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Diabetes Type 2 diabetes

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Diabetes Type 2 diabetes



Introduction 

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high.

In England in 2010, there were approximately 3.1 million people aged 16 or over with diabetes (both diagnosed and undiagnosed).

By 2030, this figure is expected to rise to 4.6 million, with 90% of those affected having type 2 diabetes (see below).

The charity Diabetes UK estimates that around 850,000 people in England have diabetes, but haven't been diagnosed.

Many more people have blood glucose (sugar) levels above the normal range, but not high enough to be diagnosed as having diabetes. This is sometimes known as "pre-diabetes", and if you have it you have a greater risk of developing full-blown diabetes.

It's very important for diabetes to be diagnosed as early as possible, because it will get progressively worse if left untreated.

You should therefore visit your GP as soon as possible if you have symptoms, which include feeling thirsty, passing urine more often than usual and feeling tired all the time (see the list below for more diabetes symptoms).

Type 1 and type 2 diabetes

There are two main types of diabetes – type 1 and type 2.

Type 2 diabetes occurs when the body doesn't produce enough insulin to function properly, or the body’s cells don't react to insulin. This is known as insulin resistance.

Type 2 diabetes is far more common than type 1 diabetes, which occurs when the body doesn't produce any insulin at all. In the UK, about 90% of all adults with diabetes have type 2. 

Type 1 diabetes usually develops before the age of 40 – often in the teenage years, while type 2 diabetes tends to be diagnosed in older people.

The danger of type 2 diabetes

The rapid rise in the number of adults developing type 2 diabetes is due to:



increasing levels of obesity



a lack of exercise



increase in unhealthy diets



an ageing population



Even if you feel healthy, you may have a higher than normal blood glucose level (pre-diabetes) and be at risk of getting the condition.

It's therefore important to take preventative measures by making any necessary lifestyle changes, such as eating more healthily, losing weight (if you're overweight) and becoming more physically active.

Diabetes can cause serious long-term health problems. It's the most common cause of visual impairment and blindness in people of working age. It's also responsible for most cases of kidney failure and lower limb amputation (other than accidents).

People with diabetes are up to five times more likely to havecardiovascular disease and stroke than those without diabetes.

Diabetes symptoms

Diabetes can cause a variety of symptoms. The main symptoms of undiagnosed diabetes include:



urinating frequently, particularly at night



feeling very thirsty



feeling very tired



unexplained weight loss and loss of muscle bulk



itching of the genitals or frequent episodes of thrush



cuts and wounds that heal slowly



blurred vision



The symptoms of type 2 diabetes may not be so obvious, because the condition usually develops slowly over a number of years. It may only be picked up during a routine medical check-up.

You should visit your GP as soon as possible if you notice any of the above symptoms.

You can also use the diabetes self-assessment tool on this page to find out your risk of developing type 2 diabetes.

Causes of type 2 diabetes

Insulin is a hormone produced by the pancreas – a large gland located behind the stomach.

Insulin controls the amount of glucose in your blood. It moves glucose from the blood into your cells, where it's converted into energy.

In type 2 diabetes, not enough insulin is produced to maintain a normal blood glucose level (insulin deficiency), or your body is unable to use the insulin that's produced effectively. This is known as insulin resistance.

At risk groups

Although all adults are at risk of developing type 2 diabetes, a number of groups have a particularly high risk of developing the condition.

Your risk of developing type 2 diabetes is increased if:



you're over 40 years of age (over 25 if you're South Asian)



you have a close family member with diabetes (a parent, brother or sister)



you're overweight or obese, with a waist size of over 80cm (31.5 inches) for women and 94cm (37 inches) for men, or 89cm (35 inches) for South Asian men 



you're of South Asian, Chinese, African-Caribbean or black African origin (even if you were born in the UK) 



you've ever had a cardiovascular disease, such as a heart attack orstroke



you're a woman with polycystic ovary syndrome (PCOS) and also overweight



you're a woman and you've had gestational diabetes or given birth to a baby of over 10 pounds 



you have a severe mental health condition, such as depression,schizophrenia or bipolar disorder, and you're taking medication for it



you've been told you have impaired glucose tolerance or impaired fasting glycaemia



Treating type 2 diabetes

There is no cure for diabetes. However, treatment aims to keep your blood glucose levels as normal as possible, which will control your symptoms and minimise the risk of health problems developing later on.

If you're diagnosed with diabetes, you may be referred to a diabetes care team for specialist treatment, or your GP surgery may provide first-line diabetes care.

In some cases, it may be possible to control your diabetes symptoms by making changes to your lifestyle, such as eating a healthy diet and taking regular exercise (see below).

However, as type 2 diabetes is a progressive condition, you may eventually need to take medication to keep your blood glucose at normal levels. You may need to take tablets initially, but move on to injected therapies, such as insulin, at a later stage.

Living with diabetes

If you have type 2 diabetes, you will be advised to look after your health very carefully.

