Diabetes management depends largely on satisfactory blood glucose control. ... control of your diabetes while continuing to live as normal a life as possible.

Health Navigator New Zealand

Type 2 diabetes

Type 2 diabetes is a condition in which your body isn't able to use insulin properly, resulting in high blood glucose levels. This can lead to a wide range of health problems if not treated.

Unlike type 1 diabetes, the pancreas in people with type 2 diabetes is able to make insulin. The main problem with type 2 diabetes is that the body doesn''s cells, where it is used for energy. If there is not enough insulin or it is not working well to open the channel for glucose to enter the cells, glucose builds up in the bloodstream.

When someone has diabetes, their body is not able to control their blood glucose levels and keep it in the safe range.

  • If the level is too low, low blood glucose, or hypoglycaemia, occurs and people feel sweaty, weak and dizzy and need to eat some glucose right away.
  • If too high, high blood glucose, or hyperglycaemia, can occur.

Symptoms depend on how high or rapidly the level changes but can include excess thirst, passing excess urine, blurred vision etc.

While diabetes cannot be cured, it can be controlled and people with diabetes can lead a full and active life.

Who is at risk of type 2 diabetes?

If you have any of the following risk factors, check with your doctor/nurse about a test for diabetes:

  • you are overweight for your height. Use our BMI calculator
  • a family member has diabetes
  • you are Maori, Pacific or Asian and aged 35 or over
  • you aged 45 year or over.

Symptoms

About 50% of people with type 2 diabetes have no symptoms or have not been diagnosed. Others may:

  • feel very thirsty
  • pass a lot of urine
  • feel very tired
  • have blurred vision
  • have urinary infections, skin infections
  • find cuts and grazes heal slowly.

If you have one or more risk factors for diabetes, or any of the symptoms above, see your doctor or nurse for a check up.

It is easy to test for diabetes and important to find out so you can take action to prevent damage to your eyes, heart, kidneys and feet.

Diagnosis

Screening tests

If you have symptoms of diabetes, your doctor or nurse will send you to the lab for a blood test. If you don't have any symptoms, signs of diabetes may be picked up as part of a heart check or other routine screening test.

A  glycated haemoglobin (HbA1c) is the recommended test for both screening and diagnosing diabetes. This needs to be done by at a specialised laboratory. Finger prick tests at community health centres are not accurate enough for diagnosing diabetes.

If it is not possible to measure HbA1c, or there are other issues to be considered, then a fasting plasma glucose is recommended.

Diagnostic tests

Since 2011, the diagnosis of diabetes is made on the basis of a lab test measuring either HbA1c or venous plasma glucose measurements. 

If you have symptoms of diabetes an HbA1c ≥50 mmol/mol (and, if measured, a fasting blood glucose ≥7.0 mmol/l or a random glucose ≥ 11.1 mmol/l) is sufficient to establish the diagnosis of diabetes.

If you do not have symptoms of diabetes the same criteria apply but, to confirm the diagnosis of diabetes, a confirmatory test (preferably HbA1c) is needed on a separate occasion.

A HbA1c of ≤40 mmol/mol is normal.

   Normal Pre-diabetes Diabetes
HbA1c ≤40 mmol/mol 41–49 mmol/mol ≥50 mmol/mol
Fasting blood glucose   6.1–6.9 mmol/l ≥7.0 mmol/l
Random glucose     ≥ 11.1 mmol/l

Pre-diabetes

If your HbA1c level is 41–49 mmol/mol or a fasting glucose concentration is slightly high at 6.1–6.9 mmol/l, you may be told that you have pre-diabetes.

If you have prediabetes, it is important to review your diet, blood pressure, physical activity levels and other clinical measures with your doctor or nurse. With some changes, you can lower your risk of getting diabetes. Your HbA1c measurement should be repeated after 6-12 months. Read more about prediabetes...

Treatment for type 2 diabetes

Type 2 diabetes is treated mainly with oral medication or tablets, which include:

New medications are being developed, but not all are currently funded. Your doctor or nurse will talk with you about which one is best for you.

Read more about diabetes medications

Insulin

With time, many people with type 2 diabetes will need to also use insulin injections. This can improve control of blood glucose levels and reduce the risk of developing complications.

  • The insulin you get from the chemist is manufactured in the laboratory. It is made to mimic the action of the hormone called insulin that occurs naturally in your body.
  • It is made by joining cell organisms with the human gene for making insulin joined. These cells are then able to make insulin.
  • The human insulin is a very safe product to take and there have been no instances of insulin becoming contaminated with anything harmful.
  • Insulin is injected just under the skin, not in a vein.

The common ways of using insulin for type 2 diabetes include:

  • Once a day insulin – often at bedtime.
  • Two times a day insulin – given morning and evening.

Read more about starting insulin from the booklet Starting insulin in type 2 diabetes (Waitematā DHB) available in 5 languages including Samoan and Tongan. 

Avoid diabetes complications

Diabetes increases the risk of many serious conditions such as poor vision, heart disease or stroke, damage to our kidneys (diabetes is the top cause of kidney failure), erectile dysfunction and loss of limbs. The key factor affecting how fast or slowly these complications develop is how well or poorly controlled your diabetes is. The best way to avoid or delay developing diabetes-related health problems is by keeping your blood glucose and blood pressure levels within the healthy range.

See: blood glucose testing

Support

There are many groups and people keen to share their knowledge and tips for living well with diabetes. Diabetes NZ has branches around the country with a wide range of services, resources, groups and shops. 

Regional diabetes support

Learn more

Diabetes NZ
Diabetes UK

Redirect

Most people with type 2 diabetes are able to control their blood glucose with oral diabetes medications (tablets), healthy eating and regular exercise. With time, some people with type 2 diabetes will need to also use insulin injections with their tablets. This can improve control of blood glucose levels and reduce the risk of developing complications.

Insulin helps to move the glucose from your blood into your cells to give you energy. When you have type 2 diabetes your body has stopped making its own insulin or your body has stopped using what you make.

The common ways of using insulin for type 2 diabetes include:

  • Once a day insulin – often at bedtime.
  • Two times a day insulin – given morning and evening.

Read more about the different types of insulin.

Tips for starting insulin

Starting insulin to manage type 2 diabetes may seem scary and overwhelming at first, but your GP or diabetes nurse will provide support and information to help guide you through.

Here are our tips when starting insulin for type 2 diabetes:

Monitor your blood glucose levels

Testing your blood glucose levels at home is important because it can provide you with useful information to monitor the effects of your insulin on your blood glucose levels. Every time you measure your blood glucose, record your blood results in a diabetes diary. Some blood glucose meters may record your blood glucose levels automatically. Your diary can also help you keep track of events such as if you had a hypo or low blood glucose and help to decide how well you are reaching your overall treatment goals. When you first start insulin you will need to test your blood glucose at least 3 to 4 times a day, but once you have found the insulin dose that bests suits you, you can test less often. Read more about blood glucose testing.

When to inject insulin

The time of your insulin injection will depend on when your blood glucose level is highest. Most people need to have insulin at bedtime, because your body makes glucose during the night, causing your blood glucose levels to be higher in the morning when you wake. Therefore, an evening dose of insulin helps to maintain lower blood glucose levels overnight. A few people find that their blood glucose levels are highest later in the day. In these people, its best to start insulin in the morning. Some people may need to use insulin two or more times a day to get better glucose control. Your doctor or nurse will help you decide on the right schedule for you. It usually takes a few weeks to get your dose and timing right.

How to inject insulin

Insulin can be injected using a syringe, but most people use insulin pens. Insulin pens are similar in size and shape to a writing pen. They make measuring and injecting your insulin easier and are easy to carry around. Insulin pens are not pre-fitted with needles. A suitably sized needle has to be attached to the pen. Insulin should be injected into the fatty tissue under the skin. The abdomen or tummy area, about 5 cm away from your belly button, is usually a good place. It is easy to reach and insulin absorbs well from this site. Read more about how to inject insulin.

Know the signs of hypoglycaemia

Hypoglycaemia or low blood glucose occurs when your blood glucose level is less than 4 mmol/l, or where symptoms of hypoglycaemia are experienced at a level close to this. Hypoglycaemia can happen quickly so it’s a good idea for you and your whānau to know what symptoms to look out for, such as:

  • blurred vision
  • dizziness
  • pale, sweaty skin
  • irritability

It’s a good idea to carry something sugary with you in case your blood glucose levels start getting low. Jellybeans are a good, quick source of sugar. Read more about hypoglycemia.

Store and dispose of your insulin and needles safely

Insulin you are not using should be stored in the door of your fridge. You can keep the insulin you are using out of the fridge for a month, as injecting insulin at room temperature is less painful.

Never put your used needles in the rubbish bin. Your GP or diabetes nurse can give you a container to put used needles in and organise a place where you can dispose of the container once it’s full.

