Type 2 Diabetes

What it is

Type 2 diabetes is a condition where the body no longer uses insulin properly, so glucose builds up in the blood instead of being used. It develops slowly, often over years, and having prediabetes or a history of gestational diabetes raises the chance of it arriving [1].

Why this guide is written for Black patients

Diabetes is more common in people who are African American, Hispanic or Latino, American Indian, Asian American, or Pacific Islander [1]. In 2024, Black adults in the United States were 24 percent more likely than US adults overall to have diagnosed diabetes, 12.4 percent against 10.0 percent [2].

The distance opens up after diagnosis rather than at it. In 2022, Black Americans died from diabetes 78 percent more often than the US population overall, an age-adjusted rate of 42.9 per 100,000 against 24.1 [2]. In 2021, the rate of new end stage kidney disease was 332.2 per million among Black adults against 151.5 per million overall [2]. Hospitalization for lower limb amputation ran 10.0 per 1,000 against 5.9 in 2022 [2].

There is also a testing problem that belongs specifically in this guide. The A1C blood test measures average blood glucose over about three months [3]. But if you are of African, Mediterranean or Southeast Asian descent, or have family members with sickle cell anemia or a thalassemia, an A1C test can be unreliable for diagnosing or monitoring diabetes and prediabetes, because a hemoglobin variant can push the result falsely high or falsely low depending on which method the laboratory uses [3].

What to ask a clinician

• Do I carry sickle cell trait or another hemoglobin variant, and has anyone ever checked?
• If I do, which A1C method does this lab use, and should we confirm with a fasting glucose or an oral glucose tolerance test instead [3]?
• What is my A1C, and what number are we aiming for?
• When were my kidneys, eyes and feet last checked, and when is the next one due?
• If I have prediabetes, what program is available to me here, and does my insurance cover it?

What good care looks like

Normal A1C is below 5.7 percent, prediabetes is 5.7 to 6.4 percent, and diabetes is 6.5 percent or above [3]. Some people with diabetes can lower the risk of complications by keeping A1C below 7 percent, though the right target is set with a clinician rather than copied from a chart [3].

Good care checks the organs the disease damages quietly. The kidney and amputation figures above are what an unchecked decade looks like [2], and both are found early by tests that cost very little.

If you have prediabetes, the number to hold on to is this: losing 5 to 7 percent of your starting weight and getting at least 30 minutes of physical activity 5 days a week can prevent or delay type 2 diabetes [4]. For a person who weighs 200 pounds that is about 10 to 14 pounds [4].

When it is urgent

Go the same day for very high blood sugar with vomiting, fast breathing, confusion or drowsiness. Go the same day for a foot wound, blister, or dark patch of skin on the foot that you did not feel happen, because the loss of sensation is what turns a small wound into an amputation [2]. Chest pain, one-sided weakness or trouble speaking is 911.

What to do next

Ask a primary care doctor for the tests, not just the A1C. Find Black primary care physicians and take the pill bottles with you.

If the numbers will not settle, if you are on insulin, or if you are pregnant and diabetic, ask for a referral to a Black endocrinologist. Bring your meter or sensor readings, and bring the question about hemoglobin variants in writing so it does not get lost.