Diabetes is a long-term (chronic) condition caused by too much glucose (sugar) in the blood. It is also sometimes known as diabetes mellitus.
Brought to you by NHS Choices
Diabetes affects two million people in England and Wales. It is also thought that there are a further 750,000 people who have the condition but are unaware of it.
How does diabetes occur?
Normally, the amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland that is located behind the stomach). When food is digested and enters the bloodstream, insulin helps to move any glucose out of the blood and into cells, where it is broken down to produce energy.
However, in diabetes, because there is either not enough insulin, or because there is a poor response (resistance) to insulin, the body is unable to fully use the glucose in the blood stream.
There are two types of diabetes: diabetes type 1 and diabetes type 2. This article focuses on type 2 diabetes. See Useful links for information about type 1 diabetes.
What is type 2 diabetes?
Type 2 diabetes occurs when not enough insulin is produced by the body for it to function properly, or when the body’s cells do not react to insulin. This is called insulin resistance.
Type 2 diabetes is far more common than type 1 diabetes, which occurs when the body does not produce any insulin at all. Around 95% of all people with diabetes have type 2 diabetes.
If you have type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet, and monitoring your blood glucose level. However, as type 2 diabetes is a progressive condition, you may eventually need to take insulin medication, usually in the form of injections.
Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity onset diabetes because it is more common in older people.
Gestational diabetes (diabetes in pregnancy)
During pregnancy, some women have such high levels of glucose in their blood that their body cannot produce enough insulin to absorb it all. This is known as gestational diabetes, and affects approximately 2-7% of pregnant women.
Pregnancy can also sometimes make existing type 1 or type 2 diabetes more difficult to control. If you are pregnant, you may require additional time and effort to manage your diabetes during your pregnancy.
Gestational diabetes can increase the risk of health problems developing in an unborn baby, so it is important that you keep the glucose levels in your blood under control.
In most cases, gestational diabetes disappears after the baby is born. However, women with the condition have an estimated 30% risk of developing type 2 diabetes later on in life.
Symptoms of type 2 diabetes
Most of the symptoms of diabetes are the same for type 1 and type 2 diabetes. However, there are differences in the way the symptoms develop.
The main symptoms of diabetes
The main symptoms of diabetes are:
- feeling very thirsty,
- producing excessive amounts of urine (going to the toilet a lot),
- extreme tiredness (fatigue), and
- weight loss and muscle wasting (loss of muscle bulk).
Other symptoms of diabetes can include:
- itchiness around the vagina or penis,
- recurring thrush as a result of the excess glucose in your urine, and
- blurred vision caused by the lenses of your eyes becoming very dry.
However, not everyone will experience these other symptoms, and they are not usually severe in those who do get them.
Type 2 diabetes
If you have type 2 diabetes, the symptoms will usually develop over weeks or months. Your symptoms may develop so slowly that you do not realise that you are unwell for some time.
Type 2 diabetes may also cause additional symptoms. For example, if you have cuts and sores, they may take longer to heal.
It is sometimes possible to develop type 2 diabetes without having any symptoms at all, or only having a few symptoms. However, you will still require treatment to prevent other health problems such as kidney disease, from developing later on.
Hypoglycaemia (low blood glucose)
If you have diabetes and you are receiving treatment, your blood glucose levels can become very low. This is known as hypoglycaemia, or a 'hypo'. A hypo occurs when any insulin that is in your body moves too much glucose out of your bloodstream.
Hypoglycaemia often occurs if you take too much insulin, although it can also occur if you skip a meal, exercise very vigorously or drink alcohol on an empty stomach.
Symptoms of a ‘hypo’ include:
- feeling shaky and irritable,
- tingling lips,
- feeling weak,
- hunger, and
- nausea (feeling sick).
A hypo can be brought under control simply by eating or drinking something that is sugary, such as a fizzy drink (but not a diet drink), sugar cubes or raisins. This should stop the attack. After you have had something sugary, you should eat a longer-acting carbohydrate food, such as some biscuits or a sandwich.
If a hypo is not brought under control it can lead to:
- slurred speech, and
If this occurs, you will need emergency treatment. One widely used treatment is an injection of a hormone called glucagon. Glucagon raises the level of glucose in your blood.
See the Treatment section, above, and Useful links for more information about hypoglycaemia and hypos.
Hyperglycaemia (high blood glucose)
Type 2 diabetes occurs because your body is unable to produce enough insulin, or because the cells in your body do not respond properly to insulin.
