Diabetes

Overview
Type 2 Diabetes
Eye Screening

Diabetes

Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high.

There are 2 main types of diabetes:

    • type 1 diabetes – where the body’s immune system attacks and destroys the cells that produce insulin
    • type 2 diabetes – where the body does not produce enough insulin, or the body’s cells do not react to insulin

Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2.

During pregnancy, some women have such high levels of blood glucose that their body is unable to produce enough insulin to absorb it all. This is known as gestational diabetes.

Pre-Diabetes

Many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes.

This is sometimes known as pre-diabetes. If your blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased.

It’s very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated.

When to see a clinician

Visit the practice as soon as possible if you experience the main symptoms of diabetes, which include:

    • feeling very thirsty
    • peeing more frequently than usual, particularly at night
    • feeling very tired
    • weight loss and loss of muscle bulk
    • itching around the penis or vagina, or frequent episodes of thrush
    • cuts or wounds that heal slowly
    • blurred vision

Type 1 diabetes can develop quickly over weeks or even days.

Many people have type 2 diabetes for years without realising because the early symptoms tend to be general.

Causes of Diabetes

The amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach).

When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it’s broken down to produce energy.

However, if you have diabetes, your body is unable to break down glucose into energy. This is because there’s either not enough insulin to move the glucose, or the insulin produced does not work properly.

There are no lifestyle changes you can make to lower your risk of type 1 diabetes.

You can help manage type 2 diabetes through healthy eating, regular exercise and achieving a healthy body weight.

Living with Diabetes

If you’re diagnosed with diabetes, you’ll need to eat healthily, take regular exercise and carry out regular blood tests to ensure your blood glucose levels stay balanced.

You can use the BMI healthy weight calculator to check whether you’re a healthy weight.

People diagnosed with type 1 diabetes also require regular insulin injections for the rest of their life.

As type 2 diabetes is a progressive condition, medicine may eventually be required, usually in the form of tablets.

Read about: 

There is evidence that in those with early type 2 Diabetes, a controlled 800 calorie per day diet to lose excess body weight may put Diabetes into remission.

Diabetic eye screening

Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year.

If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if it’s not treated.

Screening, which involves a 30-minute check to examine the back of the eyes, is a way of detecting the condition early so it can be treated more effectively.

Type 2 Diabetes

What is type 2 diabetes?

  • Type 2 diabetes is a common condition that causes the level of sugar (glucose) in the blood to become too high.
  • It can cause symptoms like excessive thirst, needing to pee a lot and tiredness. It can also increase your risk of getting 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.
  • It's caused by problems with a chemical in the body (hormone) called insulin. It's often linked to being overweight or inactive, or having a family history of type 2 diabetes.

Symptoms

Check if you have type 2 diabetes

Many people have type 2 diabetes without realising. This is because symptoms do not necessarily make you feel unwell.

Symptoms of type 2 diabetes include:

    • peeing more than usual, particularly at night
    • feeling thirsty all the time
    • feeling very tired
    • losing weight without trying to
    • itching around your penis or vagina, or repeatedly getting thrush
    • cuts or wounds taking longer to heal
    • blurred vision

You're more at risk of developing type 2 diabetes if you:

    • 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 you were born in the UK)

Type 2 diabetes risk checker

If you're worried about type 2 diabetes, you can check your risk by answering a few questions.

Depending on your risk score, you might be able to get help from the Healthier You NHS Diabetes Prevention Programme.  Check your risk of type 2 diabetes

Further information on preventing diabetes and referral can be found here. 

See a clinician if:

    • you have any of the symptoms of type 2 diabetes
    • you're worried you may have a higher risk of getting type 2 diabetes

A clinician can diagnose diabetes. You'll need a blood test, which you may have to go to your local health centre for if it cannot be done at your GP surgery.

The earlier diabetes is diagnosed and treatment started, the better. Early treatment reduces your risk of other health problems.

Getting diagnosed

Type 2 diabetes is often diagnosed following blood or urine tests for something else.

However, you should see a clinician straight away if you have any symptoms of diabetes.

To find out if you have type 2 diabetes, you usually have to go through the following steps:

    1. See a clinician about your symptoms.
    2. The clinician 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 clinician will explain the test results and what will happen next.

If you're diagnosed with diabetes

What the clinician will discuss with you during your appointment depends on the diagnosis and the treatment they recommend.

Generally, they'll talk to you about:

    • what diabetes is
    • what high blood sugar means for your health
    • whether you need to take medicine
    • your diet and exercise
    • your lifestyle – for example, alcohol and smoking

Important

The clinician will do their best to discuss the diagnosis with you, but this first appointment might only be 10 to 15 minutes.

 

If you have questions about your diagnosis

It's usually difficult to take in everything the clinician tells you during the appointment.

Talk to family and friends about what the clinician told you, and write down any questions you have.

Then make another clinician appointment and take your list of questions with you.

There's also a lot of information on diabetes available.

What happens after the diagnosis

Usually, the following things happen after your diagnosis:

    1. The clinician may prescribe medicine. It might take time for you to get used to the medicine and to find the right doses for you.
    2. You will usually need to make changes to your diet and be more active.
    3. You'll have to go for regular type 2 diabetes check-ups.
    4. You'll have to look out for certain signs to avoid other health problems.

A free education course for type 2 diabetes can help you manage your condition.

Sign yourself up online to Healthy living for people with type 2 diabetes. The clinician may refer you to Diabetes education and self management for ongoing and newly diagnosed (DESMOND).

Understanding medicine

Medicines for type 2 diabetes

Most people need medicine to control their type 2 diabetes.

Medicine helps keep your blood sugar level as normal as possible to prevent health problems. You may have to take it for the rest of your life.

Diabetes usually gets worse over time, so your medicine or dose may need to change.

Adjusting your diet and being active is usually necessary to keep your blood sugar level down.

Getting the right medicine for you

Diabetes medicines help lower the amount of sugar in your blood.

Important

There are many types of medicine for type 2 diabetes. It can take time to find a medicine and dose that's right for you.

You'll usually be offered a medicine called metformin first.

If your blood sugar levels are not lower after taking metformin, you may need another medicine.

Over time, you may need a combination of medicines. Your GP or diabetes nurse will recommend the medicines most suitable for you.

Insulin is not often used for type 2 diabetes in the early years. It's usually needed when other medicines no longer work.

Find out more about diabetes tablets and medication from Diabetes UK

 

Taking your medicine

Your GP or diabetes nurse will explain how to take your medicine and how to store it.

If you need to inject insulin, they'll show you how.

Side effects

Your diabetes medicine may cause side effects.

These can include:

    • bloating and diarrhoea
    • weight loss or weight gain
    • feeling sick
    • swelling in one or more parts of your body due to a build-up of fluid under your skin

Not everyone has side effects.

If you feel unwell after taking medicine or notice any side effects, speak to your clinician or diabetes nurse.

Do not stop taking medicine without getting advice.

How to get free prescriptions for diabetes medicine

You're entitled to free prescriptions for your diabetes medicine.

To claim your free prescriptions, you'll need to apply for an exemption certificate. This is known as a PF57 form.

To do this:

    • fill in a form at your GP surgery
    • you should get the certificate in the post about a week later – it'll last for 5 years
    • take it to your pharmacy with your prescriptions

Save your receipts if you have to pay for diabetes medicine before you receive your exemption certificate. You can claim the money back if you include the receipts along with your completed PF57 form.

Travelling with diabetes medicines

If you're going on holiday:

    • pack extra medicine – speak to your diabetes nurse about how much to take
    • carry your medicine in your hand luggage just in case checked-in bags go missing or get damaged
    • if you're flying with a medicine you inject, get a letter from your clinician that says you need it to treat diabetes

 

DVLA

You may also need to inform the DVLA if you are taking certain oral medications. Your clincian will advise you if this applies to you.

Food and keeping active

Staying healthy if you have type 2 diabetes

A healthy diet and keeping active will help you manage your blood sugar level.

It'll also help you control your weight and generally feel better.

You can eat many types of foods

There's nothing you cannot eat if you have type 2 diabetes, but you'll have to limit certain foods.

You should:

    • eat a wide range of foods – including fruit, vegetables and some starchy foods like pasta
    • keep sugar, fat and salt to a minimum
    • eat breakfast, lunch and dinner every day – do not skip meals

If you need to change your diet, it might be easier to make small changes every week.

Information about food can be found on these diabetes sites:

Important

You should go for a regular diabetes check-up once a year to make sure your blood pressure and cholesterol (blood fats) are OK.

Help with changing your diet

If you find it hard to change your diet, a dietitian might be able to help.

Talk to your clinician or diabetes nurse to see if the cost could be covered through the NHS.

Being active lowers your blood sugar level

Physical exercise helps lower your blood sugar level. You should aim for 2.5 hours of activity a week.

