Type 2 Diabetes & Insulin therapy (T2DM)

🔍 When to Suspect

May be asymptomatic, or present with thirst, polyuria, tiredness, blurred vision, or recurrent infections; consider in those with risk factors like age >40 (or >25 in South Asian, African-Caribbean or Black African people), obesity, or family history

From the full topic in The Ocean Library: Type 2 Diabetes & Insulin therapy (T2DM)

🧭 When to suspect

Type 2 diabetes is a progressive disorder of insulin resistance with relative insulin deficiency, producing chronic hyperglycaemia.

• It carries a markedly raised risk of cardiovascular, renal, retinal and neuropathic complications.

• Suspect it in any adult with persistent hyperglycaemia, whether symptomatic or detected incidentally.

Symptoms may be mild or entirely absent, so a large proportion is found on screening or opportunistic testing. When present, classic features include:

• Polydipsia

• Polyuria (especially nocturia)

• Blurred vision

• Unexplained weight loss

• Recurrent infections (thrush, balanitis, boils, urinary infection)

• Fatigue

• Slow-healing wounds

• Acanthosis nigricans (velvety dark pigmentation of skin folds signalling insulin resistance)

Raise suspicion further with:

• Age over 40 (or over 25 in South Asian, African-Caribbean or Black African people)

• Obesity (the dominant modifiable risk factor)

• Family history

• Polycystic ovary syndrome

• Previous gestational diabetes

• Hypertension

• Established cardiovascular or kidney disease

• Use of diabetogenic drugs (corticosteroids, atypical antipsychotics, thiazides)

Test	Diabetes	Non-diabetic hyperglycaemia (“pre-diabetes”)
HbA1c	≥ 48 mmol/mol (6.5%)	42–47 mmol/mol (6.0–6.4%)
Fasting plasma glucose	≥ 7.0 mmol/L	6.1–6.9 mmol/L (impaired fasting glucose)
Random glucose or 2-h oral glucose tolerance test (OGTT)	≥ 11.1 mmol/L	7.8–11.0 mmol/L at 2 h (impaired glucose tolerance)

• Symptomatic patient – a single abnormal result is sufficient to diagnose, though a confirmatory test is sensible.

• Asymptomatic patient – do not diagnose on one result; repeat the same test (preferably) within about 2 weeks. If the repeat is normal, monitor rather than label.

• Stress hyperglycaemia – acute infection, trauma or circulatory compromise can raise glucose transiently and is not diagnostic.

• Children and young people – assume type 1 diabetes unless there are strong pointers to type 2 (marked obesity, strong family history, high-risk ethnicity, acanthosis nigricans).

• Consider insulin from the outset (or refer) if there is symptomatic hyperglycaemia, ketosis, marked weight loss, or doubt about the diabetes type.

Source: NICE NG28

---