Diabetes, type 2
Introduction
Diabetes is a long-term (chronic) condition caused by too much glucose, a type of sugar, in the blood. It is also sometimes known as diabetes mellitus.
Diabetes affects 2.8 million people in the UK. It is thought that a further one million people have the condition but are not aware of it.
How does diabetes occur?
Normally, the amount of sugar in the blood is controlled by a hormone called insulin. Insulin is produced by the pancreas, a gland located behind the stomach. When food is digested and enters the bloodstream, insulin helps move any glucose out of the blood and into cells, where it is broken down to produce energy.
In people with diabetes, the body is unable to break down glucose into energy. This is because there is either not enough insulin to move the glucose, or because the insulin that is there does not work properly.
There are two types of diabetes: type 1 diabetes and type 2 diabetes. This article focuses on type 2 diabetes.
What is type 2 diabetes?
Type 2 diabetes occurs when not enough insulin is produced by the body for it to function properly, or when the body’s cells do not react to insulin. This is called insulin resistance.
Type 2 diabetes is far more common than type 1 diabetes, which occurs when the body does not produce any insulin at all. Around 90% of all adults in the UK have type 2 diabetes.
If you have type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet and monitoring your blood glucose level. However, as type 2 diabetes is a progressive condition, you may eventually need to take insulin medication, usually in the form of tablets.
Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it is more common in older people.
Update on rosiglitazone (Avandia, Avandamet) – September 24 2010
The European Medicines Agency has recommended that rosiglitazone (Avandia, Avandamet) should be withdrawn from use. A review has concluded that the risks associated with the drug outweigh the benefits. These risks include an increased risk of cardiovascular disorders, including heart attack and heart failure.
The medicine will be withdrawn gradually from the market over the next two months.
If you are currently taking rosiglitazone, you should continue to take the medicine as prescribed. You should also make an appointment to see your healthcare team to discuss alternative medication.
Diabetes in pregnancy (gestational diabetes)
During pregnancy, some women have such high levels of glucose in their blood that their body cannot produce enough insulin to absorb it all. This is known as gestational diabetes. It affects approximately 5% of pregnant women.
Pregnancy can also sometimes make existing type 2 diabetes more difficult to control. If you are pregnant, you may require additional time and effort to manage your diabetes during your pregnancy.
Gestational diabetes can increase the risk of health problems developing in an unborn baby, so it is important that you keep the glucose levels in your blood under control.
In most cases, gestational diabetes disappears after the baby is born. However, women with the condition have an estimated 30% risk of developing type 2 diabetes later on in life.
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Symptoms
Many people have type 2 diabetes for years without knowing it because early symptoms can be general.
It is important to get medical advice if you think you have signs of diabetes. Early diagnosis and treatment can reduce your risk of developing complications later.
The main symptoms of diabetes are:
- feeling very thirsty
- going to the toilet a lot, especially at night
- extreme tiredness
- weight loss and loss of muscle bulk
Other symptoms of diabetes can include:
- itchiness around the vagina or penis
- recurring thrush as a result of the excess glucose in your urine
- blurred vision caused by the lenses of your eyes becoming very dry
- cuts and sores taking longer to heal
Not everyone will experience these other symptoms, and they are not usually severe in those who do get them.
Symptoms of Hyperglycaemia (high blood glucose)
Type 2 diabetes occurs because your body is unable to produce enough insulin or because the cells in your body do not respond properly to insulin.
This means that insulin cannot regulate your blood glucose level and, as a result, your blood glucose levels may become very high. This happens because there is no insulin to move glucose out of your bloodstream and into your cells to produce energy.
If your blood glucose levels become too high, you may experience hyperglycaemia. The symptoms of hyperglycaemia are similar to the main symptoms of diabetes, but they may be more severe and come on suddenly. They include:
- extreme thirst
- a dry mouth
- blurred vision
- drowsiness
- a frequent need to pass urine
Hyperglycaemia can occur for several reasons including:
- eating too much
- being unwell
- not taking enough insulin
If it is not treated, hyperglycaemia can lead to diabetic ketoacidosis, which can eventually cause unconsciousness and even death.
Diabetic ketoacidosis occurs when your body begins to break down fats for energy, instead of glucose, leading to a build up of acids in your blood. However, diabetic ketoacidosis is a rare complication of diabetes.
