Treating type 2 diabetes
There's no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms, to prevent health problems developing later in life.
If you've been diagnosed with diabetes, your GP will be able to explain your condition in detail and help you to understand your treatment.
They will also closely monitor your condition to identify any health problems that may occur. If there are any problems, you may be referred to a hospital-based diabetes care team.
Making lifestyle changes
If you're diagnosed with type 2 diabetes, you'll need to look after your health very 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.
After being diagnosed with type 2 diabetes, or if you're at risk of developing the condition, the first step is to look at your diet and lifestyle, and make any necessary changes.
Three major areas that you'll need to look closely at are your:
- diet
- weight
- level of physical activity
By eating healthily, losing weight (if you're overweight) and exercising regularly you may be able to keep your blood glucose at a safe and healthy level without the need for other types of treatment.
Diet
Increasing the amount of fibre in your diet and reducing your fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it. You should:
- increase your consumption of high-fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables
- choose foods that are low in fat – replace butter, ghee and coconut oil with low-fat spreads and vegetable oil
- choose skimmed and semi-skimmed milk, and low-fat yoghurts
- eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers
- grill, bake, poach or steam food instead of frying or roasting it
- avoid high-fat foods, such as mayonnaise, chips, crisps, pasties, poppadums and samosas
- eat fruit, unsalted nuts and low-fat yoghurts as snacks instead of cakes, biscuits, bombay mix or crisps
The Diabetes UK website has more information and advice about healthy eating.
Weight
If you're overweight or obese (you have a body mass index (BMI) of 30 or over), you should lose weight, by gradually by reducing your calorie intake and becoming more physically active (see below).
Losing 5-10% of your overall body weight over the course of a year is a realistic initial target. You should aim to continue to lose weight until you've achieved and maintained a BMI within the healthy range, which is:
- 18.5-24.9kg/m² for the general population
- 18.5-22.9kg/m² for people of south Asian or Chinese origin ('south Asian' means Bangladesh, Bhutan, India, Indian-Caribbean, Maldives, Nepal, Pakistan and Sri Lanka)
If you have a BMI of 30kg/m² or more (27.5kg/m² or more for people of south Asian or Chinese origin), you need a structured weight loss programme, which should form part of an intensive lifestyle change programme.
To help you achieve changes in your behaviour, you may be referred to a dietitician or a similar healthcare professional for a personal assessment and tailored advice about diet and physical activity.
Physical activity
Being physically active is very important in preventing or managing type 2 diabetes.
For adults who are 19-64 years of age, the government recommends a minimum of:
- 150 minutes (2 hours and 30 minutes) of "moderate-intensity" aerobic activity – such as cycling or fast walking – a week, which can be taken in sessions of 10 minutes or more, and
- muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, tummy (abdomen), chest, shoulders and arms)
An alternative recommendation is to do a minimum of:
75 minutes of "vigorous-intensity" aerobic activity, such as running or a game of tennis every week, and
muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms)
In cases where the above activity levels are unrealistic, even small increases in physical activity will be beneficial to your health and act as a basis for future improvements.
Reduce the amount of time spent watching television or sitting in front of a computer. Going for a daily walk – for example, during your lunch break – is a good way of introducing regular physical activity into your schedule.
If you're overweight or obese (see above), you may need to be more physically active to help you lose weight and maintain weight loss.
Your GP, diabetes care team or dietician can give you more information and advice about losing weight and becoming more physically active.
The Diabetes UK website has more information and advice about getting active and staying active.
Medicines for type 2 diabetes
Type 2 diabetes usually gets worse over time. Making lifestyle changes, such as adjusting your diet and taking more exercise, may help you control your blood glucose levels at first, but they not be enough in the long term.
You may eventually need to take medication to help control your blood glucose levels. Initially, this will usually be in the form of tablets, and can sometimes be a combination of more than one type of tablet. It may also include insulin or other medication that you inject.
Metformin
Metformin is usually the first medicine that's used 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.
Metformin is recommended for adults with a high risk of developing type 2 diabetes, whose blood glucose is still progressing towards type 2 diabetes, despite making necessary lifestyle changes.
If you're overweight, it's also likely you'll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldn't 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's produced by your pancreas. Examples of sulphonylureas include:
- glibenclamide
- gliclazide
- glimepiride
- glipizide
- gliquidone
You may be prescribed one of these medicines if you can't take metformin, or if you aren't overweight. Alternatively, you may be prescribed sulphonylurea and metformin if metformin doesn't control blood glucose on its own.
Sulphonylureas can increase the risk of hypoglycaemia (low blood sugar), because they increase the amount of insulin in your body. They 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're usually used in combination with metformin or sulphonylureas, or both. They may cause weight gain and ankle swelling (oedema). You shouldn't 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.
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) prevent high blood glucose levels, but don't result in episodes of hypoglycaemia.
You may be prescribed a gliptin if you're unable to take sulphonylureas or glitazones, or in combination with them. They're 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's injected twice a day and boosts insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes ("hypos").
It also leads to modest weight loss in many people who take it. It's mainly used in people on metformin plus sulphonylurea, who are obese. A once-weekly product has also 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 for people on metformin plus sulphonylurea, who are obese, and in clinical trials it's 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 isn't 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're not commonly used, but may be an option if you have meals at irregular times. This is because their effects don't last very long, but they're effective when taken just before you eat.
Nateglinide and repaglinide can cause side effects, such as weight gain and hypoglycaemia (low blood sugar).
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