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Understanding and Treating Type 2 Diabetes

What is Type 2 Diabetes[1]
Type 2 diabetes is a common condition that causes blood sugar (glucose) levels to become too high. It can cause symptoms like excessive thirst, needing to urinate a lot and extreme tiredness. It can also increase your risk of serious problems with your eyes, heart and nerves. It’s a lifelong condition that can affect your everyday life. You may need to change your diet, take medicines and have regular check-ups.

Type 2 diabetes is caused by problems with a chemical in the body (hormone) called insulin. It is often linked to being overweight, inactive, or having a family history of type 2 diabetes.

Differences between Type 1 and Type 2 Diabetes[2]
The main difference between type 1 and type 2 diabetes is that whilst type 1 diabetes is a genetic condition often showing up early in life, type 2 is mainly lifestyle-related and develops over time. With type 1 diabetes, the immune system attacks and destroys the insulin-producing cells in the pancreas.

Picture Credit: “Type 2 Nation” by id-iom is licensed under CC BY-NC 2.0.

The main thing to remember is that both types of diabetes are as serious as each other. Having high blood glucose levels can lead to serious health complications, no matter whether you have type 1 or type 2 diabetes. You need to take the right steps to manage it.

Around 90% of people with diabetes in the UK have type 2, a serious, lifelong condition.

Having type 2 diabetes without treatment means that high sugar levels in your blood can seriously damage parts of your body, including your eyes, heart and feet. These are called the complications of diabetes. But with the right treatment and care, you can live well with type 2 diabetes and reduce your risk of developing them.[3]

Below is a guide to some of the main differences between the two types of diabetes[4]. There’s a YouTube video online here.


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Overview of the most significant symptoms of Diabetes
Public Domain. Attribution: Mikael Häggström, Public domain, via Wikimedia Commons

File URL:

Living with Type 2 Diabetes

Many people have type 2 diabetes without realising it – because symptoms do not necessarily make you feel unwell. Symptoms of type 2 diabetes include[5]:

  • Urinating more than usual, particularly during the night
  • Feeling thirsty all the time
  • Having a dry mouth – dehydration and urinating more than usual can drain moisture from your mouth
  • Feeling very weak and tired
  • Losing weight without trying to
  • Itching around the penis or vagina (repeatedly getting thrush)
  • Trouble with gums and teeth – the gums may become red, swollen, and tender, and it is more likely to get infections in your gums, causing tooth loosening.
  • Tingling hands and feet – type 2 diabetes can affect nerves in your hands and feet
  • Cuts or wounds taking longer to heal
  • Blurred vision – high blood sugar can make you have trouble focusing
  • Headaches – high blood sugar levels can cause your head to hurt
  • Loss of consciousness – after exercise, skipping a meal or taking too much medication, your blood sugar could go too low, and you could pass out

People are more at risk of developing type 2 diabetes if they:

  • are over 40 (or 25 for south Asian people)
  • have a close relative with diabetes (such as a parent, brother or sister)
  • are overweight or obese
  • are of Asian, African-Caribbean or black African origin (even if born in the UK)

If you’re worried about type 2 diabetes, you can check your risk by answering a few questions[6]/[7]. Depending on your risk score, you might be able to get help from the Healthier You NHS Diabetes Prevention Programme[8].

Type 2 diabetes is often diagnosed following blood or urine tests for something else. However, you should see a GP straight away if you have any symptoms of diabetes. To find out if you have type 2 diabetes, it’s necessary to go through the following steps:

    1. See a GP about your symptoms.
    2. The GP will check your urine and arrange a blood test to check your blood sugar levels. It usually takes about 1 to 2 days for the results to come back.
    3. If you have diabetes, the GP will explain the test results and what will happen next.