Caring for your health will also make treating your diabetes easier and minimise your risk of developing complications. You should:



eat a healthy, balanced diet



lose weight (if you're overweight) and maintain a healthy weight 



stop smoking (if you smoke)



drink alcohol in moderation



take plenty of regular exercise



If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if it's not treated. Everyone with diabetes aged 12 or over should be invited to have their eyes screenedonce a year. 



Media last reviewed: 08/04/2013
Next review due: 08/04/2015




Gestational diabetes (during pregnancy)

Blood glucose levels can sometimes increase during pregnancy, making difficult for insulin to absorb it all. This is called gestational diabetes, which affects about 5% of pregnant women.

Gestational diabetes can increase the risk of health problems developing in an unborn baby, so it's important to keep your blood glucose levels under control.

In most cases, gestational diabetes disappears after the baby is born. However, women who develop the condition have about a 30% risk of developing type 2 diabetes in later life.

 

Symptoms of type 2 diabetes 

The symptoms of diabetes include feeling very thirsty, passing more urine than usual and feeling tired all the time.

The symptoms occur because some or all of the glucose stays in your blood and isn’t used as fuel for energy.

Your body will try to get rid of the excess glucose in your urine.

The main symptoms, which are common to both type 1 diabetes and type 2 diabetes, are:



urinating more often than usual, particularly at night



feeling very thirsty



feeling very tired



unexplained weight loss



itching around the penis or vagina, or frequent episodes of thrush



cuts or wounds that heal slowly



blurred vision (caused by the lens of the eye becoming dry)



The signs and symptoms of type 1 diabetes are usually obvious and develop very quickly, often over a few weeks.

The signs and symptoms of type 2 diabetes aren't always as obvious, and it's often diagnosed during a routine check-up. This is because the symptoms are often mild and develop gradually over a number of years.

This means that you may have type 2 diabetes for many years without realising it.

Early diagnosis and treatment for type 2 diabetes is very important because it may reduce your risk of developing complications later on. Visit your GP as soon as possible if you think you may have diabetes.

Hyperglycaemia

Type 2 diabetes occurs when the pancreas (a large gland behind the stomach) can't produce enough insulin to control your blood glucose level, or when the cells in your body don't respond properly to the insulin that is produced.

Due to the lack of insulin or its inability to regulate blood glucose, your blood glucose levels may become very high. This is known ashyperglycaemia.

Hyperglycaemia can occur for several reasons, including:

 

 



eating too much



being unwell



ineffective – or not taking enough – diabetes medication 



Hyperglycaemia causes the main symptoms of diabetes, which include extreme thirst and frequent urination.

 






 

 

Healthy living with diabetes


 



Diabetes can have serious health consequences, including heart disease and blindness. But with careful management you can reduce your risk



 



 



 








Page last reviewed: 18/06/2014

Next review due: 18/06/2016

 

Causes of type 2 diabetes 

Type 2 diabetes occurs when the pancreas doesn't produce enough insulin to maintain a normal blood glucose level, or the body is unable to use the insulin that is produced – known as insulin resistance.

The pancreas (a large gland behind the stomach) produces the hormone insulin, which moves glucose from your blood into your cells, where it's converted into energy.

In type 2 diabetes, there are several reasons why the pancreas doesn't produce enough insulin.

Risk factors for type 2 diabetes

Four of the main risk factors for developing type 2 diabetes are:



age – being over the age of 40 (over 25 for South Asian people)  



genetics – having a close relative with the condition (parent, brother or sister)



weight – being overweight or obese



ethnicity – being of South Asian, Chinese, African-Caribbean or black African origin (even if you were born in the UK)



See the introduction page for a full list of the risk factors for type 2 diabetes.

The four risk factors listed above are discussed in more detail below.

Age

Your risk of developing type 2 diabetes increases with age. This may be because people tend to gain weight and exercise less as they get older.

Maintaining a healthy weight by eating a healthy, balanced dietand exercising regularly are ways of preventing and managing diabetes.

White people over the age of 40 have an increased risk of developing type 2 diabetes. People of South Asian, Chinese, African-Caribbean and black African descent have an increased risk of developing type 2 diabetes at a much earlier age.

However, despite increasing age being a risk factor for type 2 diabetes, over recent years younger people from all ethnic groups have been developing the condition.

It's also becoming more common for children, in some cases as young as seven, to develop type 2 diabetes.

Genetics

Genetics is one of the main risk factors for type 2 diabetes.

Your risk of developing the condition is increased if you have a close relative – such as a parent, brother or sister – who has the condition. The closer the relative, the greater the risk.

A child who has a parent with type 2 diabetes has about a one in three chance of also developing it (see below).

Being overweight or obese

You're more likely to develop type 2 diabetes if you're overweight or obese (with a body mass index (BMI) of 30 or more).

In particular, fat around your tummy (abdomen) increases your risk. This is because it releases chemicals that can upset the body's cardiovascular and metabolic systems.

This increases your risk of developing a number of serious conditions, including coronary heart disease, stroke and some types of cancer.

