Type 2 diabetes

Type 2 diabetes means your body can’t control the amount of glucose (sugar) in your blood. Your body might not respond properly to a hormone called insulin. Or your body doesn’t produce enough insulin. Either way, 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. Around 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. 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 doesn’t respond to insulin properly, your blood glucose level can become too high.

Type 2 diabetes risk factors

Several things can increase your risk of developing type 2 diabetes. The main one is if you’re overweight or obese.

Other type 2 diabetes risk factors include:

• a lack of physical activity
• having a close family member with diabetes
• if you’re of African, African–Caribbean, or Asian ethnicity
• getting older
• high blood pressure or high cholesterol
• polycystic ovary syndrome
• diabetes during pregnancy (gestational diabetes)
• smoking

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 type 2 diabetes 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 infections often that affect your skin or genitals – for example, thrush – or urinary tract infections
• have tingling or numb hands or feet
• develop darker patches in skin folds, such as your neck and armpits

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.

You may find you have prediabetes. This is a warning sign and means you’re at high risk of diabetes. This means 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.

Managing type 2 diabetes

Your GP will put a care plan in place for you. Type 2 diabetes treatment will usually involve lifestyle changes and type 2 diabetes medication . 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 will help you 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 talk you through this. For some people, these changes may be enough to control diabetes. It may be possible to even reverse type 2 diabetes and put it into remission with lifestyle changes. Remission means your blood sugar levels are normal.

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, which includes wholegrain foods and plenty of fruit and vegetables.

Wholegrain carbohydrates have a low glycaemic index (GI). GI measures how quickly foods increase your blood sugar. Wholegrain foods are also high in fibre, which helps to slow down sugar absorption. It may help further reduce the glucose load after a meal if you add protein to carbohydrates. For example, add peanut butter to granary toast. 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.

Also pay attention to portion sizes of foods that contain carbohydrate. If you eat large quantities of a relatively low GI carb, it will still push up your blood sugar.

If you have type 2 diabetes, you’re at increased risk of heart disease. So it’s a good idea to cut down on salt too.

Complications of type 2 diabetes

If your blood glucose (blood sugar) becomes either too high (hyperglycaemia) or too low (hypoglycaemia), it can cause type 2 diabetes complications.

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 of high blood sugar.

If you do have high blood sugar, you may feel more thirsty 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 will show 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, that causes tingling, burning sensations or a loss of feeling, most often in the feet, which can increase your risk of foot ulcers
• eye damage, potentially 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 some 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’s a possible complication of some type 2 diabetes treatments – including insulin.

You’re more likely to have a hypo if you are on these type 2 diabetes 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
• feeling 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 doing regular physical activity, 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 further increases your risk of circulatory problems, heart disease and stroke.

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 other diabetes drugs.

You’ll have check-ups with your doctor around every six months. This is to check that your blood sugar is well controlled and to check 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, and 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.

There’s more information on DVLA website.

Your sex life

Over time, high blood glucose levels can 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’re 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 physical activity. 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, to help you adopt a healthier lifestyle. If you lose weight, improve your diet and exercise more, it may delay or even stop type 2 diabetes from developing at all.