Type 2 Diabetes: Causes, Symptoms & Treatments from Expert Dietitian Louise Bula

Diabetes is a chronic condition whereby the level of sugar, or glucose, in your bloodstream is significantly high. In the United Kingdom there are currently just over 3.8 million people with diabetes and 90% of those cases with Type 2 diabetes.1,2

It is thought that 1 million people may also have undiagnosed Type 2 diabetes and by 2030 the total number of people living with the condition will reach 5.5 million.1 That’s pretty scary right? The good news is that Type 2 diabetes is totally preventable and can be put into remission. Read on further to find out how.

What is Diabetes?

There are two main types of diabetes: Type 1 and Type 2. Both conditions differ in terms of their causes and how they are managed.3,4 This article will focus mainly on Type 2 diabetes.

Type 2 diabetes is a condition in which your body doesn’t make enough insulin or when the insulin produced doesn’t work properly.4 Insulin helps your body get energy from the food you eat, by allowing glucose to pass from your blood to the cells where it’s needed. This is also called insulin resistance.

It is diagnosed when you have two readings in a row of a HbA1c level above 48 mmol/mol or 6.5% and a fasting plasma glucose (FPG) test above 7 mmol/L.5

Risk Factors for Type 2 Diabetes

For Type 2 diabetes, there are certain factors that put you more at risk of developing the condition including:
1. Having a parent or sibling with Type 2 diabetes (6)
2. Being from a South Asian, African-Caribbean or Black African descent (7)
3. Being over 40 if you’re White or over 25 if your Black African/African Caribbean or South Asian (7)
4. If you’re overweight or obese, especially if you carry most of your weight around your abdominal area (8)

Signs and Symptoms of Type 2 Diabetes

Roughly around 60% of people diagnosed with Type 2 diabetes usually have no symptoms to begin with. A few symptoms people may experience initially include: increased urination, unintentional weight-loss, increased tiredness and blurred vision.

Complications of Type-2 Diabetes

Having consistent high blood sugar levels overtime can cause serious damage to your blood vessels and nerves. This can result in chronic complications including problems with your eyes, foot, heart, kidneys, nerve damage, gum disease and related conditions like cancer.9

How to Prevent Diabetes

It is estimated that approximately 12.3 million people living in the UK are at risk of developing Type 2 diabetes.10 For every five cases it is thought that three could have been either prevented or delayed by maintaining a healthy weight, eating well and being active.

According to Diabetes Prevention guidelines if you’re overweight or obese, losing at least 5-10% of your initial weight and aiming for 150 minutes per week of activity a week over at least three days a week will help you to reduce blood sugar levels.11

Reach out to a Registered Dietitian or attend a Type 2 diabetes prevention programme in the NHS to help support you in making lifestyle and dietary changes.

Managing Type 2 Diabetes

When you’re first diagnosed with Type 2 diabetes, you may be put on oral diabetic medications including Metformin and Sulfonylureas. If it is thought that your pancreas is not producing enough insulin, you may also be placed on insulin.

Not everyone is put on medications straight away, you may be encouraged to try to control your blood sugar levels by making dietary and lifestyle changes.11

It is not possible to ‘cure’ your diabetes but you can put it into remission. This means that your blood sugar levels go back to normal without needing diabetes medications. It is encouraged for you to focus on adopting a Mediterranean-style diet, cut back on carbohydrate portions, include more starchy carbohydrates and increase total fibre intake.11

If you’re overweight or obese, prioritising a weight-loss of at least 5% of your initial body weight as per Diabetes prevention guidelines.11 Also, aiming for at least 150 minutes per week of moderate to vigorous physical activity across three days as above for Diabetes prevention.11

How can a low calorie diet help you?

There is plenty of research to show that a low-calorie diet can be beneficial in helping to promote weight-loss.12 This involves replacing one or more meals during the day with a meal replacement like a shake, bar or soup to help promote a calorie diet. This diet is usually followed for 12 weeks with the aim of reintroducing healthy foods after.

Recent findings from an exciting study known to clinicians as the DiRECT trial has shown that as part of a weight loss programme, low-calorie diets have helped some people put their Type 2 diabetes into remission.12

It’s important to know that this diet is not for everyone. If you’re in insulin or sulfonylurea tablets, being on a low-calorie diet can increase the likelihood of developing a hypo. Please consult with your GP or Diabetic nurse before embarking on a diet like this as your medication will need adjusting and you may need to be checking your blood sugar levels more often.