This means that insulin cannot regulate your blood glucose level and, as a result, your blood glucose levels may become very high. This happens because there is no insulin to move glucose out of your bloodstream and into your cells to produce energy.
If your blood glucose levels become too high, you may experience what is known as hyperglycaemia. The symptoms of hyperglycaemia are similar to the main symptoms of diabetes but they may be more severe and come on suddenly. They include:
- extreme thirst,
- a dry mouth,
- blurred vision,
- drowsiness, and
- a frequent need to pass urine.
Hyperglycaemia can occur for several reasons including:
- eating too much,
- being unwell, or
- not taking enough insulin.
If left untreated, hyperglycaemia 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. However, diabetic ketoacidosis is a rare complication of diabetes.
See the Treatment section and Useful links section for more information about hyperglycaemia and diabetic ketoacidosis.
When to seek urgent medical attention
You should seek urgent medical attention if you have diabetes and you develop:
How can gestational diabetes affect my baby?
Gestational diabetes (diabetes in pregnancy) can cause an increased risk of developing congenital health problems, such as a heart defect, or breathing difficulties.
Your baby may also be born with a high birth weight. This can make labour difficult, and you may need to have a caesarean section.
Once born, your baby's blood glucose level may be lower than usual, and will need to be monitored. They are also more likely to develop jaundice.
Causes of type 2 diabetes
Insulin is a hormone that is needed to control the amount of glucose (sugar) in your blood. Type 2 diabetes occurs either because your body cannot produce enough insulin, or because the cells in your body do not react properly to insulin. It is also possible to have type 2 diabetes as a result of both of these reasons.
When you eat, your digestive system breaks down food and passes its nutrients into your bloodstream. Normally, insulin is produced by your pancreas to take any glucose out of your blood and move it into your cells where it is broken down to produce energy.
If you have type 2 diabetes, there is either not enough insulin to move glucose out of your bloodstream, or the insulin that is there is ineffective in moving glucose.
Risk factors for type 2 diabetes
The exact cause of type 2 diabetes is not fully understood, although there are many factors that make developing the condition more likely. The more factors that apply to you, the higher your risk of developing type 2 diabetes.
Being overweight or obese
In most cases, type 2 diabetes is thought to be linked to having excess body fat. If you are overweight or obese, the cells in your body become less responsive to the effects of insulin. This explains why 80% of people who develop type 2 diabetes are overweight or obese, tend not to get much exercise, and have a large waist.
Women are thought to be at a higher risk of developing type 2 diabetes if they have a waist size of 31.5 inches (80cm), or over. Men are thought to be at a higher risk if they are Asian and their waist is 35 inches (90cm) or over, or if they are white, or black, with a waist size of 37 inches (94cm) or over.
It is not known why people of certain ethnicities are more at risk of developing type 2 diabetes than others. You are at least five times more likely to develop type 2 diabetes if you are African-Caribbean or of south Asian origin and living in the UK, compared with someone who is white.
Your risk of developing type 2 diabetes also increases as you get older, which may be due to the fact that people usually gain weight and exercise less as they get older.
You are considered to be at risk of developing type 2 diabetes if you are over 40 years of age and white or over 25 years of age and black, Asian, or from a minority ethnic group. However, some children as young as seven are now being diagnosed with type 2 diabetes.
There is also a genetic risk factor for type 2 diabetes. You are more likely to develop the condition if you have a close relative such as a parent or sibling (brother or sister) who has type 2 diabetes.
You also have an increased risk of developing type 2 diabetes if you have either impaired fasting glycaemia (IFG), or impaired glucose tolerance (IGT). These conditions are sometimes also known as pre-diabetes, and mean that your blood glucose level is higher than usual, but not high enough to cause diabetes. IFG and IGT can both progress into type 2 diabetes if you do not take steps to prevent it.
Causes of diabetes in pregnancy
It's not known why some women develop diabetes when they are pregnant, although there are several factors that make it more likely. You may be at risk of developing gestational diabetes while you are pregnant if you:
Diagnosing type 2 diabetes
It is important that diabetes is diagnosed as early as possible so that treatment can be started. You should see your GP as soon as possible if you experience the symptoms of diabetes. They will ask you some questions about your symptoms and will also request a urine sample.
Blood and urine tests
Your urine sample will be tested to see if it contains glucose. Normally, urine does not contain glucose, but if your blood glucose level is high, some glucose can overflow through your kidneys and into your urine.
