Type 2 diabetes

Type 2 diabetes is when a hormone called insulin does not work properly or there is not enough of it. This causes the level of glucose (sugar) in your blood to become too high. It affects adults and sometimes children.

What is type 2 diabetes?

• Type 2 diabetes is a common condition where your body cannot make enough of a hormone called insulin, or the insulin it makes does not work properly (insulin resistance).
• Insulin helps your body use glucose (sugar) for energy. Without enough insulin, the level of glucose in your blood becomes too high.
• Type 2 diabetes is different to type 1 diabetes, which is caused by a problem with your immune system. Unlike type 1 diabetes, type 2 diabetes may be prevented.
• You can manage type 2 diabetes with diet and exercise, or medicines.
• Having high blood glucose levels can cause complications such as heart disease, kidney disease, stroke or nerve problems.
• It may be possible to prevent type 2 diabetes or stop it (remission) by losing weight and improving your diet.

Symptoms of type 2 diabetes and how it's diagnosed

Symptoms of type 2 diabetes

The most common symptoms of type 2 diabetes are:

• feeling very tired
• peeing more than usual
• feeling thirsty all the time
• losing weight without trying to

Other symptoms can include:

• blurred vision
• cuts or wounds taking longer to heal
• itching around your penis or vagina, or you keep getting thrush

These symptoms are the same for both adults and children.

If you get symptoms (not everyone gets them), they may develop gradually.

The symptoms can be similar to type 1 diabetes, but type 1 diabetes usually develops more quickly and is more common in younger people.

Who is more likely to get type 2 diabetes

Some people have a higher risk of developing type 2 diabetes. You may be more at risk if:

• you're white and over 40 years old or over 25 years old and from a South Asian, Chinese, Black African or Black Caribbean ethnic background
• a parent, or your brother or sister has it
• you're overweight and not very physically active
• you have a condition that increases your risk, such as high blood pressure

Although type 2 diabetes is less common in children, ethnic background, weight, activity and family history can also increase the risk.

See a GP if:

• you think you or your child may have type 2 diabetes
• you or your child have a higher risk of developing type 2 diabetes

Not everyone with type 2 diabetes has symptoms, so it's important to get checked out.

Check your risk

This is an overall check that may tell you if you're at higher risk of health problems such as diabetes.

How type 2 diabetes is diagnosed

Type 2 diabetes is diagnosed with a blood test that checks how high your blood glucose (sugar) levels are. The results usually take a few days.

Tests will confirm if you have type 1 or type 2 diabetes.

Get advice about what to ask your doctor or other healthcare professional.

If you're told you have type 2 diabetes

If you're diagnosed with type 2 diabetes, it can feel overwhelming. You may feel anxious about how it will affect you. But there'll be doctors, nurses and other health professionals in your diabetes care team you can talk to. They'll be able to help with any questions about treatment and what happens next.

Treatment for type 2 diabetes

Lifestyle changes to help with type 2 diabetes

If you have type 2 diabetes or have been told that you may get it in the future (prediabetes), lifestyle changes can help lower your blood glucose (sugar) levels. This can help to manage diabetes and possibly avoid having to take medicine.

Lifestyle changes can sometimes lower your blood glucose to a normal level and stop diabetes (remission).

What you can do to make lifestyle changes:

Do

• try to eat a healthy diet including fruit, vegetables, wholegrain foods such as wholemeal bread and oats, and pulses such as chickpeas and lentils

• improve your diet slowly if you're finding it difficult – a small change every week can make it easier

• talk to a GP or diabetes nurse if you're finding it hard to change your diet as they may be able to find support in your local area

• try to spend at least 2.5 hours (across the whole week) either walking or doing another activity that leaves you out of breath

• try to lose weight if you've been told you're overweight

• stop smoking – having diabetes increases the harmful effects of smoking

• try to limit how much alcohol you drink

• have regular dental check-ups to help prevent gum disease

Don’t

• do not each too much processed foods with lots of salt and sugar – this may include things like bacon, chips, cheese, sweets and biscuits

• do not change to a very strict, low-calorie diet without talking to a health professional first – this type of diet may not be suitable if you're taking insulin or other diabetes medicine

Children with type 2 diabetes will be under specialist care.

Diabetes courses

Diabetes courses are recommended for everyone with type 2 diabetes. They’re designed to give you the confidence and skills you need to manage diabetes.

