Introduction

Diabetes, type 2
Diabetes, type 2

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

The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood

There are two main types of diabetes:

  • type 1 – where the pancreas doesn't produce any insulin
  • type 2 – where the pancreas doesn't produce enough insulin or the body's cells don't react to insulin

These pages are about type 2 diabetes. Read more about type 1 diabetes.

Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear after birth.

Symptoms of diabetes

The symptoms of diabetes occur because the lack of insulin means glucose stays in the blood and isn't used as fuel for energy.

Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine.

Typical symptoms include:

  • passing urine more often than usual, particularly at night
  • feeling very thirsty
  • feeling very tired
  • weight loss and loss of muscle bulk

Read more about the symptoms of type 2 diabetes.

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

Read about how type 2 diabetes is diagnosed.

See your GP if you think you have diabetes.

Causes of type 2 diabetes

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 means glucose stays in the blood and isn't used as fuel for energy.

Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. It's far more common than type 1 diabetes.

Read more about the causes and risk factors for type 2 diabetes.

Treating type 2 diabetes

As type 2 diabetes usually gets worse, you may eventually need to take medication  – usually tablets – to keep your blood glucose at normal levels.

Read more about treating type 2 diabetes.

Complications of type 2 diabetes

Diabetes can cause serious long-term health problems. It's the most common cause of vision loss and blindness in people of working age.

Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year for diabetic retinopathy.

Diabetes is 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 have cardiovascular disease, such as a stroke, than those without diabetes.

Read more about the complications of type 2 diabetes.

Preventing type 2 diabetes

If you're at risk of type 2 diabetes, you may be able to prevent it developing by making lifestyle changes.

These include:

Living with diabetes

If you already have type 2 diabetes it may be possible to control your symptoms by making the above changes. This also minimises your risk of developing complications.

Read more about living with type 2 diabetes.

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Symptoms

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.

This means your blood glucose levels may become very high. This is known as hyperglycaemia.

Hyperglycaemia can occur for several reasons, including:

  • eating too much
  • being unwell
  • ineffective diabetes medication, or not taking enough

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

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Causes

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 (insulin resistance).

The pancreas is a large gland behind the stomach that produces the hormone insulin. Insulin 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

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

  • age – being over the age of 40 (over 25 for south Asian,  Chinese, African-Caribbean or African origin, even if you were born in the UK
  • genetics – having a close relative with the condition, such as a parent, brother or sister
  • weight – being overweight or obese

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.

These risk factors 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 diet and 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 origin 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 the condition.

Being overweight or obese

You're more likely to develop type 2 diabetes if you're overweight or obese.

For most people in the UK, a body mass index (BMI) of:

  • 25 or above puts you in the overweight range
  • 30 or above puts you in the obese range

However, some groups have a higher risk of developing type 2 diabetes:

  • Asians with a BMI score of 23 or more are at increased risk of developing type 2 diabetes
  • Asians with a BMI of 27.5 or more are at high risk of developing type 2 diabetes

Fat around your tummy (abdomen) particularly  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

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.

Some groups have a higher risk of developing type 2 diabetes, based on their waist measurements:

  • women with a waist size of 80cm (31.5 inches) or more
  • Asian men with a waist size of  89cm (35 inches) or more
  • white or black men with a waist size of 94cm (37 inches) or more

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%.

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.

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Diagnosis

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 glucose can overflow through the kidneys and into your urine if you have diabetes.

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.

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 has pre-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.

You can read more about the HbA1c test on the Lab Tests Online UK website.

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 more exercise. 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.

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Treatment

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 type 2 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:

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 sugar and 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 about healthy 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.

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 – south Asian includes people from Bangladesh, Bhutan, India, Indian-Caribbean, Maldives, Nepal, Pakistan and Sri Lanka

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 a minimum 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 as running 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).

Read more about the physical activity guidelines for adults.

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, 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 about getting 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.

Pioglitazone

Pioglitazone is a type of thiazolidinedione medicine (TZD), which make your body’s cells more sensitive to insulin so that more glucose is taken from your blood.

Its 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 have heart failure or a high risk of bone fracture.

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.

SGLT2 inhibitors

SGLT2 inhibitors work by increasing the amount of glucose excreted in urine. They may be considered to treat type 2 diabetes if metformin and DPP-4 inhibitors aren't suitable.

The three SGLT2 inhibitors that may be prescribed include:

  • dapagliflozin
  • canagliflozin
  • empagliflozin

Each medication is taken as a tablet once a day. The main side effect is a higher risk of genital and urinary tract infections.

