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Diabetes type 2

Diabetes type 2

Type 2 diabetes is a lifelong condition in which the body is unable to regulate the amount of glucose in the blood properly. It develops when the body doesn't respond to the natural hormone insulin, usually as a result of the person being overweight.

Type 2 diabetes is also known as non-insulin-dependent diabetes mellitus.

 

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Glucose and insulin

Glucose is a simple form of sugar found in foods and sugary drinks - it's absorbed as a natural part of digestion.

One function of your blood is to carry glucose around your body. When glucose reaches body tissues, such as muscle cells, it's absorbed and converted into energy. The glucose concentration in your blood is automatically regulated and insulin is crucial for this.

Insulin helps cells absorb glucose, where it's then converted into energy. Insulin is secreted into the blood by your pancreas - a gland found behind your stomach which also produces digestive juices.

If your cells don't respond properly to insulin, this can cause glucose to build up in your blood. This is called insulin resistance. You become resistant to insulin if you're overweight or type 2 diabetes runs in your family. This means that your pancreas needs to produce more and more insulin to overcome the resistance and control blood glucose levels. Eventually your body can't produce enough insulin to control blood glucose so your levels rise and diabetes develops.

Glucose and insulin

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

There are about 700,000 people in Hong Kong who have diabetes. Type 2 diabetes is the common form, affecting nine out of every 10 people with diabetes.

Symptoms of type 2 diabetes

Many people with type 2 diabetes have no symptoms, and it's often discovered accidentally after routine medical check-ups or following screening tests for other conditions.

If you do have symptoms of type 2 diabetes, they might include:

  • excessive passing of urine
  • constant thirst
  • tiredness
  • blurred vision
  • itchy skin around your genitals or regular infections, such as thrush

You may also have noticed a change in your weight over recent months. You may have gained some (causing diabetes) or lost some as a result of high blood glucose levels. It's also possible that your weight hasn't changed at all because of a combination of high blood glucose and a high calorie diet.

Your symptoms may be very mild and can go unnoticed for years.
Complications of type 2 diabetes

Long-term complications of type 2 diabetes are similar to those of type 1. These include:

  • angina
  • heart attack
  • stroke
  • diabetic kidney damage
  • diabetic foot ulcers or circulation problems in your legs and feet
  • diabetic eye damage - if diagnosed and treated, blindness can usually be prevented

You will need to have annual check-ups to monitor whether you have developed any complications.

Rarely, if a severe infection occurs or type 2 diabetes isn't diagnosed or is poorly controlled, people with the condition can develop hyperosmotic non-ketotic coma (HONK).

HONK is caused if blood sugar levels rise to very high levels. It causes:

  • extreme thirst
  • feeling sick
  • dry skin
  • excessive urine production
  • disorientation

Eventually it can cause drowsiness and loss of consciousness. HONK needs to be treated in hospital.

In the long term, uncontrolled high blood glucose (hyperglycaemia) can be very damaging to your health and can increase your risk of heart disease, stroke, kidney failure, nerve damage and blindness.

Causes of type 2 diabetes

Type 2 diabetes develops when your body becomes resistant to insulin. This happens when your body's tissues don't respond well to insulin and so can't make use of the glucose in the blood for energy. Your pancreas responds by producing more insulin and your liver, where glucose is stored, releases more glucose.

Eventually your pancreas becomes less able to produce enough insulin and your tissues become more resistant to insulin. As a result, blood glucose levels slowly start to rise.

It can take several years for blood glucose to reach a level that causes symptoms of type 2 diabetes.

You're more likely to develop type 2 diabetes if:

  • you're overweight or obese - in particular, people who are an 'apple-shape' with lots of fat around the abdomen are more likely to develop diabetes
  • you don't exercise very often
  • type 2 diabetes runs in your family
  • you smoke
  • you drink alcohol excessively
  • you're of African-Caribbean, South-Asian or Hispanic origin
  • you're over 40 and caucasian - the risk increases further with age
  • you have high blood pressure or have had a heart attack or stroke
  • you have polycystic ovary syndrome and are overweight
  • you have impaired glucose tolerance or impaired fasting glycaemia
Diagnosis of type 2 diabetes

If you think you may be developing diabetes, visit your GP. Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

You may also be asked to have a blood test to measure the level of glucose in your blood. This might be a fasting glucose test, which is taken after you haven't eaten for at least eight hours, or a random glucose test done at any time.

