Type 2 Diabetes

Diabetes is very common. About 1 in 8 Americans has diabetes, and most of them have type 2. Many more people have prediabetes, which means blood sugar is higher than normal but not yet in the diabetes range.

Type 2 diabetes is most common after age 45, but more young adults, teens and even children are getting it.

• Prediabetes: blood sugar is above normal but below the diabetes range. This is an important time to act, because healthy changes can help delay or prevent type 2 diabetes.
• Type 2 diabetes: the body doesn't use insulin well and, over time, doesn't make enough.
• Other kinds include type 1 diabetes (the body makes little or no insulin) and gestational diabetes (diabetes during pregnancy).

Type 2 diabetes comes from a mix of genes and lifestyle. Your chance is higher if you:

• Have prediabetes
• Are overweight, especially with extra weight around the belly
• Are 45 or older
• Have a parent, brother or sister with type 2 diabetes
• Are physically active fewer than 3 times a week
• Had diabetes during pregnancy or gave birth to a baby over 9 pounds
• Have high blood pressure, high cholesterol, fatty liver disease or polycystic ovary syndrome (PCOS)
• Are African American, Hispanic or Latino, American Indian, Alaska Native, or some Asian American or Pacific Islander backgrounds

Many people have no symptoms for years. When symptoms show up, they can include:

• Being very thirsty and urinating often, including at night
• Feeling tired
• Blurry vision
• Cuts or sores that heal slowly, or frequent skin, gum, bladder or yeast infections
• Numbness, tingling or burning in the hands or feet
• Losing weight without trying (less common in type 2)
• Dark, velvety skin in body folds such as the neck or armpits
• At your visit, your provider checks your weight, waist size and blood pressure. They examine your feet closely, testing feeling with a soft thread (monofilament) or a tuning fork, checking pulses and looking for calluses, sores or skin changes. They may also check your skin and ask when you last had an eye exam.

Diabetes is diagnosed with blood tests. Unless the result is very clear, the test is usually repeated to confirm it.

Lab tests your provider may order include: hemoglobin A1C (your average blood sugar over about 3 months), fasting blood glucose, and sometimes an oral glucose tolerance test. To check for related problems, your provider may also order a comprehensive metabolic panel (kidney and liver function), a urine albumin-to-creatinine ratio (early kidney damage), a cholesterol (lipid) panel, and sometimes thyroid tests or vitamin B12 (especially if you take Glucophage (metformin)).

You'll also need a yearly dilated eye exam with an eye doctor, and we refer you for that. We don't do X-rays or other imaging at our office; if you need imaging, we refer you to a trusted outside center.

These tools are used by clinicians. Bring your results to your visit; they don't replace a medical evaluation.

• ADA Diabetes Risk Calculator ↗ (opens in a new tab)A quick score of your chance of having undiagnosed type 2 diabetes, to help decide on blood testing.
• PREVENT™ Calculator (AHA) ↗ (opens in a new tab)Estimates your chance of heart attack, stroke or heart failure. Diabetes raises this risk.
• ASCVD 2013 Risk Calculator (AHA/ACC) ↗ (opens in a new tab)Estimates your 10-year chance of heart attack or stroke; often used to guide cholesterol treatment.

The goal is to keep blood sugar, blood pressure and cholesterol in a healthy range to protect your body. Your plan may include:

• Healthy eating: more vegetables, beans, whole grains and lean protein; fewer sugary drinks, sweets and refined carbs. Watching portion sizes helps.
• Activity: aim for about 150 minutes a week, like a brisk 30-minute walk 5 days a week, if your provider says it's safe.
• Weight loss if needed. Losing even 5 to 7 percent of your body weight can make a real difference.
• Medicines: Glucophage (metformin) is often the first. Others may help protect your heart and kidneys or support weight loss. Some people need insulin. Take medicines exactly as prescribed.
• Checking your blood sugar as your provider advises, with a meter or a continuous glucose monitor.
• Daily foot checks for cuts, blisters or color changes, and good shoes.
• Yearly eye exams, regular kidney and cholesterol tests, and dental care.
• Not smoking, and limiting alcohol.

Type 2 diabetes is usually a long-term condition. It often changes over time, so your treatment may need to change too. That is common and not a failure.

Keeping your numbers near goal lowers the chance of problems with your heart, kidneys, eyes, nerves and feet. Every step counts, but no one can promise a specific result. Your care team will work with you over time.

Your primary care team at Moaddel Medical orders your A1C and other tests, goes over the results with you, and builds a plan for eating, activity and medicine that fits your life.

We check your feet at visits, help you stay on schedule with eye exams and kidney tests, and refer you to an endocrinology partner when you need specialty care. For foot wounds that are slow to heal, Royal Wound Care, part of Moaddel Medical, specializes in chronic, non-healing wounds.

We're at 7230 Medical Center Dr, Suite 100, West Hills, CA 91307.