Read more about these three new treatment options for type 2 diabetes on the National Institute for Health and Care Excellence (NICE) website.

GLP-1 agonists

GLP-1 agonists acts in a similar way to the natural hormone GLP-1 (see the section on gliptins, above).

They're given by injection and boost insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes ("hypos").

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.

You can read more about insulin and how to inject it on the Diabetes UK website.

Treatment for low blood sugar

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 detecting high 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.

In Wales, blood glucose meters may be available for free from the NHS on prescription, this is also true for blood monitoring strips. Ask a member of your diabetes care team if you're unsure.

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.

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Complications

If your diabetes is not 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 does not cause any symptoms can have long term damaging effects.

Heart disease and stroke

If you have diabetes, you are 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 completely 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 lead to 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 where the retina (the light-sensitive layer of tissue) at the back of the eye is damaged. Blood vessels in the retina can become blocked, leaky or grow haphazardly. This prevents the light from fully passing through to your retina. If it is not treated it can damage your vision.

Annual eye checks are usually organised through your GP Surgery. 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.

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. It is 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 the need for dialysis or sometimes a kidney transplant.

Foot problems

Damage to the nerves of the foot can mean that small nicks and cuts are not noticed, and this, in combination with poor circulation, can lead to the development of a foot ulcer. About one person in 10 with diabetes gets a foot ulcer, which can cause serious infection.

If you have diabetes, 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.

If poor circulation or nerve damage is detected, you should 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), damage to the nerves and blood vessels can lead to erection problems. This can usually be treated with medication.

Women with diabetes may experience:

  • a reduced sex drive
  • less pleasure from sex
  • vaginal dryness
  • less ability to orgasm
  • pain during sex

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

Miscarriage and stillbirth

Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If your blood sugar level is not carefully controlled in the early stages of pregnancy, there is 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 in a diabetic clinic, ideally with an obstetrician (a doctor who specialises in pregnancy care).

This allows 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.

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Lifestyle

Living with type 2 diabetes

If you have type 2 diabetes, it's important to look after your own health and wellbeing, with support from those involved in your care.

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

Self-care for type 2 diabetes includes:

  • maintaining good physical and mental health
  • preventing illness or accidents
  • effectively dealing with minor ailments and long-term conditions.

Your diabetes care team

As type 2 diabetes is a long-term condition, you will be in regular contact with your diabetes care team. Your GP or diabetes care team will also need to check your eyes, feet and nerves regularly because they can be affected by diabetes.

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 the HbA1c test will be 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.

Eat healthily

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

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

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

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.

Read more about healthy eating.

Further dietary advice and cooking tips are also available on the Diabetes UK website.

Exercise regularly

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

Like anyone else, aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or 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 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.

As well as increasing this risk even further, smoking also increases 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 .

Limit alcohol 

If you have diabetes and decide to drink alcohol, avoid drinking more than the recommended amount, 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.

Men and women are advised not to regularly drink more than 14 units a week.

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 a pneumoccocal vaccination, which protects against a serious chest infection called pneumococcal pneumonia.

Foot care

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.

Have regular eye tests

If you have type 2 diabetes, you should have your eyes tested at least 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 it is untreated, retinopathy can eventually cause blindness.

The Diabetes UK website has more information about diabetic retinopathy.

People with diabetes should also see their optician every two years for a regular eye test. Diabetic eye screening is specifically for diabetic retinopathy and can't be relied upon for other conditions.

Pregnancy

If you have diabetes and are 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 will need to keep your blood glucose 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. 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. 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 has more information about pregnancy and diabetes

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 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 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.

Diabetes sick day rules

If you need to take insulin to control your diabetes, you should have received instructions about looking after yourself when you're ill – known as your "sick day rules".

Contact your diabetes care team or GP for advice if you haven't received these.

The advice you're given will be specific to you, but some general measures that your sick day rules may include could be to:

  • keep taking your insulin – it's very important not to stop treatment when you're ill; your treatment plan may state whether you need to temporarily increase your dose
  • test your blood sugar level more often than usual – most people are advised to check the level at least four times a day
  • keep yourself well hydrated – make sure you drink plenty of sugar-free drinks
  • keep eating – eat solid food if you feel well enough to, or liquid carbohydrates such as milk, soup and yoghurt if this is easier
  • check your ketone levels if your blood sugar level is high

Seek advice from your diabetes care team or GP if your blood sugar or ketone level remains high after taking insulin, if:

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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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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 03/04/2017 09:10:52