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Causes
Insulin is a hormone that is needed to control the amount of glucose, a type of sugar, in your blood. When you eat, your digestive system breaks down your food to release the nutrients from it. These nutrients, including glucose, enter your bloodstream. Normally, insulin is produced by your pancreas to move the glucose from your blood into your cells, where it is broken down to produce energy.
Type 2 diabetes occurs because your body cannot produce enough insulin or because the cells in your body do not react properly to insulin.
Risk factors for type 2 diabetes
The exact cause of type 2 diabetes is not fully understood, although there are many factors that make developing the condition more likely. You are more likely to develop type 2 diabetes if:
- You have a relative with type 2 diabetes.
- You are of South Asian, African-Caribbean or Middle Eastern descent.
- You are overweight or obese.
- You are over 40.
Genetic factors
You are more likely to get type 2 diabetes if you have a close relative, such as a parent, brother or sister, who has it. The closer the relative, the greater the risk.
Ethnic origin
People of South Asian, African, African-Caribbean and Middle Eastern descent 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 three times more common among people of African and African-Caribbean origin.
People of African-Caribbean or South Asian origin are also more likely to develop complications of diabetes, such as heart disease, at a younger age than the rest of the population.
Being overweight or obese
If you are overweight or obese, you are at greater risk of developing type 2 diabetes. Fat around your abdomen (belly), sometimes called active fat, puts you at greater risk of type 2 diabetes than fat elsewhere. This is because it releases chemicals that can upset the cardiovascular and metabolic systems of the body. This can put you at higher risk of a number of conditions including heart disease, stroke and some cancers.
A quick way to assess your diabetes risk is to measure your waist. This is a measure of abdominal obesity, a particularly high-risk form of obesity. When you have excess weight around your middle, you are at high risk of developing diabetes.
Women are thought to be at a higher risk of developing type 2 diabetes if they have a waist size of 31.5 inches (80cm) or over. Men are thought to be at a higher risk if they are Asian and their waist is 35 inches (90cm) or over, or if they are white or black with a waist size of 37 inches (94cm) or over.
If you lose about 5% of your body weight and take regular exercise, you could reduce your risk of getting diabetes by over 50%.
Age
Your risk of developing type 2 diabetes also increases as you get older. This may be because people usually gain weight and exercise less as they get older.
You are considered to be at risk of developing type 2 diabetes if you are over 40 years of age and white, or over 25 years of age and black, Asian or from a minority ethnic group. However, some children as young as seven are now being diagnosed with type 2 diabetes.
Other factors
You also have an increased risk of developing type 2 diabetes if you have either impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT). These conditions are sometimes also known as pre-diabetes and mean that your blood glucose level is higher than usual, but not high enough to cause diabetes. IFG and IGT can both progress to type 2 diabetes if you do not take steps to prevent it.
Women who experienced gestational diabetes during pregnancy are also at higher risk of developing diabetes in later life.
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Diagnosis
It is important to diagnose diabetes as early as possible so that treatment can be started. If you experience symptoms, you should see your GP as soon as possible. They will ask you about your symptoms and ask for a urine sample.
Urine and blood tests
Your urine sample will be tested to see if it contains glucose. Normally, urine does not contain glucose, but if your blood glucose level is high, some glucose can overflow through your kidneys and into your urine.
If your urine contains glucose, you will have a blood test to confirm the diagnosis of diabetes. A sample of your blood will be taken in the morning before you have had anything to eat and will be tested to measure your blood glucose levels.
If your blood glucose levels are not high enough for your GP to diagnose diabetes, you may need to have an oral glucose tolerance test (OGTT). This is also sometimes referred to as a glucose tolerance test (GTT). You will be given a glucose drink and then blood tests are taken every half an hour, for two hours, to see how your body is dealing with the glucose.
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Treatment
Diabetes cannot be cured, but treatment aims to keep your blood glucose level as normal as possible and to control your symptoms to prevent health problems developing later in life.
What is good care for diabetes?
The Department of Health has set out national standards for NHS organisations and professionals for diabetes care and prevention. The Diabetes National Service Framework (which has been adapted for use in Wales) was developed by diabetes clinical experts and patients with diabetes. 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 with type 1 and type 2 diabetes, including access to a structured education programme, such as DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed).
