Managing type 2 diabetes can feel overwhelming, especially when you're trying to understand medications, lifestyle changes, and different advice. Whether you were recently diagnosed or have been living with type 2 diabetes for years, having clear answers makes a difference. In her clinical practice, Christa Steffensmeier, NP-C, Bold care provider, helps patients understand type 2 diabetes and feel confident managing it day to day.

To help you get started, Christa answers 10 common questions about type 2 diabetes, from what it is and how it's treated, to what to eat and how to exercise safely.

1. What’s the difference between type 1 and type 2 diabetes?

Type 1 diabetes is often called juvenile-onset or insulin-dependent diabetes. It occurs when the immune system attacks the cells in the pancreas that make insulin, a hormone which regulates blood sugar. As a result, the body produces little to no insulin. People with type 1 diabetes need insulin for life. They get it through injections or an insulin pump. Although it is most commonly diagnosed in children and young adults, it can develop at any age.

Risk factors of Type 1 diabetes include:

• Age
• Family history of type 1 diabetes
• Ethnic background (occurs at higher rates in Caucasian populations)

Type 2 diabetes happens when the body can’t use insulin properly. The pancreas can't make enough insulin to keep up. This causes elevated blood sugar levels. Treatment may include lifestyle changes, oral medications, and injectable therapies. In advanced cases, insulin therapy may be required.

Risk factors for type 2 diabetes include:

• Being over 40 years old
• Being overweight or obese
• Family history of type 2 diabetes
• Physical inactivity
• Non-alcoholic fatty liver disease (NAFLD)
• History of gestational diabetes or delivering a baby weighing over nine pounds

2. What are the first signs of diabetes in seniors?

Common early signs and symptoms are:

• Increased hunger or thirst
• Frequent urination
• Persistent fatigue
• Slower wound healing
• Blurry vision
• Headaches
• Dizziness
• Numbness or tingling in the hands or feet

If you notice any of these, it’s important to follow up with your primary care provider immediately.

3. Can type 1 turn into type 2 diabetes?

No. Type 1 diabetes and type 2 diabetes have very different underlying causes.  But, in rare cases, some people may have features of both conditions. When a person has type 1 diabetes and becomes insulin resistant, it’s called double diabetes. Some people also call it hybrid diabetes. This insulin resistance is a key part of type 2 diabetes.

People with double diabetes often need more insulin to manage their blood sugar.  This condition can affect people of any age, body size, or weight.

4. Can you reverse type 2 diabetes?

Type 2 diabetes can sometimes go into remission. People often call this “reversing” diabetes. This means blood sugar levels return to a healthy range. The body becomes more sensitive to insulin again. Reaching remission can lower the risk of other health issues. These issues are often  linked to insulin resistance.

These include:

• Fatty liver disease
• Heart disease
• Certain cancers linked to obesity
• Alzheimer’s disease

Remission often happens with weight loss, regular exercise, and healthier food choices. This includes eating less sugar and carbs. Sometimes, medication is needed. Even when blood sugar levels get better, keep up with healthy habits. Also, continue taking any prescribed medications to manage diabetes effectively. 

5. Does diabetes cause dizziness?

Dizziness can be a symptom of diabetes.

Causes may include:

• High or low blood sugar
• Medication side effects
• Dehydration
• Diabetic retinopathy
• Vestibular disordersIt is essential to monitor blood glucose regularly and drink plenty of water. 

6. Do type 2 diabetics take insulin?

Some people with type 2 diabetes may need insulin, but not everyone does. Insulin is often used if lifestyle changes and other diabetes meds can’t stabilize blood sugar. In some cases, insulin is only needed for a short period of time.

For most people with type 2 diabetes, treatment starts with healthy eating, managing weight, and regular exercise. They may also need oral medications or injectable options like GLP-1 therapies. These treatments can often control blood sugar without causing low blood sugar episodes.

Insulin can be used temporarily in a hospital, like after surgery or during illness. It helps keep blood sugar levels stable while the body heals. You might not need insulin after you leave the hospital.

7. What are the medications for type 2 diabetes?

There are many options to treat diabetes with medication. What works best depends on your personal health history. Always talk to your doctor before starting, stopping, or changing any medication.

