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Non-insulin-dependent diabetes

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

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

In the UK, approximately 2.9 million people are affected by diabetes. There are also thought to be around 850,000 people with undiagnosed diabetes.

Types of diabetes

There are two main types of diabetes, referred to as type 1 and type 2.

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 is known as insulin resistance.

Type 2 diabetes is far more common than type 1 diabetes, which occurs when the body doesn't produce any insulin at all. In the UK, about 90% of all adults with diabetes have type 2 diabetes.

This topic focuses on type 2 diabetes. You can read more information on type 1 diabetes.

Type 2 diabetes usually affects people over the age of 40, although increasingly younger people are also being affected. It is more common in people of South Asian, African-Caribbean or Middle Eastern descent.

Diabetes symptoms

Diabetes can cause various symptoms. Symptoms common to both types of diabetes include:

  • feeling very thirsty
  • urinating frequently, particularly at night
  • feeling very tired
  • weight loss and loss of muscle bulk

Read more about symptoms of type 2 diabetes.

You should visit your GP as soon as possible if you notice these symptoms.

Causes of type 2 diabetes

Insulin is a hormone produced by part of the pancreas, a large gland located behind the stomach.

Insulin controls the amount of glucose (sugar) in your blood. It moves glucose from the blood into your cells, where it is converted into energy.

In type 2 diabetes, not enough insulin is produced to maintain a normal blood glucose level (insulin deficiency), or your body is unable to use the insulin that is produced effectively (insulin resistance).

Read more about the causes of type 2 diabetes.

Treating type 2 diabetes

It is important diabetes is diagnosed as early as possible. Diabetes cannot be cured, but treatment aims to keep your blood glucose levels as normal as possible to control your symptoms and minimise health problems developing later.

If you are diagnosed with diabetes, you may be referred to a diabetes care team for specialist treatment, or your GP surgery may provide first line diabetes care.

In some cases of type 2 diabetes, it may be possible to control your symptoms by altering your lifestyle, such as eating a healthy diet (see below).

However, as type 2 diabetes is a progressive condition, you may eventually need medication to keep your blood glucose at normal levels. To start with this will usually take the form of tablets, but later on it may include injected therapies, such as insulin.

Read more about treating type 2 diabetes.

Complications

Left untreated, diabetes can cause many health problems. Large amounts of glucose can damage blood vessels, nerves and organs.

Even a mildly raised glucose level that doesn't cause any symptoms can have damaging effects in the long term.

Read more about different complications of type 2 diabetes.

Living with diabetes

If you have type 2 diabetes, you will be advised to look after your health carefully. Caring for your health will also make treating your diabetes easier and minimise your risk of developing complications.

It helps to eat a healthy, balanced diet, stop smoking (if you smoke), drink alcohol in moderation and take plenty of regular exercise.

Read more about living with type 2 diabetes.


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Non-insulin-dependent diabetes

Some diabetes symptoms are common to both type 1 and type 2 diabetes. Each type also has its own particular symptoms.

Some diabetes symptoms are common to both type 1 and type 2 diabetes. Each has its own particular symptoms.

The main symptoms of diabetes common to both types are:

  • feeling very thirsty
  • urinating frequently, particularly at night
  • feeling very tired
  • weight loss and loss of muscle bulk

Many people have type 2 diabetes for years without realising because the early symptoms can be mild.

Visit your GP as soon as possible if you think you have diabetes. Early diagnosis and treatment may reduce your risk of developing complications later on.

Other symptoms of diabetes can include:

  • itchiness around the vagina or penis, or regular bouts of thrush (a yeast infection)
  • blurred vision that is caused by the lens of your eye becoming very dry
  • cramps
  • constipation
  • skin infections

Not everyone will experience the above symptoms, and they are not usually severe in those who do get them.

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Hyperglycaemia (high blood glucose)

Type 2 diabetes develops when the pancreas (a large gland behind your stomach) is unable to produce enough insulin to control your blood glucose level, or when the body's cells don't respond properly to insulin that is produced.

Due to the lack of insulin or its inability to regulate blood glucose, your blood glucose levels may become very high.

Hyperglycaemia can occur for several reasons, including eating too much, being unwell and not taking enough diabetes therapy.

The main symptoms of diabetes are due to hyperglycaemia. They include:

  • extreme thirst
  • a dry mouth
  • blurred vision
  • drowsiness
  • a need to pass urine frequently

Read more about hyperglycaemia.



