Type 2 diabetes self-care is the foundation of effective long-term management, encompassing daily decisions about diet, physical activity, medication adherence, and blood glucose monitoring. Successful self-management reduces the risk of serious complications including cardiovascular disease, kidney damage, and nerve problems. NICE guidelines emphasise individualised care plans developed collaboratively with healthcare professionals, supported by structured education programmes such as DESMOND. Whilst managing type 2 diabetes requires consistent effort, understanding the rationale behind recommended behaviours empowers individuals to make informed choices that support metabolic health. This comprehensive guide explores evidence-based self-care strategies to help you achieve optimal glycaemic control and improve quality of life.

Understanding Type 2 Diabetes Self-Care

Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance and relative insulin deficiency, resulting in elevated blood glucose levels. Effective self-care is fundamental to managing this condition and preventing both acute complications and long-term microvascular and macrovascular damage. Self-care encompasses a comprehensive approach that integrates lifestyle modifications, medication adherence, regular monitoring, and proactive engagement with healthcare services.

The cornerstone of type 2 diabetes management extends beyond simply taking prescribed medications. Self-care involves daily decisions about diet, physical activity, stress management, and blood glucose monitoring that collectively influence glycaemic control and overall health outcomes. Evidence demonstrates that individuals who actively engage in structured self-care behaviours achieve better HbA1c levels, experience fewer diabetes-related complications, and report improved quality of life.

NICE guidelines (NG28) emphasise the importance of individualised care plans developed collaboratively between patients and healthcare professionals. These plans should reflect personal circumstances, cultural preferences, comorbidities, and individual treatment goals. Effective self-care requires adequate education, ongoing support, and access to appropriate resources. NICE recommends that all adults with type 2 diabetes should be offered structured education at or around the time of diagnosis. Many NHS trusts offer evidence-based programmes such as DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) or X-PERT, which provide practical skills and information to support self-management.

Successful diabetes self-care is not about perfection but rather about making consistent, informed choices that support metabolic health. Understanding the rationale behind recommended behaviours—such as how dietary choices affect blood glucose or why physical activity improves insulin sensitivity—empowers individuals to take ownership of their condition and make sustainable lifestyle changes that reduce the risk of complications including cardiovascular disease, nephropathy, retinopathy, and neuropathy.

Daily Blood Sugar Monitoring and Target Levels

Blood glucose monitoring provides essential feedback about how food, activity, stress, and medications affect glycaemic control. For individuals with type 2 diabetes, the frequency and timing of monitoring should be tailored to treatment regimen, degree of glycaemic control, and individual circumstances. NICE does not recommend routine self-monitoring of blood glucose (SMBG) for adults with type 2 diabetes unless they are on insulin therapy, taking oral medications that increase hypoglycaemia risk (such as sulfonylureas), experiencing hypoglycaemic episodes, during periods of acute illness, or when assessing changes to medication or lifestyle.

NICE recommends that target blood glucose levels for most adults with type 2 diabetes should be:

• Fasting plasma glucose: 5–7 mmol/L upon waking

• Pre-meal glucose: 4–7 mmol/L before meals

• Post-meal glucose: less than 8.5 mmol/L (around 2 hours after eating)

• HbA1c target: 48 mmol/mol (6.5%) for adults managed by lifestyle and diet alone or with a single drug not associated with hypoglycaemia; 53 mmol/mol (7.0%) for adults on medications associated with hypoglycaemia (such as insulin or sulfonylureas)

These targets should be individualised based on factors including age, frailty, comorbidities, life expectancy, and risk of hypoglycaemia. It is important to discuss personalised targets with your diabetes care team, as overly stringent control may increase hypoglycaemia risk without proportionate benefit in certain populations, particularly older adults or those with significant comorbidities.

Modern monitoring options include traditional capillary blood glucose meters and, for eligible individuals, flash glucose monitoring (FGM) or continuous glucose monitoring (CGM) systems. NICE recommends offering real-time continuous glucose monitoring (rtCGM) or intermittently scanned continuous glucose monitoring (isCGM, also known as flash) to adults with type 2 diabetes on multiple daily insulin injections if they meet specific criteria, including having problematic hypoglycaemia or being unable to self-monitor by capillary blood glucose testing. These technologies provide real-time glucose data and trend information, helping identify patterns and inform treatment adjustments. Maintaining a monitoring diary—whether paper-based or digital—enables meaningful discussions during diabetes reviews.

