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Type 2 diabetes

Type 2 diabetes is a lifelong condition in which your body can’t control the level of glucose in your blood. It develops when your body can’t make enough insulin or doesn't respond to it properly.

About 2.9 million people in the UK have been diagnosed with diabetes. There are two main types of diabetes: type 1 and type 2. Type 2 diabetes is the common form, affecting 85 out of every 100 people (including children) with diabetes. You may also hear type 2 diabetes called non-insulin-dependent diabetes and sometimes adult-onset or late-onset diabetes. However, this is misleading as type 2 diabetes is becoming more common in young adults and children.

Type 2 diabetes usually affects people over the age of 40, but can develop at any age. People of African-Caribbean or South Asian origin are more likely to develop the condition. It usually affects them earlier in life, from the age of about 25.

Type 2 diabetes develops when your body can’t produce enough insulin or doesn’t respond to insulin as it should. This happens if your body becomes less sensitive to insulin and doesn’t react to it properly (insulin resistance).

Insulin is important because it regulates the level of glucose in your blood. Glucose is a simple form of sugar found in foods and sugary drinks. It’s absorbed by your body as a natural part of digestion and is carried around your body in your blood. When glucose reaches your body tissues, such as muscle cells, insulin helps it enter the cells where it's converted into energy.

Insulin is produced by your pancreas, which is a gland located behind your stomach. If your pancreas doesn’t produce enough insulin, or your tissue cells don't respond properly to insulin, glucose can build up in your blood. This causes your blood sugar levels to rise.

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How type 2 diabetes develops
Type 2 diabetes is a lifelong condition in which the body can't control levels of glucose in the blood
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Details

  • Symptoms Symptoms of type 2 diabetes

    Many people with type 2 diabetes have no obvious symptoms. It's often discovered during a routine medical check-up with your GP. If you think you may be at risk of type 2 diabetes, speak to your GP. He or she may offer you a screening blood test to check for signs of the condition.

    If you do have symptoms of type 2 diabetes, you may:

    • pass urine more often than usual
    • be constantly thirsty
    • have unexplained weight loss
    • be extremely tired
    • have blurred vision
    • have itchy skin around your genitals or get regular infections, such as thrush

    If you have any of these symptoms, see your GP.

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  • Diagnosis Diagnosis of type 2 diabetes

    Your GP will ask about your symptoms and examine you. He or she may advise you to have a blood test to examine the levels of glucose in your blood. Your GP may also suggest that you have the following tests.

    • Fasting blood glucose test. You will need to fast overnight before having this test. Glucose levels of 7.0mmol/litre or greater suggest you have type 2 diabetes.
    • Two-hour blood glucose test (glucose tolerance test). This measures how your blood glucose level changes over time after you have a sugary drink. You will need to fast overnight before having this test. Glucose levels of 11.1mmol/litre or greater suggest you have type 2 diabetes.
    • Glycosylated haemoglobin (HbA1C) test. HbA1C is a protein that is produced when you have high blood glucose levels over a long period of time. HbA1C levels of 48mmol/mol or greater suggest you have type 2 diabetes.

    If your blood test results suggest you have type 2 diabetes, your GP may advise you to have repeat tests before your diagnosis is confirmed.

    If you're diagnosed with type 2 diabetes, you may be referred to a clinic that has nurses and doctors who specialise in treating diabetes.

  • Treatment Treatment options for type 2 diabetes

    There are a number of treatment options for type 2 diabetes, as described below. Which treatments you're offered will depend on your personal circumstances. Your doctor will discuss these with you to help you make a decision that is right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.

    There isn't a cure for type 2 diabetes but it can be controlled. Some people can control their condition with lifestyle changes alone. Others need to take medicines or have insulin injections.

    Self-help

    By making the following lifestyle changes, you can help to control your blood glucose levels.

