RELATED STORIES • Diabetes nutrition: Eating out when you have diabetes • Blood sugar tests: Understanding your results • Diabetes treatment: Medications for type 2 diabetes • Januvia: New oral diabetes medication gets federal OK • Diabetes nutrition: Including sweets in your meal plan • Diabetes diet: New guidelines for healthy eating with diabetes • Reading food labels: Tips for people with diabetes • Diabetes symptoms: When to consult your doctor • Prediabetes • Diabetes risk self-assessment • Byetta: Effective diabetes and weight-loss drug? • Exubera: Is inhaled insulin right for you? • Diabetic hyperosmolar syndrome • Body shape: Does it increase your risk of diabetes? • Diabetic ketoacidosis • Hyperinsulinemia: Is it diabetes? • Diabetes lab tests: What's normal? • Diabetic gastroparesis • Alcohol and smoking: Risk factors for diabetes? • 'Diabetic arthritis': What does it mean? DIABETES AND ENDOCRINE SYSTEM Diabetes Complications • Peripheral neuropathy • Gestational diabetes • Type 1 diabetes • Diabetic retinopathy • Metabolic syndrome • Dehydration • Type 2 diabetes • Prediabetes • Diabetic coma • Diabetic hyperosmolar syndrome • Diabetic ketoacidosis DIABETES AND ENDOCRINE SYSTEM Endocrine System • Graves' disease • Hypoglycemia • Goiter • Male hypogonadism • Gestational diabetes • Type 1 diabetes • Hyperthyroidism • Hypothyroidism • Addison's disease • Hyperparathyroidism • Diabetic retinopathy • Cushing's syndrome • Acromegaly • Hypopituitarism • Thyroid nodules • Metabolic syndrome • Prolactinoma • Pituitary tumors • Dehydration • Primary aldosteronism • Hashimoto's disease • Pheochromocytoma • Type 2 diabetes • Prediabetes • Diabetic coma • Diabetic hyperosmolar syndrome • Diabetic ketoacidosis • Diabetes insipidus

Note: All links within content go to MayoClinic.com

Type 2 diabetes is a chronic condition that affects the way your body metabolizes sugar (glucose) — your body's main source of fuel.

Type 2 diabetes develops when your body becomes resistant to the effects of insulin — a hormone that regulates the absorption of sugar into your cells — or when your body produces some, but not enough, insulin to maintain a normal glucose level.

Nearly 21 million people in the United States have diabetes, according to the American Diabetes Association. About 90 percent to 95 percent of people with diabetes have type 2 diabetes. And the condition is on the rise, fueled largely by the current obesity epidemic.

The American Diabetes Association estimates that nearly one-third of people who have type 2 diabetes don't even know it. If the condition is left uncontrolled, the consequences can be life-threatening.

There's no cure for type 2 diabetes, but there's plenty you can do to manage — or prevent — the condition. Start by eating healthy foods, getting plenty of exercise and maintaining a healthy weight. If diet and exercise aren't enough, managing your blood sugar with medication can help you continue to live a healthy and active life.

Type 2 diabetes develops slowly. Many people have type 2 diabetes for several years before the condition is diagnosed, often through routine screening tests.

Typically, the earliest red flags are increased thirst and frequent urination. That's because excess glucose circulating in your body draws water from your tissues, making you feel dehydrated. To quench your thirst, you may drink more water and other beverages — which leads to more frequent urination.

Other signs and symptoms of type 2 diabetes include:

• Flu-like symptoms. Sugar is an important fuel. When it doesn't reach your cells, you may feel tired and weak.
• Weight fluctuations. Because your body is trying to compensate for lost fluids and sugar, you may eat more than usual and gain weight — which causes your cells to become more resistant to the action of insulin. But the opposite also can occur. You may eat more than normal but still lose weight because your muscle tissues don't get enough glucose to generate growth and energy.
• Blurred vision. High levels of blood sugar pull fluid from your tissues, including the lenses of your eyes. This affects your ability to focus. Once your diabetes is treated and your blood sugar levels drop, your vision should improve. Over a period of years, however, diabetes can also cause new blood vessels to form in your retina — the back part of your eye — as well as damage old vessels. For most people this causes only mild vision problems. But for others, the effects can be much more serious. In some cases, diabetes can lead to blindness.
• Slow-healing sores or frequent infections. Diabetes affects your body's ability to heal and fight infection. Bladder and vaginal infections can be a particular problem for women.
• Nerve damage (neuropathy). Excess sugar in your blood can damage the small blood vessels to your nerves. You may notice tingling and loss of sensation in your hands and feet, as well as burning pain in your arms, hands, legs and feet.
• Red, swollen, tender gums. Diabetes increases the risk of infection in your gums and in the bones that hold your teeth in place. Your gums may pull away from your teeth, your teeth may become loose, or you may develop sores or pockets of pus in your gums — especially if you have a gum infection before diabetes develops.

During digestion, your body breaks down carbohydrates from foods such as bread, rice, pasta, vegetables, fruits and dairy products into various sugar molecules. One of these sugar molecules is glucose, a main source of energy. Glucose is absorbed directly into your bloodstream after you eat, but it can't enter your cells without the help of insulin.

Your pancreas — a gland located just behind your stomach — produces insulin continuously. When your blood sugar increases after eating, insulin production also increases. The extra insulin "unlocks" your cells to more sugar, which provides your body with energy and helps maintain a normal level of sugar in your blood.

Your liver also plays a key role in maintaining a normal blood sugar level. If you have more glucose than your cells need for energy, your body can remove the excess from your bloodstream and store it in your liver as glycogen. Then, when you run low on glucose — if you haven't eaten for a while, for example — your body can tap into the stored glucose and release it into your bloodstream.

When your pancreas is functioning normally, the amount of glucose in your blood fluctuates in response to a number of factors, including the type of food you eat, exercise, stress and infections. But the complex relationship between insulin, glucose, your liver and other hormones ensures that your blood sugar stays within set limits.

In type 2 diabetes, your pancreas makes some insulin, but one or two other problems develop:

• Your muscles and body tissue become resistant to insulin.
• Your pancreas doesn't make enough insulin.

When your cells become resistant to insulin, they refuse to accept it as the key that unlocks the door for sugar. As a result, sugar accumulates in your bloodstream. Exactly why the cells become insulin resistant is uncertain, although excess weight, inactivity and fatty tissue seem to be important factors.

Although researchers don't fully understand why some people get type 2 diabetes and others don't, it's clear that certain factors increase your risk. These factors include:

• Weight. Being overweight is one of the main risk factors for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to your own insulin. Still, it's not just a matter of how much you weigh. It also depends on where the weight is distributed. If you have extra weight in the upper part of your body — particularly around your abdomen — you're especially at risk. The good news is that many people with type 2 diabetes who are overweight can improve their glucose levels simply by losing weight.
• Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose, makes your cells more sensitive to insulin, increases blood flow and improves circulation in even the smallest blood vessels. Exercise also helps build muscle mass. That's important because most of the glucose in your blood is absorbed into your muscles. When you have less muscle tissue, more sugar stays in your blood.
• Family history. The risk of type 2 diabetes increases if you have a parent or sibling with the disease. In fact, researchers have confirmed that a variant in a particular gene increases the risk of developing type 2 diabetes. In a July 2006 study, the risk of developing diabetes was about 80 percent higher for participants who inherited two copies of the newly identified gene variant than for participants who didn't carry the variant.
• Age. The risk of type 2 diabetes increases as you get older, especially after age 45. Often, that's because people tend to exercise less, lose muscle mass and gain weight as they age. But diabetes is also increasing dramatically among children, adolescents and younger adults.
• Race. For reasons that aren't entirely clear, people of some races are more likely to develop diabetes. More than 6 percent of the general population has diagnosed diabetes, according to the American Diabetes Association. But that rate doubles for blacks and Hispanics and more than doubles for American Indians. Among the Pima Indians of Arizona, half of all adults have type 2 diabetes — one of the highest rates of diabetes in the world.
• Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes is greater. If you gave birth to a baby weighing more than 9 pounds, you're also at risk of type 2 diabetes.
• Depression. Depression seems to increase the risk of type 2 diabetes, possibly because people with depression often gain weight and are inactive.

