Type 2 diabetes

Type 2 diabetes - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Diabetes Type 2 diabetes Type 2 diabetes About type 2 diabetes Symptoms of type 2 diabetes Causes of type 2 diabetes Treating type 2 diabetes Complications of type 2 diabetes Living with type 2 diabetes About type 2 diabetes Diabetes is usually a lifelong condition that causes a persons blood glucose (sugar) level to become too high. The hormone insulin  produced by the pancreas  is responsible for controlling the amount of glucose in the blood There are two main types of diabetes: type 1  where the pancreas doesnt produce any insulin type 2  where the pancreas doesnt produce enough insulin or the bodys cells dont react to insulin This topic is about type 2 diabetes. Read more about type 1 diabetes Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear after birth. Symptoms of diabetes The symptoms of diabetes occur because the lack of insulin means glucose stays in the blood and isnt used as fuel for energy. Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine. Typical symptoms include: feeling very thirsty passing urine more often than usual, particularly at night feeling very tired weight loss and loss of muscle bulk slow to heal cuts or ulcers frequent vaginal or penile thrush blurred vision Read more about the symptoms of type 2 diabetes Its very important for diabetes to be diagnosed as soon as possible as it will get progressively worse if left untreated. Causes of type 2 diabetes Type 2 diabetes occurs when the body doesnt produce enough insulin to function properly, or the bodys cells dont react to insulin. This means glucose stays in the blood and isnt used as fuel for energy. Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. Due to increased obesity, type 2 diabetes is now being seen in young people and all ages. Its far more common than type 1 diabetes. Read about the causes and risk factors for type 2 diabetes Treating type 2 diabetes Type 2 diabetes is treated with changes in your diet and depending on the response of your blood glucose levels, sometimes tablets and insulin. Early in the course of type 2 diabetes, planned weight loss can even reverse the disease. Read more about the treatment of type 2 diabetes Complications of type 2 diabetes Diabetes can cause serious long-term health problems. Its the most common cause of vision loss and blindness in people of working age. Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year for diabetic retinopathy. Diabetes is also responsible for most cases of kidney failureand lower limb amputation, other than accidents. Read more about the complications of type 2 diabetes Preventing type 2 diabetes If youre at risk of type 2 diabetes, you may be able to prevent it developing by making lifestyle changes. These include: losing weight if youre overweight, and maintaining a healthy weight eating a healthy, balanced diet stopping smoking if you smoke drinking alcohol in moderation taking plenty of regular exercise Living with type 2 diabetes If you already have type 2 diabetes, it may be possible to control your symptoms by making the above changes. This also minimises your risk of developing complications. Read more about living with type 2 diabetes Symptoms of type 2 diabetes The symptoms of diabetes include feeling very thirsty, passing more urine than usual, and feeling tired all the time. The symptoms occur because some or all of the glucose stays in your blood and isnt used as fuel for energy. Your body tries to get rid of the excess glucose in your urine. The main symptoms oftype 2 diabetes are: urinating more often than usual, particularly at night feeling very thirsty feeling very tired unexplained weight loss itchiness around the genital area, or regular bouts of thrush(a yeast infection) cuts or wounds that heal slowly blurred vision  caused by the lens of the eye becoming dry The signs and symptoms of type 1 diabetes are usually obvious and develop very quickly, often over a few weeks. These signs and symptoms arent always as obvious, however, and its often diagnosed during a routine check-up. This is because they are often mild and develop gradually over a number of years. This means you may have type 2 diabetes for many years without realising it. Early diagnosis and treatment for type 2 diabetes is very important as it may reduce your risk of developing complications later on. Hyperglycaemia Type 2 diabetes occurs when the pancreas, a large gland behind the stomach, cant produce enough insulin to control your blood glucose level, or when the cells in your body dont respond properly to the insulin that is produced. This means your blood glucose levels may become very high, and is known as hyperglycaemia. Hyperglycaemia can occur for several reasons, including: eating too much being unwell ineffective diabetes medication not taking enough medication Hyperglycaemia causes the main symptoms of diabetes, which include extreme thirst and frequent urination. Causes of type 2 diabetes Type 2 diabetes occurs when the pancreas doesnt produce enough insulin to maintain a normal blood glucose level, or the body is unable to use the insulin that is produced (insulin resistance). The pancreas is a large gland behind the stomach