If you think you might have diabetes you should visit your GP as soon as possible.
Urine should not normally contain glucose. If you have glucose in your urine it may be a sign of diabetes. Your urine may also be tested for ketones (chemicals) which indicate type 1 diabetes.
Blood test are used to confirm whether or not you have diabetes. There are a number of different blood tests but a typical test is a fasting blood glucose – a sample of your blood is taken in the morning, before you have had anything to eat and is tested to measure your blood glucose levels. Another test is called an oral glucose tolerance test (OGTT), sometimes just referred to as a glucose tolerance test (GTT). This involves a blood test, drinking a glucose drink and further samples taken after the drink. The samples are tested to find out how your body is dealing with the glucose.
There is no cure for diabetes. The aim of treatment is to keep your blood glucose levels as normal as possible. As it is the high blood glucose levels that cause the damage it is essential to control your glucose as well as you possibly can.
Lifestyle changes are very important for those with type 2 diabetes. You should start taking regular exercise, eating healthily and losing weight if you are overweight. See the page “Living With Diabetes” for more on lifestyle changes. For many people lifestyle changes alone may be enough to keep your blood glucose at a safe and healthy level without the need for other treatment.
If regular exercise and a healthy diet are not effective in controlling your blood glucose levels, you may need medicines to treat type 2 diabetes. Several different types of medicine, usually taken as tablets, are used to treat type 2 diabetes.
Metformin works by reducing the amount of glucose that your liver releases into your bloodstream. It also makes your body’s cells more responsive to insulin.
Sulphonylureas increase the amount of insulin that is produced by your pancreas. Examples of sulphonylureas include: glibenclamide, gliclazide, glimepiride, glipizide, gliquidone.
- Glitazones (thiazolidinediones, TZDs)
Thiazolidinedione medicines (pioglitazone) make your body’s cells more sensitive to insulin so that more glucose is taken from your blood. They are usually used in combination with metformin or sulphonylureas, or both. You should not take pioglitazone if you have heart failure or a high risk of bone fracture.
Another thiazolidinedione, rosiglitazone, was withdrawn from use in 2010 due to an increased risk of cardiovascular disorders, including heart attack and heart failure.
- Gliptins (DPP-4 inhibitors)
Gliptins work by preventing the breakdown of a naturally occurring hormone called GLP-1. GLP-1 helps the body produce insulin in response to high blood glucose levels, but is rapidly broken down.
By preventing this breakdown, the gliptins (linagliptin, saxagliptin, sitagliptin and vildagliptin) act to prevent high blood glucose levels, but do not result in episodes of hypoglycaemia.
- GLP-1 agonists
Exenatide is a GLP-1 agonist, an injectable treatment that acts in a similar way to the natural hormone GLP-1 (see the section on gliptins, above). It is injected twice a day and boosts insulin production when there are high blood glucose levels, reducing blood glucose without the risk of episodes of hypoglycaemia (“hypos”).
Another GLP-1 agonist called liraglutide is a once-daily injection (exenatide is given twice a day). Like exenatide, liraglutide is mainly used in people on metformin plus sulphonylurea who are obese, and in clinical trials it has been shown to cause modest weight loss.
Acarbose helps prevent your blood glucose level from increasing too much after you eat a meal. It slows down the rate at which your digestive system breaks carbohydrates down into glucose.
Acarbose is not often used to treat type 2 diabetes because it usually causes side effects, such as bloating and diarrhoea. However, it may be prescribed if you can’t take other types of medicine for type 2 diabetes.
- Nateglinide and repaglinide
Nateglinide and repaglinide stimulate the release of insulin by your pancreas. They are not commonly used but may be an option if you have meals at irregular times. This is because their effects do not last very long, but they are effective when taken just before you eat.
If glucose-lowering tablets are not effective in controlling your blood glucose levels, you may need to have insulin treatment. Insulin treatment can be taken instead of or alongside your tablets, depending on the dose and the way that you take it.
Insulin comes in several different preparations and each works slightly differently. For example, some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but do not last very long (rapid-acting).
Type 2 diabetes can lead to long-term complications as mentioned in the next section (“Type 2 – Complications”). Other treatments may be necessary to reduce the chance of developing complications:
- anti-hypertensive medicines can be used to control blood pressure.
- a statin can be used to reduce high cholesterol levels.
- low-dose aspirin can be used to prevent stroke.
- angiotensin-converting enzyme (ACE) inhibitor might be used if you have early signs of diabetic kidney disease.