Type 2 Diabetes: Symptoms, Tests, Targets and Treatment

TL;DR:

• Type 2 diabetes is the most common form, caused by insulin resistance. World Health Organization
  
• Diagnosis uses A1C, fasting glucose, OGTT, or random glucose with symptoms. Diabetes Journals+1
  
• For many adults, the A1C goal is under 7 percent, set with your clinician. Diabetes Journals
  
• Lifestyle change can cut diabetes risk by about half in people with prediabetes. CDC+1
  
• GLP-1 RAs and SGLT2 inhibitors lower heart and kidney risks for many patients. American College of Cardiology+1
  

What is Type 2 diabetes

Type 2 diabetes happens when your body does not use insulin well, or does not make enough of it. This leads to high blood sugar over time. It is the most common form of diabetes worldwide, affecting the majority of people living with the condition.

How it develops

In the early stages, the pancreas makes extra insulin to overcome insulin resistance. Over time, insulin production may drop. High blood sugar can harm the heart, kidneys, eyes, nerves, and feet if not managed. These problems grow slowly, which is why steady control matters.

Symptoms to watch

Many people have no symptoms at first. When symptoms appear, they may include thirst, frequent urination, blurry vision, slow-healing cuts, fatigue, or tingling in hands and feet. Seek testing if you notice these signs, have risk factors, or are pregnant and at risk.

Who is at higher risk

Risk rises with family history, age, overweight or obesity, sedentary life, past gestational diabetes, and some ethnic backgrounds. Unhealthy diet, tobacco, and poor sleep can add risk. Talk to a clinician about your personal profile.

How Type 2 diabetes is diagnosed

Doctors use blood tests to diagnose diabetes. Any one of these can confirm the diagnosis, often with repeat testing unless there are clear symptoms.

Diagnostic tests and cutoffs

These thresholds reflect current standards used by major health bodies. Diabetes Journals+1

Prediabetes means A1C 5.7 to 6.4 percent, fasting glucose 100 to 125 mg/dL, or 2-hour OGTT 140 to 199 mg/dL. Prediabetes is a warning sign and a window to act.

Treatment goals and targets

A1C and daily glucose

For many nonpregnant adults, an A1C goal under 7 percent is appropriate. Some people need tighter or looser goals based on age, other health issues, risk of low blood sugar, and personal preferences. Set targets with your care team. Typical daily glucose targets are 80 to 130 mg/dL before meals and under 180 mg/dL one to two hours after meals.

Key point: Targets are personal. You and your clinician should agree on safe goals that fit your life. 

The treatment plan

Care has three pillars: lifestyle, medications when needed, and routine screening for complications.

1) Lifestyle changes that work

• Nutrition. Favor minimally processed foods, fiber-rich vegetables, whole grains, lean proteins, nuts, seeds, and healthy fats. Limit sugary drinks, refined grains, and excess saturated fat.
  
• Physical activity. Aim for at least 150 minutes per week of moderate activity, plus 2 to 3 days of resistance work.
  
• Weight management. Even a 5 to 10 percent weight loss can improve A1C, blood pressure, and lipids.
  
• Sleep, stress, tobacco. Sleep 7 to 9 hours, manage stress, and avoid tobacco and vaping.
  

If you have prediabetes, a structured lifestyle program can reduce your risk of Type 2 diabetes by about 50 percent. The CDC’s year-long National DPP Lifestyle Change Program is one proven option.
2) Medications

Medication choice depends on your A1C, heart and kidney health, weight needs, risk of low blood sugar, cost, and access. Work with your clinician to tailor therapy.

• Metformin. Often first-line for its A1C effect, weight neutrality, low cost, and long safety record.
  
• GLP-1 receptor agonists such as semaglutide or tirzepatide lower A1C, help with weight loss, and reduce major cardiovascular events in people with heart disease or high risk. Some agents now carry label claims for reducing cardiovascular risk.
  
