What type 2 diabetes is
Your body uses a hormone called insulin to move sugar (glucose) from your blood into your cells for energy.
In type 2 diabetes, two things happen. Your cells respond less well to insulin (insulin resistance), and over time the cells in your pancreas that make insulin slowly make less of it.
The result is too much sugar in the blood. This is common, it usually develops slowly, and it can be managed well with food, movement, medicines and regular checks.
It is not caused by one thing, and it is not your fault. Family history, age, weight and inactivity all play a part.
Why it matters
Over the years, high blood sugar can damage small and large blood vessels and nerves. The good news: keeping your numbers in range lowers your risk of these problems.
Heart and blood vessels
Higher risk of heart attack and stroke. Blood pressure and cholesterol matter as much as sugar.
Kidneys
Kidneys can slowly lose filtering ability. A simple urine and blood test finds this early.
Eyes
Diabetes can affect the back of the eye, often with no symptoms at first. Regular eye checks protect your sight.
Feet
Nerve damage and poor blood flow can lead to sores that heal slowly. Daily care and yearly checks prevent most serious problems.
Nerves
Tingling, burning or numbness in the feet or hands, and sometimes gut, bladder or sexual problems. Treatment is available.
Your targets and numbers
Your regular checks
| Check | How often | Why |
|---|---|---|
| HbA1c blood test | Every 3–4 months | Shows your average sugar over the last few months |
| Kidneys: urine ACR and eGFR | At least once a year | Finds kidney changes early |
| Feet | At least once a year; more often if your feet are at higher risk | Finds nerve and blood-flow problems before sores appear |
| Eyes | Every 1–2 years (yearly if you are at higher risk) | Finds eye changes before they affect sight |
| Blood pressure and cholesterol | At your regular reviews | Protects your heart and blood vessels |
What you can do
Food and drinks
- Fill your plate with vegetables, and choose wholegrain or lower-GI carbohydrates (wholegrain bread, pasta, legumes, fruit, plain milk and yoghurt).
- Carbohydrate raises blood sugar most, so watch your portions rather than cutting it out completely.
- Swap sugary drinks for water. Go easy on chips, ice cream, chocolate and pastries — they add sugar and fat.
- There is no single “diabetes diet”. A dietitian can build a plan that suits your food, culture and budget.
Move more
- 150 minutes a week of brisk activity (walking, swimming, cycling), spread over most days.
- Strength exercises 2–3 times a week (weights, bands, body-weight), on non-consecutive days.
- Break up long sitting: stand or walk for a few minutes every 30 minutes.
- If you take insulin or a sulfonylurea, check your glucose before and during longer exercise, and carry fast sugar.
Weight
Losing 5–10% of your body weight makes a real difference to blood sugar, blood pressure and cholesterol. Small steady changes count. Some people can put diabetes into remission — ask us if you would like to talk about it.
Smoking, alcohol and sleep
- Quit smoking — it is one of the best things you can do for your heart, feet and eyes. We can help.
- Alcohol: no more than 2 standard drinks a day, with alcohol-free days. Alcohol can cause low sugar, especially with insulin or a sulfonylurea.
- Aim for regular, good-quality sleep, and tell us if you snore or feel very tired.
Look after your feet
- Check both feet every day (use a mirror for the soles).
- Wash and dry well, especially between the toes. Moisturise the skin but not between the toes.
- Always wear well-fitting shoes and socks. Never walk barefoot.
- See a podiatrist for nail and callus care, and tell us about any sore, blister or colour change straight away.
Your team
You do not have to do this alone. Your GP, practice nurse, credentialled diabetes educator, dietitian, podiatrist and optometrist can all help.
Medicines
Food and activity come first, and medicines work alongside them. Most people start with one tablet and add others over the years, because type 2 diabetes changes with time. Needing more medicine is normal — it is not a failure.
Metformin Usually the first medicine
Helps your body use insulin better and lowers the sugar your liver releases.
- Take with food. The dose goes up slowly over 2–4 weeks to limit tummy upset, which often settles.
- We check your kidney function every year, and vitamin B12 from time to time.
- Pause it when you are dehydrated or vomiting (see “If you are sick” below).
SGLT2 inhibitors “gliflozins” — dapagliflozin, empagliflozin
Make your kidneys pass extra sugar in the urine. They also protect your heart and kidneys, even when your sugar is already near target.
- Can cause genital thrush, urine infections and thirst.
- Rarely they cause a serious problem called ketoacidosis, even with normal blood sugar.
- Stop them when you are unwell (vomiting, diarrhoea, not eating or drinking) and before some procedures. For a bowel prep for colonoscopy, this is usually 3 days before and the day of the procedure. Your doctor will tell you exactly when.