You can be active anywhere as long as what you're doing gets you out of breath.

This could be:

    • fast walking
    • climbing stairs
    • doing more strenuous housework or gardening

The charity Diabetes UK has tips on how to get active.

Your weight is important

Losing weight (if you're overweight) will make it easier for your body to lower your blood sugar level, and can improve your blood pressure and cholesterol.

To know whether you're overweight, work out your body mass index (BMI).

If you need to lose weight, it is recommended for most people to do it slowly over time. Aim for around 0.5 to 1kg a week.

The charity Diabetes UK has more information on healthy weight and weight loss.

There is evidence that eating a low-calorie diet (800 to 1,200 calories a day) on a short-term basis (around 12 weeks) can help with symptoms of type 2 diabetes. And some people have found that their symptoms go into remission.

A low-calorie diet is not safe or suitable for everyone with type 2 diabetes, such as people who need to take insulin. So it is important to get medical advice before going on this type of diet.

Diabetes UK has more information on low-calorie diets.

Going for regular check-ups

Every 3 months

Blood sugar checks (HbA1C test)

Checks your average blood sugar levels and how close they are to normal.

You have these checks every 3 months when newly diagnosed, then every 6 months once you're stable.

This can be done by your diabetes pharmacist.

Once a year

Feet

Checks if you've lost any feeling in your feet, and for ulcers and infections.

This can be done by your diabetes pharmacist or podiatrist.

Speak to your clinician immediately if you have cuts, bruises or numbness in your feet.

Eyes

Checks for damage to blood vessels in your eyes.

Speak to your clinician immediately if you have blurred vision.

Blood pressure, cholesterol and kidneys

Checks for high blood pressure, heart and kidney disease.

This can be done by your diabetes pharmacist.

Health problems

You need to keep an eye on your health and have regular check-ups if you have type 2 diabetes because it can lead to:

    • heart disease and stroke
    • loss of feeling and pain (nerve damage)
    • foot problems – like sores and infections
    • vision loss and blindness
    • miscarriage and stillbirth
    • problems with your kidneys
    • sexual problems – like problems getting or keeping an erection

Controlling your blood sugar level and having regular diabetes check-ups is the best way to lower your risk of complications.

Getting your heart checked

You should have your cholesterol (blood fats) and blood pressure checked at least once a year. Diabetes increases your risk of heart disease and stroke, so it's important that high blood pressure and high cholesterol are spotted and treated early.

If you're already being treated for high cholesterol and high blood pressure, keep taking your medicine.

Diabetes also worsens the effects of smoking on your heart. Get help to quit smoking.

Loss of feeling

You should let your clinician or diabetes nurse know if you notice any changes in your body.

Diabetes can damage your nerves (neuropathy). This usually affects your feet, but it can affect other parts of your body, causing:

    • numbness
    • pain or tingling
    • problems with sex
    • constipation or diarrhoea

Early treatment can prevent nerve damage getting worse.

Looking after your feet

You should check your feet every day. Diabetes can reduce the blood supply to your feet and cause a loss of feeling.

This means foot injuries do not heal well and you may not notice if your foot is sore or injured. These problems can lead to ulcers and infections.

Simple things are important, like:

    • keeping feet clean and dry to avoid infection
    • trying not to go barefoot outside to avoid nicks and cuts
    • wearing shoes that fit well

Speak to your clinician or diabetes nurse if you notice any changes in your feet, including:

    • cuts, cracks or blisters
    • pain or tingling
    • numb toes and feet

Diabetes UK has advice on how to check your feet.

Your feet should also be checked every year by your clinician, diabetes nurse or podiatrist.

Sores or infections that are not treated early can lead to gangrene. Around 175 amputations resulting from diabetes are carried out every week in England.

Checking your eyes

Your eyes should be checked every year for damaged blood vessels, which can cause sight problems (diabetic retinopathy) and blindness.

Eye checks can detect damage before it affects your sight. Treating damaged blood vessels early can prevent sight problems.

Speak to your clinician immediately if you notice changes to your sight, including:

    • blurred vision, especially at night
    • shapes floating in your vision (floaters)
    • sensitivity to light

Pregnancy and diabetes

Speak to your clinician or care team if you're thinking of having a baby. You can have a safe pregnancy and birth if you have type 2 diabetes. You will need additional check-ups during the pregnancy.

If you’re trying to get pregnant, you should be able to have your HbA1c levels measured monthly to help manage your blood glucose levels.

Finding help and support

There's a lot of information and support available for type 2 diabetes. Some of the support depends on the area you live in.

