The number of people living with Type 2 Diabetes aged under 40 is increasing. Type 2 Diabetes used to be thought of as a disease which only affected older people. The fact that we see more cases in younger people is concerning as potential complications of Diabetes are linked with how long someone has had raised sugar levels and so if the condition starts early then someone is likely to be living with these raised sugar levels for longer. Type 2 Diabetes in pregnancy increases risks of complications and so this is also something to consider as we see more younger people affected.

On the brighter side there are lots of things that can be done to reduce risks of complications with even the potential to reverse the condition or at least delay the need for additional medication.

There are a number of areas to focus on:

• Support to Aim for Remission
• Pregnancy and Contraception
• General Education & Peer Support
• Weight Loss Support
• Medication Optimisation (when needed)
• Support Stopping Smoking

There are various services locally which can help support with the above areas but we are also investigating holding a face to face group session and potentially a Zoom session also.

Support to Aim for Remission

We used to think of Type 2 Diabetes as a condition which always needed medication and that this medication would gradually need to be strengthened/added to. In more recent years it has become clear that this is not the case and it is possible for some people to get their sugar levels down through dietary measures. Remission is where your sugar levels are in the non-diabetic range for over three months without diabetes medication.

There are various ways to try and achieve remission. As a PCN we have had a lot of success recommending people reduce their dietary carbohydrates as a way of improving sugar levels. There is also the option for a more intensive dietary intervention using soups/shakes for which there is more information below. The late Michael Mosley's book "The 8-week blood sugar diet" is a great introduction to these topics.

You can find an introduction to the low-carb approach on our website here. It is important that people using SGLT2 inhibitors e.g. Dapagliflozin do not cut out carbohydrates completely. Those on Insulin or Sulphonylureas e.g. Gliclazide are at increased risks of low glucose levels if they cut their carbohydrate intake without reducing their medication.

If you are interested in the option of total dietary replacement with Soups and Shakes as a way of potentially achieving remission then have a look at the information in the box below with information on a service available.

Pregnancy and Contraception

Being pregnant while living with Type 2 Diabetes unfortunately dose increase the risks to both mother and baby. It is really important that you speak to a doctor before you start trying to get pregnant if possible or as soon as you find out that you are pregnant if it was not planned. You should be referred to a specialist clinic to help prepare for pregnancy.

The following points are important to keep in mind:

• High dose Folic Acid (5mg) should be taken during the first 12 weeks of pregnancy which is not available over the counter. Ideally this should be started 3 months before you get pregnant.
• Ideally your HbA1c should be as near to 48mmol/mol as possible before getting pregnant, we would strongly advise avoiding getting pregnant if your HbA1c is 86 or above due to the increased risks.
• Blood pressure medication may need reviewing ideally before you are pregnant as certain common blood pressure  medications are not recommended in pregnancy e.g. Ramipril. Their are other medications which can be used (Labetalol, Nifedipine, Methyldopa).
• Statin medication should be stopped before getting pregnant or as soon as pregnancy is confirmed if unplanned.
• Your Diabetes Medication will also need to be reviewed as many of these are not recommended in pregnancy.

As well as the above key points it is recommended to have up to date eye screening before getting pregnant and you should have a kidney blood test and urine test to make sure your kidney function is ok.

There is a Diabetes UK information prescription on this topic which you might want to have a look at as well as an infographic from EDEN and a "are you ready for pregnancy" quiz from Tommys.

General Education & Peer Support

There is so much to learn when you are diagnosed with Type 2 Diabetes but also things keep changing so it is difficult to keep up to date. The West Hampshire Community Diabetes Team run an online education session for those diagnosed within the last 12 months but there is also a refresher session which you can attend as long it is a year since you last attended one of their group session. To access these courses you need a referral from your practice nurse of GP.

Peer support is also really important. We recommend joining Sugarbuddies which is a FaceBook group for those living with all types of Diabetes living in Hampshire or Dorset.

It can all become a bit overwhelming and stress does not help with sugar levels. NHS Talking Therapies Hampshire can be accessed by self-referral here and have support specifically related to Diabetes.

Weight Loss Support

Some medications that we use to treat Type 2 Diabetes can have the added benefit of helping with weight loss. Diet is also really important as well as activity levels.

You can see what weight loss services are available locally on this page of ours.

Medication Optimisation

If you are on medication for Type 2 Diabetes it is really important that you are taking this regularly and having a HbA1c blood test at least yearly. If your sugar levels are raised and changes to treatment are being made then more frequent blood tests may be appropriate.  We aim for an HbA1c <58mmol/L but getting this level lower is good with <48mmol/L being in the non-diabetic range. If you are on medication then diet and lifestyle measures remain really important.

Support Stopping Smoking

The combination of smoking and Diabetes increases the risk of complications significantly and so stopping smoking is strongly recommended. You are much more likely to succeed with professional support which locally is provided by Smoke Free Hampshire.