Diabetes & Metabolic HealthLong-term condition

Type 2 Diabetes

Also called: T2D, type II diabetes, diabetes mellitus type 2, adult-onset diabetes

A long-term condition where blood sugar runs high because the body stops responding well to insulin. Usually managed with lifestyle changes and medication over many years.

Quick answer

What it is: A long-term condition in which the body becomes resistant to insulin and often stops making enough of it, so glucose builds up in the blood instead of moving into cells.
Common symptoms: Often none in the early years. When symptoms do appear they can include increased thirst, needing to urinate more often, tiredness, blurred vision and cuts that heal slowly.
How it's treated: Lifestyle changes plus medication. Metformin is usually the first medication in Canada, with others added over time depending on blood sugar, weight, heart and kidney health.
Who can help: Diagnosis and ongoing targets come from a physician or nurse practitioner. Pharmacists support the medication side — reviewing your regimen, managing side effects and checking coverage.
Warning signs: Very high blood sugar with vomiting, abdominal pain or rapid breathing, or severe low blood sugar with confusion or unresponsiveness, both need emergency care.

Managing this long term? Pill4Me pharmacists in Chilliwack can help.

Book a medication review

What is type 2 diabetes?

In type 2 diabetes, the body's cells stop responding properly to insulin — the hormone that moves glucose out of the bloodstream and into cells for energy. The pancreas compensates by producing more insulin, and over time it often cannot keep up. The result is glucose staying in the blood rather than being used, which is what a blood test picks up as a raised A1C or fasting glucose.

It develops gradually, which is why many people have it for years before it is found — often through routine bloodwork rather than symptoms. That slow onset is also why treatment is long-term: the goal is to keep blood sugar in a range that reduces the risk of damage to the eyes, kidneys, nerves, heart and blood vessels over decades, rather than to fix something quickly.

Type 2 diabetes is different from type 1, where the immune system destroys the insulin-producing cells and insulin is required from the start. The medications on this page are used for type 2.

Common symptoms

Many people have no symptoms at all early on. When symptoms are present, they can include:

Feeling thirsty more often than usual
Needing to urinate frequently, including overnight
Tiredness that does not improve with rest
Blurred vision
Cuts, scrapes or infections that are slow to heal
Unexplained weight loss
Tingling or numbness in the hands or feet
Recurrent yeast or urinary infections

Having these symptoms does not confirm a diagnosis — they overlap with other conditions. Assessment by a pharmacist, physician or nurse practitioner is what establishes the cause.

Causes and risk factors

What causes it

Insulin resistance — muscle, fat and liver cells respond less to insulin than they should
A gradual decline in the pancreas's ability to produce enough insulin to compensate
Excess fat stored around the liver and abdomen, which worsens insulin resistance

What raises the risk of developing it

A parent or sibling with type 2 diabetes
Being over 40, with risk rising with age
Carrying extra weight, particularly around the abdomen
Low physical activity levels
A history of gestational diabetes, or giving birth to a large baby
Polycystic ovary syndrome
South Asian, Indigenous, African, Hispanic or Asian ancestry, where risk is higher at a younger age and lower body weight
High blood pressure or abnormal cholesterol

Risk factors make a condition more likely across a population — they are not causes, and having several does not mean you will develop it.

When should I seek medical care?

Seek urgent or emergency care

Vomiting, abdominal pain, deep or rapid breathing, or a fruity smell on the breath — this can signal diabetic ketoacidosis and needs emergency care, and it can occur even when blood sugar is not very high in people taking SGLT-2 inhibitors
Severe low blood sugar — confusion, seizure, or someone who cannot be woken
Chest pain, sudden weakness on one side, or difficulty speaking — call 911

If you are unsure how urgent something is, call 8-1-1 to speak with a HealthLink BC nurse at any hour, or 911 in an emergency.

Worth asking a pharmacist

Side effects from a diabetes medication, especially stomach upset when starting metformin
Trouble affording or getting coverage for a medication
Questions about whether an over-the-counter product or supplement is safe with your regimen
Setting up or using a blood glucose meter
Doses being missed regularly, or a regimen that has become hard to keep track of

See a physician or nurse practitioner

An A1C that is not reaching the target you agreed on
New numbness, tingling or burning in the feet
Changes in vision
Planning a pregnancy, or finding out you are pregnant
A foot wound or sore that is not healing

How is type 2 diabetes treated?

Lifestyle measures

Eating patterns that steady blood sugar rather than spiking it — a dietitian referral is often more useful than a generic diet
Regular physical activity, which improves insulin sensitivity directly
Weight management where appropriate, which can substantially improve blood sugar
Stopping smoking, which compounds cardiovascular risk in diabetes
Sleep and stress, both of which affect glucose more than most people expect

Medication

Metformin is the usual first medication in Canada and remains part of most regimens. Other classes are added based on what else needs addressing: SGLT-2 inhibitors such as empagliflozin also protect the heart and kidneys; GLP-1 receptor agonists such as semaglutide, and dual GIP/GLP-1 agonists such as tirzepatide, lower blood sugar and reduce appetite. Insulin is added when the pancreas can no longer produce enough. Which combination suits you depends on your A1C, kidney function, weight, cardiovascular history and what you tolerate.