- An agreed care plan, helping 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 control of their blood glucose, 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
Treatment for diabetes aims to help people with the condition to control their blood glucose levels and minimise the risk of developing complications over time. If you are diagnosed with type 2 diabetes, you will need to look after your health carefully for life. This may seem daunting, but your diabetes healthcare team can offer support and advice about all aspects of your treatment.
Lifestyle modification
For many people who are diagnosed with type 2 diabetes, the first approach to treatment will be making changes to your lifestyle. These include taking regular exercise, eating a healthy diet and losing weight if you are overweight or obese. Doing this may be enough to keep your blood glucose at a safe and healthy level, without the need for other treatment.
Taking medicines
Type 2 diabetes usually gets worse over time. Even if they work at first, diet and exercise may not be enough to control your blood glucose levels.
If you have type 2 diabetes, you may need (or eventually need) medicines that reduce high levels of blood sugar. At first, this will usually be tablets, sometimes a combination of more than one type of tablet. It may also include injectable insulin.
Monitoring blood glucose levels
Blood glucose testing (HbA1c)
If you have type 2 diabetes, your GP or diabetes healthcare team will need to take a reading of your long-term blood glucose level about every 2-6 months. This shows how stable your glucose levels have been in the recent past and how well your treatment plan is working.
The test that is used to measure your blood glucose levels over the previous 6-12 weeks is known as the HbA1c test. 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 healthcare team can help you set a target HbA1c level to aim for. This will usually be less than 59 mmol/mol HbA1c (7.5%). It can be as low as 48mmol/mol (6.5%) for some people.
Monitoring blood glucose levels yourself
As well as having your blood glucose level checked by a health professional every 2-6 months, you may also be given the opportunity to monitor your own blood glucose levels.
Even if you are being treated with tablets or insulin therapy and a healthy diet, many factors such as exercise, illness and stress can affect blood glucose levels. Other factors that may affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, changes to hormone levels during the menstrual cycle.
Many people with diabetes monitor their blood glucose levels at home using a simple finger prick blood test. This is to ensure that your blood glucose level is as normal and stable as possible. Blood sugar levels vary from person to person as well as throughout the day, so you may need to do it several times a day, depending on the type of treatment that you are taking.
How blood glucose is measured
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 that is 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 4.0-6.0 mmol/l before meals (preprandial) and less than 10.0 mmol/l two hours after meals (postprandial), although this can vary from person to person. Your diabetes healthcare team can discuss your blood glucose level in more detail with you.
Medicines for type 2 diabetes (glucose-lowering tablets)
If regular exercise and a healthy diet are not effective in controlling your blood glucose levels, you may need medicines to treat type 2 diabetes.
Several different types of medicine, usually taken as tablets, are used to treat type 2 diabetes. You may need to take a combination of two or more medicines to control your blood glucose level.
Metformin
Metformin is often the first medicine that is recommended 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.
If you are overweight, it is likely that you will be prescribed metformin. Unlike some other medicines that are used to treat type 2 diabetes, metformin should not 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 is produced by your pancreas. Examples of sulphonylureas include:
- glibenclamide
- gliclazide
- glimerpirizide
- glipizide
- gliquidone
You may be prescribed one of these medicines if you cannot take metformin or if you are not overweight. You may be prescribed a sulphonylurea and metformin if metformin does not control blood glucose on its own.
Sulphonylureas can increase the risk of hypoglycaemia (low blood glucose) because they increase the amount of insulin in your body. Sulphonylureas may 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 are not usually used alone, but are usually used in addition to metformin or sulphonylureas, or both. They may cause weight gain and ankle swelling. Do not take pioglitazone if you have heart failure or if you have a high risk of bone fracture.
Another thiazolidinedione, rosiglitazone, has been withdrawn from use because of the increased risk of cardiovascular disorders, including heart attack and heart failure. If you are currently taking rosiglitazone, you should continue to take the medicine as prescribed. You should also make an appointment to see your healthcare team to discuss alternative medication.
