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Endocrinology · London

Diabetes treatments, by a consultant endocrinologist.

A modern, personalised diabetes plan - from insulin pumps and hybrid closed-loop for Type 1, through GLP-1 and SGLT2 combinations for Type 2, to the DiRECT-style remission pathway for those who want to try.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private diabetes care costs in London.

Indicative ranges across UK private providers.

In short

£280–£450, with a full plan the same visit.

Service Indicative range
Consultant endocrinologist - first appointment £280–£450
Follow-up review £180–£300
Structured education (DAFNE / DESMOND) £450–£1,200
CGM start and training (Dexcom / Libre) £350–£600
Insulin pump start (Omnipod / Medtronic / Tandem) £1,800–£3,200
Hybrid closed-loop set-up (CamAPS FX / 780G / Control-IQ) £2,200–£3,800
DiRECT-style remission programme £1,500–£3,000
Bariatric surgery referral pathway £8,500–£16,000

Prices vary by clinic, by which endocrinologist you see, by the technology chosen (pump, CGM, closed-loop) and by ongoing medication costs.

The problem

The right consultant, the right regimen, the right technology.

Diabetes care is often piecemeal - a GP for metformin, a nurse for insulin, an ophthalmologist for the eyes, and no one running the plan. We put a consultant endocrinologist in charge, with a team around them.

  • Newly diagnosed?

    A full workup - HbA1c, antibodies, C-peptide - so the type is right before the treatment is picked.

  • Control drifting despite tablets?

    Escalation is straightforward when the ladder is understood - SGLT2i, GLP-1, combinations, then insulin only if truly needed.

  • Want a pump, closed-loop or remission?

    All three are offered - with a clear conversation about which is realistic for you.

When it helps

Which type of diabetes - and what we do about it.

The five diabetes categories we treat, the annual checks that catch trouble early, and the one red flag that means an emergency rather than an appointment.

  • Type 1 diabetes (T1D)

    Autoimmune insulin deficiency - lifelong insulin, from multiple daily injections through pumps to hybrid closed-loop.

  • Type 2 diabetes (T2D)

    Insulin resistance and progressive beta-cell decline - metformin, SGLT2i, GLP-1s, combinations, insulin when needed.

  • MODY (monogenic diabetes)

    A single-gene diabetes often mistaken for T1 or T2 - some subtypes need only a sulfonylurea, not insulin.

  • Gestational diabetes

    Diabetes first recognised in pregnancy - diet first, then metformin or insulin, with tight glycaemic targets throughout.

  • Pre-diabetes

    HbA1c 42–47 mmol/mol - the window where lifestyle, and sometimes metformin, prevents progression to T2D.

  • Weight-driven T2D for remission

    Newer-onset T2D with BMI above 27 - the DiRECT-style very low calorie pathway achieves up to 46% remission at one year.

  • Complications screening

    Annual retinal (NHS DESP), foot check, urine ACR, HbA1c three-monthly, BP, lipids - the checks that catch trouble early.

  • Red flag: DKA or HHS

    Vomiting with high glucose, ketones, drowsiness or confusion is an emergency - 999 or A&E the same hour, not a clinic booking.

Treatment options

Modern diabetes care is a menu, not a script.

What each option on the table actually involves - insulin regimens, technology, drug classes, remission and surgical pathways.

  • MDI (basal-bolus insulin)

    Rapid analogue with meals plus a long-acting basal. The T1D backbone if a pump is not chosen - and often the T2D endpoint.

  • Insulin pumps

    Omnipod, Medtronic, Tandem or YpsoPump - continuous subcutaneous insulin, flexible dosing, no injections through the day.

  • Hybrid closed-loop (HCL)

    CamAPS FX with a Dexcom G6/G7, Medtronic 780G, or Tandem Control-IQ - the algorithm adjusts basal automatically from CGM data.

  • CGM (Dexcom, Libre 2/3, Guardian 4)

    Continuous glucose monitoring - a sensor every 10–14 days, phone alerts for lows and highs, the single biggest quality-of-life change in modern diabetes.

  • GLP-1 agonists

    Semaglutide, dulaglutide, tirzepatide - glycaemic control plus significant weight loss and cardiovascular protection in T2D.

  • SGLT2 inhibitors

    Empagliflozin and dapagliflozin - cardio-renal protection alongside modest glycaemic and weight benefit. Watch for euglycaemic DKA.

  • Metformin and older orals

    Metformin first, then DPP-4 inhibitors, sulfonylureas or pioglitazone as add-ons - cheaper, well understood, still first-line for most T2D.

  • Remission and bariatric pathways

    DiRECT-style very low calorie diet, Mediterranean pattern, structured exercise - and bariatric surgery for weight-related T2D at NICE thresholds.

Safety and red flags

The emergencies - and the things worth calling us about - honestly.

Diabetes is safe to live with when it is well managed. These are the situations where it stops being safe - and what to do the same day.

  • DKA is the T1D emergency

    Vomiting with high glucose and ketones is diabetic ketoacidosis. It kills quickly if ignored - 999 or A&E, not a clinic appointment.

  • HHS is the T2D emergency

    Hyperosmolar hyperglycaemic state - very high glucose, dehydration, drowsiness. Usually older patients on tablets. Same rule: A&E the same hour.