See your doctor right away if you notice any of the signs and symptoms of type 2 diabetes, especially increased thirst and urination. And if you have type 2 diabetes, get regular checkups to monitor your condition.

How often you see your doctor or other members of your health care team for checkups depends on how well you're doing. If you're having trouble managing your blood glucose levels or if you're changing medication, you may need to contact a member of your health care team every week. Your doctor may even recommend that you stop in daily until your blood sugar level stabilizes.

But if you're feeling well and keeping your blood sugar within the range you and your doctor have agreed on, you may need checkups only once every three months.

In addition, have a thorough physical exam every year. During this exam, your doctor will look for any medical problems related to your diabetes.

Because foot care is especially important for people with diabetes, your doctor may recommend that you see a podiatrist — a doctor who specializes in foot care. A podiatrist can teach you how to trim your toenails to avoid infections, buy properly fitted shoes, and prevent corns and calluses. If you have poor blood circulation in your legs or aren't able to see well enough to trim your nails, have your podiatrist do it for you.

Most people with diabetes should also have a thorough eye exam every year. If your diabetes isn't well controlled or if you have high blood pressure or kidney disease or are pregnant, you may need to see your ophthalmologist more often.

Many people first learn they have type 2 diabetes through blood tests done for another condition or as part of a routine exam. But in some cases, type 2 diabetes may not be detected before damage to your eyes, kidneys or other organs has occurred. That's why the American Diabetes Association recommends that all adults have a fasting blood glucose test at age 45. If the test results are normal, repeat the test every three years. If your results are borderline, have a fasting blood sugar test every year.

Although the amount of sugar in your blood fluctuates, the range is relatively narrow. After fasting all night, most people have levels between 70 and 100 milligrams of glucose per deciliter of blood (mg/dL). That's the equivalent of about 1 teaspoon of sugar in a gallon of water. If you consistently have fasting glucose levels above 126 mg/dL, you likely have type 2 diabetes.

Tests that can detect diabetes include:

• Random blood sugar test. This test is part of routine blood work done during a physical exam. Your blood is drawn through a needle inserted into a vein in your arm and sent to a lab for testing. Because you don't necessarily fast for this test, your blood sugar may be high because you've just eaten. Even so, it shouldn't be higher than 200 mg/dL. If it is, you likely have diabetes.
• Fasting blood glucose test. In general, your blood sugar is highest right after you eat and lowest after an overnight fast. That's why the preferred way to test your blood sugar is after you've fasted overnight or for at least eight hours. For this test, blood is drawn from a vein in your arm and sent to a lab for analysis. If your fasting blood sugar measures 126 mg/dL or higher, your doctor may repeat the test. If the results of the second test are the same, you likely have diabetes.
• Glucose challenge test. Often used to screen pregnant women for gestational diabetes, a glucose challenge test requires that you drink 8 ounces of an extremely sweet liquid after fasting for six hours. Your blood sugar is measured before you drink the liquid, then every hour for a three-hour period. If your blood sugar rises more than expected and doesn't return to normal by the third hour, you likely have diabetes.
• Glycated hemoglobin (A1C) test. Some of the glucose in your bloodstream attaches to hemoglobin, a protein found in red blood cells. This is known as glycated hemoglobin or A1C. An A1C test provides an indication of your average blood glucose level over the past two to three months. Test results show what percentage of your hemoglobin is sugar coated (glycated) — ideally less than 7 percent.

Type 2 diabetes can be easy to ignore, especially in the early stages when you're feeling fine and have no signs or symptoms. But diabetes affects nearly every major organ in your body, including your heart, nerves, eyes and kidneys. By keeping your blood sugar close to normal, you can dramatically reduce your risk of complications.

Short-term complications
Short-term complications require immediate care.

