Diabetes (Type 2)

Symptoms

Many people have type 2 diabetes without realising. This is because they may not always notice any symptoms.

Symptoms of type 2 diabetes can include:

• peeing more than usual
• feeling thirsty all the time
• feeling very tired

• losing weight without trying to
• itching around your penis or vagina, or repeatedly getting thrush
• cuts or wounds taking longer to heal
• blurred vision

Risk Factors

You're more at risk of developing type 2 diabetes if you:

• are over 40 years old, or over 25 if you're from an Asian, Black African or Black Caribbean ethnic background
• have a close relative with diabetes (such as a parent, brother or sister)
• are overweight or living with obesity or are not very physically active
• are from an Asian, Black African or Black Caribbean ethnic background

Diagnosis

Type 2 diabetes is often diagnosed following routine blood tests. However, you should see a GP straight away if you have any symptoms of diabetes or you're concerned about your risk.

To diagnose type 2 diabetes:

Your GP will arrange a blood test to check your blood sugar levels.

If your blood sugar levels are raised, the GP will explain the test results and what will happen next.

Usually, a repeat test is needed if you do not have any symptoms.

If you're diagnosed with diabetes

What the GP will discuss with you during your appointment depends on the diagnosis and the treatment they recommend.

Generally, they'll talk to you about:

• what diabetes is
• what high blood sugar means for your health

• setting your target for blood sugar levels
• the regular checks you'll need to keep you well
• how to get more information about type 2 diabetes
• whether you need to take medicine
• your diet and exercise
• your lifestyle, for example alcohol and smoking

What happens after the diagnosis

Usually, the following things should happen after your diagnosis:

1. You'll usually need to make changes to your diet and be more active.
2. The GP may prescribe medicine. It might take time for you to get used to the medicine and to find the right doses for you.
3. You'll need to go for regular type 2 diabetes check-ups.
4. You'll be given advice about certain signs to look out for, to avoid other health problems.

Treatment Options

Understanding medicine

Most people need medicine to control their type 2 diabetes. This helps keep your blood sugar level as normal as possible to prevent health problems.

You may have to take it for the rest of your life, although your medicine or dose may need to change over time.

Adjusting your diet and being active is usually also necessary to keep your blood sugar level down.

Medicines for type 2 diabetes

There are many types of medicine for type 2 diabetes. It can take time to find a medicine and dose that's right for you. You'll usually be offered a medicine called metformin first.

You may need to take extra medicines, or a different medicine such as insulin, if:

• metformin is not suitable for you
• treatment is not keeping your blood sugar levels below your target
• you have other health problems, such as heart problems or kidney problems

Your doctor will recommend the medicines most suitable for you.

Your medicine might not make you feel any different, but this does not mean it's not working. It's important to keep taking it to help prevent future health problems.

Metformin

Metformin is the most common medicine used for type 2 diabetes. It can help keep your blood sugar at a healthy level. It comes as tablets.

Common side effects of metformin include feeling sick and diarrhoea. If this happens to you, your doctor may suggest trying a different type called slow-release metformin.

Other diabetes medicines

If metformin does not work well enough on its own, you cannot take it or you have other health problems, you may need to take other medicines alongside or instead of metformin.

These include:

• other tablets that help lower your blood sugar, such as gliclazide, glimepiride, alogliptin, sitagliptin or pioglitazone
• tablets that lower your blood sugar and help your heart pump blood around your body, such as dapagliflozin, empagliflozin, ertugliflozin or canagliflozin
• injections or tablets that lower your blood sugar and help you lose weight, such as semaglutide, dulaglutide or tirzepatide

Insulin

You'll need insulin if other medicines no longer work well enough to keep your blood sugar below your target.

Insulin is a medicine that helps your body use glucose (sugar) for energy.

Sometimes you may need insulin for a short time, such as if you're pregnant, if you're ill, or to bring your blood sugar level down when you're first diagnosed.

You inject insulin using an insulin pen. This is a device that helps you inject safely and take the right dose. 

Using an insulin pen does not usually hurt. The needles are very small, as you only inject a small amount just under your skin. Your diabetes nurse should show you where to inject and how to use your pen.

Your GP or diabetes specialist will recommend the type of insulin treatment that's best for you.