What the GP will discuss with you during your appointment depends on the diagnosis and the treatment they recommend[10]. Generally, they’ll talk to you about:

  • what diabetes is
  • what high blood sugar means for your health
  • how low blood sugar can affect you and learning to recognise the signs
  • whether you need to take medications and insulin
  • changes to your diet and exercise (becoming more active)
  • your lifestyle – for example, concerning alcohol and smoking
  • the need for regular type 2 diabetes check-ups

Regular Tests[11]
Every three months: Blood sugar checks (HbA1C test) (which checks your average blood sugar levels and how close they are to normal over the last three months when newly diagnosed). Once you are stable, the HbAIC test is taken every six months. The blood taken for testing can be done by your GP or by a diabetic nurse.

Once a year:
Feet: A check to look for ulcers and infections or whether you’ve lost any feeling in your feet. This can be done by your GP, diabetes nurse or podiatrist, but you should speak to your GP immediately if you have cuts, bruises or numbness in your feet.

Eyes: Checks for damage to blood vessels in your eyes. Speak to your GP immediately if you have blurred vision. A specialist NHS unit or private optometrists usually undertake the tests as they will ‘freeze’ the eye to look for retinal neuropathy and any changes from the previous results.

Blood pressure, cholesterol and kidneys: Checks for high blood pressure, heart and kidney disease. This can be done by your GP or diabetes nurse.

Common Blood Tests and Procedures

Why test blood sugar levels?[12]
If you take certain medication, like insulin or sulphonylureas, checking your blood sugars is a vital part of living with diabetes, as it can help you work out when:

  • you need to take more medication
  • you need to eat something
  • you need to get up and move around more often

Routine checks can help you know when you might be starting to go too low (called a hypo) or too high (called a hyper). It’s a way of getting to know your body and how it works. It can help you and your healthcare team spot patterns too. But importantly, it will help you stay healthy and prevent serious diabetes complications now and in the future. Complications mean serious problems in places like your feet and your eyes. This happens because too much sugar in the blood damages your blood vessels, making it harder for blood to flow around your body, leading in extreme cases to very serious problems like sight loss and needing an amputation. If your blood sugar levels are too high for too long, the more at risk you are.

How to check your blood sugar levels
Finger-pricking is how you find out your blood sugar level at that moment in time. Your healthcare team will show you how to do the test as it’s important that you’re taught how to do it properly. Finger-prick testing isn’t a problem for most people, and it quickly becomes part of their normal routine. But it can be a stressful experience for others, and that’s understandable. Knowing all the facts and speaking to other people can help – contact the helpline or chat with other people with diabetes on the Diabetes UK online forum[13]. They’ve been through it too and will understand your worries.

Watch a video[14] and follow simple steps about testing your blood sugars in the right way and safely. You’ll need these things to do the test:

Blood sugar levels can be checked by doing a finger-prick test or using an electronic blood sugar monitor called a flash glucose monitor or CGM.

Picture Credit: “Finger Prick Diabetes Test” by danielfoster437 is licensed under CC BY-NC-SA 2.0.

You can do this several times a day – helping you keep an eye on your levels as you go about your life, which will help you work out what to eat and how much medication to take.

Ideal Blood Sugar (Glucose) Target Range[15]
The following shows the general guidelines, but your individual target range may differ – your healthcare team will agree on personal targets with you. Ideally, there is a healthy blood sugar range that you should aim for, on waking or before a meal:

  • Under 4mmol/l[16] – is too low (hypo)
  • From 4 to 7 mmol/l – is a healthy target
  • Over 7mmol/l – is too high (hyper)
  • Two hours after meals: less than 8.5mmol/l

You’ll get different readings at different times of the day, depending on things like what you’ve eaten and how much you are moving around.

Low blood sugar level [17]
If your blood sugar levels are too low, usually below 4 mmol/l, you may experience a hypo. Hypos need to be treated immediately, or your blood sugar levels will drop further, and you may experience a severe hypo and require emergency treatment. There are many different symptoms[18] of a hypo[19]. You must be able to recognise the signs of a hypo, in case your blood sugar level gets too low.

There’s more information about what to do if you are having a hypo in a video from Diabetes UK[20].

The Signs of Hyperglycemia (High Blood Sugar Levels)[21]
If your blood sugar levels are slightly above your targets, there are usually no symptoms. But if your blood sugar levels become too high, you may experience some symptoms associated with a ‘hyper’. The blood sugar level at which symptoms begin to appear is different for everyone, but the common symptoms include passing more urine than normal, being very thirsty, having headaches and feeling tired and lethargic. It’s important that you know how to treat a hyper to avoid developing ketones in the blood.

The Signs of Hypoglycemia (Low Blood Sugar Levels)[22]
A low blood sugar level can affect everyone differently. You’ll learn how it makes you feel, although your symptoms may change over time. Early warning signs of a low blood sugar level include:

  • sweating
  • feeling tired
  • dizziness
  • feeling hungry
  • tingling lips
  • feeling shaky or trembling
  • a fast or pounding heartbeat (palpitations)
  • becoming easily irritated, tearful, anxious or moody
  • turning pale

If a low blood sugar level is not treated, you may get other symptoms, such as:

  • weakness
  • blurred vision
  • confusion or difficulty concentrating
  • unusual behaviour, slurred speech or clumsiness (like being drunk)
  • feeling sleepy
  • seizures or fits
  • collapsing or passing out

A low blood sugar level, or hypo, can also happen while you’re asleep. This may cause you to wake up during the night or cause headaches, tiredness or damp sheets (from sweat) in the morning. The warning signs of a hypo may disappear following a series of frequent hypos but return when the blood sugar levels are normalised again.

Diabetic Ketoacidosis (DKA)[23]
Diabetic ketoacidosis (DKA) is a serious problem in people with diabetes if their body starts to run out of insulin. If it happens, harmful substances called ketones build up in the body, which can be life-threatening if it’s not found and treated quickly.

The condition mainly affects people with type 1 diabetes, but it can sometimes affect people with type 2 diabetes. If you have diabetes, it’s important to be aware of the risk and know what to do if you get DKA. DKA is an emergency and needs to be treated in the hospital immediately. DKA is caused by a lack of insulin in the body, which results in the body breaking down fat for energy. Ketones are released into the body as the fat is broken down. If you have diabetes, certain things can make this more likely to happen:

  • having an infection, such as flu or a urinary tract infection (UTI)
  • not following your treatment plan, such as missing doses of insulin
  • an injury or surgery
  • taking certain medicines, such as steroids
  • binge drinking
  • using illegal drugs
  • pregnancy
  • having a period

Sometimes, there’s no obvious trigger. Symptoms of DKA, which usually start over a 24-hour period, but can happen faster, include:

  • needing to urinate more frequently than usual
  • feeling very thirsty
  • being sick
  • stomach ache
  • breath that smells fruity (like pear drop sweets or nail varnish)
  • deep or fast breathing
  • feeling very tired or sleepy
  • confusion
  • passing out

The NHS says[24] you can get DKA if you have high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine. You can check your ketone levels using a home-testing kit. If your blood sugar level is 11mmol/L or above, and you have a blood or urine ketone testing kit, check your ketone level:

  • lower than 0.6mmol/L is a normal reading
  • 6 to 1.5mmol/L means you’re at a slightly increased risk of DKA, and you should test again in 2 hours
  • 6 to 2.9mmol/L means you’re at an increased risk of DKA and should contact your diabetes team or GP as soon as possible
  • 3mmol/L or above means you have a very high risk of DKA and should get medical help immediately

If you do a urine ketone test, a result of more than 2+ means there’s a high chance you have DKA, and you should get medical help immediately. Call your diabetes team or GP as soon as possible if you’re not sure whether you need emergency help – for example:

  • your blood sugar or ketone levels are high or getting higher over time, but you do not feel unwell
  • you feel unwell, but your blood sugar or ketone levels are normal or are only a little bit higher than usual

You can greatly lower your chances of getting ketoacidosis by managing your diabetes well. This includes taking all your medicines (including your insulin), as you are told, and measuring your blood sugar often during the day to ensure it is not too high or too low.