• Low blood sugar (hypoglycemia). This occurs when the level of glucose in your blood drops below 70 mg/dL. It's most common in people taking insulin, but it can also occur if you take oral medications that enhance the action of insulin. Your blood sugar can drop for many reasons, including skipping a meal, exercising more strenuously than normal or not adjusting your medication when your blood sugar levels change.

  Early signs and symptoms of low blood sugar include sweating, shakiness, weakness, hunger, dizziness and nausea. If your blood sugar falls below 40 mg/dL, you may have slurred speech, drowsiness and confusion. If you experience any of these signs or symptoms, eat or drink something that will quickly raise your blood sugar level, such as hard candy, a regular (non-diet) soda, fruit juice or glucose tablets made especially for treating low blood sugar.

  Sometimes blood sugar levels fall low enough to cause a coma. This is a life-threatening condition. The best treatment is an injection of glucagon, a hormone that stimulates the release of sugar into your blood. If you take insulin, always keep a glucagon kit nearby. Make sure your family and friends know how to give you this injection.

• High blood sugar (diabetic hyperosmolar syndrome). This condition causes your blood sugar to become so high — 600 mg/dL or more — that your blood actually becomes thick and syrupy. It's most common in people with uncontrolled type 2 diabetes, or those who don't know they have diabetes. It can also occur if you take high doses of steroids, drink large amounts of alcohol, are under stress, or have an illness or infection. Signs and symptoms include excessive thirst and increased urination, weakness, leg cramps, confusion, convulsions and even coma. Left untreated, excessively high blood sugar can be fatal.
• Increased blood acids (diabetic ketoacidosis). Sometimes your cells become so starved for energy that your body begins to break down fat, producing toxic acids known as ketones. The signs and symptoms — including loss of appetite, nausea, vomiting, fever, stomach pain and a sweet, fruity smell on your breath — can easily be mistaken for the flu. Check for excess urinary ketones if you're sick or very stressed or if your blood sugar is persistently above 240 mg/dL. You can buy a ketones test kit at most drugstores and perform the test at home. If the test reveals a high ketone level, call your doctor right away. Left untreated, diabetic ketoacidosis can lead to a coma and possibly death.

Long-term complications
Long-term complications develop gradually.

• Nerve damage (neuropathy). More than half of all people with diabetes eventually have some type of nerve damage, possibly because excess sugar injures the walls of the tiny blood vessels (capillaries) that nourish your nerves. Signs and symptoms depend on which nerves are affected. Most often, diabetes damages the sensory nerves in your legs and sometimes your arms. This can cause tingling, numbness, burning or pain that usually begins at the tips of your toes or fingers and over a period of months or years gradually spreads upward. If not treated, you could lose all sense of feeling in the affected limbs. And because you may not feel any discomfort in your feet, sores can turn into skin ulcers without you realizing it. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation.

• Kidney damage (nephropathy). Your kidneys contain millions of tiny blood vessels that filter waste from your blood and eliminate it in your urine. But diabetes can damage this delicate filtering system. By the time you develop signs and symptoms — such as swollen ankles, feet or hands, anemia, shortness of breath, and high blood pressure — extensive damage may have already occurred. Severe damage can lead to kidney failure or irreversible end-stage renal disease, requiring dialysis or a kidney transplant.

  The earlier diabetes develops, the greater the concern. In a July 2006 study, American Indians who developed type 2 diabetes before age 20 had a substantially higher risk of end-stage kidney disease and death between ages 25 and 55 than did American Indians who developed diabetes later in adulthood.

• Eye damage (retinopathy). Type 2 diabetes can deteriorate the blood vessels of the retina (diabetic retinopathy). Diabetes can also lead to cataracts and a greater risk of glaucoma. Although many people experience only mild eye changes, some changes are more severe. Diabetes is the leading cause of blindness among adults ages 20 to 74.
• Heart and blood vessel (cardiovascular) disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure. It may also raise blood levels of triglycerides, a type of blood fat, and lower levels of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol that may offer protection from heart disease.
• Infections. High blood sugar impairs your immune system and increases your risk of infections. Your mouth, gums, lungs, skin, feet, kidneys, bladder and genital area are all susceptible to infection.
• Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. In fact, studies suggest that people who have type 2 diabetes are twice as likely to develop Alzheimer's disease as are otherwise healthy adults of the same age and sex. Researchers are considering possible connections between the two conditions. One theory is that cardiovascular problems caused by diabetes could contribute to dementia by blocking blood flow to the brain or causing strokes. Another possibility is that too much insulin in the blood leads to inflammation, which can damage the brain.

