Diabetes is the result of the body not creating enough insulin to keep blood glucose (sugar) levels in the normal range. Everyone needs some glucose in their blood, but if it’s too high it can damage your body over time.

In type 2 diabetes, either the body doesn’t produce enough insulin, or the cells in the body don’t recognise the insulin that is present. The end result is the same: high levels of glucose in your blood.

For many people (but not all) type 2 diabetes can be prevented by making healthy food choices and staying active.

There is a clear link between type 2 diabetes and high blood pressure (hypertension) and / or disordered levels of fats (cholesterol) in the blood (the medical name for this is dyslipidaemia). This combination of diabetes with hypertension and dyslipidaemia is sometimes called ‘the Metabolic Syndrome’ or Syndrome X.

Type 2 diabetes most often occurs in adulthood usually after the ages of 30 – 40 years. However, increasing numbers of teenagers and children are developing type 2 diabetes.

Some groups of people are more likely to develop type 2 diabetes:

• European 40 years of age or older

• Māori, Asian, Middle Eastern or Pacific Island descent aged 30 years or older

• Diabetes in your family (grandparents, parents, brothers or sisters)

• High blood pressure

• Overweight (especially if you carry most of your weight around your waist)

• Diagnosed as having pre-diabetes (also known as impaired glucose tolerance) – this occurs when the glucose (sugar) in your blood is higher than normal, but not high enough to be called diabetes

You may have had type 2 diabetes for many years without realising it. Not everyone has symptoms. Symptoms may include:

• Feeling tired and lacking energy

• Feeling thirsty

• Going to the toilet often

• Getting infections frequently

• Getting infections which are hard to heal

• Poor eyesight or blurred vision

• Often feeling hungry

If you have any of the above symptoms, discuss these with your doctor.

Diabetes is diagnosed by blood tests which can be organised through your doctor. If you are very unwell you should seek medical assistance
immediately.

If you have a blood relative with type 2 diabetes you are more likely to develop type 2 diabetes yourself. However type 2 diabetes sometimes occurs in people who have no one in their family with the condition.

In people with type 2 diabetes, glucose builds up in the blood. But with good management, your blood glucose levels may go down to normal again. But this does not mean you are cured. Instead, a blood glucose level in your target range shows that your treatment plan is working and that you are taking care of your diabetes.

In a nutshell: some people with type 2 diabetes may be able to manage their diabetes through diet and exercise, or by taking tablet medication. However, eventually many people with type 2 will manage their diabetes with insulin as well.

Your doctor will advise you on what treatment is best for you, but whatever this may be, healthy food choices and staying active is important. The goal is to lower your blood glucose and improve your body’s use of insulin. This is achieved through:

• A healthy diet

• Exercise

• Weight loss

The focus of your food choices and regular exercise is to achieve and maintain healthy blood glucose levels. Losing weight helps your body use insulin better.

You may also have to take medication. Type 2 diabetes is a progressive condition. This means that over time you will gradually produce less and less insulin. Although you may be able to manage your blood glucose levels in the healthy range by eating healthy food and having regular exercise for a number of years, most people come to need tablets or insulin as well as their food and exercise plan.

Learn more about Diabetes Management here and download the My Diabetes Journey app from the App Store or Google Play to help you manage your diabetes.

Learn More About the My Diabetes JOurney App

The New Zealand Society for the Study of Diabetes has developed national up to date and evidence-based guidance for the management of type 2 diabetes in adults with support of the Ministry of Health. The guidance is designed as a concise pragmatic resource for all health professionals working with people with type 2 diabetes in New Zealand and will be updated as evidence and practice changes.

NZSSD Type 2 Diabetes Management Guidance

When they are diagnosed with type 2 diabetes, most people feel very anxious, sad and fearful. That is perfectly natural.

