How is type 2 diabetes managed?

Management of Type 2 Diabetes

Although type 2 diabetes does not have a cure, the disease can be well managed. The goal of any treatment for diabetes is to keep blood glucose as close to normal as possible to minimize the risk of later complications. The following components are the cornerstone of successful type 2 diabetes management:

  • Diet modification
  • Exercise
  • Monitoring blood glucose levels
  • Medications as needed
  • Regular medical examinations by a doctor

Diet management

Finding out that you have type 2 diabetes does not mean that you will never again be able to eat the foods that you enjoy. In general, a person with type 2 diabetes can enjoy the same foods as someone without diabetes as long as they control calories and stay active with exercise.

If your doctor has determined that you are obese (weighing 20 percent more than the weight recommended for your height), you will be advised to try to lose weight, since many people with type 2 diabetes can reduce their blood sugar by weight loss and exercise alone. A nutrition expert or dietitian can help develop a personal nutrition plan to improve your nutrition habits, while recognizing the need to enjoy food.

The food pyramid should guide food choices, with an emphasis placed on selecting a healthy variety of foods. No particular food needs to be considered “good” or “bad.” Rather, all foods can be enjoyed when consumed in moderation. Your daily food selection should include bread and other whole grain products, fruits, vegetables, dairy products, and meat, poultry, fish and other protein-containing foods. The amount of saturated fat in your diet should be low.

There are several ways that those with type 2 diabetes can be taught to monitor their food intake. Some meal plans focus on counting carbohydrates while others rely on a food exchange system, allowing for a specific number of servings of different food groups at each meal.

All patients with type 2 diabetes can benefit from knowing how to read nutrition labels. Nutrition Fact labels appear on most packaged foods and give information about calorie content, amount of carbohydrate, protein, fat and other nutrients present. The labels also can help you determine what is a normal portion size.

If you are taking oral medications or insulin to control your blood glucose level, the timing of your meals becomes very important. Skipping or delaying meals can result in unhealthy fluctuations in blood sugar levels and can lead to serious hypoglycemic (low blood sugar) reactions.

Exercise

Being overweight makes type 2 diabetes more difficult to control. So maintaining a healthy weight is an important part of treatment. Staying active and getting some form of regular exercise will help people with diabetes not only to manage their weight, but also to lower their blood sugar and thus reduce the overall risk of developing some of the long-term complications associated with diabetes.

The amount of exercise that is right for someone with type 2 diabetes depends on many factors such as age, weight, lifestyle, other existing health problems and previous experience with exercise. Everyone diagnosed with type 2 diabetes should have a complete physical exam by a doctor before starting any exercise program.

Increasing your daily physical activity does not mean that you have to “work out” at a gym or health club. Many activities that can be incorporated into your daily routine will go along way toward increasing your physical activity.

Here’s how you can get more exercise:

  • Take the stairs instead of the elevator.
  • Park farther away from store entrances.
  • Enlist a group of friends to take a daily walk.
  • Mow the lawn or weed the garden.
  • Sign up for a dance class.
  • Go bowling or visit a museum.

Starting slowly, perhaps aiming for 15 minutes of increased physical activity a day, is a realistic goal. As your energy level improves, you will be able to tolerate increasingly more physical activity.

Monitoring blood glucose levels

All people with type 2 diabetes need to monitor their blood glucose levels, since the single most important factor in managing type 2 diabetes is achieving tight glucose control.

Most of those with type 2 diabetes learn how to monitor their blood glucose levels at home, while others have their glucose levels checked regularly by their doctor. Home glucose monitoring involves taking a small sample of blood from the fingertip, placing it on a special strip, and waiting for a machine to read the glucose levels. This can be as quick as five seconds. Your doctor can advise you about how often you need to check your blood glucose levels.

Based on the results of your blood glucose levels, your doctor may recommend changes to your diet, exercise plan and diabetic medications.

Medications

While some people with type 2 diabetes can manage their disease with diet and exercise alone, most will require medication. Oral medications prescribed alone or in combination, with or without insulin injections, are all possible ways that your doctor might treat type 2 diabetes.

Most oral medications used to treat type 2 diabetes increase insulin production, decrease glucose production or enhance the body’s ability to use its own insulin more effectively. Many different oral medications are available to treat diabetes. They fall into the following categories:

 

Type of drug

 

Brand name of the drug

Thiazolidinediones (works by reducing the body’s natural resistance to insulin) Avandia®
Actos®
Sulfonylureas (works by pushing the pancreas to produce and release more insulin)

* These are almost never used.

