I have type 2 and am shielding at home, what is the best way to lose weight?

A. There are many  diets  you might have heard of or ways of losing weight. It can often be confusing with the wealth of information on diets and weight loss. Choosing the right pathway will depend on what suits your lifestyle and the support offered.   

To maximise your chances of losing weight it’s important to be clear about your goals, and why you want to achieve the weight loss. Being clear about your motivation for losing weight (e.g. reducing risk of complications, reducing pain, improving mood) can really help maintain the change. Our SMART goals sheet helps with this.  

Next, having a structured dietary plan and exercise routine along with regular monitoring of weight and blood glucose levels will help. Losing weight successfully requires a structured outline on a dietary plan and moving more strategy along with regular monitoring of weight and blood glucose levels.  

Our website can update you on weight loss programme that has shown evidence of losing weight, achieving remission of type 2 Diabetes, and while showing evidence of reducing medication. This page might be of help which diet is right for you.

There’s also a section which provides free tools, including menu plans.  

We are about to launch some email support programmes through the Know Diabetes service to help North West London residents lose weight effectively. 

Finally, we’re relaunching the North West London REWIND programme (which was put on pause during COVID), an exciting new weight loss programme for people with Type 2 Diabetes. This is based around an 800KCal total diet replacement approach, which is achieving fantastic results. Check in with your GP to see whether you are eligible.

I have heard in the news about low vitamin D levels and Covid19, I’m a bit worried mine might be low as I’ve been indoors, what should I do?

A. With more people staying indoors during the pandemic, some people may have been deprived of vitamin D. Normally, we get vitamin D from the sun by spending time outside. Our skin makes it when exposed to the sun. 

Due to current measures, many of us may be going outside less often or may be in self-isolation. To ensure a healthy vitamin D status, all adults should consider taking a daily supplement containing 10 micrograms of Vitamin D. 

Vitamin D can also be found in a small number of foods. These include oily fish – such as salmon, sardines, herring and mackerel; red meat/liver/egg yolks and fortified foods – such as most fat spreads and some breakfast cereals. 

For more information on Vitamin D read here.

On the basis of which factors are people with diabetes considered as high-risk patients for coronavirus? For example, is there a risk difference between type-1 and type-2 diabetic people, apart from the fact that type-2 patients are about 10 times more numerous? I've read that only 10% of diabetic patients with complications from coronavirus are type-1, but this seems to be just reflecting the fact that type-1 patients are less common)? Is the higher risk coming from the status of the immunity system in diabetic people or from the consequences that diabetes has on the patient - and so on how good/bad diabetes is treated (or both)? And how is this higher risk dependent on the fact that other clinical conditions (related or not to diabetes) might be present in the patient?

A. Thank you for your query. As you can probably imagine, there’s been a huge amount of research about this over the last two months. 

The best data about this are found in two papers published by UK groups. In both studies they’ve tried to look at each risk factor independent of the others. 

The first was the openSAFELY study which looked at the records of over 17 million UK patients.

The best way to understand this is to go straight to figure 3 on page 11, which tries to show graphically the key risks for different clinical factors. You’ll see a bunch of risk factors listed down the left, with some horizontal lines, large central dots and small vertical lines which look a bit like TIE fighters from Star Wars. If the TIE fighter is further to the right, the risk is greater (the scale at the bottom shows how much bigger). For example, being 80+ puts you at more than ten times the risk of someone aged 50-59. You’ll see that diabetes, not broken down type, puts you at higher risk, as does being male, or from a BAME background. 

The second study, which looked specifically at diabetes patients, and was analysed by the NHS England Diabetes Team, is found in two papers here and here.

This study analyses more closely the risks in people with diabetes, and includes the difference between people with Type 1 and Type 2 diabetes. If you look at the figure 3 on page 22 of paper 1, you’ll see that they showed a higher risk for people with Type 1 vs Type 2. They don’t come up with any clear ideas as to why there is this difference. Overall, however, because people with Type 1 are generally younger, the risk is somewhat lower.   

Note also that the openSAFELY study and the NHS England study show the importance of achieving ideal weight and HbA1c values (which also means not too low). 

If you’re keen for some more scientific background as to why diabetes might cause more problems for people that develop COVID, the answer is likely to be explained by a number of factors including reduced immunity but also by what we call a Cytokine storm. This is explained in some detail in an article in the Nature magazine here.