You should be offered a free course within 1 year of being diagnosed. There are also online courses that you can do at your own pace.

For example:

Medicine for type 2 diabetes

If you need medicine, you'll usually be offered metformin, which is one of a few medicines used to treat type 2 diabetes.

If you have another health problem, or metformin alone does not lower your blood glucose level, you may need to take another medicine with metformin, or change to a different diabetes medicine.

If metformin, or other diabetes medicines, do not help, you may need to take insulin. It's usually used to treat type 1 diabetes, but it can be used to treat type 2 diabetes, as well.

You may need to take insulin a few times a day, either by injection or through a pump. This will help keep your blood glucose levels within a normal range.

You'll be told how much to take and when to take it. Taking too much insulin can cause your blood glucose levels to go too low. This is known as hypoglycaemia or having a "hypo".

If you feel ill, such as vomiting, diarrhoea or a very high temperature, while you're taking diabetes medicine, speak to a doctor or a member of your healthcare team. They may tell you to stop taking your medicine temporarily, until you feel better. Do not stop taking your medicine unless your healthcare professional or doctor tells you to.

Appointments and tests

If you have type 2 diabetes, you'll need check-ups to make sure your treatment is working, and your condition is being managed.

These include:

• checking your average blood glucose levels (an HbA1c test) every 3 to 6 months
• a foot check-up once every 2 years if your last check was OK, or once a year if you need it
• checking your weight, body mass index (BMI), cholesterol, blood pressure and kidneys at least once a year

Other changes you may need to make

Managing type 2 diabetes may also involve making other changes, such as:

• wearing a medical ID wristband, in case of emergency
• remembering to pack medicines in your hand luggage when you go on holiday so you have it with you
• getting a letter from your GP to take with you when you go on holiday

If you have health problems caused by type 2 diabetes or you get hypos (a drop in blood glucose levels that can cause dizziness), you may need to contact the Driving and Vehicle Licensing Agency (DVLA).

Contraception, pregnancy and type 2 diabetes

If you're thinking of having a baby, and have type 2 diabetes, it's important to plan your pregnancy as soon as possible. This usually means:

• asking to be referred to a pre-conception clinic (if there's one available), or to a diabetes care team
• changing your medicines to ones that are safe to take in pregnancy

If you have type 2 diabetes, talk to a doctor about the best contraception to use and how to take or use it. These may include the combined pill, progestogen-only pill or contraception inserted into the womb (uterus).

Complications of type 2 diabetes

Long-term complications of type 2 diabetes

Having type 2 diabetes increases your chance of getting other long-term health problems, so it's important to get it treated and manage it well.

Other health problems include:

• damage to your blood vessels, which can cause coronary heart disease and stroke
• foot problems such as ulcers and infections, which can sometimes result in you needing surgery to remove your foot or leg (an amputation)
• sight problems such as diabetic retinopathy and blindness
• kidney problems
• gum disease

You can lower your chances of complications by managing your blood glucose (sugar) as well as you can, and by making healthy lifestyle changes such as eating a balanced diet, exercising and not smoking.

Important

It's important to go to all of your diabetes appointments, and make sure you do not miss any tests. Doing this can help find and treat any complications as soon as possible.

See a GP or diabetes nurse if:

• you have blisters or cracked skin on your feet
• you have any pain, tingling or numbness in your body, problems having sex, constipation or diarrhoea – these could be signs of nerve damage
• your vision gets worse

Complications of high blood glucose

Although it's rare in type 2 diabetes, high blood glucose levels can cause a condition called hyperosmolar hyperglycaemic state (HHS). This can happen over a few weeks and is usually caused by an infection and being dehydrated.

If you have high blood glucose levels, a lack of insulin can cause harmful substances called ketones to build up in the blood. This can cause a condition called diabetic ketoacidosis (DKA).

Both HHS and DKA can be life threatening.

Call 112 or go to A&E if:

You have type 2 diabetes and:

• are peeing a lot
• feel very thirsty
• feel sick (nauseous)
• feel confused or very sleepy
• feel drowsy
• get short of breath

These could be signs of HHS or DKA, which can be life threatening if not treated quickly.

Do not drive to A&E. Ask someone to drive you or call 112 and ask for an ambulance.

Bring any medicines you take with you.