Take a course to help you manage your diabetes

There are free education courses to help you learn more about and manage your type 2 diabetes.

Telling DVLA you have type 2 diabetes

If you're taking insulin for your type 2 diabetes, you will need to tell DVLA. This is because of the risk of low blood sugar (hypoglycaemia). You can be fined if you do not tell DVLA.

Support groups for type 2 diabetes

The charity Diabetes UK runs local support groups.

These can help with things like managing your diabetes on a daily basis, diet, exercise or dealing with emotional problems, such as depression. They offer a place to talk and find out how others live with the condition.

Blogs, forums and apps

  • Diabetes.co.uk forum – discussions about living with and managing diabetes
  • Diabetes UK blogs – a collection of blogs on work and diabetes, food, eyes and more
  • Diabetes Chat – scheduled chats with healthcare professionals or just the chance to talk to others
  • NHS Apps Library – find apps and tools to help you manage your diabetes, including some that link you to a lifestyle coach

Telling others can be difficult

It can be difficult to tell others you have diabetes, but it can help for certain people to know:

    • family can support you – especially as you will need to make changes to what you eat
    • it's important your colleagues or employer know in case of an emergency
    • being diagnosed with diabetes can affect your mood – telling your partner will help them understand how you feel

Carry medical ID in case of an emergency

Some people choose to wear a special wristband or carry something in their wallet that says they have diabetes, in case of an emergency.

If it's known that you have diabetes, this can make a difference to the treatment you'll receive.

Search the internet for "medical ID" to find websites that sell them.

Diabetic eye screening

What is diabetic eye screening?

  • Diabetic eye screening is a test to check for eye problems caused by diabetes.
  • Eye problems caused by diabetes are called diabetic retinopathy. This can lead to sight loss if it's not found early.
  • The eye screening test can find problems before they affect your sight.
  • Pictures are taken of the back of your eyes to check for any changes.
  • If you have diabetes and you're aged 12 or over, you'll get a letter asking you to have your eyes checked at least once a year.

How to book a test

You'll get a letter about the test

If you have diabetes and you're aged 12 or over, you'll get a letter every year asking you to have an eye screening test.

Sometimes you may have a choice of:

    • when you have the test
    • where you have the test – there may be more than 1 place to choose from in your area

Follow the instructions on the letter to book a test.

 

Important

Before you have the test, plan how you'll get there and back.

Do not drive yourself. You'll be given eye drops during the test that may make your sight blurry for a few hours.

 

What to do if you do not get a letter

If it's been more than a year since your last test and you have not had a letter, tell either:

What happens at the test

Before the test:

    • plan how you'll get to and from the test – do not drive, as your sight may be blurry for a few hours afterwards
    • bring all the glasses and contact lenses you wear, along with contact lens solution
    • bring sunglasses – everything can look very bright for a few hours after the test
    • eat and drink as normal

You might want to bring someone with you, or ask someone to collect you after the test.

 

What happens during the test

    1. You'll be asked to read some letters on a chart first.
    2. Drops are then put in your eyes. These may sting for a few seconds. The drops make your sight blurry after about 15 minutes.
    3. When the drops start working, you'll be asked to look into a camera. The camera will not touch your eyes.
    4. Pictures are taken of the back of your eyes. There will be a bright flash when a picture is taken.

Your appointment will usually last about 30 minutes.

 

After the test

You can go home when the test is finished.

For up to 6 hours after the test:

    • your sight may be blurry – do not drive until it goes back to normal
    • everything can look very bright – wearing sunglasses can help

You will not get your test result on the day.

You'll get a letter about your result within 6 weeks.

Go back to where you had the test or go to A&E if:

    • your eyes become very painful
    • your eyes turn red
    • your sight is still blurry after 6 hours

These side effects are very rare, but need to be checked quickly.

Your result

You'll get a letter about your result within 6 weeks of having an eye screening test.

Tell your GP practice if you do not get a letter within 6 weeks.

There are 3 types of result.

 

No eye changes

This is called no retinopathy.

This means:

    • no changes to your eyes were found
    • you'll be asked to come back for another test in a year

 

Some changes to your eyes

This is called background retinopathy.

This means:

 

Eye damage that could affect your sight

This is called referable retinopathy.

This means:

    • diabetes has damaged your eyes
    • your sight could be affected
    • you'll be referred to a specialist to talk about what happens next
    • you may need to have screening tests more often
    • you may need treatment for eye damage from diabetes