Type 2 diabetes

Next review due January 2024

Type 2 diabetes is a long-term condition in which your body can’t control the amount of glucose (sugar) in your blood. If you have type 2 diabetes, your body doesn’t respond properly to a hormone called insulin. Or it may be that your body is not able to produce enough insulin. In either case, the result is that your blood glucose level becomes too high.

About type 2 diabetes

There are two main types of diabetes:  and type 2. Type 2 diabetes is the most common – more than nine out of 10 people diagnosed with diabetes have this type.Type 2 diabetes is more common the older you get. But you can develop it at any age, and it’s becoming more common in young adults and children.

If you have type 2 diabetes, your body stops responding properly to insulin, and you may not be able to produce enough.Insulin controls the amount of glucose in your blood.It helps glucose move from your blood into your body tissues – for example, your muscle cells – when you need energy.If your body isn’t responding to insulin properly, your blood glucose level can become too high.

Causes of type 2 diabetes

There are a number of things that can increase your risk of developing type 2 diabetes. These include:

• being overweight or obese – this is the main risk factor for type 2 diabetes
• having a close family member with the condition
• being of African, African – Caribbean or South-Asian ethnicity
• getting older – your risk increases with age
• not being very active
• having  or
• smoking
• if you’re a woman, having
• for women, having previously developed diabetes during pregnancy (gestational diabetes)

Symptoms of type 2 diabetes

If you have type 2 diabetes, you may not have any obvious symptoms.Your diabetes may only be discovered during a routine medical check-up with your Doctor.

If you do develop symptoms of type 2 diabetes, 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 genitals – for example, thrush – or urinary tract infections such as cystitis
• get tingling in your hands or feet

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

Diagnosis of type 2 diabetes

Your Doctor will ask about your symptoms and examine you. If your Doctor thinks you could have diabetes, they’ll ask you to have a blood test to check your blood glucose 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.

Sometimes your doctor you may tell you that you’re at high risk of developing diabetes (this is also known as ‘prediabetes’).It means that your glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes.It’s a warning sign, but there are things you may be able to do to prevent or delay type 2 diabetes from developing.See our section on prevention of diabetes for more information.

Management of type 2 diabetes

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

Your Doctor  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 yourself to help control your blood glucose level. These include making some changes to your diet, losing weight if necessary and being more physically active.Your nurse or dietician will be able to talk you through this.For some people, these changes may be enough to keep their diabetes under control at first.

Diet

You don’t need to follow a special diet for diabetes, and it’s not recommended that you choose foods specifically marketed for people with diabetes.It’s more important to follow a normal, . This means opting for wholegrain versions of starchy foods like pasta and bread, including plenty of fruit and vegetables, and reducing your intake of saturated fat.

Following a low-carbohydrate (low-carb) diet can be an option for some people with type 2 diabetes.This can be an effective way for some people to lose weight and manage their glucose levels.But it may not be suitable for everyone, so it’s best to talk to a dietician before trying it.

The glycaemic index (GI) is a measure of how quickly foods are digested and increase your blood glucose level. Foods with a low GI raise your glucose level slowly. There’s good evidence that foods with a low GI can help to control blood glucose levels if you have type 2 diabetes.It’s more important to make sure you’re controlling the amount of carbohydrate you eat in diabetes.But if you can incorporate some healthy low GI alternatives into some of your meals and snacks, this might help too.For instance, you could eat wholegrain bread instead of white bread, and basmati rice instead of ordinary white rice.

Here’s a list of healthy food swaps for a lower GI diet that you can incorporate into your diet plan.

You can click on the image to open a larger version of ‘Bupa’s Healthy food swaps for a lower GI  ’ infographic.

If you’re overweight, your Doctor is likely to recommend you lose weight and help you set a target weight to work towards.They may refer you to a dietician, who can advise on weight management as well as keeping your blood glucose level under control.

Exercise

Regular exercise can help to lower your blood glucose level.It can also help you to stay a healthy weight and reduce your risk of cardiovascular disease (diseases affecting your heart and blood vessels).When you’re just  with exercise, any amount is beneficial – even just spending less time being sedentary (sitting) as a first step.But to get the full , try to aim for:

• 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 or
• smaller amounts of activities of very vigorous intensity

Your doctor, nurse or dietician can advise you if there are any adjustments you need to make to your medications or diet when you’re exercising.

Medicines

Your doctor may recommend you try medicines if lifestyle changes alone don’t keep your blood glucose level under control. 

They will usually begin by offering you a medicine called metformin.If metformin doesn’t help you manage your blood glucose level or you get bad side-effects, your doctor can prescribe other medicines instead.There are lots of different medicines available for diabetes. Some of the main ones include sulfonylureas, pioglitazone and DPP-4 inhibitors (gliptins).Sometimes you’ll need to take more than one of these medicines at a time.

You’ll usually only need to start treatment with insulin if lifestyle changes and medicines can’t keep your blood glucose level under control.You have insulin as injections under your skin, usually several times a day.You’ll also need to monitor your blood glucose level with a glucose meter at home if you have insulin.

Complications of type 2 diabetes

You may develop complications with diabetes if your blood glucose level becomes either too high (hyperglycaemia) or too low (hypoglycaemia). 

Hyperglycaemia

Your blood glucose level doesn’t usually become high enough with type 2 diabetes to cause noticeable symptoms.But if your blood glucose continues to rise, you may find that you’re thirstier than usual, need to pee more often and feel extremely tired.

Very rarely, your blood glucose can rise to a dangerously high level.This is a medical emergency, so it’s always important to be aware of signs of hyperglycaemia developing.

Over time, if your blood glucose isn’t controlled properly and stays too high, it can lead to a number of problems. These include:

• kidney disease
• nerve damage, which can cause tingling, burning sensations or loss of feeling
• damage to your eyes, which can lead to loss of vision
• heart disease and stroke
• foot ulcers
• persistent or regular infections, especially skin and urine infections

Hypoglycaemia

Hypoglycaemia (also known as a ‘hypo’), is when your blood glucose level becomes too low. It is a possible complication of some treatments for diabetes – including insulin and sulfonylureas.You’re more likely to develop hypoglycaemia if you are on these treatments and miss a meal or misjudge the amount of carbohydrate you need.It can also happen if you drink too much alcohol or are more active than usual.

Most people get warning signs when their glucose level begins to fall. These include: 

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

If your blood glucose level continues to fall, you may start to feel 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

Following a healthy a lifestyle can help to control your glucose level and reduce your risk of developing complications. Here are some key points. 

• Eat a and take regular exercise, as recommended by your doctor or diabetes specialist nurse. As well as helping to control your blood glucose level, this is also important for maintaining a and reducing your risk of cardiovascular disease.
• If you smoke, try to stop. Smoking is unhealthy for everyone, but it's particularly bad if you have diabetes.Diabetes increases your risk of developing circulatory problems, heart disease and stroke. Your risk of these conditions is even higher if you smoke and have diabetes.
• If you drink alcohol, stick within  of no more than 14 units a week, spread over several days.If you take certain drugs for diabetes, alcohol can increase the risk of hypoglycaemia.

You should be offered check-ups every six months to a year, to screen for complications and make sure that your blood glucose level is under control.This will involve blood tests for glycosylated haemoglobin (HbA1C), which is a measure of how well controlled your blood glucose level is.

You should also be offered annual screening tests for eye conditions, foot problems and kidney disease, as well as cholesterol tests and blood pressure checks.This will help to diagnose any complications early so that they can be treated.