Let's Talk About Type 2 Diabetes Symptoms
Clues to this common disease can be surprisingly subtle. Knowing what to look for can help you stay on top of your health.by Sunny Sea Gold Health Writer
Maybe your dad developed type 2 diabetes at age 45 and you’re just one birthday away. Or maybe you’ve noticed an unusual uptick in your thirst lately and wonder what it could mean. No matter what your reason for worrying about type 2 diabetes, the good news is that the disease is very treatable if you catch it early. Here's what to look for with this chronic condition.
Our Pro Panel
We went to some of the nation’s top experts in diabetes to bring you the most up-to-date information possible.
Anthony Nguyen, D.O.
Family Medicine Physician, Diabetes Health Initiative
Providence Hospital/Ascension Health
Stelios Mantis, M.D.
Rush University Medical Center
Katherine Araque, M.D.
Director of Endocrinology
Pacific Neuroscience Institute at Providence Saint John’s Health Center
Santa Monica, CA
The classic symptoms of type 2 diabetes are increased thirst and having to pee a lot. Sometimes, you may feel the urge to urinate, but little or nothing comes out. Other symptoms include fatigue, headaches, and darker, velvety patches of skin, often in the folds of your skin.
When too much glucose is flooding your bloodstream, your body tries to dilute it to healthier levels, even going so far as to use water from surrounding tissues, like your muscles. When they become dehydrated, they in turn signal your brain to tell you you’re thirsty so you’ll drink more.
Type 2 diabetes is treatable with diet and exercise changes and medications that lower the levels of sugar in the blood. (Some people with type 2 diabetes also take insulin.) Although there is no cure, some people may be able to keep blood sugar levels stable and lower through diet and exercise alone.
Everyone’s body reacts differently to foods and diet plans, so there’s no magic bullet. But vegetarian and vegan diets, a traditional Mediterranean diet rich in vegetables and seafood, and low-carbohydrate diets have all been shown to lower blood sugar and reduce the risk of developing type 2 diabetes.
What Exactly Is Type 2 Diabetes?
Of the 30 million cases of diabetes in the United States, 90% to 95% are type 2—if you know someone with diabetes (or if you have the disease), chances are it’s this type. Type 2 diabetes, like all forms of the disease, is characterized by high amounts of sugar (glucose) in the blood.
Here how it gets there: After you eat, your digestive system goes to work breaking down the food into glucose (among other things). When the glucose enters the bloodstream, and your pancreas responds by releasing insulin, a hormone that helps move glucose into fat and muscle cells where it is used for energy. Your brain, heart, muscles, and just about everything else in your body rely on glucose for fuel.
But in type 2 diabetes, although your pancreas usually makes plenty of insulin, your body doesn’t use it very well. It starts to take more and more insulin to help muscle and fat cells absorb glucose, where it will be converted into energy. Eventually, your pancreas can’t keep up and your blood sugar rises.
Left untreated, type 2 diabetes increases your risk of heart disease and can lead to complications like vision loss, kidney issues, nerve pain, foot problems, and even amputations. The good news is that type 2 diabetes is highly treatable. Some people are able to keep it in check with a healthy diet and regular exercise, but most need to take medication.
What Are the Symptoms of Type 2 Diabetes?
A tricky thing about diabetes symptoms: They are often mild and come on so slowly that they’re easy to miss or dismiss. That explains why about 25% of people living with type 2 diabetes don’t even know they have it.
These are some of the signs of type 2 diabetes. As always, checking one or more boxes doesn’t automatically mean you have the disease. But it does mean you should see your doctor to make sure everything is OK.
Classic Warning Signs of Type 2 Diabetes
There are two “signature” symptoms of the disease:
Thirst: Some people with type 2 diabetes feel like no matter how much they drink, they can’t quench their thirst. That’s because when there’s too much sugar, or glucose, in the bloodstream, your body pulls water from surrounding tissues to try to dilute it, leaving you dehydrated.
Frequent urination: The more you drink, the more you pee, but an increase in urination also comes from your kidneys working overtime to filter sugar out of your blood and dump it into your urine. 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.
Early Symptoms of Type 2 Diabetes
Along with the biggies—frequent urination and thirst—these early, subtle signs suggest that your blood sugar could be elevated:
Fatigue and muscle weakness: Glucose is one of your body’s most important sources of energy—but with diabetes, much of it remains circulating in the bloodstream instead of entering your cells the way it’s supposed to. Without fuel, cells struggle to do their basic jobs, from sending signals to make your muscles contract to helping neurons in your brain form connections.