Learn more

Starting insulin for type 2 diabetes
SafeRx, Waitematā DHB, 2012

English (Updated 2015) 
Chinese
Korean
Samoan
Tongan

 

  Resources

Diabetes info sheet

Health Foundation, NZ, 2019

Type 2 diabetes 
DHB Refugee Health Collaborative NZ, 2011

English 
Arabic

Staying well with type 2 diabetes Diabetes NZ, 2015

English 
Chinese (11MB) 
Hindi (3 MB) 

Diabetes and how to care for your feet 
Diabetes NZ

Starting insulin for type 2 diabetes 
SafeRx, Waitematā DHB, 2012

English (Updated 2018) 
Chinese 
Korean 
Samoan 
Tongan

Diabetes poster infographic

NZ Ministry of Health and Diabetes Project Trust, 2014

Diabetes explained in multiple languages

Note: All of the resources below are from overseas so some details may be different. Make sure you know the emergency numbers for New Zealand. Ring 111 for emergencies, or Healthline 0800 611 116.

 

Bilingual from health info translation

ASL (American Sign Language)

Amharic (amarunya)

Arabic (العربية)

Bengali (Bangla)

Bosnian (Bosanski)

Chamorro (chamoru)

Chinese – simplified (简体中文)

Chinese – traditional (繁體中文)

Chuukese (Trukese)

English

French (français)

Gujarathi (ગુજરાતી)

Hindi (हिन्दी)

Hmong (Hmoob)

Japanese (日本語)

Karen (Sgaw Karen)

Khmer (Khmer)
Korean (한국어)
Laotian (Lao)
Portuguese (português)
Russian (Русский)
Samoan (Gagana Samoa)
Somali (af Soomaali)
Spanish (español)
Tagalog (Tagalog)
Thai (ภาษาไทย)
Tongan (chiTonga)
Ukrainian (Українська)
Urdu (اردو)
Vietnamese (Tiếng Việt)

Type 2 diabetes self-management courses

 

Self-management education courses

What is it?

Range of courses covering basics about type 2 diabetes

Who is it run by?

Multiple organisations including local Primary Health Organisations, District Health Boards, and community organisations such as Diabetes NZ and Diabetes Auckland

Who is this for?

People with type 2 diabetes and their families

Contact details

Ask your GP what is available in your area or you can contact the organisations directly (see list below)

Regions

Living well with type 2 diabetes – by region:

  • Auckland District Health Board region – Auckland PHO provide diabetes self-management classes for central Auckland from Avondale to Panmure and city to Hillsborough. Phone: 09 379 4022 

  • Counties Manukau – most areas covered – check with your GP.

  • Auckland wide

    • ProCare Health has a range of self-management programmes running across wider Auckland and anyone is welcome. Contact Nivedita via email: [email protected] or Ph: 09 3547770. Call or text 0273395740
    • Diabetes Auckland – (there may be a small cost to attend) Phone: 09 623-2508

  • Nelson/Marlborough – visit website

  • Other regions 

    • Check with your GP or let us know.
  Case studies

Wellness diabetes

  • Self-management group education for people with type 2 diabetes

Waikato Bay of Plenty Primary Healthcare Organisation

Information for health professionals

The information on this page will be of most interest to clinicians (doctors, nurses, specialists, etc) and those interested in more detail.

  1. Clinical guidelines
  2. Regional HealthPathways NZ
  3. Diabetes videos and podcasts

Clinical guidelines and resources

Slowing progression of renal dysfunction in patients with diabetes BPAC NZ, 2019
Dialling back treatment intensity for older people with type 2 diabetes BPAC NZ, 2019
Optimising pharmacological management of HbA1c levels in patients with type 2 diabetes: from metformin to insulin BPAC NZ, 2019
Type 2 diabetes and the management of hyperglycaemia Research Review NZ, 2019
Type 2 diabetes and overcoming clinical inertia Research Review NZ, 2018
Guidance on the Use of Insulin in the Management of Type 2 Diabetes in Primary Care Research Review NZ, 2017
Management of type 2 diabetes NZ Primary Care Handbook, pages 45-64, including:

  • Glycaemic control
  • Management of blood pressure
  • Preventing complications
  • Starting insulin

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial The Lancet, 2017
A rising tide of type 2 diabetes in younger people: what can primary care do? BPAC NZ, 2018
Managing patients with type 2 diabetes: from lifestyle to insulin BPAC NZ, 2015
Improving glycaemic control in people with type 2 diabetes BPAC NZ, 2013
The new role of HbA1c in diagnosing type 2 diabetes BPAC NZ, 2012

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: 

Diabetes videos

Primary care – PHARMAC Seminar Series

Sick day management for type 1 and type 2 diabetes in primary care – Presented by Dr Elaine Barrington-Ward (30 minutes).


(Dr Elaine Barrington-Ward, PHARMAC, Wellington, NZ, 2014)

Goodfellow Unit Webinar

Type II diabetes in young people
Tuesday, 17 April 2018
Dr Steven Miller

Podcast

Nutrition – type two diabetics – Jennifer Crowley Goodfellow Unit, 2017
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