Type 2 diabetes

Your health expert: Paul McArdle, Registered Dietitian
Content editor review by Liz Woolf, Freelance Health Editor, April 2023
Next review due January 2026

Type 2 diabetes means your body can’t control the amount of glucose (sugar) in your blood. Your body doesn’t respond properly to a hormone called insulin. Or it may be that your body doesn’t produce enough insulin. In either case, your blood glucose (blood sugar) level becomes too high.

About type 2 diabetes

There are two main types of diabetes: type 1 and type 2. Type 2 diabetes is the most common. More than 9 out of 10 people diagnosed with diabetes have this type.

You can develop type 2 diabetes at any age. It’s more common the older you get.3 But it’s becoming more common in young adults and children.

With type 2 diabetes, your body stops responding properly to insulin. You may also not be able to produce enough insulin. Insulin controls the amount of glucose (sugar) in your blood. When you need energy, it helps glucose move from your blood into your body tissues. If your body isn’t responding to insulin properly, your blood glucose level can become too high.

Causes of type 2 diabetes

Several things can increase the risk of type 2 diabetes. The main risk factor is being overweight or obese.

Other risk factors include:

having a close family member with diabetes
being of African, African–Caribbean, South-Asian or Chinese ethnicity
getting older
lack of exercise
having high blood pressure or high cholesterol
smoking
if you’re a woman, having polycystic ovary syndrome
for women, having had diabetes during pregnancy (gestational diabetes)

Symptoms of type 2 diabetes

Type 2 diabetes may not cause any obvious symptoms. It may only be discovered during a routine medical check-up. If you do have symptoms, you may:

need to pee more often than usual
feel constantly thirsty
lose weight for no obvious reason
feel extremely tired
have blurred vision
get frequent infections affecting your skin or genitals – for example, thrush – or urinary tract infections
have tingling or numbness in your hands or feet
develop darker patches in skin folds

If you have any of these symptoms, book an appointment with your GP.

Diagnosis of type 2 diabetes

Your GP will ask about your symptoms and examine you. You may have a blood test to check your blood glucose (blood sugar) level. You might have to fast (not eat) before your blood test, and you may need to be tested a couple of times. Sometimes, you may need further blood tests to check whether you have type 1 or type 2 diabetes.

Your doctor you may tell you that you have ‘prediabetes’. This is a warning sign. It means you’re at high risk of diabetes. Your glucose levels are higher than normal, but not high enough for a diagnosis of type 2 diabetes. There are things you can do that may prevent or delay type 2 diabetes. For more information, see our section on preventing diabetes.

Management of type 2 diabetes

Your GP will put a care plan in place for you. This usually involves lifestyle changes and medicines. They’ll talk through everything you need to know about living with diabetes and how to manage it.

Your GP may also refer you to a group education programme, such as the DESMOND (Diabetes Education for Self-Management for Ongoing and Newly Diagnosed) programme. This aims to help you to learn about diabetes and how to manage your care.

Lifestyle changes

There are many things you can do to help control your blood glucose (blood sugar). These include

making changes to your diet
losing weight if necessary
being more physically active

Your nurse or dietitian will be able to talk you through this. In some cases, these changes may be enough to control diabetes. Some people are even able to reverse their type 2 diabetes and put it into remission with lifestyle changes. Remission means your blood sugar levels are normal. One clinical trial found that over half of those who took part were able to get their type 2 diabetes into remission by losing weight.

So if you’re overweight, the first thing your GP is likely to recommend is to lose weight. They’ll help you set a target weight to work towards. They may refer you to a dietitian, who can advise on weight management, as well as on controlling your blood sugar.

Diet

Doctors don’t recommended foods specifically made for people with diabetes. It’s more important to follow a normal, healthy, balanced diet. That means eating wholegrain foods instead of the white varieties, including granary bread, brown pasta and brown or basmati rice, as well as:

lentils and beans (pulses)
plenty of fruit and vegetables
less saturated fat
oily fish

The carbohydrates in this list have a low “glycaemic index (GI)”. This measures how quickly foods increase your blood sugar. Wholegrain foods are also high in fibre, which helps to slow down sugar absorption.

Foods with a low GI raise your blood sugar level slowly. There’s good evidence that a low GI diet can help to control blood sugar levels in type 2 diabetes. The more you can bring some healthy low GI alternatives into your meals and snacks, the more it’ll help.

