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Diabetes means there is too much sugar, or glucose, in the blood, because the body either does not make enough insulin or cannot use it properly. Over years, high blood sugar damages blood vessels and nerves throughout the body. Left undiagnosed or poorly managed, it leads to heart attack, stroke, kidney disease, vision loss, sores that will not heal and, in the worst cases, amputation. Managed well, most of those complications can be prevented or delayed.
There are two main types. Type 1 diabetes is an autoimmune condition in which the pancreas stops making insulin; it usually starts in childhood or young adulthood, and people with it need insulin every day. Type 2 diabetes, which the CDC says accounts for about 90 to 95 percent of cases, develops gradually as the body becomes resistant to insulin. It is closely tied to weight, inactivity, age and family history, and it is the main focus of this page and of our internal medicine practice.
Type 2 diabetes is almost always preceded by prediabetes, a stage when sugars are higher than normal but not yet in the diabetes range. This is the best time to find it, because lifestyle changes at this stage can prevent or delay diabetes altogether.
Symptoms and who should be tested
Many people with type 2 diabetes have no symptoms for years. When symptoms do appear, they include increased thirst and urination, fatigue, unusual hunger, blurred vision, weight loss without trying, slow-healing cuts and frequent infections, including yeast infections. In men, erectile dysfunction is sometimes the first sign.
Because symptoms come late, testing matters. The U.S. Preventive Services Task Force recommends screening adults aged 35 to 70 who have overweight or obesity. We also test earlier or more often if you have a family history of diabetes, a history of gestational diabetes, polycystic ovary syndrome, high blood pressure or high cholesterol, or if you already have prediabetes.
How we diagnose and evaluate diabetes at NYMD Center
Diagnosis is by blood test. The CDC and the American Diabetes Association use the same thresholds. An A1c, which reflects average blood sugar over two to three months and needs no fasting, of 6.5% or higher indicates diabetes, and 5.7% to 6.4% indicates prediabetes. A fasting glucose of 126 mg/dL or higher indicates diabetes and 100 to 125 prediabetes. On a two-hour oral glucose tolerance test, 200 or higher indicates diabetes and 140 to 199 prediabetes. A diagnosis is usually confirmed with a repeat test. If we order a fasting test, we will tell you to fast overnight; otherwise no preparation is needed.
Once diabetes is diagnosed, care is about more than sugar. We check your A1c every few months until it is at goal, then regularly. We monitor kidney function with a blood test (eGFR) and a urine albumin test, check cholesterol and blood pressure, examine your feet for loss of sensation, poor circulation and skin breakdown, and make sure you have a dilated eye exam at least yearly, arranged with an eye specialist. We also keep vaccines up to date, since diabetes raises the risk of serious infections.
Treatment options, least invasive first
Nutrition, activity and weight loss
For prediabetes and early type 2 diabetes, lifestyle change is the first and most powerful treatment. Fewer refined carbohydrates and sugary drinks, more vegetables, fiber and lean protein, and regular activity all improve how the body uses insulin. The ADA notes that losing about 7 percent of body weight with moderate exercise can substantially lower the chance of prediabetes progressing to diabetes. Our weight loss program supports patients who need more structure.
Metformin
When lifestyle is not enough, metformin is usually the first medication. It reduces the liver's output of glucose, does not by itself cause low blood sugar, and has a long safety record. The main drawback is stomach upset, which slow dose increases and extended-release forms usually ease.
GLP-1 and SGLT2 medications
Two newer classes do more than lower sugar. According to the American Diabetes Association, some GLP-1 receptor agonists have been shown to prevent heart disease, and SGLT2 inhibitors improve outcomes in people with heart disease, kidney disease and heart failure, so they are often chosen for patients who have those conditions. GLP-1 drugs, usually weekly injections, also reduce appetite and weight but can cause nausea. SGLT2 inhibitors can cause genital yeast infections and dehydration. We match the drug to your heart, kidney and weight picture.
Insulin
When other medicines are not enough, or blood sugar is very high, insulin is added. Needing insulin is not a failure; type 2 diabetes tends to progress over time. We teach you how to use it, how to check your sugar and how to recognize and treat lows.
Diabetes and men's health
Diabetes damages the nerves and blood vessels that erections depend on. The NIDDK reports that more than half of men with diabetes develop erectile dysfunction, often years earlier than men without it, and that men with diabetes are more likely to have low testosterone. Because our group includes urology, we can evaluate both in the same practice through sexual healthcare and low testosterone care. Better sugar control helps both.
What to expect at your visit
Bring your medication list, any glucose meter or sensor readings, and recent lab results. Expect a review of your history and symptoms, a blood pressure check, a foot exam and blood and urine tests. You will leave with a target A1c, a treatment plan and a schedule for follow-up labs and eye care.
When to seek care urgently
Go to the emergency room or call 911 for very high blood sugar with vomiting, abdominal pain, deep or rapid breathing, severe thirst, drowsiness or confusion, which can signal a dangerous buildup of ketones or severe dehydration. Low blood sugar with confusion, fainting or seizure is also an emergency; if you use insulin, make sure the people around you know how to help.
Questions patients ask
What A1c level means diabetes or prediabetes?
An A1c of 6.5% or higher indicates diabetes, and 5.7% to 6.4% indicates prediabetes, according to the CDC and the American Diabetes Association. Below 5.7% is normal. The A1c reflects your average blood sugar over the past two to three months and does not require fasting. A diagnosis is usually confirmed with a second test.
Can prediabetes be reversed?
Often, yes. Losing a modest amount of weight, eating fewer refined carbohydrates and sugary drinks, and exercising regularly can bring blood sugar back to normal or keep prediabetes from progressing to type 2 diabetes. We recheck your A1c periodically to see how you are doing and add support if numbers keep rising.
Do I need to fast for a diabetes test?
It depends on the test. An A1c needs no fasting. A fasting glucose requires at least eight hours without food, usually overnight, and a glucose tolerance test also starts fasting. We will tell you ahead of time which test we plan and whether to skip breakfast. Water and most usual medications are fine.
Are GLP-1 medications only for weight loss?
No. GLP-1 receptor agonists were developed to treat type 2 diabetes. They lower blood sugar, reduce appetite and weight, and some have been shown to lower the risk of heart disease. Side effects include nausea and stomach upset. Whether one suits you depends on your sugar control, weight, heart and kidney health, and insurance coverage.
Can diabetes cause erectile dysfunction?
Yes. High blood sugar damages the nerves and blood vessels needed for an erection, and more than half of men with diabetes develop ED, according to the NIDDK. Men with diabetes are also more likely to have low testosterone. Better diabetes control helps, and our urology team can evaluate and treat both problems.