These Are the Stages of Type 2 Diabetes and How They Progress

1. These Are the Stages of Type 2 Diabetes and How They Progress

Stage 1: Insulin Resistance

Stage 2: Prediabetes

Stage 3: Type 2 Diabetes

Stage 4: Type 2 Diabetes With Vascular Complications

Diagnosis

Key Takeaways

Diabetes occurs in four stages: insulin resistance, prediabetes, type 2 diabetes, and type 2 diabetes with vascular complications.

If insulin resistance or prediabetes is caught early, lifestyle changes like diet and exercise can prevent you from developing type 2 diabetes.

Blood sugar management is key to preventing the most severe complications, such as kidney damage.

Type 2 diabetes progresses through four stages, starting with insulin resistance and potentially leading to serious complications. Early detection and lifestyle changes can slow its progression and improve management.

 

 

A girl with diabetes is sitting in the pool. On the left arm is the white sensor for continuous glucose monitoring in blood – CGM – stock photo

Dragoljub Bankovic / Getty Images

Stage 1: Insulin Resistance

Insulin resistance signals early blood sugar issues, often occurring years before a type 2 diabetes diagnosis. When you eat, your body converts food into sugar (glucose) that enters your bloodstream.

 

The pancreas releases insulin to remove the sugar from your blood and enter your cells for your body to use for energy. When your body is resistant to insulin or doesn’t properly respond to insulin, your blood sugar begins to rise.1

 

 

As a result, your body signals the liver and muscles to store blood sugar. When the liver can’t hold anymore, it sends the extra sugar to fat cells, which get stored as body fat.1

 

While this first stage can go unnoticed, many changes in the body can create serious health issues in the future.

 

Type A Insulin Resistance

Type A insulin resistance is a rare disorder where the body’s tissues don’t respond to insulin. It’s caused by a mutation in a gene that helps cells take in insulin.2

 

Stage 2: Prediabetes

Prediabetes occurs when blood glucose levels are elevated but not yet at diabetic levels. Lifestyle changes, such as diet and exercise, can reverse prediabetes, reducing the risk of type 2 diabetes, heart disease, and stroke.3

 

Like insulin resistance, you may not notice any signs of prediabetes until a blood test shows elevated glucose levels. Your risk for prediabetes increases if you have:3

 

Excess weight or obesity

Low physical activity

Biological parent(s) or sibling(s) with diabetes

A history of high cholesterol, high blood pressure (hypertension), heart disease, or stroke

Polycystic ovary syndrome (PCOS)/polyendocrine metabolic ovarian syndrome (PMOS)

Prevalence of prediabetes increases for African Americans, Native Hawaiians, Alaska Natives, American Natives, Asian Americans, Hispanics/Latinos, Pacific Islanders, and those 45 or older.

 

Can you prevent prediabetes from turning into diabetes?

Yes, prediabetes is reversible. Think of it as a warning signal. Eating healthy, losing extra weight through regular physical activity, and taking prescribed medications can get your blood sugar levels back in a normal range.4

 

Stage 3: Type 2 Diabetes

In type 2 diabetes, your blood glucose levels are too high. A normal fasting blood sugar level is 99 milligrams of sugar per deciliter of blood (mg/dL) or less. Prediabetes is when blood glucose is between 100 and 125 mg/dL. A level of 126 mg/dL or higher indicates type 2 diabetes.5

 

Some with type 2 diabetes may not show symptoms; for others, symptoms may be mild. However, symptoms will get progressively worse.6

 

Type 2 diabetes symptoms include:76

 

Increased thirst and urination

Blurred vision

Increased hunger

Numbness or tingling in the hands or feet (peripheral neuropathy)

Wounds that take a long time to heal or don’t heal at all (diabetic ulcers)

Signs Blood Sugar Is Not Under Control

Even when you are following your diabetes treatment plan, blood sugar may get out of control due to the condition’s progressive nature.8 If you notice signs of your blood sugar slipping out of the normal range, contact your healthcare provider immediately to discuss your treatment plan.

 

Stage 4: Type 2 Diabetes With Vascular Complications

This final stage of diabetes involves vascular (blood vessel) damage. This includes diabetic retinopathy, atherosclerosis, and diabetic nephropathy. These conditions are caused by years of high blood sugar and are responsible for reduced life expectancy, blindness, and end-stage renal disease in those with type 2 diabetes.9

 

Diabetic retinopathy: The blood vessels in the back of your eye become swollen, leaking fluid into your eye. This can cause vision loss, retinal detachment, glaucoma (optic nerve damage), and cataracts (cloudy eye lens).10

 

Atherosclerosis: A build-up of fat and cholesterol, called plaque, collects in the arteries. It eventually hardens, and blood is unable to move freely. The plaque can get so thick that the pathway through the arteries is completely blocked, causing a heart attack or stroke.11

 

Diabetic nephropathy: High blood sugar can also damage your kidneys. When this happens, the kidneys can’t remove waste and fluid from your body effectively, eventually leading to kidney failure. Treatment requires regular dialysis, a procedure that manually removes waste from the blood until you can receive a kidney transplant.12

 

What is end-stage diabetes?

End-stage diabetes is a series of complications that can occur in people who have had diabetes for a long time. These complications can include heart disease, kidney problems, and nerve damage. Older adults are more likely to experience end-stage diabetes because increased frailty and age-related cognitive changes can make it more difficult to manage diabetes.13

 

Diagnosis

Type 2 diabetes is usually diagnosed with a blood test called the Hemoglobin A1C (A1C) test. This test shows the average blood sugar levels over the previous few months. A diagnosis of diabetes is made if the A1C result is 6.5% or higher on two separate occasions, while results between 5.7% and 6.4% suggest prediabetes.

 

A reading below 5.7% indicates normal blood sugar levels.14

 

Slowing Progression

The only way to prevent or slow the progression of type 2 diabetes is to control your blood sugar. If you’re diagnosed with insulin resistance or prediabetes, you can still avoid type 2 diabetes. If you are diagnosed with type 2 diabetes, prevention and management are the same:68

 

Eat healthily and exercise: This includes eating a healthy, low-calorie diet with fruits, vegetables, lean and/or plant proteins, whole grains, and non or low-fat dairy. Exercise is also essential. You should get at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week and incorporate strength exercises twice a week.

Lose extra weight: Eating well and moving more should help you lose weight. Speak with your healthcare provider to determine your target weight and tips for reaching it.

Take medications: Your healthcare provider may prescribe diabetes medications to help keep your blood sugar under control. This may include oral medicines or insulin injections.

Type 2 diabetes is a progressive disease, making it harder to control your blood sugar over time. Work with your healthcare provider to adjust your treatment plan and medications as needed to help prevent serious complications.8

 

How does diabetes affect life expectancy?

The life expectancy for people with type 2 diabetes depends on many factors, including age at diagnosis and how well the condition is managed. Generally speaking, people who are diagnosed at a younger age have a shorter life expectancy than those diagnosed later. One study found that people in the U.S. diagnosed at age 30 died 14 years earlier, on average, than those without diabetes.15