Recognising patterns in blood glucose readings is crucial. Consistently elevated readings may indicate the need for medication adjustment or lifestyle modification, whilst frequent hypoglycaemic episodes (below 4 mmol/L) require urgent review with your healthcare team to prevent dangerous complications. During periods of illness, blood glucose monitoring becomes particularly important, and those on SGLT2 inhibitors should also check blood or urine ketones if unwell, as advised by their healthcare team.

Healthy Eating and Meal Planning for Type 2 Diabetes

Nutritional management is a fundamental pillar of type 2 diabetes self-care, directly influencing glycaemic control, weight management, and cardiovascular risk. There is no single 'diabetic diet'; rather, NICE advocates for individualised dietary approaches that consider cultural preferences, lifestyle, and metabolic goals. The emphasis is on sustainable, balanced eating patterns rather than restrictive diets that prove difficult to maintain long-term.

Key dietary principles for type 2 diabetes include:

• Carbohydrate awareness: Understanding that carbohydrates have the most significant impact on blood glucose. Choose complex carbohydrates with a lower glycaemic index (wholegrains, pulses, vegetables) over refined options

• Portion control: Managing serving sizes to support weight management and prevent post-meal glucose spikes

• Fibre intake: Aiming for at least 30g daily from vegetables, fruits, wholegrains, and legumes to improve glycaemic control and cardiovascular health

• Healthy fats: Prioritising unsaturated fats (olive oil, nuts, oily fish) whilst limiting saturated fat intake

• Regular meal timing: Spacing meals consistently throughout the day to avoid large glucose fluctuations

The Mediterranean dietary pattern has robust evidence supporting its benefits in type 2 diabetes, emphasising vegetables, fruits, wholegrains, legumes, nuts, olive oil, and moderate fish consumption. The NHS Eatwell Guide provides a visual representation of balanced eating suitable for most people with diabetes. Some individuals may benefit from low-carbohydrate approaches, though these should be undertaken with healthcare professional guidance, particularly for those on glucose-lowering medications such as insulin or sulfonylureas, as medication doses may need adjustment to prevent hypoglycaemia.

Weight management is particularly important, as even modest weight loss (5–10% of body weight) can significantly improve insulin sensitivity and glycaemic control. For individuals with obesity and recent-onset type 2 diabetes, intensive weight management programmes using low-energy total diet replacement approaches may support remission of diabetes. The NHS Type 2 Diabetes Path to Remission Programme offers structured support for eligible individuals. For those with more complex needs, referral to specialist weight management services or registered dietitians may be appropriate.

Practical meal planning strategies include preparing meals in advance, reading food labels to understand carbohydrate content, and using the 'plate method'—filling half your plate with non-starchy vegetables, one-quarter with lean protein, and one-quarter with complex carbohydrates. NHS-approved resources and registered dietitians can provide personalised guidance tailored to individual needs and preferences.

Physical Activity and Exercise Recommendations

Regular physical activity is a cornerstone intervention in type 2 diabetes management, offering multiple metabolic benefits including improved insulin sensitivity, enhanced glycaemic control, cardiovascular risk reduction, and weight management. Exercise facilitates glucose uptake by skeletal muscle through insulin-independent mechanisms, providing immediate and sustained improvements in blood glucose regulation.

NICE and the UK Chief Medical Officers' Physical Activity Guidelines recommend that adults with type 2 diabetes should aim for:

• At least 150 minutes of moderate-intensity aerobic activity per week (such as brisk walking, cycling, swimming), spread across several days, or 75 minutes of vigorous-intensity activity

• Resistance training on two or more days per week, targeting major muscle groups to improve insulin sensitivity and maintain muscle mass

• Reducing sedentary time by breaking up prolonged sitting with brief activity every 30 minutes

Moderate-intensity activity means exercising at a level where you can talk but not sing comfortably, with noticeable increases in heart rate and breathing. For those new to exercise or with complications, starting gradually with shorter durations and lower intensity is advisable, progressively increasing as fitness improves.

