Type 2 Diabetes

The body stops responding well to insulin, so sugar builds up in the blood. It’s often silent for years but can damage the eyes, kidneys, nerves, feet and heart. More than 800 million adults worldwide have diabetes. Treated well, those risks fall, and some people put it into remission.

Symptoms

• Often none at all, which is why testing matters.
• Feeling thirsty, passing more urine and feeling tired.
• Wounds that heal slowly and infections that keep coming back, such as thrush or skin infections.
• Tingling or numb feet can be a sign that sugar has been high for a while.

Causes and risk factors

• The body becomes resistant to insulin and the pancreas can’t keep up.
• Family history and getting older.
• Carrying extra weight, especially around the waist, and not moving much.
• Prediabetes, diabetes in a past pregnancy, or polycystic ovary syndrome (PCOS).
• Higher rates in some communities, including Aboriginal and Torres Strait Islander, Pacific Islander and South Asian people.

How it’s diagnosed

• A blood test: HbA1c (your 3-month sugar average) of 6.5% (48 mmol/mol) or more, a fasting glucose of 7.0 mmol/L or more, or a random glucose of 11.1 mmol/L or more.
• Without symptoms, two abnormal results on different days are needed.
• Borderline results may need a glucose tolerance test (a sugary drink, then blood tests over 2 hours).
• Once diagnosed, you’ll also have checks of kidneys, eyes, feet, blood pressure and cholesterol.

The type 2 diabetes ladder

Lifestyle is the foundation at every step, not a step you graduate from. Medicines are added when sugar stays high or to protect the heart and kidneys. Needing more of them over time is common and isn’t a failure.

1. Step 1 · Self-careLose weight, eat well, move moreRegular activity, fewer sugary drinks and refined carbs, and weight loss if you’re above a healthy weight. A structured, supervised low-calorie program works best.

   Works

   In the DiRECT trial, 46% were in remission at 1 year on a supervised soups-and-shakes program (vs 4% with usual care), and 86% of those who lost 15 kg or more

   Cost

   Free to a program fee; dietitian visits rebated with a GP care plan

   How long

   Ongoing. Remission lasts as long as the weight stays off

   Watch for

   Very low-calorie diets need medical supervision if you take diabetes or blood pressure medicines; medicines often need reducing or stopping when the diet starts.

   Remission isn’t a cure. It’s a lease you renew by keeping the weight off.

2. Step 2 · PrescriptionMetforminThe usual first tablet, taken with meals.

   Works

   Lowers HbA1c by about 1%. In overweight people in the UKPDS trial, it cut deaths by about a third over 10 years

   Cost

   Under the $25 PBS co-payment, about $22–23 a script; $7.70 concession

   How long

   Usually long term

   Watch for

   Nausea and diarrhoea (start low, take with food, or try slow-release). Low vitamin B12 over years. Pause it on sick days when you can’t keep fluids down.

   Cheap, old and still first choice. The reliable used car of diabetes medicines.

3. Step 3 · PrescriptionSGLT2 inhibitors (empagliflozin, dapagliflozin)Tablets that make the kidneys flush extra sugar out in the urine. Often chosen early for people with heart disease, heart failure or kidney disease.

   Works

   Modest sugar lowering. In big trials, about a fifth to a quarter fewer heart failure hospital stays or heart deaths, and kidney decline cut by about 30–40%

   Cost

   On the PBS for type 2 diabetes (criteria apply)

   How long

   Long term

   Watch for

   Genital thrush, urine infections, dehydration. Rarely ketoacidosis, even with normal sugar levels: pause on sick days and before surgery as advised.

   Weeing out sugar sounds like a cheat code. The fine print is good hygiene and a sick-day plan.

4. Step 4 · PrescriptionGLP-1 medicines (semaglutide, dulaglutide and others)Mostly weekly injections that copy a gut hormone, lowering sugar and appetite.

   Works

   HbA1c down by roughly 1 to 2 points, usually with weight loss. Some also lower the chance of heart attack and stroke

   Cost

   Some are on the PBS for type 2 diabetes (criteria apply)

   How long

   Long term; benefits fade after stopping

   Watch for

   Nausea, vomiting, constipation, reflux, gallstones. Doses are stepped up slowly.