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Non-insulin-dependent diabetes

Type 2 diabetes occurs when not enough insulin is produced to maintain normal blood glucose levels, or your body is unable to use the insulin that is produced.

Type 2 diabetes occurs when the pancreas does not produce enough insulin to maintain a normal blood glucose level, or your body is unable to use the insulin that is produced (insulin resistance).

The pancreas (a large gland behind the stomach) produces the hormone insulin, which moves glucose from your blood into your cells, where it is converted into energy.

In type 2 diabetes, there are several reasons why the pancreas doesn't produce enough insulin.

These are discussed below.

Risk factors for type 2 diabetes

You are more likely to develop type 2 diabetes if you:

  • are over 40 years old
  • have a relative with the condition
  • are of South Asian, African-Caribbean or Middle Eastern origin
  • are overweight or obese

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 through a healthy, balanced diet and exercising regularly are ways of preventing and managing diabetes.

Type 2 diabetes often develops in white people over the age of 40. People of South Asian, African, African-Caribbean and Middle Eastern descent have an increased risk of developing type 2 diabetes at a much earlier age.

However, in recent years, an increasing number of younger people from all ethnic groups are developing the condition.

It is 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 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 it (see below).

Ethnicity

People of South Asian, African, African-Caribbean and Middle Eastern descent are more likely to develop type 2 diabetes.

The condition is up to six times more common in South Asian communities than in the general UK population, and it is three times more common among people of African and African-Caribbean origin.

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.

Being overweight or obese

If you are overweight or obese (you have a body mass index of 30 or greater), you are at greater risk of developing type 2 diabetes.

In particular, fat around your abdomen (tummy) puts you at increased risk. This is because it releases chemicals that can upset the body's cardiovascular and metabolic systems. This then increases your risk of a developing various conditions, including heart disease, stroke and some types of cancer.

A quick way of assessing your diabetes risk is to measure your waist. This is a measure of abdominal obesity, which is a particularly high-risk form of obesity.

Women have a higher risk of developing type 2 diabetes if their waist measures 31.5 inches (80cm) or more. Asian men with a waist size of 35 inches (90cm) or over have a higher risk, as do white or black men with a waist size of 37 inches (94cm) or over.

Reducing your body weight by about 5% and exercising regularly could reduce your risk of getting diabetes by more than 50%.

Read more about losing weight.

Other risks

Your risk of developing type 2 diabetes is also increased if you have impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT).

These conditions are sometimes referred to as "pre-diabetes" and mean that your blood glucose level is higher than normal but not high enough to cause diabetes. IFG and IGT can both progress to type 2 diabetes if you do not take preventative steps.

Women who have gestational diabetes during pregnancy also have a greater risk of developing diabetes in later life.

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Non-insulin-dependent diabetes

It is important for diabetes to be diagnosed early so that treatment can be started as soon as possible.

It is 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 will ask about your symptoms and may request urine and blood tests.

Urine and blood tests

Your urine sample will be tested for glucose. Urine doesn't usually contain glucose, but if you have diabetes, glucose can overflow through the kidneys and into your urine.

If your urine contains glucose, a specialised blood test called a glucose tolerance test (see below) can be used to determine whether you have diabetes.

Glucose tolerance test

A glucose tolerance test (GTT), also sometimes known as an oral glucose tolerance test (OGTT), can show whether your body is having problems processing glucose.

Prior to having the test, you will 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 because they may affect the results. You will be advised about this.

Before the test, a blood sample is taken so your blood glucose can be measured. You will then be given a sweet glucose drink.

After drinking the glucose drink, your blood glucose will be measured again after two hours. As you'll have a long time to wait between blood tests, it's a good idea to take something to read or listen to.

Test results

After your glucose tolerance test is complete it should be possible to determine whether you have impaired glucose tolerance (IGT) or diabetes, 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. Medication to lower your blood glucose level may also be recommended.

If your results indicate you have diabetes, medication will probably be prescribed to lower your blood glucose level and help keep it under control.

Read more about treating type 2 diabetes.



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Non-insulin-dependent diabetes

Treatment for diabetes aims to keep your blood glucose levels as normal as possible and to control your symptoms to prevent health problems developing later in life.

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 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.

Lifestyle changes

For many people who are diagnosed with type 2 diabetes, the first approach to treatment is to make lifestyle changes. These include taking regular exerciseeating healthily and losing weight if you are overweight or obese (a body mass index of 30 or over).

