Diet and diabetes: how to manage type 2 diabetes through your diet
Why type 2 diabetes check-ups are so important
More than 4.9 million people are currently living with diabetes in the UK, around 90% of them with type 2. However, the disruption caused by the pandemic has led many people to stop getting routine type 2 diabetes check-ups - putting them at risk of serious health complications.
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Why are people with type 2 diabetes missing check-ups?
In the 19 months since the UK first went into lockdown because of the COVID-19 pandemic, the news has been dominated by the virus. During the first lockdown, GPs were ordered by the NHS to operate a 'triage' policy, only seeing patients who had been screened first. Hospitals too stopped almost all routine appointments, waiting for - and then struggling under - the weight of admissions from COVID-19 patients.
The COVID-19 vaccine programme has been one of the greatest global successes of science in history, with an estimated 130,000 lives saved in the UK alone since it rolled out at the start of this year. But COVID-19 is not the only condition in town, and many patients with long-term conditions - including type 2 diabetes - have missed out on monitoring.
Fewer healthcare checks
As concerns about COVID-19 gradually reduced following the first lockdown, people flooded back to their general practices. In August 2021, there were 25.5 million appointments carried out in general practice - 5 million more than a year earlier.
Despite this, the strains on the NHS caused by COVID-19 mean there is a huge backlog of patients who weren't invited, or were unable to attend, appointments when services were all focused on COVID-19 levels. As a result, many people living with type 2 diabetes have missed regular check-ups. Research has estimated that between March and December 2020, 7.4 million fewer healthcare checks took place in UK general practices in people with type 2 diabetes, when compared to 10-year historical trends.
During the first wave of the pandemic, the number of people having monitoring of their HbA1c - a person's average blood glucose levels for the last two to three months - dropped by about 77%. While the number of checks increased significantly at the end of the first lockdown, by October 2020, routine HbA1c monitoring was still down by about 31% compared to pre-pandemic levels.
This is likely to have left large numbers of people with poorly controlled diabetes and high blood pressure, which can lead to further health complications.
Why are type 2 diabetes check-ups so important?
Diabetes is a serious condition which requires constant management. Without the right treatment, care and support, the condition can lead to devastating, life-altering complications, including heart attack, kidney failure, stroke, foot disease and blindness.
By 2030, if no further action is taken, Diabetes UK estimates there could be more than 87,000 hospital admissions a year in England due to diabetes. This would be an increase of 14% compared to 2020/21 and more than 50% higher than in 2006/07. Additionally, people with diabetes are at higher risk of severe illness from COVID-19, especially if their condition is not well managed.
If you have type 2 diabetes, regular check-ups help to keep your blood glucose levels at a level that will minimise your risk of complications. Your target HbA1c level will depend on your individual circumstances - for some this will be 48 mmol/mol (6.5%) or lower, while for others it will be 53 mmol/mol (7.0%). For frailer people, the target may be higher still - your medical team can advise you.
"For those living with the condition, blood tests provide crucial insight into how their diabetes is being managed. They help people understand, monitor and reduce their risk of developing complications," says Nikki Joule, policy manager at Diabetes UK. "Diabetes is serious, and as we emerge from the pandemic, we know that many people are still waiting for a diabetes blood test or to see their diabetes team.
"While we welcome the Government's recent commitment to invest more in preventing type 2 diabetes, it must urgently address the backlog in routine care," Joule says. "Further investment is vital to restore diabetes services."
Diagnosing type 2 diabetes
Diagnoses of diabetes have doubled in the last 15 years, and currently almost 4.1 million people in the UK are diagnosed with some form of the condition. According to Diabetes UK, a further 850,000 are living with type 2 diabetes but are yet to be diagnosed.
It's essential to speak to your doctor about getting tested if you're experiencing possible symptoms of type 2 diabetes. These include needing to urinate more or feeling more thirsty than usual, feeling very tired, recurrent minor infections such as thrush or boils, cuts or wounds taking longer to heal and blurred vision.
People who are overweight or obese, or who are of Asian, African-Caribbean or black African origin are at higher risk of developing type 2 diabetes. So too are people who have a strong family history of type 2 diabetes. Type 2 diabetes becomes more common with age and is most often diagnosed in over-40s.
"Early diagnosis of diabetes is vital in reducing the risk of potentially life-altering complications, such as heart attack and stroke," says Joule.
In addition, lifestyle changes during the pandemic may have left people at increased risk of developing type 2 diabetes. Disruption to regular routines meant that across the adult population, more than 2 in 5 people in England gained weight - and weight gain is closely linked both to developing type 2 diabetes and to worsening blood glucose control among people who have the condition.
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How often should you go for your regular type 2 diabetes check-up?
It is recommended that you see your GP or diabetes nurse every three to six months for blood sugar (glucose) checks. An HbA1C test checks your average blood glucose levels and how close they are to normal. You will usually be advised to have these checks every three months when newly diagnosed, then every six months once you're stable.
At least once a year, you should have your feet checked to see if you have lost any feeling and for ulcers and infections. This can be done by your GP, diabetes nurse or podiatrist. Speak to your GP or podiatrist immediately if you have cuts, bruises or numbness in your feet.
Your healthcare professional will also examine you for high blood pressure, and heart and kidney disease. They will ask you to provide a urine sample to check for protein in the urine, and advise on diet and lifestyle (including smoking). You should also be having an annual appointment to take photographs of the back of your eyes (retinal photography) to check for damage to blood vessels in your eyes.
How is type 2 diabetes treated?
Lifestyle changes, such as a healthy diet and keeping active, will help you manage your blood glucose level. It is generally advised to eat a wide range of healthy foods, including fruit and vegetables, while reducing your intake of refined starchy and sugary carbohydrates, fat and salt. If you're overweight, losing weight will make it easier for your body to lower your blood glucose level.
Exercise also helps to lower your blood glucose level and you should aim for 2.5 hours of activity a week. This can involve walking, swimming, strenuous gardening or fitness classes - it's important to find something you enjoy.
In addition to diet and lifestyle measures, most people use medicine to control their type 2 diabetes. Glucose-lowering medicines help keep your blood glucose levels as normal as possible to prevent health problems.
Over time, you may need a combination of medicines and your GP or diabetes nurse will recommend the medicines most suitable for you. Insulin is not often used for type 2 diabetes in the early years, but it may be needed when other medicines no longer work.
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