Your complete guide to Type 2 Diabetes and The Type 2 Diabetes Path to Remission

The symptoms of type 2 diabetes can include increased thirst, frequent urination, increased hunger, fatigue, blurred vision, and slow healing of wounds. However, the best way to know for sure is to see a healthcare professional for proper testing and diagnosis.  

They can perform blood tests to check your blood glucose levels and determine if you have type 2 diabetes. Early detection and management are crucial for maintaining good health. 

Type 1 diabetes is an autoimmune condition where the immune system attacks and destroys insulin-producing cells in the pancreas, leading to little to no insulin production. It often develops in childhood or adolescence, and individuals with type 1 diabetes require insulin injections for life. 
 
Type 2 diabetes, on the other hand, typically develops in adulthood and is characterized by insulin resistance, where the body’s cells don’t respond effectively to insulin, and the pancreas may not produce enough insulin to compensate. It’s often associated with lifestyle factors such as obesity, physical inactivity, and poor diet, although genetics also play a role. Initially, type 2 diabetes may be managed with lifestyle changes, oral medications, and sometimes insulin therapy. 
 
In summary, while both types involve problems with insulin, type 1 is an autoimmune condition with little to no insulin production, while type 2 involves insulin resistance and impaired insulin secretion, often influenced by lifestyle factors. 

If you’ve been diagnosed with type 2 diabetes, here are some important steps to take: 

• Follow your doctor’s recommendations: Work closely with your healthcare team to develop a treatment plan tailored to your needs. This may include medications, blood glucose monitoring, lifestyle changes, and regular check-ups. 

• Educate yourself: Learn as much as you can about diabetes, including how to manage it, potential complications, and lifestyle changes you can make. 

• Adopt a healthy lifestyle: Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit your intake of sugary and processed foods, and control portion sizes. Aim for regular physical activity, such as walking, swimming, or cycling, to help control blood glucose levels and maintain a healthy weight. 

• Manage stress: Find healthy ways to cope with stress, such as exercise, meditation, or spending time with loved ones. 

• Seek support: Joining a diabetes support group or connecting with others who have diabetes can provide valuable support and encouragement.
   

Remember, managing type 2 diabetes is a lifelong journey, but with the right tools, support, and mindset, it is possible to live a full and healthy life. 

Type 2 diabetes is a serious condition that requires careful management to prevent complications. If left untreated or poorly managed, it can lead to serious health problems, including heart disease, stroke, kidney disease, nerve damage, vision loss, and foot problems that may require amputation. 
 
However, with proper treatment, lifestyle changes, and regular monitoring, many people with type 2 diabetes can lead healthy and fulfilling lives while reducing the risk of complications. It’s important to take the diagnosis seriously and work closely with healthcare professionals to manage the condition effectively. 

Having type 2 diabetes can impact various aspects of your life, these include:  

Diet and Nutrition: You’ll need to pay close attention to your diet, focusing on healthy, balanced meals to help manage blood glucose levels.  

Physical Activity: Regular exercise is important for managing type 2 diabetes.  

Medications and Monitoring: Depending on your individual needs, you may need to take medications to help control blood glucose levels.  

Doctor Visits: You’ll need to see your healthcare team regularly for check-ups, monitoring, and adjustments to your treatment plan as needed. 

Lifestyle Changes: Managing type 2 diabetes often involves making significant lifestyle changes, such as quitting smoking, reducing alcohol consumption, and managing stress effectively. 

Complications: If left untreated or poorly managed, type 2 diabetes can lead to serious complications such as heart disease, stroke, kidney disease, nerve damage, and vision problems. However, by managing the condition effectively, you can reduce the risk of complications. 

Emotional Well-being: Living with a chronic condition like type 2 diabetes can have emotional implications, including stress, anxiety, and depression. It’s important to seek support from friends, family, healthcare professionals, or support groups if you’re struggling emotionally. 