    • Eat a healthy, balanced diet with regular meals, three times a day. Include carbohydrates, such as pasta or potatoes, in each meal.
    • Aim to do 150 minutes of moderate exercise over a week in bouts of 10 minutes or more. This will help you to stay a healthy weight and control your blood glucose levels.
    • Only drink alcohol in moderation and stick within the recommended limits.
    • If you smoke, stop. Smoking is unhealthy for everyone, but it's especially important to stop if you have diabetes. This is because you already have an increased risk of developing circulatory problems and heart disease. Smoking further increases your risk of developing these conditions.

    Ask at your clinic whether they run structured education classes. These aim to help you learn how to look after your condition and how to monitor it yourself.

    Medicines

    If lifestyle changes alone don’t keep your blood glucose levels under control, your doctor may advise you to take medicines. There are many types of diabetes medicines available. Your doctor will usually begin by offering you a medicine called metformin.

    Metformin works by reducing the amount of glucose that gets released into your blood from your liver. It also improves the way glucose is used by your muscles. If metformin doesn’t help you reach your desired blood glucose levels within three months, there is a range of medicines that your doctor can offer you instead. The one that you’re offered will depend on many things but some of the possible medicines include the following. 

    • Insulin secretagogues help your pancreas to produce more insulin. Sulphonylurea medicines are a commonly used insulin secretagogue – examples include gliclazide, glipizide and glimepiride.
    • A type of medicine called a DPP-4 inhibitor (such as sitagliptin, saxagliptin or linagliptin) help your body to produce insulin when it’s needed.
    • GLP-1 agonists, such as exenatide or liraglutide. These medicines are given by injection and work by helping your body to make more insulin when it’s needed. They can also reduce your appetite and help you lose weight.
    • Pioglitazone helps to reduce insulin resistance. However, it’s less commonly used now as there are concerns that it may increase the risk of bladder cancer.

    For more information about medicines for type 2 diabetes, speak to your doctor or diabetes specialist nurse.

    Insulin injections

    If lifestyle changes and medicines can’t keep your blood glucose levels under control, your doctor may suggest you have insulin injections.

    You will usually inject yourself with insulin once or twice a day, using either a small needle or a pen-type syringe with replaceable cartridges. There are several different types of insulin that work at different rates and for different lengths of time. Ask your doctor for advice on which type is best for you.

    If you have insulin injections, you will be advised to monitor your blood glucose levels with a home test kit. This involves taking a pinprick of blood from your finger and putting a drop on a testing strip. A meter will read the result automatically.

    Your 'normal' blood glucose range will be specific to you but a general guide for adults with type 2 diabetes is:

    • before meals: 4 to 7mmol/litre
    • after meals: less than 8.5mmol/litre (two hours after a meal) – however, this is less reliable than testing your blood sugar before eating

    Your doctor, GP or diabetes specialist nurse will show you how to monitor your blood glucose levels and tell you how often you need to check it.

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  • Monitoring your blood glucose level Monitoring your blood glucose level

    Your doctor may advise you to have your levels of HbA1C tested at least once a year. HbA1C is a measure of how well you’re controlling your blood sugar levels over the long term. The test is done by taking blood from a vein in your arm or sometimes a drop of blood from a fingerprick.

    You will usually be offered at least one full review of your condition every year.

  • Causes Causes of type 2 diabetes

    There are several risk factors that make you more likely to develop type 2 diabetes, including:

    • being overweight or obese – in particular, if you’re an 'apple shape' with lots of fat around your abdomen (tummy)
    • having a close family member with the condition
    • being of African-Caribbean or South-Asian origin
    • being over 40 – your risk increases with age
    • having high blood pressure or heart disease
    • not exercising regularly
    • smoking
    • being a woman with polycystic ovary syndrome
    • being a woman and having had diabetes that developed during pregnancy (gestational diabetes)
    • having a condition such as impaired glucose tolerance or impaired fasting glycaemia – where your blood sugar levels are naturally higher than normal
  • Complications Complications of type 2 diabetes

    Persistently high blood glucose levels due to uncontrolled diabetes can increase your risk of complications, which can include:

    • heart disease – diabetes is the second most common cause after smoking
    • stroke – people with diabetes are up to three times more likely to have a stroke than those without diabetes
    • nerve damage
    • periodontal disease
    • persistent or regular infections, such as skin, chest or urinary infections
    • kidney failure
    • blindness

    In the long-term, type 2 diabetes can lead to complications even with good control of blood glucose.