Here's an overview of the most common medications used to treat type 2 diabetes:

• Biguanides (Metformin): Oral medication
• • What they do: Improves insulin sensitivity by lowering liver glucose production
  • Benefits: Effective, cheap, minimal effect on weight, low risk of hypoglycemia
  • Negatives: Potential stomach upset or diarrhea 
• Dipeptidyl peptidase 4 (DPP-4) inhibitors (ex: Sitagliptin/Januvia, Linagliptin/ Tradjenta): Oral medications
• • What they do: Prevent the breakdown of naturally occurring hormones in the body: GLP-1 and GIP. This helps lower blood glucose levels when they are high. 
  • Benefits: Minimal effect on weight, generally well tolerated
  • Negatives: Modest decrease in HbA1c levels
• GLP-1 receptor agonists include Rybelsus (oral), Byetta, Trulicity, Ozempic, Victoza, and Mounjaro (injectable).
• • What they do: Mimic GLP-1 (glucagon-like peptide-1) and/or GIP.  These hormones are found naturally in your body and produced in the gut. Their main role is to help regulate blood sugar after you eat, but also affect digestion and appetite. They slow down gastric emptying, lower appetite, and help manage blood glucose levels. Plus, they do this without causing low blood sugar.
  • Benefits include:
  • • Moderate weight loss
    • Cardiovascular protection for high-risk patients
    • Treatment for moderate to severe sleep apnea (teirzepatide)
    • Treatment for moderate to severe fibrosis in nonalcoholic steatohepatitis (NASH)
    • Reduces inflammation levels
  • Negatives: Cost, potential GI upset (nausea/vomiting, constipation).
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors (ex: Empaglifozin/Jardiance, dapaglifozin/Farxiga): Oral medications
• • What they do: Cause excess glucose to be eliminated in the urine
  • Benefits: Mild weight loss, slight blood pressure reduction, improved HbA1c.  Great choice for patients with heart disease, kidney disease, and heart failure.
  • Negatives: Higher risk of genital infections
• Sulfonylureas (ex: glipizide, glyburide, and glimepiride): Oral medications
• • What they do: Stimulate the pancreas to release insulin
  • Benefits: Cheap and effective
  • Negatives: Risk of hypoglycemia and weight gain
• Thiazolidinediones (TZDs) (ex: pioglitazone, rosiglitazone): Oral medications
• • What they do: Help insulin work better in the muscle and fat and reduce glucose production in the liver
  • Benefits: Improve insulin sensitivity in fat and muscle.  Low risk of hypoglycemia.
  • Negatives: May cause weight gain. It can raise heart failure risk in some patients. It might also lead to fluid retention (edema) in the legs and feet.
• Insulin (ex: glargine and lispro): Injections
• • What they do: Directly lower blood sugar
  • Benefits: Works fast, available in pumps or injections, and comes in long or short-acting forms.
  • Negatives: Can cause hypoglycemia or weight gain, must monitor blood glucose frequently

If you have any questions about medications, it’s best to talk to your healthcare team.

8. What’s the best breakfast for type 2 diabetes?

There’s lots of options for healthy breakfasts for type 2 diabetics. Pair lean proteins and healthy fats with carbs that won’t cause big spikes in your blood sugar , such as non-starchy vegetables, legumes (lentils, chickpeas), whole grains, and fruits like berries and apples. 

Breakfast ideas include:

• Scrambled egg whites or egg-beaters with greens, bell pepper, and low-fat cheese. Enjoy with 1 slice of sprouted bread or 2 clementines.
• 1 serving low fat cottage cheese with 1 diced medium apple and cinnamon
• ½ cup cooked oatmeal with serving of protein powder added and ½ cup blueberries
• Avocado toast: Use 1/2 a medium avocado, sliced or mashed, on one slice of sprouted toast. Add tomatoes and a slice of low-fat cheese.
• Low fat, zero sugar Greek yogurt with 3/4 cup berries, ¼ cup almonds or walnuts (or ¼ cup granola)
• Overnight protein oats:
• • Mix 1/4 cup old-fashioned oats.
  • Add 1 scoop of protein powder (20 grams of protein or more).
  • Stir in 1 tsp chia seeds.
  • Add 1 tsp vanilla, 1 tsp maple syrup or honey, and 1/3 cup protein milk.
  • Mix and put in the fridge overnight. These store well in small mason jars.
  • In the morning, serve with fresh berries, using one part berries. 
• Tofu, spinach, and cherry tomato scramble with slice of whole wheat toast
• 1/2 sweet potato with onions and 1/2 cup spinach plus 1 egg stir fry.
• Unsweetened low fat yogurt, 8 ounces plus 1 serving fresh berries and 1 tbsp hemp or chia seeds.
• Make-ahead egg muffins:
• • Combine eggs
  • Add chopped turkey sausage
  • Mix in spinach or kale
  • Include chopped bell peppers or mushrooms
  • Top with a sprinkle of low-fat shredded cheese
  • Distribute into muffin tins and bake or sous vide for sous vide egg bites)
  • Refrigerate and eat each morning for breakfast.
• Protein smoothie:
• • 1 cup low-fat milk (your choice)
  • 1 scoop protein powder
  • 1/2 cup spinach or kale
  • 1 serving of berries or fruit (your choice)
  • 1 tbsp hemp or chia seeds
  • Add ice and water as needed for desired consistency.