  • Severe hypoglycaemia and unawareness

    Repeated hypos below 3.0 mmol/L, especially with lost warning signs, need urgent review - usually a CGM and often a pump.

  • Foot ulcer or infection

    Any break in the skin of a diabetic foot is an emergency footwear-and-podiatry review, not next week. Untreated foot ulcers cost limbs.

  • Retinopathy needing anti-VEGF

    Proliferative retinopathy or diabetic macular oedema on NHS DESP is a same-week ophthalmology referral - treatment saves sight.

  • CKD stage progression

    Rising ACR or falling eGFR needs an SGLT2i (unless contraindicated), tighter BP control and a nephrology referral before stage 4.

  • GLP-1 side effects are usually GI

    Nausea and reflux settle over weeks. Pancreatitis is rare but real - stop the drug and seek help for severe abdominal pain radiating to the back.

  • Euglycaemic DKA on SGLT2i

    Rare, but SGLT2 inhibitors can cause DKA with normal-looking glucose. Any unwell patient on an SGLT2i needs ketone testing.

  • Pregnancy in poorly controlled diabetes

    Pregnancy targets are tighter than usual - HbA1c ideally under 48 mmol/mol before conception.

Reading your clinic letter

Your clinic letter in four parts. Read the last one first.

Whichever regimen you are on, the letter the endocrinologist sends you keeps to the same shape.

A UK consultant endocrinologist reviewing a patient’s diabetes clinic letter

A quiet reminder

Medical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the letter before your next review, just ask.

  1. 01 Header

    Diagnosis and type

    Which type of diabetes, how it was confirmed (HbA1c, antibodies, C-peptide, genetic testing) and the year of diagnosis.

  2. 02 Regimen

    Medication, insulin and technology

    Every drug, every dose, the insulin schedule, whether a pump or CGM is in use, and any hybrid closed-loop settings.

  3. 03 Findings

    Control and complications

    The current HbA1c, time-in-range, BP, lipids, urine ACR, retinal screening result and the state of the feet.

  4. 04 Impression

    Plan, escalation and review timing

    Read this first: the target, the next escalation if the target is missed, and when the consultant wants to see you again.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for diabetes care varies by insurer and by product. Most plans fund consultant reviews and initial investigations; pumps, closed-loop technology and GLP-1 medication are often self-pay.

Frequently asked

Everything we get asked about diabetes treatment.

Quick answers on pumps, closed-loop, GLP-1 versus SGLT2, remission, and when to go to A&E.

  • What are the main treatments for Type 1 diabetes?

    Insulin - always. Either multiple daily injections (a long-acting basal plus rapid analogue with meals) or an insulin pump. The best modern option for most people is a hybrid closed-loop system: a pump linked to a continuous glucose monitor with an algorithm that adjusts basal insulin automatically. Islet cell transplantation is offered to a small, selected group.

  • What is the T2D drug ladder in 2026?

    Metformin first for almost everyone. Then an SGLT2 inhibitor (empagliflozin, dapagliflozin) for cardio-renal protection, or a GLP-1 agonist (semaglutide, dulaglutide, tirzepatide) if weight loss and cardiovascular benefit matter most. Combinations follow; DPP-4 inhibitors, sulfonylureas, pioglitazone and eventually basal insulin are added as needed.

  • Can Type 2 diabetes actually be reversed?

    Remission - not cure - is possible for many people with newer-onset, weight-related T2D. The DiRECT trial showed up to 46% remission at one year and 36% at two years using a very low calorie diet followed by structured food reintroduction and weight maintenance. Bariatric surgery achieves higher and more durable remission for the right patients.

  • What is a hybrid closed-loop system?

    An insulin pump connected to a continuous glucose monitor, driven by an algorithm that adjusts basal insulin every few minutes. The three main systems in the UK are CamAPS FX (with Dexcom G6 or G7), the Medtronic 780G, and the Tandem t:slim X2 with Control-IQ. They dramatically improve time-in-range and reduce hypoglycaemia.

  • GLP-1 versus SGLT2 - which should I take?

    It depends on what you need. GLP-1 agonists give the biggest weight loss and strong cardiovascular protection. SGLT2 inhibitors give the strongest renal and heart failure protection. Many patients end up on both. Your consultant weighs weight, kidney function, cardiovascular risk and cost.

  • What checks should I have every year?

    HbA1c every three months, blood pressure at every visit, an annual urine ACR and lipid panel, an annual retinal screening (NHS DESP is free), and an annual foot check by a podiatrist. Missed checks are the commonest reason complications are found late.

  • Am I a candidate for bariatric surgery?

    NICE currently supports bariatric surgery for T2D with BMI over 35 (or over 30 in some South Asian and other groups), especially when medical treatment has not achieved control. The endocrinologist and bariatric surgeon assess you together.

  • What is the difference between DKA and HHS?

    DKA (diabetic ketoacidosis) is the T1D emergency: high glucose, high ketones, acidosis. HHS (hyperosmolar hyperglycaemic state) is the T2D emergency: very high glucose, profound dehydration, no significant ketosis. Both are treated in hospital - go to A&E, do not wait for a clinic slot.

  • When should I seek urgent help?

    Vomiting with high glucose, ketones on a strip, drowsiness or confusion, a foot ulcer or infection, chest pain, sudden vision change, or severe abdominal pain on a GLP-1 - all of these are A&E-level. In pregnancy with high glucose, contact your team the same day.

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