HomeMemberHelpful ToolsHealth ResourcesDiabetes Types
Diabetes is a disease in which the body cannot properly use insulin. The body either doesn’t make enough insulin, or can’t use the insulin properly. As a result, there is too much sugar in the blood. People with diabetes can take steps to control the disease and lower the risk of serious complications.
Types of Diabetes:
Causes,Identification, and More
➤There are different types of diabetes, each with different causes, but they all share the common problem of having too much glucose in your bloodstream.
Select a class in the dropdown to learn more.
Type 1 Diabetes
Type 1 Diabetes occurs when the pancreas does not make enough insulin. People with Type 1 diabetes are usually diagnosed as children or adolescents, and depend on insulin therapy and other treatments to make up for the lack of insulin.
Type 2 Diabetes
Type 2 Diabetesoccurs when the pancreas makes some insulin, but it’s not enough to meet the body’s needs. People with Type 2 diabetes are usually diagnosed as adults and are not dependent on insulin therapy.
Gestational Diabetes
Gestational Diabetescan occur in pregnant women. While it doesn’t mean a woman had diabetes before pregnancy or will have diabetes after birth, her doctor’s advice should be followed to remain healthy.
Prediabetes
Prediabetes means you have a higher than normal blood sugar level. Unmanaged prediabetes can lead to Type 2 diabetes. Prediabetes doesn’t always have symptoms, so it’s crucial to get blood sugar levels tested, especially if you’re at high risk. Losing weight, exercising regularly and healthy eating habits can reverse prediabetes and prevent Type 2 diabetes.
Other types of Diabetes
According to the American Diabetes Association (ADA), about2% of people have rarer types of diabetes. Including MODY, LADA, cystic fibrosis-related diabetes, and diabetes caused by rare syndromes.
- MODY➤MODY (Maturity Onset Diabetes of the Young) is caused by a mutation in a single gene. If a parent has this gene mutation, any child they have, has a 50% chance of inheriting it from them. If a child does inherit the mutation, thesymptoms of MODY are oftenestablishedbefore the age of 25, regardless of their weight or lifestyle.It’s estimated that 90% of those diagnosed with MODY are mistakenly diagnosed with type 1 or type 2 diabetes at first.
- LADA ➤LADA (Latent Autoimmune Diabetes in Adults) is a type of diabetes whichstraddles type 1 and type 2 diabetes. The symptoms reported of this variant correspond with each Type 1 and Type 2 diabetes, which is why some people call it type 1.5 diabetes or type 1 ½ diabetes. Whereas being overweight is a major risk factor for type 2 diabetes, people with LADA tend to have a healthy weight.
- CFRD➤ CFRD(Cystic Fibrosis-related Diabetes) is atype of diabetes that is unique tochildren and adults with cystic fibrosis(CF). The accumulationof sticky mucus caused by CF can sometimeslead to inflammation and scarring of the pancreas. This can damage the cells that produce insulin,leading to high blood glucose (sugar) levels. Whenthe pancreas can’t produce enough insulin, blood sugar levels may continue to rise and developintoCFRD.
Testing & Diagnosis
Common Tests for Type 1 Diabetes, Type 2 Diabetes, and Prediabetes
If diagnosed, your doctor will have you take one or more of the following blood tests:
A1C Test
The A1C test measures your average blood sugar level over the past 2 or 3 months.
- An A1C below 5.7% is normal
- An A1C between 5.7 and 6.4% indicates you have prediabetes
- An A1C 6.5% or higher indicates you have diabetes
*Results for gestational diabetes can differ. Ask your health care provider what your results mean if you’re being tested for gestational diabetes.
Glucose Tolerance Test
This test measures your blood sugar before and after you drink a liquid that contains glucose. You’ll be asked to fastovernight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward.
At 2 hours, a blood sugar level of....
- 140 mg/dL or lower is considered normal
- 140 to 199 mg/dL indicates you have prediabetes
- 200 mg/dL or higher indicates you have diabetes
*Results for gestational diabetes can differ. Ask your health care provider what your results mean if you’re being tested for gestational diabetes.
Fasting Blood Sugar Test
This test measures your blood sugar after an overnight fast.