Measuring your waist is a quick way of assessing your diabetes risk. This is a measure of abdominal obesity, which is a particularly high-risk form of obesity.

Women have a higher risk of developing type 2 diabetes if their waist measures 80cm (31.5 inches) or more. Asian men with a waist size of  89cm (35 inches) or over have a higher risk, as do white or black men with a waist size of 94cm (37 inches) or over.

Use the BMI calculator to find out if you're a healthy weight for your height.

Exercising regularly and reducing your body weight by about 5% could reduce your risk of getting diabetes by more than 50%.

Ethnicity

People of South Asian, Chinese, African-Caribbean and black African are more likely to develop type 2 diabetes.

Type 2 diabetes is up to six times more common in South Asian communities than in the general UK population, and it's three times more common among people of African and African-Caribbean origin.

People of South Asian and African-Caribbean origin also have an increased risk of developing complications of diabetes, such as heart disease, at a younger age than the rest of the population.

 Other risks 

Your risk of developing type 2 diabetes is also increased if your blood glucose level is higher than normal, but not yet high enough to be diagnosed with diabetes.

This is sometimes called "pre-diabetes" – doctors sometimes call it impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT).

Pre-diabetes can progress to type 2 diabetes if you don't take preventative steps, such as making lifestyle changes. These include eating healthily, losing weight (if you're overweight) and taking plenty of regular exercise.

 

Women who have had gestational diabetes during pregnancy also have a greater risk of developing diabetes in later life.

 

 Diagnosing type 2 diabetes  

It's important for diabetes to be diagnosed early, so treatment can be started as soon as possible.

If you experience the symptoms of diabetes, visit your GP as soon as possible. They'll ask about your symptoms and may request blood and urine tests.

Your urine sample will be tested for glucose. Urine doesn't normally contain glucose, but if you have diabetes, glucose can overflow through the kidneys and into your urine.

If your urine contains glucose, a specialised blood test, known as glycated haemoglobin (HbA1c), can be used to determine whether you have diabetes.

 Glycated haemoglobin (HbA1c) 

In people who have been diagnosed with diabetes, the glycated haemoglobin (HbA1c) test is often used to show how well their diabetes is being controlled.

The HbA1c test gives your average blood glucose levels over the previous two to three months. The results can indicate whether the measures you're taking to control your diabetes are working.

If you've been diagnosed with diabetes, it's recommended that you have your HbA1c measured at least twice a year. However, you may need to have your HbA1c measured more frequently if:



you've recently been diagnosed with diabetes



your blood glucose remains too high



your treatment plan has been changed



Unlike other tests, such as the glucose tolerance test (GTT), the HbA1c test can be carried out at any time of day and it doesn't require any special preparation, such as fasting. However, the test can't be used in certain situations, such as during pregnancy.

The advantages associated with the HbA1c test make it the preferred method of assessing how well blood glucose levels are being controlled in a person with diabetes.

HbA1c can also be used as a diagnostic test for diabetes and as a screening test for people at high risk of diabetes (see below).

 HbA1c as a diagnostic test 

In 2011, the World Health Organization (WHO) recommended that HbA1c could also be used to help diagnose type 2 diabetes in people who aren't known to have the condition.

An HbA1c level of 6.5% (48mmol/mol) or above indicates type 2 diabetes. Although there's no fixed point to indicate when someone haspre-diabetes, a UK expert group has recommended that an HbA1c level of 6-6.4% (42-47 mmol/mol) would indicate that a person has a high risk of developing diabetes.

Y

 Glucose tolerance test (GTT) 

A glucose tolerance test (GTT), sometimes known as an oral glucose tolerance test (OGTT), can show if your body is having problems processing glucose.

Before having the test, you'll be asked not to eat or drink certain fluids for 8-12 hours. You may also need to avoid taking certain medications before the test, as they may affect the results. 

A blood sample will be taken before the test and your blood glucose will be measured. You'll then be given a sweet glucose drink.

After drinking the glucose drink, your blood glucose will be measured again after two hours. As you will have a long time to wait between blood tests, you may want to take something to read or listen to.

 Test results 

The results of the GTT will show whether you have impaired glucose tolerance (IGT) or diabetes. This will be based on the amount of glucose in your blood both before and after drinking the glucose drink.

Blood glucose is measured in millimoles per litre, often written as mmol/l.

For someone without diabetes, the amount of glucose in their blood should be:



less than 6 mmol/l before the test



less than 7.8 mmol/l two hours after the test



If you have IGT, the amount of glucose in your blood will be:



6-7 mmol/l before the test



7.9-11 mmol/l two hours after the test



If you have diabetes, the amount of glucose in your blood will be:



more than 7 mmol/l before the test



more than 11 mmol/l two hours after the test



If your test results indicate you have IGT, you may be advised to make lifestyle changes, such as eating more healthily and taking moreexercise. Medication to lower your blood glucose level may also be recommended.