If your urine contains glucose, your GP will carry out a blood test in order to confirm the diagnosis of diabetes. A sample of your blood will be taken in the morning before you have had anything to eat and it will be tested to measure your blood glucose levels.
If your blood glucose levels are not high enough for your GP to diagnose diabetes, you may need to have an oral glucose tolerance test. This is also sometimes referred to as a glucose tolerance test (GTT). Your GP will give you a glucose drink and take blood tests every half an hour, for two hours to see how your body is dealing with the glucose.
Diagnosing type 2 diabetes
If you are diagnosed with diabetes, your GP may do further blood and urine tests to find out whether you have type 1 or type 2 diabetes. However, in some cases, it may be clear to your GP from your symptoms and medical history which type of diabetes you have.
There are no specific tests to diagnose type 2 diabetes, but you may be diagnosed with the condition if the results of the tests for type 1 diabetes are negative.
Diagnosing diabetes in pregnancy
Your GP or midwife may test your urine for glucose at your antenatal appointments.
If your urine contains glucose, your GP or midwife may test you for gestational diabetes using the oral glucose tolerance test.
Treating type 2 diabetes
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 in order 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 to remain healthy such as taking regular exercise and eating a healthy diet. 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.
If you have type 2 diabetes, there is a possibility that you may also need (or eventually need) insulin treatment, or other medicines, for your condition. This is because type 2 diabetes is a progressive condition (it gets worse over time) and therefore diet and exercise may not be enough to control your blood glucose levels.
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 average blood glucose level every 2-6 months. This shows how stable your glucose levels are over time and how well your treatment plan is working.
The test that is used to measure your average blood glucose level is known as the HbA1c test. HbA1c is the name of the red blood cells that have glucose attached to them. Measuring them can highlight the amount of glucose that has been in your blood over the past 6-12 weeks.
A high HbA1c level can mean that your blood glucose level is consistently high, and your diabetes treatment plan may need to be altered. 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.
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 need to monitor your own blood glucose levels. This is to ensure that your blood glucose level is as normal and stable as possible.
Even with insulin therapy and a healthy diet, many factors such as exercise, illness and stress, can affect your 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.
In most cases, you will need to monitor your blood glucose levels at home using a simple finger prick blood test. You may need to do this up to four (or more) times a day, depending on the type of insulin treatment that you are taking.
How blood glucose is measured
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.
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.
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.
Examples of sulphonylureas include:
- glipizide, and
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.
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.
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.
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 usually used alone, and they are sometimes used in addition to metformin.
Sometimes, thiazolidinediones can cause liver damage, so while taking one of these medicines you will need regular blood tests to check that your liver is working properly. They may also cause weight gain and, in rare cases, hyperglycaemia (high blood glucose).
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).
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.
In most cases of diabetes, you will need to have insulin injections. Insulin must be injected because the enzymes in your stomach would be unable to digest it if it was taken as a tablet.
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.
Once you begin to come round, you will need to eat something sugary. If you lose consciousness as a result of hypoglycaemia, 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.
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 pneumococcal polysaccharide vaccine (PPV) because these infections can be particularly unpleasant and more serious if you have diabetes.
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).
Diabetes in pregnancy
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.
If you have type 2 diabetes, you will need to look after your health very carefully.
Ensuring that you lead a healthy lifestyle by eating a healthy, balanced diet, exercising regularly and looking after your condition can, in many cases, be enough to control your blood glucose levels without the need for further treatment.
Caring for your health will also make treating your diabetes easier and minimise your risk of developing any complications.
Your GP and diabetes care team will be able to advise you about what you need to do to ensure that you remain healthy and reduce your risk of developing further problems. They may also refer you to other specialists within your care team, such as a dietician, for further advice and support.
Some of the advice that you will receive in order to treat your condition is outlined below.
The belief that if you have diabetes you will have to eat special foods is untrue. Your diet should be the same as that of anyone else - high in fibre, fruit and vegetables and low in fat, salt and sugar.
However, different foods will affect you in different ways, so it is important to know what to eat so you get the right amount of glucose for the insulin that you are taking. A diabetes dietician can help you to work out a diet plan that can be fitted to your specific needs.
Please see the 'lifestyle' section for more information on diet and recipe ideas.
Physical activity lowers your blood glucose level, so it is particularly important to exercise regularly if you have diabetes.
Like anyone else, you should aim to do at least 30 minutes of moderate exercise, at least five times a week. This can be any activity that gets you slightly out of breath and raises your heart rate. However, you should not start a new activity without consulting your GP or diabetes care team first.
