Diabetes (Type 2)

What is diabetes?

Diabetes mellitus refers to a group of conditions that cause an individual’s blood glucose (sugar) levels to become too high, due to an inability to either make or use insulin[3].

 Insulin is a hormone that regulates blood glucose. When you eat, insulin moves glucose out of your blood and into your cells, where it can be turned into energy[4]. However, if you have diabetes, this process is disrupted.

The two main types of diabetes are:

•       Type 1 diabetes – a lifelong condition that occurs when your body cannot make insulin because your immune system attacks and destroys the cells that produce it [5]
•       Type 2 diabetes – a condition that occurs when your body either cannot use insulin properly or cannot make enough insulin [6]

In the UK, type 2 diabetes is far more common than type 1, affecting over 90% of all adults with diabetes.

Type 1 and type 2 diabetes are chronic conditions, meaning they cannot be cured. However, there are two types of diabetic conditions that are potentially reversible:

•       Gestational diabetes – you can develop high blood glucose during pregnancy. However, this usually goes away after giving birth
•       Prediabetes (non-diabetic hypoglycaemia) – this is a term used to describe when your blood glucose levels are above the normal range but not high enough for a diagnosis of diabetes. People who are pre-diabetic have a higher risk of developing type 2 diabetes

If you suspect you have diabetes, it's very important to be diagnosed as early as possible. This is because the condition only gets worse if left untreated and can lead to further complications, such as diabetic retinopathy (which can lead to loss of vision).

Type 1 diabetes symptoms

As you are born with type 1 diabetes, the symptoms will develop very quickly, over a few days or weeks[7]. These include:

•       Urinating more than usual
•       Feeling very thirsty
•       Feeling tired and weak
•       Unexplained weight loss
•       Having blurred vision
•       Slow-healing cuts and wounds
•       Your breath smelling sweet or fruity (like nail polish remover or pear drop sweets)
•       Getting a lot of infections, such as thrush

Type 2 diabetes symptoms

As you develop type 2 diabetes over time, the symptoms tend to occur more gradually, potentially over several years[8]. Although not everyone with type 2 diabetes experiences symptoms. These include:

•       Urinating more than usual
•       Feeling very thirsty
•       Feeling tired and weak
•       Unexplained weight loss
•       Having blurred vision
•       Slow-healing cuts and wounds
•       Genital itching, or you keep getting thrush
•       Diabetes rash

How is diabetes diagnosed?

Type 1 and type 2 diabetes are typically diagnosed using a blood test. There are a variety of blood tests that can be used, including:

•       HbA1c test – a quick and simple diabetes test which uses blood taken from a vein in your arm. This identifies your average blood glucose levels for the past two to three months. An A1c level of 6.5% or higher on two separate tests confirms diabetes. An A1c between 5.7% and 6.4% indicates prediabetes. An A1c level below 5.7% is considered normal
•       Random blood glucose test – a blood test taken at a random time, either from a vein in your arm or via a finger prick. A blood glucose level of 11.1 millimoles per litre (mmol/L) or higher suggests diabetes
•       Fasting blood sugar test – as the name suggests, this is a blood test taken after you’ve fasted (not eaten anything) for at least eight hours before. A fasting blood sugar level of 7 mmol/L or higher on two separate tests indicates you have diabetes. Levels from 5.6 to 6.9 mmol/L are considered prediabetes. Less than 5.6 mmol/L is classed as normal
•       Glucose tolerance test – this diabetes test is typically used for diagnosing gestational diabetes. After fasting overnight, blood taken from a vein in your arm will be used to test your blood glucose levels. You will then drink a sugary liquid and have your blood glucose levels tested again two hours later. You are considered to have gestational diabetes if your fasting glucose is 5.6mmol/l or more (the first test) and your 2-hour glucose is 7.8mmol/l or more (the second test)

Additionally, if your GP suspects you have type 1 diabetes, they may also test a sample of your urine.

What causes diabetes?

