Type 2 diabetes occurs mostly in people aged over 40 years. However, an increasing number of younger people, even children, are being diagnosed with type 2 diabetes.
The first-line treatment is diet, weight control and physical activity. If the blood sugar (glucose) level remains high despite these measures then tablets to reduce the blood glucose level are usually advised. Insulin injections are needed in some cases. Other treatments include reducing blood pressure if it is high, lowering high cholesterol levels and also using other measures to reduce the risk of complications.
Type 2 diabetes tends to develop gradually (over weeks or months). This is because in type 2 diabetes you still make insulin (unlike in type 1 diabetes). However, you develop diabetes because:
- You do not make enough insulin for your body’s needs; or
- The cells in your body do not use insulin properly. This is called insulin resistance. The cells in your body become resistant to normal levels of insulin. This means that you need more insulin than you normally make to keep the blood sugar (glucose) level down; or
- A combination of the above two reasons.
Type 2 diabetes is much more common than type 1 diabetes.
Who develops type 2 diabetes?
Type 2 diabetes develops mainly in people older than the age of 40 (but can also occur in younger people).
- In England, about 1 in 10 people aged 45-54 years have diabetes and about 1 in 4 people aged over 75 years have diabetes.
- Type 2 diabetes is now becoming more common in children and in young people.
- 9 out of every 10 people with diabetes have type 2 diabetes.
The number of people with type 2 diabetes is increasing in Australia, as it is more common in people who are overweight or obese. It also tends to run in families. 280 Australians develop diabetes every day. That is one person every 5 minutes. It is around five times more common in South Asian and African-Caribbean people (often developing before the age of 40 in this group). It is estimated that there are around 1.7 million Australians have diabetes. This includes all types of diagnosed diabetes (1.2 million known and registered) as well as silent, undiagnosed Type 2 diabetes (up to 500,000 estimated).
Other risk factors for type 2 diabetes include:
- Having a first-degree relative with type 2 diabetes. (A first-degree relative is a parent, brother, sister, or child.)
- Being overweight or obese.
- Having a waist measuring more than 31.5 inches (80 cm) if you are a woman or more than 37 inches (94 cm) if you are a man.
- Having pre-diabetes (impaired glucose tolerance). Impaired glucose tolerance means that your blood sugar (glucose) levels are higher than normal but not high enough to have diabetes. People with impaired glucose tolerance have a high risk of developing diabetes and so impaired glucose tolerance is often called pre-diabetes.
- Having diabetes or pre-diabetes when you were pregnant.
What are the symptoms of type 2 diabetes?
As already mentioned, type 2 diabetes symptoms often come on gradually and can be quite vague at first. Many people have diabetes for a long period of time before their diagnosis is made.
The most common symptoms are:
- Being thirsty a lot of the time.
- Passing large amounts of urine.
- Weight loss.
The reason why you make a lot of urine and become thirsty is because blood sugar (glucose) leaks into your urine, which pulls out extra water through the kidneys.
As the symptoms may develop gradually, you can become used to being thirsty and tired and you may not recognise that you are ill for some time. Some people also develop blurred vision and frequent infections, such as recurring thrush. However, some people with type 2 diabetes do not have any symptoms if the glucose level is not too high. But, even if you do not have symptoms, you should still have treatment to reduce the risk of developing complications.
How is type 2 diabetes diagnosed?
A simple dipstick test may detect sugar (glucose) in a sample of urine. However, this is not sufficient to make a definite diagnosis of diabetes. Therefore, a blood test is needed to make the diagnosis. The blood test detects the level of glucose in your blood. If the glucose level is high then it will confirm that you have diabetes. Some people have to have two samples of blood taken and may be asked to fast. (Fasting means having nothing to eat or drink, other than water, from midnight before the blood test is performed.)
It is now recommended that the blood test for HbA1c can also be used as a test to diagnose type 2 diabetes. An HbA1c value of 48 mmol/mol (6.5%) or above is recommended as the blood level for diagnosing diabetes.
In many cases type 2 diabetes is diagnosed during a routine medical or when tests are done for an unrelated medical condition.
What are the possible complications of diabetes?
Short-term complication – a very high glucose level
This is not common with type 2 diabetes. It is more common in untreated type 1 diabetes when a very high level of blood sugar (glucose) can develop quickly. However, a very high glucose level develops in some people with untreated type 2 diabetes. A very high blood level of glucose can cause lack of fluid in the body (dehydration), drowsiness and serious illness which can be life-threatening.
If your blood glucose level is higher than normal over a long period of time, it can gradually damage your blood vessels. This can occur even if the glucose level is not very high above the normal level. This may lead to some of the following complications (often years after you first develop diabetes):
- Furring or ‘hardening’ of the arteries (atheroma). This can cause problems such as angina, heart attacks, stroke and poor circulation.
- Kidney damage which sometimes develops into chronic kidney disease.
- Eye problems which can affect vision (due to damage to the small arteries of the retina at the back of the eye).