When is the best time of the day to test blood sugar levels? Before or after food ...or on an empty stomach/morning?

A. Thanks for your query, 

Generally speaking the best time to check your blood glucose is first thing in the morning  before breakfast and also pre meals. 

However this will depend on factors such as your type of diabetes, whether you inject insulin or are taking tablets or non- insulin injectables and what you are working towards. 

When you test your blood sugar will be determined by what you are trying to  achieve and it's a good idea to discuss this with your diabetes care provider. 

If you are focusing on getting your fasting or early morning blood sugar ‘ to target’ you will probably be checking first thing in the morning before breakfast. 

Having a blood sugar that is ‘in target’ (between 4-7) first thing in the morning is important because it indicates that  overnight blood sugar has also been ‘in target’. 

Having blood sugar ‘within target’ overnight, generally makes it easier to stay on target for the rest of the day. 

Also as this is a prolonged period of time it is important that blood sugar is not elevated. 

For some people with Type 1 diabetes or with any type of diabetes in pregnancy you may be checking blood sugar both pre and post meals.

The key message is that the frequency and timing of your blood sugar tests will depend on what you are setting out to achieve, with the support of your diabetes care provider. Click here for more information about checking your blood sugar levels.

If the person has a low blood glucose overnight (hypoglycaemia), it can cause the body to react by increasing glucagon (a blood glucose increasing hormone). 

This forces the liver to push out glucose in response to the low blood glucose and you can wake up with a higher blood glucose than when you went to sleep. 

If this is happening to you it is important to speak to your diabetes care provider as soon as possible for support.

You may need to reduce or change the timing of your insulin.  You should discuss with your diabetes care provider the possible reasons you are having low blood glucose with a plan to reduce or stop them. 

There are many potential causes of overnight low blood glucose such as exercise, alcohol, weather, hormones etc.

 Can Diabetes cause skin rashes? I get itchy rashes on my forearms and thighs.

A. Thanks for your query, diabetes can affect different parts of your body.  If blood glucose is raised, people with diabetes may become dehydrated from fluid loss and this can affect your skin which can become dry, flaky and irritated. 

Dry itchy skin is more likely to become scratched or cracked and these areas can become irritated and infected.   

Speak to your GP if your skin is inflamed or has any blisters or any discharge. 

If your blood glucose is high and you have dry skin, the first thing is to get your blood glucose down. 

If you aren’t blood glucose testing, contact your GP practice and ask for a diabetes review. 

Have a look at the programmes and resources available to help you self-manage your diabetes.

See the following link for Diabetes UK information prescription, this will help you understand what your HbA1c should be.  This is your average blood glucose for the past 2-3 months.

Your GP should also check your thyroid function (this is a routine blood test) as part of a regular diabetes review, as well as kidney and liver function. 

Dry skin and hair is also a common symptom of an underactive thyroid which is more commonly seen in people with diabetes.

You could try moisturising the areas of dry skin, as long as the skin is not broken. 

If high blood glucose is left untreated, some people can have fungal infections of the skin, the mouth or genital area and they could experience recurrent cysts or abscesses. 

One final possibility is that the itchy skin could be a reaction to one of your medications, and this should be discussed with your GP practice. 

I am a heart patient. How can I be careful about my condition by not getting diabetes?

A. To prevent Type 2 Diabetes, there are two key messages to understand, particularly if you have prediabetes / non-diabetic hyperglycaemia (NDH). 

1) Lose weight if you are overweight or obese. Even losing as little as 5kg or around 11lbs will make a huge difference to your risk 

2) Minimise carbohydrates (including sweet things such as biscuits and cakes as well as starchy carbohydrates such as bread, pasta, rice and potatoes). 

The main risk factors for diabetes include age, diet, physical activity, family history, ethnicity. Obviously you can only change some of these (diet, weight, physical activity) and not others (age, ethnicity, family history). 

Many people who are overweight and have prediabetes (non-diabetic hyperglycaemia or NDH) are focusing on losing weight, which also improves blood glucose levels, blood pressure and reduces the risk of more severe disease. 

