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Your guide to Type 2 diabetes

What is type 2 diabetes?
Type 2 diabetes is more common than type 1 diabetes and usually develops in
people over the age of 35. It is often associated with being overweight. It tends to
run in families and is also more common in people from the Asian community. It is
also more common in women who have had diabetes during a pregnancy
(Gestational Diabetes).
This type of diabetes often develops slowly. It may be diagnosed during a routine
health check on the basis of a blood or urine sample or because of symptoms.
Sometimes people can have type 2 diabetes for many months or even years before it
is diagnosed.
Type 2 diabetes is not caused by stress, but is often diagnosed during a stressful
event. In people who are prone to develop diabetes, putting on weight, especially
around the waistline can precipitate the development of diabetes. Diabetes is not
infectious.
People with type 2 diabetes can still produce insulin but they are either not making
enough to meet their body's needs or they are unable to use the insulin which is
produced efficiently.
How is type 2 diabetes treated?

The main treatment of Type 2 diabetes is:-
 A healthy diet, which is low in sugar, low in fat and high in fibre.
 Exercise, to keep weight and blood glucose under control.
 Tablets are often added; they are not a substitute for healthy eating!
 Insulin is sometimes necessary in some people, when tablets are not sufficient to

People with type 2 diabetes can develop the complications of diabetes, especially if
blood glucose is not kept under control. For this reason Type 2 diabetes must be
taken seriously and treated correctly. Type 2 diabetes should never be regarded
as 'mild diabetes'.

The main aim of treatment is to achieve near normal blood glucose levels which,
together with a healthy lifestyle, will help to improve well-being, and protect against
long-term damage to the eyes, kidneys, nerves, heart and major arteries.
Milton Keynes Hospital NHS Foundation Trust Produced By: Adapted by Dr S Weatherhead Date Produced: 11/2004, reviewed 08/2007, 09/2009 Review Date: 09/2012 Version No: ENDO/PI/007/V2 Page 1 of 3
Diabetes & tablets

Tablets are sometimes started if sugar levels do not come under control with a
healthy diet; however they are not a substitute for healthy eating.
Metformin
Metformin is usually the first choice for people who are normal weight or overweight.
It helps the insulin already present to work more efficiently, but does not cause
hypoglycaemia (low blood sugar). Metformin can cause stomach upset e.g.
sickness, vomiting & diarrhoea; if any of these symptoms happen please inform your
GP or Diabetes team. The side effects can be helped by taking the drug with or after
food.
Sulphonylureas
These tablets encourage the pancreas to produce more insulin; because of this they
can cause hypoglycaemia (a low blood sugar). Examples include Glibenclamide and
Gliclazide They should be taken before food. They can be given alone or in
combination with Metformin.
Glitazones (Thiazolidinediones)
These drugs also help insulin to work more efficiently. They may be prescribed as an
alternative to Metformin in overweight people with type 2 diabetes, especially when
Metformin has caused side effects, or they may be used in combination with
Metformin. Examples are Pioglitazone and Rosiglitazone. These drugs cannot be
used alone or combined with insulin and they are not suitable for some patients,
including those with heart failure or liver problems.
DPP4 Inhibitors (Sitagliptin and Vildagliptin)
These drugs work by blocking the action of the enzyme DPP4 which destroys the
hormone incretin. Incretin is a hormone produced by the gut which helps the body to
produce more insulin only when it is needed. DPP4 inhibitors are usually given in
combination with other blood glucose lowering medication.
Incretin like drugs (Exenatide and Liraglutide)

These are injectable drugs that mimic the action of the hormone incretin, increasing
insulin secretion. They usually result in weight loss by reducing appetite. They are
given in combination with other blood glucose lowering medication.
Some people take a combination of tablets, or even tablets combined with insulin, to
control blood sugar levels. Since the requirements for tablets can change over a
period of time; it is necessary to have regular check-ups with the Diabetes team or
your GP.
Milton Keynes Hospital NHS Foundation Trust Produced By: Adapted by Dr S Weatherhead Date Produced: 11/2004, reviewed 08/2007, 09/2009 Review Date: 09/2012 Version No: ENDO/PI/007/V2 Page 2 of 3
Hypoglycaemia (hypo) or low blood sugar
 This happens if the level of glucose in the blood drops down too low, (below 4)
 It is unlikely in people controlled by diet or on Metformin
Symptoms include trembling, sweating, dizziness and a feeling of hunger Confusion
can also occur. The most common causes of hypoglycaemia are missed or delayed
meals, excessive exercise or too large a dose of tablets. If this happens, eat
something sweet immediately eg. 3 glucose tablets or a small glass of coke or
lemonade. Let your diabetes team know.

How to achieve good blood glucose control
Attend the clinic, either the hospital or your general practice regularly. Regular
check-ups mean that you will receive advice on how to avoid complications of
diabetes. It also means that if problems develop, they can be picked up and treated
at an early stage.
Self Testing: Testing either urine or blood for glucose is a way for you to monitor
how well you are controlling your diabetes. The diabetes nurse or practice nurse will
show you how to do this.
Diet: It is important to keep to a healthy diet which is low in sugar, low in fat and high
in fibre.
Exercise: Regular exercise is an ideal way to keep fit and healthy. Any form of
exercise is beneficial e.g. swimming, keep fit classes or walking. Exercise also helps
to reduce blood glucose levels. Thirty minutes walking a day is enough to improve
your diabetes.
Smoking significantly increases the risk of developing problems
associated with diabetes. This is why all people with diabetes are
advised to stop smoking.

Diabetes UK

Diabetes UK can provide advice on all aspects of diabetes and provide a voice for There is a local Diabetes UK branch in Milton Keynes. Ask you Specialist Nurse Diabetes UK is at 10 Parkway, London NW1 7AA, Tel 020 7424 1000
Diabetes UK Careline is a confidential information service, Tel 0845 120 2960
You can find Diabetes UK on the Internet at www.diabetes.org.uk
Contact numbers: Diabetes Nurse Specialist at MK hospital. 01908 243089
'Adapted with permission from Tayside Diabetes Clinical Network leaflet' Milton Keynes Hospital NHS Foundation Trust Produced By: Adapted by Dr S Weatherhead Date Produced: 11/2004, reviewed 08/2007, 09/2009 Review Date: 09/2012 Version No: ENDO/PI/007/V2 Page 3 of 3

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