As exercise will affect your blood glucose level, you and your care team may have to adjust your insulin treatment, or diet plan, in order to keep your glucose level steady.
Do not smoke
If you have diabetes, you have an increased risk of developing a cardiovascular disease, such as a heart attack or stroke. If you also smoke, you are increasing this risk even further, as well as increasing your risk of many other serious smoking-related conditions, including lung cancer.
If you smoke and you would like to give up, your GP will be able to provide you with advice, support, and treatment to help you quit.
Drink alcohol in moderation
If you have diabetes, you should only drink alcohol in moderation, and you should never drink alcohol on an empty stomach. Depending on the amount that you drink, alcohol can cause either high, or low, blood glucose levels (hyperglycaemia or hypoglycaemia).
Drinking alcohol may also affect your ability to carry out insulin treatment, or blood glucose monitoring, so always be careful not to drink too much. For men, the recommended daily amount of alcohol is between 3-4 units and, for women, the recommended daily amount is between 2-3 units.
Let others know about your condition
If you have type 2 diabetes, you should wear an identity bracelet in order to let others know that you have the condition. This will ensure that if you blackout or collapse, emergency healthcare professionals will quickly know that you have diabetes.
You should also carry a glucagon kit with you in case of hypoglycaemia (low blood glucose). Your diabetes care team should train you, plus several of your family members, and close friends, in how to use it.
See the Symptoms and Treatment sections, above, for more information about hypoglycaemia.
Look after your feet
Having diabetes means that you are more likely to develop problems with your feet, including foot ulcers and infections from minor cuts and grazes. This is due to the possibility of high blood glucose damaging the nerves in your feet (see the Complications section above).
To prevent problems with your feet, you should keep your nails short and wash your feet daily using warm water. Wear shoes that fit properly and see a podiatrist or chiropodist (a specialist in foot care) regularly so that any problems are detected early.
You should also regularly check your feet for any cuts, blisters or grazes because you may not be able to feel them if there is damage to the nerves in your feet. See your GP if you have a minor injury to your foot that does not start to heal within a few days.
Have regular eye tests
If you have type 2 diabetes, you should have your eyes tested at least once a year to check for retinopathy.
Retinopathy is an eye condition where the small blood vessels in your eye become damaged. It can occur if your blood glucose level is too high for a long period of time (hyperglycaemia). If left untreated, retinopathy can eventually cause blindness.
Regular eye tests should help to ensure that any signs of retinopathy are picked up as soon as they appear.
Complications caused by diabetes
If your diabetes is not treated, it can lead to many different health problems. Large amounts of glucose can damage blood vessels, nerves and organs, and even a mildly raised glucose level that does not cause any symptoms can have damaging effects in the long term.
Heart disease and stroke
If you have diabetes, you are up to five times more likely to suffer heart disease and stroke compared with people without diabetes. Prolonged, poorly controlled blood glucose levels increase the likelihood of atherosclerosis (furring up and narrowing of the blood vessels). This may result in poor blood supply to the heart, causing angina. It also increases the chance that a blood vessel in your heart or brain will become completely blocked, causing a heart attack or stroke.
High blood glucose levels can damage the tiny blood vessels of your nerves. This can lead to a tingling or burning pain that spreads from your fingers and toes up through your limbs. If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation.
Retinopathy (damage to the retina at the back of the eye)
Blood vessels in the retina of your eye can become blocked, leaky or grow haphazardly. This prevents the light from fully passing through to your retina. If left untreated, it can damage your vision.
The better you control your blood sugar levels, the less chance you have of developing serious eye problems. Having an annual eye check by a specialist (an ophthalmologist or an optometrist) can help to pick up signs of any potentially serious eye problems early on, so that they can be treated.
If it is caught early enough, diabetic retinopathy can be treated using laser treatment. However, it is important to realise that this will only preserve the sight you have, not make it better.
If the small blood vessels of your kidney become blocked and leaky, your kidneys will work less efficiently. In rare, severe cases this can lead to kidney failure and the need for a kidney transplant.
Damage to the nerves of the foot can mean that small nicks and cuts are not noticed, leading to the development of a foot ulcer. About one in 10 people with diabetes get foot ulcers, which can cause serious infection.
Check your feet every day and report any changes to your doctor, nurse or podiatrist. Look out for sores and cuts that do not heal, puffiness, or swelling, and skin that feels hot to the touch. You should also have a foot examination at least once a year.
Impotence in men (erectile dysfunction)
Damage to the nerves and blood vessels can lead to erection problems in men, particularly in men who smoke. This may be treated with medication.
