Type 2 diabetes in adults: management

If your blood glucose level is very high

If your blood glucose level is high, the medical name for this is hyperglycaemia. The symptoms of hyperglycaemia include feeling very thirsty, needing to pass urine a lot and feeling more tired than usual. If your blood glucose level is too high and you notice any or all of these symptoms, you'll be offered insulin or a medicine called a sulfonylurea to lower your blood glucose level.

When your blood glucose is under control your doctor will review your treatment.

Medicine to control blood glucose

There are several different types of medicines that can be used to treat type 2 diabetes. Some medicines are used on their own and some can be used together with others. The medicine (or medicines) you are offered will depend on your diabetes, what diabetes medicines you have had before, any other health issues you have and your preferences.

Most people with type 2 diabetes who need medicine start off taking a medicine called metformin. This isn't suitable for everyone so your doctor will discuss other options with you if needed.

You may also be offered a type of medicine called an SGLT2 inhibitor, to control your blood glucose. SGLT2 inhibitors are helpful for people with type 2 diabetes who have cardiovascular disease, or who are at high risk of developing it. Your doctor should work out your individual risk of cardiovascular disease and use this to discuss the potential benefits of an SGLT2 inhibitor with you. If an SGLT2 inhibitor could help you, you might take it on its own or with metformin.

If this first medicine (or combination of medicines) doesn't help or your diabetes is getting worse over time, you may need to add in another type of medicine as well as the ones you are already taking. If this still doesn't help or your diabetes is getting worse, you may be offered a third medicine. Your doctor may suggest you start on insulin if you are already taking 3 medicines, or if they think insulin would be better for you than a third medicine.

Your doctor or nurse will review your HbA1c target with you if you need more than 1 medicine to control your blood glucose.

When your doctor is discussing different types of medicines with you, they should explain all the possible benefits and risks, including any possible side effects, so you can decide together what will suit you best. They should also review your medicines after you start taking them, to make sure they are working and are still right for your circumstances.

Insulin for controlling blood glucose

As type 2 diabetes progresses over time, the blood sugar levels naturally tend to rise. This means many people with type 2 diabetes will need insulin at some point in order to feel better, simply because the tablets are no longer strong enough.

Insulin cannot be taken as a tablet and has to be injected.

There are several different types of insulin treatment, which vary in both the insulins used and the number of injections. If you have type 2 diabetes and need insulin, you should usually be offered treatment with a 'long‑acting' insulin that is injected once or twice a day. The insulin used will depend on which suits you best – your diabetes care team will talk with you about this.

If you have been taking metformin without any problems you should continue to take this, as well as insulin.

Injecting insulin

Insulin is commonly injected using a device called an 'insulin pen'. Your diabetes care team should help you choose the type of device and needles that suit you, and offer you different needles to try if your skin gets sore or irritated.

Your skin can get lumpy if you keep injecting in the same place, so you should use different areas of the body (stomach, thighs, bottom, upper arms) and different spots in these areas. Your diabetes care team will check your skin at your annual review, and more often if needed.

You should be given a special secure container (called a 'sharps bin') for used needles, lancets (from finger pricking) and any other sharps. You should also be told how to get rid of these containers when they are full and how to get new ones.

Information and support

If you start using insulin, you should be given: