What happens if you have type 2 diabetes

Type 2 diabetes is a progressive condition and 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 may 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 another medication that you inject.

Metformin

Metformin is usually the first medicine used to treat type 2 diabetes. It works by reducing the amount of glucose your liver releases into your bloodstream. It also makes your body's cells more responsive to insulin.

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.

SGLT2 inhibitors

SGLT2 inhibitors work by increasing the amount of glucose excreted in urine. They're particularly useful in people with type 2 diabetes and who have cardiac disease.

The three SGLT2 inhibitors that may be prescribed include:

• dapagliflozin
• canagliflozin
• empagliflozin

Each medication is taken as a tablet once a day. The main side effect is a higher risk of genital and urinary tract infections.

If you're unwell and have a dehydrating illness (e.g. fever, vomiting or diarrhoea), it's important you stop these medications. Get your glucose and ketone level checked by your healthcare professional to prevent diabetic ketoacidosis developing.

GLP-1 agonists

GLP-1 agonists acts in a similar way to the natural hormone GLP-1 (see the section on gliptins, below).

They're given by injection and boost your own insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes ("hypos"). They're also particularly useful for people with type 2 diabetes and cardiac disease.

Sulphonylureas

Sulphonylureas increase the amount of insulin that's produced by your pancreas.

Examples include:

• glibenclamide
• gliclazide
• glimepiride
• glipizide
• gliquidone

You may be prescribed one of these medicines if you can't take metformin.

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 glucose) because they increase the amount of insulin in your body. They can sometimes cause side effects, including weight gain, nausea and diarrhoea.

Pioglitazone

Pioglitazone is a type of thiazolidinedione medicine (TZD), which make your body's cells more sensitive to insulin so more glucose is taken from your blood.

It's usually used in combination with other oral diabetes medication. It 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.

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 and are often used with other oral diabetes medication for those who are obese.

Insulin treatment

If glucose-lowering tablets aren't effective in controlling your blood glucose levels, you may need to have insulin treatment.

This can be taken instead of or alongside your tablets, depending on the dose and the way you take it.

Insulin comes in several different preparations, and each works slightly differently. Your treatment may include a combination of these different insulin preparations.

Insulin injections

Insulin must be injected because it would be broken down in your stomach like food and unable to enter your bloodstream if it were taken as a tablet.

If you need to inject insulin, your diabetes care team will advise you about when you need to do 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, also called an insulin pen (auto-injector). Most people need between two and four injections of insulin a day.

Your GP practice or diabetes nurse will also teach a relative or a close friend how to inject the insulin properly.

You can read more about insulin and how to inject it on the Diabetes UK website.

Treatment for low blood glucose (hypoglycaemia)

If you have type 2 diabetes that's controlled using insulin or certain types of tablets (e.g. sulfonylurea), 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. You should aim for a hypo to be treated and to recheck your blood glucose level within 15 minutes.

If blood glucose still less than 4mmol/l then repeat the treatment using a fast acting carbohydrate. When your blood glucose returns to normal then have your longer acting carbohydrate.

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.

You may require input from a health care professional. If the glucagon is not successful, you may require an injection of dextrose into your vein.

Your diabetes care team can advise you on 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, stroke, foot problems, eye and kidney disease is increased.

To reduce your risk of developing other serious health conditions, you may be advised to take other medicines, including:

• anti-hypertensive medicines to control high blood pressure
• a 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.

Monitoring blood glucose levels

If you have type 2 diabetes, your GP or diabetes care team will need to take a reading of your 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 HbA1c test is used to measure blood glucose levels over the previous two to three months.

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 53 mmol/mol (7%) or individualised as agreed with your diabetes team.

Read more about the HbA1c test

Monitoring your own blood glucose

If you have type 2 diabetes, 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 for detecting high blood glucose (hyperglycaemia) or low blood glucose (hypoglycaemia).

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

Blood glucose meters aren't 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're unsure.

Diabetes UK also provides further information about the availability of blood glucose test strips.

Regularly monitoring your blood glucose levels will ensure 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 a day, depending on the treatment you're 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 4-7 mmol/l before meals (preprandial) and less than 8.5 mmol/l two hours after meals (postprandial), although this can vary from person to person.

Your diabetes care team can discuss your blood glucose level with you in more detail. It's important to know your individual targets.

Is type 2 diabetes serious?

What happens in type 2 diabetes?

Can type 2 diabetes be cured?

How do you deal with diabetes 2?