Feeling hungrier: To try to get the energy it needs to function, the brain ramps up hunger signals and cravings. But eating more doesn’t help because again, the glucose from the food you eat remains trapped in the bloodstream instead of being funneled to the cells for energy.
Diabetes headaches: When your body finds itself short of the glucose it needs to function, your central nervous system may send pain signals, in the form of headaches, as a warning sign. In addition, dehydration from excessive urination may also lead to headache pain, although the exact mechanism remains unclear. Lastly, high blood sugar may lead to increased production of epinephrine and norepinephrine, hormones that can constrict blood vessels in the brain.
Dark patches of skin: In type 2 diabetes, your pancreas pumps out large amounts of insulin to try and move glucose from your blood into your body’s cells for energy. High levels of insulin can cause skin cells to multiply rapidly, resulting in darkened, velvety-feeling patches of skin called acanthosis nigricans. They can occur anywhere on your body, but are often found in skinfolds of the neck, groin, or armpit.
What Do I Do If I Have Symptoms?
The U.S. Preventive Services Task Force recommends that anyone over age 40 with a BMI of 25 or more should be screened for diabetes, then checked every three years thereafter. But even if that’s not you, if you’re noticing any of the warning signs above, talk to your doctor about testing for type 2 diabetes.
There are three ways to do that:
A1C (or glycated hemoglobin) test: This common 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 score. An A1C result below 5.7 is considered normal; 5.7 to 6.4 is prediabetic; 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 is normal; 100 to 125 mg/dL is prediabetic; 126 mg/dL indicates diabetes. Your doctor will likely want to do the test twice before officially diagnosing you.
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 indicates diabetes.
Signs of Severe Type 2 Diabetes
The longer your blood sugar stays high, the more damage it does to nerves, blood vessels, and other organs in the body. In cases of prolonged high blood sugar, you may experience these symptoms:
Tingling toes: Over time, excess blood sugar can damage your nerve endings, leading to tingling, burning, or numbness in your hands and feet.
Skin infections: High glucose levels interfere with white blood cells’ ability to fend off bacterial and fungal infections. Cuts, scrapes, and other wounds also tend to take longer to heal because of poor blood flow to the skin surface, further boosting the risk of infection. Severe infections that don’t heal can lead to amputations.
Ketoacidosis: In an effort to get the fuel it needs, your body may break down fat, in lieu of glucose, for energy. This floods the bloodstream with substances called ketones which make the blood acidic and potentially toxic. Ketoacidosis is more common in type 1 diabetes, but it can also happen in people with type 2.
If all this seems like a lot to absorb, take a deep breath. Type 2 diabetes is a challenging condition, but it’s also manageable. Making modifications to your diet and exercise routine will greatly help with many of these symptoms. Medication can also lower your blood sugar levels, so you can get back to feeling good and living strong.
Diabetes Prevalence: National Institute of Diabetes and Digestive and Kidney Diseases. (2019). “Current Burden of Diabetes in the U.S.” niddk.nih.gov/health-information/communication-programs/ndep/health-professionals/practice-transformation-physicians-health-care-teams/why-transform/current-burden-diabetes-us
Diabetes Definition: National Institute of Diabetes and Digestive and Kidney Diseases. (2019). “Type 2 Diabetes.” niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes#whois
Diabetes and Symptoms: National Institute of Diabetes and Digestive and Kidney Diseases. (2019). “Symptoms & Causes of Type 2 Diabetes.” niddk.nih.gov/health-information/diabetes/overview/symptoms-causes#type2
Diabetes and Headache: Mayo Clinic. (2020). “Hyperglycemia in Diabetes.” mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631
Diabetes and Skin Conditions: American Academy of Dermatology. (2020.) “Diabetes: 12 Warning Signs that Appear on Your Skin.” aad.org/diseases/a-z/diabetes-warning-signs
Diabetes and Nerve Damage: Mayo Clinic. (2020). “Diabetic Neuropathy.” mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580
Diabetes and Screening: American Family Physician. (2016). “Diabetes Mellitus: Screening and Diagnosis.” aafp.org/afp/2016/0115/p103.html
Diabetes and Diagnostic Tests: Mayo Clinic. (2019). “Diabetes.” mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451
Diabetes and Ketones Urine Test: US National Library of Medicine/MedlinePlus. (2019). “Ketones in Urine.” medlineplus.gov/lab-tests/ketones-in-urine/
Diabetes and Ketoacidosis: U.S. National Library of Medicine MedlinePlus. (2020.) “Diabetic Ketoacidosis.” medlineplus.gov/ency/article/000320.htm