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 (sitagliptin and vildagliptin) act to prevent high blood glucose levels, but do not result in episodes of hypoglycaemia. You may be prescribed a gliptin if you are unable to take sulphonylureas or glitazones. They are 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 section on gliptins, above). It is injected twice a day and boosts insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemic episodes ('hypos'). It also leads to modest weight loss in many people who take it. It is mainly used in people on metformin plus sulphonylurea who are obese (with a BMI of 35 or above).
Another GLP-1 agonist called liraglutide has recently been launched in the UK. It is a once daily injection (exenatide is given twice a day). Like exenatide, it is mainly used in people on metformin plus sulphonylurea who are obese, and in clinical trials it has 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 is not often used to treat type 2 diabetes because it usually causes side effects, such as bloating and diarrhoea. However, you may be prescribed acarbose if you cannot take other types of medicine for type 2 diabetes.
Nateglinide and repaglinide
Nateglinide and repaglinide stimulate the release of insulin by your pancreas. They are not commonly used but may be an option if you have meals at irregular times. This is because their effects do not last very long, but they are effective when taken just before you eat.
Nateglinide and repaglinide can cause side effects, such as weight gain and hypoglycaemia (low blood glucose).
Insulin treatment
If glucose-lowering tablets are not effective in controlling your blood glucose levels, you may need to have insulin treatment. Insulin treatment 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 work 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 do not last very long (rapid acting).
Your treatment may include a combination of these different insulin preparations.
Insulin injections
In most cases of diabetes, you will need to have insulin injections. Insulin must be injected because if it were taken as a tablet, it would be broken down in your stomach, just like food, and wouldn’t be able to enter the bloodstream.
If you need to take insulin by injection, your diabetes healthcare team will advise you about when you need to take it. They will also show you how to inject it yourself. They 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 2-4 injections a day. Your GP or diabetes nurse will also teach one of your close friends or relatives how to inject the insulin properly.
Treatment for hypoglycaemia (low blood glucose)
If you have type 2 diabetes that is controlled using insulin, you may experience episodes of hypoglycaemia. Hypoglycaemia can occur when 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.
However, if you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness. If this occurs, you will need to have an injection of glucagon into your muscle. Glucagon is a hormone that quickly increases your blood glucose levels.
Your diabetes healthcare team can tell you how to avoid a hypo and what to do if you have one.
Other treatments
If you have type 2 diabetes, you have an increased risk of developing heart disease, a stroke and kidney disease. To reduce the chance of this, you may be advised to take other medicines which will reduce your risk, including:
- anti-hypertensive medicines to control high blood pressure.
- a statin, such as simvastatin or atorvastatin, to reduce high cholesterol levels.
- low-dose aspirin to prevent 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 it is treated early enough, diabetic kidney disease is often reversible.
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Complications
If your diabetes is not treated, it can lead to many different health problems. Large amounts of glucose can damage blood vessels, nerves and organs. Even a mildly raised glucose level that does not cause any symptoms can have damaging effects in the long term.
Heart disease and stroke
If you have diabetes, you are up to five times more likely to suffer heart disease and a stroke than someone without diabetes. Prolonged, poorly controlled blood glucose levels increase the likelihood of atherosclerosis (furring up and narrowing of the blood vessels). This may result in poor blood supply to the heart, causing angina. It also increases the chance that a blood vessel in your heart or brain will become completely blocked, causing a heart attack or stroke.
Nerve damage
High blood glucose levels can damage the tiny blood vessels of your nerves. This can lead to a tingling or burning pain that spreads from your fingers and toes up through your limbs. If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation.
Retinopathy (damage to the retina at the back of the eye)
Blood vessels in the retina of your eye can become blocked, leaky or grow haphazardly. This prevents the light from fully passing through to your retina. If left untreated, it can damage your vision.
The better you control your blood sugar levels, the less chance you have of developing serious eye problems. Having an annual eye check by a specialist (an ophthalmologist or an optometrist) can help to pick up signs of any potentially serious eye problems early on, so that they can be treated.
If it is caught early enough, diabetic retinopathy can be treated using laser treatment. However, it is important to realise that this will only preserve the sight you have and will not make it better.
Looking after your eyes - Screening for Diabetic Retinopathy
Every person who has diabetes, and is registered with a GP in Wales, is being called to a special screening set up to detect diabetic retinopathy. For more information visit Eye Care Wales
Kidney disease
If the small blood vessels of your kidney become blocked and leaky, your kidneys will work less efficiently. In rare, severe cases this can lead to kidney failure and the need for a kidney transplant.