You also have to pay attention to portion sizes of foods containing carbohydrate. If you eat large quantities of a relatively low GI carb, it will push up your blood sugar.

With type 2 diabetes, you are at increased risk of heart disease. So cutting down on salt is a good idea too.

The following infographic lists healthy food swaps for a lower GI diet that you can incorporate into your diet plan.

Infographic: Healthy food swaps for a lower GI diet

The following infographic shows us some examples of healthy food swaps for a lower glycaemic (GI) diet. You can click on the image below to download a larger version of the infographic (JPG, 0.15 MB)

Infographic showing the Healthy food swaps for a lower glycaemic index (GI) diet

You may want to follow a “Mediterranean diet”. This has been shown to be helpful in both preventing and controlling type 2 diabetes. As with any healthy diet, the Mediterranean diet includes lots of wholegrains, fruit and vegetables and pulses. But it also includes lots of nuts and seeds and virgin olive oil, plus fish or seafood at least twice a week. Poultry, eggs and dairy products are fine, but you have red meat and sugary foods less often.

Following a low-carbohydrate (low-carb) diet can be an option for some people with type 2 diabetes. It may help you to lose weight and manage your blood sugar. But it may not be suitable for everyone, so talk to a dietitian before trying it.

Exercise

Regular exercise can help to lower your blood sugar. It can help you to stay a healthy weight and lower your risk of heart disease and stroke (cardiovascular disease).

When you’re getting started with exercise, any amount will help – even just spending less time sitting down as a first step. But to get the full benefits of exercise, try to aim for the recommended levels for adults in the UK:

two-and-a-half hours (150 minutes) a week of moderate-intensity activities or
one-and-a-quarter hours (75 minutes) a week of vigorous-intensity activities

You can do some of each to make up your weekly exercise and you don’t have to do it all at once. Moderate intensity exercise includes brisk walking, heavy housework such as vacuuming or washing windows, mowing the lawn or light cycling. Vigorous exercise includes jogging, fast cycling, hiking or playing sports such as football, basketball or tennis.

Your doctor, nurse or dietitian can advise you about any adjustments you need to make to your medications or diet when you’re exercising.

Medicines

Your doctor may recommend medicines if lifestyle changes alone don’t control your blood sugar.

You usually have a medicine called metformin. You start with a low dose and gradually increase it over a few weeks. This lowers the risk of side-effects, such as sickness and diarrhoea. If you do get side-effects, they usually go away on their own as you get used to the medicine.

Your doctor will suggest other medicines, such as gliclazide, if metformin doesn’t help, or if you get bad side-effects. You may need to take more than one diabetes medication at a time.

With type 2 diabetes, you only usually have insulin if lifestyle changes and medicines aren’t controlling your blood sugar. You have insulin as injections under your skin, from once to several times a day, depending on your needs.

Gliclazide and insulin can cause your blood sugar to drop too far (a hypo). So if you take either of these, you will need to monitor your blood sugar with a glucose meter. Your doctor will advise on how often you need to do this.

Complications of type 2 diabetes

If your blood glucose (blood sugar) becomes either too high (hyperglycaemia) or too low (hypoglycaemia), it can cause problems.

High blood sugar (hyperglycaemia)

With type 2 diabetes, your blood sugar doesn’t usually become high enough to cause noticeable symptoms. Very rarely, it can rise to a dangerously high level. This is a medical emergency, so it’s always important to be aware of the symptoms.

If you do have a high blood sugar, you may feel thirstier than usual, need to pee more often and feel extremely tired. You may also feel sick. If your blood sugar continues to rise, you may become confused and drowsy.

In the long term, it’s very important to try and control your blood sugar as well as possible. Your doctor will monitor it every few months with a blood test called HbA1c. This shows how well blood glucose levels have been controlled over the past two or three months.

If your blood sugar is too high for too much of the time, it can lead to problems. These happen because the high sugar levels in your blood can damage nerves and small blood vessels. Problems include:

kidney disease
nerve damage, causing tingling, burning sensations or loss of feeling
eye damage, leading to blindness
heart disease and stroke
foot problems, including infections, ulcers and problems related to lack of blood flow
infections that are frequent or don’t go away, especially urinary and skin infections

These are serious problems and can be life threatening. Nerve problems and lack of blood flow can even lead to toe, foot or lower limb amputations, particularly in people with diabetes who smoke.