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 glucose. Initially, this will usually be in the form of tablets, and may sometimes be a combination of more than one type of tablet. It may also include insulin or other medication that you inject.

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Monitoring blood glucose levels

Blood glucose testing (HbA1c)

If you have type 2 diabetes, your GP or diabetes care team will need to take a reading of your long-term 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 test that is used to measure your blood glucose levels over the previous six to 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 care 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 your own blood glucose levels

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 hypoglycaemia or hyperglycaemia. If blood glucose monitoring is recommended, you should be trained in how to use a blood glucose meter and what you should do should the reading be too high or too low.

Blood glucose meters are not currently available for free on the NHS but, in some cases, blood monitoring strips may be. Ask a member of your diabetes care team if you are 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 during the day, depending on the type of treatment you are 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 will be able to discuss your blood glucose level with you in more detail.

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 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 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:

You may be prescribed one of these medicines if you cannot take metformin or if you are not overweight. Alternatively, 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 can also 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 usually used in combination with metformin or sulphonylureas, or both. They may cause weight gain and ankle swelling. Do not take pioglitazone if you have heart failure or a high risk of bone fracture.

Another thiazolidinedione, rosiglitazone, was withdrawn from use in 2010 due to an increased risk of cardiovascular disorders, including heart attack and heart failure.

Read more about the withdrawal of rosiglitazone.

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) 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, or in combination with them. 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 the 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 episodes of hypoglycaemia ("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. A once-weekly product has recently been introduced.

Another GLP-1 agonist called liraglutide is a once-daily injection (exenatide is given twice a day). Like exenatide, liraglutide 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, 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 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).

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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 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 do not 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 would be unable to enter your bloodstream.

If you need to take insulin by injection, your diabetes care team will advise you about when you need to take 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.

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Treatment for hypoglycaemia (low blood glucose)

If you have type 2 diabetes that is 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 about 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, a stroke and kidney disease is increased. 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
  • 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.




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Non-insulin-dependent diabetes

If diabetes is not treated, it can lead to a number of different health problems. High glucose levels can damage blood vessels, nerves and organs.

If diabetes is not treated, it can lead to a number of different 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 damaging effects in the long-term.

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 (a condition involving the furring and narrowing of your blood vessels).

This may result in a 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 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 cause 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.

If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation.

Retinopathy

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 or leaky, or can grow haphazardly. This prevents light from fully passing through to your retina. If it is not treated, it can damage your vision.

Annual eye checks are usually organised by a regional photographic unit. If significant damage is then detected, you may be referred to an ophthalmologist (a doctor who specialises in treating eye disease).

The better you control your blood sugar levels, the lower your risk of developing serious eye problems.

Diabetic retinopathy can be managed using laser treatment if it is caught early enough. However, this will only preserve the sight you have; it will not improve it.

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 a kidney replacement treatment with dialysis (or sometimes kidney transplantation) will be necessary.

Foot problems

Damage to the nerves of the foot can mean small nicks and cuts are not noticed and this, in combination with poor circulation, can lead to a foot ulcer developing. About 1 in 10 people with diabetes get 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. You should also have a foot examination at least once a year.

If poor circulation or nerve damage is detected, check your feet every day and report any changes to your doctor, nurse or podiatrist (foot care specialist).

Read more about foot care and diabetes.

Sexual dysfunction

In men with diabetes, particularly smokers, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication.

Women with diabetes may experience:

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

If you experience a lack of vaginal lubrication, or you find sex painful, you can use a vaginal lubricant or a 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 during 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 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 sugar levels and control your insulin dosage more easily, as well as monitoring the growth and development of your baby.

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Non-insulin-dependent diabetes

If you have type 2 diabetes, you will need to look after your health very carefully.

Look after your feet

Having diabetes means you are more likely to develop 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 in your feet.

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 (a specialist in foot care) regularly so any problems are 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 does not start to heal within a few days.

Read more about feet and diabetes.

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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 left untreated, retinopathy can eventually cause blindness.

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Pregnancy

If you have diabetes and are thinking about having a baby, it is 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. It is now recommended 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. As pregnancy can place extra pressure on the small vessels in your eyes, it is important to treat retinopathy before you become pregnant.

Your GP or diabetes care team can give you further advice. Diabetes UK also provides useful information to help you get your pregnancy off to a healthy start.

