Type 2 Diabetes Mellitus in Nepal: Symptoms, Causes & Treatment | aihealz
Endocrinology
Type 2 Diabetes Mellitus.Care & specialists in Nepal
In Nepal, type 2 Diabetes Mellitus is managed by endocrinologists. Type 2 diabetes mellitus is a metabolic disease driven by progressive insulin resistance and beta-cell dysfunction that leaves blood glucose persistently elevated. It affects roughly 38.4 million Americans (11.6% of the adult population, CDC 2024) and more than 537 million adults globally (IDF Atlas 10th edition), with prevalence rising fastest in South and East Asia.
aliases · Type 2 Diabetes (insulin-resistance diabetes)· टाइप 2 मधुमेह· Type 2 Diabète· Diabetes Tipo 2· reviewed May 13, 2026
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Reviewed by AIHealz Medical Editorial Board · EndocrinologyLast reviewed May 13, 2026
Type 2 diabetes mellitus (ICD-10: E11) is a chronic disorder of glucose homeostasis defined by insulin resistance in liver, skeletal muscle, and adipose tissue combined with progressive failure of pancreatic beta cells to compensate. The American Diabetes Association 2024 Standards of Care diagnose diabetes when any of the following is confirmed on two occasions or paired with classical symptoms: fasting plasma glucose ≥126 mg/dL (7.0 mmol/L), 2-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) on a 75-gram oral glucose tolerance test, HbA1c ≥6.5% (48 mmol/mol), or a random plasma glucose ≥200 mg/dL with classical symptoms of hyperglycemia. The disease intersects three organ axes simultaneously — atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease — and is now framed by the ADA and EASD as a cardio-renal-metabolic syndrome rather than a glucose-centric disease. Management is delivered by endocrinologists, primary care physicians, diabetes specialist nurses, dietitians, podiatrists, and ophthalmologists in coordinated programs..
key facts
Prevalence
11.6% of US adults; 38.4 million Americans (CDC 2024)
Demographics
South Asians, African Americans, Hispanic/Latino, Pacific Islanders, and Native Americans carry 1.5-2x risk versus white adults
Avg. age
Most diagnoses age 45-64; incidence rising in adolescents and young adults
Global cases
537 million adults globally (IDF Atlas 2021); projected 783 million by 2045
Specialist
Endocrinology
§ 02
How you might notice it
The key symptoms of Type 2 Diabetes Mellitus are: Increased thirst and frequent urination, especially overnight, occurring once blood glucose exceeds the renal threshold of roughly 180 mg/dL (10 mmol/L)., Unexplained fatigue and reduced exercise tolerance, often present months before diagnosis as cells fail to take up glucose efficiently., Slow wound healing and recurrent skin infections — small cuts on the feet or hands persist for weeks rather than days., Blurred vision from osmotic shifts in the lens, fluctuating with glucose levels and often resolving with treatment., Recurrent vaginal or balanitis fungal infections driven by glucose in skin and mucosal secretions., Unintended weight loss of 5-10% over 3-6 months in a minority of patients, especially when glucose is markedly elevated., Numbness, tingling, or burning in the feet that worsens at night — early diabetic peripheral neuropathy can predate diagnosis by years..
01Increased thirst and frequent urination, especially overnight, occurring once blood glucose exceeds the renal threshold of roughly 180 mg/dL (10 mmol/L).
02Unexplained fatigue and reduced exercise tolerance, often present months before diagnosis as cells fail to take up glucose efficiently.
03Slow wound healing and recurrent skin infections — small cuts on the feet or hands persist for weeks rather than days.
04Blurred vision from osmotic shifts in the lens, fluctuating with glucose levels and often resolving with treatment.