Check out the Know Diabetes pages about low carbohydrate meals and healthy eating, staying active and the Type 2 diabetes remission pages. Whilst the Type 2 remission pages and videos aren’t specifically aimed at those with prediabetes /NDH, the key information about weight loss, appetite and carbohydrates still hold true. 

Read more about diabetes prevention here. 

It is important for you to maintain good heart health, normal cholesterol and triglyceride levels by maintaining a healthy diet; to prevent diabetes. You can find more information here.

Diabetes can develop in people who are overweight or obese and in whom glucose metabolism is impaired - meaning their blood sugar levels rise because the insulin generated by their pancreas is not adequate to regulate blood sugar levels. Having diabetes puts you at a significantly greater risk of developing or worsening your heart disease due to the damage that sugar does to all the blood vessels in our body. So it is important to prevent diabetes. For more info on Type 2 diabetes please click here.

For information on diabetes and heart disease please click here, or have a look at the British Heart Foundation website.

Please continue discussing any concerns with your cardiologist or GP and monitor your health status regularly for good health, wellbeing and quality of life.

Please also visit our ‘Be Healthier’ section of our website for tips on making healthier lifestyle choices to prevent type 2 diabetes.

My Hb1ac reading is 4.8. Should I be considered pre-diabetic? And if yes what should I do to avoid taking tablets?

Thank you for your query. We think by that you mean an HbA1c of 48 mmol/mol rather than the older measurement of 4.8% (which is no longer commonly used, and is entirely normal). 

This page, and in particular the video should help explain the HbA1c test.

If your HbA1c reading is 48 (which we think is what you meant), then you are right on the edge of diabetes and prediabetes (we call it non-diabetic hyperglycaemia or NDH). 42-47 is NDH, 48 or above on two occasions is diagnostic for diabetes. 

Normally, if your HbA1c was 48, you would be asked to repeat the test – if the second value is below 48 then you don’t quite have diabetes but do have NDH. If the second value is 48 or above, then you have diabetes. Your doctor or nurse would normally explain this to you and you would be asked to come in for various other assessments (Diabetes UK call these the 15 healthcare essentials) and be referred for annual eye screening. 

It’s important if you have diabetes to be aware of your type – Type 1 (generally younger and needing insulin right from the start), Type 2 (generally a bit older though not always, more likely to be overweight or obese) or one of the rare types.

Whether you have Type 2 diabetes or NDH, the key is the same. Significant weight loss (ideally 5kg at least, 10-15kg if you can manage it), reduction in carbohydrate intake and getting more active will all help. We’ve put together a set of resources at Type 2 diabetes remission which will be relevant whether you have NDH or Type 2 diabetes. We'd recommend watching the videos on this page as a starter.

We’ve also put together a large number of resources on reducing carbs, as these have the biggest impact on your blood sugar, and many people have found that they are able to lose weight, feel less hungry, manage their Type 2 diabetes more effectively and reduce medication by changing to a low carb healthy fats (LCHF) diet. Jason Fund explains the body mechanisms behind reducing carbs really well here.

After seeing someone with diabetes contract coronavirus, his sugar level went very high and he went into a coma and died. I’m type 2 taking two types of medications - am I at risk if I go back to work? I’m so scared.

A. Thank you for sharing your feelings of anxiety and fear about coronavirus.  It may be some comfort to you to know that so many other people living with diabetes will share your exact concerns. We hope to respond to you and to others who share your anxiety as fully as possible. 

Knowing about a person with diabetes who became sick and subsequently sadly died of coronavirus will be really upsetting and worrying. It brings the reality of this virus really close to home, especially if we are also living with diabetes. 

Since coronavirus hit the UK in February this year, there have been an increasing number of scary headlines in the news. Many of these focus on how the virus seems to impact people with diabetes and it is easy to feel overwhelmed with anxiety. 

These feelings of anxiety will be increased at a time when many of us have had to observe social distancing or social isolation. We may not have the same level of social support and contact with family and friends to help us.

Here are some top tips: 

First of all, the advice for people with diabetes is still to stay at home as much as possible and minimise contact with people outside your household.  

Secondly, follow social distancing, wash hands frequently and continue to observe the 2 metre rule as much as possible. 

It is important to remember that having diabetes in itself doesn’t make you more at risk of catching coronavirus and we need to remember that the majority of people who do contract coronavirus have only mild symptoms and don’t need to go into hospital. 