• SGLT2 inhibitors such as empagliflozin or dapagliflozin reduce A1C modestly and give strong heart and kidney protection in type 2 diabetes, and in chronic kidney disease even without diabetes.
  
• DPP-4 inhibitors lower A1C modestly and are weight neutral.
  
• Sulfonylureas lower A1C but may cause low blood sugar and weight gain.
  
• Basal insulin is added when oral or injectable non-insulin drugs do not meet targets, or when A1C is very high at diagnosis.
  

The 2025 Standards of Care summarize when to prefer GLP-1 RAs or SGLT2 inhibitors in people with atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease.

3) Routine screening and vaccines

• Eyes. A dilated exam at diagnosis, then every 1 to 2 years if stable.
  
• Kidneys. Annual urine albumin and eGFR.
  
• Feet and nerves. At least yearly foot exam.
  
• Heart risk. Blood pressure and lipids at regular visits.
  
• Vaccines. Stay current with influenza, COVID-19, pneumococcal, hepatitis B, and others as advised.
  

Eating for steady glucose

Simple rules help most people.

• Build meals around vegetables and protein.
  
• Choose whole grains in modest portions.
  
• Add healthy fats like olive oil or nuts for fullness.
  
• Time carbs around activity when possible.
  
• Limit sugary drinks and juices.
  
• Use a plate model if counting grams feels hard.
  

If you use insulin or drugs that can cause lows, learn how to match carb intake with your dose. A dietitian can set a safe plan.

Exercise, safely

Aim for a mix of aerobic and strength work. Spread activity across at least 3 days. Avoid more than 2 days in a row without movement. If you take insulin or sulfonylureas, check glucose before and after new workouts. Carry rapid carbs to treat lows.

Tech that can help

• Glucose meters give point-in-time readings.
  
• Continuous glucose monitors show trends and alerts.
  
• Smart pens and pumps simplify dosing.
  Ask your clinician which tools fit your needs and budget.
  

Common mistakes to avoid

• Skipping follow-up after diagnosis.
  
• Cutting carbs too far, then overeating later.
  
• Ignoring foot care and shoes.
  
• Not checking blood pressure and lipids.
  
• Stopping medication early due to mild side effects without asking for advice.
  

Quick reference: targets and follow-up

Personal care checklist

• Confirm your A1C goal with your clinician. For many adults, aim under 7 percent.
  
• Agree on daily glucose targets and how often to check.
  
• Start a realistic food and activity plan. Consider a CDC-recognized lifestyle program if you have prediabetes.
  
• Review heart and kidney risk. Ask if a GLP-1 RA or SGLT2 inhibitor fits you.
  
• Schedule eye, kidney, foot, and dental checks.
  
• Keep vaccines up to date.
  
• Make a foot care routine. Inspect daily.
  
• Recheck A1C every 3 months until at goal, then at least twice a year.
  

Living well with Type 2 diabetes

You can lead a full life with Type 2 diabetes. Build a small set of daily habits. Use medicines when needed. Keep regular checkups. Most of the benefit comes from steady steps that you can maintain.

Why it matters

Type 2 diabetes is common and rising. It is a major driver of heart disease, kidney failure, blindness, and amputations. The good news is that early diagnosis, clear targets, smart lifestyle changes, and modern medicines can prevent many problems. Acting today pays off over decades.

Sources:

• American Diabetes Association, Standards of Care in Diabetes — 2025, Diabetes Care Supplement, sections on Glycemic Goals and Pharmacologic Treatment, https://diabetesjournals.org/care/issue/48/Supplement_1, accessed 2025-10-13.
  
• World Health Organization, Diabetes Fact Sheet, https://www.who.int/news-room/fact-sheets/detail/diabetes, published 2024-11-14, accessed 2025-10-13.
  
• Centers for Disease Control and Prevention, National DPP Lifestyle Change Program, https://www.cdc.gov/diabetes-prevention/lifestyle-change-program/index.html, updated 2024-05-15, accessed 2025-10-13.