Type 2 diabetes

Type 2 diabetes is more common than type 1 diabetes and usually develops in people over the age of 35.  It is often associated with being overweight.  It tends to run in families and is also more common in people from the Asian community.  It is also more common in women who have had diabetes during a pregnancy (Gestational Diabetes)

This type of diabetes often develops slowly.  It may be diagnosed during a routine health check on the basis of a blood or urine sample or because of symptoms.  Sometimes people can have type 2 diabetes for many months or even years before it is diagnosed.

Type 2 diabetes is not caused by stress, but is often diagnosed during a stressful event.  In people who are prone to develop diabetes, putting on weight, especially around the waistline can precipitate the development of diabetes.  Diabetes is not infectious.

People with type 2 diabetes can still produce insulin but they are either not making enough to meet their body’s needs or they are unable to use the insulin, which is produced efficiently. 

HOW IS TYPE 2 DIABETES TREATED?

The main treatment of Type 2 diabetes is

• A healthy diet, which is low in sugar, low in fat and high in fibre.
• Exercise, to keep weight  and blood glucose under control.
• Tablets are often added; they are not a substitute for healthy eating!
• Insulin is sometimes necessary in some people, when tablets are not sufficient to keep blood glucose under control.

People with type 2 diabetes can develop the complications of diabetes, especially if blood glucose is not kept under control. For this reason Type 2 diabetes must be taken seriously and treated correctly. Type 2 diabetes should never be regarded as ‘mild diabetes’.

The main aim of treatment is to achieve near normal blood glucose levels which, together with a healthy lifestyle, will help to improve well-being, and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.
DIABETES & TABLETS

Tablets are sometimes started if sugar levels do not come under control with a healthy diet; however they are not a substitute for healthy eating.

Sulphonylureas

These tablets are usually the first choice for people who are of normal weight.  They encourage the pancreas to produce more insulin; because of this they can cause hypoglycaemia (a low blood sugar).  Examples include Glipizide, Gliclazide or Glimepiride.  They should be taken before food.

Metformin

Metformin is usually the first choice for people who are overweight.  It helps the insulin already present to work more efficiently, but does not cause hypoglycaemia (low blood sugar).  Metformin can cause stomach upset e.g. sickness, vomiting & diarrhoea; if any of these symptoms happen please inform your GP or Diabetes team.  The side effects can be helped by taking the drug with or after food.

Alpha-Glucosidase Inhibitors

These work by delaying the rate at which sugars are digested and enter the bloodstream after eating.  The most common one is Acarbose.  The drug must be taken with the first mouthful of food to be effective.  It may cause stomach upset e.g. rumbling stomach, wind, diarrhoea or soft smelly stools.  If any of these happen, discuss with your GP or Diabetes team.

Glitazones (Thiazolidinediones)

These drugs also help insulin to work more efficiently. They may be prescribed as an alternative to Metformin in overweight people with type 2 diabetes, especially when Metformin has caused side effects, or they may be used in combination with Metformin. Examples are Pioglitazone and Rosiglitazone. These drugs cannot be used alone or combined with insulin and they are not suitable for some patients, including those with heart failure or liver problems. Patients taking either of these drugs should have blood tests to check their liver function every 2 months for the first year of treatment.

Some people take a combination of tablets, or even tablets combined with insulin, to control blood sugar levels.  Since the requirements for tablets can change over a period of time; it is necessary to have regular check-ups with the Diabetes team or your GP.

Other Medications

• Steroids and some water tablets (diuretics) can cause higher blood sugar levels. Your diabetes treatment may need to be altered if you are on either of these.
• If you need cough, cold or indigestion remedies please obtain sugar-free varieties.

Hypoglycaemia (hypo) or low blood sugar

• This happens if the level of glucose in the blood drops down too low
• It is unlikely in people controlled by diet or on Metformin

Symptoms include trembling, sweating, dizziness and a feeling of hunger Confusion can also occur.  The most common causes of hypoglycaemia are missed or delayed meals, excessive exercise or too large a dose of tablets. If this happens, discuss your treatment with on of your Diabetes team.

HOW TO ACHIEVE GOOD BLOOD GLUCOSE CONTROL

Attend the clinic, either the hospital or your general practice regularly. Regular check-ups mean that you will receive advice on how to avoid complications of diabetes.  It also means that if problems develop, they can be picked up and treated at an early stage.

Self Testing: Testing either urine or blood for glucose is a way for you to monitor how well you are controlling your diabetes.  The diabetes nurse or practice nurse will show you how to do this.

Diet: It is important to keep to a healthy diet which is low in sugar, low in fat and high in fibre.

Exercise:  Regular exercise is an ideal way to keep fit and healthy.  Any form of exercise is beneficial e.g. swimming, keep fit classes or walking.  Exercise also helps to reduce blood glucose levels.