Managing type 2 diabetes requires effort and commitment. With proper self-care, support, and medical treatment, you can minimise the impact of diabetes on your life and overall well-being. 

The rate at which type 2 diabetes progresses can vary greatly from person to person and depends on various factors, including genetics, lifestyle, and overall health. Some individuals may experience a relatively slow progression of the disease over many years, while others may develop complications more rapidly. 

Factors that can influence the progression of type 2 diabetes include: 

• Lifestyle: Diet, physical activity level, weight management, and other lifestyle factors can impact the progression of type 2 diabetes.  
• Blood glucose Control: Effective management of blood glucose levels through medication, diet, and exercise can help slow the progression of type 2 diabetes and reduce the risk of complications.  
• Genetics: Individuals with a family history of the disease may be at higher risk and may experience a faster progression. 
• Other Health Conditions: Coexisting health conditions, such as high blood pressure, high cholesterol, and obesity, can accelerate the progression of type 2 diabetes.  
• Compliance with Treatment: Adherence to medication regimens, lifestyle changes, and regular monitoring are essential for managing type 2 diabetes effectively and slowing its progression.  

Overall, the progression of type 2 diabetes is highly individualised, and proactive management of the disease through lifestyle modifications, medication, and regular monitoring is key to slowing its progression and reducing the risk of complications. It’s important for individuals with type 2 diabetes to work closely with their healthcare team to develop a treatment plan.  

Type 2 diabetes can lead to various complications if left untreated or poorly managed. Some of the common complications include: 

• Heart Disease and Stroke: Diabetes increases the risk of developing cardiovascular diseases, including coronary artery disease, heart attack, and stroke. 
• Kidney Damage (Diabetic Nephropathy): High blood glucose levels over time can damage the kidneys, leading to chronic kidney disease or even kidney failure. 
• Nerve Damage (Neuropathy): Diabetes can cause damage to the nerves throughout the body, leading to symptoms such as numbness, tingling, pain, and weakness, particularly in the hands and feet. 
• Eye Damage (Diabetic Retinopathy): High blood glucose levels can damage the blood vessels in the retina, leading to diabetic retinopathy, which can cause vision problems and even blindness if left untreated. 
• Foot Problems: Diabetes can cause nerve damage and poor circulation in the feet, increasing the risk of foot ulcers, infections, and, in severe cases, amputation. 
• Skin Conditions: Diabetes increases the risk of developing various skin conditions, including bacterial and fungal infections, itching, and slow wound healing. 
• Gum Disease (Periodontal Disease): Diabetes increases the risk of gum infections and periodontal disease, which can lead to tooth loss if not properly treated. 

It’s important for individuals with type 2 diabetes to work closely with their healthcare team to manage their condition effectively and prevent or delay the onset of complications. This includes controlling blood glucose levels, managing blood pressure and cholesterol levels, adopting a healthy lifestyle, and attending regular check-ups. Early detection and treatment of complications can help minimize their impact on overall health and quality of life. 

While type 2 diabetes cannot be “cured” in the traditional sense, it is possible to achieve remission of the condition.  

It can be improved through lifestyle changes, particularly in the early stages of the disease. This means that with the right interventions, blood glucose levels can be brought back to a normal range, and the need for diabetes medications may be reduced or eliminated.

If you’re considering making lifestyle changes to improve your diabetes management, it’s important to work closely with your healthcare team to develop a personalised plan that meets your needs and goals. 

Make sure to read the section of this guide on the NHS Path to Remission Programme which explains how you can proactively work towards remission of Type 2 Diabetes. 

Stress can significantly impact blood glucose levels through a series of physiological responses: 

• Hormonal Response: When stressed, the body releases stress hormones such as cortisol and adrenaline. These hormones trigger the liver to release glucose into the bloodstream to provide immediate energy for the “fight or flight” response. 

• Insulin Resistance: Chronic stress can lead to increased insulin resistance, meaning the body’s cells become less responsive to insulin. This impairs the body’s ability to use glucose effectively, leading to higher blood glucose levels. 

