According to the Centers for Disease Control and Prevention, as of 2021, more than 38 million Americans have diabetes, and 97 million are prediabetic. The symptoms of type 2 diabetes are often so subtle that many people overlook them, making regular testing important. Here is what you should know.

Type 2 diabetes is a disease that develops slowly over decades. Most people have prediabetes for a long time before the disease progresses to diabetes and, once at the diabetes stage, it continues to progress gradually.

Diabetes occurs when your blood glucose, also called blood sugar, is too high. Elevated blood sugar levels can damage blood vessels and affect circulation, putting you at risk for a host of ailments, from a heart attack and a stroke to blindness, kidney failure and nerve damage.

Signs and Symptoms

The earliest signs of diabetes are usually subtle, including urinating more frequently (often at night), being more thirsty and hungrier than usual, weight loss without trying, feeling very tired, having dry itchy skin and blurry vision. Symptoms of advanced diabetes and long-term damage may include cuts or sores that heal slowly, having more infections than usual and pain or numbness in your feet or legs.

Who Should Get Tested?

Because prediabetes typically causes no outward symptoms and the signs of early type 2 diabetes can easily be missed, a blood test is needed. Everyone 45 years or older should consider getting tested for diabetes, especially if they are overweight.

If you are younger than 45 but are overweight, have high blood pressure, a family history of diabetes, or belong to an ethnic group with a higher risk (such as Latino, Asian, African or Native American), you should get checked too. To help you determine your risk for diabetes, the American Diabetes Association (ADA) has a quick, online risk test you can take for free at Diabetes.org/risk-test.

Diabetes Tests

There are three different tests utilized to diagnose diabetes. The most common is the “fasting plasma glucose test,” which requires an eight to 12-hour fast before you take it. There is also the “oral glucose tolerance test” that analyzes how your body processes sugar and the “hemoglobin A1C test” that measures your average blood sugar over the past few months.

Most private health insurance plans and Medicare cover diabetes tests. If you cannot visit your doctor to get tested, an alternative is to go to the drug store, buy a blood glucose meter and test yourself at home. The cost for the device is in the range of $15 and $30, with additional costs for the test strips.

If you find that you are prediabetic or diabetic, you should visit your doctor to develop a plan to get it under control. In many cases, lifestyle changes like losing weight, exercising, eating a healthy diet and cutting back on carbohydrates may be all you need to do to get your diabetes under control. For others who need more help, many medications are available.

For more information on diabetes and prediabetes or to find help, join a lifestyle change program recognized by the CDC (CDC.gov/diabetes-prevention). These programs offer in-person and online classes in more than 2,100 locations throughout the U.S.

The majority of traditional IRA owners with larger IRA balances take the RMD during the months of October, November and December. Because many individuals with larger IRAs do not require funds immediately for living expenses, by delaying an RMD until the end of the year, they benefit from additional tax-free growth in the IRA.

Fortunately, the IRA charitable rollover will qualify for the donor's RMD. The IRS term for an IRA charitable rollover is a qualified charitable distribution (QCD). Your IRA custodian may also use this term.

There are five donor profiles for IRA charitable rollover gifts. The first are the convenience donors who appreciate the simplicity and ease of using this method for their end-of-year contributions. The second is the generous donor, who wants to give past the 60% of AGI deduction limit. The third is a major donor. This person may be a generous individual who is looking for a favorable opportunity to make a major gift. Fourth, the Social Security recipient may reduce taxes with an IRA rollover gift. Finally, a standard deduction donor will benefit from a direct IRA to charity gift.

Convenience Donor

Many IRA owners delay taking IRA withdrawals until October, November or December each year. As the individual approaches the end of the year, he or she will need to make decisions. If an IRA owner is actively making gifts to charity during the year, then it may occur to him or her that this is a good opportunity to make a gift.

Convenience donors may contact their IRA custodians to arrange for an IRA charitable rollover. There is no charitable income tax deduction, but also no inclusion in federal taxable income. It is simply a very convenient way to help their favorite charity.

Generous Donor

Some very generous individuals are already giving up to the 60% of adjusted gross income level. This is the maximum level under IRS rules to deduct cash gifts each year. Any gifts over this limit may be carried forward and deducted over the following five years. Some generous donors may also have a large IRA. Since they frequently live at a moderate level in proportion to their income and assets, they may not actually need all of their IRA.

If there is a desire to give more, they can give up to 60% of adjusted gross income from their regular assets and then make "over and above" gifts from their IRA. Some generous donors may in effect give nearly 100% of income per year through this method. Since the IRA rollover is not included in taxable income, it will have no impact on their regular income and other charitable gifts.

