What is type 2 diabetes?
Diabetes simply means high levels of glucose in the blood.
Our bodies make a hormone called insulin. Insulin is made in special cells in the pancreas which is an organ found in our bodies just behind the stomach.
When carbohydrate foods (starches and sugars) are eaten they are broken down into glucose which is then transported in the blood to different parts of the body where it can be used by the cells in our bodies for energy. Insulin acts like a key and ‘unlocks’ the cells to allow glucose to enter from the bloodstream.
Type 2 diabetes may be caused by a combination of the insulin being less effective
(insulin resistance) and insufficient amounts of insulin being made. This results in some of the glucose remaining in the blood stream leading to high blood glucose levels.
Insulin, shown as keys is made in the pancreas. It is then transported to the bloodstream in response to events like eating.
After eating, the glucose is absorbed into the bloodstream and then transported into the cells.
Normally insulin would ‘unlock ‘the cell wall to let glucose into the cells. In type 2 diabetes the insulin does not work as well so some of the glucose stays in the bloodstream, leading to high blood glucose levels.
What are the signs of type 2 diabetes?
You may: –
- Have increased thirst
- Feel tired
- Need to go to the toilet to pass urine a lot
- Notice dark patches of skin on your neck, armpits, groin or fingers (Acanthosis Nigricans)
- Be overweight or noticed an increase in your weight
- Notice an increase in your waist measurement
- Not have noticed any signs.
What is insulin resistance?
People with type 2 diabetes usually have insulin resistance.
Insulin resistance is “closed cell doors.” The cell doors are shut tight. This causes insulin to build up in the bloodstream. The cells are resisting insulin.
Insulin resistance may happen in the early stages of diabetes. That means that some of the cell doors are closed. A few of the cell doors are open. The pancreas makes more and more insulin to try to push through the closed doors. This puts a lot of insulin in the blood. Even with a lot of insulin, the glucose cannot get into the cells. As a result, blood glucose (BG) becomes high.
Insulin resistance is thought to be the main cause of type 2 diabetes and is associated with being overweight or obese. Increased fat tissue leads to a higher level of insulin resistance. Insulin resistance can be improved by losing weight and being more active.
What will help my insulin work better?
- Exercise and being more active
- Eating healthily and making appropriate food choices
- Aiming for or maintaining a healthy weight
- Medication to reduce insulin resistance
Avoiding high blood glucose levels
Exercise and being active
Increasing daily activity and how much the body moves is the most important thing to improve your diabetes.
This does not need to be done all in one session and can be broken down into shorter sessions over the day.
The benefits of exercise for overall health and diabetes include improvements to: –
- Heart health
- Weight management
- Bone health
- Self-confidence and emotional health
Different types of exercise offer different health benefits. A mixture of both aerobic and anaerobic exercise is recommended. Examples of each type of exercise are: –
- Aerobic exercise: Cycling, walking, jogging, skipping, dancing, shopping
- Anaerobic exercise: A short fast sprint, run for a bus, lifting weights, HIIT training.
The diabetes team will explore what activities you do and support you with activity goals at each consultation. Limiting screen time could also help increase physical activity levels.
Food choices in type 2 diabetes
The foods you eat are a very important part of managing type 2 diabetes. Family food choices and shopping habits help support good decision making. A dietitian will meet with you to discuss your food and drink choices and support you in making healthy food choices which fit into your family routine.
Below are some general suggestions that are helpful for everybody:
- Eat regular meals throughout the day
- Reduce portion sizes of meals – buy smaller plates and bowls to help with this
- Eat fewer snacks such as crisps, chocolate, sweets, biscuits, cakes – buy less of these foods so they are not in the house every day
- Drink water
- Cut out full sugar drinks and fruit juice choose diet, zero or no added sugar instead
- Replace sugary cereals with plainer ones
- Limit the frequency of takeaway foods
- Include vegetables, salad and, or fruit as part of every main meal
The Eatwell Guide shows the types of foods we should try to include as part of a healthy balanced diet.
- Green – Fruit and vegetables
Eat at least 5 portions of a variety of fruit and vegetables every day
- Yellow – Potatoes, bread, rice, pasta and other starchy carbohydrates
Choose wholegrain or higher fibre versions with less added fat, salt and sugar
- Purple – Oil and spreads
Choose unsaturated oils and use in small amounts
- Blue – Dairy and alternatives
Choose lower fat and lower sugar options
- Pink – Beans, pulses, fish, eggs, meat and other proteins
Eat more beans and pulses, 2 portions of sustainably sourced fish per week, on eon which is oily. Eat less red and processed meat.
Carbohydrate foods are broken down into glucose when we eat them. The more carbohydrate that is eaten, the greater the rise in blood glucose. Some carbohydrates are broken down into glucose faster than others and will cause blood glucose levels to increase more quickly.
The foods that will affect your blood glucose levels the most include: –
- Energy drinks, sugary drinks, fruit juice, smoothies, milkshakes.