Foot problems
Damage to the nerves of the foot can mean that small nicks and cuts are not noticed, leading to the development of a foot ulcer. About one person in 10 with diabetes gets a foot ulcer, which can cause serious infection.
Check your feet every day and report any changes to your doctor, nurse or podiatrist. Look out for sores and cuts that do not heal, puffiness or swelling, and skin that feels hot to the touch. Have a foot examination at least once a year.
Sexual dysfunction
In men with diabetes (especially those who smoke), damage to the nerves and blood vessels can lead to erection problems. This may be treated with medication.
Women with diabetes may experience a reduced sex drive, reduced pleasure from sex, lack of vaginal lubrication, reduced ability to orgasm or painful sex. Women with a lack of vaginal lubrication or painful sex may find a vaginal lubricant or water-based gel helpful.
Miscarriage and stillbirth
Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If blood sugar levels are not carefully controlled in the early stages of pregnancy, there is an increased risk of the baby developing a serious birth defect.
Pregnant women with diabetes will usually have their antenatal check-ups in hospital or in a diabetic clinic, where healthcare professionals can keep a close eye on their blood sugar levels.
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Prevention
The exact cause of type 2 diabetes is not fully understood, but many factors can increase your chance of developing it. For example, you may be at risk of developing type 2 diabetes if you:
- are overweight or obese
- do not get enough regular exercise
See Type 2 diabetes - Causes for more information about the risk factors for type 2 diabetes.
It may not be possible to avoid developing type 2 diabetes, but by controlling the risk factors you may be able to reduce your chances of getting it. For example, you should:
- Lose weight, if you are overweight or obese.
- Keep your waist size under 31.5 inches (80cm) if you are a woman, 35 inches (90cm) if you are an Asian man, and 37 inches (94cm) if you are a man who is white or black.
- Get at least 30 minutes of exercise every day.
- Do not smoke.
- Keep your blood pressure and cholesterol levels under control.
- Only drink alcohol in moderation.
This advice can help anyone reduce their risk of developing type 2 diabetes, but is particularly important for those who have an increased risk of developing it.
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Lifestyle
Living with type 2 diabetes
If you have type 2 diabetes, you will need to look after your health very carefully. Caring for your health will also make treating your diabetes easier and minimise your risk of developing any complications.
Self-care
Self-care is an integral part of daily life. It means that you take responsibility for your own health and wellbeing with support from the people involved in your care. Self-care includes the 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 support for self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent.
Regular reviews
Because type 2 diabetes is a long-term condition, you will be in regular contact with your healthcare team. A good relationship with the team will allow you to easily discuss your symptoms or concerns. The more the team knows, the more they can help you. Your GP or diabetes healthcare team will also need to check your eyes, feet and nerves regularly because they can be affected by diabetes.
Eat healthily
The belief that if you have diabetes you will have to eat special foods is untrue. Your diet should be a healthy diet, high in fibre, fruit and vegetables and low in fat, salt and sugar. Read more about healthy eating.
You may have been advised to try to make changes to your diet. A diabetes dietician can advise you about a dietary plan that can be fitted to your specific needs.
Exercise regularly
Physical activity lowers your blood glucose level, so it is particularly important to exercise regularly if you have diabetes.
Like anyone else, aim to do at least 30 minutes of moderate exercise at least five times a week. This can be any activity that gets you slightly out of breath and raises your heart rate. However, do not start a new activity without consulting your GP or diabetes healthcare team first.
As exercise will affect your blood glucose level, you and your care team may have to adjust your insulin treatment or diet plan to keep your blood glucose level steady.
Do not smoke
If you have diabetes, you have an increased risk of developing a cardiovascular disease, such as a heart attack or a stroke. If you smoke, you increase this risk even further, as well as increasing your risk of other serious smoking-related conditions, such as lung cancer.
If you smoke and you would like to give up, your GP can give you advice, support and treatment to help you quit.
Drink alcohol in moderation
If you have diabetes, drink alcohol only in moderation 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 alcohol limit is 3-4 units a day for men and 2-3 units a day for women.
