In people with diabetes, the body’s usual ways of controlling blood glucose levels do not work properly.

Normally, a hormone called insulin (made in the pancreas) controls the amount of glucose in the blood.

Insulin helps glucose enter cells in the body to be used as energy or to be stored for later use.

In type 2 diabetes, one of two things can happen: 

• either the pancreas doesn’t make enough insulin, or 
  
• cells stop responding properly to the insulin (this is known as ‘insulin resistance’). 
  

In both cases, the end result is higher than normal blood glucose levels.

Over time, high blood glucose levels can cause a range of problems and complications, such as vision loss, kidney disease, foot and leg problems, and an increased risk of stroke and heart disease.

If you are living with type 2 diabetes, your treatment will usually include both lifestyle changes and diabetes medicines.

People with diabetes have a greater chance of developing a variety of complications and health problems, especially if their blood glucose is not well managed. Whether, and how quickly, these complications develop depends on how long a person has had diabetes, and how well their blood pressure, cholesterol and blood glucose levels have been controlled.

It’s not just about glucose

If you have diabetes, managing your blood pressure and cholesterol is just as important as managing your blood glucose levels. Many of the complications of diabetes are related to blood vessel damage as a result of high cholesterol, smoking and high blood pressure. Research has shown that lowering blood pressure and cholesterol can prevent 3 times as many heart attacks and strokes compared with lowering blood glucose alone.

Complications can include:

• eye problems, such as cataracts (clouding in the lens of the eye affecting vision), glaucoma and loss of vision (diabetic retinopathy)
  
• kidney disease
  
• heart disease, including atherosclerosis (narrowing or hardening of the arteries) and blood clots
  
• stroke
  
• nerve problems
  
• foot problems, including wounds that won’t heal. Diabetes can also cause damage to nerves in the feet, which means that your ability to feel pain or temperature extremes is reduced, increasing the chance of injury.
  

So if you have diabetes, it is important to do whatever you can to prevent these complications by making lifestyle changes and if necessary using diabetes medicines or other medicines for type 2 diabetes-related health problems – it’s never too late to try.

There are three main reasons to treat type 2 diabetes:

• to relieve the symptoms of diabetes, including increased thirst and needing to urinate frequently
  
• to keep blood glucose as close as possible to recommended levels (ie, 6.1–8.0 millimoles [mmol] per litre [L] before a meal and 6.0–10.0 mmol/L after a meal)
  
• to reduce the risk of developing the complications of diabetes, such as heart disease, kidney disease, eye conditions, and foot and leg problems.
  

Following a healthy lifestyle is an important part of successfully managing type 2 diabetes and includes:

• eating a balanced diet
  
• being physically active (ideally for at least 30 minutes 5 days per week)
  
• having regular health checks
  
• limiting the amount of alcohol you drink
  
• quitting smoking
  
• checking your glucose levels as recommended.
  

These actions can help maintain weight and may reduce or delay the need for blood glucose-lowering medicines. A healthy lifestyle can also help to prevent some of long-term complications of diabetes.

Keeping your blood glucose, blood pressure and cholesterol at levels recommended by your doctor, nurse or diabetes educator, can help reduce the risk of complications of type 2 diabetes.

There are a number of free check-ups you can have each year to make sure that any complications are spotted early, monitored, and treated if necessary. This is known as your Diabetes Annual Cycle of Care.

Completing an Annual Cycle of Care will help you and your healthcare professional plan all the health checks and test you'll need each year to stay healthy and keep your diabetes well managed. Each cycle of care has standard checks and tests, but the timing of these will be individual and depend on your personal circumstances.

Medicare rebates are available for people who undergo a Diabetes Annual Cycle of Care. This collection of important health checks includes the following:

• a comprehensive eye examination
• a test of kidney function
• a foot examination
• a review of all medicines (prescription and non-prescription)
• a review of diet and physical activity
• a check of HbA_1c, blood pressure, blood cholesterol and blood triglycerides levels.

What should I do?

• Make an appointment with your health professional to plan your Diabetes Annual Cycle of Care.
• Ask your health professional how often you should have each test.
• Ask your health professional to refer you to a dietitian or exercise physiologist for advice about healthy eating and physical activity.

One test that people with type 2 diabetes can take to help monitor their blood glucose is the HbA_1c glycated haemoglobin test. A blood sample is taken in this test, and sent to a laboratory for testing.

HbA_1c is glucose attached to haemoglobin (Hb) and is present in everyone’s red blood cells. High levels of glucose in the blood result in high levels of HbA_1c. The HbA_1c test measures your average blood glucose level over the previous 10-12 weeks, and gives you and your health professional a good idea about how well your diabetes is being managed. Your doctor or nurse will order this test every 3-6 months depending on your individual situation.

For most people, the recommended level of HbA_1c is 53 mmol/mol (7%) or less. Your health professional will let you know what HbA1c target is best for you and give you advice about how to achieve that target.

It is important to know that some health conditions can affect red blood cells and may affect the reliability of the HbA_1c test.

HbA_1c test reports

Your HbA_1c result is reported as a percentage and as another unit called millimoles per mole (mmol/mol). These are simply two ways of reporting the same HbA_1c result. For example, a result of 7% will also appear as 53.0 mmol/mol.

The Australian Diabetes Society has an HbA_1c converter on its website.

People with type 2 diabetes may need medicines if dietary changes and physical activity alone do not adequately control blood glucose levels.

There are many types of medicines for controlling type 2 diabetes – each with their own benefits and side effects. Each type of medicine works in a different way to control blood glucose levels.

Everyone with type 2 diabetes will need different types and doses of medicine according to their symptoms and individual needs. The medicines you take may need to change during pregnancy, illness, or during and after surgery.

Some people with type 2 diabetes will also have other health conditions that need medicines for control or treatment.

Whether you take one, two or many medicines (prescription and non-prescription) it is important that you:

• understand why you are taking them
  
• make sure to take your medicine(s) as prescribed
  
• keep track of your medicine(s) and their active ingredients
  
• know what possible side effects to expect and how to manage them (including when to seek medical assistance).
  

Find out more about the different types of medicines that are prescribed for treating type 2 diabetes, use our Medicine Finder to learn more about your individual medicines or download our MedicineWise app. 

Support groups

Joining a local diabetes support group can be helpful. Your health professional, community health centre, diabetes educator or local council can all provide information about programs and groups in your area.

Register with the National Diabetes Services Scheme

The National Diabetes Services Scheme (NDSS) can provide diabetes-related blood glucose monitoring equipment at subsidised prices, and provides information and support on a range of topics. Registration is free. Ring them on 1300 136 588 or visit www.ndss.com.au.

Links to other organisations

Diabetes Australia – Diabetes Australia is the national peak body for people with diabetes

Diabetes Australia–NSW & ACT

Diabetes Australia–Queensland

Diabetes Australia–VIC

Diabetes SA

Diabetes Tasmania

Diabetes WA

Healthy Living NT

1. Diabetes Australia. Managing your diabetes: managing type 2 [Online] (accessed 16 April 2017).
   
2. Diabetes Australia. Managing your diabetes: blood glucose monitoring [Online] (accessed 16 April 2017).
   
3. Royal Australian College of General Practitioners and Diabetes Australia. General practice management of type 2 diabetes 2016–18. 2016 [Online] (accessed 16 April 2017).