The most important things to know about diabetes

If you’ve recently been diagnosed with diabetes, that can be an upsetting, confusing, and isolating feeling. Know that you’re not alone: the condition affects 38.4 million people of all ages — that’s more than 11% of the U.S. population. It’s a chronic disease caused by too much glucose, or blood sugar, circulating in your body. This can be caused by one of two things: Either your pancreas doesn't produce enough insulin (a hormone that regulates blood sugar), or your body can’t properly respond to the insulin it has (something known as insulin resistance). Insulin’s job is to carry glucose to your cells for energy. When it doesn’t, you wind up with too much glucose in your blood, triggering inflammation and ultimately organ damage. That’s part of why diabetes can lead to severe, even life-threatening complications — so if you have it, you want to get the most accurate info ASAP so you can begin managing it and reducing your risks.

Yet “the most common diabetes symptom is no symptom,” says Dr. Shabina Ahmed, M.D., an endocrinologist and an assistant professor of medicine at Johns Hopkins University, in Baltimore. “People will say they feel perfectly fine, and then they’re diagnosed through routine blood work.” That’s why annual screenings with blood work from your primary care doctor are a must.

If you are diagnosed, WeightWatchers is here to support you with a specific Diabetes Program, which is proven to help you lose weight and lower your blood sugar.*

What is diabetes exactly?

Diabetes mellitus is the full name of what most people call diabetes. On the most simple level, diabetes develops when too much glucose (blood sugar) is circulating in your body. You get glucose from two sources: the foods and drinks you consume and your body’s built-in supplier of glucose, your liver.

If your glucose level dips — say, between meals — then the liver converts glycogen (a form of sugar stored in the body) into glucose for an energy boost (it can also produce glucose using other molecules in the body). In order for that glucose to get distributed to the body’s cells and get to work, though, we need a hormone called insulin (made by the pancreas) to help transport it.

When you have diabetes, however, your pancreas may not produce enough insulin. Or it does produce enough insulin, but your body just doesn’t respond to it. In fact, “most people who have type 2 diabetes actually have very elevated insulin levels,” says Ahmed.

As a result, you wind up with an excess of glucose in your bloodstream, which, if left unchecked, can lead to inflammation, triggering additional health issues.

What are the types of diabetes?

Type 1 diabetes

Type 1 diabetes (T1D) is an autoimmune condition with a strong genetic link. In people with type 1, an overactive immune system attacks the pancreas, damaging its insulin-producing cells (known as beta cells) until they no longer make enough insulin to manage blood sugar levels. Because of the genetic predisposition and the underlying autoimmune component, T1D is typically diagnosed in childhood (but it can be diagnosed at any age). You may have even heard it referred to as juvenile diabetes, but that’s a misnomer because an increasing number of people are getting diagnosed in adulthood.

Type 2 diabetes

With type 2 diabetes (T2D), your pancreas produces enough insulin, but your body is insulin-resistant, meaning it can’t absorb and use glucose properly — the result of a perfect storm of genetic and lifestyle factors, such as carrying excess weight and living a sedentary lifestyle. The most common form of the disease, T2D affects up to 95% of all people with diabetes. It's often referred to as adult-onset diabetes, but just as the rate of T1D in adults is rising, so is the rate of T2D in children.

Prediabetes

Often considered a precursor to T2D, prediabetes means your blood sugar is elevated, but not yet elevated enough to be considered diabetes. According to the Centers for Disease Control and Prevention (CDC), an astounding 97.6 million people in America have prediabetes — but many don't show symptoms so don’t even know they have it.

“When you have prediabetes, your blood sugar levels are not necessarily going to be consistently high, so you may not be symptomatic,” says Dr. Joshua Miller, M.D., the medical director of diabetes care at Stony Brook Medicine in New York, and an associate professor of endocrinology and metabolism at Stony Brook University. That means the best way to get a diagnosis is through a regular checkup with your doctor, like an annual physical and corresponding blood tests. While prediabetes puts you at a higher risk of developing T2D, it isn't inevitable: Consider it a heads-up to prioritize healthy habits and get blood sugar levels back on track.

Gestational diabetes

This type of diabetes occurs during pregnancy and is temporary. When someone is pregnant, their placenta produces hormones that can cause higher levels of glucose in the blood. In roughly 10% of women, this leads to insulin resistance and excess blood sugar. Untreated gestational diabetes is scary because it can lead to premature birth and stillbirth. The good news is that gestational diabetes should be routinely screened for during the second trimester, per guidelines by the American College of Obstetricians and Gynecologists. Luckily, gestational diabetes typically goes away after delivery — but it can be a precursor to prediabetes and/or T2D.