The following tips can help reduce your chances of getting DKA:

  • check your blood sugar level regularly so you can notice and treat an increase quickly
  • follow your treatment plan – do not stop taking insulin unless you’re told to by a healthcare professional
  • take extra care when you’re ill – your diabetes team can give you some “sick-day rules” to follow, which include things like checking your blood sugar more often and checking your ketone level
  • be careful taking new medicines – check with a doctor or pharmacist first, as some medicines can increase the risk of DKA

DKA is usually treated in a hospital where treatment for DKA is given. The treatment includes:

  • insulin, usually given into a vein (intravenously)
  • fluids are given into a vein to rehydrate your body
  • nutrients are given into a vein to replace any you’ve lost

Lifestyle Changes
Management of type 2 diabetes includes[25]:

  • Healthy eating
  • Regular exercise
  • Weight loss
  • Possibly, diabetes medication or insulin therapy
  • Blood sugar monitoring

Recommended lifestyle interventions[26] include:

  • Taking two and a half hours each week of moderate-intensity[27] physical activity or one hour and 15 minutes of high-intensity[28] exercise
  • Losing weight gradually to achieve a healthy body mass index (BMI)
  • Replacing refined carbohydrates with whole grain foods and increasing intake of vegetables and other foods high in dietary fibre
  • Reducing the amount of saturated fat in the diet

NICE recommends taking either 2.5 hours of moderate-intensity physical activity or 75 minutes of intense exercise. A healthy BMI range is between 18.5 and 24.9, or for people of South Asian descent, between 18.5 and 22.9. For those with a BMI above the healthy range, NICE recommends achieving weight loss gradually, with a target to reduce weight by 5 to 10% over 22 months.

Weight loss can help reduce the risk of developing diabetes and enable people with pre-existing pre-diabetes or type 2 diabetes to better control their blood glucose levels.

Could Vitamin D supplements prevent type 2 diabetes?[29]
Vitamin D deficiency has been linked to increased risk for several conditions, including type 2 diabetes. Many studies have sought to determine whether, how much, and which type of vitamin D supplements could help reduce the risk of developing type 2 diabetes.

The latest research shows that these studies have largely proved inconclusive, and the reduction in risk that daily vitamin D supplements could provide is small. Vitamin D deficiency is a growing problem, particularly in countries in the northern hemisphere. Similarly, so is type 2 diabetes. This has led some researchers to think there might be a link between the two.

Could whey protein before meals help blood sugar?[30]
Drinking a shot of whey protein before meals could help with blood sugar control:

  • A recent study finds a simple way to help people with diabetes manage their blood sugar.
  • Researchers observed that the participants who drank a shot of whey protein before meals had levelled out blood sugar levels after eating.
  • The study participants also had two extra hours each day with healthy blood glucose levels thanks to the whey protein.

The study revealed that when people with type 2 diabetes consumed a small drink (100 ml shot) containing 15 grams of whey protein 10 minutes before their meals, they reduced post-meal glucose levels and achieved a more balanced and healthy daily blood sugar levels.

The shot of whey protein:

  • Reduced daily blood sugar levels without increasing the risk of hypoglycaemia.
  • In addition, participants in the survey experienced two additional hours per day within euglycaemia[31].

Can Type 2 Diabetes be cured?[32]
There isn’t a permanent cure for type 2 diabetes yet. But strong evidence shows that some people can put their type 2 diabetes into remission by losing weight. Remission in type 2 diabetes means your blood sugar levels are below the diabetes range, and you don’t need to take diabetes medication. It can be life-changing, but it’s not possible for everyone. Learn more about diabetes remission.

Tirzepatide, a drug sold under the brand name Mounjaro, is used to treat type 2 diabetes[33] and is effective in weight reduction. Tirzepatide is given by subcutaneous injection (under the skin). Common side effects may include nausea, vomiting, diarrhoea, decreased appetite, constipation, upper abdominal discomfort and abdominal pain. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are hormones involved in blood sugar control.

