Treatment and healthcare

How do you treat Type 2 diabetes?

Two things that are important here – lifestyle changes and medication.

Lifestyle changes

By “lifestyle changes” we mean losing weight and being more active. For most children and young people with Type 2 diabetes it’s the first type of treatment recommended.

Lifestyle changes are just as important as any medication your doctor might give you. And it’s something that your whole family can be involved in, not just you.

Your dietitian will give you detailed individual advice, but here are a few tips to get you stared:

  • Cut sugary drinks like fruit juice,fizzy drinks and full sugar squash and aim to cut them out completely. Sugary drinks just give your body unnecessary extra energy that will make you put on weight and make your blood glucose level go up. If plain water leaves you cold go for diet drinks or no added sugar squash instead.
  • Eat meals on time with no distractions like TV, reading or computergames. This will help you eat more slowly.
  • Eat your meals from a plate or bowl, not directly from the packet Eat more slowly and don’t go back for seconds! Often children who are overweight eat very fast and then want more.
  • Cut back on the high fat and high sugar foods. High fat foods are things like pastries,pies,fried foods,processed meats and cheese. High sugar foods are things like sugary drinks, sweets and cakes.
  • Look for food labels that have green or amber colours for fat, sugar and salt. – You don’t have to cut all these foods out completely but try to have them less often or have smaller portions.
  • Make sure your meals are the right size – too much of any food is going to make you put on weight.
  • Eat breakfast every day. Breakfast is important because if you start your day out right with healthy food you are more likely to eat healthier foods throughout the day. Something like wholegrain breakfast cereal, porridge or granary bread will fill you up until lunchtime so you’ll be less likely to snack on crisps and sweets.
  • Choose healthier snacks. Instead of crisps or sweets, try fruit, low-fat yogurt or, if you can’t resist your crisps, go for a low-fat variety.
  • Wholemeal or whole grain varieties of things like pasta, rice and bread will leave you feeling fuller for longer. So try them instead of the white varieties – you never know, you might prefer them!
  • Aim to eat five portions of fruit and veg a day. One portion of fruit is two small plums/satsumas or one medium sized apple or orange. One portion of vegetables is three heaped tablespoons of cooked peas, carrots,broccoli or three heaped tablespoons baked beans. Fruit and vegetables fill you up and are relatively low in calories too. It’s easy to say you don’t like fruit and veg but when did you last try a new variety? Join Mum or Dad on the supermarket run and pick up something that looks interesting.
  • Cut back on the time you spend in front of the TV or computer. While you’re in front of the screen you’re not really burning up energy.
  • Get more active as a family – activity with others can be a lot more fun. Children need one hour of physical activity every day, but you can fit this into your normal day. Try walking to school, taking the stairs rather than the lift and maybe get yourself a pedometer to see how many steps you can do?

Find more tips on eating healthily and being more active.

Medication

By “medication” we mean tablets or insulin injections. Your doctor might suggest you try some medication if your diabetes still isn’t very well controlled after three to six months of making lifestyle changes.

Medication isn’t instead of the lifestyle changes we’ve suggested - it’s important you keep up with your healthy living as this will help your medication to work better. The first medication your doctor will give you is likely to be a tablet called Metformin.

Metformin lowers your blood glucose by helping your body use it’s own insulin better, and stopping your liver making glucose.  It can also help you lose weight and lower your blood fats.

Metformin can give you some diarrhoea or tummy problems when you first start taking it so your doctor might well just give you a small dose to begin with and gradually increase it as you get used to it. And for most people the tummy problems go away quite quickly so it’s worth persevering with. If after about three months Metformin doesn’t seem to be working, your doctor might give you another type of tablet as well. Or they might suggest you go on to insulin injections.

Insulin injections

If you need insulin injections, that might just a once a day injection of a long-lasting insulin, at least to start with. But your doctor might suggest you also take another type of insulin (called “rapid acting”) with your meals as well.

What are 'complications' and what might they do to me?

Doctors often use the word “complications” to describe the other health problems that can happen if you have diabetes. While these apply to Type 1 as well as Type 2 diabetes, unfortunately for children or young people with Type 2 they tend to happen earlier. And sometimes they are present when you first get diagnosed with Type 2.

Because we know these complications can happen to people with diabetes, your doctor will check for them very carefully both when you’re diagnosed and every year after that. And we know that the better you can look after your diabetes, the less chance there is of getting any of these complications.

Health problems to be aware of:

Heart or blood vessel problems (known as “Cardiovascular disease”)

This can cause things like heart attacks and strokes. It’s very unlikely that you’ll have a heart attack or a stroke as a child, but you might already have high blood pressure and/or high blood fat levels which might make them more likely when you’re older.

What can be done?

If your doctor finds you’ve got high blood pressure or high blood fat levels they can give you tablets to lower them. And losing weight and getting active really helps as well.

Kidney problems (known as “Nephropathy”)

The first sign of kidney problems is when your kidneys starting to leak protein (called “albuminuria”). If this isn’t looked after properly, your kidneys could fail completely and you’d need dialysis or a kidney transplant.

Again, this isn’t likely to happen when you’re a child but if you’ve got high blood pressure as well as Type 2 diabetes it could be more likely when you’re older.

What can be done?

If your kidneys do start leaking protein your doctor can give you tablets to stop it happening. And again, losing weight and getting active helps.

Problems with your eyes (called “retinopathy”) and nerves (called “neuropathy”) can also be more common in people with diabetes. But these can be treated by your doctor as well. And remember the important bit – keeping your diabetes under control will not only help reduce the chance of you getting any of these complications, but if you do have any already it will help control them as well.

How will I know if my Type 2 diabetes is under control?

This is something both you and your paediatric diabetes team can check for.

What you can do

Your paediatric diabetes specialist nurse or PDSN will give you a monitor to check your blood glucose levels and show you how to use it. They’ll also discuss with you what level you should be aiming for how often you need to check your blood glucose levels.

As a general guide you should do a few tests a week both before and after meals. But there are times when you’ll need to test a bit more often:

  • When you’re newly diagnosed with Type 2 diabetes
  • If you’re ill (being unwell can make blood glucose levels high)
  • If you’re levels are higher than usual (you’ll need to talk to your doctor or nurse about changing your medication)
  • If your treatment or medication has recently been changed (to check the change is working)
  • If your levels are too low (some medications can make blood glucose levels too low – again, you’ll need to talk to your doctor or nurse)

What your team can do

As well as seeing your PDSN at home, you’ll also need to come to the hospital regularly to see your doctor.

At least twice a year they will do a blood test called an HbA1c which measures your overall diabetes control. For most that test should be less than 58mmols/mol (7.5%) but we’re all different so your doctor might suggest a different level for you.

As well as this, every year you’ll get a full examination which checks for any problems with your heart, kidneys, eyes and nerves. And if any problems are found, your doctor will be able to give you some treatment.