What contributes to diabetes?

Risk factors for type 1 diabetes

It’s not clear why the immune system overreacts in T1D, but researchers believe it’s due to a mix of genetic and environmental factors: “We know that something triggers the immune system to attack the pancreas,” says Miller. “I think it’s a combination of having a baseline risk and an environmental trigger.”

That trigger, notes Miller, can happen at any age, which could explain the rise in adult-onset cases. T1D may potentially be set off by viruses (including Covid) and stressors such as surgery or the use of certain medications like new cancer treatments, and it can also occur when the pancreas is damaged or removed due to another health condition, such as chronic pancreatitis. A family history of T1D and other autoimmune diseases can also up your risk. “You may have a family member with hypothyroidism or multiple sclerosis — autoimmune diseases tend to run in families, but they don’t always present in the same way,” says Ahmed.

Risk factors for type 2 diabetes

Like T1D, experts believe both genetics and environmental triggers play a large role in T2D. “If you talk to someone with T2D, they will probably tell you of at least one relative who also has the disease,” says Ahmed. But having a genetic predisposition doesn’t mean you’ll definitely develop the disease. Other factors raise your risk, including:

• Excess weight. Living with excess weight (a BMI, body mass index, between 25 and 29.9) or obesity (30 or greater) can lead to insulin resistance, particularly if that weight is concentrated around your midsection. According to the National Heart, Lung, and Blood Institute, a waist circumference greater than 35 inches in women and greater than 40 inches in men is considered a risk factor. That’s because belly fat can indicate visceral fat, the kind that wraps around your internal organs and causes inflammation. This could be one reason why T2D is more common in men than women, as men tend to have higher amounts of visceral fat.
• Lack of activity. Research has long established that a sedentary lifestyle increases your risk of developing T2D. For example, the more time men spend sitting, the more likely they are to develop T2D.
• Age. Diabetes is more likely diagnosed in those 45 and older (although, as mentioned, juvenile cases of T2D are on the rise).
• Related conditions. A personal or family history of prediabetes, gestational diabetes, cardiovascular disease, high blood pressure, and/or high cholesterol ups your risk of T2D.
• Race. Black Americans, Latin Americans, American Indians, and Alaska Natives are at a greater risk of developing T2D than other ethnic groups — partly due to genetic factors but also due to broad health inequities that are systemic and persistent. A review published in Diabetes Care showed that unsatisfactory access to both healthcare and healthy foods and a dearth of safe areas for physical activity play a role in why people of color, Indigenous people, and individuals with low income are at a higher risk of developing T2D.
• Tobacco use. Research shows that smoking may increase the risk of T2D, as it may increase insulin resistance.
  
  

Risk factors for prediabetes

Since prediabetes can act as a precursor to T2D, the risk factors are primarily the same, including family history, lack of physical activity, and excess weight.

Risk factors for gestational diabetes

If you previously had gestational diabetes, gave birth to a baby over nine pounds, or have overweight (a BMI higher than 25) before your current pregnancy, you’re more likely to develop gestational diabetes. Other risk factors include:

• Prediabetes
• A family history of diabetes
• Another condition that affects insulin, such as polycystic ovary syndrome (PCOS)
• One or more other health conditions, such as high blood pressure

Your blood sugar levels should return to normal after you give birth, but having gestational diabetes does put you at a higher risk of developing T2D; according to the CDC, 50% of women with gestational diabetes wind up with the condition later on.

What are the symptoms of diabetes?

A tricky thing about diabetes is that often people show no symptoms at all; it's estimated that one in five people with diabetes have no idea that they have it. And type 1 and type 2 diabetes do have some common symptoms, prediabetes and gestational diabetes don't have clear symptoms. If you're experiencing any of the below, it's time to check in with your doctor.