Before commencing a new exercise programme, particularly if you have existing cardiovascular disease, neuropathy, or retinopathy, consult your healthcare team for personalised advice. Certain complications may require activity modifications—for example, individuals with proliferative retinopathy should avoid high-impact activities that increase intraocular pressure, and those with active foot ulceration or severe peripheral neuropathy should avoid weight-bearing or high-impact exercise until reviewed by a specialist.

Safety considerations for exercise include:

• Monitoring blood glucose before, during (for prolonged activity), and after exercise

• Carrying fast-acting carbohydrates to treat hypoglycaemia if taking insulin or sulfonylureas

• Staying well-hydrated

• Wearing appropriate, well-fitting footwear and checking feet regularly for injuries

• Adjusting medication or carbohydrate intake as advised by your diabetes team

Incorporating enjoyable activities increases adherence—whether walking, dancing, gardening, or group exercise classes. Many local authorities and NHS trusts offer exercise referral schemes or diabetes-specific activity programmes that provide structured support and professional guidance.

Medication Management and Adherence

Pharmacological therapy forms an integral component of type 2 diabetes management when lifestyle modifications alone do not achieve adequate glycaemic control. Metformin remains the first-line medication for most individuals, working primarily by reducing hepatic glucose production and improving peripheral insulin sensitivity. It is generally well-tolerated, though gastrointestinal side effects (nausea, diarrhoea) are common initially and can be minimised by gradual dose titration and taking medication with food. Modified-release formulations may improve tolerability.

Important safety considerations for metformin include monitoring renal function before starting and at least annually, as dose adjustment or discontinuation is required in moderate to severe renal impairment. Long-term metformin use is associated with reduced vitamin B12 levels; the MHRA advises monitoring B12 annually in those with risk factors for deficiency (such as anaemia or neuropathy). Metformin carries a rare risk of lactic acidosis, particularly in the context of acute kidney injury or severe dehydration, and should be temporarily stopped during intercurrent illness that may cause dehydration or renal impairment (see sick-day rules below).

When metformin monotherapy proves insufficient, NICE recommends individualised treatment intensification based on factors including HbA1c levels, cardiovascular risk, heart failure, chronic kidney disease, renal function, and patient preferences. Second-line options include:

• SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin): reduce glucose reabsorption in kidneys; offer cardiovascular and renal protection. NICE recommends SGLT2 inhibitors as preferred options for adults with type 2 diabetes and established cardiovascular disease, chronic heart failure, or chronic kidney disease. Important safety warnings include risk of diabetic ketoacidosis (including atypical euglycaemic DKA), genital and urinary tract infections, and very rarely Fournier's gangrene (necrotising fasciitis of the perineum). SGLT2 inhibitors should be temporarily stopped during periods of acute illness, dehydration, or before major surgery.

• DPP-4 inhibitors (e.g., sitagliptin, linagliptin): enhance incretin activity; weight-neutral with low hypoglycaemia risk

• GLP-1 receptor agonists (e.g., semaglutide, dulaglutide): injectable medications that enhance insulin secretion, suppress glucagon, and promote weight loss. NICE recommends GLP-1 receptor agonists as preferred options for adults with type 2 diabetes and established cardiovascular disease or those who would benefit from weight loss. Common side effects include nausea, vomiting, and diarrhoea, which often improve over time. Rare but serious risks include pancreatitis and gallbladder disease.

• Sulfonylureas (e.g., gliclazide): stimulate insulin release; associated with risk of hypoglycaemia and weight gain

• Insulin therapy: reserved for inadequate control with other agents or specific clinical situations

Medication adherence is crucial for achieving treatment goals. Non-adherence—whether intentional or unintentional—is common and multifactorial, relating to factors such as complex regimens, side effects, polypharmacy, or lack of understanding about medication purpose. In England, most people with diabetes are exempt from prescription charges. Strategies to improve adherence include:

• Using pill organisers or smartphone reminders

• Linking medication-taking to daily routines

• Understanding each medication's purpose and expected benefits

• Discussing concerns or side effects promptly with healthcare professionals

• Utilising pharmacy support services, including medication reviews

Regular medication reviews with your GP or diabetes specialist nurse ensure that your treatment regimen remains appropriate as your condition evolves. Never discontinue or adjust diabetes medications without professional guidance, as this may result in dangerous hyperglycaemia or diabetic emergencies. If you experience problematic side effects, contact your healthcare team to discuss alternative options rather than simply stopping treatment. Suspected side effects or adverse reactions to any medication should be reported via the MHRA Yellow Card scheme, available online or through your healthcare professional.