If your GP can't make a definite diagnosis after these tests, you may have a glucose tolerance test. This measures how your blood glucose level changes over time after you swallow a sugary drink. You will need to fast overnight before having this test.

Your care will probably be managed by your GP. However, you may be referred to a hospital clinic that has nurses and doctors who specialise in diabetes.

Treatment of type 2 diabetes

Some people with type 2 diabetes can initially control their condition with lifestyle changes alone.

Self-help

Diet

A healthy diet is essential if you have diabetes and it's important to eat regularly three times a day.

Special diabetic foods aren't necessary for a healthy diet; you just need to eat a balanced diet that is low in saturated fat, sugar and salt, and high in fibre, vegetables and fruit. Include carbohydrates, such as pasta, potatoes or sugary foods such as fruit in each meal.

Ask a dietitian at your GP surgery or hospital clinic for more information.


Exercise

Exercise promotes a healthy circulation and will help you to stay a healthy weight. The Department of Health recommends that you do at least half an hour of moderate activity on at least five days a week. 


Smoking

Smoking is unhealthy for everyone, but it's especially important for people with diabetes to quit. This is because you already have an increased chance of developing cardiovascular disease or circulatory problems. Smoking makes the chances of developing these diseases even greater.

Alcohol

If you have diabetes, there's no need to give up alcohol completely, but it's important to drink sensibly. However, don't drink on an empty stomach - eat food containing carbohydrate before and after drinking and monitor your blood glucose levels regularly.

Medicines

If lifestyle changes alone don't reduce your glucose levels, you may be prescribed medicines to increase insulin production and strengthen its effect. Some examples are listed here.

  • Metformin is a medicine called a biguanide that improves the effectiveness of insulin by reducing the amount of glucose released from the liver and improving the way glucose is used by muscles.
  • Sulphonylureas encourage your pancreas to produce more insulin, and include glibenclamide and glipizide.
  • Prandial glucose regulators also encourage your pancreas to produce more insulin - they work more quickly than sulphonylureas but only last for a short time. Examples include repaglinide and nateglinide.
  • Thiazolidinediones reduce your body's resistance to insulin and are sometimes used with metformin and sulphonylureas if other standard treatments aren't working or aren't tolerated. Examples include rosiglitazone and pioglitazone.
  • Newer medicines called DPP-4 inhibitors, such as sitagliptin or vildagliptin, help your body to produce more insulin in response to meals. They don't cause weight gain and only rarely cause hypos.
  • Acarbose lowers blood glucose by slowing the breakdown of some carbohydrates.

Two or more of the medicines listed here can be given in combination as they may give better control than one on its own.

Ask your doctor for advice on which medicine is best for you.

It's also possible that you will be given medicines to control your blood pressure if lifestyle changes including those mentioned above aren't enough to do this. Your GP will prescribe either an angiotensin converting enzyme (ACE) inhibitor, or an angiotensin II receptor blocker depending on which is most suitable for you.

It's also important to try to lower your cholesterol levels through lifestyle measures such as changing your diet, losing excess weight and taking regular exercise. However, if these don't work, you're likely to be prescribed a medicine to help lower your cholesterol. This will probably be a statin such as atorvastatin or fluvastatin.

It's very important to keep your blood pressure and the level of cholesterol in your blood well controlled. High blood pressure and high cholesterol levels have been linked to heart attack and stroke - you're more at risk of these and other complications if you have diabetes.

Insulin injections

If lifestyle changes and medicines don't control your blood glucose levels, you may need to start insulin injections in addition to, or instead of, tablets.