Mixed in with these feelings may also be a sense of relief. Why? Well, there is a feeling of certainty that comes with finding out just what it is that has been wrong (when you have undiagnosed type 2 diabetes you may have been unwell and tired for some time but haven’t known what the problem was). It can be a relief to get a diagnosis but also a shock to learn it is diabetes.

Your own personal experience plays an important part in how you will react to, and cope with, your diabetes. Many of you will know someone who had, or has, diabetes. How they coped (or not) will influence how you feel. People who successfully coped with diabetes will be positive role models for you. Those who had a bad diabetes experience, on the other hand, may make you feel more fearful.

But, it’s important to remember that everyone has their own personal choices to make about the way they choose to live with their diabetes. The other thing to remember is that with increasing knowledge about diabetes, and ever more sophisticated tools to deal with diabetes, there never has been as ‘good’ a time to have diabetes as now (although it may not seem like it at the moment!). At this point in time, you’ve never had a better opportunity to live a long, happy and healthy life.

Although most people are shaken by a diagnosis of type 2 diabetes many people come to see the diagnosis in a more positive light, as a wake-up call. It is often an incentive to become more active, to eat healthier food and to manage your body weight.

It can also be an opportunity for you to make a positive difference to those around you, be they your friends or your immediate and larger family. You taking a positive and active approach to living with your diabetes can sometimes act to improve the health and happiness of your entire family group.

You can make a very practical difference too. The skills you learn to manage your diabetes may be the very skills your children or other family members need to prevent them developing type 2 diabetes at all.

Things you can do for yourself to help you cope with type 2 diabetes include:

• Taking time out so you can have space within which to make the emotional and practical adjustments you need.

• Talking to others. Share your thoughts and feelings with your friends and family. Spend time with those who can support you and understand your feelings. Talk to other people with diabetes. Their insights will help you and it’s important for you to know that you are not alone.

• Take time to learn the skills you need to manage your diabetes. But remember you can’t learn it all at once. Don’t be too hard on yourself. Take it one step at a time.

• Seeing a dietitian to get the most up-to-date information and support for your food choices.

• Attending local diabetes groups or classes or visit a diabetes nurse educator.

• Making contact with your local diabetes organisation and seeing if they run support groups or have other resources.

• Having some counselling if you find living with diabetes especially hard.

• When you do make changes to your lifestyle don’t try doing it all at once. One manageable step at a time is best. And don’t forget to give yourself a pat on the back when you achieve each step.

• Looking around in your community for groups or activities that may help you make changes, for example, activity groups, walking groups, dance classes etc.

• Don’t expect miracles overnight. Your adjustment process will have its highs and its lows. It doesn’t follow a set pattern. Be prepared for setbacks and bad patches. But remember that getting back on track is only a moment away.

• Thirst

• Passing more urine

• Weight loss

• Very tired

• Mood changes

May also have:

• Abdominal pain, nausea, vomiting

• Skin infections, thrush

• Extreme hunger

• Poor concentration and performance

Diabetes is diagnosed by blood tests which can be organised through your doctor. If you are very unwell you should seek medical assistance immediately.

If you have type 1 diabetes, you will need to manage your blood glucose levels with insulin. Healthy eating and physical activity will also help you stay well.

If you have a blood relative with diabetes you are more likely to develop Type 1 diabetes. However Type 1 diabetes often occurs in people who have no one in their family with the condition.

Currently there is no cure for type 1 diabetes. There is a lot of research going on in the field of finding a cure for Type 1 diabetes.

Yes! Type 1 diabetes can be managed and people with type 1 diabetes can and do live long, active and healthy lives. There are many stories of people with type 1 diabetes finding success in professional sports, business, arts and more.

Many people experience a strong grief reaction when first finding out they have type 1 diabetes. Mixed in with these feelings of grief may also be a sense of relief.

Why? Well, there is a feeling of certainty that comes with finding out just what it is that has been wrong (people with undiagnosed type 1 diabetes may have been feeling unwell for some time but haven’t known what the problem was). It is a relief to get a diagnosis but it is also a big shock to learn it is diabetes.

