Diabetes: Types, Symptoms, Treatment and Staying Well

Diabetes is a condition in which the amount of glucose in the blood becomes too high. There is more than one kind. Type 1, type 2 and gestational diabetes (diabetes in pregnancy) have different causes and are managed in different ways.^{[1]NHS — Diabetes}

This page is general information only. It cannot diagnose diabetes, set anyone’s targets, or tell anyone what dose of insulin or medicine to take. It does not replace your diabetes team, your GP or your own care plan. Please do not stop or change any prescribed treatment because of something you have read online.

Glucose is the main sugar in the blood and the body’s everyday fuel. It comes mostly from food and drink. A hormone called insulin, made by the pancreas, lets glucose move out of the blood and into cells. If there is not enough insulin, or the body cannot use it properly, glucose stays in the blood and the level rises.^[1]NHS

• Type 1 diabetes — the immune system attacks the cells in the pancreas that make insulin, so the body makes little or none. It is not caused by diet, weight or lifestyle, and nothing anyone did or ate caused it. It is treated with insulin for life.^{[2]NHS — type 1}
• Type 2 diabetes — the body does not make enough insulin, or the insulin does not work as well as it should. Many things affect the risk, including age, family history, ethnic background and weight. It is a medical condition, not a personal failing.^{[4]NHS — type 2}
• Gestational diabetes — high blood glucose that develops during pregnancy in someone who did not have diabetes before. It usually goes away after birth, but needs specialist monitoring and raises the chance of type 2 diabetes later.^{[9]NHS — gestational diabetes}
• Prediabetes (non-diabetic hyperglycaemia) — blood glucose is higher than usual but not high enough to be called diabetes. It is a warning sign, and support is available to reduce the chance of developing type 2 diabetes.^[4]NHS
• Less common forms — these include diabetes caused by other conditions or medicines, and rarer inherited types. Only the healthcare team can work out which type someone has, and sometimes the type is reviewed again later.^{[11]NICE NG17}

Common symptoms of diabetes include:

• passing urine more often, especially at night
• feeling very thirsty
• feeling very tired
• losing weight without trying
• blurred vision
• cuts and wounds healing slowly
• repeated infections, or thrush that keeps coming back

^{[1]NHS — diabetes[4]NHS — type 2}

Type 2 diabetes often develops slowly, and some people have no obvious symptoms at all. It is frequently picked up through a blood test done for another reason or at a health check.^[4]NHS

Blood tests used include HbA1c, which reflects average blood glucose over the previous two to three months, and blood-glucose tests taken while fasting or at a random time. A diagnosis is made by a healthcare professional who looks at the results together with your symptoms and history — please do not try to diagnose yourself from a single number, including a reading from a home monitor or a smartwatch.^[1]NHS

A hypo means blood glucose has fallen too low — usually below 4 mmol/L. It mainly affects people who take insulin or certain glucose-lowering medicines such as sulfonylureas. Signs can include shaking or trembling, sweating, feeling hungry, dizziness, tingling lips, a fast or pounding heartbeat, blurred vision, feeling irritable or tearful, and difficulty concentrating or confusion.^{[6]NHS — low blood sugar}

Contact your diabetes team or GP if you are having hypos that are:

• frequent, or happening at similar times each day
• happening overnight, or waking you from sleep
• severe, or needing someone else’s help
• not being felt in advance any more (sometimes called loss of hypo awareness) — this needs review and can also affect driving

Hypos are treatable and adjustable. Your treatment can usually be changed so they happen less often, so it is always worth raising.

Hyperglycaemia means blood glucose is too high. Symptoms can include feeling very thirsty, passing urine often, tiredness, blurred vision, headaches and stomach pain. Occasional high readings are common; readings that stay high, or that do not respond to your usual plan, need advice.^{[7]NHS — high blood sugar}

Diabetic ketoacidosis (DKA) happens when the body has too little insulin, cannot use glucose for energy and breaks down fat instead, producing acids called ketones. It is most common in type 1 diabetes, can be the first sign of undiagnosed type 1, and can also affect people with type 2 diabetes. DKA is a medical emergency and is treated in hospital.^{[8]NHS — diabetic ketoacidosis}

Hyperosmolar hyperglycaemic state (HHS) is another serious emergency, seen mainly in people with type 2 diabetes. Very high blood glucose develops with severe dehydration, and the person may become extremely thirsty, weak, drowsy or confused over several days. It cannot be diagnosed or treated at home — call 999 or go to A&E.^{[7]NHS — high blood sugar}

Diagnosis is made by a healthcare professional using your symptoms and history alongside blood tests. Different tests are used for different situations.^{[1]NHS[13]NICE NG28}

The broad roles of commonly used medicines are set out below. This is background information to help you have a conversation with your clinician — it is not a recommendation, and we do not suggest any particular medicine or dose.^{[5]NHS — understanding diabetes medicine}

Illness can push blood glucose up, even if you are eating less, and sometimes down. Vomiting, diarrhoea and fever also cause dehydration, which increases risk.^{[8]NHS — DKA}

• Follow the individual sick-day rules your diabetes team has given you. These are personal, and we cannot publish a universal version.
• Check blood glucose, and ketones, as often as your plan tells you to.
• Keep drinking fluids to reduce dehydration, unless you have been told to limit fluids for another medical reason.
• Never stop insulin just because you are not eating. You may still need it, and stopping can lead to DKA. Only a specialist diabetes professional can give different individual instructions.
• Some non-insulin medicines may need to be paused during certain illnesses — for example dehydrating illnesses. Do this only if your own sick-day advice or a healthcare professional tells you to.