Sick-Day Rules and When to Seek Medical Advice

Whilst effective self-care enables individuals to manage type 2 diabetes successfully on a daily basis, certain situations require prompt medical attention. Understanding when to seek professional support and how to manage illness is essential for preventing complications and ensuring optimal outcomes.

Sick-day rules are important guidance for managing diabetes during intercurrent illness, such as infections, vomiting, or diarrhoea. During illness, blood glucose levels often rise even if you are eating less, and there is increased risk of dehydration and acute kidney injury. Key sick-day principles include:

• Continue taking insulin and most diabetes medications

• Monitor blood glucose more frequently (at least four times daily)

• Check blood or urine ketones if you are on an SGLT2 inhibitor or if blood glucose is persistently above 15 mmol/L

• Stay well-hydrated with sugar-free fluids

• Temporarily stop certain medications that may worsen dehydration or kidney function during acute illness (often remembered as 'SADMAN': SGLT2 inhibitors, ACE inhibitors/ARBs, Diuretics, Metformin, NSAIDs). Restart these once you are eating and drinking normally and are no longer acutely unwell. Discuss your individual sick-day plan with your diabetes team.

Routine diabetes care typically involves annual reviews with your GP or practice nurse, including HbA1c monitoring, blood pressure checks, lipid profiles, renal function tests, foot examinations, and retinal screening. Annual influenza vaccination, pneumococcal vaccination (as per schedule), and COVID-19 boosters are recommended for all people with diabetes to reduce complication risk.

Contact your GP or diabetes care team within a few days if you experience:

• Persistently elevated blood glucose readings (consistently above 15 mmol/L) despite medication adherence

• Unexplained weight loss

• Recurrent infections, particularly urinary or skin infections

• New or worsening symptoms such as increased thirst, frequent urination, or fatigue

• Concerns about medication side effects

• Difficulty achieving target blood glucose levels

Seek same-day medical attention (urgent GP appointment, NHS 111, or emergency multidisciplinary foot service) for:

• Diabetic foot problems including new ulceration, breaks in the skin, swelling, discolouration, warmth, or signs of infection. NICE guidance (NG19) recommends same-day assessment by a multidisciplinary foot care service for suspected diabetic foot infection, acute Charcot arthropathy, or an ulcer with fever or any signs of sepsis.

• Symptoms of diabetic ketoacidosis (though less common in type 2 diabetes): excessive thirst, frequent urination, nausea, vomiting, abdominal pain, fruity breath odour, confusion, or raised ketones

• Symptoms of hyperosmolar hyperglycaemic state (HHS): severe dehydration, extreme thirst, very high blood glucose (often above 30 mmol/L), drowsiness, confusion, or disorientation

• Severe hypoglycaemia that does not respond to treatment or recurs frequently

• Signs of infection with poor glycaemic control or raised ketones

• Chest pain or suspected cardiovascular events

Call 999 or attend A&E immediately if experiencing:

• Loss of consciousness or severe confusion

• Seizures

• Symptoms of stroke (FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 999)

• Severe chest pain suggesting myocardial infarction

Driving and DVLA considerations: If you are treated with insulin or experience problematic hypoglycaemia (including severe episodes or impaired awareness of hypoglycaemia), you must inform the DVLA and your car insurer. Specific rules apply to different licence types; consult DVLA guidance or discuss with your diabetes team.

NHS support services for diabetes self-care include structured education programmes, diabetes specialist nurses, dietitians, podiatrists, and psychological support services. Many areas offer community diabetes services providing enhanced support for complex cases. The NHS Diabetes Prevention Programme is available for those at high risk of developing type 2 diabetes. Additionally, organisations such as Diabetes UK provide valuable resources, peer support groups, and helplines. Proactive engagement with these services, combined with consistent self-care practices, optimises long-term health outcomes and quality of life for individuals living with type 2 diabetes.

Frequently Asked Questions