When you are first diagnosed it’s perfectly natural to feel a range of strong emotions, fear, anger, frustration, sadness. You have had a lot of big things to deal with – all at once. There are things you can do, however, that will help you manage your way through this period. For example:

• Talk to your family and friends. Talking to others often helps you to feel supported and explaining things to other people is often a good way of getting things clear in your own mind.

• Talk to your health professionals about how you feel. Ask them what things you can do to help yourself feel better.

• Do lots of nice things for yourself. This is a hard time and a little bit of self-indulgence goes a long way at times like this. The more good things you do, the more you will move into a positive frame of mind.

• Don’t expect miracles overnight. Grief comes and goes; it doesn’t follow a set pattern. Be prepared for these feelings to resurface from time to time.

 Take your time: use the support that’s there

Fact: You and your type 1 diabetes will be together for the rest of your life.

Fact: You are going to be doing lots of learning in order to manage your diabetes.

Many people say that living with type 1 diabetes is a life long journey of learning. You don’t have to take it all in at once. It often feels easier to take it step by step.

And remember – you are not alone. You have a whole team of health professionals who are able to help you learn what you need to know, when you need to know it. Your team consists of specialist diabetes doctors, diabetes nurse educators, dietitians, your GP and others. They can act as your guide during your learning journey.

Your blood glucose levels are directly affected by the kind and amount of carbohydrate (starchy foods and sugar) you eat.

Your risk of having a heart attack or stroke is affected by the kind and amount of fat you eat.

People with diabetes do not need to buy special foods or cook separate meals. The whole family can eat the same healthy foods.

• Drink plenty of water and stop drinking fruit juice and sugar-sweetened drinks.

• Eat breakfast, lunch and dinner every day.

• Eat some carbohydrate at each meal, but not too much.

• Stop eating foods high in sugar.

• Choose foods low in fat.

• Follow the Diabetes New Zealand Healthy Plate, in the Diabetes and healthy food choices pamphlet here.

• Match the food you eat to your weight, medications, medical conditions and activity.

• Lowers blood glucose levels.

• Makes the body work better.

• Helps with weight control.

• Lowers high blood pressure.

• Relieves stress.

Activities can include brisk walking, biking, swimming, dancing and mowing the lawn. Aim for at least 30 minutes of moderate activity each day. More is better but begin gradually and build up slowly.

If you are joining a gym or exercise class talk to your doctor first.

See the Diabetes New Zealand pamphlet Diabetes and physical activity for more information, here.

To stay well:

• Lose weight if you need to.

• Eat healthy food.

• Keep physically active.

• Don’t smoke.

• Have regular health checks.

Remember, everyone in your family can eat the same healthy foods. Children need to have healthy food and plenty of activity from a young age

• Because pregnancy causes certain types of hormones (that are made by the placenta) to be released. These hormones make it harder for insulin to do its job

• Because the growth demands of the foetus (developing baby) increases the mother’s need for insulin

Unlike type 1 and type 2 diabetes, gestational diabetes is only temporary and usually disappears after pregnancy. However, a person who has had gestational diabetes has an increased risk (50-60%) of developing type 2 diabetes in the future; therefore they should be tested for type 2 diabetes each year.

Insulin is a natural hormone produced by the body. It is needed to take the sugar from your blood and move it into your cells (where it is used as an energy source for the various things that cells have to do). If your body cannot make enough insulin, sugars from the foods you eat will stay in your blood stream and cause high blood sugars. High blood sugar levels are known as hyperglycaemia.

• Untreated, the high sugar (and fat) in the blood of a woman with gestational diabetes can overfeed the baby while it is in the womb, leading to "macrosomia" or a larger than average baby (weighing more than 4kg).

• Premature birth (baby being born before 37 weeks) is more common.

• Miscarriage (before 23 weeks) and stillbirth rates (baby dying before birth) are also higher.

