Type 2 diabetes: symptoms, labs and video care in Puerto Rico

In type 2 diabetes, your body does not use insulin well and sugar (glucose) builds up in your blood. Over time, high blood sugar can damage the eyes, kidneys, nerves and feet, and it raises the risk of heart disease. Good control lowers that risk a lot. In men, nerve and blood-vessel damage can also cause erection problems; read about erectile dysfunction and diabetes.

It is very common in Puerto Rico: in 2021, 14.4% of adults had diagnosed diabetes, the highest of any US state or territory (Colorado was lowest at 6.5%), according to a CDC analysis published in Preventing Chronic Disease.

Booking a diabetes visit is simple:

A doctor visit has the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the clinic can’t see you. A doctor's note after your visit is included at no extra charge. See all prices.

If you only need a refill of a medicine you already take (non-controlled), choose the follow-up visit; anyone can book it. A review of lab results is also a follow-up visit, for existing patients. If a follow-up or forms visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.

Type 2 diabetes symptoms often take several years to develop, and some people notice none at all. That is why most diagnoses come from a blood test. Common symptoms include:

• Peeing often
• Increased thirst and hunger
• Losing weight without trying
• Fatigue
• Blurry vision
• Frequent urinary tract or yeast infections
• Cuts or sores that are slow to heal
• Dark patches of skin on the neck, armpits or groin (acanthosis nigricans)
• Numbness or tingling in the hands or feet

The hemoglobin A1c (A1C) test is a blood test that shows your average blood sugar over the past 3 months, according to the CDC. Along with fasting blood sugar, it is the main test used to diagnose and monitor diabetes. Diabetes is confirmed with blood tests, and a second test is usually done to confirm it. If you have symptoms or risk factors, the doctor gives you a lab order. These are the ranges (see also how to read lab results):

• A1C: below 5.7% is normal; 5.7% to 6.4% is prediabetes; 6.5% or above indicates diabetes.
• Fasting blood sugar: 99 mg/dL or below is normal; 100 to 125 mg/dL is prediabetes; 126 mg/dL or above indicates diabetes.
• Random blood sugar: 200 mg/dL or above, with symptoms, indicates diabetes.

For many people with diabetes the A1C goal is below 7%, but your own goal depends on your age and other conditions, and the doctor talks it through with you. The CDC recommends an A1C test at least twice a year. Follow-up also covers blood pressure (some people with diabetes aim for below 130/80), cholesterol, and blood and urine tests that check your kidneys. The doctor also watches for fatty liver, which is common with type 2 diabetes.

Depending on your situation, treatment can include changes in eating and activity, pills, injectable medicines or insulin. According to the American Diabetes Association (ADA) Standards of Care, metformin is a commonly used pill that has historically been the first medicine for type 2 diabetes; today the choice also weighs your heart, kidneys and weight. If you take it, the doctor checks your kidney function (creatinine) and, with long-term use, your vitamin B12. How it works, how to take it and its side effects are in the metformin guide.

Among injectables, Ozempic (semaglutide) is FDA-approved for type 2 diabetes in adults, and Mounjaro (tirzepatide) in adults and children 10 and older; if appropriate for you, the doctor can prescribe them. See our guides to Ozempic and Mounjaro, and if weight loss is also your goal, our medical weight loss program. Other GLP-1s for diabetes include Trulicity (dulaglutide), a weekly injection, and Victoza (liraglutide); to see how they all differ, read Ozempic vs Mounjaro.

Some people with diabetes also need a statin for cholesterol. The doctor adjusts the plan with you at each visit. Some medicines, such as insulin, can drop your blood sugar too low: learn the signs of low blood sugar. For the same reason, if you take insulin or a sulfonylurea such as glipizide, skipping meals or fasting can drop your blood sugar too low: before you try intermittent fasting, talk with the doctor.

Empagliflozin (Jardiance) and dapagliflozin (Farxiga) are once-daily pills in the SGLT2 inhibitor class: they help your kidneys remove more sugar in the urine. Their FDA-approved labels cover blood sugar control in adults and children 10 and older with type 2 diabetes. The labels also cover certain adults with heart failure or chronic kidney disease, to lower the risk of hospitalization, worsening kidney function and cardiovascular death. They are not recommended to control blood sugar in type 1 diabetes, and they are not weight-loss drugs. If you have high creatinine, the doctor reviews your labs to decide whether they fit you.

On the labels, the most common side effects are urinary tract infections and genital yeast infections, especially in women. A rare but serious one is ketoacidosis, which can happen even with blood sugar below 250 mg/dL: if you have nausea, vomiting, belly pain, unusual tiredness or trouble breathing, get emergency care.

Glipizide is a sulfonylurea: it makes your pancreas release more insulin. That is why it can drop your blood sugar too low; learn the signs of low blood sugar (hypoglycemia) and what to do.

Insulin glargine (Lantus) is a long-acting insulin injected once a day. According to MedlinePlus, unopened insulin is kept in the refrigerator and never frozen, and a pen in use can be kept at room temperature for up to 28 days, away from heat. If the power goes out, plan how to keep it cool: see our guide to medicines in hurricane season.

If you already take any of these medicines and are running low, see how prescription refills work: a refill is a follow-up visit. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. Do not stop or change a medicine on your own. Book your visit.

Good diabetes care means keeping your checkups current. The doctor helps you stay on top of them:

• A dilated eye exam at least once a year with an eye doctor.
• A full foot exam at least once a year, including a check of feeling and pulses. Look at your feet every day and tell the doctor about any sore, change in color or ingrown toenail.
• Kidney tests in blood and urine, with your lab order.
• Medicines for hurricane season: plan ahead so you have enough medicine on hand and a way to keep insulin cool (hurricane medicines guide).

We see adults and children of all ages. If your child is very thirsty, peeing a lot or losing weight for no reason, the doctor evaluates them and gives you a lab order to check their blood sugar. For their safety, if they are also vomiting, breathing fast or very drowsy, take them to the emergency room.

For your safety, call 911 or go to the emergency room if you have any of these signs. See also when to go to the ER.

• Very low blood sugar with confusion, fainting, seizures or inability to swallow
• Fruity-smelling breath, fast deep breathing, vomiting that will not stop or stomach pain with high blood sugar
• Blood sugar that stays at 300 mg/dL or higher
• Chest pain, shortness of breath, weakness on one side of the body or trouble speaking
• A foot wound with fever, pus, a bad smell or skin turning dark