Keeping well
Everyone with a long-term condition such as type 2 diabetes is encouraged to get a flu jab each autumn to protect against flu (influenza). They are also recommended to get an anti-pneumoccocal vaccination, which protects against a serious chest infection called pneumococcal pneumonia.
Look after your feet
Having diabetes means that you are more likely to develop problems with your feet, including foot ulcers and infections from minor cuts and grazes. This is because high blood glucose can damage the nerves in your feet.
To prevent problems with your feet, keep your nails short and wash your feet with warm water every day. Wear shoes that fit properly and see a podiatrist or chiropodist (a specialist in foot care) regularly so that any problems are detected early.
Check your feet regularly for any cuts, blisters or grazes. You may not be able to feel them if there is damage to the nerves in your feet. See your GP if you have a minor injury to your foot that does not start to heal within a few days.
Have regular eye tests
If you have type 2 diabetes, you should have your eyes tested at least once a year to check for retinopathy.
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 it is untreated, retinopathy can eventually cause blindness.
Pregnancy
If you have diabetes and are thinking about having a baby, it’s a good idea to discuss this with your diabetes healthcare team. Planning your pregnancy means you can ensure your blood sugar levels are as well controlled as they can be before you get pregnant.
You will need to keep your blood sugar under tight control, 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. 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. Doctors now recommend 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. Pregnancy can place extra pressure on the small vessels in your eyes, so it’s important to treat retinopathy before you become pregnant.
Your GP or diabetes healthcare team can give you further advice. Diabetes UK also provides useful information to help you get your pregnancy off to a healthy start.
Get educated
You will be best equipped to manage your diabetes every day if you are given information and education when you are diagnosed and on an ongoing basis.
The National Institute for Health and Clinical 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.
What is structured patient education?
Structured patient education means that there is 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 is a national patient education programme that meets all the key criteria for structured education. This is called the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) programme.
There are also several local adult education programmes, many of which are working towards the criteria for structured education. Ask your diabetes healthcare 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 who have been diagnosed with the condition.
To find your local diabetes support group, visit the Diabetes UK website. If you want to get in touch with a trained counsellor directly, call Diabetes UK’s careline on 0845 120 2960 or email careline@diabetes.org.uk.
Financial support and benefits
People with diabetes that is controlled by medication are entitled to free prescriptions and eye examinations. Some people with diabetes may be eligible for disability benefits and incapacity benefits, depending on the impact of the condition 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 diabetic complications.
People over 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 can check whether you are getting all the benefits you are entitled to. They, as well as your diabetes specialist nurse, should also be able to provide advice on filling in the forms.
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Q&A
Can I get chiropody on the NHS?
Chiropodists, also sometimes known as podiatrists, treat a wide variety of abnormalities and conditions of the foot and lower limb, from verrucas and ingrown toenails, to arthritis.
Chiropodists work with people of all ages, but also play an important role in helping older people, and disabled people, to stay mobile and independent.
Chiropody is available on the NHS free of charge in most areas of the UK, although the availability in your local area will depend on your Health Board.
Each case is also assessed on an individual basis. Whether or not you receive free treatment will depend on how serious your condition is and how quickly it needs to be treated. If your condition is unlikely to affect your health, or mobility, you may not be eligible for treatment.
People with diabetes
Most people with diabetes who need to see a chiropodist are treated as priority cases, although some Health Boards will only prioritise people if their diabetes is severe. Your Health Board will be able to provide you with more information about their referral policies.
Referral
To have treatment with a chiropodist, you will usually need a referral from your GP, practice nurse or health visitor. Some NHS clinics accept self referral enquiries (from patients directly) to establish if they meet the eligibility criteria for accessing the service.
If treatment is available in your area, your case will be assessed, and you will be added to a waiting list. If necessary, it may be possible to arrange a chiropodist to come out to your home. Tell your GP if you will need to have a home visit.
Private treatment
If free NHS treatment is not available in your area, your GP can still refer you to a local clinic for private treatment, but you will have to pay.
If you decide to contact a chiropodist yourself, make sure that they are fully qualified, registered with the Health Professionals Council (HPC) and that they are an accredited member of one of the following organisations:
- The British Chiropody and Podiatry Association,
- The Society of Chiropodists and Podiatrists, or
- The Institute of Chiropodists and Podiatrists.
Further information:
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