Physician may do/request:
- History & Physical Exam
- Fasting plasma glucose
- Preferred test for diagnosing type 1 or type 2 diabetes and is most reliable when done in the morning. However, a diagnosis of diabetes can be made after positive results on any one of three tests, with confirmation from a second positive test on a different day:
- A random (taken any time of day) plasma glucose value of 200 mg/dL or more, along with the presence of diabetes symptoms.
- A plasma glucose value of 126 mg/dL or more after a person has fasted for 8 hours.
- An oral glucose tolerance test (OGTT) plasma glucose value of 200 mg/dL or more in a blood sample taken 2 hours after a person has consumed a drink containing 75 grams of glucose dissolved in water. This test, taken in a laboratory or the doctor’s office, measures plasma glucose at timed intervals over a 3-hour period.
- Gestational diabetes is diagnosed based on plasma glucose values measured during the OGTT. Glucose levels are normally lower during pregnancy, so the threshold values for diagnosis of diabetes in pregnancy are lower. If a woman has two plasma glucose values meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting plasma glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.
For type 1 diabetes, your pancreas no longer makes the insulin your body needs to use blood sugar for energy. You will need insulin in the form of injections or through use of a continuous pump.
Insulin comes in four types:
- Rapid-acting (taking effect within a few minutes and lasting 2-4 hours)
- Regular or short-acting (taking effect within 30 minutes and lasting 3-6 hours)
- Intermediate-acting (taking effect in 2-4 hours and lasting up to 18 hours)
- Long-acting (taking effect in 6-10 hours and lasting up to 24 hours)
A rapid-acting inhaled insulin (Afrezza) is also FDA-approved for use before meals. It must be used in combination with long-acting insulin in patients with type 1 diabetes and should not be used by those who smoke or have chronic lung disease. It comes as a single dose cartridge.
Premixed insulin is also available for people who need to use more than one type of insulin.
Each treatment plan is tailored for the person and can be adjusted based on what you eat and how much you exercise, as well as for times of stress and illness.
Self-monitoring of blood glucose levels is key in the managment. A glucometer measures glucose levels in a sample of your blood dabbed on a strip of treated paper. Also, there are now devices, called continuous glucose monitoring systems (CGMS), that can be attached to your body to measure your blood sugars every few minutes for up to a week at a time.
For some people with type 2 diabetes, diet and exercise are enough to keep the disease under control. Other people need medication, which may include insulin and an oral drug.
Drugs for type 2 diabetes work in different ways to bring blood sugar levels back to normal. They include:
- Drugs that increases insulin production by the pancreas, including chlorpropamide (Diabinese), glimepiride, (Amaryl), glipizide (Glucotrol), glyburide (Diabeta, Micronase), nateglinide (Starlix), and repaglinide (Prandin)
- Drugs that decrease sugar absorption by the intestines, such as acarbose (Precose) and miglitol (Glyset)
- Drugs that improve how the body uses insulin, such as pioglitazone (Actos) and rosiglitazone (Avandia)
- Drugs that decrease sugar production by the liver and improve insulin resistance, like metformin (Glucophage)
- Drugs that increases insulin production by the pancreas or its blood levels and/or reduce sugar production from the liver, including albiglutide (Tanzeum), alogliptin (Nesina), dulaglutide (Trulicity), linagliptin (Tradjenta), exenatide (Byetta, Bydureon), liraglutide (Victoza), saxagliptin (Onglyza), and sitagliptin (Januvia)
- Drugs that block the reabsorption of glucose by the kidney and increase glucose excretions in urine, called sodium-glucose co-transporter 2 (SGLT2) inhibitors. They are canaglifozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
- Pramlinitide (Symlin) is an injectable synthetic hormone. It helps lower blood sugar after meals in people with diabetes who use insulin.