In the UK, around 90% of all adults with diabetes have Type 2 diabetes. In this blog, we interview Dr Richard Quigley, a GP with over 35 years' experience, on some of the most frequently asked questions from patients about Type 2 diabetes. Dr Quigley specialises in diabetes and was the former chairperson of the Primary Care Diabetes Society Scotland.
If I have a history of diabetes in my family, what are some things I can do help me from developing it too?
It is important to understand that the development of Type 2 diabetes is due to lifestyle factors such as being overweight or obese and not taking regular exercise.
If you are overweight or obese, which means having a BMI (Body Mass Index) over 30, losing weight will substantially reduce your risk of developing Type 2 diabetes. If you do have these risk factors, it may be worth getting your bloods checked by your healthcare professional to see if your blood sugar is raised, even marginally (pre-diabetes) and your healthcare professional will be able to advise you further.
What is pre-diabetes?
Pre-diabetes is when your blood sugar is not within the normal range. Your blood sugar is raised, but it’s not high enough to meet the criteria for the diagnosis of Type 2 Diabetes. The good news is that the progression of pre-diabetes to Type 2 diabetes is not inevitable. Detecting this early and making changes to your lifestyle habits can significantly reduce the chances of you developing Type 2 diabetes in the future.
What causes Type 2 diabetes?
Four out of five cases of Type 2 diabetes are linked to obesity and lack of exercise. A family history is also important. Also, there is a higher risk of developing Type 2 diabetes in some ethnic groups. For example, people from Black African, African Caribbean and South Asian (Indian, Pakistani, Bangladeshi) backgrounds are at a higher risk of developing Type 2 diabetes from a younger age.
There is a much greater probability of developing Type 2 diabetes if you have any of these risk factors.
How do you know if you have Type 2 diabetes? Are there any early signs of developing it?
There are almost no visible signs of Type 2 Diabetes in the early stages of the condition. In addition, there are many thousands of people across the UK who have early diabetes without any noticeable symptoms and therefore do not know they have the condition. According to Diabetes UK, 13.6 million people are now at increased risk of Type 2 diabetes in the UK.
However, the two main symptoms that patients experience if the condition has progressed are thirst and frequent urination (passing urine more often than usual). If you are experiencing these symptoms (and others such as tiredness or weight loss), you should contact a healthcare professional as soon as possible.
How do you treat Type 2 diabetes?
The first part of a treatment programme is to tackle the lifestyle issues that are the root cause of the problem. This would involve a weight reduction programme and exercise programme (usually 5 episodes of exercise that make you breathless per week, lasting half an hour each). There is evidence that both regular exercise and reducing weight can reduce your blood sugar substantially.
Your healthcare professional will be able to help you access dietary and exercise programmes on the NHS.
If a patient cannot make the necessary lifestyle changes, a healthcare practitioner may prescribe the patient oral medication of which there are many different types, such as Metformin. There are also injectable treatments (which are not insulin) now quite often used to treat Type 2 diabetes, but eventually many patients will require insulin.
If I have been diagnosed with Type 2 diabetes, will I need to take insulin for the rest of my life?
No, many people do not have to take insulin, however, it depends on how well you do with other aspects of your treatment programme, particularly improving your lifestyle. Increased weight tends to accelerate your diabetes and therefore you may need insulin sooner than expected. You must take your insulin as directed by your clinician or this could have severe adverse effects on your health such as stroke or blindness.
Do I need to monitor my blood sugar if I have Type 2 diabetes?
If you are trying to control your Type 2 diabetes with lifestyle changes or medication, then you do not need to measure blood sugar with daily finger prick testing. Instead, your healthcare professional will check various blood tests at your clinical visits which give them enough information to alter your treatment as necessary.
However, if you are on certain types of medication, even some tablet medication, or insulin or you have other complex conditions that may interfere with your condition, then you may have to move on to testing your blood on a regular basis. Occasionally some patients may prefer to check their own blood sugar to educate themselves on the effects of lifestyle and medication changes.
Do I need to follow a low carb diet if I have Type 2 diabetes?
There is now strong evidence to show that following a low carb diet approach to weight loss is useful in the treatment of Type 2 diabetes. If a low carb diet is adhered to, it can be quite successful in reducing your blood sugar and weight. You don’t need to follow a low carb diet, but it would be highly recommended for most patients.
Can regular exercise help my Type 2 diabetes?
Yes. A healthcare professional will recommend five half hour exercise sessions per week. Patients who do not exercise regularly, or who are overweight, are advised to start with simple exercises such as walking or making sure you are mildly out of breath without causing distress. Many GP practices have access to exercise programmes and local gyms who are signed up as NHS partners.
Is Type 2 diabetes reversible/curable?
There is currently no evidence of a cure for Type 2 diabetes, but we can certainly reverse it to a state where the blood sugars return to normal and you can be below the diabetic range. The diabetes is then said to be in remission, however, if your weight was to start increasing again and you stop exercising, your Type 2 diabetes could come back.
The best way to stay in remission is to control your weight, follow an exercise regime and general lifestyle changes. In this setting some patients have managed to come off all their medication for diabetes.
What is the difference between Type 1 and Type 2 diabetes?
Type 2 diabetes is largely caused by lifestyle issues such as being overweight or obese, and a lack of exercise.
Type 1 diabetes is a disease that often presents in childhood and is associated with an immune attack on your own insulin producing cells which are in your pancreas. You can become very rapidly ill with Type 1 diabetes and will require insulin straight away. This is unlike Type 2 diabetes which tends to be a chronic disease and worsens over a long period of time.
If you would like to find out more information about Type 2 diabetes, visit the websites below. Diabetes UK is an excellent resource for patients with advice on every aspect of diabetes and is dedicated to informing and educating patients who suffer from this condition.
Diabetes UK: https://www.diabetes.org.uk/
Low Carb Program: https://www.lowcarbprogram.com/
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