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Diabetes, type 2

Treating type 2 diabetes 

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The way blood sugar levels (HbA1c) for people with diabetes are reported was changed on June 1 2009. An expert explains what the blood test is used for and why the reporting system was changed

Diabetes cannot be cured but the aim of treatment is to keep your blood glucose level as normal as possible and to control your symptoms to prevent health problems developing later on in life.

If you have been diagnosed with diabetes, you will be referred for specialist treatment from a diabetes care team. Your care team will be able to:

  • explain your condition to you in detail,
  • help you to understand your treatment, and
  • answer any questions you may have.

They will also closely monitor your condition in order to identify any other health problems that may occur.

Treating type 2 diabetes

If you are diagnosed with type 2 diabetes, you will need to look after your health carefully for life. This may seem daunting but your diabetes care team can offer support and advice about all aspects of your treatment.

If you have type 2 diabetes, there are a number of things you can do yourself to remain healthy, such as taking regular exercise, eating a healthy diet, and losing weight if you are overweight or obese. These measures may be enough to keep your blood glucose at a safe and healthy level, without the need for other treatment.

See the Self help section, above, for more information about how to look after your health when you have type 2 diabetes.

Type 2 diabetes usually gets worse over time and, even if they work at first, diet and exercise may not be enough to control your blood glucose levels.

If you have type 2 diabetes, you may need (or eventually need) medicines that reduce high levels of blood sugar. At first this will usually be tablets, sometimes a combination of more than one type of tablet. It may also include injectable insulin.

The various ways that type 2 diabetes can be treated are outlined below.

Blood glucose testing

If you have type 2 diabetes your GP or diabetes care team will need to take a reading of your long term blood glucose level about every 2-6 months. This shows how stable your glucose levels have been in the recent past and how well your treatment plan is working.

The test that is used to measure your blood glucose levels over the previous 6-12 weeks  is known as the HbA1c test. HbA1c is a form of haemoglobin, the oxygen-carrying chemical in red blood cells, that has glucose attached to it. 

A high HbA1c level means 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 will be able to help you to set a target HbA1c level for you to aim for. This will usually be less than 7.5% HbA1c (59 mmol/mol). It can be as low as 6.5%  (48mmol/mol) for some people, or higher for some people who experience frequent episodes of hypoglycaemia ('hypos').

A new way of reporting HbA1c results was introduced on June 1 2009, initially alongside the way of recording it that many diabetes patients will already be familiar with.

For more information on these changes and why they happened, please see Changes to how HbA1c levels are reported

Monitoring your blood glucose levels

As well as having your blood glucose level checked by a health professional every 2-6 months, you may also choose to monitor your own blood glucose levels.

Even with treatment with tablets and/or insulin therapy and a healthy diet, many factors such as exercise, illness and stress, can affect blood glucose levels. Other factors that may also affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, changes to hormone levels during the menstrual cycle.

Many people with diabetes monitor their blood glucose levels at home using a simple finger prick blood test. This is to ensure that your blood glucose level is as normal and stable as possible. Blood sugar levels vary thoughout the day so you may need to do it several times a day, depending on the type of treatment that you are taking.

How blood glucose is measured

In home testing, blood glucose levels are usually measured in terms of how many millimoles of glucose there is in a litre of blood. A millimole is a measurement that is used to define the concentration of glucose in your blood. The measurement is expressed as millimoles per litre, or mmol/l, for short.

Blood glucose levels vary from person to person and the amount of glucose in your blood will also change throughout the day. Therefore, there is no such thing as an ‘ideal' blood glucose level.

However, a normal blood glucose level is between 4.0-6.0 mmol/l before meals (preprandial), and less than 10.0 mmol/l two hours after meals (postprandial). Your diabetes care team will be able to discuss your blood glucose level in more detail with you.

Find out how to test your glucose levels

Medicines for type 2 diabetes (glucose-lowering tablets)

If regular exercise and a healthy diet are not effective in controlling your blood glucose levels, you may need medicines to treat type 2 diabetes.

There are several different types of medicines, taken as tablets, that are used to treat type 2 diabetes, You may need to take a combination of two or more medicines to control your blood glucose level. Some of the medicines that may be prescribed for you are outlined below.

In the UK it is usual to give metformin as the initial tablet treatment for type 2 diabetes. If a second glucose lowering drug is needed a sulphonylurea is often added. If a third glucose lowering treatment is needed this could be a glitazone, a gliptin, exenatide or insulin.