In general, your risk of developing complications is greatly reduced if your blood glucose level is well controlled and if other risk factors, such as high blood pressure and high cholesterol, are properly controlled.
Miscarriage and stillbirth
Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If their blood sugar level is not carefully controlled in the early stages of pregnancy, there is also an increased risk of the baby developing a serious birth defect.
Pregnant women with diabetes will usually have their antenatal check-ups in hospital or in a diabetic clinic, where healthcare professionals can keep a close eye on their blood sugar levels and control their insulin dosage more easily.
Looking after your eyes
The National Diabetic Retinopathy Screening Programme will arrange for you to have your eyes checked every year. From December 2007, everyone on a diabetes register will be offered the opportunity to have a digital picture taken of the back of their eye. To register, speak to your GP.
Preventing type 2 diabetes
The exact cause of type 2 diabetes is not fully understood but there are many factors that can increase your chance of developing it. For example, you may be at risk of developing type 2 diabetes if you are:
- overweight or obese, and
- if you do not get enough regular exercise.
See the Causes section, above, for more information about the risk factors for type 2 diabetes.
It may not be possible to prevent developing type 2 diabetes but by controlling the risk factors, you may be able to reduce your chances of getting the condition. For example, you should:
- Lose weight, if you are overweight or obese.
- Keep your waist size under 31.5 inches (80cm) if you are a woman, 35 inches (90cm) if you are an Asian man, and 37 inches (94cm) if you are a man who is white, or black.
- Get at least 30 minutes of exercise every day,
- Keep your blood pressure and cholesterol levels under control.
- Only drink alcohol in moderation.
This advice can help anyone to reduce their risk of developing type 2 diabetes, but it is particularly important for those who have an increased risk of developing the condition.
Diabetes in pregnancy. Bupa, January 2008
Causes and Risk Factors. Diabetes UK, 2006
Diabetes symptoms. Diabetes UK, 2006
What is diabetes? Diabetes UK, 2006
Hicks, R. Symptoms of diabetes. BBC Health, (2006)
Hicks, R. What is diabetes? BBC Health, 2006
Type 2 diabetes. MayoClinic.com, Oct 24 2007
Treatments for Type 2 Diabetes. Patient UK, 2006
Type 2 Diabetes. Patient UK, 2008
Diabetes expert Grace Vanterpool on the questions to ask
We asked Grace Vanterpool, a diabetes consultant nurse at Hammersmith and Fulham Primary Care Trust, what she would want to know if she was diagnosed with diabetes.
Will I need injections?
A healthy diet will help you to manage your type 2 diabetes. However, because the condition is progressive, you may eventually need various tablets and possibly insulin injections.
Will I have to give up sugar?
What you eat directly affects the level of glucose, fat and salt in your blood. You'll need to cut down on sugar and sugary foods because these directly affect your blood glucose levels. By choosing a healthier diet that’s high in fibre, fruit and vegetables and low in sugar, fat and salt, you can reduce your chance of developing complications.
You don’t need to buy special diabetic food. When you're newly diagnosed, you'll be referred to a dietitian. By sticking to your management plan, monitoring your condition and following a healthy lifestyle, you should be able to continue the daily activities that you enjoy.
Are there foods that will be beneficial to me?
Eat regular meals containing starchy carbohydrates. Foods such as wholemeal bread, potatoes and brown rice will help to control your glucose levels. Wholegrain varieties are best.
Can I still drink alcohol?
Yes, but in moderation. According to national guidelines that means no more than 21 units of alcohol a week for men and no more than 14 units for women.
Is my weight a factor in coping with my diabetes?
If you're overweight, losing weight will help control your diabetes. Aim to lose 0.4-0.9kg (1-2lbs) a week. Try to cut down on fat. Choose low-fat dairy products and lean cuts of meat. Use low-fat cooking methods, such as grilling and baking. Skim all the fat from casseroles, stews and curries. Choose mono-unsaturated oils, such as olive oil or rapeseed oil and aim for at least five portions of fruit and vegetables a day. They’re low in fat and calories and are a good source of vitamins and minerals.
How important is exercise?
Physical activity is just as important as healthy eating so make it part of your management plan. Exercise helps to regulate blood glucose levels. It also helps your insulin (the hormone that regulates the body’s metabolism) work more effectively, reduces your weight, improves your blood cholesterol and helps to prevent heart disease. Do a physical activity that makes you feel a little out of breath but so you can still talk, for at least 30 minutes each day.