• You're peeing more than usual. When blood sugar levels are elevated, your kidneys notice and try to filter out the excess. They're working overtime, sending you to the bathroom a lot more than usual. How much more exactly? “We’ve had patients say they’re going hourly,” says Miller.
• You're (very) thirsty. Due to the increased urination, you may be dehydrated. And being dehydrated may make you thirsty. And being thirsty may make you drink more. And drinking more may make you urinate more. (And the cycle continues.)
• Increased hunger. You ate just 15 minutes ago, but you're already feeling starved. What gives? Your muscles and other tissues aren't getting their necessary dose of glucose, so they're telling your brain that they're hungry even if you’re freshly nourished.
• You're tired. Like fall-asleep-at-your-desk tired. Extreme fatigue is a classic sign of diabetes. Again, because all that glucose, a prime energy source, isn't getting where it needs to go. (Dehydration can also sap your energy.)
• You're losing weight. When your body isn't getting enough glucose for fuel, it may break down fat and muscle in order to produce glucose. And that can cause a drop on the scale. This tends to happen more with T1D than T2D.
• Your vision is less clear. Blurry vision happens when the lenses of your eyes swell due to too much blood sugar.
• Minor cuts take forever to heal. Critical genes involved in tissue repair are suppressed in those with diabetes, so even slight wounds can take a long time to recover.
• You have tingles. High blood sugar can damage nerves, leading to tingling, pain, and numbness in the hands and feet. It's more common in those with T2D but can occur with T1D.

How can diabetes be prevented?

Researchers don’t know enough about T1D yet to advise on how to prevent it — or whether it’s even preventable. There is one drug approved that may delay the progression of T1D, but it only is for people who already have early stages of the disease. But for prediabetes, research shows that even losing just 5% to 7% of your body weight (that's 10 to 14 pounds for a 200-pound person) reduces your risk of developing T2D.

One way to do that is through a customized plan, like the WeightWatchers Points Program. Research shows that it can help people with prediabetes lose weight and lower their A1C. It’s also recognized by the Centers for Disease Control and Prevention (CDC) as a Diabetes Prevention Program for people living with prediabetes.

How is diabetes diagnosed?

Doctors rely on several blood tests for diabetes, with the most common being the fasting blood sugar test. It measures the amount of glucose in your blood after an overnight fast (i.e., not eating). The scoring goes like this:

• A blood sugar level of 99 mg/dL (milligrams per deciliter) or less is considered normal.
• Between 100 and 125 mg/dL is prediabetes.
• Anything 126 mg/dL or over indicates diabetes.

Your physician will likely check your A1C levels too, which gives doctors an average of your blood sugar levels over three months.

• An A1C level under 5.7% is considered normal.
• Anything between 5.7% and 6.4% is prediabetes.
• A level of 6.5% and above means diabetes.

There's also an oral glucose tolerance test, often used to diagnose gestational diabetes. (It can be used to diagnose any diabetes, though.) During this test, your blood sugar levels are measured in regular intervals over three hours after you drink a glucose drink. The results of the test vary based on the glucose drink used, but your doctor will be able to explain if your blood sugar is normal or if you have diabetes.

If your blood sugar is ever tested randomly and shows up as being 200 mg/dL or higher, that is also enough to diagnose you with diabetes.

What are possible diabetes complications?

When blood sugar stays elevated for too long, it leads to inflammation that can damage your organs. Here’s what can happen over years and decades when glucose levels go untreated.

• Heart disease. Because of the damage to blood vessels, people with diabetes are at a higher risk of heart attack or stroke.
• Kidney disease. Diabetes is the leading cause of kidney disease. Your doctor will monitor your urine for protein to watch kidney function.
• Eye issues. People with diabetes are also referred to an ophthalmologist at the time of diagnosis and continue to go biannually or annually.
• Diabetic ketoacidosis (DKA). This severe complication is more common in those with T1D. Cells starved for glucose (because there isn't enough insulin to get glucose to the cells) turn to fat for energy. This process creates a chemical by-product called ketones. When ketones build up in the blood, it becomes acidic. In severe cases, this can lead to diabetic coma (losing consciousness for long periods) and even death.
• Hand and foot problems. Nerve damage, known as diabetic neuropathy, occurs in about a third of diabetes patients. It can lead to pain, numbness, and tingling in the hands and feet. Also, stagnant blood flow means minor cuts (often in the feet) can heal poorly and may cause a severe infection that, in some cases, can lead to amputation. High blood sugar levels can also invite fungal infections; vaginal yeast and fungal nail infections are common in people with diabetes.
• Skin issues. Often a symptom of elevated blood sugar levels, skin conditions can manifest in a variety of ways, including necrobiosis lipoidica (pimple-like bumps that progress into swollen, hardened patches), skin tags (hanging skin growths), and diabetic dermopathy (dark spots or lines that create an impression in the skin, typically on the shins), as well as blisters, dry patches, and open wounds that result from poor circulation.
• Gum issues. Periodontitis, an infection of the gums and bone that hold teeth in place, occurs more frequently in people living with diabetes, as does dry mouth and thrush (a fungal infection).

What is the best diabetes treatment?

Your treatment will depend on your type of diabetes and its severity. Are you destined to be on meds? Not necessarily. Your physician will encourage lifestyle changes, which may help stave off medication. “If a patient’s blood sugar levels aren’t too high when they’re first diagnosed, I’ll give them three months to turn things around through diet and exercise,” says Ahmed. “If they have moderate to high hyperglycemia [high blood sugar], then we do lifestyle changes plus medication right away,” she adds. Here are the treatment options:

Lifestyle changes

Diet and exercise alone can't reverse T1D, but healthy eating, exercise, and prioritizing sleep can help you better manage the disease and its symptoms. For patients with T2D, eating well, exercising, and losing weight may help you avoid medications, including insulin.

For people with T2D who are living with overweight or obesity, the recommendation from the American Diabetes Association and the International Diabetes Federation is to lose at least 5% of your weight and keep it off. Exercise has been shown to reduce insulin resistance, but you'll need to make dietary changes if your goal is to lose weight. “Weight loss is very unlikely to happen with exercise alone,” says Ahmed.

The WeightWatchers Diabetes Program can help; it’s twice as effective for weight loss as physician counseling and research shows people can reduce their A1C by 0.75% after six months while also feeling less stressed about managing their condition.

Insulin

With T1D, your pancreas doesn't produce enough insulin, so supplementing with insulin is a must. However, insulin is less common in treating T2D. Insulin can be taken in a few different ways:

• A self-administered injection via a syringe or a pen
• An insulin pump, which delivers the insulin required throughout the day via an insulin patch
• An inhaler containing a powdered form of insulin

Oral medications

Several prescription oral drugs can help lower blood sugar and A1C levels, including:

• Metformin (a.k.a. Glucophage, Glumetza, Fortamet, or Riomet): This is often the first line of defense for diabetes. It slows the breakdown of glucose from foods and reduces how much glucose your liver produces.
• SGLT2 inhibitors (Farxiga, Invokana, Jardiance): These help the kidneys remove sugar from your blood. Bonus: They've been shown to help lower blood pressure.
• DPP-4 inhibitors (Januvia, Onglyza, Tradjenta): This med class stimulates the pancreas to produce more insulin.
• GLP-1 receptor agonists (Ozempic, Mounjaro, Victoza, Trulicity): These newer drugs lower blood sugar, reduce the risk of cardiovascular disease, and help patients lose weight.

There are other medications as well, including sulfonylureas, meglitinides, and thiazolidinediones. Your doctor will be able to guide you to what prescription medication is right for you.

What’s the best diet and exercise plan for people with diabetes?

Diabetes and diet

Reducing your intake of carbohydrates — particularly processed, sugary foods — while boosting your fiber intake (which includes beans, peas, and lentils) is helpful for people with diabetes who are trying to lose weight. That’s because high-fiber foods break down more slowly, so your system doesn't get a flood of glucose.

If you need nutrition guidance, recipes, and a way to track what you’re eating, the WeightWatchers Diabetes Program can help you lose weight while still eating the foods you love. You don’t have to go it alone — the program makes diabetes nutrition easier and is proven to help you lose weight and lower your blood sugar.

It also is great for those who wear a Continuous Glucose Monitor (CGM). Members on the program who wore a CGM had a 5x greater reduction in average glucose and a 2x greater reduction in A1C compared to usual care.

Diabetes and exercise

Exercise can help reduce blood sugar and A1C levels; those with T2D who work out regularly tend to have better blood sugar control than those who don’t. But you don’t need to sign up for a marathon to get the benefits. Here’s what to do.

• Move more. We already mentioned that being sedentary is linked to a higher risk of T2D. Even just moving your body more in everyday activities — taking the stairs instead of the elevator or pacing while talking on the phone instead of sitting — can help.
• Aim for 150 minutes of exercise a week. When broken up over seven days, that's just a little over 20 minutes of movement a day of moderate-intensity exercise, such as brisk walking.
• Add resistance training. Research shows that working with weights, resistance bands, or even your body weight for 20 minutes two to three times a week can help you respond better to insulin and can aid in weight loss.