However, the evidence that has been emerging is understandably causing great anxiety and indicates that if people with diabetes catch coronavirus, they have an increased risk of more severe illness. 

From the evidence so far it seems that people with COVID -19 and diabetes are more at risk of serious coronavirus disease if they have the following factors: 

• Older age
• Male gender
• BMI over 30 (this is your Body Mass Index and a BMI greater than 30 is a clinical definition of obesity)
• Some BAME groups
• High HbA1c (your HbA1c is a measure of your average blood glucose levels for the last 2-3 months)
• High blood pressure 
• Complications such as heart or kidney disease.

There is also evidence that as Vitamin D helps prevent respiratory infections, adults should consider taking a daily supplement containing 10 micrograms of Vitamin D. 

There is also evidence that some jobs are associated with a higher risk than others such as frontline staff and key workers and it will be difficult in these occupations to work from home.   

Other important research shows that people from some Black and Asian Minority Ethnic (BAME) groups are at increased risk of severe coronavirus disease than others and this is seen here and in USA. 

The reason for this is probably multi factorial meaning that there are a number of factors involved. We already know about the high rates of diabetes amongst some groups, Type 2 diabetes is 3 to 6 times more likely in people of South Asian and African-Caribbean or Black African descent and it seems that this is linked. 

Other factors thought to be involved are economic deprivation, geographic location, the jobs that people do and inequality in healthcare. 

Trying to understand the reasons or drivers for this is the subject of urgent national research and a government enquiry here in the UK. 

So, risk factors such as age, gender or where you live cannot be changed, or not easily! 

However, the good news is that people with diabetes can help to reduce their risk factors such as high blood glucose, high blood pressure and a high BMI and there is lots of support on the Know Diabetes website to help achieve this. 

Many people who are overweight and have type 2 diabetes or if they have pre-diabetes (non-diabetic hyperglycaemia) are focusing on losing weight which also improves their blood glucose levels,  their blood pressure and reduces the risk of more severe disease.

There is lots of helpful information about low carbohydrate meals and healthy eating, staying active and type 2 diabetes remission.

In many ways, with fewer other things to distract us, it’s never been easier to focus on improving your health. 

We've also provided information about what to do if you becmone unwell with COVID at home and your blood glucose becomes high. These are known as Sick Day Rules.

Some medications used for Type 2 diabetes should be stopped if you become unwell with coronavirus and these are Metformin and SGLT2 inhibitors such as Canagliflozin, Dapagliflozin or any tablet ending in ‘Gliflozin” 

For more specific advice for people with coronavirus and diabetes click here.

Going back to work when you have diabetes:

Your employer should do everything in their power to support you to work from home. However, working from home isn’t always possible especially if you are a front line or key worker. 

If this is the case then your employer has a duty of care to ensure that your workplace is safe for you to come into work and all employers should be doing a risk assessment at work.

However as this is all so new, the guidance is not yet clear enough and Diabetes UK are influencing the government to ensure that people with diabetes are protected and supported during the coronavirus pandemic: 

See the Diabetes UK campaign to keep people with diabetes safe at work.  They are asking for clearer advice, access to support and better protections for people with diabetes.

You can find another useful link about coronavirus and BAME groups here.

Your emotional wellbeing

We all can become anxious at times.  Find ways to help you manage feelings of anxiety or depression on the website including access to talking therapies, which you can find here on the Know Diabetes site.

I don’t like having breakfast but I do eat dinner every day, I try hard not to eat cake. Also, i drink a lot of milk what’s my daily intake limit, please?

A. Making small changes to our habits and behaviours can help us improve our health and well being as well as better manage our diabetes outcomes.

Some people with Type 2 diabetes have found that an intermittent fasting regime is really helpful to support weight loss and improve blood sugar. We do normally recommend having breakfast in order to maintain a healthy balanced diet and avoid fluctuations of blood glucose. Some quick and simple breakfast suggestions include fruit (ideally berries) and yoghurt or scrambled egg as these will raise your blood sugar less than cereal and toast. 

Have a look at our seven-day meal plan to get some meal inspirations.

People with diabetes have the same daily recommended amount of dairy food as the general population. Cow's milk or any other dairy foods are part of a healthy balanced diet. Dairy foods have carbohydrates in the form of lactose in milk. Lactose is a natural sugar that provides energy to the body. 

