Diabetes or prediabetes management
During a diabetes or prediabetes visit, your doctor will talk with you about how you feel, review your blood sugar records and ask about symptoms like frequent urination, increased thirst, extreme hunger, fatigue, blurred vision, slow‑healing cuts or tingling in your hands or feethttps://diabetes.org/about-diabetes/warning-signs-symptoms#:~:text=Common%20symptoms%20of%20diabetes%3A. They will check your weight and blood pressure, examine your feet for sensation and sores, and may look into your eyes for signs of damage. To diagnose or monitor diabetes, they will order tests that measure how much sugar is in your blood: the A1C test shows your average blood sugar over the past 2–3 months and does not require fastinghttps://diabetes.org/about-diabetes/diagnosis#:~:text=The%20A1C%20test%20measures%20your,to%20fast%20or%20drink%20anything; a fasting plasma glucose test checks your blood sugar after at least 8 hours without eatinghttps://diabetes.org/about-diabetes/diagnosis#:~:text=,for%20diabetes%2C%20prediabetes%2C%20and%20normal; and an oral glucose tolerance test measures your blood sugar before and two hours after drinking a sweet drink to see how your body processes sugarhttps://diabetes.org/about-diabetes/diagnosis#:~:text=Oral%20Glucose%20Tolerance%20Test%20. They may also order a random plasma glucose test if you have symptoms and will screen for high cholesterol, kidney disease and other complications at least once a year. Together, you’ll discuss lifestyle changes and decide whether medications are needed.
Most people start with metformin, a pill that helps your body use insulin better and lowers sugar production in the liverhttps://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications#:~:text=Metformin%20,can%20be%20used%20for%20energy. If metformin alone isn't enough, other medicines may be added: DPP‑4 inhibitors boost natural hormones (GLP‑1 and GIP) to reduce blood sugar without causing low sugarhttps://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications#:~:text=DPP; GLP‑1 receptor agonists and dual GIP/GLP‑1 agonists mimic these hormones and help you feel full, lose weight and lower blood sugarhttps://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications#:~:text=GLP,Agonists; SGLT2 inhibitors help your kidneys remove excess sugar in urine and may also protect your heart and kidneyshttps://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications#:~:text=Glucose%20in%20the%20bloodstream%20passes,be%20eliminated%20in%20the%20urine; sulfonylureas make the pancreas release more insulin but can cause low blood sugar and weight gainhttps://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications#:~:text=Sulfonylureas; and thiazolidinediones improve insulin sensitivity but can cause fluid retentionhttps://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications#:~:text=thiazolidinediones,glucose%20production%20in%20the%20liver. Some people need insulin injections when their A1C is above 9 % or when other medicines do not control blood sugarhttps://www.aafp.org/pubs/afp/issues/2011/0715/p183.html#:~:text=Insulin%20therapy%20is%20recommended%20for,percent%20of%20the%20total%20daily. Your doctor will choose medicines based on your A1C, weight, heart and kidney health, and how well you tolerate each drug.
• A1C test – measures your average blood sugar over the past 2–3 months; less than 5.7 % is normal, 5.7–6.4 % indicates prediabetes, and 6.5 % or higher confirms diabeteshttps://diabetes.org/about-diabetes/diagnosis#:~:text=The%20A1C%20test%20measures%20your,to%20fast%20or%20drink%20anything.
• Fasting plasma glucose – checks your blood sugar after not eating for at least 8 hours; 126 mg/dL or higher indicates diabetes and 100–125 mg/dL indicates prediabeteshttps://diabetes.org/about-diabetes/diagnosis#:~:text=This%20test%20checks%20your%20fasting,in%20the%20morning%2C%20before%20breakfast.
• Oral glucose tolerance test (OGTT) – measures your blood sugar before and two hours after you drink a sugary beverage; a two‑hour level of 200 mg/dL or more diagnoses diabetes, while 140–199 mg/dL indicates prediabeteshttps://diabetes.org/about-diabetes/diagnosis#:~:text=The%20OGTT%20is%20a%20two,how%20your%20body%20processes%20sugar.
• Random plasma glucose – a blood test at any time of day; a level of 200 mg/dL or higher with symptoms can diagnose diabeteshttps://diabetes.org/about-diabetes/diagnosis#:~:text=Random%20,Glucose%20Test.
• Urine albumin–creatinine ratio and blood creatinine/eGFR – performed at least once a year to detect kidney damagehttps://medlineplus.gov/ency/patientinstructions/000082.htm#:~:text=Once%20a%20year%2C%20you%20should,for%20a%20protein%20called%20albumin.
• Lipid panel – checks cholesterol and triglycerides annuallyhttps://medlineplus.gov/ency/patientinstructions/000082.htm#:~:text=A%20cholesterol%20profile%20test%20measures,eating%20since%20the%20night%20before.
• Additional tests – comprehensive metabolic panel for liver function and electrolytes; complete blood count; thyroid tests; pregnancy test if relevant.
