Type 2 diabetes

Diabetes mellitus typus 2 · Diabetes 2. typu

What it is

Cells stop listening to insulin and the pancreas eventually can't shout loud enough.

call 112 / 911 now Very drowsy, confused or unconscious, with high or very low sugar
call 112 / 911 now Very thirsty, passing lots of urine and vomiting
see a doctor soon A foot wound, blister or colour change that isn't healing
see a doctor soon Sudden change in vision

Metformin first — cheap, with decades of safety data trials support
SGLT2 inhibitors and GLP-1 agonists — fewer heart and kidney events, at a price, and the trials are run by the makers trials support
Insulin when the pancreas gives out trials support
Statin and ACE inhibitor, weighed on your own risk mixed evidence
Yearly eye, foot and kidney checks — cheap and they catch damage early trials support
Tirzepatide — approved (FDA, EMA 2022) trials support

Weight loss of 10–15 kg can put it into remission — about half of DiRECT participants at a year
low-carbohydrate or Mediterranean diet
150 min exercise + resistance training
sleep repair
fibre
walking after meals

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

Berberine — trials lower HbA1c about as much as metformin; it interacts with many drugs mixed evidence
Low-carbohydrate and ketogenic diets — trials show lower HbA1c and fewer drugs needed; long-term data are limited mixed evidence
Intermittent fasting — small trials, remission in some early / small studies
Cinnamon — meta-analyses show small falls in fasting glucose; effect on HbA1c unclear mixed evidence
Bitter melon, fenugreek, gymnema — small trials, small effects early / small studies
Apple cider vinegar — tiny glucose effects in small studies anecdotal / traditional