that produces the hormone insulin. Insulin moves glucose from your blood into your cells, where its converted into energy. In type 2 diabetes, there are several reasons why the pancreas doesnt produce enough insulin. Risk factors for type 2 diabetes Four of the main risk factors for developing type 2 diabetes are: age  being over the age of 40 (over 25 for south Asian people) genetics  having a close relative with the condition, such as a parent, brother or sister weight  being overweight or obese ethnicity  being of south Asian, Chinese, African-Caribbean or black African origin, even if you were born in the UK Age Your risk of developing type 2 diabetes increases with age. This may be because people tend to gain weight and exercise less as they get older. Maintaining a healthy weight by eating a healthy, balanced diet and exercising regularly are ways of preventing and managing diabetes. White people over the age of 40 have an increased risk of developing the condition. People of south Asian, Chinese, African-Caribbean and black African descent have an increased risk of developing type 2 diabetes at a much earlier age. However, despite increasing age being a risk factor for type 2 diabetes, over recent years younger people from all ethnic groups have been developing the condition. Its also becoming more common for children  as young as seven in some cases  to develop type 2 diabetes, mainly due to rising obesity levels. Genetics Genetics is one of the main risk factors for type 2 diabetes. Your risk of developing the condition is increased if you have a close relative such as a parent, brother or sister who has the condition. The closer the relative, the greater the risk. A child who has a parent with type 2 diabetes has about a one in three chance of also developing the condition. Being overweight or obese Youre more likely to develop type 2 diabetes if youre overweight or obese with a body mass index (BMI) of 30 or more. Fat around your tummy (abdomen) particularly increases your risk. This is because it releases chemicals that can upset the bodys cardiovascular and metabolic systems. This increases your risk of developing a number of serious conditions, including coronary heart disease , stroke and some types of cancer. Measuring your waist is a quick way of assessing your diabetes risk. This is a measure of abdominal obesity , which is a particularly high-risk form of obesity. Women have a higher risk of developing type 2 diabetes if their waist measures 80cm (31.5 inches) or more. Asian men with a waist size of 89cm (35 inches) or more have a higher risk, as do white or black men with a waist size of 94cm (37 inches) or more. Exercising regularly and reducing your body weight by about 5% could reduce your risk of getting diabetes by more than 50%. Read about measuring your waist size Ethnicity People of south Asian, Chinese, African-Caribbean and black African origin are more likely to develop type 2 diabetes. Type 2 diabetes is up to six times more common in south Asian communities than in the general UK population, and its three times more common among people of African and African-Caribbean origin. People of south Asian and African-Caribbean origin also have an increased risk of developing complications of type 2 diabetes , such as heart disease, at a younger age than the rest of the population. Other risks Your risk of developing type 2 diabetes is also increased if your blood glucose level is higher than normal, but not yet high enough to be diagnosed with diabetes. This is sometimes called pre-diabetes, and doctors sometimes call it impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT). Pre-diabetes is reversible if you lose weight. Discuss your options with your GP. Pre-diabetes can progress to type 2 diabetes if you dont take preventative steps, such as making lifestyle changes. These include eating healthily , losing weight if youre overweight, and taking plenty of regular exercise . Women who have had gestational diabetes during pregnancy also have a greater risk of developing diabetes in later life. Treating type 2 diabetes Medicines for type 2 diabetes Type 2 diabetes is a progressive condition andusually gets worse over time. Making lifestyle changes, such as adjusting your diet and taking more exercise, may help you control your blood glucose levels at first, but may not be enough in the long term. You may eventually need to take medication to help control your blood glucose levels. Initially, this will usually be in the form of tablets and can sometimes be a combination of more than one type of tablet. It may also include insulin or another medication that you inject. Metformin Metformin is usually the first medicine used to treat type 2 diabetes. It works by reducing the amount of glucose your liver releases into your bloodstream. It also makes your bodys cells more responsive to insulin. If youre overweight, its also likely youll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldnt cause additional weight gain. However, it can sometimes cause mild side effects, such as nausea and diarrhoea , and you may not be able to take it if you have kidney damage. SGLT2 inhibitors SGLT2 inhibitors work by increasing the amount of glucose excreted in urine. Theyre particularly useful in people with type 2 diabetes and who have cardiac disease. The three SGLT2 inhibitors that may be prescribed include: dapagliflozin canagliflozin empagliflozin Each medication is taken as a tablet once a day. The main side effect is a higher risk of genital and urinary tract infections. If youre unwell and have a dehydrating illness (e.g. fever, vomiting or diarrhoea), its important you stop these medications. Get your glucose and ketone level checked by your healthcare professional to prevent diabetic ketoacidosis developing. GLP-1 agonists GLP-1 agonists acts in a similar way to the natural hormone GLP-1 (see the section on gliptins, below). Theyre given by injection and boost your owninsulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes (hypos). Theyre also particularly useful for people with type 2 diabetes and cardiac disease. Sulphonylureas Sulphonylureas increase the amount of insulin thats produced by your pancreas. Examples include: glibenclamide gliclazide glimepiride glipizide gliquidone You may be prescribed one of these medicines if you cant take metformin. Alternatively, you may be prescribed sulphonylurea and metformin if metformin doesnt control blood glucose on its own. Sulphonylureas can increase the risk of hypoglycaemia (low blood glucose) because they increase the amount of insulin in your body. They can sometimes cause side effects, including weight gain, nausea and diarrhoea. Pioglitazone Pioglitazone is a type of thiazolidinedione medicine (TZD), which make your bodys cells more sensitive to insulin so more glucose is taken from your blood. Its usually used in combination with other oral diabetes medication. It may cause weight gain and ankle swelling (oedema). You shouldnt take pioglitazone if you have heart failure or a high risk of bone fracture. Gliptins (DPP-4 inhibitors) Gliptins work by preventing the breakdown of a naturally occurring hormone called GLP-1. GLP-1 helps the body produce insulin in response to high blood glucose levels, but is rapidly broken down. By preventing this breakdown, the gliptins (linagliptin, saxagliptin, sitagliptin and vildagliptin) prevent high blood glucose levels, but dont result in episodes of hypoglycaemia. You may be prescribed a gliptin if youre unable to take sulphonylureas or glitazones, or in combination with them. Theyre not associated with weight gainand are often used with other oral diabetes medication for those who are obese. Insulin treatment If glucose-lowering tablets arent effective in controlling your blood glucose levels, you may need to have insulin treatment. This can be taken instead of or alongside your tablets, depending on the dose and the way you take it. Insulin comes in several different preparations, and each works slightly differently.Your treatment may include a combination of these different insulin preparations. Insulin injections Insulin must be injected because it would be broken down in your stomach like food and unable to enter your bloodstream if it were taken as a tablet. If you need to inject insulin, your diabetes care team will advise you about when you need to do it. They will show you how to inject it yourself, and will also give you advice about storing your insulin and disposing of your needles properly. Insulin injections are given using either a syringe or an injection pen, also called an insulin pen (auto-injector). Most people need between two and four injections of insulin a day. Your GP practiceor diabetes nurse will also teach a relative or a close friend how to inject the insulin properly. You can read more about insulin and how to inject it on the Diabetes UK website. Treatment for low blood glucose (hypoglycaemia) If you have type 2 diabetes thats controlled using insulin or certain types of tablets (e.g. sulfonylurea), you may experience episodes of hypoglycaemia . Hypoglycaemia is where your blood glucose levels become very low. Mild hypoglycaemia (a hypo) can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary. If you have a hypo, you should initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets. This should be followed by a longer-acting carbohydrate, such as a cereal bar, sandwich or piece of fruit. In most cases, these measures will be enough to raise your blood glucose level to normal. You should aim for a hypo to be treated and to recheck your blood glucose level within 15 minutes. If blood glucose still less than 4mmol/l then repeat the treatment using a fast acting carbohydrate. When your blood glucose returns to normal then have your longer acting carbohydrate. If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness. If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein. Glucagon is a hormone that quickly increases your blood glucose levels. You may require input from a health care professional. If the glucagon is not successful, you may require an injection of dextrose into your vein. Your diabetes care team can advise you on how to avoid a hypo and what to do if you have one. Other treatments If you have type 2 diabetes, your risk of developing heart disease , stroke , foot problems, eyeand kidney disease is increased. To reduce your risk of developing other serious health conditions, you may be advised to take other medicines, including: anti-hypertensive medicines to control high blood pressure a statin , such as simvastatin or atorvastatin, to reduce high cholesterol low-dose aspirin to prevent a stroke an angiotensin-converting enzyme (ACE) inhibitor, such as enalapril, lisinopril or ramipril, if you have the early signs of diabetic kidney disease Diabetic kidney disease is identified by the presence of small amounts of albumin (a protein) in your urine. If treated early enough, it may be reversible. Monitoring blood glucose levels If you have type 2 diabetes, your GP or diabetes care team will need to take a reading of your blood glucose level about every two to six months. This will show how stable your glucose levels have been in the recent past and how well your treatment plan is working. The HbA1c test is used to measure blood glucose levels over the previous two to three months. HbA1c is a form of haemoglobin, the chemical that carries oxygen in red blood cells, which also has glucose attached to it. A high HbA1c level means that your blood glucose level has been consistently high over recent weeks, and your diabetes treatment plan may need to be changed. Your diabetes care team can help you set a target HbA1c level to aim for. This will usually be less than 53 mmol/mol (7%) or individualised as agreed with your diabetes team. Read more about the HbA1c test Monitoring your own blood glucose If you have type 2 diabetes, as well as having your blood glucose level checked by a healthcare professional every two to six months, you may be advised to monitor your own blood glucose levels at home. Even if you have a healthy diet and are taking tablets or using insulin therapy, exercise, illness and stress can affect your blood glucose levels. Other factors that may affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, hormonal changes during the menstrual cycle. A blood glucose meter is a small device that measures the concentration of glucose in your blood. It can be useful for detecting high blood glucose (hyperglycaemia) or low blood glucose (hypoglycaemia). If blood glucose monitoring is recommended, you should be trained in how to use a blood glucose meter and what you should do if the reading is too high or too low. Blood glucose meters arent currently available for free on the NHS but, in some cases, blood monitoring strips may be. Ask a member of your diabetes care team if youre unsure. Regularly monitoring your blood glucose levels will ensure your blood glucose is as normal and stable as possible. As your blood glucose level is likely to vary throughout the day, you may need to check it several times a day, depending on the treatment youre taking. In home testing, blood glucose levels are usually measured by how many millimoles of glucose are in a litre of blood. A millimole is a measurement used to define the concentration of glucose in your blood. The measurement is expressed as millimoles per litre, or mmol/l for short. A normal blood glucose level is 4-7 mmol/l before meals (preprandial) and less than 8.5 mmol/l two hours after meals (postprandial), although this can vary from person to person. Your diabetes care team can discuss your blood glucose level with you in more detail. Its important to know your individual targets. Complications of type 2 diabetes If diabetes isnt treated, it can lead to a number of other health problems. High glucose levels can damage blood vessels, nerves and organs. Even a mildly raised glucose level that doesnt cause any symptoms can have long-term damaging effects. Heart disease and stroke If you have diabetes, youre up to five times more likely to develop heart disease or have a stroke . Prolonged, poorly controlled blood glucose levels increase the likelihood of atherosclerosis, where the blood vessels become clogged up and narrowed by fatty substances. This may result in a poor blood supply to your heart or to your lower limbs, causing angina (a dull, heavy or tight pain in the chest) or claudication (pain in the back of your calves when walking). It also increases the chance that a blood vessel in your heart or brain will become blocked, leading to a heart attack or stroke. Nerve damage High blood glucose levels can damage the tiny blood vessels in your nerves. This can cause a tingling or burning pain that spreads from your fingers and toes up through your limbs. It can also cause numbness, which can lead to ulceration of the feet. Damage to the peripheral nervous system, which includes all parts of the nervous system that lie outside the central nervous system, is known as peripheral neuropathy . If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation . Diabetic retinopathy Diabetic retinopathyis when the retina, the light-sensitive layer of tissue at the back of the eye, becomes damaged. Blood vessels in the retina can become blocked or leaky, or can grow haphazardly. This prevents light fully passing through to your retina. If it isnt treated, it can damage your vision. Annual eye checks are usually organised by a regional photographic unit. If significant damage is detected, you may be referred to a doctor who specialises in treating eye conditions (ophthalmologist) such as cataract and glaucoma. The better you control your blood glucose levels, the lower your risk of developing serious eye problems. Treatment for diabetic retinopathy is only necessary if screening detects significant problems that mean your vision is at risk. If the condition hasnt reached this stage, the advice on managing your diabetes, BP and cholesterol level is recommended. The main treatments for more advanced diabetic retinopathy are: laser treatment injections of medication into your eyes an operation to remove blood or scar tissue from your eyes Read about diabetic eye screening. Kidney disease If the small blood vessels of your kidney become blocked and leaky, your kidneys will work less efficiently. Its usually associated with high blood pressure, and treating this is a key part of management. In rare, severe cases, kidney disease can lead to kidney failure . This can mean a kidney replacement, treatment with dialysis or sometimes kidney transplantation becomes necessary. Foot problems Damage to the nerves of the foot can mean small nicks and cuts arent noticed and this, in combination with poor circulation, can lead to a foot ulcer. About 1 in 10 people with diabetes get a foot ulcer, which can cause a serious infection. If you have diabetes, look out for sores and cuts that dont heal, puffiness or swelling, and skin that feels hot to the touch. You should also have your feet examined at least once a year. If poor circulation or nerve damage is detected, check your feet every day and report any changes to your doctor, nurse or podiatrist. Sexual dysfunction In men with diabetes, particularly those who smoke, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication. Women with diabetes may experience: reduced sex drive (loss of libido) less pleasure from sex vaginal dryness less ability to orgasm pain during sex If you experience a lack of vaginal lubrication or find sex painful, you can use a vaginal lubricant or a water-based gel. Miscarriage and stillbirth Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If your blood glucose level isnt carefully controlled during the early stages of pregnancy, theres also an increased risk of the baby developing a birth defect. Pregnant women with diabetes will usually have their antenatal check-ups in hospital or a diabetic clinic, ideally with a doctor who specialises in pregnancy care (an obstetrician). This will allow your care team to keep a close eye on your blood glucose levels and control your insulin dosage more easily, as well as monitoring the growth and development of your baby. The Diabetes UK website has more information about diabetes complications . Looking after your eyes The NHS diabetic eye screening programme will arrange for you to have your eyes checked every year. Everyone who is on a diabetes register will be given the opportunity to have a digital picture taken of the back of their eye. Speak to your GP to register. Living with type 2 diabetes Look after your feet If you have diabetes, youre at greater risk of developing problems with your feet, including foot ulcers and infections from minor cuts and grazes. This is because diabetes is associated with poor blood circulation in the feet, and blood glucose can damage the nerves. To prevent problems with your feet, keep your nails short and wash your feet daily using warm water. Wear shoes that fit properly, and see foot care specialists (a podiatrist or chiropodist) regularly so any problems can be detected early. Regularly check your feet for cuts, blisters or grazes as you may not be able to feel them if the nerves in your feet are damaged. See your GP if you have a minor foot injury that doesnt start to heal within a few days. Regular eye tests If you have type 2 diabetes, you should be invited to have your eyes screened once a year to check for diabetic retinopathy. Diabetic retinopathy is an eye condition where the small blood vessels in your eye become damaged. It can occur if your blood glucose level is too high for a long period of time (hyperglycaemia). Left untreated, retinopathy can eventually lead to sight loss. Read more about diabetic eye screening People with diabetes should also see their optician every two years for a regular eye test. Diabetic eye screening is specifically for diabetic retinopathy and cant be relied upon for other conditions. Pregnancy If you have diabetes and youre thinking about having a baby, its a good idea to discuss this with your diabetes care team. If youre taking oral medications to manage your diabetes, this may need to change before you are pregnant. Its important that you plan your pregnancy and discuss it with your diabetes team. Planning your pregnancy means you can ensure your blood glucose levels are as well controlled as they can be before you get pregnant. Youll need to tightly control your blood glucose level  particularly before becoming pregnant and during the first eight weeks of your babys development  to reduce the risk of birth defects. You should also: check your medications  some tablets used to treat type 2 diabetes may harm your baby, so you may have to switch to insulin injections, stop statin medication or some blood pressure medications take a higher dose of folic acid tablets  folic acid helps