feel less alone and more connected to this welcoming community.

• Diabetes Daily Grind. Amber Clour, who has lived with type 1 diabetes since childhood, brings together a team of people with type 1 or type 2 diabetes on this engaging podcast. The focus: Real advice about everyday life. No fluff, just reality.

• Juicebox. Scott Benner is an author, blogger, and stay-at-home dad of a daughter with type 1 diabetes. Though he doesn’t have diabetes himself, he had to learn to manage diabetes as if it were his own, since his daughter was only 2 when she was diagnosed.

• My Lazy Pancreas. Type 1 diabetes doesn’t have to hold you back from being an athlete. Kyle Masterman, whose goal is to cycle across Australia, brings on guests who are breaking barriers in sports and fitness—all while living with diabetes. Give it a listen on the way to the gym to help kick your butt into gear.

• 2 Keto Dudes. This podcast follows Carrie Brown and her pal Carl Franklin on their journey from metabolic syndrome and type 2 diabetes to a cleaner and healthier life, which they credit to following a keto diet. Expect convos on the pros, cons, and controversies of keto.

Top Diabetes Support Groups and Nonprofits

Want to get more connected with other people living the diabetes life? These nonprofits provide seemingly endless resources, including virtual and IRL support groups to connect directly with others who get what you’re going through.

• American Diabetes Association. With more than 565,000 volunteers, 540,000 members, and 400 staffers, this nonprofit is a force to be reckoned with. At the heart of their mission: Raising awareness about the impact of insulin prices and treatments for those with diabetes and advocating for policy changes.

• Diabetes Research Institute Foundation. It starts here with the scientists who are working to find a cure for those living with diabetes. Their goal, a little unconventional, is to put themselves out of business. A cure means their work is done!

• DiabetesSisters. While diabetes does not discriminate, there’s a whole world of the disease that only affects women (hello pregnancy, menopause, and other hormone-imbalanced moments). Come here for peer support, education, and stories of hope.

• JDRF (Formerly called Juvenile Diabetes Research Foundation). This one’s for the kids—or, more often than not, parents of kids fighting type 1 diabetes. The nonprofit is the leading global organization funding type 1 diabetes research, having raised $2 billion for research to date.

• Taking Control of Your Diabetes. The founder of this nonprofit is an endocrinologist who was diagnosed with type 1 diabetes at age 15. Steve Edelman, M.D., brings together patients and experts at conferences across the United States to help them better understand and manage their lives with diabetes.

While a diagnosis of diabetes can certainly throw your world off-kilter in some ways, you can learn to manage the condition and get back to living the life you want. These days, there are tons of highly effective ways to get your blood glucose levels under control, from tried-and-true medications to meaningful changes to your diet and exercise routine. And remember, you’re not alone: As you navigate this condition, don’t hesitate to reach out to those who can help you—whether that’s a loved one, your healthcare team, others in the diabetes community, or all of the above.

—Additional reporting by Lara DeSanto