- Nerve damage.
- Foot problems (due to poor circulation and nerve damage).
- Impotence (again due to poor circulation and nerve damage).
- Other rare problems.
The type and severity of long-term complications vary from case to case. You may not develop any at all. In general, the nearer your blood glucose level is to normal, the less your risk of developing complications. Your risk of developing complications is also reduced if you deal with any other risk factors that you may have, such as high blood pressure.
Complications of treatment
Hypoglycaemia (which is often called a ‘hypo’) occurs when the level of glucose becomes too low, usually under 4 mmol/L. People with diabetes who take insulin and/or certain diabetes tablets are at risk of having a hypo. Not all tablet medicines used for diabetes can cause a hypo.
A hypo may occur if you have too much diabetes medication, have delayed or missed a meal or snack, or have taken part in unplanned exercise or physical activity. To treat hypoglycaemia you should take a sugary drink or some sweets. Then eat a starchy snack such as a sandwich.
Monitoring to detect and treat any complications promptly
Most GP surgeries and hospitals have special diabetes clinics. Doctors, nurses, dieticians, specialists in foot care (podiatrists – previously called chiropodists), specialists in eye health (optometrists) and other healthcare workers all play a role in giving advice and checking on progress. Regular checks may include:
- Checking levels of blood sugar (glucose), HbA1c, cholesterol and blood pressure.
- Ongoing advice on diet and lifestyle.
- Checking for early signs of complications – for example:
- Eye checks – to detect problems with the retina (a possible complication of diabetes), which can often be prevented from becoming worse. Increased pressure in the eye (glaucoma) is also more common in people with diabetes and can usually be treated. Eye checks usually include taking photographs of the back of your eye (retinal photography) to see whether there are any problems.
- Urine tests – which include testing for protein in the urine, which may indicate early kidney problems.
- Foot checks – to help prevent foot ulcers.
- Other blood tests – these include checks on kidney function and other general tests.
It is important to have regular checks, as some complications, particularly if detected early, can be treated or prevented from becoming worse.
You should be immunised against flu (each autumn) and also against pneumococcal germs (bacteria)(just given once). These infections can be particularly unpleasant if you have diabetes.
Although diabetes cannot be cured, it can be treated successfully. If a high blood sugar level is brought down to a normal level, your symptoms will ease.
You still have some risk of complications in the long term if your blood glucose level remains even mildly high – even if you have no symptoms in the short term. However, studies have shown that people who have better glucose control have fewer complications (such as heart disease or eye problems) compared with those people who have poorer control of their glucose level.
Therefore, the main aims of treatment are:
- To keep your blood glucose level as near normal as possible.
- To reduce any other risk factors that may increase your risk of developing complications. In particular, to lower your blood pressure if it is high and to keep your blood lipids (cholesterol) low.
- To detect any complications as early as possible. Treatment can prevent or delay some complications from becoming worse.
Type 2 diabetes is usually initially treated by following a healthy diet, losing weight if you are overweight, and having regular physical activity. If lifestyle advice does not control your blood sugar (glucose) levels then medicines are used to help lower your blood glucose levels. One medicine (usually metformin) is used first but two or even three medicines may be needed.
Most of the medicines for type 2 diabetes are given in tablet form. However, some people with type 2 diabetes need insulin injections to help control blood glucose levels. Some people gain a great deal of benefit from insulin injections and these are sometimes used fairly soon after the diagnosis of type 2 diabetes has been made. Insulin injections can be used in combination with other medicines to further improve glucose control.
Lifestyle – diet, weight control and physical activity
You can usually improve your blood sugar (glucose) control if you:
- Eat a healthy balanced diet. Your practice nurse and/or a dietician will give details on how to eat a healthy diet. The diet is the same as recommended for everyone. The idea that you need special foods if you have diabetes is a myth. Basically, you should aim to eat a diet low in fat, high in fibre and with plenty of fruit and vegetables.
- Lose weight if you are overweight. Getting to a perfect weight is unrealistic for many people. However, if you are obese or overweight then losing some weight will help to reduce your blood glucose level (and have other health benefits too).
- Do some physical activity regularly. If you are able, a minimum of 30 minutes’ brisk walking at least five times a week is advised. Anything more vigorous and more often is even better – for example, swimming, cycling, jogging, dancing. Ideally you should do an activity that gets you at least mildly out of breath and mildly sweaty. You can spread the activity over the day – for example, two 15-minute spells per day of brisk walking, cycling, dancing, etc. Regular physical activity also reduces your risk of having a heart attack or a stroke.
Many people with type 2 diabetes can reduce their blood glucose (and HbA1c) to a target level by the above measures. However, if the level remains too high after a trial of these measures for a few months then medication is usually advised. Medication is used in addition to, and not instead of, the above lifestyle measures.
Inverell Pharmacy – your locally owned and operated pharmacy at 132 Byron Street (next to Telstra). Phone 0267 223146.