Type 2 Diabetes:
Symptoms, Medications & What You Can Do Yourself
At a glance
Affected in Germany
~10.3% of adults with diagnosed diabetes; plus an estimated number of undiagnosed cases
Share
Over 90% of all diabetes cases
Cause
Generally insulin resistance + relative insulin deficiency; interplay of genetics and lifestyle factors
Remission
Possible in individual cases — especially in the first years through weight loss and 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 condition in which two problems generally come together: the body's cells no longer respond adequately to insulin (insulin resistance) and the pancreas can over time usually no longer fully compensate for the rising demand (relative insulin deficiency). Blood glucose remains persistently elevated and can gradually damage blood vessels, nerves and organs.
In Germany, the prevalence of diagnosed diabetes was around 10.3% of adults according to the Robert Koch Institute (2024 panel analysis).³ Type 2 accounts for by far the largest share of all diabetes cases.
Remission is possible
Type 2 is currently the only form of diabetes for which remission has been described. Particularly in the first years after diagnosis, weight loss, dietary change and regular exercise can in some cases normalize blood glucose to the point that no medications are temporarily needed.¹
2. Symptoms — often unnoticed for years
The tricky part about Type 2: the condition generally develops gradually over months to years. Many people have no or only nonspecific symptoms for a long time — and the diabetes is often only detected at routine check-ups or in the context of complications.
- Increased thirst and frequent urination — sometimes also at night
- Fatigue and drop in performance without a clear cause
- Increased susceptibility to infections — particularly urinary tract infections and fungal infections
- Poorly healing wounds
- Vision problems — e.g. temporarily blurred vision due to changes in the lens of the eye
- Tingling or numbness in hands and feet (possible signs of polyneuropathy)
- Itching, dry skin
- Dark patches of skin in body folds (acanthosis nigricans — can indicate insulin resistance)
Get tested early — even without symptoms
A not-small proportion of people in Germany live with undiagnosed diabetes.³ From around your mid-30s onwards, have your blood glucose checked at your health check-up — a simple blood test is generally enough.
3. Prediabetes: recognize the precursor and act
Prediabetes is a precursor stage of Type 2 diabetes: blood glucose is already elevated but not yet in the diabetes range. Without countermeasures, in many cases manifest diabetes develops over time.¹
Approximate values for prediabetes
Fasting blood glucose 100–125 mg/dL (5.6–6.9 mmol/L) OR HbA1c 5.7–6.4% OR a 2-hour OGTT value between 140 and 199 mg/dL.
At this stage, a lot can still be done
Studies of lifestyle intervention in prediabetes have shown that a combination of balanced nutrition, regular exercise and moderate weight loss can significantly reduce the risk — in some studies the effect was even greater than with medications.¹
Warning signs of elevated risk: increased waist circumference (> 80 cm in women, > 94 cm in men, per IDF cutoffs for Europids), family history of diabetes, dark skin patches (acanthosis nigricans) or previous gestational diabetes.
4. Causes and risk factors
Main risk factors
- Overweight/obesity — considered the most important modifiable factor. Visceral abdominal fat in particular increases the risk
- Lack of exercise — can directly promote insulin resistance, independently of weight
- Genetic predisposition — diabetes in first-degree relatives can increase the risk
- Age — risk rises from middle age onwards; however, younger adults are increasingly affected
- Socioeconomic factors — people in groups with lower socioeconomic status are significantly more often affected³
Other risk factors
- Previous gestational diabetes
- PCOS (polycystic ovary syndrome)
- Chronic sleep deprivation and sleep apnea
- Certain medications (e.g. prolonged cortisone therapy, certain antipsychotics)
- Smoking — increases the risk of Type 2 in studies
- Unfavorable dietary patterns (high sugar, many ultra-processed foods)
5. Diagnosis
The diagnosis is generally made using defined lab values. For a reliable diagnosis, the current guideline usually requires two pathological lab values.¹
- Fasting blood glucose ≥ 126 mg/dL (7.0 mmol/L) — generally confirmed on two different days
- HbA1c ≥ 6.5% (48 mmol/mol) — the "long-term blood glucose" of the past 2–3 months
- 2-hour OGTT value ≥ 200 mg/dL (11.1 mmol/L)
- Random blood glucose ≥ 200 mg/dL with typical symptoms at the same time
Extended baseline screening after a new diagnosis
Blood pressure, lipids (cholesterol, triglycerides), kidney values (eGFR, urinary albumin), liver values, ophthalmologic examination, foot status.
Learn more: Preparing for a doctor's appointment.
6. Treatment without medications — the foundation
Lifestyle therapy is the cornerstone of every Type 2 diabetes treatment. In the first years after diagnosis, it can in individual cases even lead to remission.¹
Nutrition
- A special "diabetic diet" is generally not necessary — a balanced, wholesome diet is usually enough
- The Mediterranean diet has good evidence in studies: plenty of vegetables, fruit, legumes, whole grains, olive oil, fish; little red meat and little sugar
- Consistently reduce sugar and sugary drinks — usually the biggest single lever
- Reduce ultra-processed foods where possible
- Eat plenty of fiber — fiber generally slows sugar absorption
- Intermittent fasting (e.g. 16:8) can be an effective strategy
Exercise
- Generally recommended: around 150–300 minutes of moderate activity per week (e.g. brisk walking, swimming, cycling)
- Combination of endurance and strength training — building muscle can improve insulin sensitivity
- Regularly interrupt sitting time
- Every bit of movement counts — even short sessions are generally better than none
Use the DMP Diabetes program
People with Type 2 diabetes in Germany are generally entitled to participate in the Disease Management Program (DMP) Diabetes — a German structured care program. It includes structured education, regular check-ups and nutritional counseling. Enrollment is usually via your GP.
