How Type 2 Diabetes Can Change Over Time
Diabetes is a progressive disease, which means that even if you work hard to keep your blood sugar levels in check, you may need to adjust your treatment plan over time.
Even if your diabetes has been well controlled for years, the condition can still worsen over time, meaning, you may have to adjust your treatment plan more than once.
The key to learning about the progression of diabetes is understanding the role of your pancreas, which produces insulin: a hormone needed to move glucose (blood sugar) into cells, where it’s used for energy. If your body doesn’t produce enough insulin or your cells don’t respond to insulin as well as they should, glucose can build up in your bloodstream.
With type 1 diabetes, the pancreas does not make any insulin, so it must be given via injection. If you don’t have type 1 diabetes but your cells don’t respond normally to insulin (a state called insulin resistance), your pancreas goes into overdrive to make more insulin to try to get cells to respond. Over time, this can damage the insulin-producing cells in the pancreas, eventually causing the organ to lose its ability to make enough insulin to keep up with your body’s needs. This leads to a rise in blood sugar and sets the stage for type 2 diabetes, according to the Centers for Disease Control and Prevention.
Chronically high blood sugar (hyperglycemia), can increase your risk of complications, such as vision loss, heart disease, nerve damage, kidney disease, and foot or leg amputation, according to the American Diabetes Association (ADA). The good news is, proper diabetes management can help prevent or delay the onset of these complications. This includes eating a well-balanced diet, getting regular exercise, and taking medication as prescribed, which can help you keep your blood sugar in a healthy range.
What Changes to Expect if You Have Type 2 Diabetes
Type 2 diabetes is a progressive condition, meaning it can get worse over time. In that case, your medications, diet, and exercise goals may need adjustments. “Initially, the pancreas produces extra insulin to make up for insulin resistance, but in most people, the pancreas eventually is unable to make the extra insulin to keep blood sugar levels normal,” says Marc Jaffe, MD, an endocrinologist in practice with Kaiser Permanente in San Francisco.
After a type 2 diabetes diagnosis, your doctor will set blood sugar goals for you, recommend lifestyle changes, and perhaps prescribe medications to help manage your blood sugar levels, Dr. Jaffe says.
The next step in diabetes management, if these initial strategies aren’t working, is to change your prescription or add medication or insulin, according to the latest recommendations from the Standards of Medical Care in Diabetes — 2022. “Because type 2 diabetes usually progresses over time, even people who don’t need medications at first are likely to need medications eventually,” Jaffe notes. Your blood sugar goals might also need to be adjusted, based on your overall health and history with diabetes control.
These guidelines also note that because many people with type 2 diabetes will eventually need insulin therapy, you should not fear it or view it as having failed at managing your diabetes.
“This is a progression of the disease and not to be thought of as something that you caused,” says Erin Palinski-Wade, RD, a certified diabetes care and education specialist (CDCES) in Franklin, New Jersey, and the author of 2 Day Diabetes Diet.
How to Tailor Your Diabetes Management Plan as You Age
Not only does diabetes change over time, Palinski-Wade points out, but so does your body. For example, as you age, you may experience complications from diabetes, such as nerve pain, or develop an unrelated condition, such as osteoarthritis, that could make exercise more challenging, she says. Those kinds of changes in your body would necessitate adjustments to your diabetes management plan.
You may want to have a CDCES on your diabetes care team. They can help you adjust your diet, exercise regimen, and medication management plan to help you navigate your life changes, challenges, and age-related issues.
Here are some strategies your diabetes educator may suggest:
- Eat healthfully. While there’s no one diabetes diet, your food choices can affect your blood sugar levels. Your diet should be individualized, but you can benefit from Palinski-Wade’s advice: “Focus on filling your plate halfway with plant-based foods, such as vegetables, at all meals.” She also urges you to get into the habit of reading labels and understanding portion sizes — skills that will serve you well throughout your life. The ADA recommends tracking your carbohydrate intake and emphasizing nutrient-dense carbohydrates, such as fruits and vegetables, over highly refined, processed carbs, such as white bread, sugary drinks, cakes, and cookies. A registered dietitian or CDCES can work with you to develop a meal plan that can help you maintain healthy blood sugar levels and manage your weight.
- Stay active. Incorporating aerobic activity and resistance training into your exercise plan can improve insulin sensitivity, which allows your body to use insulin more efficiently, according to the ADA. The National Institute of Diabetes and Digestive and Kidney Diseases recommends aiming for at least 30 minutes of physical activity at least five days a week. Talk to your doctor before starting or changing an exercise program.
- Aim for a healthy weight. If you’re overweight, shedding pounds can improve your diabetes control and reduce your risk of complications. According to the ADA, losing just 10 to 15 pounds can make a big difference in diabetes management. Check with your doctor for a recommendation specific to you.
- Monitor your blood sugar levels more frequently. As you get older, your target blood sugar range may change. What’s more, says Jaffe, “As diabetes progresses, people may need to start or increase the frequency of checking their blood sugar levels, especially when blood sugar levels are high or low, hard to control, or [being managed with] insulin.”
You may want to ask your doctor about continuous glucose monitoring (CGM) devices, which use a sensor inserted under the skin to get real-time readings of blood sugar levels. This technology not only makes it possible for you to respond immediately to high or low blood sugar, but it can also give important information to help you make dietary and exercise changes to optimize your diabetes management.
CGMs also allow you and your diabetes care team to assess how well your diabetes is being controlled, using a concept called “time in range,” says Martha M. Funnell, RN, CDCES, an emeritus research scientist of learning health sciences at the University of Michigan Medical School and past president of health care and education of the ADA. This metric, which is endorsed by the ADA, refers to the percentage of time your blood sugar is within target values. Greater time in range has been associated with more stable blood sugar control, which is linked to a reduced risk of complications.
It can be challenging to live with a progressive and chronic condition such as diabetes, but taking care of yourself every day and checking in with your doctor and CDCES regularly can help you manage the condition.