A fasting blood sugar level of...
- 99 mg/dL or lower is normal
- 100 to 125 mg/dL indicates you have prediabetes
- 126 mg/dL or higher indicates you have diabetes
*Results for gestational diabetes can differ. Ask your health care provider what your results mean if you’re being tested for gestational diabetes.
Random Blood Sugar Test
This measures your blood sugar at the time you’re tested. You can take this test at any time and don’t need to fast prior to your appointment. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.
*Results for gestational diabetes can differ. Ask your health care provider what your results mean if you’re being tested for gestational diabetes.
What Does Insulin Do?
Insulin allows the cells in the muscles, fat and liver to absorb glucose that is in the blood. The glucose serves as energy to these cells, or it can be converted into fat when needed. Insulin also affects other metabolic processes, such as the breakdown of fat or protein. Learn more below:
How is insulin created?
Insulin is a hormone created by your pancreas that regulates the amount of glucose in your bloodstream at any given moment. It also helps store glucose in your liver, fat, and muscles. In addition, insulin balances your body’s metabolism of carbohydrates, fats, and proteins.
What happens with insulin when you eat?
When you eat, your blood glucose levels elevate, and this leads a typical person’s pancreas to release insulin, so that the sugar can be stored as energy for later use. Without this pancreatic ability, as a person with either type 1 diabetes or advanced type 2 diabetes, one's blood sugar levels may rise dangerously high, or drop too low.
What happens when insulin no longer works?
Without proper insulin function, your body can’t store glucose in your muscles or liver, but neither can it make any fat. Instead, the fat breaks down and produces, among other things, keto acids.If the acid levelsgrow too high, the imbalance can trigger diabetic ketoacidosis, a potentially fatal condition if not treated immediately.
Diabetes & Heart Disease
According to the National Institute of and Digestive and Kidney Diseases (NIDDK), individuals with diabetes are more likely to develop heart disease. People with diabetes are also more likely to have certain risk factors, such as high blood pressureor high cholesterol, that increase their chances of having a heart attack or a stroke. Learn more below:
What is the connection between diabetes and heart disease?
- High blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. Over time, this damage can potentiallylead to heart disease.
- People with diabetes alsotend to develop heart disease at a younger age than people without diabetes. In fact, adults with diabetes are nearly twice as likely to have heart disease or stroke as adults without diabetes.
- The good news is that the steps you take to controlyour diabetes also help lower your chances of developingheart disease.
What other factors increase my chances of heart disease if I have diabetes?
- Smoking➤Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking, because both smoking and diabetes narrow blood vessels.
- High blood pressure➤If you have high blood pressure, your heart has to pump harder to circulate blood. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack and stroke. Consider having your blood pressure checked regularly, and work with your doctor to regulate or lower high blood pressure.
- Harmful cholesterol levels➤Cholesterol is a type of fat produced by your liver. You have two kinds of cholesterol in your blood: LDL and HDL. LDL, often referred to as “bad” cholesterol, can build up and clog your blood vessels. HDL, sometimes referred to as the “good cholesterol.” Higher levels of HDL is linked to lower risk for heart disease and stroke. To improve LDL and HDL balance, try to limit the amount of fat in your eating plan, consume more plant-based foods, and get regular physical activity.
- Family history of heart disease➤Unfortunately, a family history of heart disease may add to your chances of developing the condition. If one or more of your family members had a heart attack before the age of 50, you have double the chance of developing heart disease, compared with diabetics who have no family history of the disease.
Obesity and Diabetes
Being overweight or having obesity can make it more difficult to manage your diabetes and may compound into additional health problems, including heart disease and high blood pressure. If you are overweight and have diabetes, adopting a healthy eating plan with fewer calories and more physical activity often will lower your blood glucose levels and reduce your need for medicines.
Infographic ➤ Obesity and Diabetes: Interrelationship
Living with Diabetes
Managing your ABCs
While diabetes is a serious and critical illness requiring constant attention and maintenance, living a happy, healthy, active lifestyle is still possible. With the right determination, you can manage the numbers without excessive stress and inconvenience.