The cause of type 1 diabetes is currently unknown[9]. However, you are at greater risk of developing type 2 diabetes if you:

•       Are at a higher weight or have a high BMI
•       Do not do much exercise
•       Don’t eat a healthy, balanced diet
•       Have a family history of type 2 diabetes
•       Have a waist-to-height ratio of 0.5 or more
•       Are of Asian, Black African or African Caribbean origin
•       Have high blood pressure
•       Have had gestational diabetes during pregnancy
•       Use certain medications long-term, such as HIV/AIDS medicines and corticosteroids
•       Have experienced damage to your pancreas, which produces insulin
•       Are over the age of 40

How can diabetes be treated?

The main treatments for diabetes depend on which type of the condition you have.

Type 1 diabetes

Type 1 diabetes is treated using insulin to help regulate your blood glucose[10]. You’ll be taught by your healthcare provider how to calculate how much you need, as too much insulin can cause hypoglycaemia (hypos). As such, you’ll also be guided on how to identify and manage hypos.

You will need to inject insulin several times a day, using a fine needle and syringe or an insulin pen. Or you may be able to use an insulin pump, a small device you attach to your skin and wear all the time. This gives you tiny amounts of insulin throughout the day and night.

Some insulin pumps work with a continuous glucose monitor to automatically give you the right amount of insulin based on your blood glucose levels. This is known as a hybrid closed loop system.

Alongside taking insulin regularly, you will need to monitor your blood glucose levels and check how much carbohydrate is in your food and drink[11].

Checking your blood glucose

The NHS recommends that you check your blood glucose at least four times a day (or five times for children), including before meals and before bed. You should also check it more frequently when you're unwell, or when you’re doing things that can affect it, such as exercise or drinking alcohol.

To check your blood glucose using finger-prick tests, you will need:

•       A blood glucose monitor
•       Small needles (diabetes lancets)
•       Diabetes glucose test strips

You should also be able to get a continuous glucose monitor on the NHS to reduce the number of finger-prick tests you need to do.

Checking your carbohydrates

Carbohydrates are broken down into glucose[12]. As a result, you will need to monitor how many carbohydrates you're eating and drinking to manage your blood glucose levels and match your insulin dose to your carbohydrate intake.

Type 2 diabetes

Type 2 diabetes is primarily treated using lifestyle changes to help you manage your blood glucose and avoid taking medication[13]. However, you may still need to take medication if you have type 2 diabetes.

Lifestyle changes

Certain lifestyle changes can help to lower your blood glucose levels[14]. In some cases, they can even help to return your blood glucose to a normal level and prevent prediabetes from turning into type 2 diabetes. As a result, lifestyle changes are also recommended if you have prediabetes or gestational diabetes.

These include:

•       Eating a healthy, balanced diet
•       Avoiding processed foods with lots of salt and sugar
•       Engaging in regular physical activity
•       Managing your weight
•       Stopping smoking 
•       Reducing your alcohol intake

Medicines

Metformin is a diabetes medication which lowers your blood glucose levels by improving your body’s sensitivity to insulin. However, metformin is usually only prescribed if you are not able to manage your type 2 diabetes with lifestyle changes[15].

If metformin isn’t sufficiently lowering your blood glucose levels, you may need to take insulin instead. Metformin and insulin can also be used to treat gestational diabetes, if lifestyle changes aren’t helping to manage your blood glucose levels[16].

Sources

1. https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/statistics
2. https://www.who.int/news-room/fact-sheets/detail/diabetes
3. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
4. https://www.nhs.uk/conditions/diabetes/
5. https://www.nhs.uk/conditions/type-1-diabetes/
6. https://www.nhs.uk/conditions/type-2-diabetes/
7. https://www.nhs.uk/conditions/type-1-diabetes/symptoms/
8. https://www.nhs.uk/conditions/type-2-diabetes/symptoms/
9. https://www.bhf.org.uk/informationsupport/risk-factors/diabetes#Heading3
10. https://my.clevelandclinic.org/health/diseases/7104-diabetes
11. https://www.nhs.uk/conditions/type-1-diabetes/treatment/
12. https://www.diabetes.org.uk/living-with-diabetes/eating/carbohydrates-and-diabetes
13. https://www.nhs.uk/conditions/type-2-diabetes/treatment/
14. https://www.diabetes.org.uk/about-diabetes/type-2-diabetes/prediabetes
15. https://www.nhs.uk/medicines/metformin/about-metformin/
16. https://www.nhs.uk/conditions/gestational-diabetes/treatment/