§ 03
How it’s diagnosed
diagnosis
Diagnosis follows the 2024 ADA Standards of Care. Type 2 diabetes is established by any of: fasting plasma glucose ≥126 mg/dL (7.0 mmol/L), 2-hour plasma glucose ≥200 mg/dL on a 75-gram oral glucose tolerance test, HbA1c ≥6.5% (48 mmol/mol), or a random plasma glucose ≥200 mg/dL with classical hyperglycemic symptoms. A single random plasma glucose ≥200 mg/dL with symptoms is diagnostic; all other criteria require confirmation on a separate day. HbA1c is the preferred test for asymptomatic screening because it does not require fasting, captures average glucose over 8-12 weeks, and predicts microvascular complications well. HbA1c is unreliable in hemoglobinopathies, hemolysis, recent transfusion, and severe iron deficiency — in these settings, fasting glucose or oral glucose tolerance testing is preferred. Initial workup at diagnosis includes lipid panel, urine albumin-to-creatinine ratio, serum creatinine with eGFR, liver function tests, dilated fundus examination by ophthalmology, comprehensive foot examination including monofilament and vibration testing, blood pressure, and cardiovascular risk assessment. Antibody testing (GAD, IA-2, ZnT8) is reserved for atypical presentations — lean adults, rapid progression to insulin requirement, or strong personal or family history of autoimmunity — to detect latent autoimmune diabetes in adults. C-peptide measurement helps distinguish residual beta-cell function in unclear cases. Screening adults from age 35 every 3 years, or earlier with risk factors, is recommended.
Key tests
01
HbA1c (glycated hemoglobin)Measures average blood glucose over the prior 8-12 weeks. ≥6.5% diagnoses diabetes; 5.7-6.4% indicates prediabetes. Preferred for screening and treatment monitoring.
02
Fasting plasma glucoseDirect measure of overnight glucose homeostasis. ≥126 mg/dL on two occasions diagnoses diabetes; 100-125 mg/dL indicates prediabetes.
03
§ 04
Treatment & cost
medical treatments
✓Metformin (start 500 mg once or twice daily with meals; titrate to 1000 mg twice daily)
Roux-en-Y gastric bypassDiabetes remission in roughly 60% at 5 years; durable weight loss of 25-30% of baseline body weight.
Sleeve gastrectomyDiabetes remission in 30-50% at 5 years; weight loss of 20-25% of baseline body weight.
Pancreas or islet transplantation (selected cases)Five-year graft survival 73% for simultaneous pancreas-kidney transplantation.
§ 05
Causes & risk factors
known causes
Insulin resistance in muscle, liver, and adipose tissue
Visceral adiposity, ectopic lipid deposition in muscle and liver, and chronic low-grade inflammation impair insulin signaling through the IRS-1/PI3K/Akt pathway. Glucose uptake into muscle falls, hepatic gluconeogenesis is unrestrained, and circulating glucose rises.
Progressive beta-cell dysfunction
Pancreatic beta cells initially compensate for insulin resistance by hypersecreting insulin. Over years, beta-cell function declines roughly 4% per year (UKPDS data), driven by glucolipotoxicity, amyloid deposition, and oxidative stress. Once beta-cell capacity falls below demand, fasting hyperglycemia emerges.
Genetic susceptibility
Over 400 genetic loci influence type 2 diabetes risk, with TCF7L2 the strongest single common variant. Heritability estimates from twin studies are 40-70%. South Asian, East Asian, African, Hispanic, and Native American ancestries carry higher polygenic risk and develop disease at lower BMI thresholds.
Adiposity and ectopic fat deposition
Excess visceral and intrahepatic fat drive insulin resistance more strongly than total adiposity. Each 5 kg/m2 increase in BMI roughly doubles diabetes risk; the Twin Cycle hypothesis (Taylor) implicates excess liver and pancreatic fat in beta-cell dysfunction reversible with weight loss.
Physical inactivity
Sedentary behavior independently raises diabetes risk by reducing skeletal muscle glucose uptake. Each additional 2 hours of daily sitting raises diabetes incidence by roughly 14% independent of BMI.
Dietary patterns and ultra-processed foods
High intake of refined carbohydrates, sugar-sweetened beverages, processed red meat, and ultra-processed foods raises diabetes risk. Two servings of sugar-sweetened beverages daily raise diabetes incidence by 26% in pooled meta-analyses.
§ 06
Living with it
01Achieve and maintain 5-10% weight loss in prediabetic adults — reduces diabetes incidence by 58% over 3 years (Diabetes Prevention Program)
02Accumulate at least 150 minutes weekly of moderate-intensity aerobic activity plus 2 weekly resistance sessions
03Adopt a Mediterranean or DASH dietary pattern — independently lowers diabetes incidence by 20-30%
04Limit sugar-sweetened beverages, refined carbohydrates, and ultra-processed foods
05Screen adults from age 35 every 3 years with HbA1c or fasting glucose, and earlier in patients with overweight plus another risk factor
06Treat obstructive sleep apnea with CPAP if confirmed on polysomnography — improves insulin sensitivity
recommended foods
•Mediterranean dietary pattern emphasizing vegetables, legumes, whole grains, nuts, olive oil, and fish
•DASH dietary pattern for combined hypertension and diabetes
•
§ 07
When to seek help
why see an endocrinology
An endocrinologist or diabetologist should be involved when HbA1c remains above target despite metformin plus two additional agents, when insulin is being initiated or titrated, when complications such as diabetic kidney disease, severe neuropathy, or recurrent hypoglycemia emerge, in suspected LADA or unusual phenotypes, in pregnancy or pre-pregnancy counseling, and when bariatric or metabolic surgery is being considered. Primary care manages most uncomplicated type 2 diabetes effectively if treat-to-target is followed.
PrediabetesFasting glucose 100-125 mg/dL, 2-h glucose 140-199 mg/dL, or HbA1c 5.7-6.4%. Roughly 1 in 3 US adults; 5-10% per year progress to overt diabetes without intervention.
Uncomplicated type 2 diabetesDiagnosed type 2 diabetes without overt micro- or macrovascular complications. HbA1c ≥6.5% on confirmatory testing.
Type 2 diabetes with cardiovascular diseaseEstablished atherosclerotic cardiovascular disease, heart failure, or high cardiovascular risk. ADA/EASD 2022 algorithm prioritizes SGLT2 inhibitors or GLP-1 receptor agonists with proven cardiovascular benefit regardless of HbA1c.
Type 2 diabetes with chronic kidney diseaseeGFR <60 mL/min/1.73 m2 or urine albumin-to-creatinine ratio ≥30 mg/g. SGLT2 inhibitors slow kidney function decline by roughly 39% (DAPA-CKD).
Type 2 diabetes in remissionHbA1c <6.5% maintained for at least 3 months without glucose-lowering medication. Achievable in roughly 46% of recently diagnosed patients on intensive weight loss (DiRECT trial).
Latent autoimmune diabetes in adults (LADA)GAD-antibody-positive adult-onset diabetes that mimics type 2 initially but progresses to insulin dependence. Distinguished by autoantibody testing in atypical type 2 presentations.
Living with Type 2 Diabetes Mellitus
Timeline
Glycemic improvement begins within 1-2 weeks of metformin or lifestyle change; full HbA1c response is seen at 3 months. Weight loss with GLP-1 agonists plateaus at 12-18 months. Diabetic retinopathy and nephropathy progression is measurably slowed within 1-2 years of tight glycemic and blood pressure control. Remission from intensive weight loss is most likely within 6 years of diagnosis; the longer the disease duration, the lower the remission probability.
Lifestyle
01Engage with a structured diabetes self-management education program at diagnosis and refresh annually
02Monitor blood glucose patterns with self-monitoring or continuous glucose monitoring as agreed with the care team
03Examine feet daily for cuts, blisters, redness, or temperature change — early detection prevents ulcers
04Schedule annual dilated eye examinations and biennial assessments thereafter if stable
05Maintain blood pressure under 130/80 mmHg and LDL under 70 mg/dL if cardiovascular disease is established
06Stop smoking — doubles cardiovascular and microvascular risk in diabetes
07Limit alcohol to less than 1 drink daily for women and 2 for men; alcohol potentiates hypoglycemia in insulin or sulfonylurea users
Daily management
Complementary approaches
Mediterranean dietary patternPREDIMED extension and meta-analyses show lower diabetes incidence and HbA1c reduction equivalent to many oral agents in early disease (Salas-Salvado Ann Intern Med 2014).
Structured weight-loss programs (DiRECT-style)Total diet replacement at 800-900 kcal daily for 12-20 weeks induced diabetes remission in 46% of recently diagnosed patients at one year and 36% at two years (DiRECT trial, Lean Lancet 2018).
Choosing a doctor
Look for endocrinology board certification, structured diabetes education programs at the practice (registered dietitians, diabetes educators, podiatry), access to continuous glucose monitoring and insulin-pump training, comfort with newer GLP-1 and SGLT2 regimens, and integrated care for cardiovascular and renal complications. Continuity matters more than prestige — diabetes management is a multi-decade relationship.
Type 2 diabetes is a chronic metabolic disease in which the body becomes resistant to insulin and pancreatic beta cells fail to keep up, leaving blood glucose persistently elevated. It affects 11.6% of US adults and over 537 million people worldwide.
What is a normal HbA1c?▾▴
Normal HbA1c is below 5.7%. Prediabetes is 5.7-6.4%. Diabetes is diagnosed at 6.5% or higher on confirmatory testing. Most adults with type 2 diabetes target an HbA1c under 7%, with stricter or looser targets based on age, complications, and hypoglycemia risk.
What are the early signs of type 2 diabetes?▾▴
Early signs include increased thirst, frequent urination especially overnight, fatigue, blurred vision, slow-healing wounds, recurrent yeast infections, and darkened skin patches in folds (acanthosis nigricans). Many patients have no symptoms and are diagnosed on routine screening.
Can type 2 diabetes be reversed?▾▴
Type 2 diabetes can enter remission in roughly 46% of recently diagnosed patients who achieve substantial weight loss (DiRECT trial). Remission means HbA1c under 6.5% sustained for at least 3 months without glucose-lowering medication.
What is the best diet for type 2 diabetes?▾▴
Mediterranean and DASH dietary patterns have the strongest evidence for glycemic improvement and cardiovascular risk reduction. Both emphasize vegetables, legumes, whole grains, nuts, olive oil, and fish, while limiting sugar-sweetened beverages, refined carbohydrates, and ultra-processed foods.
How is type 2 diabetes diagnosed?▾▴
Type 2 diabetes is diagnosed by HbA1c at or above 6.5%, fasting plasma glucose at or above 126 mg/dL, 2-hour plasma glucose at or above 200 mg/dL during an oral glucose tolerance test, or a random plasma glucose at or above 200 mg/dL with classical symptoms.
What is the difference between type 1 and type 2 diabetes?▾▴
Type 1 diabetes is autoimmune destruction of pancreatic beta cells, usually presenting in children or young adults with rapid onset and a need for insulin from diagnosis.
Is metformin still first-line for type 2 diabetes?▾▴
Yes for most patients. Metformin is effective, weight-neutral, low-cost, and has decades of safety evidence.
What are SGLT2 inhibitors?▾▴
SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin) block kidney glucose reabsorption, lower HbA1c, induce 2-3 kg weight loss, and reduce cardiovascular mortality by 14% and heart failure hospitalization by 32% (EMPA-REG OUTCOME).
Most patients with type 2 diabetes are managed without insulin, particularly in the first decade. Insulin is added when HbA1c remains above target despite metformin plus two or three other agents, in severe symptomatic hyperglycemia, in pregnancy, or when other agents are contraindicated.
Can children get type 2 diabetes?▾▴
Yes. Adolescent type 2 diabetes incidence in the US has nearly doubled in two decades, paralleling rising childhood obesity. Type 2 diabetes in youth tends to progress more rapidly and develops complications earlier than adult-onset disease.
What are the long-term complications of type 2 diabetes?▾▴
Untreated type 2 diabetes causes diabetic retinopathy (leading cause of working-age blindness), kidney disease (44% of new CKD), peripheral neuropathy and foot ulcers, doubled cardiovascular mortality, heart failure, and increased dementia risk.
How often should I check my blood sugar?▾▴
Frequency depends on therapy. Patients on lifestyle plus metformin often need infrequent home monitoring. Insulin users typically check 2-4 times daily or wear continuous glucose monitors. Discuss a personalized monitoring plan with your care team.
What is prediabetes?▾▴
Prediabetes is an HbA1c of 5.7-6.4%, fasting glucose 100-125 mg/dL, or 2-hour glucose 140-199 mg/dL. It affects roughly 1 in 3 US adults and progresses to type 2 diabetes at 5-10% per year without intervention.
Is type 2 diabetes hereditary?▾▴
There is a strong genetic component — heritability is estimated at 40-70%. Over 400 genetic loci influence risk, with TCF7L2 the strongest single common variant. A first-degree relative with diabetes raises personal risk roughly 2-3 fold.
Can exercise alone control type 2 diabetes?▾▴
Regular exercise improves insulin sensitivity and lowers HbA1c by roughly 0.5-0.7% as monotherapy. Combined with weight loss and dietary change, exercise can normalize glucose in early disease.
Should I take aspirin if I have type 2 diabetes?▾▴
Low-dose aspirin is recommended for secondary prevention after established cardiovascular disease. Primary prevention with aspirin is selective in diabetes — the 2024 ADA guideline reserves it for patients with high cardiovascular risk and low bleeding risk because the absolute benefit is modest. Discuss with your physician.
What is the cost of type 2 diabetes treatment?▾▴
Costs vary widely. Metformin is inexpensive (under USD 10 per month generic). SGLT2 inhibitors and GLP-1 agonists cost USD 400-1000 monthly in the US without insurance but are widely covered. In India and other markets, generic metformin, sulfonylureas, and increasingly generic SGLT2 inhibitors are affordable.
When should I see an endocrinologist for type 2 diabetes?▾▴
See an endocrinologist if HbA1c remains above target despite metformin plus two other agents, when initiating or titrating insulin, when severe complications emerge, in suspected LADA or atypical presentations, in pregnancy or pre-pregnancy planning, and when bariatric or metabolic surgery is being considered.
Is bariatric surgery recommended for type 2 diabetes?▾▴
Bariatric or metabolic surgery is recommended for patients with type 2 diabetes and BMI 35 or above, and considered in those with BMI 30-34.9 when glycemic control is inadequate. Roux-en-Y gastric bypass and sleeve gastrectomy achieve diabetes remission in 30-60% at 5 years with durable weight loss.
Recurrent vaginal or balanitis fungal infections driven by glucose in skin and mucosal secretions.
06Unintended weight loss of 5-10% over 3-6 months in a minority of patients, especially when glucose is markedly elevated.
07Numbness, tingling, or burning in the feet that worsens at night — early diabetic peripheral neuropathy can predate diagnosis by years.
08Darkened velvety patches in skin folds (acanthosis nigricans) on the neck, axillae, or groin in insulin-resistant patients.
09No symptoms at all in roughly 50% of newly diagnosed patients — discovered on routine screening or on workup of cardiovascular disease.
early warning signs
•Fasting plasma glucose 100-125 mg/dL or HbA1c 5.7-6.4% on routine screening (prediabetes)
•Acanthosis nigricans in adolescents or young adults, especially with central obesity
•Recurrent fungal infections (vulvovaginitis, balanitis, thrush) or slow-healing minor wounds
•History of gestational diabetes — confers a 7-fold lifetime risk of type 2 diabetes
•Strong family history of type 2 diabetes in a first-degree relative
● emergency signs
•Marked hyperglycemia (glucose >300 mg/dL) with vomiting, abdominal pain, fruity breath, or rapid deep breathing — assess for diabetic ketoacidosis or hyperosmolar hyperglycemic state and seek emergency care
•Confusion, drowsiness, or sweating with measured blood glucose under 54 mg/dL — symptomatic severe hypoglycemia requiring oral or parenteral glucose
•New chest pain, breathlessness, or facial droop — diabetes doubles the lifetime risk of myocardial infarction and stroke
•Sudden vision loss or new floaters — vitreous hemorrhage from proliferative diabetic retinopathy needs urgent ophthalmology
•Foot ulcer with surrounding redness, fever, or systemic illness — diabetic foot infection can progress to limb-threatening sepsis within 24-48 hours
75-gram oral glucose tolerance testSensitive test of glucose handling. 2-hour glucose ≥200 mg/dL diagnoses diabetes; 140-199 mg/dL indicates impaired glucose tolerance. Standard during pregnancy and in atypical adult cases.
04
Urine albumin-to-creatinine ratio (UACR)Detects early diabetic kidney disease. ≥30 mg/g indicates albuminuria; results guide ACE inhibitor or ARB initiation and SGLT2 inhibitor selection.
Lipid panel (LDL, HDL, triglycerides)Cardiovascular risk stratification. Most patients with type 2 diabetes warrant statin therapy regardless of LDL.
07
Comprehensive foot and eye examinationDetects subclinical neuropathy and retinopathy. ADA recommends annual dilated fundus examination from diagnosis and annual foot examination with 10-g monofilament and vibration testing.
08
GAD antibodies and C-peptide (selected cases)Distinguishes type 2 from latent autoimmune diabetes (LADA) and from type 1 diabetes in atypical presentations.
Outlook
With contemporary therapy, the prognosis of type 2 diabetes has improved substantially. Maintaining HbA1c under 7%, blood pressure under 130/80 mmHg, and LDL under 70 mg/dL with appropriate ACE inhibitor or ARB, statin, and SGLT2 inhibitor or GLP-1 agonist therapy reduces cardiovascular events by 50% versus standard care (Steno-2 trial). Recently diagnosed patients who achieve and sustain substantial weight loss can enter diabetes remission — 46% at one year and 36% at two years in the DiRECT trial. Without treatment, type 2 diabetes doubles cardiovascular mortality, causes 44% of new chronic kidney disease, and is the leading cause of adult blindness and non-traumatic lower-limb amputation. Median life expectancy is reduced by 4-6 years in middle-aged adults at diagnosis, narrowing substantially with modern multifactorial care. The decisive prognostic factors are early intensive treatment, sustained weight management, smoking status, and adherence to long-term cardiovascular-protective therapy.
