Type 2 Diabetes

Type 2 diabetes is a condition in which the body no longer responds properly to insulin and, over time, the pancreas cannot make enough of it. Blood glucose rises slowly, often for years before it is noticed.

Persistently high glucose damages small and large blood vessels, which affects the eyes, kidneys, nerves, heart and feet. Good control of glucose, blood pressure and cholesterol greatly lowers these risks, and in some people substantial weight loss puts the condition into remission. It is managed rather than cured.

Symptoms

• Passing urine more often, especially at night
• Increased thirst
• Tiredness
• Blurred vision that comes and goes
• Slow-healing cuts and frequent thrush or skin infections
• Tingling or numbness in the feet
• No symptoms at all, with the diagnosis made on a routine blood test

Causes and risk factors

The main drivers are excess weight, particularly fat around the waist and in the liver, and an inherited tendency. Risk rises with age, physical inactivity, a family history, previous diabetes in pregnancy and polycystic ovary syndrome. People of South Asian, African, Caribbean and Middle Eastern background develop it at a lower body weight. Steroids and some antipsychotic medicines can also raise glucose.

How it is diagnosed

• HbA1c: A blood test reflecting average glucose over 2 to 3 months. A value of 48 mmol/mol (6.5 percent) or above, confirmed on a repeat, indicates diabetes.
• Fasting glucose or glucose tolerance test: Used when HbA1c is unreliable, for example with anaemia or some haemoglobin variants.
• Kidney tests: Blood creatinine and a urine albumin test detect early kidney involvement.
• Retinal screening: Photographs of the back of the eye look for diabetic retinopathy each year or two.
• Foot examination: Checks sensation, pulses and skin to find nerve damage and ulcer risk.
• Cholesterol and blood pressure: Measured because heart and stroke risk drive most of the long-term harm.

Treatment options

• Diet, activity and weight loss: Losing 10 to 15 percent of body weight soon after diagnosis gives a real chance of remission. Any sustained loss helps.
• Metformin: The usual first medicine. It lowers glucose production by the liver and is taken as tablets.
• SGLT2 inhibitors: Tablets that remove glucose through the urine and also protect the heart and kidneys.
• GLP-1 based injections: Weekly injections that lower glucose, reduce appetite and cut cardiovascular risk in people with heart disease.
• Insulin: Added when other treatments no longer control glucose. It needs training in dosing and in recognising low blood sugar.
• Metabolic (bariatric) surgery: Sleeve gastrectomy or gastric bypass for people with obesity. Many come off diabetes medication afterwards, most reliably when diabetes is of shorter duration.
• Blood pressure and cholesterol treatment: Statins and blood pressure tablets are as important as glucose control for preventing complications.

When it is urgent

Seek emergency care locally for very high glucose with vomiting, drowsiness, confusion or deep rapid breathing, and for severe low blood sugar that does not respond to sugar by mouth. A hot, swollen or ulcerated foot, sudden loss of vision and chest pain also need urgent assessment.

Travelling to Türkiye for treatment

Day-to-day diabetes care needs a team near home and is not a reason to travel. A visit can sensibly offer a full complications screen in a few days, a second opinion on treatment, a planned metabolic operation, or treatment of a complication such as retinopathy. If you take insulin, plan for time zones, carry supplies in hand luggage and bring a medical letter.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions