The type of medication you require will depend on your own individual needs and situation, so you should discuss the types of medication available and the most suitable options for you with your healthcare team. Whichever medication you are prescribed, it will only work and help control your diabetes if you take it properly and regularly. Make sure that your doctor or pharmacist explains how much medication to take and when to take it – in relation to your food – before, during or after food.
You may find that, despite keeping to a healthy diet, physical activity and taking your diabetes medication regularly, your diabetes control is not as good as it was. This is because Type 2 diabetes is a progressive condition and, over time, you may need more help to manage your blood sugar levels.
Types of diabetes medication
There are several different ‘families’ (or types) of diabetes medication:
Note: These groups may contain more than one medication. Your doctor may recommend increasing the dose of your medication or taking more than one kind of medication.
Islet transplants for Type 1 diabetes
Type 1 diabetes results from the destruction of insulin-producing cells in the islets of the pancreas. Islet cell transplantation involves extracting islet cells from the pancreas of a deceased donor and implanting them in the liver of someone with Type 1. This minor procedure is usually done twice for each transplant patient, and can be performed with minimal risk using a needle under local anaesthetic.
In 2008, the UK launched the first government-funded islet transplant programme in the world. As of March 2015, 152 islet transplants had been performed in the UK since the launch. Islet cell transplants are now available through the NHS for people who satisfy the criteria given below.
When are islet transplants needed?
About one third of people with Type 1 diabetes each year will experience a ‘severe’ hypo – meaning that they need someone else to help them. Severe hypos can occur in anyone taking insulin, but they are more likely to occur in people who have had diabetes for more than 15 years and those who are unable to recognise when their blood glucose is low (a problem known as hypoglycaemic unawareness). For these people, an islet transplant can be a life-changing, and sometimes a life-saving, therapy.
Who might be suitable for an islet transplant?
- People with Type 1 diabetes who have experienced two or more severe hypos within the last two years, and have impaired awareness of hypoglycaemia.
- People with Type 1 diabetes and a functioning kidney transplant who experience severe hypos and impaired hypoglycaemia awareness or poor blood glucose control despite the best medical therapy.
Who might not be suitable for an islet transplant?
- People who need a lot of insulin (e.g. more than 50 units per day for a 70kg person).
- People who weigh over 85kg.
- People with poor kidney function.
What are the potential benefits?
Islet transplants have been shown to reduce the risk of severe hypos. Results from UK islet transplant patients showed that the frequency of hypos was reduced from 23 per person per year before transplantation to less than one hypo per person per year afterwards.
Islet transplants usually also lead to improved awareness of hypoglycaemia, less variability in blood glucose levels, improved average blood glucose, improved quality of life and reduced fear of hypos. Long-term results are good and are improving all the time. For example, the majority of transplant patients can now expect to have a functioning transplant after six years and some people have had more than 10 years of clinical benefit.
What risks are involved?
Islet transplants involve a small but increased risk of certain cancers, severe infections and other side effects related to the medication needed to prevent the islets from being rejected by the body (which is the same medication used by people who receive other kinds of transplants).
Islet transplants are unsuitable for people who are desperate to stop their insulin injections. If freedom from insulin injections is achieved, this is usually short-lived, and most people who receive an islet transplant continue to take low-dose insulin therapy. Therefore, islet transplants should not be seen as a cure for diabetes.
Find out more
If you think you might be eligible for an islet transplant, please read the detailed guide to islet transplants (PDF, 7MB) prepared by the UK Islet Transplant Consortium and discuss it with your diabetes healthcare team.
Who to contact
Referrals for islet transplant are being accepted by teams at seven centres across the UK. The doctors at each centre are very happy to discuss possible referrals and can be contacted directly.
Contact details for UK islet transplant centres.
Surgery for Type 2 diabetes
For many years, a variety of obesity surgery procedures applied to the stomach or intestine have been used as a method of losing weight, and losing weight can help people manage their Type 2 diabetes.
More recently, medical research has shown that obesity surgery can also directly affect how the body uses insulin. In addition to the benefit of directly losing weight and improving blood sugar levels, this surgery itself assists people in managing their Type 2 diabetes. It can:
- change how the hormones in your gut work, which in turn affects how your body makes insulin
- increase the amount of bile acids that your body makes – these make your body cells more sensitive to insulin
- improve the way the cells use insulin, leading to lower blood sugar levels.
What are the different versions of Type 2 diabetes surgery?
There are various forms of obesity surgery, also known as bariatric surgery, that may be offered. Surgical options include removal of part of the stomach to reduce stomach size and consequently restrict appetite and food intake, or a surgical re-route of the digestive system to bypass the stomach.
Both treatments assist people in reducing their food intake due to requiring less food to feel full, but also beneficially affect how your body uses insulin. You can discuss surgery with your diabetes healthcare team, who will be able to give you further information.
Who can have surgery for diabetes?
Until now, surgery of this type hasn’t been fully recognised as a standard treatment for Type 2 diabetes. NICE obesity guidelines recommend surgery for weight loss for people who meet a certain strict criteria, including those newly diagnosed with Type 2 diabetes. However, in practice surgery is mostly offered only for a restricted group of people who have already had have attempted suitable lifestyle changes and/or received drug treatment for weight loss. Unfortunately, the NICE Type 2 diabetes guidelines also failed to fully recognise surgery as an option for treating Type 2 diabetes.
In May 2016, new international clinical guidelines on surgery for Type 2 diabetes were published by a group of leading international diabetes organisations including Diabetes UK and endorsed by 45 international professional organisations. The group states that "obesity surgery, which was originally designed to induce weight loss, should be included among the current treatment options for certain categories people with Type 2 diabetes".
These new guidelines state that surgery should be recommended if they:
- have a BMI (Body Mass index) of over 40, regardless of how well their Type 2 diabetes is managed, or what other diabetes treatment they are undergoing
- have a BMI of 35-40 with blood sugar levels that aren’t sufficiently controlled by following a healthy lifestyle and taking medication for Type 2 diabetes.
The new guidelines state that surgery should also be considered if you have Type 2 diabetes, a BMI of 30-35 and your blood sugar levels are not well managed by healthy lifestyle and medication. The guidelines also recommend a lower BMI threshold for those from an Asian background with Type 2 diabetes, as statistically people from that ethnic background can develop Type 2 at a lower BMI to other ethnic groups.
It is important to note that these are guidelines, so it is important to discuss your options with your healthcare team to understand whether surgery is a potential option for you.
Are there any risks of diabetes surgery?
All surgery carries a slight element of risk, but surgery for Type 2 diabetes does not have any greater risk than common surgical procedures. In the long term, there may be a risk of nutritional deficiencies, such as anaemia and the need to take vitamin or nutritional supplements. You will also need regular, long-term follow up consultations and monitoring.
Can surgery cure Type 2 diabetes?
Surgery for Type 2 diabetes is not a permanent cure. However, there is strong evidence that surgery can help some people to stop taking blood sugar medications or place their diabetes into remission. It is important to maintain your regular diabetes reviews so that any relapse in blood sugar levels, or diabetes related complications, can be monitored and treated.
What does Diabetes UK think of the new guidelines?
Evidence shows that surgery is a very effective treatment option for some people with Type 2 diabetes and can be cost-effective for the NHS. Diabetes UK believes that you should have access to all proven effective treatments. Simon O’Neill, Director of Health Intelligence and Professional Liaison at Diabetes UK said: “We strongly support the call for obesity surgery to be fully recognised as an active treatment for Type 2 diabetes alongside established forms of treatment such as following a healthy lifestyle and medications to lower blood glucose levels.”