9. What are the best snacks for type 2 diabetes?

Snack options for type 2 diabetics follow a simple rule. Combine lean proteins, healthy fats, and 'healthy' carbs. These carbs can be colorful fruits, veggies, or whole grains.

Examples include:

• Raw vegetables with hummus
• Low-fat Greek yogurt with berries; optionally, add low-sugar granola
• Low-fat cottage cheese with fruit or vegetables
• Turkey roll-ups with raw vegetables and cheese in low-sodium deli meat
• Nuts (almonds, walnuts, pistachios, or cashews) with mandarin oranges
• Tuna fish with a few whole wheat crackers or veggies
• Hard-boiled eggs with fruit or vegetables
• Apple with almond or peanut butter
• Homemade protein shake (whey protein, non-fat milk or water, ice, and a serving of fruit)
• Roasted chickpeas
• Celery with peanut butter

Verify that you are eating appropriate serving sizes of these snacks.

10. What exercises should diabetics avoid?

Diabetics do not need to avoid any specific exercise. If you’re new to exercise or have questions, it’s smart to meet with your primary care provider. They can help you understand your needs and create a personalized exercise plan.

Here are a few things to keep in mind:

• Try low to moderate intensity exercise.  Examples include brisk walking, hiking, swimming, light weight lifting, Pilates, and yoga.  These types of exercise pose a low risk to low or highrisk of abnormal blood sugar.  During low to moderate intensity exercise, you should be able to speak several words at a time withoutThese types of exercise involve when you can move and talk at the same time (you shouldn’t be breathing too hard)feeling short of breath. Examples include brisk walking, hiking, swimming, light weight lifting, Pilates, and yoga.
• Eat a balanced meal or snack before exercising to keep blood sugar steady,  Choose foods that mix carbs and protein. Good options include whole grain toast with peanut butter or yogurt with fruit. After your workout, eat a snack. Try apple slices with almond butter, a hard-boiled egg with fruit, or a handful of nuts with an orange.
• Avoid exercise in the heat: Older adults with diabetes or health issues, like heart disease or lung disease, should avoid outdoor exercise on hot or humid days.
• Start your exercise routine gradually. Start with low-intensity aerobic activities, like walking or biking. Keep the sessions short at first. Then, gradually increase the intensity and duration. For resistance training, start with light weights or your body weight. As you get stronger, increase the weight or the number of repetitions.
• If you take diabetes medications, check your blood sugar before, during, and a fewseveral hours after exercise. Talk with your PCP about any needed medication adjustments.
• Talk to your provider before starting a higher-intensity program. They can help you develop a plan to prevent low blood sugar after exercise.
• Always pay attention to your body. If you notice symptoms of low or high blood sugar, stop exercising immediately!
• • Hypoglycemia symptoms include shakiness, excessive sweating, irritability, headache, blurry vision, and hunger/nausea. If you notice these signs, check your blood sugar. Then, eat a fast-acting carb like juice or glucose tablets if needed.
  • Hyperglycemia symptoms include increased thirst, fatigue, and excessive urination. If you notice these, stop exercising and check your blood sugar. If you are unsure what to do, seek medical advice promptly.
• Read here for more information on exercising safely with diabetes.

Living with type 2 diabetes is a journey, and you don't have to figure it out alone. Small, steady changes to your diet, exercise routine, and daily habits can make a big difference over time. Work closely with your care team to find the right plan for you.

Get a plan tailored to your diabetes management in your next visit with a Bold care provider. Go to your Bold portal and schedule your next appointment.