If your results indicate that you have diabetes, it is likely that medication will be prescribed. This will lower your blood glucose level and help keep it under control.



The aim of treating diabetes is to help people with the condition control their blood glucose levels and minimise the risk of developing future complications.

The diabetes national service framework was developed by diabetes clinical experts and diabetes patients. Good diabetes care includes:



awareness of the risk factors for type 2 diabetes



advice and support to help people at risk of type 2 diabetes reduce that risk



access to information and appropriate support for people withtype 1 diabetes and type 2 diabetes, including access to a structured education programme, such as the Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) or X-PERT Health



an agreed care plan to help all people with diabetes to manage their care and lead a healthy lifestyle, including a named contact for their care



information, care and support to enable all people with diabetes to optimise their blood glucose level, maintain an acceptable blood pressure and minimise other risk factors for developing complications



access to services to identify and treat possible complications, such as screening for diabetic retinopathy and specialised foot care



effective care for all people with diabetes admitted to hospital, for whatever reason



 


 Treating  type 2 diabetes  

There's no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms, to prevent health problems developing later in life.

If you've been diagnosed with diabetes, your GP will be able to explain your condition in detail and help you to understand your treatment.

They will also closely monitor your condition to identify any health problems that may occur. If there are any problems, you may be referred to a hospital-based diabetes care team.

Making lifestyle changes

If you're diagnosed with type 2 diabetes, you'll need to look after your health very carefully for the rest of your life.

This may seem daunting, but your diabetes care team will be able to give you support and advice about all aspects of your treatment.

After being diagnosed with type 2 diabetes, or if you're at risk of developing the condition, the first step is to look at your diet and lifestyle, and make any necessary changes.

Three major areas that you'll need to look closely at are your:



diet



weight



level of physical activity



By eating healthily, losing weight (if you're overweight) and exercising regularly you may be able to keep your blood glucose at a safe and healthy level without the need for other types of treatment.

Diet

Increasing the amount of fibre in your diet and reducing your fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it. You should:



increase your consumption of high fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables



choose foods that are low in fat – replace butter, ghee and coconut oil with low fat spreads and vegetable oil



choose skimmed and semi-skimmed milk, and low fat yoghurts



eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers



grill, bake, poach or steam food instead of frying or roasting it



avoid high fat foods, such as mayonnaise, chips, crisps, pasties, poppadums and samosas



eat fruit, unsalted nuts and low fat yoghurts as snacks instead of cakes, biscuits, bombay mix or crisps



The Diabetes UK website has more information and advice abouthealthy eating.

Weight

If you're overweight or obese (you have a body mass index (BMI) of 30 or over), you should lose weight, by gradually by reducing your calorie intake and becoming more physically active (see below).

Losing 5-10% of your overall body weight over the course of a year is a realistic initial target. You should aim to continue to lose weight until you've achieved and maintained a BMI within the healthy range, which is:



18.5-24.9kg/m² for the general population



18.5-22.9kg/m² for people of South Asian or Chinese origin



If you have a BMI of 30kg/m2 or more (27.5kg/m2 or more for people of South Asian or Chinese origin), you need a structured weight loss programme, which should form part of an intensive lifestyle change programme.

To help you achieve changes in your behaviour, you may be referred to a dietitician or a similar healthcare professional for a personal assessment and tailored advice about diet and physical activity.

Physical activity

Being physically active is very important in preventing or managing type 2 diabetes.

For adults who are 19-64 years of age, the government recommends aminimum of:



150 minutes (2 hours and 30 minutes) of "moderate-intensity" aerobic activity, such as cycling or fast walking, a week, which can be taken in sessions of 10 minutes or more, and



muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, tummy (abdomen), chest, shoulders and arms).



An alternative recommendation is to do a minimum of:



75 minutes of "vigorous-intensity" aerobic activity, such asrunning or a game of tennis every week, and



muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms).



In cases where the above activity levels are unrealistic, even small increases in physical activity will be beneficial to your health and act as a basis for future improvements.

Reduce the amount of time spent watching television or sitting in front of a computer. Going for a daily walk – for example, during your lunch break – is a good way of introducing regular physical activity into your schedule.

If you're overweight or obese (see above), you may need to be more physically active to help you lose weight and maintain weight loss.

Your GP, diabetes care team or dietician can give you more information and advice about losing weight and becoming more physically active.

The Diabetes UK website has more information and advice aboutgetting active and staying active.


Medicines for type 2 diabetes 

 



Type 2 diabetes usually gets worse over time. Making lifestyle changes, such as adjusting your diet and taking more exercise, may help you control your blood glucose levels at first, but they not be enough in the long term.

You may eventually need to take medication to help control your blood glucose levels. Initially, this will usually be in the form of tablets, and can sometimes be a combination of more than one type of tablet. It may also include insulin or other medication that you inject.

Metformin

Metformin is usually the first medicine that's used to treat type 2 diabetes. It works by reducing the amount of glucose that your liver releases into your bloodstream. It also makes your body's cells more responsive to insulin.