Tirzepatide is a first-in-class medication that activates both the GLP-1 and GIP receptors, which leads to improved blood sugar control. It was approved for medical use in the United States in May 2022.

Sources and Further Reading

Reduced insulin secretion and absorption leads to high glucose content in the blood.
File URL:

Attribution: Manu5, CC BY-SA 4.0 <;, via Wikimedia Commons

CAUTION: This paper is not medical advice. No advice is implied or given in articles published by us but is only for general information. You should always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. This paper is about treating type 2 diabetes only and is compiled from the sources stated but has not been medically reviewed. It should never be used as a substitute for obtaining advice from your Doctor, a consultant Endocrinologist or other qualified clinician/medical practitioner. If you have already been given dietary advice, you should not make changes without first talking to your GP, consultant, dietitian or diabetic nurse. Any medications mentioned may include names for US drugs which may have a different name to those available in the UK. The facts are believed to be correct as at the date of publication, but there may be certain errors and omissions for which we cannot be responsible. There is no implied endorsement or promotion of any organisation by the writer. The hyperlinks were valid at the date of publication.

  1. Sources: © Crown Copyright duly acknowledged,
  2. Source:
  3. Source:
  4. Attribution:
  5. Sources:, © Crown Copyright duly acknowledged, and
  6. The Tool is available on the NHS website at:
  7. Based on the Diabetes Risk Score developed by Diabetes UK, the University of Leicester and University Hospitals of Leicester NHS Trust.
  8. See details at:
  9. Source: © Crown Copyright duly acknowledged,
  10. Based on advice from the NHS, at: © Crown Copyright duly acknowledged
  11. Ibid
  12. See:
  13. At:
  14. At:
  15. Source:
  16. mmol/l stands for millimoles per litre. A mole is a scientific unit often used to measure chemicals.­­
  17. See:
  18. See page 3 of this paper
  19. hypo is short for hypoglycaemia
  20. YouTube video at:
  21. See:
  22. Source: © Crown Copyright duly acknowledged
  23. Source: © Crown Copyright is duly acknowledged.
  24. Ibid
  25. Source:
  26. Source:
  27. Moderate-intensity physical activity includes brisk walking, cycling on relatively flat terrain, water aerobics, hiking, rollerblading and using a manual lawnmower. Source: NICE (National Institute for Heath and Care Excellence) at:
  28. High-intensity exercise includes jogging, swimming lengths, cycling either rapidly or over steep terrain, football, gymnastics, and skipping. Source: NICE (National Institute for Heath and Care Excellence) at:
  29. Source:
  30. Source:
  31. Euglycaemia is a state of balance in which blood glucose remains at healthy levels (which, depending on when food was last eaten, are generally between 4 and 7 mmol/l.
  32. Source:
  33. Sources: (1) “Mounjaro- tirzepatide injection, solution”.: DailyMed. 13 May 2022., (2) “FDA Approves Novel, Dual-Targeted Treatment for Type 2 Diabetes”. U.S. Food and Drug Administration (FDA) (Press release). 13 May 2022. (incorporating text from this source, which is in the public domain). (3) Thomas MK, Nikooienejad A, Bray R, Cui X, Wilson J, Duffin K, et al. (January 2021). “Dual GIP and GLP-1 Receptor Agonist Tirzepatide Improves Beta-cell Function and Insulin Sensitivity in Type 2 Diabetes”. The Journal of Clinical Endocrinology and Metabolism. 106 (2): 388–396. doi:10.1210/clinem/dgaa863. PMC 7823251. PMID 33236115, and (4) Coskun T, Sloop KW, Loghin C, Alsina-Fernandez J, Urva S, Bokvist KB, et al. (December 2018). “LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus: From discovery to clinical proof of concept”. Molecular Metabolism. 18: 3–14. doi:10.1016/j.molmet.2018.09.009. PMC 6308032. PMID 30473097.

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