Type 2 Diabetes

This page provides general information about diet-related ill-health. For individual advice always seek guidance from a qualified health professional.

What is diabetes?

Diabetes occurs when the body cannot control blood sugar properly.

High levels of sugar in the blood can cause serious health problems involving the eyes, heart, kidneys, feet, and nerves. There are also short-term complications which include hyperglycaemia, when blood sugar levels are too high, and hypoglycaemia, when blood sugar levels are too low.

People with diabetes can lead full and active lives if their condition is controlled. In the UK, it is thought that 3.8 million people over 16 years old have been diagnosed with diabetes. Nearly 1 million are unaware that they have the condition.

Eating a healthy diet, exercising, and losing weight (if necessary) can greatly help to reduce the risk of developing type 2 diabetes.

There are certain risk factors that can increase the likelihood of developing type 2 diabetes. You cannot change all of them, but you can make some changes to your lifestyle and diet that will help to reduce your risk.

Helena Gibson-Moore, Nutrition Scientist, British Nutrition Foundation

Key Facts about Type 2 Diabetes

Type 1 and type 2 diabetes happen when the body cannot control blood sugar properly. This can cause serious health complications.
About 90% of people with diabetes have type 2 diabetes.
Type 2 diabetes is linked with obesity.
Type 2 diabetes can be prevented whereas type 1 diabetes cannot.

What are the different types of diabetes?

There are two types of diabetes, type 1, and type 2

About 90% of people with diabetes have type 2 diabetes.

This condition occurs when the body either cannot produce enough insulin (the hormone needed to move sugar from the blood into the body’s cells) or the insulin the body produces is not used properly (known as insulin resistance), leading to sugar build up in the blood.
Type 2 diabetes tends to be diagnosed in people aged over 40 years. However, increasingly, the symptoms are being seen in younger adults and even children.
Type 2 diabetes is strongly linked with overweight and obesity, although not all people with type 2 diabetes are overweight or obese.
This condition can generally be treated by making lifestyle changes, such as eating a healthy, varied diet and doing regular physical activity. Sometimes oral medication (such as metformin) and/or insulin are also needed.

About 10% of people with diabetes have type 1 diabetes.

This condition cannot be prevented and occurs when cells in the pancreas that produce insulin have been destroyed by the immune system.
In type 1 diabetes there is no insulin and so sugar stays in the blood.
This means that people with type 1 diabetes need to take insulin (either with an injection or an insulin pump) to help the body use sugar properly and control blood sugar levels.
We do not know why the insulin-producing cells in the pancreas become damaged, but it may be triggered by a viral or other infection.

What are the risk factors for type 2 diabetes?

There are certain risk factors that can increase the likelihood of developing type 2 diabetes. You cannot change all of them, but you can make some changes to your lifestyle that will help to reduce your risk.

The more risk factors that apply to you, the greater the risk of developing type 2 diabetes.

Risk Factor	Explanation
Your weight…	The more overweight you are the greater your risk, with obese people being seven times more likely to develop type 2 diabetes than people with a healthy body weight. To find out if you are overweight ask your GP to measure your BMI (body mass index) - a healthy BMI is 18.5-25
Your waist…	Women – if your waist measures 80cm or more you have an increased risk of developing type 2 diabetes; the risk is very high if it is more than 88cm. Men – if your waist measures 94cm or more you have an increased risk of developing type 2 diabetes. If you are male with South Asian background the measurement is 90cm or more; the risk is very high if it is more than 102cm.
Your age…	You are at increased risk of type 2 diabetes if you are over 40 years of age. If your background is Black African, Chinese, South Asian or African-Caribbean, you are at increased risk if you are over 25 years of age. The risk continues to increase with age.
Your family history…	Having type 2 diabetes in the family increases your risk. The closer the relative is, the greater the risk. Tell your GP whether anyone in your family has type 2 diabetes. If you know that type 2 diabetes runs in your family, make sure that you are doing all you can to reduce your risk in other ways.
Your ethnicity…	Some ethnic groups have higher risk of type 2 diabetes than others and are likely to be affected at an earlier age (see ‘Your age’ section above). If you have an African-Caribbean or South Asian background and live in the UK, then you are at least three times more likely to have type 2 diabetes than the White population. It is particularly important for you to make sure that you maintain a healthy body weight.
Lifestyle factors…	Several lifestyle factors, some of which are linked to overweight and obesity, have been associated with an increased risk of developing type 2 diabetes. These include smoking, being sedentary and eating an unhealthy diet.
Other factors...	You may also have an increased risk of having type 2 diabetes if you: Have high blood pressure or if you’ve had a heart attack or a stroke Are a woman with a history of polycystic ovary syndrome, gestational diabetes (a temporary type of diabetes during pregnancy) or have given birth to a large baby Have been told you have impaired glucose tolerance or metabolic syndrome.

How can I reduce the risk of developing type 2 diabetes?

Eating a healthy, varied diet, being physically active and losing weight (if necessary) can reduce your risk of type 2 diabetes.

Eat a healthy, balanced diet

In the UK, it’s recommended that a healthy, balanced diet is based on starchy foods, has plenty of fruit and vegetables, and is low in saturated fat, sugar, and salt. For more information, take a look at our page on creating a healthy diet.

If you have a diagnosis of diabetes, foods containing starchy carbohydrates are still an important part of a healthy, balanced diet. However, these foods affect blood sugar levels, so it is recommended that you talk with your diabetes healthcare team about the best type and amount to include in your diet.

If you need to lose weight, calorie and portion size control is important. For more information see our page on healthy weight loss.

Get active!

It is recommended that adults choose activities that include aerobic and strength exercises. The recommended minimum weekly amount of physical activity for adults is:

The recommended minimum weekly amount of physical activity for adults is:

150 minutes of moderate level aerobic activity. This should raise your heart rate and make you breathe faster and feel warmer. Or 75 minutes of vigorous aerobic activity, this should make you breathe hard and fast.
Strength exercises two or more days of the week. This includes yoga, exercises like sit ups or press ups or heavy gardening like digging.
You don’t have to join a gym. Walking, dancing, swimming, gardening, golf, bowling, and cycling all count towards physical activity.
Activity can be spread out through the day so the small changes you make add up to a lot more activity. For example, use the stairs instead of taking the lift, leave the car at home for small trips, or get off the bus one stop earlier.
Even housework can count!

For more information see our pages on keeping active.

13 Tips For Eating A Healthy, Balanced Diet:

Try to eat meals at regular times during the day.
Base meals on starchy foods, such as potatoes, rice, pasta, bread and breakfast cereals, choosing wholegrain or higher fibre versions where possible.
Just over a third of the food we eat each day should be fruit and vegetables. Aim for at least five portions of fruit and vegetables a day (green leafy vegetables are associated with reduced risk of type 2 diabetes).
Avoid or limit foods high in saturated fat and sugars, such as chocolate, cakes, biscuits, full-sugar soft drinks, butter and ice-cream.
Choose beans, pulses and other vegetable sources of protein (like tofu), lean meat, poultry and fish, instead of fatty meat or processed meat products.
Choose low-fat and low-sugar dairy foods, such as skimmed or semi-skimmed milk and low-fat, unsweetened yogurt.
Use unsaturated oils, such as vegetable, rapeseed and olive oils, in cooking but only in small amounts.
Swap butter for lower fat spreads.
Try grilling or boiling your food instead of frying it. Cooking in this way will reduce the amount of fat in your food.
Choose products lower in salt and use less salt in cooking.
If you drink alcohol, do so in moderation - no more than 14 units per week for both men and women.
Keep hydrated, try to drink 6-8 glasses of fluid a day.
Swap sugary soft drinks for those without sugar, such as water, tea, coffee and diet drinks.

What should I do if I am worried about type 2 diabetes?

If you are worried you may be at risk of type 2 diabetes, or if you just want to find out whether you are a healthy weight then talk to your GP.

For further information, advice and support on all matters related to diabetes see the Diabetes UK website.