    If too much sugar builds up in your blood, you may develop hyperglycaemia. This may happen because you missed a dose of insulin or another medicine. You could also develop hyperglycaemia if, you have eaten more carbohydrate than usual or if you have an infection. Symptoms of hyperglycaemia include:

    • needing to pass urine frequently
    • feeling more thirsty and hungry than usual
    • feeling tired or weak

    Very rarely, if you have an infection or become dehydrated, your blood glucose can rise to dangerously high levels. This can lead to a condition called hyperosmolar hyperglycaemic state. If this happens, you may become drowsy and lose consciousness. Although the risk of this condition is low, it is a medical emergency and you will need to be treated in hospital.

    Hypoglycaemia

    Your blood glucose levels can become too low (hypoglycaemia) if you don't eat enough carbohydrate while taking insulin or particular medicines called sulphonylureas (eg gliclazide). You’re more likely to develop hypoglycaemia if you take other medicines such as beta-blockers, drink too much alcohol or do more physical activity than usual. Hypoglycaemia can cause you to feel faint, sweaty, confused and you may feel your heart pounding. You can treat it straight away by eating glucose tablets (or a few sweets or a sugary drink), followed by a couple of biscuits or a sandwich.

  • Glycaemic index Glycaemic index

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    Click to open full-size image (1.2MB)

  • FAQs FAQs

    Are there any side-effects of using insulin for type 2 diabetes?

    Answer

    Side-effects are the unwanted effects of a medicine. Insulin can have a number of different side-effects. It’s important to talk to your GP for advice.

    Explanation

    If you use insulin injections for diabetes, you may get swelling and bruising on and around the skin where you inject. You may also get a skin rash, but this is rare.

    Insulin can cause fat to grow more quickly around the injection site, causing soft lumps to build up under your skin. It’s very important that you change injection sites regularly to prevent these lumps forming. Injection sites for insulin include your abdomen (tummy), thighs, bottom and sometimes your arms. You should also change the exact spot that you use within the injection site each time.

    Hypoglycaemia (low blood glucose) is a potential complication of insulin therapy. It can be caused if you take too much insulin. If you get hypoglycaemia, you may:

    • feel shaky
    • sweat
    • be tired
    • have blurred vision
    • not be able to concentrate
    • have headaches
    • go pale

    If this happens, you must eat or drink something sugary straight away. Then eat something containing long-lasting carbohydrates such as a sandwich, some toast or a piece of fruit. Test your blood glucose level to see whether it's returning to normal. If it's not, call for emergency help immediately.

    If you have any of these side-effects, it’s important to talk to your GP.

    Can I drive if I have type 2 diabetes?

    Answer

    You can continue to drive a car, motorcycle, heavy goods vehicle (HGV) or a passenger vehicle (such as a minibus) if you have type 2 diabetes. However, you need to contact the Driver and Vehicle Licensing Agency (DVLA) if you take certain medicines. For example, you’ll need to contact the DVLA if you take insulin or a sulphonylurea medicine (eg gliclazide) and drive a HGV or passenger vehicle.

    Explanation

    In the interests of road safety you must be sure that you can safely control a car at all times. You need to be aware of how your condition might affect your ability to drive safely. For example, this could be if your blood glucose levels fall or your eyesight gets worse.

    If you take sulphonlyureas or insulin, alone or in combination with other medicines, you may be at risk of developing hypoglycaemia (known as a ‘hypo’) when driving. If you take these medicines and you drive a HGV or passenger vehicle, you must inform the DVLA.