• Behavioural Changes: Stress can influence behaviors that affect blood glucose levels. People under stress might be more likely to engage in unhealthy eating habits, such as consuming high-sugar or high-fat foods, which can spike blood glucose levels. Additionally, stress might lead to decreased physical activity, further contributing to higher blood glucose. 

• Impact on Diabetes Management: For individuals with diabetes, stress can complicate blood glucose management. Stress can make it harder to follow treatment plans, such as taking medications on time, monitoring blood glucose levels regularly, and adhering to a balanced diet and exercise routine.
   

In summary, stress affects blood glucose levels by triggering the release of glucose into the bloodstream, increasing insulin resistance, and influencing behaviours that can lead to higher blood glucose levels. Managing stress through techniques such as exercise, meditation, and proper sleep can help maintain healthier blood glucose levels. 

Exercise plays a crucial role in managing diabetes by helping to control blood glucose levels, improve insulin sensitivity, and contribute to overall health. Here are several key ways exercise benefits individuals with diabetes: 

• Improving Insulin Sensitivity: Physical activity increases insulin sensitivity, meaning that the cells in the body become more responsive to insulin and use glucose more effectively, reducing blood glucose levels. 

• Lowering Blood Glucose Levels: During exercise, muscles use glucose for energy, which can help lower blood glucose levels. Both aerobic and resistance training exercises are beneficial in this regard. 

• Weight Management: Regular exercise helps in maintaining a healthy weight or losing excess weight, which is particularly important for individuals with type 2 diabetes.  

• Cardiovascular Health: People with diabetes are at higher risk for cardiovascular diseases. Regular physical activity strengthens the heart and improves circulation, reducing the risk of heart disease and stroke. 

• Improving HbA1c Levels: Exercise can help lower glycated haemoglobin (HbA1c) levels, a marker of average blood glucose levels over the past three months, which is associated with better diabetes control. 

• Enhancing Mood and Reducing Stress: Exercise can improve mental health by reducing stress, anxiety and depression. Reduced stress levels can lead to better blood glucose control. 

• Increasing Energy Levels: Regular physical activity can improve overall energy levels and reduce feelings of fatigue, making it easier for individuals to stay active and manage their diabetes. 

• Improving Sleep Quality: Exercise can help regulate sleep patterns and improve sleep quality, which is important for overall health and blood glucose management. 

• Preventing Complications: Consistent exercise can help prevent or delay the onset of diabetes-related complications, such as neuropathy, retinopathy, and nephropathy, by improving overall health and circulation. 

For individuals with diabetes, it is important to consult with a healthcare provider before starting an exercise program to ensure this is suitable based on individual health status and fitness level. Generally, a combination of aerobic exercises (like walking, cycling, or swimming) and resistance training (such as weightlifting or bodyweight exercises) is recommended for optimal benefits. 

For individuals with diabetes, regular exercise is highly recommended, but the frequency and type of exercise should be tailored to their specific needs and health status.  

General guidelines 

• Aerobic Exercise:
  ◦ Aim for at least 150 minutes of moderate-intensity aerobic exercise per week. This can be spread out over most days of the week (e.g., 30 minutes a day, five days a week).
  ◦ Alternatively, 75 minutes of vigorous-intensity aerobic exercise per week can be beneficial.
  ◦ Activities can include walking, cycling, swimming, or dancing. 

• Resistance Training:
  ◦ Incorporate resistance training exercises at least two to three times per week.
  ◦ Exercises can involve free weights, resistance bands, or body-weight exercises like squats and push-ups. 

• Flexibility and Balance Exercises:
  ◦ Include flexibility exercises, such as stretching, and balance exercises, like yoga or tai chi, at least two to three times per week. 

Safety Considerations include: 

• Monitoring blood glucose levels during exercise as directed by your healthcare team.  