Metformin

Metformin is often the first medicine that is recommended 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.

If you are overweight, it is likely that you will be prescribed metformin. Unlike some other medicines that are used to treat type 2 diabetes, metformin should not 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

Examples of sulphonylureas include:

  • glibenclamide,
  • gliclazide,
  • glimerpirizide,
  • glipizide, and
  • gliquidone.

These medicines increase the amount of insulin that is produced by your pancreas. You may be prescribed one of these medicines if you cannot take metformin or if you are not overweight.You may be prescribed a sulphonylurea and metformin, if metformin does not 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. Sulphonylureas may sometimes cause side effects including weight gain, nausea and diarrhoea.

Glitazones (thiazolidinediones, TZDs)Pioglitazone and rosiglitazone are both examples of thiazolidinediones.
These medicines make your body’s cells more sensitive to insulin so that more glucose is taken from your blood. They are not often used alone, but are usually used in addition to metformin or sulphonylureas, or both.They may cause weight gain and ankle swelling. There have been some recent reports that rosiglitazone might be associated with a small increased risk of getting a heart attack

Gliptins (DPP-4 inhibitors)

Gliptins are a new group of treatments for type 2 diabetes that 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 (sitagliptin and vildagliptin) act to prevent high blood glucose levels, but do not result in episodes of
hypoglycaemia. They are not associated with weight gain. Because they are new, they are used cautiously, but may be added to metformin or sulphonylureas if blood glucose does not come under control with one

Exenatide

Exenatide is a new injectable treatment that acts in a similar way to the natural hormone GLP-1 (see section on gliptins, above). It boosts insulin production when there are high blood glucose levels and so reduces blood glucose without the risk of
hypogycaemic episodes ('hypos'). It also results in a modest weight loss in many people who take it. It is mainly used in people on metformin plus sulphonylurea who are obese (with a BMI of 35 or above).

 

Acarbose

Acarbose helps to 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 is not often used to treat type 2 diabetes because it usually causes side effects, such as bloating and diarrhoea. However, you may be prescribed acarbose if you cannot take other types of medicines for type 2 diabetes.

Nateglinide and repaglinide

Nateglinide and repaglinide stimulate the release of insulin by your pancreas. They are not commonly used but may be an option if you have meals at irregular times. This is because their effects do not last very long, but they are effective when taken just before you eat.

Nateglinide and repaglinide can cause side effects, such as weight gain and hypoglycaemia (low blood glucose).

Insulin treatment

You may need to have insulin treatment if glucose-lowering tablets are not effective in controlling your blood glucose levels. Insulin treatment can be taken instead of or alongside your tablets, depending on the dose and the way that you take it.

Insulin comes in several different preparations and each work slightly differently. For example, some are long-acting (lasting up to a whole day), some are short-acting (lasting up to eight hours), and some are rapid-acting (they work quickly but do not last very long). Your treatment may include a combination of these different insulin preparations. 

Insulin injections

In most cases of diabetes, you will need to have insulin injections. Insulin must be injected because it is a protein. The enzymes in your stomach would  digest it, like a food, if it was taken as a tablet. It could not then be absorbed in the gut.

If you need to take insulin by injection, your diabetes care team will advise you about when you need to take it. They will also show you how to inject it yourself. They 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, which is also called an insulin pen (auto-injector). Most people need between 2-4 injections a day. Your GP or diabetes nurse will also teach one of your close friends or relatives how to inject the insulin properly.

Insulin pump therapy

Insulin pump therapy is an alternative to injecting insulin. An insulin pump is a small device (about the size of a pack of playing cards) that holds insulin.

The pump is attached to you by a long piece of thin tubing, with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach but you could also insert it into your hip, thigh, buttock or arm.

The pump allows insulin to flow into your bloodstream at a rate that you control. This means that you no longer need to give yourself injections, although you will need to monitor your blood glucose levels very closely to ensure that you are receiving the right amount of insulin.

Insulin pump therapy can be used by adults, teenagers and children (with adult supervision) who have type 2 diabetes. However, it may not be suitable for everyone. Your diabetes care team may suggest pump therapy if you often have hypoglycaemia (low blood glucose), or if you can manage your own day-to-day diabetes treatment and look after your health carefully. 

See the Useful links section, above, for further information about insulin pump therapy.