Metformin is recommended for adults with a high risk of developing type 2 diabetes, whose blood glucose is still progressing towards type 2 diabetes, despite making necessary lifestyle changes.

If you're overweight, it's also likely you'll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldn't cause additional weight gain.

However, it can sometimes cause mild side effects, such as nausea and diarrhoea, and you may not be able to take it if you have kidney damage.

Sulphonylureas

Sulphonylureas increase the amount of insulin that's produced by your pancreas. Examples of sulphonylureas include:



glibenclamide



gliclazide



glimepiride



glipizide



gliquidone



You may be prescribed one of these medicines if you can't take metformin, or if you aren't overweight. Alternatively, you may be prescribed sulphonylurea and metformin if metformin doesn't control blood glucose on its own.

Sulphonylureas can increase the risk of hypoglycaemia (low blood sugar), because they increase the amount of insulin in your body. They can also sometimes cause side effects including weight gain, nausea and diarrhoea.

Glitazones (thiazolidinediones, TZDs)

Thiazolidinedione medicines (pioglitazone) make your body’s cells more sensitive to insulin so that more glucose is taken from your blood.

They're usually used in combination with metformin or sulphonylureas, or both. They may cause weight gain and ankle swelling (oedema). You shouldn't take pioglitazone if you haveheart failure or a high risk of bone fracture.

Another thiazolidinedione, rosiglitazone, was withdrawn from use in 2010 due to an increased risk of cardiovascular disorders, including heart attack and heart failure.

Gliptins (DPP-4 inhibitors)

Gliptins work by preventing the breakdown of a naturally occurring hormone called GLP-1. GLP-1 helps the body produce insulin in response to high blood glucose levels, but is rapidly broken down.

By preventing this breakdown, the gliptins (linagliptin, saxagliptin, sitagliptin and vildagliptin) prevent high blood glucose levels, but don't result in episodes of hypoglycaemia.

You may be prescribed a gliptin if you're unable to take sulphonylureas or glitazones, or in combination with them. They're not associated with weight gain.

GLP-1 agonists

Exenatide is a GLP-1 agonist, an injectable treatment that acts in a similar way to the natural hormone GLP-1 (see the section on gliptins, above).

It's injected twice a day and boosts insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes ("hypos").

It also leads to modest weight loss in many people who take it. It's mainly used in people on metformin plus sulphonylurea, who are obese. A once-weekly product has also been introduced.

Another GLP-1 agonist called liraglutide is a once-daily injection (exenatide is given twice a day). Like exenatide, liraglutide is mainly used for people on metformin plus sulphonylurea, who are obese, and in clinical trials it's been shown to cause modest weight loss.

Acarbose

Acarbose helps prevent your blood glucose level from increasing too much after you eat a meal. It slows down the rate at which your digestive system breaks carbohydrates down into glucose.

Acarbose isn't often used to treat type 2 diabetes because it usually causes side effects, such as bloating and diarrhoea. However, it may be prescribed if you can't take other types of medicine for type 2 diabetes.

Nateglinide and repaglinide

Nateglinide and repaglinide stimulate the release of insulin by your pancreas. They're not commonly used, but may be an option if you have meals at irregular times. This is because their effects don't last very long, but they're effective when taken just before you eat.

Nateglinide and repaglinide can cause side effects, such as weight gain and hypoglycaemia (low blood sugar).





Insulin treatment 

 



If glucose-lowering tablets aren't effective in controlling your blood glucose levels, you may need to have insulin treatment. This can be taken instead of or alongside your tablets, depending on the dose and the way that you take it.

Insulin comes in several different preparations, and each works slightly differently. For example, some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but don't last very long (rapid-acting).

Your treatment may include a combination of these different insulin preparations.

Insulin injections

Insulin must be injected because if it were taken as a tablet, it would be broken down in your stomach like food and unable to enter your bloodstream.

If you need to inject insulin, your diabetes care team will advise you about when you need to do it. They will show you how to inject it yourself and will also give you advice about storing your insulin and disposing of your needles properly.

Insulin injections are given using either a syringe or an injection pen, which is also called an insulin pen (auto-injector). Most people need between two and four injections of insulin a day.

Your GP or diabetes nurse will also teach a relative or a close friend how to inject the insulin properly.





Treatment for low blood sugar (hypoglycaemia) 

 



If you have type 2 diabetes that's controlled using insulin or certain types of tablets, you may experience episodes of hypoglycaemia.

Hypoglycaemia is where your blood glucose levels become very low. Mild hypoglycaemia (a "hypo") can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary.

If you have a hypo, you should initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets. This should be followed by a longer-acting carbohydrate, such as a cereal bar, sandwich or piece of fruit. In most cases, these measures will be enough to raise your blood glucose level to normal, although it may take a few hours.

If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness. If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein. Glucagon is a hormone that quickly increases your blood glucose levels.

Your diabetes care team can advise you on how to avoid a hypo and what to do if you have one.





