In May 2020, the Food and Drug Administration (FDA) recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. This is because an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets. If you currently take this drug, call your healthcare provider. They will advise whether you should continue to take your medication or if you need a new prescription.

Diabetes is a serious chronic condition that impairs the body’s ability to process blood glucose, otherwise known as blood sugar. There are several types of diabetes, which have various treatments.

In the United States, the estimated number of people of all ages living with diagnosed and undiagnosed diabetes is 34.2 million.

Without ongoing, careful management, diabetes can lead to a buildup of sugars in the blood, which can increase the risk of dangerous complications, including stroke and heart disease.

Different kinds of diabetes can occur, and how people manage the condition depends on the type. Not all forms of diabetes stem from a person being overweight or leading an inactive lifestyle. Some are present from childhood.

The most common types of diabetes include type 1, type 2, and gestational diabetes, which we cover in more detail below. Less common types of diabetes include monogenic diabetes and cystic fibrosis-related diabetes.

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There are several types of diabetes.

Also known as juvenile diabetes, type 1 diabetes occurs when the body does not produce insulin. Insulin is a hormone responsible for breaking down the sugar in the blood for use throughout the body. A person living with type 1 diabetes may receive a diagnosis during childhood.

People living with type 1 diabetes need to administer insulin on a regular basis. Individuals may do this with injections or an insulin pump.

There is no cure for type 1 diabetes. Once a person receives their diagnosis, they will need to regularly monitor their blood sugar levels, administer insulin, and make some lifestyle changes to help manage the condition.

Successfully managing blood sugar levels can help people living with type 1 diabetes avoid serious complications. Some common complications include:

Learn about symptoms of type 1 diabetes in children here.

People with type 2 diabetes do not make or use insulin effectively. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this is the most common type of diabetes, and it has strong links with obesity.

A person living with type 2 diabetes may or may not need insulin. In many cases, medication along with changes in exercise and diet can help manage the condition.

Anyone, including children and adults, can develop type 2 diabetes. The most common risk factors for type 2 diabetes include:

  • age 45 or older
  • overweight
  • family history

Learn about the early warning signs of type 2 diabetes here.

Gestational diabetes occurs during pregnancy when an individual becomes less sensitive to insulin. According to the Centers for Disease Control and Prevention (CDC), between 2–10% of pregnancies each year result in gestational diabetes. Individuals who are overweight going into their pregnancy have an elevated risk of developing the condition.

The CDC adds that around 50% of people with gestational diabetes will later develop type 2 diabetes.

During pregnancy, individuals can take steps to manage the condition. These include:

  • staying active
  • monitoring the growth and development of the fetus
  • adjusting their diet
  • monitoring blood sugar levels

Gestational diabetes can increase a person’s risk of developing high blood pressure during pregnancy. It can also cause:

  • premature birth
  • increased birth weight
  • blood sugar issues with the newborn, which typically clear up within a few days
  • increased risk of the baby developing type 2 diabetes later in life

Learn the signs and symptoms of gestational diabetes here.

Prediabetes, or borderline diabetes, occurs when a person’s blood sugar levels are elevated but not enough for a diagnosis of diabetes. For a doctor to diagnose prediabetes, an individual must meet the following criteria:

  • glucose tolerance levels of 140–199 milligrams per deciliter (mg/dl)
  • an A1C test result of 5.7–6.4%
  • fasting blood sugar levels between 100–125 mg/dl

People living with prediabetes have a higher risk of developing type 2 diabetes, but they do not usually experience the symptoms of full diabetes.

Learn about naturally reversing prediabetes here.

The risk factors for a person developing prediabetes and type 2 diabetes are similar. They include:

  • being overweight
  • a family history of diabetes
  • having a high-density lipoprotein (HDL) cholesterol level lower than 40 mg/dl or 50 mg/dl
  • a history of high blood pressure
  • having gestational diabetes or giving birth to a child with a birth weight of more than 9 pounds
  • a history of polycystic ovary syndrome (PCOS)
  • being of African-American, Native American, Latin American, or Asian-Pacific Islander descent
  • being more than 45 years of age
  • having a sedentary lifestyle

Learn about why type 2 diabetes can affect African Americans more here.