Contact your diabetes team, urgent GP service or NHS 111 if you have repeated vomiting, diarrhoea, a fever, signs of dehydration, glucose readings that are not responding to your plan, or if you are unsure what to do about your medicines.

Call 999 or go to A&E for DKA symptoms, severe confusion, unconsciousness or any other serious deterioration.

People with diabetes are offered a range of checks. Depending on your care plan these may include:

• HbA1c blood test
• blood pressure
• cholesterol and other blood fats
• kidney checks — a blood test and a urine test for protein
• weight, where this is relevant and wanted
• a foot check looking at circulation, sensation and skin
• diabetic eye screening — a separate NHS screening programme with its own invitations^{[10]NHS — diabetic eye screening}
• a review of your medicines
• support to stop smoking, if you smoke
• a conversation about emotional wellbeing
• vaccinations where you are eligible, such as the flu vaccine^{[16]NHS — flu vaccine}

How often each check happens varies. It depends on your type of diabetes, your age, whether you are pregnant, your previous results and your individual needs — so not every check is automatically once a year. If you are unsure when yours are due, ask your GP surgery or diabetes team.^{[4]NHS[13]NICE NG28}

Diabetes can reduce feeling in the feet and affect circulation. That means an injury can go unnoticed and heal slowly, so small problems can become serious.^[4]NHS

• Look at your feet every day, including the soles and between the toes — use a mirror or ask someone.
• Wash and dry your feet carefully, and moisturise dry skin but not between the toes.
• Wear shoes that fit properly and check inside them before putting them on.
• Do not walk barefoot outdoors, and take care with hot water, hot-water bottles and heaters.
• Ask about podiatry rather than using corn plasters or sharp tools on your own feet.

• There is no single “diabetic diet”. You do not need special diabetic products. Regular, balanced meals that suit your culture, budget and routine work better than rules you cannot keep.
• An individual plan helps. Ask about a referral to a dietitian or a structured education course rather than following diets found online.
• Carbohydrate counting. People using insulin are often taught to match doses to the carbohydrate in a meal. This is taught properly by your team.
• Activity is good for blood glucose, mood, blood pressure and sleep. It can lower glucose during exercise and for hours afterwards, so if you use insulin or a sulfonylurea, ask your team how to plan for it and carry hypo treatment.
• Alcohol can cause delayed hypos, sometimes many hours later or overnight. Eat with alcohol, be careful of the amount, and tell people you are with what to do if you have a hypo.^{[6]NHS — low blood sugar}
• Remission of type 2 diabetes is possible for some people, usually through significant weight loss with professional support. Remission is not a cure: blood glucose can rise again, and regular checks should continue.^[4]NHS

Living with diabetes is demanding, and nobody manages it perfectly. Blame and crash diets do not help — small, sustainable changes and honest conversations with your team do.

• Act urgently on the 4 Ts. Toilet, thirsty, tired, thinner — a child with these symptoms needs same-day medical assessment.^[3]NHS
• A paediatric diabetes team looks after children and young people, covering insulin, monitoring technology, education, growth and emotional support.^{[12]NICE NG18}
• An individual healthcare plan should be agreed with the school or college, setting out treatment, hypo response, emergency contacts and who is trained.
• Safe access matters — to glucose monitoring, insulin, hypo treatment, food, drink and the toilet, without needing to ask permission each time or being made to feel awkward.
• Exams, trips and sport should be planned in advance: access arrangements for exams, extra supplies for trips, and hypo treatment on the sports field.
• Transition to adult services usually happens in the late teens and should be planned and gradual, not sudden.
• Emotional wellbeing counts. Young people can feel different, watched or fed up with diabetes. Support is available, and no one should be shamed for readings.

This is health information written for families and young people to use together.

Diabetes before or during pregnancy needs specialist care from a joint diabetes and maternity team. With good support, most pregnancies go well.^{[14]NICE NG3}

• If you have diabetes and are thinking about a baby, contact your diabetes team before trying to conceive, so care, medicines and monitoring can be reviewed.
• If you find out you are pregnant, tell your diabetes team and GP promptly.
• Gestational diabetes is monitored during pregnancy and usually reviewed again after birth.^{[9]NHS — gestational diabetes}

We do not publish pregnancy glucose targets, medicine changes or supplement doses — these must come from your own team.

Whether you must tell the DVLA about diabetes depends on your treatment, whether you have hypos, and the type of licence you hold. The rules are detailed and change, so please check the official GOV.UK service rather than relying on a summary.^{[15]GOV.UK — diabetes and driving}

• Never drive during a hypo, or until you have fully recovered and waited the period required by DVLA rules.
• Follow the current DVLA requirements on checking glucose before and during journeys if you take insulin or medicines that can cause hypos, and keep hypo treatment within reach in the vehicle.
• Tell the DVLA about severe hypos or loss of hypo awareness as the rules require.
• At work, reasonable adjustments may apply — for example breaks to test or eat, somewhere to store insulin, or adjustments to shifts. Diabetes does not automatically stop anyone working or driving.

Diabetes asks for decisions every single day, and that is tiring. Many people experience diabetes distress, burnout, low mood, anxiety about complications, or a strong fear of hypos that leads to running glucose higher than planned. These are common, understandable, and worth talking about.

• Tell your diabetes team or GP how you are coping — it is a normal part of a review, not a complaint.
• Ask what psychological support is available through your diabetes service.
• NHS talking therapies and mental health support can be accessed through your GP or self-referral.
• Diabetes UK is a national diabetes charity, not an NHS service. It runs a helpline and online support — please check the current phone number and opening hours on its official website before calling.^{[18]Diabetes UK}

In a life-threatening emergency, always call 999.