Gestational diabetes and PCOS
Both reflect underlying insulin resistance. Women with prior gestational diabetes have a 7-fold lifetime risk of type 2 diabetes; women with PCOS have a 3-4 fold elevated risk. Both warrant lifelong surveillance.
risk factors
Overweight or obesity (BMI ≥25, or ≥23 in Asian populations)modifiable
The dominant modifiable risk factor. Each 5 kg/m2 increase in BMI roughly doubles diabetes incidence; intentional 5-10% weight loss reduces incidence by 58% (Diabetes Prevention Program).
Family history of type 2 diabetesgenetic
A first-degree relative with diabetes raises personal risk roughly 2-3 fold; heritability estimates 40-70%. Risk is multiplicative when combined with adiposity.
Age over 45 (or younger in high-risk populations)non-modifiable
Beta-cell function declines with age. ADA recommends universal screening from age 35 in average-risk adults and earlier in patients with overweight plus another risk factor.
South Asian, East Asian, African, Hispanic, or Native American ancestrynon-modifiable
These populations develop diabetes at lower BMI thresholds and younger ages, reflecting both genetic susceptibility and altered fat distribution. Indian adults develop type 2 diabetes a decade earlier than European adults on average.
History of gestational diabetes or polycystic ovary syndromenon-modifiable
Gestational diabetes confers a 7-fold lifetime diabetes risk; PCOS a 3-4 fold risk. Annual screening is recommended.
Hypertension and dyslipidemiamodifiable
Clustering of metabolic risk factors (metabolic syndrome) doubles diabetes incidence independent of BMI. Treating hypertension and dyslipidemia reduces cardiovascular events but does not directly prevent diabetes.
Physical inactivitymodifiable
Less than 150 minutes weekly of moderate-intensity activity raises diabetes risk; structured exercise programs reduce incidence by roughly 30% independent of weight change.
Sleep disturbance and obstructive sleep apneamodifiable
Short sleep (<6 hours) and untreated obstructive sleep apnea each raise diabetes risk by roughly 30-40%. CPAP improves insulin sensitivity but does not consistently lower HbA1c.
High-fiber foods (25-35 g daily) — slows postprandial glucose rise and lowers LDL
•Lean protein sources including fish, poultry, eggs, dairy, and plant proteins
•Non-starchy vegetables filling half the plate at most meals
•Water, unsweetened coffee, and tea as primary beverages
foods to avoid
•Sugar-sweetened beverages and fruit juices — raise diabetes incidence and worsen glycemic control
•Ultra-processed foods, refined carbohydrates, and added sugars
•Excess saturated and trans fats — raise cardiovascular risk in an already elevated baseline
•Frequent snacking and large evening meals — disrupt glycemic patterns
•Excess alcohol — risks hypoglycemia, weight gain, and worsens triglycerides
Diabetic ketoacidosis or hyperosmolar hyperglycemic state — acute decompensations, especially during illness or with SGLT2 inhibitor use
07Severe hypoglycemia — especially with insulin or sulfonylureas; associated with cardiovascular events and dementia
01Take medications at the same time daily — adherence is the strongest predictor of glycemic control
02Self-monitor blood glucose or use continuous glucose monitoring as agreed with the team; adjust food and activity around readings
03Examine feet daily for cuts, blisters, redness, or warmth — small wounds escalate quickly in diabetes
04Track HbA1c every 3-6 months until at target, then every 6 months once stable
05Carry rapid-acting carbohydrate (glucose tablets) if on insulin or sulfonylureas
06Hydrate adequately, especially in warm weather and during exercise
Exercise
Aim for 150-300 minutes weekly of moderate-intensity aerobic activity spread over at least three days, with no more than two consecutive days without exercise. Add 2-3 resistance training sessions weekly targeting major muscle groups. Break up prolonged sitting every 30 minutes with light activity. Patients on insulin or sulfonylureas should monitor glucose around exercise and have rapid carbohydrate available.