Aim for 3 portions of dairy foods daily. An adult portion size is:  

• 1 glass of milk (250mls) 
• A 150g pot of plain yogurt 
• A matchbox-size piece of cheese (30g)

Read more about Diet and Diabetes here- https://www.knowdiabetes.org.uk/be-healthier/ 

I take a blood sample once a week before breakfast and the result varies between 8.6 and 10.6.  Is this normal?

Thank you for contacting us. You don’t mention your type of diabetes. 

If you have type 2 diabetes and you are checking your fasting blood glucose (before breakfast), it should ideally be between 4-7mmol, although blood glucose too close to 4mmol may be too low (hypoglycaemia). 

Blood glucose that is regularly more than 7mmol in the morning is usually too high (you mention that yours varies between 8.6-10.6mmol before breakfast) although every person will have their individual blood glucose targets which will depend on a number of factors such as your age, type of diabetes and whether you have any other medical conditions). 

Why is fasting blood glucose important? 

Because if the day starts with raised blood glucose levels, it is probable that blood glucose levels will be high throughout the day and over time this can lead to a raised HbA1c  and long term diabetes complications of the heart, kidneys, eyes, nerves and the brain. 

Importantly: please do contact your GP practice and ask for a diabetes review which would include having an assessment of your HbA1C (your long term blood glucose) and a review of your diabetes medications or / insulin. 

See the helpful information below about blood glucose testing and targets for type 2 diabetes 

What’s my target range? 

I am female 85 can not exercise and need to lose weight at home, do you have a diet sheet? 

Thank you for your email.   

The Know Diabetes website has a wealth of information on healthy eating, portion control, carbohydrate awareness as well as weight loss options. Try our section on reducing carbohydrates, or if you have type 2 diabetes, our remission videos. 

The Know Diabetes Be healthier section will provide you with information on Low carb diets. High carbohydrate foods, including bread, potatoes, pasta and rice, can increase blood glucose and contribute to weight gain or prevent you from losing weight.  

Reducing your carbohydrate intake can assist with weight loss and improve your diabetes management. We have a 7 day low carb meal plan you can follow and try. 

You can  follow some simple recipes from our website  

https://www.knowdiabetes.org.uk/be-healthier/eat-better/#recipes.  

You could also join the Diabetes UK online forum where people share recipes and advice on healthy cooking.  

https://www.diabetes.org.uk/how_we_help/community/diabetes-support-forum 

My only problem since I have been diagnosed with diabetes is my nail toe. I have a terrible fungus that I really, really want to get rid of. Maybe I am very lucky I don’t have any symptoms yet. But my problem is my feet. Is there any solution to take out that horrible nail? 

Please contact your GP to discuss treatment options for your fungal nail infection,  

As you will know it's really important to look after your feet if you have diabetes.   

There is lots of information and advice and helpful videos about how to look after your feet on our website:

https://www.knowdiabetes.org.uk/know-more/feet-heart-eyes-and-kidneys/footcare/ 

It's also important to wear shoes that fit well and don't squeeze or rub, to prevent problems with corns, calluses, ulcers and nail problems.

I am having a problem with my diagnosis as either pre diabetic or type 2 diabetic.  I have my health in control, and in February I bought the machine and I am in normal sugar level range. However, my GP told me I am diabetic and they've not called me to tell me what happens next. I can’t understand because I had my control since February 2020.

It sounds like you have had prediabetes (or non-diabetic hyperglycaemia as we call it) and have now been told that you have type 2 diabetes. 

From what we understand, you are testing your blood glucose at home and it’s been fine but you had a blood test at your GP and the blood glucose level there was high. GPs normally test the HbA1c level, which is a more reliable measure as it looks at the average blood sugars over a 3 month period. We would suggest that you ask your GP to tell you about your HbA1c value. 

There are lots of reasons it may have gone up over the last few months. COVID lockdown has meant that many people have been less active than before or there may be dietary changes. 

Whatever the reason, losing weight would have a dramatic effect on your disease and would be likely to support you to get into remission. For most people, about  10-15kg is enough to reverse your diabetes.  

Our remission videos help explain how this is possible. 

In addition to reversing your diabetes, losing this weight would reduce your risk of cancer, arthritis and heart disease as well as increasing your energy and wellbeing.