   Not cheating. A hormone that turns down the food noise.

5. Step 5 · PrescriptionInsulinInjections when other medicines aren’t enough, during illness or pregnancy, or when sugars are very high.

   Works

   Lowers blood sugar as far as needed; there’s no ceiling on the dose

   Cost

   $25 per script on the PBS ($7.70 concession); pen needles and supplies subsidised through the NDSS

   How long

   Often long term

   Watch for

   Hypos (low sugar): shaky, sweaty, confused. Carry fast sugar. Some weight gain.

   Type 2 diabetes often progresses. Needing insulin is biology, not a report card.

6. Step 6 · SpecialistEndocrinologist and the diabetes teamDiabetes educator, dietitian, podiatrist and eye checks are part of routine care; an endocrinologist helps when targets are hard to reach.

   Works

   No trials of referral itself; team care helps get hard-to-control sugar to target and spots complications early

   Cost

   Medicare rebates for some allied health visits with a GP care plan; specialist fees vary

   How long

   As needed

   Watch for

   Bring your sugar readings, medicines and recent blood tests.

   It takes a village to raise a normal HbA1c.

Costs are rough Australian prices in November 2026 and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.

Save your money

Popular, heavily marketed or often asked about, but the evidence is weak or says no.

• Cinnamon capsulesA Cochrane review found cinnamon didn’t lower HbA1c more than a dummy treatment. Lovely on porridge, useless as medicine.
• Supplements or programs promising to “reverse” diabetesNo supplement has been shown to put diabetes into remission. Weight loss can; capsules can’t.
• Cutting out all fruitWhole fruit in normal amounts fits a diabetes diet. Juice, soft drink and sweets are the bigger problem.

What you can do

• Register with the NDSS: it’s free and gives subsidised supplies, education and support.
• Keep up the yearly checks: HbA1c every 6–12 months, kidneys and cholesterol yearly, blood pressure every 6 months, eyes at least every 2 years, feet at least yearly.
• Look at your feet every day for cuts, blisters or colour changes.
• Have a written sick-day plan, especially if you take metformin, an SGLT2 inhibitor or insulin.
• Know your cholesterol and blood pressure: treating them protects your heart as much as sugar control does.
• If you smoke, quitting is one of the biggest wins for your heart and feet.

See your GP if

• You have thirst, frequent urination, tiredness or repeated infections
• Your sugar readings or HbA1c are creeping up
• New tingling, numbness or pain in your feet, or a change in vision
• Side effects from your medicines, or you’re having hypos

Get urgent help (call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries) if you’re very drowsy or confused, breathing fast, or vomiting and can’t keep fluids down, especially with high sugar readings. On an SGLT2 inhibitor, nausea, tummy pain and feeling very unwell can mean ketoacidosis even when sugar looks normal. Call 000 for a hypo that isn’t improving with fast sugar, or anyone who is unconscious.

See a doctor the same day for a foot wound that’s red, hot, swollen, smelly or turning dark.

Helpful resources

• NDSS registrationFree, lifelong registration for subsidised diabetes supplies, a helpline, education and programs. Your GP or diabetes educator signs you up. Australia.
• KeepSightFree eye-check reminder program for people with diabetes, run with Diabetes Australia. Australia.

Evidence and more information

• Diabetes Victoria: Diagnosis of diabetes
• Diabetes annual cycle of care (South Western Sydney PHN)
• Lancet (2017): DiRECT remission trial (summary)
• UKPDS 34: Metformin in overweight people with type 2 diabetes (The Lancet, 1998)
• DAPA-HF trial: Dapagliflozin in heart failure (NEJM)
• EMPA-KIDNEY trial (NEJM)
• SELECT trial: Semaglutide and heart outcomes (NEJM)
• Cochrane: Cinnamon for diabetes
• Lancet/WHO (2024): Global diabetes numbers (summary)

Reviewed 1 November 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

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