Putting type 2 diabetes into remission with weight loss

It’s not possible to reverse or cure type 2 diabetes permanently but some people are able to put the condition into remission for months or even years. This happens when blood sugar levels fall below the threshold for a diagnosis of type 2 diabetes and remain there for three months without taking any medication.

Key facts

Research shows that losing weight is the most effective way to achieve type 2 diabetes remission for those above the healthy weight range.
Losing weight soon after a diagnosis of type 2 diabetes increases the likelihood of remission, though it can still be achieved years later.
A rapid, safe weight loss of around 15kg (2st 5lb) soon after diagnosis is particularly effective for achieving remission in people living with obesity or overweight.
Meal replacement diets that use soups and shakes have strong evidence for supporting weight loss and type 2 diabetes remission.
Not everyone who loses weight will achieve or stay in remission, but any weight loss achieved will benefit health.

Weight loss approaches for remission

There are several ways to achieve weight loss and put type 2 diabetes into remission. Your healthcare team can offer guidance and more information is available on the Diabetes UK website.

Research shows a low-calorie diet works well for many people wanting to achieve remission. There are many diets to choose from. The key to success is finding one that fits your lifestyle, budget, and food preferences. You can find more information on options like low-carb diets, low-fat diets, intermittent fasting and the Mediterranean diet on the Diabetes UK website.

Total diet replacement plans

Although losing a large amount of weight can be challenging, studies show low-calorie diets that replace all food with soups and shakes can give good results. Sometimes referred to as ‘Total Diet Replacement’ or ‘Soup and Shake’ diets, they are so effective they’re now included in nationwide weight loss programmes aimed at putting type 2 diabetes into remission.

For example, in England, this type of low-calorie diet is part of the NHS Type 2 Diabetes Path to Remission Programme. For information on available programmes in the UK, see the Diabetes UK website.

Programmes designed to put type 2 diabetes into remission are supported by healthcare teams. They last 12 months and have three steps:

Step 1

For the first 12 weeks, all meals are replaced with specially formulated low-calorie soups and shakes. These provide a total of around 800-900 calories a day and provide all the nutrients needed to stay healthy.

Step 2

After 12 weeks, with advice from the healthcare team, nutritious foods are slowly reintroduced over the next six weeks. These provide around 1,200 calories a day. Physical activity is also encouraged – as well as benefitting overall health, regular exercise helps with maintaining a new lower weight.

Step 3

The final step focuses on keeping the weight off with diet and lifestyle support from the healthcare team.

FAQ on type 2 diabetes remission

How does losing weight achieve type 2 diabetes remission?

The liver and pancreas help to control blood sugar levels. An excess of fat in and around these organs means they work less well causing blood sugar to rise. Losing weight reduces the amount of fat in the liver and pancreas, helping them work more efficiently. This often lowers blood sugar levels below the threshold for a diagnosis of type 2 diabetes and keeps them there.

Isn’t it better to lose weight slowly?

While slow, steady weight loss – around 0.5-1kg (1-2lb) a week – has typically been recommended by health professionals, research shows that rapidly losing a large amount of weight is the most effective way to put type 2 diabetes into remission in people above the healthy weight range.

While gradual weight loss is still a successful approach for many, fast weight loss can have a greater impact for diabetes remission.

Won’t fast weight loss mean fast regain?

Maintaining weight loss can be challenging, regardless of the diet followed to achieve this. Studies confirm weight regain is common after dieting. This can mean people fall out of remission.

However, many people still weigh less than when they start out and even a short time in remission offers health benefits. Some research also suggests rapid weight loss doesn’t necessarily result in faster or larger weight regains compared to slower weight loss.

Can I try my own ‘Soup and Shake’ diet with regular soups and milkshakes?

It’s not recommended. Total Diet Replacement programmes use specially formulated soups and shakes to ensure a balanced intake of essential nutrients needed to stay healthy. Meal replacement products are widely available in supermarkets but speak to your healthcare team before using them to ensure they are suitable for you.

Is a ‘Soup and Shake’ diet suitable for everyone?

Total Diet Replacement plans are unsuitable for some people such as those using insulin, if you have had a heart attack or stroke, or if you have an eating disorder. It’s always advisable to speak to your healthcare team first.