Treatment of type 2 diabetes

Some people with type 2 diabetes can initially control their condition with lifestyle changes alone.

Self-help

• Diet. A healthy diet is essential if you have diabetes and it's important to eat regularly three times a day. Special diabetic foods aren't necessary for a healthy diet; you just need to eat a balanced diet that is low in saturated fat, sugar and salt, and high in fibre, vegetables and fruit. Include carbohydrates, such as pasta, potatoes or sugary foods such as fruit in each meal. Your GP, dietitian/nutritionist or diabetes educator can help you design a healthy eating plan.
• Exercise. Exercise promotes a healthy circulation and will help you to stay a healthy weight. At least half an hour of moderate activity on at least five days a week can help you lose weight.
• Smoking. Smoking is unhealthy for everyone, but quitting is especially important for people with diabetes. This is because you already have an increased chance of developing cardiovascular disease or circulatory problems. Smoking makes the chances of developing these diseases even greater.
• Alcohol. If you have diabetes, there's no need to give up alcohol completely, but it's important to drink sensibly. It is recommended to drink no more than two standard drinks each day. However, don't drink on an empty stomach - eat food containing carbohydrate before and after drinking and monitor your blood glucose levels regularly.

Medicines

If lifestyle changes alone don't reduce your glucose levels, you may be prescribed medicines to increase insulin production and strengthen its effect. Some examples are listed below:

• Metformin. This improves the effectiveness of insulin by reducing the amount of glucose released from the liver and improving the way glucose is used by muscles.
• Sulfonylureas. These medicines encourage your pancreas to produce more insulin, and examples include glibenclamide and glipizide.
• Prandial glucose regulators. These medicines also encourage your pancreas to produce more insulin - they work more quickly than sulfonylureas but only last for a short time. An example is repaglinide.
• Glitazones. These medicines reduce your body's resistance to insulin and are sometimes used with metformin and sulfonylureas if other standard treatments aren't working or aren't tolerated. Examples include rosiglitazone and pioglitazone.
• DPP-4 inhibitors. These are newer medicines that help your body to produce more insulin in response to meals. They don't cause weight gain and only rarely cause hypos. Examples are as sitagliptin or vildagliptin.
• Alpha-glucosidase inhibitor. This is a medicine called acarbose that lowers blood glucose by slowing the breakdown of some carbohydrates.

Two or more of the medicines listed here can be given in combination as they may give better control than one on its own. Your doctor and diabetes educator can advise on which treatments are most appropriate for you.

It's very important to keep your blood pressure and the level of cholesterol in your blood well controlled. High blood pressure and high cholesterol levels have been linked to heart attack and stroke - you're more at risk of these and other complications if you have diabetes.

It's important to try to lower your cholesterol levels through lifestyle measures such as changing your diet, losing excess weight and taking regular exercise. However, if these don't work, you're likely to be prescribed a medicine to help lower your cholesterol.

You may also be given medicines to control your blood pressure if lifestyle changes including those mentioned above aren't enough to do this.

Insulin injections

If lifestyle changes and oral medicines don't control your blood glucose levels, you may need to start insulin injections in addition to, or instead of, tablets.

You will usually give insulin injections to yourself once or twice a day, using either a traditional needle or a pen-type syringe with refillable cartridges. There are different kinds of insulin that work at different rates and for different lengths of time. Each can have varying rates of success in different people - ask your doctor for advice on which type is best for you.

Monitoring your blood sugar

You may be able to monitor your blood glucose levels with a home test kit. This involves taking a pinprick of blood from your finger and putting a drop on a testing strip. A meter will read the result automatically. However, self-monitoring isn't usually recommended unless you're using insulin injections. More research is needed to find out whether self-monitoring is an effective way of controlling blood glucose.

You can adjust both your diet and insulin to keep your blood glucose level within the normal range. Your 'normal' range will be specific to you but a general guide for adults is:

• before meals: 4 to 7 mmol/L
• after meals: less than 8.5 mmol/L.

Your GP or diabetes educator can guide you on how to monitor and manage your blood glucose and will give you continuing support.