Eating the right food
There is no ‘special’ diet for people with diabetes. Along with the rest of the population, people with diabetes are advised to eat a healthy, balanced diet low in fat, sugar and salt and with plenty of fresh fruit and vegetables.
Dr Sarah Schenker, one of the UK’s leading dieticians, gives her top diabetes diet tips.
Eat plenty of starchy carbohydrates
- Choose carbohydrate foods that have a low glycaemic index (GI). Low GI foods release their energy slowly into the bloodstream and help to keep blood sugar levels more stable.
- Try not to eat too many high GI foods, especially between meals, as these foods can cause blood sugar levels to rise quickly.
Have regular meals and snacks
- Eat breakfast. By the morning, your body has been without food for many hours, and blood sugar levels can be low. A bowl of wholegrain cereal or a toasted bagel with peanut butter boosts your energy levels and sets you up for the day ahead.
- Eat healthy snacks between meals, such as yoghurts, fruit, low-fat cheese and crackers, vegetables sticks with a healthy dip.
- Don't skip meals.
Reduce your intake of unhealthy fats
- Add pulses, beans and lentils as a healthy alternative to meat when making stews, curries or casseroles.
- Choose low-fat dairy products, such as semi-skimmed milk and low-fat yoghurts.
- Always check labels on food, and avoid products that contain hydrogenated fats.
- Avoid fatty meats and meat products. Choose lean cuts of meat and remove visible fat and skin.
- Don't eat fried foods, fast foods and too many pastries, cakes, buns and biscuits.
Keep well hydrated and stick to alcohol guidelines
- Sip water and other healthy drinks throughout the day and carry a bottle of water with you wherever you go.
- Drink alcohol sensibly.
- Don’t let yourself get dehydrated. By the time you feel thirsty it’s too late; you’re already dehydrated.
- Don't overdo it. People with diabetes should be extra-careful not to binge drink, drink too quickly or drink on an empty stomach. If you do drink regularly, aim to have a few alcohol-free days each week.
Choose low GI foods
Try these alternatives:
Try these tasty and healthy recipes:
(Links open in new windows)
Dr Sarah Schenker
Or, try the Diabetes UK online guide to shopping and menu planning to find out how balanced your shopping basket is, and for everything you need to know about food and food labelling.
Diabetes and pregnancy
If you have diabetes and have learned that you are pregnant, you will experience all the emotions that come with having a baby but you will probably also be concerned about the effect your diabetes could have on you and your child. Because of your diabetes, you will have extra challenges to deal with during your pregnancy. The most important challenge is keeping your blood sugar under tight control, particularly before becoming pregnant and during the first eight weeks when your baby is developing. You should also:
- Check your medications. Tablets used to treat type 2 diabetes may harm your baby, so you may have to switch to insulin injections.
- Take a higher dose of folic acid tablets. Folic acid helps to prevent your baby from developing spinal cord problems. Doctors now recommend that all women planning to have a baby take folic acid. Women with diabetes are advised to take 5mg each day (only available on prescription).
- Have your eyes checked. Retinopathy, which affects the blood vessels in the eyes, is a risk for all people with diabetes. Pregnancy can place extra pressure on the small vessels in your eyes, so it’s important to treat retinopathy before you become pregnant.
Your GP or diabetes care team can give you further advice. Diabetes UK also provides useful information to help you get your pregnancy off to a healthy start.
You’ll be best equipped to manage your diabetes on a day-to-day basis if you’re given information and education when you’re diagnosed and then on an ongoing basis.
In 2001, the Department of Health published a national service framework for Diabetes. The purpose of this was to improve the standards of care for everyone with diabetes. The national service framework says that people with diabetes should have information and education to help them self care.
What is structured patient education?
Structured patient education means that there's a planned course that:
- covers all aspects of diabetes,
- is flexible in content,
- is relevant to a person’s clinical and psychological needs, and
- is adaptable to a person’s educational and cultural background.
How do I know if I am receiving good structured education?
The Department of Health together with Diabetes UK set up a group to support good structured education. The group has developed some guidance and published a report so that you can judge whether the education you're getting about your diabetes is of a high standard. If you're not sure, you should ask your diabetes team.
A good planned education course should:
- Provide a written outline, so that you can see what will be taught on the course.
- Be delivered by trained educators. As a minimum the course should be given by someone who understands the principles of patient education and has been assessed as competent to teach the programme.
- Be quality assured to make sure it's of a consistently high standard.