Controlling your blood sugar is essential to feeling healthy and avoiding long-term complications of type 2 diabetes. Some people are able to control their blood sugar with diet and exercise alone. Others may need to take medications, in addition to making lifestyle changes. In either case, monitoring your blood sugar is a key part of your treatment program.

Monitoring your blood sugar
If you've just been diagnosed with diabetes, monitoring your blood sugar may seem like an overwhelming task. But once you learn to measure your blood sugar and understand how important it is, you'll feel more comfortable with the procedure and more in control of your disease.

Testing is crucial because it tells you whether you're keeping your glucose levels in the range you and your doctor have agreed on. Your doctor sets this target range based on your age, the presence of diabetes complications or other medical conditions, and whether you can tell when your blood sugar is low. The ideal target range before meals is 90 to 130 mg/dL, and below 180 mg/dL two hours after meals.

If you have type 2 diabetes and don't use insulin, you may need to test your blood sugar levels only once a day or as little as twice a week. Keep in mind that the amount of sugar in your blood is constantly changing. Self-monitoring — blood sugar testing and recording the results — helps you learn what makes your blood sugar levels rise and fall, so you and your health care team can make adjustments in your treatment. Factors that affect your blood sugar include:

• Food. Food raises your blood sugar level — it's highest one to two hours after a meal. What and how much you eat, and the time of day, also affect your blood sugar level.
• Exercise and physical activity. The more active you are, the lower your blood sugar. Physical activity causes sugar to be transported to your cells, where it's used for energy. Aerobic exercises such as brisk walking, jogging or biking are especially good ways to lower your blood sugar. But gardening, housework and even just being on your feet all day also can lower your blood sugar.
• Medications. The purpose of oral diabetes medications is to lower your blood sugar. But medications you take for other conditions may affect glucose levels as well. Corticosteroids, in particular, may raise blood sugar levels. Medications such as thiazides, used to control high blood pressure, and niacin, used for high cholesterol, also may increase blood sugar. Certain high blood pressure medications can affect blood glucose so dramatically that your doctor will likely make changes in your diabetes treatment to even things out.
• Illness. The physical stress of a cold or other illness causes your body to produce hormones that raise your blood sugar level. The additional sugar helps promote healing. But if you have diabetes, this can be a problem. In addition, a fever increases your metabolism and your cells' rate of glucose utilization, which can alter the amount of insulin you need. Be sure to monitor your glucose levels frequently when you're sick.
• Alcohol. Even a small amount of alcohol — about 2 ounces — can cause your blood sugar level to rise or fall. If you choose to drink, do so only in moderation. And monitor your blood sugar before and after you drink alcohol to see how it affects you. Also, keep in mind that alcohol counts as carbohydrate calories in your diet.

• Fluctuations in hormone levels. The female hormone estrogen typically makes cells more responsive to insulin, while progesterone makes cells more resistant. Although these two hormones fluctuate throughout the menstrual cycle, most women don't notice a corresponding change in blood sugar levels. Those who do are more likely to experience changes in blood sugar during the third week of their menstrual cycle, when estrogen and progesterone levels are highest.

  Hormone levels also fluctuate during perimenopause — the time before menopause. How this affects blood sugar varies, but most women can control signs and symptoms with additional exercise and changes in their diet. If your symptoms are more severe, your doctor may recommend oral contraceptives or hormone replacement therapy (HRT). After menopause, many women with diabetes require less medication because their cells are more sensitive to insulin.

A healthy diet
Contrary to popular belief, there's no single diabetes diet. And having diabetes doesn't mean you have to eat only bland, boring foods. Instead, it means you'll eat more fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. Actually, it's the same eating plan that's recommended for everyone.

Yet understanding what and how much to eat can be challenging. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. Your dietitian may recommend developing your meal plan based on the dietary exchange system, carbohydrate counting or the glycemic index.

Once you've decided on a meal plan, remember the importance of consistency. To keep your blood sugar at a consistent level, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.

But even with all the information you need and the best intentions, sticking to your diet can be one of the most challenging parts of living with diabetes. The key is to find ways to stay motivated. Don't let others undermine your determination to eat in the healthiest way possible. You have to believe that what you're doing matters — and that you're worth it.

Exercise
Everyone needs regular aerobic exercise, and people with diabetes are no exception. In fact, the same exercises that are good for your heart and lungs also help lower your blood sugar levels.

Consult your doctor before beginning an exercise program. Once you have your doctor's OK, think about the activities you enjoy and those you're most likely to do consistently. Walking, hiking, jogging, biking, tennis, cross-country skiing and swimming are all good choices.

Aim for at least 30 minutes of aerobic exercise most days. But if you haven't been active for a while, start slowly and build up gradually. For the best results, combine your aerobic activity with stretching and strength training exercises.

Healthy weight
Fat makes your cells more resistant to insulin. But when you lose weight, the process reverses and your cells become more receptive to insulin. For some people with type 2 diabetes, weight loss is all that's needed to restore blood sugar to normal. A modest weight loss of 10 to 20 pounds is often enough.

Yet losing even 10 pounds can be a challenge for most people. Fortunately, you don't have to do it alone. A registered dietitian can help you develop a weight-loss plan based on your current weight, activity level, age and overall health.

Medications
If diet, exercise and maintaining a healthy weight aren't enough, you may need medication. Various drugs may be used to treat type 2 diabetes, including:

• Sulfonylurea drugs. These medications stimulate your pancreas to produce and release more insulin, as long as your pancreas already produces some insulin on its own. Second-generation sulfonylureas such as glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase, Micronase) and glimepiride (Amaryl) are prescribed most often. The most common side effect is low blood sugar, especially during the first four months of therapy. You're at much greater risk of low blood sugar if you have impaired liver or kidney function.
• Meglitinides. These medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but they're not as likely to lead to low blood sugar. Meglitinides work quickly, and the results fade rapidly.
• Biguanides. Metformin (Glucophage, Glucophage XR) is the only drug in this class available in the United States. It works by inhibiting the production and release of glucose from your liver, which means you need less insulin to transport blood sugar into your cells. One advantage of metformin is that it tends to cause less weight gain than do other diabetes medications. Possible side effects include a metallic taste in your mouth, loss of appetite, nausea or vomiting, abdominal bloating, or pain, gas and diarrhea. These effects usually decrease over time and are less likely to occur if you take the medication with food. A rare but serious side effect is lactic acidosis, which results when lactic acid builds up in your body. Symptoms include fatigue, weakness, muscle aches, dizziness and drowsiness. Lactic acidosis is especially likely to occur if you mix this medication with alcohol or have impaired kidney function.
• Alpha-glucosidase inhibitors. These drugs block the action of enzymes in your digestive tract that break down carbohydrates. This means sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise in blood sugar that usually occurs right after a meal. Drugs in this class include acarbose (Precose) and miglitol (Glyset). Although safe and effective, alpha-glucosidase inhibitors can cause abdominal bloating, gas and diarrhea. If taken in high doses, they may also cause reversible liver damage.
• Thiazolidinediones. These drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose. Side effects of thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos), include swelling, weight gain and fatigue. A far more serious potential side effect is liver damage. If your doctor prescribes these drugs, it's important to have your liver checked every two months during the first year of therapy. Contact your doctor immediately if you experience signs or symptoms of liver damage, such as nausea and vomiting, abdominal pain, loss of appetite, dark urine, or yellowing of your skin and the whites of your eyes (jaundice). These may not always be related to diabetes medications, but your doctor will need to investigate all possible causes.
• Amylin mimetics. Pramlintide (Symlin) mimics the action of amylin, a protein secreted by the pancreas. This medication slows down the movement of food through your stomach after meals. As a result, it affects how rapidly glucose enters your bloodstream. Pramlintide is designed for adults with type 2 diabetes who require insulin and aren't reaching their target blood sugar levels. As with most types of insulin, you must inject this drug. However, you can't mix it with insulin in the same syringe, so you must give yourself two injections before meals.
• Incretin mimetics. Exenatide (Byetta) mimics the action of the hormone incretin, which helps regulate fasting glucose levels and glucose levels after meals. Exenatide is an injectable drug that is used with metformin (Glucophage, Glucophage XR) or with a combination of metformin and a sulfonylurea. You inject this drug an hour before your morning and evening meal using a pre-filled injector pen.
• DPP-4 inhibitors. Sitagliptin phosphate (Januvia) is an oral diabetes medication in a new class of drugs known as DPP-4 inhibitors. The medication blocks an enzyme called dipeptidyl peptidase 4, or DPP-4, which breaks down the proteins that trigger the release of insulin. The result is better insulin release and blood sugar control. The most common side effects of sitagliptin phosphate are upper respiratory tract infection, sore throat and diarrhea.
• Drug combinations. By combining drugs from different classes, you may be able to control your blood sugar in several different ways. Each class of oral medication can be combined with drugs from any other class. Most doctors prescribe two drugs in combination, although sometimes three drugs may be prescribed. Some medications, such as Glucovance, which contains both glyburide and metformin, combine different oral drugs in a single tablet.

