How is Diabetes Diagnosed?
Several tests may be used for diagnosing diabetes. A simple blood test known as a hemoglobin A1C (or glycated hemoglobin test) measures average blood glucose levels over the past three months. (Why three months? Because glucose attaches to a protein called hemoglobin in red blood cells, and those cells get recycled and replenished about every three months.)
A normal A1C is below 5.7%. A higher percentage reflects higher blood glucose levels. Prediabetes is defined as a reading of 5.7 to 6.4, while diabetes is diagnosed when glucose levels reach 6.5% or higher.
A fasting plasma glucose test measures blood glucose at a single point in time. Generally, this test is performed first thing in the morning before breakfast, after at least eight hours of fasting. A normal reading is less than 100 milligrams per deciliter (mg/dl). A reading of 100 to 125 mg/dl signals prediabetes, and a reading of 126 mg/dl or higher indicates diabetes.
An oral glucose tolerance test measures your body’s ability to handle glucose. It is mostly used to diagnose gestational diabetes. First, blood is drawn after an overnight fast. Then you drink a special glucose solution, and your blood is drawn again two hours later. A normal reading at that time is 139 mg/dl or below. A reading of 140 to 199 mg/dl indicates prediabetes, while diabetes is diagnosed at 200 mg/dl or above.
A random or casual plasma glucose test may be performed any time you have diabetes symptoms. It doesn’t require fasting. A reading of 200 mg/dl or above suggests diabetes.
These tests cannot distinguish between type 1 and type 2 diabetes. Generally, people with type 1 diabetes are diagnosed as children, teens, or young adults, while type 2 diabetes usually occurs in adults 45 and older. Type 1 diabetes is an autoimmune disease, so an auto antibody test may be done to help a doctor determine if you have type 1 or type 2 diabetes.
Type 2 Diabetes Treatment
Type 2 diabetes is treated through diet, exercise, and medication. The goal of treatment is to keep blood sugar under control and stave off diabetes complications.
Some people manage through diet and exercise alone. Others need oral medicines, insulin, other injectable medications, or some combination of type 2 diabetes med–along with healthy food and fitness–to keep blood sugar in check.
There are lots of treatment options. What your doctor prescribes may depend on what other health conditions you have and how well certain medications work for you.
Diabetes treatment includes:
- Metformin. This oral medication comes as a pill or liquid. It’s often the first medicine that people with type 2 diabetes take. Metformin improves your body’s use of insulin and reduces the amount of glucose your liver makes.
- Sulfonylureas. These pills stimulate the release of insulin by the pancreas and help the body use insulin better. Popular sulfonylureas include glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (DiaBeta, Micronase, and Glynase).
- Meglitinides. Much like sulfonylureas, this class of medicines boosts insulin production in the body. These oral meds, including repaglinide (Prandin) and nateglinide (Starlix), are fast acting and don’t stay in the body for long, so they must be taken just before meals.
- Thiazolidinediones. Also known as TZDs or glitazones, these oral medications work by lowering insulin resistance. This class includes pioglitazone (Actos) and rosiglitazone (Avandia).
- Gliptins or DPP-4 inhibitors. This class of drugs improves the release of insulin in the body. One example is sitagliptin (Januvia).
- SGLT2 inhibitors. These oral medicines help your kidneys remove sugar from the body through urine. The class includes canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
- GLP-1 receptor agonists. Injectable drugs like exenatide (Byetta), liraglutide (Victoza), and dulaglutide (Trulicity) control blood sugar by slowing digestion, improving how insulin works in the body, and preventing the liver from releasing too much sugar into the bloodstream.
- Insulin therapy. There are many different types of insulin. They vary by how soon they start to work, when they peak, and how long they last. Insulin comes in different strengths and has multiple delivery methods–needle, pen, pump, port, jet injector, and inhaler.
- Bariatric surgery. Research suggests that weight-loss surgery can improve blood sugar control in some obese people with type 2 diabetes. Some people may no longer need diabetes medication after bariatric surgery, but these results tend to vary patient to patient.
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