Please note – Our blog articles should be used for informational and educational purposes only and are not intended to be taken as medical advice. If you are concerned, please consult a health professional before taking dietary supplements or introducing any major changes to your diet.

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1. NCVIN (2016), Diabetes Prevalence Model for England + estimated growth between 2015–2020 from APHO (2010) Prevalence Models for Scotland and Wales.
2. NHS Digital (2018) National Diabetes Audit 2017/18: Report 1: Care Processes and Treatment Targets: shows Type 1 8% and Type 2 and other 92%. (Private communication from NHS digital has broken down Type 2 and other.) NHS Scotland (2018) Scottish Diabetes Survey 2017.
3. Wilkin T. The accelerator hypothesis: Weight gain as the missing link between type 1 and type 2 diabetes. Diabetologia 2001;44:914–22.
4. Mahler, R. and Adler, M., 1999. Type 2 Diabetes Mellitus: Update on Diagnosis, Pathophysiology, and Treatment. The Journal of Clinical Endocrinology & Metabolism, 84(4), pp.1165-1171.
5. Type 2 diabetes: prevention in people at high risk | NICE Public Health Guideline 38 – NICE. Published July 12, 2012. Retrieved June, 2020.
6. Vaxillaire M and Froguel, P (2010). The genetics of Type 2 diabetes: from candidate gene biology to genome-wide studies, in Holt RIG, Cockram CS, Flyvbjerg A et al (ed.) Textbook of diabetes, 4th edition. Oxford
7. Health and Social Care Information Centre (2006). Health Survey for England 2004, Health of Ethnic Minorities and Ntuk, U.E., Gill, J.M.R., Mackay, D.F., Sattar N. & Pell, J.P. (2014). Ethnic-Specific Obesity Cufoffs for Diabetes Risk: Cross-sectional Study of 490,288 UK Biobank Participants. Diabetes Care 37(9), 2500–7.
8. Ng M et al (2014) Global, regional and national prevalence of overweight and obesity in children and adults 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384 (9945); 766–781.
9. Stratton, I., 2000. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ, 321(7258), pp.405-412.
10. Office for National Statistics estimates of UK population. Estimates for UK, England and
Wales, Scotland and Northern Ireland – Mid-2016): 26,031,331 adult men and 27,226,626 adult women are recorded. 22% of the men is 5,726,893 and 24% of the women is 6,534,390 – which is a total of 12,261,283.
11. Twenefour, D. and Dyson, P., 2018. Evidence-Based Nutrition Guidelines For The Prevention And Management Of Diabetes. [ebook] Diabetes UK. Available at: <https://diabetes-resources-production.s3.eu-west-1.amazonaws.com/resources-s3/2018-03/1373_Nutrition%20guidelines_0.pdf> [Accessed 6 June 2020].
12. Lean, M., Leslie, W., Barnes, A., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K., Rodrigues, A., Rehackova, L., Adamson, A., Sniehotta, F., Mathers, J., Ross, H., McIlvenna, Y., Stefanetti, R., Trenell, M., Welsh, P., Kean, S., Ford, I., McConnachie, A., Sattar, N. and Taylor, R., 2018. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet, 391(10120), pp.541-551.
13. Nice.org.uk. 2020. Treatment And Care | Information For The Public | Epilepsies: Diagnosis And Management | Guidance | NICE. [online] Available at: <https://www.nice.org.uk/guidance/cg137/ifp/chapter/treatment-and-care#other-ways-of-treating-epilepsy> [Accessed 6 June 2020].
14. Bolla, A., Caretto, A., Laurenzi, A., Scavini, M. and Piemonti, L., 2019. Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes. Nutrients, 11(5), p.962.

Louise Bula

Writer and expert

Louise Bula is a UK Registered Dietitian with the Health and Care Professions Council. She has a Bachelor’s of Science in Nutrition and Food Science from the University of Reading and a Postgraduate Diploma in Dietetics from Queen Margaret University. Louise has a great amount of experience that spans from working as a research assistant for a study funded by the prestigious Medical Research Council looking into the effects of saturated fats on heart disease. She also has worked in the NHS as a Dietitian as part of various multidisciplinary teams providing patients with acute and chronic illnesses a range of nutritional interventions. She now specialises in Obesity and Type‐2 Diabetes and works for a company providing patients’ care through a range of digital-based approaches.