Major Donor

Board members, trustees and other major donors frequently have large IRAs. As the rules have continually become more favorable for IRAs and required withdrawals have been reduced, large IRAs will continue to grow. Over longer periods of time, there are occasional market dips, but the longer-term trend is positive and large IRAs will continue to increase in value.

For many professionals and business owners, the IRA may even become the vast majority of the estate. They have a need to do some "asset balancing" or there may be major future income tax problems. Therefore, it may be desirable for the major donor to give up to $105,000 in 2024 to charity from his or her IRA. This has the advantage of "balancing" the estate assets.

In addition, there may be income tax benefits. If the donor were to take the IRA distribution into his or her own personal income, there are several types of exemptions that are phased out at higher income levels. Thus, it may actually be preferable to make the gift directly from the IRA rather than making a charitable gift from regular income.

Social Security Donor

Social Security is subject to two levels of taxation. For donors who have income in excess of the first level, 50% of Social Security is taxed. For donors with income in excess of the second level, up to 85% of Social Security income may be subject to tax.

Withdrawing an amount from an IRA will potentially cause your income to increase from the 50% taxable bracket to the 85% Social Security taxable bracket. Even though the withdrawn amount is given to charity and deducted, there still is increased tax on your IRA. Thus, by making the transfer directly to charity, many Social Security recipients will save income taxes.

Standard Deduction Donor

Many seniors do not have a mortgage and their medical deductions are less than 7.5% of adjusted gross income (AGI). Thus, they may not have a sufficient level of deductions to itemize and choose instead to use the standard deduction.

If this donor withdraws $1,000 from his or her IRA and then gives it to charity, there is $1,000 of increased income with no offsetting charitable deduction, since the standard deduction is taken. Therefore, it will be preferable for all donors who are taking a standard deduction to make IRA rollover gifts directly to charity and avoid the additional income tax.

Engaging an attorney can be costly, whether you require assistance in drafting a will or a contract, or if you are confronted with a legal issue or predicament. Most lawyers today charge anywhere between $200 and $400 an hour. Fortunately, many different programs and organizations provide free or low-cost legal advice, as well as assistance in finding an affordable attorney. Here is where to look for help in your area.

Legal Aid: Directed by the Legal Services Corporation, Legal Aid provides free legal assistance to low-income individuals. Each community program will differ slightly in the services they offer and income qualifications. Visit LSC.gov/find-legal-aid to locate a program near you.

LawHelp: Powered by Pro Bono Net, a national nonprofit organization, LawHelp.org is a resource that will help you locate free legal aid near you, find answers to your legal questions or assist in filling out legal documents. These free services are for people with low to moderate incomes.

Free Legal Answers: This is an online program created by the American Bar Association that connects low-income clients with volunteer lawyers who agree to provide free legal advice online. This service does not answer criminal law questions and is not available in every state. See ABAfreelegalanswers.org to look for a program in your state.

Senior Legal Hotlines: There are approximately 30 states that offer legal hotlines for those over age 60 to access free legal advice over the telephone. To find out if this service is available in your state, go to ProSeniors.org and click on “Resources,” followed by “U.S. Senior Legal Hotline Directory.”

Senior Legal Services: Coordinated by the Administration on Aging, this service may offer free or low-cost legal advice, legal assistance or access to legal representation for people over the age of 60. Your Area Agency on Aging can tell you what is available in your community. Call the Eldercare Locator at 800-677-1116 to get your local number.

Local Law Schools: More than 200 law schools across the country have pro bono programs that offer free legal assistance provided by law students, who are supervised by law professors. See AmericanBar.org/groups/center-pro-bono – scroll down and click on “Directory of Law School Public Interest and Pro Bono Programs” to locate a program near you.

Pension Rights Center: This is a nonprofit consumer organization that provides free legal assistance for problems with a pension, 401(k) or other retirement plan. Visit PensionRights.org/find-help to search for help in your state.

Stateside Legal: For military members, veterans, and their families, StatesideLegal.org provides access to free legal information and legal assistance in your area.

National Disability Rights Network: This is a nonprofit membership organization that provides legal assistance to people with disabilities through their Protection and Advocacy System and Client Assistance Program. If you are disabled, visit NDRN.org to find help in your state.

Other Options: If you cannot get help from one of these programs, or find that you are not eligible, another option is to contact your state or local bar association to ask if there are any volunteer lawyer projects in your area or if they can refer you to an affordable lawyer. To contact your state or local bar association, go to FindLegalHelp.org.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.