A person cannot prevent type 1 diabetes.

However, people can take some steps to help prevent type 2 diabetes. Some ways to help prevent type 2 diabetes include:

  • maintaining a moderate weight
  • eating a balanced diet low in added sugars, saturated fats, and processed foods
  • exercising regularly

To reduce the risk of developing gestational diabetes, a person should maintain a moderate weight before becoming pregnant.

While these steps can help, it is important to note that people may still develop either type 2 or gestational diabetes.

Doctors do not know the exact causes of type 1 diabetes. However, insulin resistance, which can lead to type 2 diabetes, has clearer causes.

Insulin allows the glucose from a person’s food to access the cells in their body to supply energy. Insulin resistance is usually a result of the following cycle:

  1. A person has genes or an environment that make it more likely for them to be unable to produce enough insulin to cover how much glucose, or sugar, they eat.
  2. The body tries to make extra insulin to process the excess blood sugar.
  3. The pancreas cannot keep up with the increased demands, and the excess blood sugar starts to circulate in the blood, causing damage.
  4. Over time, insulin becomes less effective at introducing glucose to cells, and blood sugar levels continue to rise.

With type 2 diabetes, insulin resistance takes place gradually. This is why doctors often recommend making lifestyle changes in an attempt to slow or reverse this cycle.

Learn more about the function of insulin here.

If a doctor diagnoses somone with diabetes, they will often recommend making lifestyle changes to support weight management and overall health.

A doctor may refer a person living with diabetes or prediabetes to a nutritionist. A specialist can help people living with diabetes lead an active, balanced lifestyle and manage the condition.

Steps a person can take to stay healthy with diabetes include:

  • Eating a diet high in fresh, nutritious foods, including whole grains, fruits, vegetables, lean proteins, low-fat dairy, and healthy fat sources, such as nuts.
  • Avoiding high-sugar foods that provide empty calories or calories that do not have other nutritional benefits, such as sweetened sodas, fried foods, and high-sugar desserts.
  • Refraining from drinking excessive amounts of alcohol or keeping intake to less than one drink a day for females or two drinks a day for males.
  • Engaging in at least 30 minutes of exercise per day on at least 5 days of the week, such as walking, aerobics, riding a bike, or swimming.
  • Recognizing signs of low blood sugar when exercising, including dizziness, confusion, weakness, and profuse sweating.

Some people can also take steps to reduce their body mass index (BMI) if needed, which can help those with type 2 diabetes manage the condition without medication.

All people living with type 1 diabetes and some people living with type 2 diabetes need to administer insulin to keep their blood sugar levels from becoming too high.

Various types of insulin are available, and most are grouped by how long their effect lasts. There are rapid-acting, short-acting, intermediate-acting, long-acting, and mixed insulins.

Some people will use long-acting insulin to maintain consistently low blood sugar levels. Others may use short-acting insulin or a combination of insulin types. Whatever the type, a person will usually check their blood sugar levels to determine how much insulin they need.

To check blood sugar levels, a person can use a blood glucose monitor, which involves pricking their skin, or a combination of a continuous blood glucose monitor (CGM) and skin pricks.

A CGM takes blood sugar readings regularly throughout the day. They can help a person make any adjustments to their medications.

Self-monitoring is the only way a person can find out their blood sugar levels. Assuming the level from any physical symptoms that occur may be dangerous unless a person suspects extremely low sugar and thinks they need a rapid dose of glucose.

Learn more about the discovery of insulin here.

How much is too much?

Insulin helps people living with diabetes live an active lifestyle. However, it can lead to serious side effects, especially if a person administers too much.

Excessive insulin can cause hypoglycemia, or extremely low blood sugar, and lead to nausea, sweating, and shaking.

It is essential that people measure insulin carefully, adjust their medications based on their needs, and eat a consistent diet that helps to balance blood sugar levels as much as possible.

In addition to insulin, other types of medication are available that can help people manage their condition.


A doctor may prescribe metformin in pill form to a person with type 2 diabetes.