Amaryl®

Diabeta®

Diabinese®*

Dymelor®*

Glucotrol®

Glucotrol XL®

Glynase®

Micronase®

Orinase®*

Tolinase®*

Alpha-glucosidase inhibitors (works by delaying the breakdown of food into glucose, slowing the absorption from the intestine Precose®
Glyset®
Biguanides (works by overcoming insulin resistance to slow the liver’s release of stored glucose)
Glucovance is a combination of Glucophage and Glyburide.
Glucophage®
Meglitinides and the phenylalanine derivative Starlix® (work by stimulating the pancreas to produce insulin)

A phenylalanine derivative

Prandin®

Starlix®

The person with type 2 diabetes needs to inject insulin when the pancreas is no longer able to produce the insulin needed to regulate blood glucose levels. Insulin may be needed from the onset of type 2 diabetes, or it may become necessary as the disease progresses.

Most patients with diabetes who require insulin are able to administer their own insulin after learning the proper techniques. Your doctor will decide which type of insulin and how much is needed, based on your blood glucose levels.

New insulin options

The 62nd Annual Scientific Session of the American Diabetes Association (ADA) stated that there will be new options for diabetic patients who take insulin injections. Some new options are pills, a transdermal skin patch, a mouth spray and several types of pulmonary inhaled insulin. A pill, now in clinical trials, uses polymer technology to avoid degradation and make it more absorbent into the bloodstream. Stephen Clement, M.D., associate professor of medicine at Georgetown University in Washington, D.C., noted that when taken 15 minutes before a meal, the pill gave “insulin-lowering benefits equal to injected insulin when multiple doses were given over a three-day period.”

The skin patch is battery-powered. When it is put on the skin it vaporizes cells on the skin’s surface, creating “microscopic” openings through which insulin is absorbed during 12 hours of wear. Scientists are still testing the effectiveness of an oral spray for insulin that resembles a metered dose inhaler used by asthmatic patients. When the method is perfected, the insulin would be sprayed directly into the lungs.

Regular medical examinations by a doctor

An important part of the overall treatment plan for type 2 diabetes is regular medical examinations by a doctor who is experienced in treating diabetes type 2 patients. Maintaining tight blood glucose control and getting regular checkups and screenings can prevent many of the complications associated with diabetes. If you wait until symptoms occur before seeking medical advice, it may be too late.

What is a hypoglycemic reaction and how is it treated?

Hypoglycemia is a potentially serious side effect of diabetes management that can occur in diabetics when taking oral medications and/or insulin. It results when the level of glucose in the blood falls to an abnormally low level. When mild hypoglycemia occurs, the diabetes patient is able to recognize the symptoms of a falling blood glucose level and treat them. More severe hypoglycemia can occur suddenly and cause unconsciousness or seizures. This type of hypoglycemia is a medical emergency.

The following signs and symptoms often accompany mild hypoglycemia:

  • Anxiety
  • Tremors or shaky feelings
  • Sweating or warm feeling inside
  • Hunger
  • Nausea
  • Rapidly beating heart
  • Mental confusion or difficulty concentrating
  • Dizziness
  • Headache

The following signs and symptoms often accompany more severe hypoglycemia:

  • Slurred speech
  • Disorientation
  • Confusion and irrational behavior
  • Loss of consciousness
  • Seizures

The treatment for hypoglycemia is glucose. Glucose is necessary to raise the blood sugar to a normal level. If the patient is awake and alert, he or she can ingest a food or drink that contains about 15 to 20 grams of carbohydrate. Good choices would include 6 ounces of fruit juice or cola product, about seven Life Saver candies, 14 ounces of milk, or four glucose tablets. After ingesting one of these foods, it will take about 10 to 15 minutes for the blood glucose level to rise.

Severe hypoglycemia, which renders a diabetes patient unconscious, must be treated with an injection of glucose or glucagon. Some people carry a kit for the injection of glucagons, which stimulates the liver to release glucose.

A family member or friend can give this injection at home, or wherever the reaction occurs. If the patient does not respond (wake up) after the glucagon injection, the paramedics must be called to transport the person to a hospital. If glucagon is not available, or does not raise the blood sugar enough, emergency personnel will administer an intravenous injection of concentrated glucose. This will result in a rapid rise in blood sugar.