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Type 2 diabetesPublished by Bupa's health information team, July 2007. This factsheet is for people with type 2 diabetes or for those who want to know more about it. Diabetes mellitus is a long-term condition where the body is unable to regulate the amount of glucose in the blood properly. Diabetes develops when the body no longer responds adequately to the natural hormone insulin, or when production of insulin is too low. Type 2 diabetes often has no symptoms. However, type 2 diabetes can sometimes cause excessive thirst, frequent trips to the toilet to pass urine and weight loss. Type 2 diabetes can usually be controlled with diet, exercise or medicines. But if type 2 diabetes is poorly controlled, you have an increased risk of heart disease, stroke, nerve damage and blindness. There are two types of diabetes - type 1 and type 2. For more information on type 1 diabetes, see Related topics.
There are about 2 million people in the UK who are known to have diabetes - and another 750,000 people who have the condition but don't know it. Type 2 diabetes is the commonest form, affecting about 85 percent of all people who have the disease. Glucose and insulinGlucose is a simple form of sugar which enters the blood from the intestines. It is absorbed from food and sugary drink as a natural part of digestion. One of the many functions of your blood is to carry glucose around the body. When it reaches body tissues, like muscle cells, it is converted into energy. Glucose concentration in the blood is automatically regulated. The hormone insulin is crucial for this. It's secreted into the blood by the pancreas - a gland which also produces digestive juices - found behind the stomach. The body needs insulin to help cells absorb glucose, where it is then converted into energy. A shortage of insulin causes glucose to build up in the blood, leading to diabetes. Symptoms of type 2 diabetesMany people with type 2 diabetes have no symptoms, and it is often discovered accidentally after routine medical check ups or when you are being screened for something else. If present, the symptoms of type 2 diabetes might include:
These symptoms may be very mild and can go unnoticed for years. Some people simply feel a bit unwell or assume that they are just ageing. Occasionally people with type 2 diabetes develop a condition called hyperosmotic non-ketotic acidosis (HONK). HONK is caused by blood sugar levels rising to very high levels. It causes extreme thirst, nausea, dry skin, increased urine production and disorientation. Eventually it can cause drowsiness and loss of consciousness. HONK needs to be treated in hospital. Causes of type 2 diabetesType 2 diabetes develops when the body becomes resistant to insulin. This happens when the body's tissues (eg muscle), do not fully respond to insulin and so cannot make use of the glucose in the blood for energy. The pancreas responds by producing more insulin. In addition the liver, where glucose is stored, releases more glucose to try to increase the amount available. Eventually the pancreas becomes less able to produce enough insulin and the tissues become more resistant to insulin. As a result, blood glucose levels slowly start to rise. It can take several years for blood sugar to reach a level that causes symptoms of type 2 diabetes. The symptoms may only be subtle, and sometimes there may be no symptoms at all (see Symptoms). Who is at risk of type 2 diabetes?Type 2 diabetes usually develops in people over the age of 40, and the risk of getting it increases with age. However, type 2 diabetes is becoming increasingly common among overweight children in the UK. Type 2 diabetes runs in families, and it is more common in men. Type 2 diabetes is also particularly common among people of African-Caribbean, Asian, or Hispanic origin. People who are overweight or obese and who aren't physically active are more at risk of developing type 2 diabetes. In particular, people who are an "apple-shape" - with lots of fat around the abdomen - are at a greater risk of developing diabetes. If you have high blood pressure or have had a heart attack or a stroke you're also more likely to get type 2 diabetes. High blood glucoseUncontrolled high blood sugar (hyperglycaemia) caused by untreated type 2 diabetes can also lead to a number of long-term complications. Over time, very small blood vessels become damaged. This can cause irreversible damage to the eyes and kidneys, leading to blindness and kidney failure, if left unchecked. Nerves can also be damaged, which can affect your ability to feel sensations and pain, especially in your hands and feet. Badly controlled blood sugar can also damage larger blood vessels. It makes the lining of arteries more likely to fur up and become narrower (atherosclerosis). This makes heart disease and stroke more likely. Damage to your circulation can also increase the risk of leg or foot ulcers, which can lead to gangrene and even amputation. Diagnosis of type 2 diabetesType 2 diabetes can be detected with a blood test to measure the level of glucose in the blood. This might be a fasting glucose test, which is taken after fasting for at least eight hours, or a random glucose test, which can be carried out at any time. You may have another type of blood sugar test called a glucose tolerance test. This measures how your blood sugar changes over time after you swallow a sugary drink. You need to fast overnight before having this test. Treatment of type 2 diabetesIn many cases, type 2 diabetes can be controlled by lifestyle changes alone. DietA healthy diet is essential for people with type 2 diabetes. So called "diabetic foods" aren't necessary for a healthy diet; you just need to watch what you eat. This is the same as the normal, balanced diet that's recommended for good health - low in saturated fat, sugar and salt; high in fibre, vegetables and fruit. Carbohydrates should be spread throughout the day to prevent high blood sugar levels after a meal. Carbohydrates include starchy food such as pasta, potatoes, bread and cereals, and sugary foods including fruit, sweets and biscuits. It's important is to keep your weight under control. This will help keep your risk of getting cardiovascular disease to a minimum. Talk to a state registered dietitian for more information. ExerciseRegular physical activity can increase the body's response to insulin. To stay healthy the government recommends that you do at least half an hour of moderate activity, at least five days a week. SmokingSmoking damages the circulation and, like diabetes, increases the risk of cardiovascular disease. Smoking is unhealthy for everyone, but it's especially important for smokers with diabetes to give up. AlcoholIf you have diabetes, there's no need to give up alcohol. However, women should limit themselves to 2 to 3 units of alcohol a day, and men shouldn't drink more than 3 to 4 units a day. You should also avoid drinking on an empty stomach. MedicinesIf lifestyle changes don't reduce your glucose levels, you may be prescribed medicines to increase insulin production and strengthen its effect. Some examples are listed below.
Insulin injectionsIf lifestyle changes and medicines don't control blood glucose levels, you may need to start insulin injections in addition to, or instead of, oral treatments. Insulin injections may be temporary, or they could be longer-term. Insulin injections are usually self-administered two to four times a day, using either a traditional needle or a pen type syringe with refillable cartridges. There are different kinds of insulin that work at different rates and for different lengths of time. Monitoring your blood sugarYou can monitor your blood sugar levels with a home test kit. This can be useful for your doctor when assessing your treatment for type 2 diabetes. It involves taking a pinprick of blood and analysing it with either colour-coded strips of paper (which give a blood sugar reading based on the colour they turn) or an electronic monitor. Diet and insulin can be adjusted to keep the level within the normal range. Hospital clinics, run by diabetologists (doctors with a special interest in the disease) and specialist nurses are available to provide you with guidance and support to do this. Specialist nurses and GPs at some surgeries provide local diabetic clinics. Further information
Sources
Related topicsThis information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre, and by BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: July 2007. Expected review date: July 2009.
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