Understanding Diabetes: Types, Risk Factors, and What You Can Do Starting Today

Diabetes is one of the most common chronic conditions in the U.S. — and one of the most misunderstood. Many people think of it as simply "high blood sugar," but what's actually happening in your body is more nuanced than that, and so are your options.

37.3 million Americans have diabetes, according to the CDC. Another 96 million have prediabetes — elevated blood sugar that hasn't yet crossed the threshold for a diabetes diagnosis. About 1 in 5 people with diabetes don't know they have it. That number is even higher for prediabetes: 8 in 10 are unaware.

This is not a reason to panic. It's a reason to understand what's happening and take it seriously.

The three types you should know

Type 1 diabetes

Type 1 is an autoimmune condition. The immune system mistakenly attacks the beta cells in the pancreas that produce insulin, leaving the body unable to make it. Without insulin, glucose can't enter cells and just builds up in the bloodstream.

Type 1 is usually diagnosed in children, teens, or young adults — though it can occur at any age. It always requires insulin therapy to manage. It is not caused by diet or lifestyle, and it cannot be reversed. People with Type 1 live full, active lives, but they need consistent medical management.

Type 2 diabetes

Type 2 is the most common form, accounting for 90–95% of all diabetes cases. It develops when the body becomes resistant to insulin or the pancreas can't produce enough of it to keep up. Unlike Type 1, Type 2 is strongly influenced by lifestyle factors and typically develops over time — often years before diagnosis.

The early stages of Type 2 are usually silent. This is why it often gets caught at an annual exam rather than when someone walks in with symptoms.

Prediabetes

Prediabetes means your blood sugar is higher than normal — but not yet high enough to be classified as diabetes. Think of it as a warning window. Here's the critical thing: prediabetes is reversible. With the right lifestyle changes, many people can bring their blood sugar back to the normal range and prevent the progression to Type 2 altogether.

That reversal window doesn't stay open forever. Acting early matters.

Who is at higher risk for Type 2?

Type 2 diabetes develops from a combination of genetics and lifestyle. You can't change your family history, but you can understand your risk and address the factors you do control.

• Excess body weight — particularly fat carried around the abdomen, which is closely linked to insulin resistance
• Physical inactivity — regular movement helps your cells use insulin more effectively
• Family history — having a parent or sibling with Type 2 meaningfully increases your risk
• Age over 45 — risk increases as we get older, though Type 2 is increasingly diagnosed in younger adults
• History of gestational diabetes — having diabetes during pregnancy raises your lifetime risk
• Race and ethnicity — Black, Hispanic, Native American, and Asian American adults have higher rates of Type 2 diabetes
• Prediabetes — already having elevated blood sugar is itself the strongest predictor of progression

Signs and symptoms — or the lack of them

In the early stages, diabetes often produces no symptoms at all. This is exactly why so many people don't know they have it. Later, or when blood sugar is significantly elevated, symptoms can include:

• Frequent urination, especially at night
• Unusual thirst that doesn't resolve
• Persistent fatigue
• Blurred vision
• Wounds or cuts that heal slowly
• Unexplained weight loss (more common with Type 1)

If you're experiencing several of these, it's worth getting checked. And if you're not experiencing any of them but have risk factors, that's also worth getting checked — because it may feel like nothing right up until it doesn't.

Understanding A1C

The A1C test is a blood test that gives an average of your blood sugar levels over the past two to three months. It's the most common tool used to diagnose and monitor diabetes — and it's part of most annual exam bloodwork for people with risk factors.

• Normal: below 5.7%
• Prediabetes: 5.7% to 6.4%
• Diabetes: 6.5% or higher

For people already diagnosed with diabetes, the goal is generally to keep A1C below 7%, though your doctor may set a personalized target based on your age, other conditions, and treatment approach.

Managing diabetes — what it actually involves

Treatment for Type 2 diabetes usually starts with lifestyle: changes to diet, physical activity, and weight. These are not small suggestions — they are genuinely powerful medicine. But diabetes is a progressive condition, and many people need medication at some point, which is not a failure.

• Metformin — typically the first-line medication; lowers blood sugar production in the liver and improves insulin sensitivity
• GLP-1 receptor agonists — a newer class (including semaglutide/Ozempic) that lowers blood sugar, supports weight loss, and has been shown to reduce cardiovascular risk
• Insulin — required for Type 1, and used in Type 2 when other approaches aren't enough
• Other classes — SGLT-2 inhibitors, DPP-4 inhibitors, and others each work through different mechanisms

Diet matters enormously: reducing refined carbohydrates, increasing fiber, eating lean proteins, and managing portion sizes all help keep blood sugar more stable. Exercise helps your cells respond to insulin more efficiently — even a 20-minute walk after meals can have a measurable effect on blood sugar.

Prevention: the CDC's numbers are worth knowing

If you have prediabetes or significant risk factors, the CDC's Diabetes Prevention Program (DPP) has shown that losing just 5–7% of body weight — about 10–14 pounds for someone who weighs 200 pounds — reduces the risk of developing Type 2 diabetes by 58%. That's not a dramatic transformation. It's achievable, and it works.

The DPP is a structured program with evidence behind it, and many versions of it are covered by Medicare and some commercial insurance plans. Ask your doctor whether it's right for you.