Other treatments 

 



If you have type 2 diabetes, your risk of developing heart disease,stroke and kidney disease is increased.

To reduce your risk of developing other serious health conditions, you may be advised to take other medicines, including:



anti-hypertensive medicines to control high blood pressure



a statin, such as simvastatin or atorvastatin, to reduce high cholesterol



low-dose aspirin to prevent a stroke



an angiotensin-converting enzyme (ACE) inhibitor, such as enalapril, lisinopril or ramipril, if you have the early signs of diabetic kidney disease



Diabetic kidney disease is identified by the presence of small amounts of albumin (a protein) in your urine. If treated early enough, it may be reversible.





Monitoring blood glucose levels 

 



If you have type 2 diabetes, your GP or diabetes care team will need to take a reading of your blood glucose level about every two to six months. This will show how stable your glucose levels have been in the recent past and how well your treatment plan is working.

The HbA1c test is used to measure blood glucose levels over the previous two to three months. HbA1c is a form of haemoglobin, the chemical that carries oxygen in red blood cells, which also has glucose attached to it.

A high HbA1c level means that your blood glucose level has been consistently high over recent weeks, and your diabetes treatment plan may need to be changed.

Your diabetes care team can help you set a target HbA1c level to aim for. This will usually be less than 59mmol/mol (7.5%). However, it can be as low as 48mmol/mol (6.5%) for some people.

 

Monitoring your own blood glucose

If you have type 2 diabetes, as well as having your blood glucose level checked by a healthcare professional every two to six months, you may be advised to monitor your own blood glucose levels at home.

Even if you have a healthy diet and are taking tablets or using insulin therapy, exercise, illness and stress can affect your blood glucose levels. Other factors that may affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, hormonal changes during the menstrual cycle.

A blood glucose meter is a small device that measures the concentration of glucose in your blood. It can be useful in detectinghigh blood sugar (hyperglycaemia) or low blood sugar (hypoglycaemia).

If blood glucose monitoring is recommended, you should be trained in how to use a blood glucose meter and what you should do if the reading is too high or too low.

Diabetes UK also provides further information about the availability of blood glucose test strips (PDF, 195kb).

Regularly monitoring your blood glucose levels will ensure that your blood glucose is as normal and stable as possible. As your blood glucose level is likely to vary throughout the day, you may need to check it several times a day, depending on the treatment you're taking.

In home testing, blood glucose levels are usually measured by how many millimoles of glucose are in a litre of blood. A millimole is a measurement used to define the concentration of glucose in your blood. The measurement is expressed as millimoles per litre, or mmol/l for short.

A normal blood glucose level is 4-6 mmol/l before meals (preprandial) and less than 10 mmol/l two hours after meals (postprandial), although this can vary from person to person. Your diabetes care team can discuss your blood glucose level with you in more detail.







Care standards for diabetes 

 



The aim of treating diabetes is to help people with the condition control their blood glucose levels and minimise the risk of developing future complications.

The diabetes national service framework was developed by diabetes clinical experts and diabetes patients. Good diabetes care includes:



awareness of the risk factors for type 2 diabetes



advice and support to help people at risk of type 2 diabetes reduce that risk



access to information and appropriate support for people withtype 1 diabetes and type 2 diabetes, including access to a structured education programme, such as the Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) or X-PERT Health



an agreed care plan to help all people with diabetes to manage their care and lead a healthy lifestyle, including a named contact for their care



information, care and support to enable all people with diabetes to optimise their blood glucose level, maintain an acceptable blood pressure and minimise other risk factors for developing complications



access to services to identify and treat possible complications, such as screening for diabetic retinopathy and specialised foot care



effective care for all people with diabetes admitted to hospital, for whatever reason



Complications caused by diabetes 

If diabetes isn't treated, it can lead to a number of other health problems.

High glucose levels can damage blood vessels, nerves and organs.

Even a mildly raised glucose level that doesn't cause any symptoms can have long-term damaging effects.

Heart disease and stroke

If you have diabetes, you're up to five times more likely to develop heart disease or have a stroke.

Prolonged, poorly controlled blood glucose levels increase the likelihood of atherosclerosis (where the blood vessels become clogged up and narrowed by fatty substances).

This may result in poor blood supply to your heart, causing angina (a dull, heavy or tight pain in the chest). It also increases the chance that a blood vessel in your heart or brain will become blocked, leading to a heart attack or stroke.

Nerve damage

High blood glucose levels can damage the tiny blood vessels in your nerves. This can cause a tingling or burning pain that spreads from your fingers and toes up through your limbs. It can also cause numbness, which can lead to ulceration of the feet.

Damage to the peripheral nervous system, which includes all parts of the nervous system that lie outside the central nervous system, is known as peripheral neuropathy.

If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation.

Diabetic retinopathy

Diabetic retinopathy is when the retina (the light-sensitive layer of tissue at the back of the eye) becomes damaged. Blood vessels in the retina can become blocked or leaky or can grow haphazardly. This prevents light from fully passing through to your retina. If it isn't treated, it can damage your vision.