You will usually give insulin injections to yourself once or twice a day, using either a traditional needle or a pen-type syringe with refillable cartridges. There are different kinds of insulin that work at different rates and for different lengths of time. Each can have varying rates of success in different people - ask your doctor for advice on which type is best for you.

Monitoring your blood sugar

You may be able to monitor your blood glucose levels with a home test kit. This involves taking a pinprick of blood from your finger and putting a drop on a testing strip. A meter will read the result automatically. However, self-monitoring isn't usually recommended unless you're using insulin injections. More research is needed to find out whether self-monitoring is an effective way of controlling blood glucose.

You can adjust both your diet and insulin to keep your blood glucose level within the normal range. Your 'normal' range will be specific to you but a general guide for adults is:

  • before meals: 4 to 7mmols/litre
  • after meals: less than 8.5mmols/litre

Your GP or specialist nurse can guide you on how to monitor and manage your blood glucose and will give you continuing support.

How will type 2 diabetes affect my work?

Although being diagnosed with type 2 diabetes can leave you feeling worried about the future, it shouldn't stop you leading an active and full career. However, you may need to plan well and make some changes to your activities.

Explanation

Type 2 diabetes can potentially have an impact on many areas of your life including work. How you manage your condition, how well controlled your diabetes is and any other medical conditions you have can all influence how well you cope with work and the choices you make.

There are very few jobs that you're unable to do if you have diabetes but you may need to make some adjustments. Your doctor or nurse can give you more information and advice about your individual circumstances.

Working shifts can sometimes cause difficulties because you may need to change mealtimes and adjust any tablets or insulin you take. If food isn't readily available, you will need to plan well to make sure you don't go without. If you have a physically demanding job, you may also need to make changes to your treatment or your work patterns.

Can I go on holiday if I have type 2 diabetes?

Yes, it's fine to go abroad on holiday if you have diabetes so long as you are well prepared.

Explanation

People with diabetes travel all over the world and take the same kinds of holiday as people without the condition. However, it makes sense to plan well. Bear the following in mind when you go on holiday.

  • Consider carrying or wearing some form of diabetic identification, particularly if you're travelling alone.
  • If you're travelling across time zones, you may need to adjust your tablets and insulin. Get advice from your doctor or nurse.
  • If you become unwell while you're away, drink plenty of fluids and if you can't eat, make sure you have sugary drinks. If you can't eat or drink anything, go to hospital for treatment.
  • Security issues at airports may mean you have to make special arrangements if you need to travel with insulin. Carry diabetes identification and a letter from your doctor and check with the airline you're flying with before you go.
  • If you take insulin, you, and the people you travel with, should know how you behave if you have a hypo and should know what to do about it.
  • Declare your condition when you buy travel insurance and never travel without it.

If you have any questions or concerns about travelling, speak to your doctor or specialist nurse.

What am I aiming for with my day-to-day treatment?

It's important to aim to lead a healthy lifestyle - to be the right weight for your height, to be active, to eat the right foods and not smoke. You have a large part to play in the control of your condition so it's important that you understand and follow your treatment plan.

Explanation

In the long term, uncontrolled high blood glucose (hyperglycaemia) can be very damaging to your health and can increase your risk of heart disease, stroke, kidney failure, nerve damage and blindness.

It's important to aim for your blood glucose levels, blood pressure readings and cholesterol (lipid) levels to be as near to normal as possible. The better your control of these factors, the less likely you're to have short-term and long-term health problems associated with diabetes.

If you manage your condition well, it can also help you to feel better and have a better quality of life. The main targets that you're aiming for with your treatment are described here.