Monitoring

A1C is usually checked every three to six months. Blood pressure, cholesterol, kidney function (eGFR and urine albumin), eye examinations and foot checks are part of routine diabetes care, because the complications that matter most develop quietly.

This is a general overview, not a treatment plan. What is right for you depends on your history, your other conditions and everything else you take — that is a conversation with your prescriber or pharmacist.

Medications used for type 2 diabetes

These are commonly used in Canada for this condition. Being listed here does not mean a medication is appropriate for you — that depends on your assessment.

Metformin

metformin hydrochloride

The usual first medication for type 2 diabetes in Canada — inexpensive, well studied, and taken with meals.

Jardiance

empagliflozin

A once-daily tablet that lowers blood sugar by removing glucose through the urine, and is also used to protect the heart and kidneys.

Ozempic

semaglutide

A once-weekly injection for type 2 diabetes that lowers blood sugar and slows how quickly the stomach empties.

Mounjaro

tirzepatide

A once-weekly injection for type 2 diabetes that acts on two gut hormone pathways rather than one.

Browse every guide in the Drug Information A–Z.

Can a BC pharmacist assess type 2 diabetes?

Not for diagnosis

Type 2 diabetes is diagnosed and managed by a physician or nurse practitioner — it is not one of the minor ailments BC pharmacists can diagnose. What a pharmacist can do is the medication side of it: a full medication review covered by BC PharmaCare for eligible patients, checking for interactions and duplicate therapy, sorting out side effects, confirming coverage and Special Authority requirements, and working with your prescriber when something needs to change.

Coverage in British Columbia

Coverage depends on the medication, your indication, your PharmaCare plan and, for some diabetes medications, Special Authority approval from your prescriber. Metformin is inexpensive and widely covered; some newer medications are not covered until specific criteria are met. Pill4Me Pharmacy can check exactly what applies to your prescription — call 604-705-3644 or ask at the counter.

Coverage depends on the medication, indication, PharmaCare plan and, for some medications, Special Authority requirements — see BC PharmaCare.

Frequently asked questions

What are the first signs of type 2 diabetes?

Often there are none — type 2 diabetes is frequently found on routine bloodwork before any symptoms appear. When early symptoms do show up they tend to be easy to dismiss: more thirst than usual, needing to urinate more often, tiredness, or blurred vision. Because symptoms are unreliable, screening bloodwork is how most cases are caught. If you have risk factors, ask your physician or nurse practitioner whether you should be screened.

Is metformin still the first treatment in Canada?

For most adults, yes. Metformin remains the usual starting medication in Canadian practice — it is effective, inexpensive, does not cause weight gain, and does not cause low blood sugar when used on its own. Other medications are typically added to metformin rather than replacing it, depending on your A1C and whether heart or kidney protection is also a goal.

Can a pharmacist treat type 2 diabetes in BC?

Not diagnose it — type 2 diabetes is not one of the conditions BC pharmacists can assess and prescribe for under the Minor Ailments and Contraception Service. But pharmacists have a real role in managing it: medication reviews covered by PharmaCare for eligible patients, interaction checks, help with side effects, coverage and Special Authority paperwork, and direct contact with your prescriber when something needs adjusting.

Are diabetes medications covered by BC PharmaCare?

It depends on the medication and your plan. Metformin is inexpensive and broadly covered. Several of the newer medications require Special Authority approval before PharmaCare will pay, meaning your prescriber has to apply and document that you meet the criteria. Coverage also depends on your indication and deductible. We check this for free — call 604-705-3644 with your prescription and we will tell you where you stand before you commit to anything.

Do I need to check my blood sugar at home?

It depends on your treatment. People taking insulin or a sulfonylurea generally do need to monitor, because those medications can cause low blood sugar. People managed on metformin alone often need much less frequent testing. Your prescriber sets the plan — and if you have a meter you are not confident using, bring it in and a pharmacist will go through it with you.

Related conditions

High Blood Pressure High Cholesterol

Guides and services

Ozempic and BC PharmaCare coverage How BC PharmaCare coverage works

Managing this long term?

Most of what goes wrong with long-term conditions is medication-related — interactions, side effects that quietly stop people taking things, doses that drift out of step. A pharmacist review covers all of it, and moving your prescriptions to Pill4Me means someone is watching Type 2 Diabetes between appointments.

Book a medication review Transfer my prescription Request a refill

Pill4Me Pharmacy is at 5625 Promontory Rd Unit 101, Chilliwack, BC. We deliver free to Chilliwack, Sardis, Promontory, Vedder and Yarrow, and you can reach a pharmacist directly at 604-705-3644.