Diabetes – Type 2

Received a diagnosis of diabetes?

You are not alone. In the UK more than 4 million people have diabetes, which is expected to rise to 5 million by 2025. Many people have the condition without knowing it yet.

Whether you’ve just found out or have been living with diabetes for some time, understanding your condition allows you to be in control of your health and better able to share how it is managed with your medical team.

NOTE: Type 1 diabetes is different condition, more commonly diagnosed in children or young adults. This will be dealt with on a separate page.

The basics…

Diabetes is long term high sugar levels in the blood.

This matters because high sugar damages blood vessels and if these are damaged, blood stops going properly to the places it’s needed including eyes, feet, kidneys, heart, brain (and importantly the penis too).

A little bit of science…

Sugar or glucose gives our bodies energy.

Blood carries it away from the gut after eating and moves it where you need it such as your muscles.

If we don’t use up this sugar and there’s too much around, our bodies make it into fat as a way of storing it.

Insulin is the special chemical that makes our bodies store sugar. The more sugar floating around, the more insulin your body has to make to help get that sugar out of your blood so it cant do damage.

In type 2 diabetes, the body stops being able to make enough insulin to keep up with the high level of sugar in the blood. It tries very hard, so normally lots of sugar is stored which is why people with diabetes are often overweight.

When we fail to store all the sugar and the level goes higher and higher, sugar will start to come out in your urine (wee).

This is when most people start to notice something is wrong, as loosing sugar in your wee makes you need to go to the toilet more, makes you thirsty and can make you prone to infections.

Hopefully this makes some sense, but if you’d like to find out more, have a chat to your GP or nurse who can help direct you to good sources of information or clear up any questions you have.

How we deal with it…

There are several important parts here so lets divide them into:

Finding out

Regular checks

Lifestyle changes / non-medicine treatments

Medication

Problems or complications

Support

Finding out

You may find out by having a routine blood test as part of a health check or monitoring of a long term condition such as high blood pressure.

You may also have come to your doctor with a problem that made them do a blood test to look for diabetes such as recurrent infections, being very thirsty, going to the toilet or feeling generally unwell.

Diabetes tests can either be for glucose levels or HbA1c levels.

Glucose levels are best tested when fasting (not having eaten anything since the night before and only water in the morning) as everyones goes up a bit after food.

HbA1c looks at how much sugar your blood has been exposed to over the last 3months so is a good way of seeing overall levels not just a snap shot. This means its helpful not just for diagnosis but for monitoring how well sugars come down with treatment.

You may be shocked or upset to be diagnosed, especially if you have loved-ones who have had the condition and have seen some of the problems it can cause. We are here to support you. By taking charge of your diagnosis, you can change how it affects your life.

Regular checks

You will be invited for regular check ups. All diabetics will have a yearly review, where a blood test is done in advance, then an appointment with the nurse allows assessment of feet, any issues and changes to medication. How frequently you are reviewed in-between will be tailored to your needs. For example if you are trying out a new medicine, you may come back in 1 or 3 months, but if you are stable, with well controlled sugars and no problems, you may be seen less often.

Check ups are there to help us all ensure we provide the right care in a timely manner. Some of the most important things that should be covered can be considered in the alphabet strategy (developed by Dr Vinod Patel, Consultant endocrinologist/ diabetologist at George Eliot Hospital)

A – Advice – how your lifestyle affects diabetes – smoking, exercising, healthy diet and weight.

B – Blood pressure- aiming for less than 140/80

C – Cholesterol – aiming for a total of 4 but certainly less than 5.

D – Diabetic control – the HbA1c blood test result, home readings between 4-7 mmol/L

E – Eyes – an annual retinal screening programme at the practice to look at the back of the eye

F – Feet – making sure there are no foot ulcers, checking the blood supply and sensation

G- Guardian drugs: medicines that can help protect against kidney damage heart disease and stroke. These should be tailored to the individual rather than everybody be on them. These can include: aspirin, ACE / ARB blood pressure drugs and statins for cholesterol.

Lifestyle changes / non-medicine treatments – The most important section!

Having read about how high sugar and the body struggling to control how it is stored results in someone developing diabetes (please see “A little bit of science…”), it hopefully makes sense why changing your diet and doing more exercise is so important.

Firstly, cut out ALL sugar. Whether its in tea and coffee, sprinkled on cereal, in baking, or in the form of biscuits, chocolate, cake, “low-fat” desserts, mid-morning snack bars…. FIND A NO SUGAR-REPLACEMENT.