  • A negative urine test for glucose. Your GP may ask to test your urine for glucose, instead of a blood test. This is more likely if you're elderly or have difficulties testing your blood.
  • Blood pressure levels of 130/80mmHg or below. Many people with type 2 diabetes develop high blood pressure. Having high blood pressure as well as diabetes puts you at even greater risk of developing heart problems or stroke. This is why it's very important to keep your blood pressure well controlled. You can do this with lifestyle changes and medicines.
  • Aim for an HbA1c level of less than 7 percent with few or no hypos. HbA1c is a blood test that you have at least twice a year. It shows what your average blood glucose levels were like over the previous six to eight weeks and is a good guide to how well controlled your blood glucose levels have been.
  • Blood glucose levels before meals of 4 to 7mmol/l. This is the level you're aiming for when you test your blood glucose at home. Your GP will advise you on whether home monitoring of your blood glucose levels is suitable for you.
  • Total blood cholesterol levels of less than 4mmol/l. Like high blood pressure, raised blood cholesterol can also increase your risk of heart problems and stroke. Your doctor will ask you to eat foods that are low in saturated fats and to be active. He or she may also ask you to take medicines to lower your cholesterol levels. These are likely to be statins, but you may be prescribed other medicines called fibrates as well or instead of statins if these aren't suitable for you.

Type 2 diabetes is a progressive condition, which means that it will gradually worsen as time goes on. This means that in future you will probably need to increase the amount of medication you take, or move on to insulin, in order to keep your condition well controlled.

Can I look after my diabetes myself?

Yes you can, and you will be encouraged to do so. Care for people with diabetes is planned around you and helping you to take control of your condition. Your GP and nurses can help you to manage your diabetes but ultimately you live with it day to day and have to be able to manage your condition at home by yourself. You will be responsible for leading a healthy lifestyle, taking any medicines and learning how to spot health problems. The better you do this, the less chance there is of you developing serious health problems in later life.

Explanation

When some people are diagnosed with type 2 diabetes they find it quite overwhelming. The fact that type 2 diabetes is a lifelong illness means that your treatment must also be lifelong and this can be a difficult thing to come to terms with. Making changes to your life to fit in around your diabetes can be hard work and you won't always get it right, particularly when it's all very new.

You will be managing your diabetes as part of a team that includes your GP, practice nurse, and possibly a specialist doctor. Some people visit their local hospital for check-ups and others go to their GP surgery. You will have at least one full review of your condition and health every year. This will include testing to see whether your kidneys are working properly and looking at your feet and eyes to check that they are healthy. Outside of these visits to your doctor or nurse, you're very likely to be looking after your condition yourself.

Your GP or nurse will discuss your choices with you and help you to find the information and support you need to feel confident at home. When you're first diagnosed with type 2 diabetes, your GP or nurse may give you the option of monitoring your own blood glucose levels at home. Depending on how your diabetes is treated, you may be asked to test your urine or blood regularly.

You might be invited to take part in a more structured diabetes education programme. There are lots of different courses available, depending on where you live. These courses are usually held in small groups. They aim to help you to manage and change your lifestyle, to learn how to look after your condition and how to monitor it.
Further Information
Sources
  • Guide to diabetes. Diabetes UK.www.diabetes.org.uk,accessed 28 June 2011
  • Type 2 diabetes: the management of type 2 diabetes. National Institute for Health and Clinical Excellence (NICE), 2008.www.nice.org.uk
  • Diabetes mellitus. The Merck Manuals.www.merckmanuals.com, published June 2008
  • DESMOND: Diabetes Education and Self management for Ongoing and Newly Diagnosed. Diabetes UK.www.diabetes.org.uk, published October 2005
  • Diagnosis and management of type 1 diabetes in children, young people and adults. National Institute for Health and Clinical Excellence (NICE), 2004.www.nice.org.uk
  • Joint Formulary Committee. British National Formulary. 61st ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2011
  • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 352–53
  • Personal communication, Dr Jonathan Katz, Consultant Endocrinologist, Barnet Hospital, 8 June 2011
  • Kilpatrick ES, Winocour ES. ABCD position statement on haemoglobin A1C for the diagnosis of diabetes. Pract Diab Int 2010; 27(6):1–5
  • Start active, stay active: a report on physical activity from the four home countries' Chief Medical Officers. Department of Health, 2011.www.dh.gov.uk

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