• Insulin. Some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce. Unfortunately, insulin can't be taken in pill form because enzymes in your stomach break it down, making it ineffective. Many people inject themselves with insulin by using a syringe or an insulin pen injector — a device that looks like a pen, except the cartridge is filled with insulin.

  Inhaled insulin (Exubera) is now available as well. Approved by the Food and Drug Administration (FDA) in January 2006, inhaled insulin is a powdered form of insulin absorbed by the lungs through the use of a hand-held inhaler. Inhaled insulin is rapid acting, usually taken before a meal. It replaces only short-acting forms of injectable insulin — not the longer acting (basal) insulin that may be required as part of a diabetes treatment program.

  The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but manufactured in a lab. Unfortunately, synthetic human insulin isn't perfect. One of its chief failings is that it doesn't mimic the way natural insulin is secreted. But newer types of insulin, known as insulin analogs, more closely resemble the way natural insulin acts in your body. Among these are lispro (Humalog), aspart (NovoLog), glargine (Lantus) and glulisine (Apidra).

Healthy lifestyle choices can help you prevent type 2 diabetes. Even if diabetes runs in your family, diet and exercise can help you prevent the disease. And if you've already been diagnosed with diabetes, the same healthy lifestyle choices can help you prevent potentially serious complications.

• Eat healthy foods. Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition.
• Get more physical activity. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.
• Lose excess pounds. If you're overweight, losing even 10 pounds can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glucophage) and rosiglitazone (Avandia) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.

Your health care team can provide helpful advice, but it's up to you to follow through.

• Make a commitment to managing your diabetes. Learn all you can about type 2 diabetes. The more you know, the better you'll be able to control it. Monitor your glucose levels, eat well, exercise and maintain a healthy weight. Ask your health care team for help if your best efforts aren't enough to control your blood sugar.
• Schedule a yearly physical. It's important to have a thorough physical exam every year in addition to your regular diabetes checkups. This is an opportunity to check for complications of diabetes and to screen for conditions such as cardiovascular and kidney diseases.
• Schedule a yearly eye exam. By the time signs and symptoms of diabetic retinopathy develop, you may have sustained permanent damage to your eyes. Make sure your eye care specialist knows you have diabetes. He or she should check for signs of retinal damage and cataracts and test you for glaucoma.
• Take good care of your teeth and gums. People with type 2 diabetes are prone to gum infections. Brush and floss your teeth at least twice a day, and schedule twice-a-year dental cleanings. Consult your dentist if your gums bleed or look red or swollen.
• Keep your vaccinations current. Because high blood sugar can weaken your immune system, you may be more likely to get influenza or pneumonia — and to experience more serious effects — than may people who don't have diabetes. Ask your doctor about a yearly flu shot, as well as vaccination for pneumonia and hepatitis B. Make sure you're up-to-date on your tetanus booster shots as well.

