Type 2 diabetes is a chronic disease in which the body resists insulin and cannot make enough of it to keep blood glucose normal. Over the years, high glucose damages the vessels and nerves of the eyes, kidneys, heart and feet.
Key symptoms
- Often no symptoms; found on screening
- Thirst, frequent urination, blurred vision
- Tiredness, slow wound healing, frequent infections
- Numbness or burning in the feet
What you find on exam
- Weight, BMI, waist size and blood pressure
- Dark velvety skin in body folds (acanthosis nigricans)
- Foot exam: monofilament sensation, pulses, skin and ulcers
- Referral for a dilated eye exam
Tests
- HbA1c 6.5% or higher, fasting glucose 126 mg/dL or higher, or 2-hour glucose 200 mg/dL or higher on an oral glucose test
- Random glucose 200 mg/dL or higher with symptoms
- Lipids, kidney function and urine albumin-to-creatinine ratio
Treatment basics
- Diet, physical activity and weight loss
- Metformin first line for most patients
- GLP-1 receptor agonist or SGLT2 inhibitor with heart or kidney disease, or to help weight loss
- Insulin if glucose is very high or other drugs are not enough
- Control blood pressure and cholesterol; yearly eye, foot and kidney checks
Red flags
- Very high glucose with confusion or dehydration (hyperosmolar state)
- Low blood sugar on insulin or sulfonylureas
- Foot ulcer, especially with infection or weak pulses
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.