Type 2 diabetes: symptoms, medications & what you can do yourself
At a glance
Affected in Germany
~10.3% of adults with known diabetes; on top of that comes an estimated number of unreported cases
Share
Over 90% of all diabetes cases
Cause
Generally insulin resistance + relative insulin deficiency; an interplay of genetics and lifestyle factors
Remission
Possible in individual cases — especially in the first years through weight loss and a lifestyle change
Medications (selection)
Metformin, SGLT2 inhibitors (e.g. empagliflozin), GLP-1 RAs (e.g. semaglutide, tirzepatide), insulin if needed
ICD-10
E11
1. What is type 2 diabetes?
Type 2 diabetes is a chronic metabolic disease in which two problems generally come together: the body's cells no longer react sufficiently to insulin (insulin resistance) and over time the pancreas can mostly no longer fully compensate for the rising demand (relative insulin deficiency). The blood sugar remains permanently elevated and can gradually damage vessels, nerves and organs.
In Germany, the prevalence of known diabetes was around 10.3% of adults according to the Robert Koch Institute (panel evaluation 2024).³ Type 2 makes up by far the largest part of all diabetes cases.
Remission is possible
Type 2 is currently the only form of diabetes for which a remission is described. Especially in the first years after the diagnosis, weight loss, a dietary change and regular movement can in some cases normalize the blood sugar so far that no medications are needed for a time.¹
2. Symptoms — often unnoticed for years
The insidious thing about type 2: the disease generally develops gradually over months to years. For a long time, many of those affected have no or only nonspecific complaints — and the diabetes is often only discovered during routine examinations or in the context of secondary diseases.
- increased thirst and frequent urination — sometimes at night too
- fatigue and a drop in performance without a clear cause
- increased susceptibility to infection — especially urinary tract infections and fungal infections
- poorly healing wounds
- visual disturbances — e.g. temporarily blurred vision due to changes in the lens of the eye
- tingling or numbness in the hands and feet (possible indications of polyneuropathy)
- itching, dry skin
- dark patches of skin in skin folds (acanthosis nigricans — can point to insulin resistance)
Get tested early — even without complaints
A not-small portion of people in Germany live with an undetected diabetes.³ From about the mid-30s, have the blood sugar checked too at the health check-up — a simple blood test is generally enough.
3. Prediabetes: recognizing the precursor and acting
Prediabetes is a precursor of type 2 diabetes: the blood sugar is already elevated, but not yet in the diabetes range. Without countermeasures, a manifest diabetes develops over the course in many cases.¹
Guiding values for prediabetes
Fasting blood sugar 100–125 mg/dl (5.6–6.9 mmol/l) OR HbA1c 5.7–6.4% OR a 2-hour value in the OGTT between 140 and 199 mg/dl.
In this phase a lot can still be achieved
Studies on lifestyle intervention with prediabetes have shown that a combination of a balanced diet, regular movement and moderate weight loss can considerably lower the risk — in some studies the effect was even greater than under medications.¹
Warning signals for an increased risk: an increased waist circumference (> 80 cm in women, > 94 cm in men), a familial burden with diabetes, dark patches of skin (acanthosis nigricans) or a previous gestational diabetes.
4. Causes and risk factors
Main risk factors
- Excess weight/obesity — considered the most important influenceable factor. Especially visceral abdominal fat increases the risk
- Lack of exercise — can directly favor insulin resistance, also independently of weight
- Genetic predisposition — diabetes in first-degree relatives can increase the risk
- Age — the risk rises from middle age; increasingly, however, younger adults are affected too
- Socioeconomic factors — people in education groups with a lower socioeconomic status are affected considerably more often³
Further risk factors
- previous gestational diabetes
- PCOS (polycystic ovary syndrome)
- chronic sleep deprivation and sleep apnea
- certain medications (e.g. longer cortisone therapy, certain antipsychotics)
- smoking — increases the risk for type 2 in studies
- unfavorable dietary patterns (a lot of sugar, many highly processed foods)
5. Diagnosis
The diagnosis is generally made via defined laboratory values. For a reliable diagnosis, two pathological laboratory values are mostly required according to the current guideline.¹
- Fasting blood sugar ≥ 126 mg/dl (7.0 mmol/l) — generally confirmed on two different days
- HbA1c ≥ 6.5% (48 mmol/mol) — the "long-term blood sugar" of the last 2–3 months
- 2-hour value in the OGTT ≥ 200 mg/dl (11.1 mmol/l)
- Random blood sugar ≥ 200 mg/dl with simultaneously typical symptoms
Extended basic screening after a new diagnosis
Blood pressure, blood lipids (cholesterol, triglycerides), kidney values (eGFR, albumin in the urine), liver values, an ophthalmological examination, foot status.
More: Preparing for a doctor's appointment.
6. Treatment without medications — the basic therapy
The basic therapy is the cornerstone of every type 2 diabetes treatment. In the first years after the diagnosis it can in individual cases even lead to a remission.¹
Diet
- A special "diabetic diet" is generally not necessary — a balanced, wholesome diet is mostly enough
- The Mediterranean diet has good evidence in studies: a lot of vegetables, fruit, legumes, whole-grain products, olive oil, fish; little red meat and little sugar
- consistently reduce sugar and sweet drinks — mostly with the largest single effect
- reduce highly processed foods where possible
- eat fiber-rich foods — fiber generally slows down the absorption of sugar
- intermittent fasting (e.g. 16:8) can be an effective strategy
Movement
- Generally recommended: about 150–300 minutes of moderate activity per week (e.g. brisk walking, swimming, cycling)
- a combination of endurance and strength training — building muscle can improve insulin sensitivity
- interrupt sitting times regularly
- every bit of movement counts — short sessions too are generally better than none
Use the DMP Diabetes
People with type 2 diabetes generally have a claim to participation in the disease management program (DMP) Diabetes. It includes structured education sessions, regular checks and nutritional counseling. Enrollment usually with the GP.