• Take care of your feet. Diabetes can damage nerves in your feet, which reduces your ability to feel pain. You may develop a cut or other injury without realizing it. And because diabetes reduces blood flow to your feet, it's harder for sores to heal. To help prevent foot problems, check your feet every day for blisters, cuts, bruises, cracked or peeling skin, and redness or swelling.

  Wash your feet daily in lukewarm water, including between the toes. Dry them gently and moisturize well. Diabetes may cause you to sweat less, which can lead to cracked, dry skin. When you trim your toenails, take care not to injure the surrounding skin. If you have poor blood circulation in your legs or aren't able to see well enough to trim your nails, have your podiatrist do it for you. Wear moisture-wicking socks and well-fitting shoes with flexible soles and soft leather tops that allow your feet to breathe. To prevent pressure sores on your feet, make sure your socks don't bunch or wrinkle inside your shoes. And be sure to see your doctor if any sores on your feet don't start to heal in a few days.

• Don't smoke. People with diabetes who smoke are three times as likely to die of cardiovascular disease or stroke as are nonsmokers. Smoking also increases the risk of nerve damage and kidney disease. Talk to your doctor about ways to quit smoking.
• Avoid alcohol. Alcohol prevents the release of glucose from your liver and can increase the risk of your blood sugar falling too low. If you drink alcoholic beverages, do so only in moderation. It also helps to eat first.
• Take a daily aspirin. Taking an aspirin every day after age 40 may reduce your risk of heart attack. But keep in mind that regular aspirin use can cause stomach irritation, bleeding or ulcers and can make you bruise more easily. Talk with your doctor to make sure aspirin is safe for you and, if so, which strength you should take. Anyone younger than age 21 shouldn't take aspirin because of the risk of Reye's syndrome — a potentially life-threatening condition.
• Monitor your blood pressure. If you have diabetes, you're twice as likely to develop high blood pressure as you'd be if you didn't have the disease. The risk for blacks and Hispanics is even higher. The combination of diabetes and high blood pressure is serious because both conditions can damage your blood vessels, increasing your risk of heart attack, stroke and other life-threatening conditions. But eating healthy foods and exercising regularly can help reduce your blood pressure. If lifestyle changes aren't enough, your doctor may recommend medications such as angiotensin-converting enzyme (ACE) inhibitors. The blood pressure goal for most people with diabetes is less than 130/80 millimeters of mercury.

• Monitor your cholesterol. Unhealthy levels of cholesterol and triglycerides can cause cardiovascular disease in anyone, with type 2 diabetes or without. But as with high blood pressure, the damage is usually worse and more rapid when you have diabetes. People with type 2 diabetes often have high triglycerides and a decreased level of high-density lipoprotein (HDL), or "good," cholesterol. Particles of low-density lipoprotein (LDL), or "bad," cholesterol are usually smaller and denser, making them more likely to block blood vessels.

  Your targets: LDL below 100 milligrams per deciliter (mg/dL) — perhaps as low as 70 mg/dL if you have other heart disease risk factors; HDL 60 mg/dL or above; triglycerides below 150 mg/dL.

• Learn to manage stress. Constantly dealing with stress can make it more difficult to take care of yourself and manage your diabetes. You may find yourself eating all the wrong foods or forgetting to exercise or take your medications. And prolonged stress can cause your blood sugar levels to rise even if you stick to your diet and medication plan. To manage stress, consider techniques such as yoga, meditation, tai chi or deep-breathing exercises.

Do your best to stay positive. Diabetes is a serious illness, but it can be controlled. If you're willing to do your part, you can continue to enjoy an active and healthy life.