Hypoglycaemia

Hypoglycaemia (also known as a ‘hypo’), is when your blood sugar level becomes too low. It is a possible complication of some diabetes treatments – including insulin and a type of diabetes tablet called a sulfonylurea, such as gliclazide (Diamicron).

You’re more likely to have a hypo if you are on these treatments and:

skip a meal
misjudge the amount of carbohydrate you need
drink alcohol on an empty stomach
are more active than usual.

Most people get warning signs when their blood sugar begins to fall. These include:

feeling hungry
sweating
feeling your heart pounding
being anxious or irritable
tingling lips
feeling shaky

If your blood sugar continues to fall, you may start feeling dizzy or confused, weak and lethargic and develop blurred vision.

Hypoglycaemia can be dangerous if not dealt with quickly. If you’re taking diabetes treatment where this might be a problem, your nurse or doctor will give you more information about how to manage hypos.

Living with type 2 diabetes

A healthy lifestyle can help to reduce your risk of long-term complications from type 2 diabetes. This means eating a healthy, balanced diet and taking regular exercise, as recommended by your doctor, diabetes specialist nurse or dietitian. This will help to control your blood glucose (blood sugar), keep to a healthy weight and reduce your risk of heart disease and stroke.

If you smoke, try to stop. Smoking is unhealthy for everyone, but it's particularly bad if you have diabetes. It increases your risk of circulatory problems, heart disease and stroke even further.

If you drink alcohol, stick within the recommended limit of no more than 14 units a week, spread over several days. Don’t drink on an empty stomach – it can increase your risk of a hypo. Alcohol can also increase the risk of hypoglycaemia if you take insulin or some diabetes drugs.

You’ll have check-ups with your doctor every six months to a year. This is to check that your blood sugar is well controlled and to screen for complications. You’ll have an HbA1C blood test to check how well your diabetes is controlled. And you’ll have other checks for diabetes complications, including blood tests for cholesterol and kidney function, blood pressure, eye and foot examinations. This will help to pick up any complications early, so they can be treated.

Driving

You don’t need to let the Driver and Vehicle Licensing Agency (DVLA) know you have type 2 diabetes unless:

you take insulin
you have any complications

Complications include episodes of hypoglycaemia, eye problems or nerve damage to your legs or feet. The DVLA may contact your doctor for more information.

If you drive a heavy goods vehicle or passenger vehicle (bus or minibus) you do need to tell the DVLA. There is more information on DVLA website.

Your sex life

Over time, high blood glucose levels damage your nerves (known as neuropathy) and blood vessels. This can restrict blood flowing to your sexual organs causing erectile dysfunction in men and loss of sensation in women. Erectile dysfunction is more common if you are very overweight (obese) or have high blood pressure or high cholesterol. If you’re having sexual problems, contact your GP for help and advice.

Prevention of diabetes

Type 2 diabetes is preventable. On average, you can halve your risk by improving your diet, losing weight if necessary and doing more exercise. This is particularly important if you:

are from a South Asian, Chinese, Black African or African–Caribbean background
have a close relative with diabetes
are over 40 (or over 25 if you are from one of the ethnic groups listed above)
are overweight
have high blood pressure

You may be diagnosed with prediabetes through a routine blood test. This means you have higher glucose levels than normal, but not yet type 2 diabetes. Your doctor will refer you to a diabetes prevention programme, with the aim of adopting a healthier lifestyle. Taking action to lose weight, improve your diet and exercise more may delay or even stop type 2 diabetes from developing at all. See our section on management of type 2 diabetes for more information on diet and exercise.

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Type 2 diabetes isn’t curable. But some people manage to get it into remission with lifestyle changes. Remission means your blood sugar level is within the normal range. But you’ll still have to take care because type2 diabetes can come back. See our section on managing type 2 diabetes for more information.

The main cause of type 2 diabetes is being overweight or obese. But some people are at greater risk. Type 2 diabetes is more common in people from a South Asian, Chinese, Black African or African–Caribbean background. It also becomes more common with age. See our section on causes of type 2 diabetes for more information.

Yes, you can drive a car or motorbike with no restrictions. But you have to notify the DVLA if you need insulin to control your diabetes, if you have particular complications or if you drive a heavy goods vehicle or a passenger vehicle. See our section on living with type 2 diabetes for more information.

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