• Foot exam – monofilament test to check nerve sensation and look for soreshttps://medlineplus.gov/ency/patientinstructions/000082.htm#:~:text=Your%20provider%20should%20check%20the,provider%20should%20also%20look%20for.
• Dilated eye exam – retinal exam by an eye doctor each year to look for diabetic retinopathyhttps://medlineplus.gov/ency/patientinstructions/000082.htm#:~:text=Eye%20Exams.
Imaging is not part of routine diabetes care, but your doctor may order specific studies if complications are suspected. A kidney ultrasound can evaluate diabetic kidney disease or fatty liver; foot X‑rays or MRI may be used if there are ulcers or bone problems; and cardiac tests such as an electrocardiogram, echocardiogram or stress test may be recommended to evaluate heart disease.
Call your doctor if you notice signs of high blood sugar, such as urinating often, being very thirsty or hungry, unexplained weight loss, fatigue, blurred vision, cuts or bruises that heal slowly, or numbness and tingling in your hands or feethttps://diabetes.org/about-diabetes/warning-signs-symptoms#:~:text=Common%20symptoms%20of%20diabetes%3A. Symptoms of very high blood sugar include nausea, vomiting, stomach pain and fruity‑smelling breath; symptoms of low blood sugar include shakiness, sweating, confusion, weakness or fainting. Seek emergency care for chest pain, shortness of breath or if you cannot keep fluids down.
Get an A1C test at least every 6 months if your blood sugar is at goal and every 3 months if medications change or your last A1C was above your targethttps://diabetes.org/living-with-diabetes/newly-diagnosed/health-checks-people-with-diabetes#:~:text=1. See your diabetes provider every 3–6 months to check your blood pressure, weight and feethttps://medlineplus.gov/ency/patientinstructions/000082.htm#:~:text=See%20your%20diabetes%20provider%20every,your%20provider%20should%20check%20your. Have a comprehensive foot exam and a dilated eye exam each year, or more often if you have nerve damage or retinopathyhttps://medlineplus.gov/ency/patientinstructions/000082.htm#:~:text=Eye%20Examshttps://medlineplus.gov/ency/patientinstructions/000082.htm#:~:text=Your%20provider%20should%20check%20the,provider%20should%20also%20look%20for. Have your cholesterol and kidney function tested annuallyhttps://medlineplus.gov/ency/patientinstructions/000082.htm#:~:text=A%20cholesterol%20profile%20test%20measures,eating%20since%20the%20night%20before. Women who are pregnant or planning pregnancy may need more frequent visits.
You can help manage or prevent diabetes by maintaining a healthy body weight, eating balanced meals and staying active. Work with a dietitian to create a meal plan that includes fruits, vegetables, whole grains, lean proteins and healthy fats and limits sugar and saturated fathttps://www.cdc.gov/diabetes/caring/steps-to-help-you-stay-healthy-with-diabetes.html#:~:text=Make%20healthy%20food%20choices. Keep a food diary, plan your meals and carry healthy snacks with youhttps://www.cdc.gov/diabetes/caring/steps-to-help-you-stay-healthy-with-diabetes.html#:~:text=Make%20healthy%20food%20choices. Aim to be physically active for at least 30 minutes most days (for example, a brisk 10‑minute walk three times a day) and do muscle‑strengthening activities twice a weekhttps://www.cdc.gov/diabetes/caring/steps-to-help-you-stay-healthy-with-diabetes.html#:~:text=Be%20physically%20active. Avoid smoking and limit alcohol. Learn stress‑management and coping skills, such as mindfulness and spending time with supportive peoplehttps://www.cdc.gov/diabetes/caring/steps-to-help-you-stay-healthy-with-diabetes.html#:~:text=Step%203%3A%20Learn%20how%20to,live%20well%20with%20diabetes. Get adequate sleep, follow your care schedule, and if you have prediabetes, losing just 7 % of your weight and exercising 30 minutes a day, five days a week can reduce your risk of developing type 2 diabetes by more than halfhttps://diabetes.org/about-diabetes/diagnosis#:~:text=You%20will%20not%20develop%20type,levels%20to%20the%20normal%20range.
Effective diabetes care is a team effort. Your primary care doctor may collaborate with an endocrinologist for complex cases or insulin adjustments; a certified diabetes educator for self‑management training; and a registered dietitian to help you plan meals. You may be referred to an ophthalmologist for annual dilated eye exams, a podiatrist for foot care, a nephrologist if you have kidney disease and a cardiologist if heart disease is a concern. Pharmacists can review your medications, and mental health professionals can support emotional well‑being. Women planning pregnancy should see an obstetrician experienced in diabetes management. Attending diabetes self‑management education programs helps you learn skills and stay motivatedhttps://www.cdc.gov/diabetes/caring/steps-to-help-you-stay-healthy-with-diabetes.html#:~:text=Step%201%3A%20Ask%20your%20doctor,management%20education%20and%20support%20%28DSMES.