TYPE 2 DIABETES

How do you diagnose Type 2 diabetes?

There are different ways for your doctor to diagnose diabetes

• Fasting (pre-meal) blood glucose level more than 7.0 mmol/L

• Random blood glucose level more than 11.1 mmol/L

• Glycated haemoglobin (HbA1c) more than 48 mmol/mol (6.5%; on two separate occasions)

Other tests used to determine a patient's type of diabetes, stage, progression, treatment pathways or effective diabetes management are:

Urine Test:

This is done to check for the presence of protein, glucose or ketones in the urine. Presence of glucose in the urine is highly suggestive of diabetes. Presence of protein in the urine can suggest the kidneys are damaged or “leaky” and may be a sign of renal failure.

HbA1c Test:

HbA1c is a measure of how much glucose is stuck to the red cells and gives an average of all your blood sugar levels over the last three months.

Target HbA1c is usually individualised for each patient:

• For most people living with diabetes the target HbA1c is ideally less than 7% (53 mmol/mol) to reduce the chance of long term diabetes complications.

• For young people or women planning pregnancy the target HbA1c may be lower at around 6.5% (48 mmol/mol) or less.

Oral Glucose Tolerance Test:

This is done to confirm Type 2 Diabetes and Gestational Diabetes Mellitus.

Following an overnight fast, your blood is tested for glucose. This is compared with periodic blood tests taken for the next two hours after drinking a special sugar drink.

It measures how quickly glucose can be cleared from the blood.

Fasting blood sugar test:

• The blood sugar level is tested after an overnight fast.

• Levels of 5.5mmol/L to 6.9 mmol/L is inferred as pre-diabetes

• Levels more than 6.9mmol/L on two or more separate tests on different days indicates diabetes.

Random blood sugar test:

• Blood is tested at a random time of the day for glucose levels. For example, this may be after a meal.

• Blood glucose levels of 11.1 mmol/L or higher indicates diabetes.

Watch this video find out why it is important to detect diabetes early

TYPE 2 DIABETES MANAGEMENT

Treatments for Diabetes

There is no such thing as ‘mild’ diabetes. All types of diabetes are serious and require life long follow up and management  in combination with a healthy lifestyle and often medications.
Management of Type 2 Diabetes is with lifestyle changes and often medications.

Watch this video to find out more about managing type 2 diabetes

Lifestyle Changes

• Healthy eating

• Increased physical activity

• Healthy body weight

• Quitting smoking

Medication

Along with healthy eating, weight control, increased physical activity and diabetes education, medications are needed for some people. Medications can be taken either orally or as injections.

Examples of classes of medications that may be used include:

• Biguanides (Metformin)

• Sulfonylurea

• Thiazolidinedione

• DPP-4 inhibitor

• SGLT-2 inhibitor

• GLP-1 agonist

• Insulin

Each of the different class of medications has different levels of efficacy, side-effects, impact on weight loss, varying costs and risks of hypoglycaemia.In Australia most, but not all, of the medications used for treating diabetes are subsidised  by the government PBS (Pharmaceutical Benefits Scheme). Visiting an endocrinologist can help to individualise the right management plan for you.

How often do I need to check my blood sugar level if I am on insulin?

If you are on insulin, routine self-monitoring of your blood glucose is recommended.

The type of insulin you are on and the type of diabetes that you have will determine how often you will need to check your glucose level.  It may include checking your blood glucose:

• Before food

• Before going to bed

• Before driving

• Before exercise

• If you think you have symptoms of a low blood glucose level (hypoglycaemia)

• Or a combination of these

You will need to check with your doctor to find out what is best for you and how often you need to check.

How often do I need to check my blood sugar level if I am on tablets (and not on insulin)?

If you are on tablets that do not cause hypoglycaemia you may not need to routinely monitor your blood sugar level. Instead your doctor may organise routine HbA1c levels to measure your 3 monthly average glucose level.

What should my target blood glucose level be?

The ideal target for everyone with diabetes will vary. Talk to your doctor about what the right targets should be for you.  In general targets for blood glucose levels are:

• Fasting blood glucose level of 4-7 mmol/L

• Post meal blood glucose level of 6–10 mmol/L  

Blood glucose levels should be individualised. If you are young or planning pregnancy lower blood sugar levels may be recommended. For some people, such as those with cancer or dementia, higher blood sugar levels may be ok.

How does diabetes affect your body?

High blood sugar levels can affect your entire body.  Many people with high blood glucose levels may initially feel normal and not realise that the high blood glucose level is silently doing damage.

Diabetes is a chronic condition that can impact other functions of the body including the:

• Heart and Vascular System.

• Nervous System

• Kidneys

• Eyes and Vision

• Feet

• Skin and Mouth

With the right treatment you can prevent diabetes causing complications.

How can you reduce your risk of diabetes complications?

There are three important ways to reduce your risk of developing  long term, irreversible diabetes complications:

1. Aiming for optimal blood glucose control
2. Aiming for a blood pressure of less than 140/90 mmHg
3. Regular screening tests to pick up early changes before any damage has occurred.

What screening tests do you need if you live with type 2 diabetes mellitus?

Regular screening tests can reduce your risk of long term diabetes related complications.Your diabetes care plan or annual cycle of care will include regular tests and screening:

What if diabetes is untreated?

If left untreated, blood sugar can reach abnormally high levels leading to a condition called hyperglycaemia.

Uncontrolled diabetes can result in complications such as damage to

• Eyes (leading to blindness)

• Kidneys (leading to renal failure)

• Heart (leading to heart disease or heart attack)

• Brain (leading to stroke)

• Nerves (leading to loss of sensitivity in various parts of the body)

• Blood vessels (leading to poor blood flow to the feet, which can make them susceptible to poorly healing cuts and blisters. This could lead to amputation)

With the right management high blood glucose levels can be avoided and the damage from diabetes complications can be prevented.