Insulin jet system

The insulin jet system is a new device for delivering insulin without using a needle. It is available on the NHS and it can be used on your stomach, buttocks, and thighs.

The insulin jet system works by forcing a very small stream of insulin through a nozzle that is placed against your skin. The insulin travels at a very high speed and passes through your skin. Your diabetes care team will be able to advise you about whether this needle free method of insulin delivery is suitable for you.

Treatment for hypoglycaemia (low blood glucose)

Hypoglycaemia can occur when 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 the majority of cases, these measures will be enough to raise your blood glucose level to normal, although it may take a few hours.

However, if you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness. If this occurs, you will need to have an injection of glucagon into your muscle. Glucagon is a hormone that quickly increases your blood glucose levels.

If you have type 2 diabetes, you may need to carry glucagon with you at all times, and your diabetes care team may show several of your family members and close friends how to inject the glucagon into your muscle if you need it.   

If you do lose consciousness because of hypoglycaemia you will need to eat something sugary when you come round.There is a risk that it may happen again within a few hours, so you will need to rest afterwards and have someone with you.

If the glucagon injection into your muscle does not work and you are still drowsy or unconscious 10 minutes after the injection, you will need urgent medical attention. If you are with someone who is in this situation, you should call 999 to request an ambulance.

You will need to have another injection of glucagon straight into a vein, which must be given by a trained healthcare professional.

Treatment for hyperglycaemia (high blood glucose) and diabetic ketoacidosis

Hyperglycaemia is a condition that can occur when your blood glucose levels become too high. It can happen for several reasons such as eating too much, being unwell or, if you have insulin treatment, not taking enough insulin.

If hyperglycaemia occurs, you may need to adjust your diet or your dosage of insulin to keep your glucose levels normal. Your diabetes care team will advise you about the best way to do this.

However, if hyperglycaemia is left untreated, it can lead to diabetic ketoacidosis, which can eventually cause unconsciousness and even death.

Diabetic ketoacidosis occurs when your body begins to break down fats for energy instead of glucose, leading to a build up of acids in your blood. See the Symptoms section, above, for the warning signs of diabetec ketoacidosis.
 
If you develop diabetic ketoacidosis, you will need urgent treatment in hospital. You will be given insulin directly into a vein (intravenously). If you are dehydrated, you may also need other fluids given by a drip, including saline (salt solution) and potassium.

Other treatments

If you have either type of diabetes, you have an increased risk of developing heart disease, stroke and kidney disease. To reduce the chance of this, you may be advised to take:

  • Anti-hypertensive medicines to control high blood pressure.
  • A statin, such as simvastatin or atorvastatin, to reduce high cholesterol levels.
  • Low dose aspirin to prevent 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 it is treated early enough, diabetic kidney disease is often reversible. For more information about ACE inhibitors, see the Useful links section.

It is also recommended that you have an influenza (flu) vaccine each year and a one-off vaccination that protects against some forms of pneumonia and meningitis (pnemococcal disease). These infections can be particularly unpleasant and more serious if you have diabetes.

Regular check-ups

Your GP or diabetes care team will need to check your eyes, feet and nerves regularly because they can be affected by diabetes (see the Complications section, above).

Carers

 

 If you are looking after someone who suffers from diabetes that affects them so much that they need you to help them with their activities, Carers Direct can help you. On Carers Direct you can find out all about how to get help with caring for the person you look after, your legal and employment rights, and getting benefits on Carers Direct.

 

 

Diabetes in pregnancy

  • If you have gestational diabetes, you'll need more antenatal appointments and check-ups than a pregnant woman without diabetes.
  • Your diabetes care team will show you how to check your blood glucose levels every day.
  • You may need to alter your diet and increase the amount of moderate exercise that you do.
  • You may need to have injections of insulin (your care team will help you with this).

If you developed diabetes while you were pregnant, it is likely your blood glucose levels will return to normal after your baby is born.

If you had diabetes before you became pregnant, you'll need to continue to treat and manage your condition with the help of your care team.


  • show glossary terms

 

Insulin

Insulin is a hormone released by the pancreas that helps the body to control blood sugar levels.

Glucose

Glucose (or dextrose) is a type of sugar that is used by the body to produce energy.

Liver

The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.

Nausea

Nausea is when you feel like you are going to be sick.

Kidney

Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.

 

Last reviewed: 05/01/2009

Next review due: 05/01/2010

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