prevent your baby developing spinal cord problems, and its recommended all women planning to have a baby take folic acid; women with diabetes are advised to take 5mg each day (only available on prescription) along with pregnancy multivitamins that include vitamin D have your eyes checked  retinopathy, which affects the blood vessels in the eyes, is a risk for all people with diabetes; as pregnancy can place extra pressure on the small vessels in your eyes, its important to treat retinopathy before you become pregnant Your GP or diabetes care team can give you further advice. Diabetes education Youll be best equipped to manage your diabetes day-to-day if youre given information and education when youre diagnosed and on an ongoing basis. The National Institute for Health and Care Excellence (NICE) recommends that all people who have diabetes should be offered a structured patient education programme, providing information and education to help them care for themselves. Structured patient education Structured patient education means theres a planned course that: covers all aspects of diabetes is flexible in content is relevant to a persons clinical and psychological needs is adaptable to a persons educational and cultural background For type 2 diabetes, there are several local adult education programmes, many of which are working towards the criteria for structured education. Ask your diabetes care team about the adult education programmes they provide. Talk to others Many people find it helpful to talk to others in a similar position, and you may find support from a group for people with diabetes. Patient organisations have local groups where you can meet others diagnosed with the condition. To find your local diabetes support group , visit Diabetes UK . If you want to get in touch with a trained counsellor directly, you can call the Diabetes UK Helpline on 0345 123 2399 (Monday to Friday, 9am to 7pm) or email helpline@diabetes.org.uk Financial support and benefits Some people with diabetes may be eligible for disability and incapacity benefits, depending on the impact the condition has on their lives. The main groups likely to qualify for welfare benefits are children, the elderly, and those with learning disabilities, mental health difficulties or diabetes complications. People over the age of 65 who are severely disabled may qualify for a type of disability benefit called Attendance Allowance. Carers may also be entitled to some benefits, depending on their involvement in caring for the person with diabetes. Citizens Advice Scotland can check whether youre getting all the benefits youre entitled to. Your diabetes specialist nurse and Citizens Advice can also provide advice about filling in the forms. Driving with diabetes Its a common myth that people with diabetes arent allowed to drive anymore. Although there are some restrictions on drivers with diabetes, its not as severe as you may think. You should always tell your insurer that you have diabetes as this may affect your insurance claim. Only individuals who use insulin have to tell the DVLA that they have diabetes. A high majority of individuals who use insulin can carry on driving on a restricted licence. This usually has to be renewed every 3 years. Additional restictions may apply for different licences (e.g Group 2 HGV) so always refer to the DVLA guidelines . Unfortunately, some individuals do lose their driving license, most commonly due to experiencing severe hypos. If you start to have a hypo whilst driving you should: Pull over safely Switch off your car engine Take fast-acting carbs, like glucose tablets or sweets, and some longer-acting carbohydrates too, like plain biscuits or crackers Dont drive until 45 minutes after your blood sugar level has gone back to 5mmol/l or above For more information about driving with diabetes, visit Diabetes UK. Diabetes sick day rules If you need to take insulin to control your diabetes, you should have received instructions about looking after yourself when youre ill  known as your sick day rules. Contact your diabetes care team or GP for advice if you havent received these. The advice youre given will be specific to you, but some general measures that your sick day rules may include could be to: keep taking your insulin  its very important not to stop treatment when youre ill; your treatment plan may state whether you need to temporarily increase your dose test your blood glucose level more often than usual  most people are advised to check the level at least four times a day keep yourself well hydrated  make sure you drink plenty of sugar-free drinks keep eating  eat solid food if you feel well enough to, or liquid carbohydrates such as milk, soup and yoghurt if this is easier check your ketone levels if your blood glucose level is high Seek advice from your diabetes care team or GP if your blood glucose or ketone level remains high after taking insulin, if: youre not sure whether to make any changes to your treatment you develop symptoms of diabetic ketoacidosis you have any other concerns Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Source: NHS Grampian - Opens in new browser window Last updated: 17 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any perso