It contributes to:

  • lowering blood sugar
  • making insulin more effective

People living with diabetes may also have other health risks, which they may also need medication to control. A doctor will advise the individual about their needs.

SGLT2 inhibitors and GLP-1 receptor agonists

In 2018, new guidelines also recommended prescribing additional drugs for people with:

These are sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 (GLP-1) receptor agonists.

For those with atherosclerotic cardiovascular disease and a high risk of heart failure, the guidelines advise doctors to prescribe an SGLT2 inhibitor.

GLP-1 receptor agonists work by increasing the amount of insulin the body produces and decreasing the amount of glucose that enters the bloodstream. It is an injectable medication. People may use it with metformin or alone. Side effects include gastrointestinal problems, such as nausea and a loss of appetite.

SLGT2 inhibitors are a new type of drug for lowering blood sugar levels. They work separately from insulin, and may be useful for people who are not ready to start using insulin. People can take it by mouth. Side effects include a higher risk of urinary and genital infections and ketoacidosis.

Learn more about other medications and treatments for managing diabetes here.

Self-monitoring blood sugar levels is vital for effective diabetes management, helping to regulate meal scheduling, physical activity, and when to take medication, including insulin.

While self-monitoring blood glucose machines vary, they will generally include a meter and test strip for generating readings. It will also involve using a lancing device to prick the skin for obtaining a small quantity of blood.


People should refer to the specific instructions of a meter in every case, as machines will differ. However, the following precautions and steps will apply to many devices on the market:

  • Making sure both hands are clean and dry before touching the test strips or meter.
  • Using a test strip once only and keeping them in their original canister to avoid any external moisture changing the result.
  • Keeping canisters closed after testing.
  • Checking the expiration date before use.
  • Checking whether the machine requires coding before use, which may apply to older varieties
  • Storing the meter and strips in a dry, cool area.
  • Taking the meter and strips to consultations so that a primary care physician or specialist can check their effectiveness.


People checking their blood sugar levels with a blood glucose meter will also use a device called a lancet to prick their finger. While the idea of drawing blood might cause distress for some people, lancing the skin to obtain a blood sample should be a gentle, simple procedure. Many meters require only a teardrop-sized sample of blood.

A person may also find the following tips useful:

  • Using their fingertips to obtain a blood sample. While some meters allow samples from other test sites, such as the thighs and upper arms, the fingertips or outer palms produce more accurate results.
  • Cleaning their skin with soapy, warm water to avoid food residue entering the device and distorting the reading.
  • Choosing a small, thin lancet for maximum comfort.
  • Adjusting the lancet’s depth settings for comfort.
  • Taking blood from the side of their finger, as this causes less pain. Using the middle finger, ring finger, and little finger may be more comfortable.
  • Teasing blood to the surface in a “milking” motion rather than placing pressure at the lancing site.
  • Following local regulations for disposing of sharp objects, including lancets.

While remembering to self-monitor involves people making lifestyle adjustments, it need not be an uncomfortable process.

Diabetes is a serious, chronic condition. According to the American Diabetes Association (ADA), the condition was the seventh leading cause of death in the U.S. in 2017.

While diabetes is manageable, its complications can severely impact daily living, and some can be fatal if not treated immediately.

Complications of diabetes include:

Kidney disease can lead to water retention when the body does not dispose of water correctly, difficulties with bladder control, and kidney failure.

Regularly monitoring blood sugar levels and moderating glucose intake can help people prevent the more damaging complications of diabetes.

For those living with type 1 diabetes, administering insulin is the main way to help them manage the condition.

Diabetes is a life changing condition that requires careful blood sugar management and a healthy lifestyle for a person to manage it safely. There are several different types of diabetes.

Type 1 occurs when the body does not produce insulin. Type 2 develops when insulin production or effectiveness can no longer meet the body’s needs.

Depending on the type of diabetes, people may need to administer insulin and take other medications to manage their condition and improve glucose absorption. If a person is living with prediabetes, they can reduce the risk of developing type 2 diabetes through regular exercise and a balanced diet.

The complications of diabetes can be severe, including kidney failure and stroke, so managing the condition is vital.

Anyone who suspects they may be living with diabetes should contact their doctor.