    To reduce your risk of developing hypoglycaemia while driving, you should always:

    • check your blood glucose before you start driving
    • eat a snack before driving if your blood glucose level is 5mmol/litre or less
    • not drive with a blood glucose level of less than 4mmol/litre
    • not drive for more than two hours without stopping for a snack
    • keep some kind of carbohydrate, such as sweets and a sugary drink, in the car

    If hypoglycaemia develops while you're driving:

    • pull over and stop somewhere safe
    • take glucose tablets or some other form of fast-acting carbohydrate immediately
    • leave the driver's seat and take the keys out of the ignition to make it clear that you're no longer in charge of the car
    • don't start driving again until all your symptoms have gone – this usually takes about 45 minutes

    You do need to tell the DVLA if your diabetes is managed with insulin. You also need to tell them if you have another associated condition, such as eye problems or nerve damage to your legs or feet, even if your diabetes is treated with medicines. The DVLA may contact your doctor for information about how your condition is managed. The DVLA may also ask your doctor about how well controlled it is and whether you have any complications that might make it unsafe for you to drive.

    Can I go on holiday if I have type 2 diabetes?

    Answer

    Yes, it's fine to go on holiday as long as you’re well prepared.

    Explanation

    People with diabetes travel all over the world and take the same kinds of holiday as people without diabetes. However, you must plan well before your trip and remember the following.

    • Take extra supplies of your medication with you.
    • If you're travelling across time zones, you may need to adjust your medicine schedule. Get advice from your doctor or nurse.
    • If you become unwell when you're away, make sure you drink enough drink plenty of fluids and if you can't eat, make sure you have sugary drinks. If you can't eat or drink anything, go to hospital for treatment.
    • Security regulations at airports may mean you have to make special arrangements to travel with insulin. Carry your diabetes identification and a letter from your doctor, and check with the airline you're flying with before you go.
    • Declare your condition when you buy travel insurance and never travel without it.

    If you have any questions or concerns about travelling, speak to your GP or diabetes specialist nurse.

    What am I aiming for with my day-to-day treatment?

    Answer

    It's important to lead a healthy lifestyle – to be the right weight for your height, be active, eat the right foods and not smoke. You have a large part to play in the control of your condition, so it's important that you understand and follow your treatment plan.

    Explanation

    In the long term, uncontrolled high blood glucose (hyperglycaemia) can be very damaging to your health. It can increase your risk of heart disease, stroke, kidney failure, nerve damage and blindness.

    It's important to aim for your blood glucose levels, blood pressure readings and cholesterol (lipid) levels to be as near to normal as possible. The better your control of these factors, the less likely you are to have short- and long-term health problems associated with diabetes.

    If you manage your condition well, it can also help you to feel better and have a better quality of life. The main targets that you're aiming for with your treatment are described here.

    • Blood glucose levels before meals of 4 to 7mmol/litre. This is the level you're aiming for when you test your blood glucose at home. Your GP will advise you on whether home monitoring of your blood glucose levels is suitable for you.
    • Blood pressure of 130/80mmHg or below. Many people with type 2 diabetes develop high blood pressure. Having high blood pressure as well as diabetes puts you at even greater risk of developing heart problems or stroke. This is why it's very important to keep your blood pressure well controlled. You can do this with lifestyle changes and medicines.
    • Aim for a stable HbA1c level with few or no occurrences of hypoglycaemia. HbA1c is a blood test that you will be offered at least once a year. It shows what your average blood glucose levels were like over the previous three to four months. It is also a good guide to how well controlled your blood glucose levels have been.
    • Total blood cholesterol levels of less than 4mmol/litre. Like high blood pressure, raised blood cholesterol can also increase your risk of heart problems and stroke. Your doctor will advise you to eat foods that are low in saturated fats and to be active. He or she may also suggest that you take medicines to lower your cholesterol levels. These are likely to be statins, but you may be prescribed other medicines called fibrates as well as or instead of statins if these aren't suitable for you.

    Type 2 diabetes is a progressive condition, which means that it can gradually worsen as time goes on. This means that in future you may need to increase the amount of medication you take. Your doctor may also suggest that you move on to insulin, in order to keep your condition well controlled.

    Will I be able to manage type 2 diabetes by myself?

    Answer

    Yes you can, and you will be encouraged to do so. Care for diabetes is planned around you and helping you to take control of your condition.