- Sweets, chocolate, cakes, chocolate biscuits, chocolate desserts, puddings, sugar, ketchup, ice cream.
- Bread, breakfast cereal, potatoes, chips, rice, pasta, pizza.
Sugary drinks should be avoided and swapped for sugar free varieties. Sweet foods should be limited in amount and frequency to 2 to 3 times a week.
Starchy carbohydrates such as bread, rice, pasta, potatoes and cereals should be included at every meal because they provide us with energy. However, portion sizes should be limited so they resemble the size of your fist. Choosing wholegrain varieties may help avoid large rises in blood glucose levels.
Losing weight and aiming to achieve a healthy body weight for height (body mass index or BMI) will help improve blood glucose control as well as improve overall health and wellbeing. There is also evidence showing some people can put their type 2 diabetes into remission by losing weight. Remission in type 2 diabetes means your blood glucose levels are below the diabetes range, and you do not need to take diabetes medication.
It is recommended to aim for initial weight loss of 5% of body weight over 3 to 6 months and 10% weight loss over one year. Your diabetes team will help you set a personal weight loss target and goals to help you achieve this.
Medication and type 2 diabetes
Will I need to take medicine to help my body use insulin better?
The treatment is similar to adults who have type 2 diabetes but with some slight differences. Medicines are not all suitable for all age groups.
Most young people with type 2 diabetes will need to take Metformin. It is safe and works by making the insulin your body is still making, or the insulin you may need to inject, work better. It comes as a tablet, and you will usually be started on a lower dose.
It should be taken with food to reduce possible side effects such as feeling sick, tummy pain and diarrhoea. Any side effects usually settle down as your body gets used to the medicine.
Over the first few weeks you will be advised by the diabetes team about increasing your doses. We will advise you on the times and the doses to take to suit you. Low blood glucose results are not usually associated with taking Metformin. Without Metformin the blood glucose levels will continue to rise, it is therefore very important to take Metformin regularly if it has been prescribed for you.
Special advice for Metformin
- If you develop an itchy rash contact the diabetes team.
- If you are ill or need surgery, you should STOP TAKING YOUR METFORMIN and contact the diabetes team for further advice.
An acid called Lactic acid can build up in your blood if you become unwell or get dehydrated from vomiting, diarrhoea or fasting. Lactic acid build up can be serious and could make you very unwell. This is called lacto-acidosis.
If Metformin has not been effective in bringing HbA1c levels down to 48mmol/mol after 4 months, an additional medication may be required called Liraglutide which is given as an injection.
Insulin injections may be necessary if your blood glucose levels remain high on oral medications. If insulin is required you will be taught how much to give, when and how to do the injections.
Insulin may have been started at diagnosis if you have been unwell or if your blood glucose levels have been high for some time. In this situation the insulin injection treatment may be stopped once your blood glucose levels remained stable in the range of 4 to 7 mmols/L.
Blood glucose monitoring
Avoiding high blood glucose levels is very important.
You will be taught how to test your blood glucose levels. It is sometimes called a finger prick test. This will tell you if your medicines or insulin doses need to be changed or if certain foods make your blood glucose levels go too high.
You will need to check twice a day to start with; before breakfast and 2 hours after the main meal of the day. Your target blood glucose is 5 mmols/L, with a range of 4 to 7mmols/L.
You may find it helpful to record your blood glucose results in a diary which your diabetes team can provide you with. Or you may be advised to use an app called MyLife to record your blood glucose readings onto. This can then be shared with your diabetes team remotely.
Low blood glucose levels and hypoglycaemia
Low blood glucose is unlikely when on oral medications alone. However, for patients on insulin, blood glucose levels may occasionally go low. A low blood glucose level is 3.9 mmols/L or lower. This is called hypoglycaemia (hypo) and needs immediate treatment with 3 or 4 glucose tablets.
You may feel shaky or unwell beforehand, so we advise you check your blood glucose before you treat. Wait 15 minutes after you have taken the glucose tablets and recheck your blood glucose again to make sure it is higher than 5 mmols/L.
Sick day guidance and type 2 diabetes
Illness can affect blood glucose levels; they may go high or low. If you are vomiting or have diarrhoea please telephone for advice. You may need your doses of medications adjusting, especially if taking insulin or Metformin. Metformin may need to be stopped; you could become very unwell and need hospitalisation if you become dehydrated.
If your blood glucose results are higher than 10 mmols/L and/or you have symptoms of increased thirst and tiredness, you may need more insulin or medication changes so please telephone for advice on 01642 854660. This is very rare, but some young people may be asked to check their blood ketones if they are unwell.
Immunisations are recommended for young people with Type 2 diabetes, especially the annual “flu “vaccine and pneumococcal injections which are available from your GP.