• Medication adjustments as directed by your healthcare team. 

• Be aware of how you are feeling and notice any symptoms of hypoglycaemia (low blood glucose), such as shakiness, dizziness, sweating, and confusion.  

• Keep a source of fast-acting carbohydrate (like glucose tablets or juice) handy. 

• Stay hydrated, drink plenty of water before, during, and after exercise to stay hydrated, as dehydration can affect blood glucose levels. 

• Foot care, wear proper footwear to prevent blisters and foot injuries. Check your feet daily for any signs of sores, blisters, or cuts, especially if you have diabetic neuropathy. 

• Warm-up and cool down, this is important for everyone. Start with a warm-up to prepare your muscles and cardiovascular system. Finish with a cool-down to gradually bring your heart rate back to normal and prevent stiffness. 

• Medical conditions and complications, if you have diabetes-related complications (e.g., retinopathy, neuropathy, cardiovascular disease), consult with your healthcare provider to tailor an exercise plan that is safe and appropriate for your condition. 

• Gradual progression, if you are new to exercise, start slowly and gradually increase the intensity and duration of your workouts to avoid injury and excessive fatigue.
   

Regular exercise, when done safely, can greatly benefit individuals with diabetes by improving blood glucose control, enhancing insulin sensitivity, and promoting overall health. Always consult with a healthcare provider before starting a new exercise regimen to ensure it is safe and effective for your specific health needs. 

Genetic factors play a significant role in influencing the prevalence and progression of diabetes among different ethnic groups. These differences can affect susceptibility, disease progression, and response to treatment. Here are some ways in which genetic factors influence diabetes across various ethnic groups: 

• Type 2 Diabetes: Certain ethnic groups have a higher genetic predisposition to type 2 diabetes. For example, people of African, Hispanic/Latino, Native American, Asian, and Pacific Islander descent are at a higher risk compared to those of European descent. This increased risk is partly due to the presence of specific genetic variants that affect insulin secretion and glucose metabolism. 

• Insulin Resistance and Beta-Cell Dysfunction
  Genetic factors influencing insulin resistance and beta-cell dysfunction vary among ethnic groups. For instance, African Americans and Hispanics often exhibit higher insulin resistance, which increases the risk of developing type 2 diabetes. Additionally, the capacity of pancreatic beta cells to compensate for insulin resistance differs, with some populations having a higher predisposition to beta-cell dysfunction. 

• Fat Distribution and Metabolic Profiles
  Different ethnic groups have distinct patterns of fat distribution, which are genetically influenced and affect diabetes risk. For example, South Asians tend to have higher visceral fat accumulation, even at lower body mass indices (BMIs), which is strongly associated with insulin resistance and type 2 diabetes. African Americans, on the other hand, may have a greater tendency to store fat subcutaneously rather than viscerally, yet still experience high rates of diabetes due to other genetic and metabolic factors. 

• Gene-Environment Interactions
  The interaction between genetic predisposition and environmental factors, such as diet, physical activity, and socioeconomic status, plays a crucial role in diabetes prevalence among different ethnic groups. For instance, Native American populations have experienced dramatic lifestyle changes over the past century, which, combined with genetic susceptibility, have led to high rates of type 2 diabetes. 

• Genetic Studies and Variants
  Genome-wide association studies (GWAS) have identified numerous genetic variants associated with diabetes risk. Some of these variants have different frequencies in different ethnic groups. For example, variants in the TCF7L2 gene are strongly associated with type 2 diabetes and are more prevalent in individuals of European and African descent. Other variants, such as those in the KCNQ1 gene, are more common in East Asian populations and influence diabetes risk differently. 

• Epigenetics
  Epigenetic modifications, which are changes in gene expression without altering the DNA sequence, can also play a role in diabetes risk and are influenced by both genetic background and environmental factors. These modifications can be passed down through generations and may contribute to differences in diabetes prevalence among ethnic groups. 

• Response to Treatment
  Genetic differences can influence how individuals from various ethnic groups respond to diabetes medications. For example, African Americans may respond better to certain classes of medications, such as thiazolidinediones, compared to others. Understanding these genetic differences is important for personalized medicine and optimizing treatment strategies. 

In summary, genetic factors significantly influence the risk, progression, and treatment response of diabetes among different ethnic groups.  

Several treatment options are available, and the most appropriate approach depends on individual factors such as blood glucose levels, overall health, and lifestyle. Here are some common treatment options: 

Lifestyle Changes: This includes adopting a healthy diet, increasing physical activity, losing weight (if overweight or obese), and quitting smoking.  

Oral Medications: There are several classes of oral medications available to help lower blood glucose levels in type 2 diabetes.  

Injectable Medications: If oral medications are not sufficient to control blood glucose levels, injectable medications may be prescribed.  

Insulin Therapy: Some people with type 2 diabetes may eventually require insulin therapy to manage their blood glucose levels effectively. Insulin can be administered via injections or insulin pumps and may be used alone or in combination with other medications. 

Blood Glucose Monitoring: Regular monitoring of blood glucose can be important for managing type 2 diabetes. Your healthcare team will tell you if you need to do this and it can be done using a glucose meter or continuous glucose monitoring system. 

Education and Support: Diabetes education programs can help individuals learn about their condition, develop self-management skills, and make informed decisions about their treatment and lifestyle choices. Support from healthcare professionals, family, and support groups can also be valuable in managing type 2 diabetes effectively. 

NHS Type 2 Diabetes Path to Remission Programme – The programme is based on research showing that a 3-month specially formulated diet comprising of total diet replacement products including soups and shakes, followed by healthy lifestyle support helped people living with type 2 diabetes and obesity or overweight to lose over 10kg in weight, improve their blood glucose levels, reduce diabetes-related medication and, in almost half of participants, put their type 2 diabetes into remission. 

It’s important for individuals with type 2 diabetes to work closely with their healthcare team to develop a personalised treatment plan that meets their needs and goals.  

Regular monitoring, medication adjustments, and lifestyle modifications may be necessary to achieve and maintain optimal blood glucose control and prevent complications.  

For those wanting to take charge of their treatment plan, speak to your GP about the NHS Type 2 Diabetes Path to remission programme now to organise a referral.

The NHS Path to Remission programme is a structured approach developed by the UK’s National Health Service (NHS) to help people with type 2 diabetes achieve remission through lifestyle changes. The programme supports individuals in making sustainable changes to their diet, physical activity, and overall lifestyle to improve their blood glucose control and potentially put their diabetes into remission. 

• Education – Participants will receive education about type 2 diabetes, including its causes, risk factors, and the importance of lifestyle changes in managing the condition.  

• Nutrition Guidance – Participants will receive guidance on adopting a healthy diet that promotes weight loss and improves blood glucose control. This may include recommendations for portion control, carbohydrate management, and making healthier food choices. 

• Physical Activity – The programme encourages participants to increase their physical activity levels through regular exercise. This may involve setting achievable goals for exercise frequency, duration, and intensity, as well as incorporating activities they enjoy into their daily routine. 

• Support – Participants receive ongoing support from healthcare professionals, including nurses, dietitians, and exercise specialists, to help them stay motivated and accountable throughout the programme. This may include regular check-ins, group sessions, or individual counselling sessions. 

• Monitoring and Evaluation – Participants’ progress is monitored regularly through blood tests to assess their blood glucose levels, weight loss, and other relevant health markers. This allows healthcare professionals to track their progress and make any necessary adjustments to their treatment plan. 

The NHS Path to Remission programme is designed to empower individuals with type 2 diabetes to take control of their health and make positive lifestyle changes that can potentially lead to remission of the condition.  

