How to explain a type 2 diabetes mellitus (DM) diagnosis to a patient

How to Explain Type 2 Diabetes Diagnosis to a Patient

Type 2 diabetes is a condition where your body doesn't make enough insulin and the insulin you do make doesn't work properly, causing sugar to build up in your blood instead of being used for energy. 1

What's Happening in Your Body

• Your pancreas produces a hormone called insulin that acts like a key to let sugar (glucose) from food into your cells for energy 2, 1
• In type 2 diabetes, two problems occur: your body's cells resist insulin's effects (insulin resistance), and your pancreas cannot produce enough insulin to overcome this resistance 2, 3
• Over time, your pancreas becomes exhausted and produces even less insulin, making the problem worse 3, 4
• This causes sugar to accumulate in your bloodstream instead of entering your cells, leading to high blood sugar levels 1

Why This Diagnosis Matters

• High blood sugar damages blood vessels and nerves throughout your body over many years, even when you feel fine. 2, 5
• Type 2 diabetes often goes undiagnosed for years because it develops gradually—you may not notice symptoms initially, but damage is already occurring 2, 5
• Without treatment, this leads to serious complications including heart attacks, strokes, kidney failure requiring dialysis, vision loss or blindness, and nerve damage 3
• The good news: controlling your blood sugar now prevents these complications, even if you've had undiagnosed diabetes for some time 3

How We Made This Diagnosis

• Your diagnosis was confirmed because your test results met specific criteria: fasting blood sugar ≥126 mg/dL, or hemoglobin A1C ≥6.5%, or 2-hour glucose during testing ≥200 mg/dL 5, 3
• We confirm abnormal results with repeat testing on a different day to ensure accuracy (unless you had classic symptoms like excessive thirst, urination, and weight loss with a random glucose ≥200 mg/dL) 5
• Your A1C test shows your average blood sugar over the past 2-3 months, giving us a picture of how long sugar has been elevated 5

Risk Factors That Led to Your Diagnosis

• Type 2 diabetes develops from a combination of factors you can and cannot control 2, 5
• Non-modifiable risk factors include: family history of diabetes, age over 35 years, and certain ethnicities (Native American, African American, Latino, Asian American, Pacific Islander) 2, 5
• Modifiable risk factors include: being overweight or obese (BMI ≥25 kg/m², or ≥23 kg/m² for Asian Americans), physical inactivity, high blood pressure, abnormal cholesterol levels, and history of gestational diabetes 2, 5
• Even if you're not significantly overweight by traditional standards, excess abdominal fat increases your risk 2

What to Expect Going Forward

• Type 2 diabetes is a chronic condition that requires ongoing management, but it is controllable with the right approach 3
• Your main treatment goal is keeping your blood sugar in a healthy range to prevent complications. 1, 3
• This involves three key components: healthy eating, regular physical activity, and usually medication 1, 3
• Most people start with metformin, a medication that helps your body use insulin more effectively and reduces sugar production by your liver 3
• You'll need regular monitoring with A1C tests every 3-6 months and annual screening for complications affecting your eyes, kidneys, feet, and heart 5

Important Warnings and What to Watch For

• Seek immediate medical attention if you develop: severe weakness, unusual muscle pain, trouble breathing, unusual sleepiness, unexplained nausea/vomiting, feeling cold especially in arms and legs, dizziness, or slow/irregular heartbeat—these may indicate a rare but serious medication complication called lactic acidosis 1
• While metformin alone rarely causes low blood sugar, this can occur if you skip meals, drink excessive alcohol, or take other diabetes medications 1
• Common medication side effects include diarrhea, nausea, and upset stomach, which typically improve after a few weeks—taking medication with meals helps 1
• Avoid excessive alcohol intake, as it increases risks of both low blood sugar and lactic acidosis 1
• Inform all healthcare providers that you have diabetes and take metformin before any surgery or imaging procedures requiring contrast dye, as you may need to temporarily stop the medication 1

Critical Pitfalls to Avoid

• Don't assume you'll feel sick when your blood sugar is high—you can have dangerously elevated levels without symptoms 2, 5
• Don't delay treatment hoping diabetes will resolve on its own—every year of uncontrolled blood sugar increases your risk of irreversible complications 5
• Don't stop medications without consulting your doctor, even if you feel well or your blood sugar improves 1
• Although rare in type 2 diabetes, you can develop diabetic ketoacidosis (a life-threatening condition) during severe illness, with certain medications like steroids, or if you miss insulin doses (if prescribed later) 2, 6

Lifestyle Changes That Make a Real Difference

• Physical activity can lower your A1C by 0.4-1.0% and improve blood pressure and cholesterol 3
• Weight loss of even 5-10% of your body weight significantly improves blood sugar control 3
• No single "diabetes diet" is proven superior—focus on portion control, limiting refined carbohydrates and sugary foods, and eating more vegetables, lean proteins, and whole grains 3
• Regular monitoring of your blood sugar at home helps you understand how food, activity, and medications affect your levels 1