You will initially be seen monthly by your diabetes team for the first 5 to 6 months following your diagnosis. Some of these will be with the whole multi-disciplinary team (MDT) which includes the doctor, psychologist, nurse and dietitian, and some may be with just the psychologist, or the nurse and dietitian.
After this, if your diabetes is being managed, you will then be seen 3 monthly in the diabetes MDT clinic. You may also be referred to a Paediatric Specialist Weight Management Clinic.
At each diabetes appointment we will: –
- Ask for your permission to check your weight, height and blood pressure to assess how well the treatment is working.
- Download your blood glucose meter and talk through your results so we can agree a plan and help you set goals.
- Do a separate finger prick test called the HbA1c (Haemoglobin A1c). This measures how much glucose has been attached to your red blood cells in the previous the 8 to 12 weeks. The target HbA1c is 48mmol/l. Meeting this target will help ensure you remain healthy and reduces the risk of diabetes related complications later in life.
- Give you the opportunity to ask questions so you get the most out of your visit.
- Offer you a chance to talk through your emotional feelings with a clinical psychologist who works with the team.
- Share information with you about taking part in research projects as the team are keen to offer the most up to date treatments and advice.
- Send you a copy of the consultation letter explaining what was discussed.
- Copy this letter to your GP along with any amendments made to the repeat prescription.
If you are unable to attend an appointment
Please telephone the office on 01642 854660 if you are unable to attend so we can arrange an alternative appointment.
Research studies clearly show if the HbA1c is 48 mmols/L or less, the risks of diabetes complications are substantially reduced.
Every year at your annual review appointment, the following checks will be done: –
We will track your HbA1c every clinic and advise you on how to keep yourself well. It is very important that these checks at annual review are carried out to recognise any changes to your body that may have been caused by high blood glucose levels as early as possible and work with you to set your personal goals.
- Retinopathy eye screening because small blood vessels in the eye can be affected by high blood glucose levels
- Annual blood and urine tests to check your kidney and liver health, as well as looking for the risk factors of heart disease
- Cholesterol levels to check if you may need additional treatment
- Foot check because nerves in your feet can also be affected by blood glucose levels
- Check injection sites if taking insulin
- Relationship, sexual and pregnancy advice as appropriate
You will be asked to complete a questionnaire about how you are feeling about living with diabetes
It is important to look after your feet when you have type 2 diabetes. Your team will provide you with further information on foot care.
Living with type 2 diabetes can impact on how you are feeling. We offer the opportunity to talk to our team psychologist.
School, college or work
Your school/college or work will need to know about your type 2 diabetes, if you take insulin you may need to have supplies in place or may need help from the team to educate staff about diabetes. We can help by providing a written care plan or advice about food choices, activity and exercise.
Holidays and festivals
We are happy to discuss holiday and festival advice before your trip and provide a holiday travel letter naming your medications and permission to carry sharps as needed.
We recommend you do not start smoking. In addition to increasing your risk of cancers, smoking with type 2 diabetes significantly increases your risk of heart disease. We can direct you to smoking cessation services and support if required.
Alcohol and substance misuse
We recommend you do not get involved with recreational drugs or other substances. This activity is dangerous and can affect blood glucose control. Information and support around drugs can be discussed in clinic.
Advice regarding drinking sensibly will be given. Alcohol does affect blood glucose levels and they may go high and low and affect your body’s ability to remain safe.
If you are thinking about a provisional driving licence or have passed your test you will need to contact the DVLA if you are ever prescribed insulin.
Some oral tablets for type 2 diabetes have increased risk of hypoglycaemia so the DVLA need to know about this for safety reasons. The DVLA may write to the diabetes consultant regarding your diabetes.
Detailed advice can be found at: https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving
Keeping safe with type 2 diabetes
Diabetes is not a condition that people can see. Having your medical identification in your mobile telephone would be helpful in times of emergency or you may want to consider other forms of ID as shown in the websites below.
Set up your Medical ID
To make your important health information accessible in case of an emergency, you can set up your Medical ID in the Health app on your phone.
Create your Medical ID:
- Open Health and tap Medical ID > Edit
- Enter your emergency contacts and health information
like your birth date, height and blood type.
- Turn on Show When Locked to make your Medical ID available for the Lock screen. In an emergency, this gives people who want to help some important information, like the emergency contacts that you’ve entered.
- When you’re finished, tap Done.
Medical alert bracelets and bands are also available to buy.
Watch free essential training films and resources to support you and your family with practical skills.
- Physical activity guidelines for children and young people – NHS (www.nhs.uk)
- Leeds Children’s Diabetes Team (2018) Type 2 Diabetes Workbook for Children and Young People
- ACDC Guideline Development Group (2021) A Practical Approach to Management of Type 2 diabetes in Children and Young People (CYP) under 18 years
- RCPCH DUK (Living with Type 2 Diabetes: ideas from children and young people on staying healthy, happy and well.
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850
Adapted from the Leeds Children’s hospital with their permission.