• An increased chance of getting urinary tract infections

• Much higher risk of developing diabetes in the future.

At birth:

• Being large at birth. Babies who are too large at birth have a much higher risk of developing serious problems following their birth.

• Shoulder dystocia, which is a serious complication when the baby’s head passes through the vagina, but their shoulder gets stuck behind the mother's pelvic bone (the hips and ring of bone that supports your upper body).

• Having a serious low blood glucose level soon after birth. This can happen because before being born your baby had been getting a very high level of glucose out of your blood (across the placenta). The baby had adjusted to this high glucose level by making high levels of its own insulin. When the placenta separates after birth this high level of glucose (from you) suddenly stops. The baby still has very high levels of its own insulin and this can cause its blood glucose to fall too low.

• Prolonged new-born jaundice

• Low levels of calcium in the blood

• Respiratory distress syndrome (this can be quite dangerous)

Later in life:

• Babies are at increased risk of developing diabetes or obesity (having a body mass index of more than 30) later in life.

If you have one or more of the following factors you are more likely to develop gestational diabetes:

• Having a family history of type 2 diabetes in a close relative (parents or brothers and sisters)

• Having gestational diabetes in a previous pregnancy

• If a previous baby had a birth defect

• If you are very overweight

• If you are aged over 30

• If you have had a previous stillbirth or spontaneous miscarriage

• If you’ve had a previous large baby (greater than 4 kilos)

• If you have a history of pregnancy-induced high blood pressure, urinary tract infections, or polyhydramnious (too much amniotic fluid)

Every pregnant woman should now be offered a blood test for glycated haemoglobin (HbA1c), as a routine part of booking antenatal blood tests before 20 weeks. This will help identify women with probable undiagnosed diabetes or prediabetes and will help to identify women at high risk of developing gestational diabetes.

At 24–28 weeks of pregnancy, you will be offered a further blood test to check for any diabetes.

The screening test is called an oral glucose tolerance test (OGTT), which takes about 2 hours.

It involves having a blood test in the morning, when you have not had any food or drink for 8 to 10 hours (though you can usually drink water, but check with the hospital if you're unsure). You're then given a glucose drink. 

After resting for 1-2 hours, another blood sample is taken to see how your body is dealing with the glucose.

• For women whose earlier HbA1c was 41–49 mmol/mol at booking, a two-hour glucose tolerance test (GTT) is organised.

• For women whose HbA1c was normal, a one-hour, 50 g oral glucose challenge test (polycose) is done.

In most cases, gestational diabetes is able to be managed by diet and exercise during the pregnancy. It usually disappears after the baby is born once the need for high levels of insulin (during pregnancy) has gone.

Some women with gestational diabetes require insulin to manage their blood sugar levels in a healthy range during the pregnancy. If you do need insulin, it will help to keep both you and your baby healthy during the pregnancy.

It is very much better for both you and your baby to be in the care of a specialist team if you have been diagnosed with gestational diabetes. This team can help you to learn the skills you need to know to manage your gestational diabetes.

You will most probably want to talk over each of the following issues with your health care team members:

• Keeping your blood glucose levels in a healthy range.

• Using a home blood glucose meter to test your blood glucose levels. Whether you need to do this testing and if so how often, will depend on the results of your laboratory blood glucose levels.

• Managing your weight gain during pregnancy. But remember that good nutrition is important during pregnancy. A dietitian will help you work out your nutritional needs.

• A healthy level of exercise (exercise helps improve blood glucose levels for some people, and is important to improve flexibility and prepare you for childbirth)

• Breastfeeding. There isn’t any reason why you shouldn’t breastfeed baby. Your milk is the best source of food for your baby.

Remember, if you have had gestational diabetes you should be checked for type 2 diabetes every year for the rest of your life. Your best defence against developing type 2 diabetes is to try to keep your body weight lean and get plenty of physical exercise. Some people remember this by ‘staying lean and mean’.