health articles

Type 2 Diabetes

Type 2 diabetes is a common condition that affects one in ten people over the age of forty in the UK1. In type 2 diabetes, the levels of sugar or glucose in the blood are too high, which can impact your health, wellbeing and longevity.

The experienced doctors at Virtually Healthcare can provide expert investigation, support and treatment to help you control your diabetes, prevent complications and protect your future health.


What is type 2 diabetes?

Type 2 diabetes is a common long-term condition that increases the level of glucose in the blood.

Diabetes affects the way the body uses energy from the food you eat. Carbohydrates in your diet are broken down into glucose. This is absorbed into the blood and distributed around your body, providing cells in your organs and tissues with the fuel they need to function.

A hormone called insulin controls glucose levels in your blood. It acts like a key, unlocking cells so that they can burn glucose for energy. It also ensures that any excess glucose is safely stored for future use.

If you have type 2 diabetes, your body either can’t produce enough insulin for its need, or your cells can’t respond properly to the insulin produced. As a result, the cells are starved of the energy they need to live and work, and glucose builds up in your bloodstream.

If you have diabetes, the high levels of glucose can affect your body’s fluid balance. You may notice that you’re very thirsty and have to pass water more frequently. The lack of fuel to the cells can make you feel tired and weak. Over time, diabetes can progressively damage your body, increasing your risk of having problems with your eyes, kidneys, heart, and nerves.

What are the symptoms of type 2 diabetes?

Many people living with type 2 diabetes have no symptoms at all; the condition is picked up on routine screening or a health check. However, some symptoms can indicate diabetes. These include:

  • Feeling tired, weak and lacking in energy.
  • Passing large volumes of urine or passing urine more frequently.
  • Feeling thirsty.
  • Increased hunger, especially after meals.
  • Blurred vision.
  • Sudden weight loss.
  • Slow healing of cuts and other wounds.
  • Itching.
  • Recurrent thrush infection in the mouth, genitals or skin creases.

If you are worried about diabetes, make an appointment with a doctor at Virtually Healthcare for assessment, advice and investigation.

Diabetes care at Virtually Healthcare

Virtually Healthcare is an innovative GP practice, providing expert care in the comfort, safety and privacy of your home. The Virtually Healthcare service is designed to fit with modern lives. Consultations are easy to access, discreet and convenient, with virtual appointments available seven days a week.

The highly skilled team includes more than 40 clinicians working together to investigate and treat disease and help you optimise your health and wellbeing. As well as experienced GPs, the team includes sexual health specialists, physiotherapists and practice nurses to offer a comprehensive primary care service.

During the pandemic, many patients are finding it more challenging to access healthcare. Virtually Healthcare provides rapid access video or telephone appointments, with consultations available the same day if you contact us before 3 pm. Our clinicians can provide professional assessment and advice, arrange investigations, prescribe treatment or arrange for a face-to-face review.

At Virtually Healthcare, our focus is on you. Our clinicians take an individual holistic approach to diabetes treatment. They can arrange investigations, provide support and advice, follow NICE best-practice treatment guidelines2 and guide you to reliable information that will help you manage your blood glucose and reduce complications.

Health screening in diabetes

Type 2 diabetes can affect your body from top to toe. The chronically raised blood glucose levels can damage your eyes, kidneys, blood vessels, heart and feet. Regular screening can identify problems at an early stage so that you can have effective treatment and protect your health.

We recommend a programme of annual screening for all adults living with type 2 diabetes. Screening should include:

  • Eye screening for diabetic retinopathy.
  • Kidney screening for diabetic nephropathy.
  • Foot examinations to check for nerve damage and circulation problems.
  • Cholesterol screening for cardiovascular health.
  • Blood pressure screening.7

How do you diagnose type 2 diabetes?

The experienced GPs at Virtually Healthcare can diagnose most people with diabetes based on their symptoms, clinical history and investigations. Tests can include:

  • Random venous plasma glucose concentration: A result of 11.1 mmol/l or higher indicates diabetes if you have diabetes symptoms. If you do not have symptoms, your doctor will arrange a repeat test, a fasting test or an oral glucose tolerance test (OGTT).
  • Fasting plasma glucose concentration. A result of 7.0 mmol/l or more indicates diabetes.
  • An oral glucose tolerance test (OGTT): Your blood glucose is taken before and up to two hours after a sugary drink.
  • HbA1c: A blood test that demonstrates your average glucose levels over the previous few months.

Who is at risk of type 2 diabetes?

Type 2 diabetes is connected to several factors, including obesity, inactivity, and having a family history of the disease3. Anyone could potentially develop diabetes, but some things can put you at increased risk:

  • Age: You are at higher risk with increasing age.
  • Ethnicity: You are at increased risk if you’re of African-Caribbean, Black African, or South Asian heritage.
  • Family history: You’re two to six times more likely to get type 2 diabetes if you have a parent, brother, sister or child with diabetes.
  • High blood pressure.
  • High cholesterol.
  • If you are overweight or obese, especially if you carry the weight around your middle.
  • If you have high body fat.
  • If you have previously had gestational diabetes.
  • Chronic stress.
  • Some medications, including corticosteroids.45

It can be worrying if your genetic or ethnic heritage makes you vulnerable to diabetes, but it’s important to realise that you can make a difference. The WHO says:

‘A healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.

Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.’6

What is the treatment of type 2 diabetes?

The GPs at Virtually Healthcare provide holistic and supportive care for all our patients with diabetes. They follow NICE guidelines and work with you to control your blood glucose, maintain your health and reduce the risk of long-term complications. The team will:

  • Provide advice and offer reliable sources of information and support.
  • Advise about diet and nutrition and achieving a healthy BMI.
  • Recommend ways of increasing activity and safe exercise.
  • Help you understand your blood glucose levels and how to recognise and manage high blood glucose (hypers) and low blood glucose (hypos) levels. Most people with type 2 diabetes will not need to regularly check their glucose levels unless they are on insulin.
  • Prescribe medication, if needed, to help improve diabetes control.
  • Monitor your average blood glucose using an HbA1c blood test. Your doctor will set a target level and work with you to help you achieve this goal.
  • Advise about regular screening to check your eye, cardiovascular, kidney and foot health.

Medication for diabetes

Many people can control type 2 diabetes with changes to diet and daily activity. However, you may need medication to control glucose levels down and keep you healthy. Medications include:

  • Metformin: An oral medication that helps your body respond to insulin and reduces your body’s natural glucose production. It is usually the first line of medical treatment for people with type 2 diabetes.
  • Pioglitazone: An oral medication that decreases insulin resistance in the cells so that there is a reduction in blood glucose.
  • Sulfonylureas: Oral drugs that trigger insulin release from the pancreas.
  • Gliptins or DPP-4 blockers: These oral medications block DPP-4, a chemical that breaks down the hormone incretin. As a result, incretin levels increase, the body produces more insulin and glucose levels fall.
  • Acarbose: An oral medication that slows the absorption of starchy foods in the bowel.
  • Prandial glucose regulators: Oral medications that act for a short time to trigger the pancreas to produce more insulin.
  • GLP1 therapies: These innovative drugs are injected daily or weekly. They mimic your natural incretin hormones stimulating insulin release, reducing glucagon release and slowing down stomach emptying. These medications can make you feel less hungry, so they can help you lose weight.8
  • SGLT2 or sodium glucose like co-transporter 2 inhibitors: These drugs prevent the kidneys from reabsorbing glucose so that more glucose is lost in the urine and blood sugar levels are lower.

Type 2 diabetes is a progressive condition, with insulin production slowly decreasing over time. Your doctor may need to modify your medication, increase the dose, prescribe a combination of drugs, or recommend injections with insulin to adequately control blood glucose levels.

Hot topics in diabetes

Can you put type 2 diabetes into remission?

Many people with type 2 diabetes can return their blood sugar levels to the normal range by changing their diet and lifestyle.

Diabetes is in remission when your blood sugar stays at a healthy level without medication. Studies have shown that many overweight people living with diabetes have restored their blood glucose to normal levels by achieving a sustained weight loss of around 15 kg. This is important because achieving remission not only means reducing the risk of developing complications but also improves life expectancy.

Insulin resistance is thought to be caused by fat in the muscles, pancreas and liver. Studies have shown that a low-calorie diet can put type 2 diabetes into remission.

Research at Newcastle University showed that participants had reduced fat levels in their liver and pancreas after eight weeks on a low-calorie diet. This increased their bodies’ insulin production and put their type 2 diabetes into remission. Find out more:

Is Saxenda available on the NHS?

Saxenda is an innovative drug used for weight loss and diabetes treatment. It’s also known as Liraglutide and is part of the GLP1 agonists. These drugs are injected daily or weekly, acting to mimic your natural incretin hormones. They stimulate insulin release, reduce glucagon release and slow down stomach emptying. These medications can improve glucose control and help you lose weight.

The doctors at Virtually Healthcare can prescribe Saxenda for adult patients who are overweight or obese and also have additional health risk factors. They can also prescribe GLP 1 agonists for people with type 2 diabetes in:

  • People for whom triple therapy with metformin and two other oral drugs is not effective, not tolerated or not safe.
  • People with a BMI of 35 kg/m2 or higher
  • People with a BMI lower than 35 kg/m2 for whom insulin therapy would have significant implications at work.
  • People with a BMI of lower than 35 for whom weight loss would benefit other significant health problems related to obesity.
  • As recommended in the NICE guidelines, our doctors will adjust the recommendations for people from black, Asian and other minority ethnic groups and for people with specific psychological or other medical problems associated with obesity.

Types of consultations we offer

We offer written, telephone and video consultations with a range of male and female clinicians from GPs, nurse practitioners, and primary care specialists such as physiotherapy.