Type 2 diabetes

Type 2 diabetes is a common health condition, and it can cause high blood sugar.

Blood sugar, also called glucose, is the main type of sugar in your blood. Your body uses it for energy. The pancreas, a small organ behind the stomach, makes a hormone called insulin.

Insulin works like a key. It lets blood sugar move from the blood into the body's cells, where it can be used for energy.

With type 2 diabetes, the body's system for handling sugar doesn't work as well as it should. This happens in 2 ways. Either the pancreas doesn't make enough insulin, or the insulin it makes doesn't work correctly.

Both of these mean sugar stays in the blood instead of going into the cells, where the body uses it for energy.

Type 2 diabetes can cause no symptoms at all for a long time. The signs usually come on slowly, over a few years, so many people don't realise they have it. Often it's found during a check-up.

Common symptoms include:

• feeling very thirsty
• needing to pee more than usual, especially at night
• feeling very tired
• losing weight without trying
• cuts or ulcers that take a long time to heal
• blurred vision
• repeatedly getting thrush

If you notice any of these signs, see a doctor as soon as possible.

Anyone can get type 2 diabetes, but some things make it more likely.

Some things raise your chance of getting type 2 diabetes and can't be changed. These include your:

• age
• family history
• family background

Type 2 diabetes becomes more common as people get older.

If a close relative has it, you're more likely to develop it too.

People from certain family backgrounds are more at risk from a younger age, including:

• South Asian
• Chinese
• African-Caribbean
• Black African

Some risk factors for type 2 diabetes are ones you can change. These include:

• your weight
• your lifestyle

Being overweight is a common risk factor, especially if you carry the extra weight around your tummy.

Type 2 diabetes is treated with:

• changes to your diet
• losing weight
• medicine

Some people with type 2 diabetes need medicine to treat it.

Metformin is a common medicine, and doctors often prescribe it first. It helps bring your blood sugar down towards normal levels, but it doesn't put you at risk of low blood sugars.

SGLT2 inhibitor tablets make your kidneys release sugar into your pee, and this helps lower your blood sugar. These medicines are also used for heart failure and kidney disease.

GLP-1 agonists can be injections or tablets. They help your pancreas make more insulin and can help you make more healthy food choices.

Other medicines are sometimes used too, like:

• sulphonylureas such as gliclazide
• gliptins
• pioglitazone

Some people with type 2 diabetes may need insulin injections. Your diabetes care team will teach you how to inject insulin yourself.

If you think a medicine or vaccine has caused a side effect, tell your doctor or pharmacist. In Bangladesh, suspected side effects can also be reported to the Directorate General of Drug Administration (DGDA), which runs the national adverse drug reaction monitoring programme.

If you have type 2 diabetes and you use insulin or sulphonylureas (like gliclazide), one side effect of these medicines can be a hypo. That means your blood glucose level can drop too low.

Most people who take other medicines for type 2 diabetes don't get hypos. Because of this, you wouldn't normally be asked to check your blood sugar with a finger prick strip.

Read more about hypoglycaemia

Remission of type 2 diabetes means your blood sugar is normal, or close to normal, and you're not using any medicines to get it there. It's easier to reach if you have had type 2 diabetes for less than 10 years. Your doctor can talk through which options are open to you.

You are less likely to develop type 2 diabetes if you:

• keep to a healthy weight
• eat plenty of fruit, vegetables and whole grains
• are more active
• don't smoke
• cut down on how much alcohol you drink

You can live a full and healthy life with type 2 diabetes. There are a few things you should do:

• have a care plan that you've talked through with your doctor
• stay active and eat well
• have blood tests and urine tests every year
• have eye checks and feet checks

If remission isn't possible, you might be able to control type 2 diabetes with diet and exercise. Over time, many people need medicine. Your doctor will talk to you about your options.

Your doctor may also ask you to check your blood sugar at home with a small machine called a blood glucose meter.

These checks matter if you take insulin, or sulphonylureas (such as gliclazide), because either can push your blood sugar too low. This is known as a hypo. If you need a meter, your diabetes team will show you how to use it.

If your blood sugar stays high for a long time, it can cause other health problems in type 2 diabetes. These could be:

• heart and circulation problems
• nerve damage
• eye problems
• kidney problems
• foot problems
• sexual problems

You can also help reduce the risk of complications by:

• having an Hb1Ac at the target level
• reducing your cholesterol
• stopping smoking
• treating any high blood pressure

Over time, high blood sugar can damage the blood vessels. The damage can make them narrow, and they can become blocked. This can lead to heart disease, a heart attack or a stroke.

High blood sugar can also damage the small blood vessels in your nerves. This can cause a tingling or burning pain, or numbness, most often in your hands and feet. If you have numbness, take extra care of your feet. You might not notice cuts and sores, and that can lead to serious infections.

The tiny blood vessels in the retina, the part of the eye that lets you see, can be damaged too. This is called diabetic retinopathy. Everyone with diabetes who is over 12 should have an eye screening to check for it. The screening isn't painful and takes a picture of the back of your eye. If the problem is found early, treatment can help protect your sight.

Other conditions can affect your eyes as well, cataracts for example. Don't wait for your screening. If you have any problems or worries about your eyes, contact your optician.

High blood sugar can harm the tiny blood vessels in your kidneys, so they don't work as well. Regular urine tests and checking your blood pressure help to pick up problems before they become serious.

Poor circulation and nerve damage make it easier for cuts or blisters on your feet to get infected. This can lead to problems like foot ulcers. Your care team will check your feet at least every 2 years. You should still check your feet every day, and tell your doctor or nurse about any changes in between those checks.

Nerve and blood vessel damage can cause:

• problems with erections
• vaginal dryness
• pain during sex

Thrush is more common in people with diabetes. These problems can often be treated, so speak to your doctor if you're worried.

If you have diabetes and are thinking about having a baby, talk to your doctor first. You need to control your blood sugar very well before pregnancy and in early pregnancy. Some diabetes tablets are not safe during pregnancy, and you may need to switch to insulin injections. You may also need a higher dose of folic acid, which helps prevent problems with your baby's spine. This is only available on prescription.

Pregnancy can put extra pressure on the small blood vessels in your eyes, so any eye problems should be treated before you get pregnant.