Types Of Insulin For Type 2 Diabetes:

People who need insulin for type 2 diabetes usually take either:

• a long-acting or intermediate-acting insulin once or twice a day
• a long-acting or intermediate-acting insulin once or twice a day, and a separate rapid-acting or short-acting insulin before meals
• a mixed insulin (biphasic insulin), containing both intermediate and rapid-acting or short-acting insulin, 1 to 3 times a day before meals

Your doctor or diabetes care team will discuss your treatment with you and recommend the insulin treatment they think is best for you. The type of insulin you take and your dose may change over time.

Side effects

Your diabetes medicine may cause side effects.

The side effects you may get depend on which medicines you're taking.

Do not stop taking your medicine if you get side effects. Talk to your doctor, who may suggest trying a different medicine.

Low blood sugar (hypos)

Some diabetes medicines can cause low blood sugar, known as hypoglycaemia or a hypo. These medicines include insulin and medicines such as gliclazide.

If you take medicine that can cause hypos, your doctor might recommend that you check your blood sugar regularly. You should be recommended to use a testing kit and shown how to do a finger-prick test.

If you take insulin at least twice a day and have frequent or severe hypos, you might also be offered a continuous glucose monitor (CGM) or flash monitor. This is a small sensor you wear on your skin that lets you check your blood sugar level at any time.

Travelling with diabetes medicines

If you're going on holiday, you should:

• pack extra medicine – speak to your diabetes nurse about how much to take
• carry your medicine in your hand luggage just in case checked-in bags go missing or get damaged
• get a letter from your GP that says you need medicine and to carry medical supplies to treat diabetes if you're going abroad

Food and keeping active

Staying healthy if you have type 2 diabetes

A healthy diet and keeping active will help you manage your blood sugar level. It'll also help you control your weight and generally feel better.

There's nothing you cannot eat if you have type 2 diabetes, but you'll have to limit certain foods.

You should:

• eat a wide range of foods – including fruit, vegetables and some starchy foods like pasta, potatoes and rice

• keep sugar, fat and salt to a minimum
• avoid missing meals if you take medicines that can cause hypos

If you need to change your diet, it might be easier to make small changes every week.

Being active lowers your blood sugar level 

Physical exercise helps lower your blood sugar level. You should aim for at least 2.5 hours of activity a week.

You can be active anywhere as long as what you're doing gets you out of breath.

This could be:

• fast walking
• climbing stairs

• doing more strenuous housework or gardening

Your weight is important

Losing weight (if you're overweight) will make it easier for your body to lower your blood sugar level, and can improve your blood pressure and cholesterol, reducing your risk of further health problems.

There is evidence that eating a low-calorie diet (800 to 1,200 calories a day) on a short-term basis (around 12 weeks) can lead to significant weight loss and reduce blood sugar levels in people with type 2 diabetes. And some people have found that their type 2 diabetes can go into remission.

A low-calorie diet is not safe or suitable for everyone with type 2 diabetes. So it is important to get medical advice before going on this type of diet.

Going for regular check-ups

Type 2 diabetes check-ups help you reduce the risk of other health problems related to diabetes and help spot and manage any problems early.

Every 3 to 6 months

Blood sugar checks (HbA1C test)

Checks your average blood sugar levels and how close they are to normal.

You should have these checks every 3 months when newly diagnosed, then every 6 months once you're stable.

This may be done by your GP or diabetes nurse.

At least once a year

Feet

Checks if you've lost any feeling in your feet, and for ulcers and infections. This can usually be done by your GP, diabetes nurse or podiatrist.

Speak to your GP immediately if you have cuts, bruises or numbness in your feet.

Blood pressure, cholesterol, kidneys and weight

Checks for high blood pressure, heart and kidney disease, and your weight, BMI and waist measurement.

This can be usually done by your GP or diabetes nurse.

Every 1 to 2 years

Eyes

Checks for damage to blood vessels in your eyes. These checks are usually by a diabetic eye screening service. They may be once a year or every 2 years, depending on your risk and previous test results.

Speak to your GP immediately if you have blurred vision.

When To See A Doctor

See a GP if:

• you have any of the symptoms of type 2 diabetes
• you're worried you may have a higher risk of getting type 2 diabetes

You'll need a blood test, which you may have to go somewhere else for, such as your local health centre or hospital, if it cannot be done at your GP surgery.

The earlier diabetes is diagnosed and treatment started, the better. Early treatment reduces your risk of other health problems.