Ideas? For snacks try some nuts (cheap but tasty bags of mixed nuts available at discount supermarkets are great). Yes, nuts contain fat but these are generally the good fats, and they are high in protein, making you fuller on less for longer!

Low fat yoghurts and desserts make up for loosing the tastiness of the fat with more sugar- avoid! Artificial sweeteners can be useful if you need to add some sweetness, but we are still learning about how our bodies actually react to these (being tricked and thinking its getting sugar). It is best to ween yourself off the habit of sugary things. This is difficult, sugar is addictive so re-learning to enjoy foods for their taste not their sweetness is important.

Rice, potatoes, pasta, bread. These foods are our big supply of starch or carbohydrate and make up a large part of most of our diets. The problem is, once eaten, these foods get broken down into sugar. They may not taste sweet, but sugar is the building block that makes them.

If you really want to help your sugar levels then having only small amounts (and some would suggest heavy restriction) of these, and choosing ones that breakdown slowly such as the brown or wholemeal versions, is the best plan.

Exercise. Moving more and spending less time sitting has a major effect on blood sugar. If you don’t move around much every day, all the energy if the food you eat will need to be stored rather than burnt. The government recommends doing 150mins per week of moderate exercise- that means you could still chat to someone but you’re breathing heavier and raising your heart rate with the effort, for 30mins a day, 5 days a week. This could be a brisk walk, a cycle ride or parking 15mins away from work.

Not sure where to start? check out NHS Couch to 5K for some ideas. You don’t have to do it all, start small and you might surprise yourself with how far you go!

Medication

Medication may be offered depending on how high your blood sugar seems to be and how much effect you manage to have by tackling lifestyle changes first.

Medicines can work in a number of ways to lower your blood sugar. There are various tablets that can make you more sensitive to insulin, stop sugar being released into the blood, make you pee out excess sugar or make your body produce more insulin.

Ones that make more insulin can cause your sugars to go lower than normal levels ( a “hypo”). This can also happen if you are prescribed insulin injections. These drugs are often very effective but are not suitable for everyone- for example if you drive for a living- and so the choice of medicines will depend on your individual circumstances.

Problems or complications

Diabetes is worth making a fuss about because it affects so many parts of your body that the impact on your life if its left uncontrolled can be devastating. This information is not here to be depressing, its here to help you know why you are making some difficult changes to help yourself and your future! Remember, these things CAN be prevented.

Impotence. Erectile dysfunction. Struggling to perform. Call it what you like, but don’t be afraid to mention it. It is common and there is help available. The blood vessels that give the flow to the penis can be affected just like to any other bit of the body. Good blood pressure and sugar control, exercise and not letting it get to you to mentally, can all make the difference here.

Feet. Amputation or having to have toes/ feet removed by a surgeon, is a major issue for poorly controlled diabetics. Your feet are the furthest away from your heart so when blood is not getting to the smallest vessels, they are the part that suffer and so ulcers and infections happen. Loosing a foot then leads to it being harder to be active and mobile and so can make managing your condition harder. Showing any signs of breaks in the skin or ulcers should be a prompt for urgent attention and being really strict with yourself on anything that better controls your sugar.

Eyes, Diabetic retinopathy is the term used to describe the damage to the back of eye by long term high sugars and can  lead to blindness.

Kidneys. Diabetes is one of the top causes of kidney failure along with high blood pressure. Your kidneys are needed to clear out all the waste from your blood and are constantly filtering it. Again controlling sugars and blood pressure is key to stopping this but if it goes too far, dialysis (tubes into the tummy or blood vessels in the arm to filter the blood artificially) or transplant are needed.

Heart and brain. Its not just the little blood vessels that get damaged. Damaged can cause big events in the body as well as slow developing ones. Heart attacks and strokes are much more common in people with diabetes, but as with all the other problems listed above, really good control can reduce this massively.

There are endless reports of people “curing” themselves of diabetes with weight loss, diet changes and exercise. This may not be the case for everyone as many things contribute to having diabetes but you have the power to change what happens to your body. Do not be passive. You body, your choices, take control and change what happens to you.

Support

Your GP and your practice nurse are here to support, encourage, inform and treat you as best we can. We hope the above information is helpful and welcome any feedback that can help us shape it better.

Sometimes, we might need to refer you to a consultant or community nurse for additional input and support and all discuss this with you. All new diabetics should be offered to go on a course to help them better understand their diabetes.

DiabetesUK is a charitable organisation that has a lot of support and guidance online and local groups. There is also a forum for sharing ideas and experiences.

NHS Choices also has plenty of additional information and links to other relevant organisations.