Patient information
Living with type 2 diabetes
This leaflet explains type 2 diabetes, what your HbA1c result means, how your medicines work, and the everyday steps that protect your heart, kidneys, eyes and feet.
Your plan
Name:
Your latest HbA1c: mmol/mol
Your target:
Medicines:
Next review:
What is type 2 diabetes?
Type 2 diabetes means the level of sugar (glucose) in your blood is too high. This happens because your body does not make enough insulin, or the insulin does not work properly. Over time, high blood sugar can damage blood vessels, which raises the risk of heart attack, stroke, kidney disease, eye problems and nerve damage in the feet.
The good news is that good care greatly reduces these risks, and for some people with type 2 diabetes, weight loss can even put it into remission.
What is HbA1c?
HbA1c is a blood test that shows your average blood sugar over the last 2 to 3 months. Most people aim for 48 to 53 mmol/mol, but your target is personal to you. It may be set higher if you are older, frail, or at risk of low blood sugar (hypos). You will usually have this test every 3 to 6 months until it is stable, then every 6 months.
Your medicines
Most people are now offered two medicines from the start, because together they protect the heart and kidneys as well as lowering blood sugar.
- Metformin lowers blood sugar. The slow-release (MR) form is easier on the stomach. Take it with food.
- SGLT2 inhibitors (names ending in "-gliflozin", such as dapagliflozin or empagliflozin) remove extra sugar in your urine and protect your heart and kidneys. Keep well hydrated and wash the genital area daily, because thrush is more likely.
- GLP-1 medicines (such as semaglutide) or tirzepatide are weekly or daily injections, or a daily tablet. They lower blood sugar and weight, and some protect the heart. Nausea is common at first. These should not be used in pregnancy, so use reliable contraception and ask about the pill, as tirzepatide can make it less effective.
- Other medicines such as gliptins, gliclazide, pioglitazone or insulin may be added if needed. Gliclazide and insulin can cause hypos.
Sick day rules
If you are unwell with vomiting, diarrhoea or a fever, or are not eating and drinking normally, pause your SGLT2 inhibitor and metformin (and any blood pressure tablets or water tablets you have been told to pause). Keep drinking fluids and restart once you have been eating and drinking normally for 24 to 48 hours.
On an SGLT2 inhibitor, a rare but serious problem called ketoacidosis can happen even when your blood sugar is normal. Get urgent help if you have nausea or vomiting, stomach pain, fast breathing or unusual sleepiness.
What can I do?
Eat well
- Base meals on vegetables, beans, pulses, wholegrains, fish and lean protein.
- Cut down on sugary drinks, sweets, cakes, white bread and other refined starchy foods. Watch portion sizes.
- There is no need for special "diabetic" foods.
Move more
Aim for at least 150 minutes of moderate activity a week, such as brisk walking, plus strength exercises twice a week. Activity lowers blood sugar for hours afterwards.
Lose weight if you need to
Losing 5 to 10% of your body weight improves blood sugar, blood pressure and cholesterol. Larger weight loss early on can lead to remission. Ask about the NHS Type 2 Diabetes Path to Remission programme.
Stop smoking and drink sensibly
Smoking greatly increases the risk of heart, foot and eye problems, and free NHS support can help you stop. Keep alcohol to no more than 14 units a week, and eat when you drink if you take gliclazide or insulin.
Learn about your diabetes
Free education courses, in groups or online, help you understand diabetes and manage it confidently. Ask to be referred.
Your yearly checks
- HbA1c, blood pressure and cholesterol
- kidney blood and urine tests
- foot check, and diabetic eye screening (photographs of the back of your eyes)
- weight, smoking and a review of your medicines
Look after your feet every day. Check them for cuts, blisters or colour changes, and see a podiatrist if you have problems. Visit your dentist regularly, because gum disease is more common with diabetes.
Hypos (low blood sugar)
If you take gliclazide or insulin, your blood sugar can go too low. Signs include shaking, sweating, hunger, confusion and blurred vision. Treat it with a sugary drink or glucose tablets, then a snack. Tell the DVLA about diabetes treated with insulin, and follow the driving rules your clinician gives you.
When to get help
Contact your GP practice the same day, or call 111, if you are very thirsty, passing lots of urine, losing weight without trying, or feeling unwell while on an SGLT2 inhibitor. Also get help for any foot wound that is not healing, or sudden changes in your vision.
Call 999 for chest pain, stroke symptoms, a hypo that does not improve, or drowsiness or confusion with vomiting and fast breathing.
Where to find more help
- NHS – type 2 diabetes: nhs.uk/conditions/type-2-diabetes
- Diabetes UK (helpline 0345 123 2399): diabetes.org.uk
- Know Diabetes (free online education): knowdiabetes.org.uk
- NHS Better Health (activity, weight, alcohol, smoking): nhs.uk/better-health
Based on NICE guideline NG28, Type 2 diabetes in adults: management (updated February 2026), and NHS advice. This leaflet is general information and does not replace advice from your own healthcare team.