    Explanation

    You will be managing your diabetes as part of a team that includes your GP, practice nurse and possibly a doctor or nurse who specialises in diabetes. You will usually be offered an appointment to see your doctor or nurse every four to six months. You will also be offered at least one full review of your condition every year. Outside of these appointments you're likely to be looking after your condition yourself.

    Your GP or nurse will discuss your treatment choices with you. He or she will help you to find the information and support you need to feel confident at home. If you’re having insulin injections, your GP or nurse may give you the option of monitoring your blood glucose levels at home.

    You might be invited to take part in a more structured diabetes education programme. There are lots of different courses available, depending on where you live. These courses are usually held in small groups. They aim to help you learn how to look after your condition and how to monitor it yourself.

    One of these programmes is called DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed). This is an educational programme specifically for people with type 2 diabetes. It's usually run for one full day or over two half days. It teaches you ways to manage your diabetes yourself and can help you to feel more in control of your condition.

    Will type 2 diabetes affect my sex life?

    Answer

    Yes it can. If diabetes isn’t managed properly, you’re likely to have higher than normal blood glucose levels. Over time, the high blood glucose levels can damage your nerves and blood vessels. This can affect your sex drive and, if you’re a man, your ability to get an erection.

    Explanation

    If diabetes isn’t managed properly, you’re likely to have higher than normal blood glucose levels. Over time, the high blood glucose levels damage your nerves (neuropathy), blood vessels and tissues.

    Neuropathy is the most common complication of diabetes. It affects more than half of people aged over 60 with type 2 diabetes.

    Early signs of diabetic neuropathy include tingling, pain, numbness or weakness in your feet and hands. As the nerve damage progresses, it can cause erectile dysfunction in men. In women, the nerve damage can cause loss of sensation and affect sexual arousal, and may make sex painful.

    You’re more likely to have sexual problems if you’re overweight or have high blood pressure or high cholesterol. Psychological problems such as feeling anxious or stressed can also influence your sex drive and ability to get and keep erections.

    If you’re having sexual problems, it’s a good idea to see your GP. He or she may recommend you make changes to your lifestyle, such as trying to lose excess weight, and can prescribe various treatments to help.

  • Resources Resources

    Further information

    Sources

    • Diabetes – type 2. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2010
    • Type 2 diabetes in adults. BMJ Best Practice. www.bestpractice.bmj.com, published 10 October 2012
    • Diabetes in the UK 2012 (April 2012): key statistics on diabetes. Diabetes UK. www.diabetes.org.uk, published April 2012
    • Type 2 diabetes. Diabetes UK. www.diabetes.org.uk, accessed February 2013
    • Hyperosmolar hyperglycaemic state. BMJ Best Practice. www.bestpractice.bmj.com, published 19 July 2012
    • Diabetes – factsheet 312. World Health Organization. www.who.int, published September 2012
    • Diabetes mellitus. The Merck Manuals. www.merckmanuals.com, published December 2012
    • Management of diabetes. Clinical guideline 116. Scottish Intercollegiate Guidelines Network (SIGN), March 2010. www.sign.ac.uk
    • About DESMOND. Desmond Project. www.desmond-project.org.uk, accessed 28 February 2013
    • Informing the Driving and Vehicle Licensing Agency (DVLA). Diabetes UK. www.diabetes.org.uk, accessed 28 February 2013
    • Insulin therapy in type 2 diabetes. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2010
    • Diabetic neuropathy. BMJ Best Practice. www.bestpractice.bmj.com, published 5 December 2012
    • Type 2 diabetes (diabetes mellitus type 2). Diabetes.co.uk. www.diabetes.co.uk, accessed 10 May 2013
    • Insulin resistance. Diabetes.co.uk. www.diabetes.co.uk, accessed 10 May 2013
    • Diabetes and hyperglycaemia. Diabetes.co.uk. www.diabetes.co.uk, accessed 10 May 2013
    • Pioglitazone: risk of bladder cancer. Medicines and Healthcare products Regulatory Agency. www.mhra.gov.uk, published August 2011
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    Reviewed by Pippa Coulter, Bupa Health Information Team, June 2013.

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