Type 2 diabetes: symptoms, causes, treatment, diet and remission

NHS inform says people with type 2 diabetes can have no symptoms for a long time. Signs often appear slowly over a few years, so some people do not realise they have it, and it is often found during a check-up.

The NHS lists the most common symptoms as feeling very tired, peeing more than usual, feeling thirsty all the time and losing weight without trying to. Other symptoms can include blurred vision, cuts or wounds taking longer to heal, and itching around the penis or vagina or getting thrush repeatedly. NHS inform also lists needing to pee more, especially at night.

The symptoms are the same for adults and children. The NHS says they can be similar to type 1 diabetes, but type 1 usually develops more quickly and is more common in younger people. If any signs appear, see a healthcare professional as soon as possible.

NHS inform explains that glucose is the main type of sugar in blood and the body uses it for energy. The pancreas makes a hormone called insulin, which works like a key letting glucose move from the blood into cells. In type 2 diabetes this does not work as well as it should: either the pancreas does not make enough insulin, or the insulin made does not work correctly, so sugar stays in the blood.

The NHS says that unlike type 1 diabetes, which is caused by a problem with the immune system, type 2 diabetes may be prevented. Diabetes UK says it can go undiagnosed for years if you do not have symptoms or they are missed, and that it does not only affect people living with overweight or obesity, although this is a risk factor along with ethnicity.

The NHS says lifestyle changes can help lower blood glucose levels and possibly avoid having to take medicine, and can sometimes lower blood glucose to a normal level and stop diabetes (remission). Its advice on food is:

• Try to eat a healthy diet including fruit, vegetables, wholegrain foods such as wholemeal bread and oats, and pulses such as chickpeas and lentils.

• Improve your diet slowly if you find it difficult: a small change every week can make it easier.

• Do not eat too much processed food with lots of salt and sugar, such as bacon, chips, cheese, sweets and biscuits.

• Do not change to a very strict, low-calorie diet without talking to a health professional first, as it may not be suitable if you are taking insulin or other diabetes medicine.

• Talk to a GP or diabetes nurse if you are finding it hard to change your diet, as they may be able to find support locally.

• Try to limit alcohol, stop smoking and try to lose weight if you have been told you are overweight.

• The NHS says to spend at least 2.5 hours across the week walking or doing another activity that leaves you out of breath.

NHS inform says type 2 diabetes is treated by changes to your diet, losing weight and medication. The NHS says that if you need medicine and have no other serious health conditions, you will usually be offered a combination of metformin and an SGLT2 inhibitor. If metformin causes side effects you may be recommended an SGLT2 inhibitor alone, and a GLP-1 agonist, usually given by weekly injection, may be offered if you have a history of heart disease or, in some cases, obesity.

If metformin or other medicines do not help, you may need insulin, which the NHS says may be a few times a day by injection or through a pump. Your clinician chooses and adjusts medicines, and you should not stop taking medicine unless told to by a healthcare professional.

NHS inform says anyone can get type 2 diabetes, but some things make it more likely. Risk factors you cannot change include age (it is more common as people get older), family history and family background. People from South Asian, Chinese, African-Caribbean and Black African backgrounds are at risk from a younger age.

Risk factors you can change include your weight and lifestyle, and being overweight is a common risk factor, especially when weight is carried around the tummy. The NHS says you may also be more at risk if you are not very physically active or have a condition such as high blood pressure.

Diabetes UK says that if you are over 40 and from a White background your risk increases, but if you are from an African Caribbean, Black African or South Asian background it increases from age 25. The NHS suggests using Diabetes UK's Know Your Risk tool, and if you are aged 40 to 74 with no existing health condition you can ask for a free NHS Health Check.

The NHS says type 2 diabetes is diagnosed with a blood test that checks how high your blood glucose levels are, and the results usually take a few days. Tests confirm whether you have type 1 or type 2 diabetes.

Prediabetes means your blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes, which puts you at higher risk of diabetes in the future. Most people with it have no symptoms. The NHS says to talk to your care team about eating more healthily, exercise and other lifestyle changes, and mentions NHS programmes such as the NHS Diabetes Prevention Programme for those who are eligible.

NHS inform defines remission as having a normal or near-normal blood sugar without using medications, and says it is easier to achieve if you have had type 2 diabetes for less than 10 years. Your healthcare professional can discuss what options are available to you. The NHS says it may be possible to prevent type 2 diabetes or stop it (remission) by losing weight and improving your diet.

Diabetes UK says there is no cure, but some people can put their diabetes into remission. If remission is not possible, NHS inform says you might be able to control it with diet and exercise, though over time many people need medicine.

The NHS lists the following regular checks, which are designed to make sure treatment is working and to find complications early.

The NHS says type 2 diabetes increases your chance of long-term problems including damage to blood vessels (causing coronary heart disease and stroke), foot problems such as ulcers and infections that can sometimes result in amputation, sight problems such as diabetic retinopathy, kidney problems and gum disease. You can lower your chances by managing blood glucose well and making healthy lifestyle changes.

See a GP or diabetes nurse if you have blisters or cracked skin on your feet, any pain, tingling or numbness, problems having sex, constipation or diarrhoea, or your vision gets worse.

The NHS says high blood glucose can rarely cause hyperosmolar hyperglycaemic state (HHS), and a lack of insulin can lead to diabetic ketoacidosis (DKA); both can be life threatening. Call 999 or go to A&E if you have type 2 diabetes and are peeing a lot, feel very thirsty, feel sick, feel confused or very sleepy, drowsy or short of breath. Ask for an urgent GP appointment or call NHS 111 if you are taking diabetes medicine and have vomiting, diarrhoea or a very high temperature.

The NHS says type 2 diabetes is less common in children, but ethnic background, weight, activity and family history can increase the risk. Children with type 2 diabetes will be under specialist care, and children aged 12 and over are offered diabetic eye screening.

If you are thinking of having a baby and have type 2 diabetes, the NHS says it is important to plan your pregnancy as soon as possible. This usually means asking to be referred to a pre-conception clinic or a diabetes care team, and changing your medicines to ones that are safe to take in pregnancy. Talk to a doctor about the best contraception to use.

NHS inform says you can drive if you have diabetes, but you must tell your insurance company. If you take a medicine that puts you at risk of a hypo you should know what to do and have a way of checking your blood sugar. If you have a hypo while driving, pull over safely and stop the engine, have something sugary, and wait at least 45 minutes after your blood sugar is back to a safe level (5 mmol/l or above) before driving again.

The NHS says you may need to contact the DVLA if you have health problems caused by type 2 diabetes or you get hypos, and suggests a medical ID wristband and a letter from your GP for holidays.

Most type 2 diabetes care is provided by your GP practice with diabetes nurses, dietitians, structured education courses and national screening programmes, with hospital teams involved for complex cases or complications.

Some people choose private endocrinologist reviews, dietitians or weight programmes. Check what evidence supports a programme, avoid very restrictive diets without medical advice, and share results with your GP so that checks and prescribing stay coordinated.