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Get educated

You will be best equipped to manage your diabetes day-to-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 all people who have diabetes should be offered a structured patient education programme, providing information and education to help them care for themselves.

Structured patient education

Structured patient education means 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. It is called the DESMOND programme (Diabetes Education and Self Management for Ongoing and Newly Diagnosed).

There are also several local adult education programmes, many of which are working towards the criteria for structured education. Ask your diabetes care team about the adult education programmes they provide.

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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 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, you can call the Diabetes UK’s care line on 0845 120 2960 or email careline@diabetes.org.uk.

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Financial support and benefits

People with diabetes controlled by medication are entitled to free prescriptions and eye examinations. Some people with diabetes may also be eligible for disability and incapacity benefits, depending on the impact that the condition has 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 about filling in the forms.

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Non-insulin-dependent diabetes

After his victory at the 2000 Sydney Olympics, Sir Steve Redgrave became the only British athlete ever to win five consecutive Olympic gold medals.

After his victory in the rowing at the 2000 Sydney Olympics, Sir Steve Redgrave became the only British athlete to win five consecutive Olympic gold medals.

But what many people don’t realise is that Sir Steve achieved this final triumph against all the odds. Three years before the Sydney Olympics, he discovered he had diabetes.

“It was November 1997 and I had this tremendous thirst coming back from training one day,” he says. “After drinking three or four pints of fluids, I knew something was not quite right.”

Sir Steve’s grandfather was also diabetic, so the athlete wasn’t totally ignorant of the condition. While training abroad, he and his team mates were given dip-sticks to test their dehydration levels and Sir Steve could also test his urine for sugar levels.

“For some reason, I decided to do my own test and it came back positive,” he says. “I called my wife, who's a doctor, and she suggested going to see my GP. My blood sugar level was 32 [the norm is somewhere between 4 and 7] and I was sent to see a specialist. From that day on I’ve been taking insulin.”

The Olympic champion was 35 years old when he was diagnosed with type 2 or "adult-onset" diabetes, in which the body doesn't make enough insulin or the cells in the body don't use insulin properly. He thought it was the end of his career.

“The little I knew about diabetes was that there were few sportspeople with the condition competing at the level I wanted to be at. I thought it was impossible to be diabetic and do what I did, so obviously I was a little depressed. I took it in my stride to some extent because I’d already achieved four Olympic gold medals. But after a consultation, my specialist said he didn’t see any reason why I couldn’t achieve my dreams in Sydney. He said it wouldn’t be straightforward, and he was certainly right about that.”

Initially, Sir Steve was put on a low-sugar diet, but he soon found he didn’t have the energy to carry out the physically enduring training needed to compete at the highest level. His specialist decided that, as he had performed well on his previous diet (of 6,000 calories a day and which included a high-sugar content), he should go back on that diet and adjust his insulin dose accordingly.

“After I won in Sydney, my specialist and I did a press conference and another diabetes specialist stood up and said, ‘You’re a very lucky man,’” Sir Steve recalls. “He said if I’d come to the clinics of any of the specialists in that room, they would have said I couldn’t do it. They were amazed.”

In theory, he could have been given tablets to control his blood sugar level, but Sir Steve says they wouldn’t have given him enough insulin in his system for the amount of training he was doing.

“I was testing my blood sugar levels, using a pin prick to draw a spot of blood 10 times a day. Normally, people with diabetes do it just once. If you’re not diabetic, your body naturally adjusts your insulin levels, so I was just trying to mimic as closely as possible what the body does naturally.”

Sir Steve now uses an insulin pump. Instead of injecting several times a day, the pump is attached all day, every day, feeding a small amount of the drug into the body all the time. The pump is about the size of a pack of playing cards and is attached to the side of the abdomen. The infusion unit only needs changing every three days.

“It’s a lot more convenient,” he says. “Particularly when you’re out and about. And you can take it off to shower or exercise. The down side is I sometimes wake up during the night with it wrapped around me.

“There are fundamental changes you have to make when you discover you have diabetes, but there is no reason why you can’t achieve your dreams. I made the decision that diabetes was going to live with me; I wasn’t going to live with diabetes.”



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Non-insulin-dependent diabetes

Clare Mehmet, a 58-year-old retired telecommunications interpreter, found out by chance that she had type 2 diabetes 10 years ago.

Clare Mehmet, a 58-year-old retired telecommunications interpreter, found out by chance that she had type 2 diabetes 10 years ago.