GLP-1 medicines semaglutide, dulaglutide, liraglutide
Given by injection (most are once a week). They lower blood sugar, help with weight, and protect your heart.
- Nausea is the most common side effect and usually settles as the dose builds up.
- Have an eye check before starting if you have not had one recently.
- Vomiting or diarrhoea can stop other tablets (including the pill) being absorbed.
- Tell your anaesthetist or endoscopy team you use one before any procedure. Do not stop it unless told to.
Other tablets gliptins, sulfonylureas, others
- Gliptins (sitagliptin, linagliptin…): gentle, low risk of low sugar. Not used together with a GLP-1 medicine.
- Sulfonylureas (gliclazide…): effective, but can cause low sugar and weight gain, especially if you skip meals.
- Acarbose and pioglitazone are used less often. Ask us if you have been given one.
Insulin a normal part of treatment later on
If tablets and injections are no longer enough, insulin is the next step. It is not a punishment and it does not mean you did something wrong.
- Usually starts as one injection a day (long-acting insulin) at the same time each day, with a small dose that we adjust using your morning glucose readings.
- Main risk is low sugar. We will teach you injection technique and what to do.
If you are sick (a “sick-day plan”)
- Vomiting, diarrhoea, fever, or not eating and drinking? Drink plenty of fluids and check your glucose every 2–4 hours.
- SGLT2 inhibitor: stop it. If you have a ketone meter, check ketones, even if your glucose looks normal.
- Metformin: pause it if you are dehydrated. GLP-1: can be paused if you are vomiting. Sulfonylurea: keep taking it unless your sugar is running low or you cannot eat.
- Insulin: never stop it. Ask us if your dose needs changing.
- Restart your medicines once you are eating and drinking normally. Ask us for a written sick-day plan.
Warning signs — when to get help
Low blood sugar (a “hypo”): below 4.0 mmol/L
Most likely if you take insulin or a sulfonylurea. Signs: shaky, sweaty, pale, fast heartbeat, anxious, very hungry, hard to concentrate, confused.
- Treat: take 15 g of fast sugar — 4 glucose tablets, or 6–7 jellybeans, or 150 mL regular soft drink (half a can), or 125 mL juice, or 3 teaspoons of sugar or honey.
- Retest in 10–15 minutes. If it is still below 4.0, treat again.
- Once it is back up, have a slower carbohydrate, such as a slice of bread or a 250 mL glass of milk, unless a meal is due.
If you take insulin or a sulfonylurea, check your glucose before you drive. It should be 5 or above. If someone is drowsy, confused or unconscious, call 000 and do not put food or drink in their mouth.
Call your GP the same day, or go to the emergency department
- Blood glucose over 15 mmol/L twice in a row (2 hours apart), or you feel unwell.
- Feeling very unwell with vomiting, tummy pain, drowsiness, fast deep breathing or confusion. If you take an SGLT2 inhibitor, this can happen even when your glucose looks normal (ketones). Call 000 if you are very drowsy or cannot keep fluids down.
Get urgent help (000 or emergency department)
- Chest pain, pressure or tightness, especially with sweating or shortness of breath
- Sudden change in vision, new flashes or floaters, or a curtain over part of your vision
- A foot sore or ulcer, or a foot that is red, hot and swollen — do not wait for your next appointment
Next steps and when to come back
Your care plan
We can prepare a GP Chronic Condition Management Plan with you. It sets your goals and can give you Medicare-subsidised visits with allied health, such as a diabetes educator, dietitian, podiatrist or exercise physiologist. We review the plan with you about every 3 months.
Ask about group diabetes programs (up to 8 sessions a year) and about a Home Medicines Review with your pharmacist.
Register with the NDSS
The National Diabetes Services Scheme (run by Diabetes Australia) gives you subsidised supplies such as needles and test strips, plus education and support. We can help you register.
Bring to every visit
- Your glucose meter and any readings
- A list of all your medicines, including over-the-counter and herbal
- Your questions
Also ask us about
- Vaccines, including flu and pneumococcal
- Dental checks
- Feeling low, stressed or worn out by diabetes — this is common and we can help
- Planning a pregnancy, if that could apply to you
Trusted websites and phone numbers
- NDSS: Type 2 diabetes (ndss.com.au) — fact sheets and short online modules, in many languages
- NDSS: Low blood glucose (hypo) — what to do, step by step
- NDSS: Sick days with diabetes — ask us for your own written sick-day plan too
- KeepSight (keepsight.org.au) — free reminders for your eye checks
- MyDESMOND — online diabetes education program (needs NDSS registration)
- Quitline 13 7848 — phone support to quit smoking
- NDSS helpline 1800 637 700 (weekdays)