The programme is based on a very successful clinical trial known as The DiRECT trial (Diabetes Remission Clinical Trial). The DiRECT trial is a landmark study that investigated the effectiveness of a structured weight management program for achieving type 2 diabetes remission. The trial was conducted in the UK and involved individuals with type 2 diabetes who were overweight or obese. 

The trial tested the effects of rapid weight loss through a low-calorie diet. Participants were placed on a total diet replacement (TDR) plan consisting of specially formulated meal replacement shakes and soups, providing around 800 calories per day for 8-12 weeks. After the initial phase, food was gradually reintroduced over 2-8 weeks, followed by a weight maintenance phase. 

• Primary Outcome: The primary outcome of the DiRECT trial was diabetes remission, defined as achieving and maintaining blood glucose levels below the diabetic range (HbA1c < 48mmol/mol) without the need for diabetes medications for at least 6 months. 

• Results: The DiRECT trial demonstrated that the structured weight management programme led to significant weight loss and diabetes remission in a substantial proportion of participants. After 12 months, nearly half of the participants achieved diabetes remission, and many sustained it for up to 24 months. 

• Mechanisms: The rapid weight loss achieved through the low-calorie diet was believed to contribute to improvements in insulin sensitivity and beta-cell function, leading to normalisation of blood glucose levels and diabetes remission in some individuals. Additionally, weight loss has been associated with reductions in visceral fat, inflammation, and insulin resistance, all of which are important factors in the development and progression of type 2 diabetes. 

• Long-Term Follow-Up: The DiRECT trial included long-term follow-up to assess the durability of diabetes remission achieved through the weight management program. Preliminary findings suggested that many participants maintained remission for several years, highlighting the potential for sustained benefits with lifestyle interventions. 

Overall, the DiRECT trial provided robust scientific evidence supporting the effectiveness of structured weight management programs for achieving type 2 diabetes remission.  

When you complete the programme you will have gained a vast depth of knowledge in the fields of nutrition and understanding the right levels of physical activity to support your health. Not only that, you will have taken the time to understand what lifestyle factors influence your health, this can include stress, sleep and mental wellbeing.  

Following 12 months of 1:1 coaching support you will have everything you need to continue to improve your health long after the programme. At Xyla, we also provide you with an extended support package packed full of webinars from our expert clinicians. 

Some people don’t experience any side effects during the programme however, others will experience some at times. This is a summary of commonly reported side effects and suggested solutions. We find that most of these are easily managed. 

Your soups and shakes are free during the programme! Saving you money on your weekly shop and allowing you to focus on your health.

Yes, there are vegetarian and vegan options available as well as gluten free options.

The drinks you have in addition to TDR must be calorie free, which means no drinks containing sugar, no milk in tea or coffee and no alcohol.

We recommend that you maintain your existing activity levels whilst taking part in the TDR. It is important to listen to your body and only do what you are able to. You may find that there are some days when you are unable to be as active as you would like to be – especially in the beginning when you may be experiencing side effects. A lot of people report having “extra energy” once they have adapted to TDR. If you feel like this, do an activity that you feel that you are able to.

We recommend that you find a 12-week period that gives you the best chance of staying on TDR for the full 12 weeks without taking a break.

You can choose to participate digitally or 1:1. Xyla are your provider in the following areas:

• Bedfordshire, Luton and Milton Keynes
• Derbyshire
• Gloucestershire
• Kent & Medway
• Northamptonshire
• West Yorkshire
• Black Country
• Lincolnshire
• Hampshire and Isle of Wight

If you are outside these areas speak to your GP for information on your local provider.

With Xyla you will always be speaking to a qualified health coach who is an expert in the Type 2 Diabetes Pathway to Remission programme. Your coach will support you on your journey by answering any questions you have and coaching you through the 12 months. They are there to support you in any challenges you face and celebrate your successes at this exciting time.

You can find out more on our website.

You can also book onto a patient information session by clicking the link below.

A coach will take you through an in depth overview of the programme and explain how to get started. Click the link below now to get started.

https://bit.ly/t2dr-info