Treatment

Lifestyle changes

Diet

Increasing the amount of fibre in your diet and reducing your sugar and fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it.

You should:

• increase your consumption of high-fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables
• choose foods that are low in fatreplace butter, ghee and coconut oil with low-fat spreads and vegetable oil
• choose skimmed and semi-skimmed milk, and low-fat yoghurts
• eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers
• grill, bake, poach or steam food instead of frying or roasting it
• avoid high-fat foods, such as mayonnaise, chips, crisps, pasties, poppadoms and samosas
• eat fruit, unsalted nuts and low-fat yoghurts as snacks instead of cakes, biscuits, bombay mix or crisps

The Diabetes UK website has more information and advice about healthy eating .

Weight

If you're overweight or obese you have a body mass index (BMI) of 30 or overyou should lose weight by gradually reducing your calorie intake and becoming more physically active.

Losing 5-10% of your overall body weight over the course of a year is a realistic initial target.

You should aim to continue to lose weight until you've achieved and maintained a BMI within the healthy range, which is:

• 18.5-24.9kg/m for the general population
• 18.5-22.9kg/m for people of south Asian or Chinese origin south Asian includes peoplefromBangladesh, Bhutan, India, Indian-Caribbean, Maldives, Nepal, Pakistan and Sri Lanka

If you have a BMI of 30kg/m or more (27.5kg/m or more for people of south Asian or Chinese origin), you need a structured weight loss programme, which should form part of an intensive lifestyle change programme.

To help you achieve changes in your behaviour, you may be referred to a dietititian or a similar healthcare professional for a personal assessment and tailored advice about diet and physical activity.

Physical activity

Being physically active is very important in preventing or managing type 2 diabetes.

For adults who are 19-64 years of age, the government recommends a minimum of:

• 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity such as cycling or fast walking a week, which can be taken in sessions of 10 minutes or more, and
• muscle-strengthening activities on two or more days a week that work all major muscle groups the legs, hips, back, tummy (abdomen), chest, shoulders and arms

An alternative recommendation is to do a minimum of:

• 75 minutes of vigorous-intensity aerobic activity, such as running or a game of tennis every week, and
• muscle-strengthening activities on two or more days a week that work all major muscle groups the legs, hips, back, abdomen, chest, shoulders and arms

Going for a daily walkfor example, during your lunch break is a good way of introducing regular physical activity into your schedule.

If you're overweight or obese, you may need to be more physically active to help you lose weight and maintain weight loss.

Your GP, diabetes care team or dietitian can give you more information and advice about losing weight and becoming more physically active.

The Diabetes UK website has more information and advice about getting active and staying active .

Medicines for type 2 diabetes

Type 2 diabetes usually gets worse over time. Making lifestyle changes, such as adjusting your diet and taking more exercise, may help you control your blood glucose levels at first, but may not be enough in the long term.

You may eventually need to take medication to help control your blood glucose levels.

Initially, this will usually be in the form of tablets and can sometimes be a combination of more than one type of tablet. It may also include insulin or another medication that you inject.

Metformin

Metformin is usually the first medicine used to treat type 2 diabetes. It works by reducing the amount of glucose your liver releases into your bloodstream. It also makes your body's cells more responsive to insulin.

Metformin is recommended for adults with a high risk of developing type 2 diabetes andwhose blood glucose is still progressing towards type 2 diabetes, despite making necessary lifestyle changes.

If you're overweight, it's also likely you'll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldn't cause additional weight gain.

However, it can sometimes cause mild side effects, such as nausea and ankle swelling (oedema) .

You shouldn't take pioglitazone if you have

Insulin treatment

If glucose-lowering tablets aren't effective in controlling your blood glucose levels, you may need to have insulin treatment.

This can be taken instead of or alongside your tablets, depending on the dose and the way 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 don't last very long (rapid-acting).

Your treatment may include a combination of these different insulin preparations.

Insulin injections

Insulin must be injected becauseit would be broken down in your stomach like food and unable to enter your bloodstream if it were taken as a tablet.

If you need to inject insulin, your diabetes care team will advise you about when you need to do it.

They will show you how to inject it yourself, and will also give you advice about storing your insulin and disposing of your needles properly.

Insulin injections are given using either a syringe or an injection pen, also called an insulin pen (auto-injector). Most people need between two and four injections of insulin a day.

Your GP or diabetes nurse will also teach a relative or a close friend how to inject the insulin properly.

You can read more about insulin and how to inject it on the Diabetes UK website.

A blood glucose meter is a small device that measures the concentration of glucose in your blood. It can be usefulfor detecting high blood sugar (hyperglycaemia) or low blood sugar (hypoglycaemia) .