- Provide the opportunity for feedback to show that it's making a difference to the people who go on it.
What course should I go on?
You need to go on a course that meets your needs and will support you. Different courses will suit different people, depending on things such as what type of diabetes they have, and how long they have had it.
- Courses should reflect established methods of adult learning and the curriculum should be clearly written down.
- Courses should be run by appropriately trained professionals from a variety of backgrounds (such as nurses and dietitians) to groups of people with diabetes, unless group work is considered unsuitable for an individual.
- Sessions should be accessible to the broadest range of people, taking into account the person’s culture, ethnicity, any disability they might have and where they live.
- Sessions should be held locally, for instance in a community setting or local diabetes centre.
- Courses should use a variety of teaching styles to promote active learning, where everyone gets involved and can relate what they're learning to their own experiences.
- Courses should be adapted to meet the different needs, personal choices and learning styles of people with diabetes.
- Education should become part of your normal diabetes care.
For type 2 diabetes, there is a national patient education programme that meets all the key criteria for structured education. This is called DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed).
There are also a number of local adult education programmes, many of which are working towards the criteria for structured education. Ask your diabetes team about the adult education programmes they are providing.
Steve Redgrave's story
'There's no reason why you can’t achieve your dreams'
After his victory in the rowing at the Sydney Olympic Games in 2000, Sir Steve Redgrave became the only British athlete ever to have won gold at five consecutive Olympic Games. But what many people don’t realise is that Sir Steve achieved this final triumph against all the odds. Just three years before competing in the Sydney Olympics he discovered he had diabetes
“It was November 1997 and I had this tremendous thirst coming back from training one day,” he says, “and after three or four pints of fluids, I knew something was not quite right.”
Sir Steve’s grandfather was also diabetic, so the athlete wasn’t totally ignorant of the condition. While training abroad, he and his fellow team mates were given ‘dip-sticks’ to test their dehydration levels and Sir Steve knew that he could also test his urine for sugar levels.
“For some reason I decided to do my own test and it came back positive,” he says. “I called my wife, who's a doctor, and she suggested going to see my GP. My blood sugar level was 32 [the norm is somewhere between four and seven] and I was sent to see a specialist. From that day on I’ve been taking insulin.”
The Olympic champion was 35-years-old when he was diagnosed with type 2 or ‘adult onset’ diabetes, in which your body doesn't make enough insulin or the cells in your body don't use insulin properly. He thought it was the end of his career.
“The little I knew about diabetes was that there were few sportspeople with the condition competing at the level I wanted to be at. I thought it was impossible to be diabetic and do what I did, so obviously I was a little depressed. I took it in my stride to some extent because I’d already achieved four Olympic gold medals, but after a consultation with my specialist, he said he didn’t see any reason why I couldn’t achieve my dreams in Sydney. He said it wouldn’t be straightforward, and he was certainly right about that.”
Initially, Sir Steve was put on a low-sugar diet, but swiftly found he didn’t have the energy to carry out the physically enduring training needed to compete at the highest level. Again he returned to his specialist who decided that, as he had performed well on his previous diet (of 6,000 calories a day and which included a high sugar content), he would put him back on that and adjust his insulin dose accordingly.
“After I won in Sydney my specialist and I did a press conference and another diabetes specialist stood up and said, ‘You’re a very lucky man,’” Sir Steve recalls. “He said if I’d come to the clinics of any of the specialists in that room, they would have said I couldn’t do it. They were amazed.”
In theory, he could have been given tablets to control his blood sugar level, but Sir Steve says they wouldn’t have given him enough insulin in his system for the amount of training he was doing.
“I was testing my blood sugar levels, using a pinprick to draw a spot of blood 10 times a day. Normally, people with diabetes do it just once. If you’re not diabetic this happens naturally millions of times a day and it adjusts the insulin accordingly, so I was just trying to mimic as closely as possible what the body does naturally.”
For the past six months, Sir Steve has used an insulin pump. Instead of injecting several times a day, the pump is attached all day, every day, feeding a small amount of the drug into the body all the time. About the size of a pack of playing cards, it's attached to the side of the abdomen and the infusion unit only needs changing every three days.
“It’s a lot more convenient,” he says. “Particularly when you’re out and about. And you can take it off to shower or exercise. The down side is I sometimes wake up during the night with it wrapped around me.
“There are fundamental changes you have to make when you discover you have diabetes, but there is no reason why you can’t achieve your dreams. I made the decision that diabetes was going to live with me; I wasn’t going to live with diabetes.”