An easy way to stay on top of your condition is to remember your diabetes ABCs.
A is for the A1C test
As referenced in our Testing & Diagnosis segment, The A1C test shows your average blood glucose level over the past 3 months.
- The A1C goal for many people with diabetes is below 7%.
- Some people may do better with a slightly higher A1C goal. Your A1C goals may also change as you get older and your lifestyle changes.
- Ask your health care team what your goal should be.
B is for blood pressure
Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure can cause a heart attack or stroke and damage your kidneys and eyes.
- The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Talk to your primary to determine what your goal should be.
C is for cholesterol
A buildup of cholesterol, a form of fat found in your blood, can cause a heart attack or stroke. Monitor your cholesterol levels regularly.
As a rule-of-thumb, the 50-100-150 rule is general consensus for healthycholesterol levels. Be sure to ask your health care team what your specific cholesterol numbers should be.
- HDL Cholesterol ➤ 50 or higher
- LDL Cholesterol ➤ 100 or lower
- Triglycerides ➤ 150 or lower
Additional Diabetes Resources
- For more diabetes information, including helpful videos, click here .
- If you would like a downloadable resource, please refer to our booklet, Managing Your Diabetes.
External Health Resources
- American Diabetes Association ➤ Become an Advocate
- American Diabetes Association ➤ COVID-19 and Diabetes
- American Diabetes Association ➤ Fitness and Training
- American Diabetes Association ➤ Healthy Living
- American Diabetes Association ➤ Research Foundation
- American Diabetes Association ➤ Technology and Innovation
- New York State Department of Health ➤ Diabetes and Prevention
- Centers for Disease Control and Prevention ➤ Diabetes Education Program
Healthwise
Browse a library of health articles, videos, and tools from Healthwise.Available in both English and Spanish.
More on Diabetes
Ketoacidosis
•When ketone levels become too high, it can lead to potentially life-threatening condition, called diabetic ketoacidosis or DKA.
Fidelis Care Pharmacy Benefits and Authorizations
8/28/2024 • Posted by Provider Relations in Provider News
Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.
Medications Covered Under Fidelis Care Medical Benefit
- Physician Administered Drugs – medications administered to a member during the course of an outpatient visit
- Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing.
- Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific).
- Medical Benefit Authorization Grids are plan specific.
- If a medication is listed on one of the above Authorization Grids, a prior authorization is required prior to use/billing date of service in order to receive payment.
- If a medication is not listed, no prior authorization needed
- Physician administered drugs remain in-scope under the Fidelis Care Medical Benefit for Medicaid & HARP members (not impacted by NYS Pharmacy Benefit transition).
- Medical Benefit Pharmacy prior authorizations can be faxed, submitted electronically via ePA, and/or called in to Fidelis Care directly.
| Line of Business | Medical Benefit Initial Request Fax Number | Medical Benefit Appeals Request Fax Number |
| Medicare | 844-235-5090 | 833-757-0611 (only for Part B) |
| Medicaid, CHP, EP, & Ambetter | 844-235-5090 | 844-235-5091 |
Medications Covered Under Fidelis Care Pharmacy Benefit
- Coverage is dictated by Fidelis Care Formularies.
- Members obtain medications from community or retail outpatient pharmacies.
- Pharmacy Benefit Formularies are plan specific.
- Each formulary clearly indicates if a medication requires a prior authorization or not. Non-formulary (NF) medications also require authorization prior to the prescription being filled at a community or retail outpatient pharmacy.
- As of 4/1/2023, Medicaid & HARP Pharmacy benefits are administered by the NYS NYRx program. Visit the NYRx program website for information on the NYRx Preferred Drug List (PDL) and Prior Authorization submission requirements.
- Pharmacy Benefit Pharmacy Prior Authorizations can be faxed, submitted electronically via ePA, and/or called in to Fidelis Care directly.
| Line of Business | Pharmacy Benefit Initial Request Fax Number | Pharmacy Benefit Appeals Request Fax Number |
| Medicare | 844-235-5021 | 866-388-1766 |
| CHP, EP, & Ambetter | 844-235-4852 | 888-865-6531 |
If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager.To find your designated representative, please click here.