“I was waiting for a train when I saw a poster saying, ‘You could have diabetes: Are you thirsty all the time? Are you always tired? Is your vision blurred?’ I was shocked because I’d been experiencing all the symptoms but put it to the back of my mind. So I promptly made an appointment with my GP, who confirmed that I had type 2 diabetes.

“At first I was terrified. I always thought people with diabetes were seriously ill, but once I looked into the condition I realised that as long as you change your diet and keep yourself fit and healthy, you can lead a full and active life.

“I’ve joined lots of support groups since I was diagnosed with diabetes and I do voluntary work to raise awareness about the condition. It’s important that people watch out for the signs. Late diagnosis can cause serious complications, such as blindness, kidney failure, heart disease, stroke and nerve damage, which could lead to blood flow problems and even amputation. So if you have any worries, get tested.”

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Non-insulin-dependent diabetes

When Charles Torkington, 54, was diagnosed with diabetes it gave him the determination to change his diet and his life.

Charles Torkington, 54, an IT specialist from Thirsk in North Yorkshire, says that being diagnosed with diabetes gave him the determination to change his diet and his life.

“I was a pilot for 30 years, and was fit and active. But when I left the forces eight years ago, my life changed. I studied IT and stopped exercising due to pressures of work. My weight went up to just over 15 stone (95kg).

“Then I started getting pains in my legs, which I thought were linked to a back injury. My doctor said it was either cancer or diabetes. A week later he rang to say I had diabetes. My blood sugar levels were so high they were off the scale.

“My GP put me on an exercise and diet regime, reducing portion size and cutting out alcohol completely. I now eat lots of vegetables, salmon and skinned chicken, and no processed food at all.

“I run up the stairs instead of walking, I walk to get the weekend shopping, and polish the car vigorously by hand. I also walk three or four miles in the countryside at weekends.

“I’m now 11 stone 8lb (74kg) and feel so much better. I’ve loads of energy and my blood sugar is under control. Becoming diabetic forced me to change my life. I’m very happy now.”



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Non-insulin-dependent diabetes

Shafina Bibi was shocked to hear she had diabetes. But now she’s changed her lifestyle and has never felt better.

Shafina Bibi was shocked to hear she had diabetes, but now she’s changed her lifestyle and has never felt better.

"I was devastated when I found out I had diabetes," says Shafina Bibi, 35. “I never dreamed it would happen to me.”

Shafina moved to the UK from Pakistan nearly 15 years ago. As someone of South Asian origin, she had a higher risk of getting diabetes. She was diagnosed with type 2 diabetes in 2001 and feared the worst.

“Being South Asian and overweight, I was more at risk,” Shafina says. In fact, the more overweight and unfit you are, the greater your risk of developing the condition. More than 80% of people with type 2 diabetes are overweight.

Shafina also developed temporary gestational diabetes during pregnancy, and this put her at an even greater risk of developing type 2 diabetes. “But, in spite of all these high-risk factors, I never dreamed it would happen to me,” Shafina says. “Suddenly, I was told I was at greater risk of serious complications such as heart attacks, blindness and kidney damage. I felt very frightened and alone.

“When the diabetes educator from the community diabetes team called to invite me to their ‘new to type 2’ group education session, it was a huge relief. The educator held the group at my local community centre and spoke in Urdu, my first language, which put me at ease. She explained all about type 2 diabetes, making it absolutely clear that we should keep fit and slim by exercising, cutting back on fat and eating more fruit and veg. It began to sink in that if I wanted to see my grandchildren, I’d have to lose some weight.

“When you’re a mother of five, finding time to look after yourself is hard. After my youngest was born nearly four years ago, I became very overweight and felt far too tired to exercise.

“But I left the session feeling really motivated. I reduced the oil in my cooking and cut out butter and ghee. I began eating more fruit and veg and moved from full-fat to semi-skimmed milk. Now, when I feel peckish, I eat an apple rather than half a packet of biscuits. I walk my children to school every day and make sure I’m going as fast as I can.

“In the last seven months, I’ve lost nearly four stone (25kg) and my blood sugar levels have come right down. I feel full of energy. My children can’t believe how good their mum looks.”



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Non-insulin-dependent diabetes

Grace Vanterpool MBE, a nurse consultant in diabetes, talks about her support work and raising awareness of the condition.

In this video Grace Vanterpool MBE, a nurse consultant in diabetes, talks about her support work and raising awareness of the condition.



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