'If you have worries, get tested'
Clare Mehmet, a 58-year-old retired telecommunications interpreter, found out by chance that she had type 2 diabetes 10 years ago
“I was waiting for a train when I saw a poster saying, ‘You could have diabetes: Are you thirsty all the time? Are you always tired? Is your vision blurred?’ I was shocked – I’d been experiencing all the symptoms but put it to the back of my mind. So I promptly made an appointment with my GP, who confirmed that I had type 2 diabetes.
“At first I was terrified. I always thought people with diabetes were seriously ill, but once I looked into the condition I realised that as long as you change your diet and keep yourself fit and healthy, you can lead a full and active life.
“I’ve joined lots of support groups since I was diagnosed with diabetes and I do voluntary work to raise awareness about the condition. It’s important that people watch out for the signs. Late diagnosis can cause serious complications, such as blindness, kidney failure, heart disease, stroke and nerve damage, which could lead to blood flow problems and even amputation. So please, if you have any worries, get tested.”
'Becoming diabetic forced me into changing my life around'
Charles Torkington, 54, an IT specialist from Thirsk in North Yorkshire, says that being diagnosed with diabetes gave him the determination to change his diet and his life
“I was a pilot for 30 years, and was fit and active. But when I left the Forces eight years ago my life changed. I studied IT and stopped exercising due to pressures of work. My weight went up to just over 15 stone (92kg).
“Then I started getting pains in my legs, which I thought were linked to a bad back injury. My doctor said it was either cancer or diabetes. A week later he rang to say I had diabetes – my blood sugar levels were so high they were off the scale.
“My GP put me on an exercise and diet regime, reducing portion size and cutting out alcohol completely. I now eat lots of vegetables, salmon and skinned chicken, and no processed food at all.
“I run up the stairs instead of walking, I walk to get the weekend shopping, and polish the car vigorously by hand. I also walk three or four miles in the countryside at weekends.
“I’m now 11 stone 8lb (74kg) and feel so much better. I’ve loads of energy and my blood sugar is under control. Becoming diabetic forced me into changing my life around. I’m very happy.”
'My children can’t believe how good their mum’s looking!'
Shafina Bibi was shocked to hear she had diabetes. But now she’s changed her lifestyle and has never felt better
I was devastated when I found out I had diabetes,” says Shafina Bibi, aged 35. “I never dreamed it would happen to me.”
Shafina moved to the UK from Pakistan nearly 15 years ago. As someone of south Asian origin, she was more at risk of diabetes. Then in 2001, she was diagnosed with type 2 diabetes and she feared the worst.
“Being south-Asian and overweight, I was more at risk,” Shafina says. In fact, the more overweight and unfit you are, the greater your risk of developing the condition. More than 80% of people with type 2 diabetes are overweight.
Shafina also developed temporary gestational diabetes during pregnancy, and this put her at even greater risk of type 2 diabetes. “But, in spite of all these high-risk factors I never dreamed it would happen to me,” Shafina says. “Suddenly, I was told I was at greater risk of complications, as serious as heart attacks, blindness and kidney damage. I felt very frightened and alone.
“When the diabetes educator from the community diabetes team called to invite me to their ‘new to type 2’ education group session it was a huge relief. The educator held the group at my local community centre and spoke in Urdu, my first language, which put me at ease. She explained all about type 2 diabetes, making it absolutely clear that we should keep fit and slim by exercising, cutting back on fat and eating more fruit and veg. It began to sink in that if I wanted to see my grandchildren I’d have to lose some weight.
“When you’re a mother of five, finding time to look after yourself is hard. After my youngest was born nearly four years ago, I became very overweight, and felt far too tired to exercise.
“But I left the session feeling really motivated. I reduced the oil in my cooking and cut out butter and ghee. I began eating more fruit and veg and moved from full-fat to semi-skimmed milk. Now, when I feel peckish, I eat an apple, not half a packet of biscuits. I walk my children to school every day, and make sure I’m going as fast as I can.
“In the last seven months I’ve lost nearly four stone (25kg) and my blood sugar levels have come right down. I feel full of energy. My children can’t believe how good their mum’s looking!”
NHS Choices links
- Carers Direct
- Carers: practical support
- NHS Guide: diabetes
- News: anxiety 'ups men's risk'
- News: broccoli and diabetes
- News: camomile tea helps
- Live Well: diabetes facts
- Health A-Z: diabetic retinopathy
- Health A-Z: type 1 diabetes
- Choices' diabetes blog