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Could I have diabetes and not know it?

Yes! Almost one-third of the 18.2 million Americans with diabetes have not been diagnosed. The onset of type 2 diabetic symptoms is usually gradual. Those symptoms include feeling tired or ill, frequent urination (especially at night), unusual thirst, weight loss, blurred vision, frequent infections and slow healing of sores. If you have any of these symptoms, seek testing immediately. You should also be tested if you have any of the major risk factors, which include obesity, lack of exercise, a close relative with diabetes, high blood pressure or cholesterol level and giving birth to a baby that weighs more than nine pounds. You are also at elevated risk if you are over 45 or are of African American, American Indian, Alaska Native, Asian and Pacific Islander American or Latino/Hispanic descent.

Can I just take one of those finger-stick tests at the health fair?

No! These tests measure glucose levels in the capillaries, whereas the more reliable tests for diagnosis tap into your veins to get a truer reading. If you do have the opportunity to have a finger-stick test, be sure to follow up with a glucose test recommended and administered by your health care professional. Finger-stick tests may be used as an initial diabetes screening tool and for glucose monitoring of those with confirmed diabetes.

What is the best test for diabetes?

For most people, a fasting plasma glucose test is optimal. This blood test is usually done at a health care professional's office or in a lab in the morning after an overnight fast and before you've eaten. The normal, non-diabetic range for blood glucose is from 70 to 100 mg/dL. A level over 126 mg/dL usually means diabetes (except for newborns and some pregnant women). A fasting plasma glucose test of 100 mg/dL or greater, but less than 126 mg/dL, indicates impaired fasting glucose or pre-diabetes, a frequent precursor to diabetes.

I've got diabetes. How do I prevent debilitating damage to my eyes, kidneys and feet?

If you're worried, you're off to a good start—diabetic retinopathy is the leading cause of blindness, and diabetic kidney disease is the leading cause of kidney failure. Diabetic neuropathy is the leading cause of amputations. In a study of 1,441 type 1 diabetics, intensive glucose management reduced the risk of eye disease by 76 percent, kidney disease by 50 percent and nerve disease by 60 percent.

How do I reduce my risk for heart disease and stroke, the biggest killers of people with diabetes?

Data from the National Health and Nutrition Examination Survey show that women with diabetes are at particular risk for heart disease and stroke. Deaths from heart disease for women with diabetes increased 23 percent in the past 30 years, compared to a 27 percent decrease in women without diabetes. But women with diabetes who keep their blood glucose, blood pressure and cholesterol levels in the recommended range can lower their risk of cardiovascular disease.

What is intensive glucose management?

Plans are individually tailored and involve frequently testing blood sugar, administering insulin on the basis of food intake and exercise, following a diet and exercise plan, and frequently consulting a health care team. It all boils down to keeping your glucose level in the normal range as much of the time as possible. Intensive management is not for everyone—risks should be discussed with your health care professional.

Is there any way to take insulin that doesn't involve needles?

Yes, although it is expensive. The US Food and Drug Administration has approved insulin jet injectors, which look like large pens and send a fine spray of insulin through the skin by a high-pressure air mechanism. Insulin jet injectors are costly, so try out several models before you purchase one.

What medications are available to treat Type 2 diabetes?

For type 2 diabetes, as long as your body is making enough insulin, you won't need insulin injections. Sometimes lifestyle modifications are sufficient to keep type 2 under control in the early years, but many types of medications can help those with type 2 diabetes lower their blood sugar by such means as stimulating insulin production, decreasing the amount of sugar made by the liver, slowing starch absorption and boosting insulin sensitivity. Your health care professional may recommend a combination of two of these drugs or one of these drugs plus insulin.

Which is more dangerous, hypoglycemia or hyperglycemia?

Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) are potentially life threatening. Maintaining a normal glucose level is critical.