Annual eye checks are usually organised by a regional photographic unit. If significant damage is detected, you may be referred to an ophthalmologist (a doctor who specialises in treating eye conditions).

The better you control your blood glucose levels, the lower your risk of developing serious eye problems.

Diabetic retinopathy can be managed using laser treatment if it's caught early enough. However, this will only preserve the sight you have rather than improve it.

Kidney disease

If the small blood vessels of your kidney become blocked and leaky, your kidneys will work less efficiently. It's usually associated with high blood pressure, and treating this is a key part of management.

In rare, severe cases, kidney disease can lead to kidney failure, and a kidney replacement treatment with dialysis, or sometimes kidney transplantation, will be necessary.

Foot problems

Damage to the nerves of the foot can mean small nicks and cuts aren't noticed, and this, in combination with poor circulation, can lead to a foot ulcer.

About 1 in 10 people with diabetes get a foot ulcer, which can cause a serious infection.

If you have diabetes, look out for sores and cuts that don't heal, puffiness or swelling, and skin that feels hot to the touch. You should also have your feet examined at least once a year.

If poor circulation or nerve damage is detected, check your feet every day and report any changes to your doctor, nurse or podiatrist (foot care specialist).

Sexual dysfunction

In men with diabetes, particularly those who smoke, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication.

Women with diabetes may experience:



a reduced sex drive (loss of libido)



less pleasure from sex



vaginal dryness



less ability to orgasm



pain during sex



If you experience a lack of vaginal lubrication, or you find sex painful, you can use a vaginal lubricant or a water-based gel.

Miscarriage and stillbirth

Pregnant women with diabetes have an increased risk of miscarriageand stillbirth. If your blood glucose level isn't carefully controlled during the early stages of pregnancy, there's also an increased risk of the baby developing a birth defect.

Pregnant women with diabetes will usually have their antenatal check-ups in hospital or a diabetic clinic, ideally with an obstetrician (a doctor who specialises in pregnancy care).

This will allow your care team to keep a close eye on your blood glucose levels and control your insulin dosage more easily, as well as monitoring the growth and development of your baby.

The Diabetes UK website has more information about diabetes complications.

 


Looking after your eyes with diabetes

Everyone who is on a diabetes register will be given the opportunity to have a digital picture taken of the back of their eye. Speak to your GP to register.

Type 2 diabetes - looking after yourself 

If you have type 2 diabetes, you'll need to look after your health very carefully.

Caring for your health will make treating your diabetes easier and minimise your risk of developing complications of diabetes.

Self care

Self care is an integral part of daily life. It means you take responsibility for your own health and wellbeing, with support from those involved in your care.

Self care includes things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions.

People living with long-term conditions can benefit enormously if they receive self care support. They can live longer, experience less pain,anxiety, depression and fatigue, have a better quality of life and be more active and independent.

Regular reviews

As type 2 diabetes is a long-term condition, you'll be in regular contact with your diabetes care team. Developing a good relationship with the team will enable you to freely discuss your symptoms or any concerns you have.

The more the team knows, the more they can help you. Your GP or diabetes care team will also need to check your eyes, feet and nerves regularly, because they can also be affected by diabetes.

HbA1c test

You should be tested regularly (at least once a year) to check how well your diabetes is being controlled over the long term.

A blood sample will be taken from your arm and a test known as the HbA1c test carried out. It measures how much glucose is in the red blood cells, and gives your blood glucose levels for the previous two to three months.

The HbA1c target for most people with diabetes is below 48 mmol/mol. There's evidence that this level can reduce the risk of complications, such as nerve damage, eye disease, kidney disease and heart disease.

An HbA1c of less than 58 mmol/mol is recommended for those at risk of severe hypoglycaemia (an abnormally low blood glucose level).

The Diabetes UK website has more information about the HbA1c test.

Healthy eating

Eating a healthy, balanced diet is very important if you have diabetes. However, you don't need to avoid certain food groups altogether.

As long as you eat regularly and make healthy choices, you can have a varied diet and enjoy a wide range of foods.

You can make adaptations when cooking meals, such as reducing the amount of fat, salt and sugar, and increasing the amount of fibre.

You don't need to completely exclude sugary and high fat foods from your diet, but they should be limited. It's possible to achieve good blood glucose control by including sugary foods in your diet.

The important thing in managing diabetes through your diet is to eat regularly and include starchy carbohydrates, such as pasta, as well as plenty of fruit and vegetables. If your diet is well balanced, you should be able to achieve a good level of health and maintain a healthy weight.

Regular exercise

As physical activity lowers your blood glucose level, it's very important to exercise regularly if you have diabetes.

Like anyone else, you should aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cyclingor fast walking, every week.

However, before starting a new activity, speak to your GP or diabetes care team first. As exercise will affect your blood glucose level, your care team may have to adjust your insulin treatment or diet to keep your blood glucose level steady.

Don't smoke

If you have diabetes, your risk of developing a cardiovascular disease, such as a heart attack or stroke, is increased.

As well as increasing this risk further, smoking also increases your risk of many other serious smoking-related conditions, such as lung cancer.

If you want to give up smoking, your GP can provide you with advice, support and treatment to help you quit.

Limit alcohol

If you have diabetes and decide to drink alcohol, avoid drinking more than the recommended daily amounts (see below), and never drink alcohol on an empty stomach.

Depending on the amount you drink, alcohol can cause either high or low blood glucose levels (hyperglycaemia or hypoglycaemia).

Drinking alcohol may also affect your ability to carry out insulin treatment or blood glucose monitoring, so always be careful not to drink too much.

The recommended daily alcohol limits are:



3-4 units for men



2-3 units for women



Keeping well

People with long-term conditions, such as type 2 diabetes, are encouraged to get a flu jab each autumn to protect against flu (influenza).

A pneumoccocal vaccination, which protects against a serious chest infection called pneumococcal pneumonia, is also recommended.


Look after your feet 

 



If you have diabetes, you're at greater risk of developing problems with your feet, including foot ulcers and infections from minor cuts and grazes.

This is because diabetes is associated with poor blood circulation in the feet, and blood glucose can damage the nerves.

To prevent problems with your feet, keep your nails short and wash your feet daily using warm water. Wear shoes that fit properly, and see a podiatrist or chiropodist (foot care specialist) regularly so that any problems can be detected early.

Regularly check your feet for cuts, blisters or grazes because you may not be able to feel them if the nerves in your feet are damaged. See your GP if you have a minor foot injury that doesn't start to heal within a few days.





Regular eye tests 

 



If you have type 2 diabetes, you should be invited to have your eyes screened once a year to check for diabetic retinopathy.

Diabetic retinopathy is an eye condition where the small blood vessels in your eye become damaged. It can occur if your blood glucose level is too high for a long period of time (hyperglycaemia). If left untreated, retinopathy can eventually lead to sight loss.





Pregnancy  

 



If you have diabetes and you're thinking about having a baby, it's a good idea to discuss this with your diabetes care team.

Planning your pregnancy means you can ensure your blood glucose levels are as well controlled as they can be before you get pregnant.

You'll need to tightly control your blood glucose level, particularly before becoming pregnant and during the first eight weeks of your baby's development to reduce the risk of birth defects. You should also:



check your medications – some tablets used to treat type 2 diabetes may harm your baby, so you may have to switch to insulin injections 



take a higher dose of folic acid tablets – folic acid helps prevent your baby from developing spinal cord problems; it's now recommended that all women planning to have a baby take folic acid; women with diabetes are advised to take 5mg each day (only available on prescription)



have your eyes checked – retinopathy, which affects the blood vessels in the eyes, is a risk for all people with diabetes; as pregnancy can place extra pressure on the small vessels in your eyes, it's important to treat retinopathy before you become pregnant



Your GP or diabetes care team can give you further advice.

Diabetes UK also has more information about pregnancy and diabetes





Get educated 

 



You'll be best equipped to manage your diabetes day-to-day if you're given information and education when you're diagnosed and on an ongoing basis.

The National Institute for Health and Care Excellence (NICE)recommends that all people who have diabetes should be offered a structured patient education programme, providing information and education to help them care for themselves.

Structured patient education

Structured patient education means there's a planned course that:



covers all aspects of diabetes



is flexible in content



is relevant to a person’s clinical and psychological needs



is adaptable to a person’s educational and cultural background



For type 2 diabetes, there's a national patient education programme that meets all the key criteria for structured education. It's called the Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND).

There are also several local adult education programmes, many of which are working towards the criteria for structured education. Ask your diabetes care team about the adult education programmes they provide.





Talk to others 

 



Many people find it helpful to talk to others in a similar position, and you may find support from a group for people with diabetes. Patient organisations have local groups where you can meet others diagnosed with the condition.

To find your local diabetes support group, visit the Diabetes UKwebsite.

If you want to get in touch with a trained counsellor directly, you can call the Diabetes UK’s care line on 0345 123 2399 (Monday to Friday, 9am-7pm), or email careline@diabetes.org.uk.







Financial support and benefits  

 



People with diabetes controlled by medication are entitled to free prescriptions and eye examinations.

Some people with diabetes may also be eligible for disability and incapacity benefits, depending on the impact that the condition has on their lives.

The main groups likely to qualify for welfare benefits are children, the elderly, those with learning disabilities or mental health problems, and those with diabetes complications.

People over the age of 65 who are severely disabled may qualify for a type of disability benefit called Attendance Allowance.

Carers may also be entitled to some benefit, depending on their involvement in caring for the person with diabetes.

Your local Citizen’s Advice Bureau (CAB) can check whether you're getting all the benefits you're entitled to. They, as well as your diabetes specialist nurse, should also provide advice about filling in the forms.