All the treatments for type 2 diabetes focus on keeping blood sugar levels within normal limits. The most important and most effective treatment is lifestyle change including eating right, losing weight, and increasing exercise/activity levels. Many people with type 2 diabetes can control their disease just by improving their diet and increasing their activity level. However, if this alone does not work, doctors can prescribe medications that can help stabilize blood sugar levels. The ultimate goal of treatment is to reduce the effects of diabetes symptoms and prevent secondary complications from arising.
Eating right is one of the most important ways to help keep blood sugar levels in line, even if you are not overweight. This includes choosing healthy foods, eating sensible portions, and eating at appropriate intervals. A nutritionist can help you plan meals with the right combinations of nutrients and appropriate energy content. Eating foods with a low glycemic index helps reduce the rate of rise in blood sugar that occurs after a meal.
The glycemic index ranks sugar-containing foods based on how much and how quickly they increase blood sugar levels. Foods with a high glycemic index such as white bread and most breakfast cereals tend to cause rapid spikes in blood glucose and therefore should be consumed only in limited amounts. Foods with a low glycemic index such as most vegetables and whole grains tend to cause a slower and less pronounced increase in blood sugar and thus should be the preferred source of carbohydrates.
In general, a healthy diet includes lots of nutrient rich foods like fruits, vegetables, and whole grains, as well as fish. But a healthy diet also avoids foods that are low in overall nutrients and limits the intake of trans and saturated fats, cholesterol, sodium, and foods with a high glycemic index. Controlling portion size and eating frequent, small meals also helps the body better digest food and limits the rise in blood sugar levels.
Reducing your weight and BMI to appropriate levels also helps keep blood sugar levels down and since obesity is intimately tied to insulin resistance, losing weight can help your body respond better to insulin.
A simple way to lose weight is to figure out the number of calories you need to consume each day to maintain your weight and then eat fewer calories than you need. That way, your body can obtain the extra energy it needs by burning fat and you will lose weight. This is much easier to do when you eat healthy, nutrient-rich foods that fill you up and eliminate empty calories like soda pop.
Besides reducing your caloric intake, the other factor involved in weight loss is activity. Increase the amount and intensity of your physical activity to exceed the number of calories you take in and you are certain to lose weight.
When you have reached an ideal weight as determined by a doctor or nutritionist, you may be able increase your caloric intake a little but the important thing is to always expend all the calories you take in; otherwise, they will be stored as fat and you will gain weight.
Attaining a healthy weight can help reduce insulin resistance and keep blood sugar levels in line. But losing weight alone is not the full story. Doctors recommend shedding the pounds that accumulate around the midsection, the ones that contribute to an "apple shape" figure. Increasing your activity level can help redistribute your existing weight to a healthier pattern. Even modest weight loss can improve blood sugar levels by changing fat into muscle mass. Exercise can also improve circulation and lower blood pressure, blood cholesterol levels, and triglycerides, all of which reduce the risk of diabetes complications such as heart disease, stroke, and vision loss.
How much activity do you need? According to the American Heart Association, the average person should aim to get at least 30 minutes of moderate exercise five times per week or 20 minutes of vigorous exercise three times per week. If you are trying to lose weight, you should aim for 30 to 60 minutes on most days.
IMPORTANT: before starting any new exercise regimen, consult a health professional to determine what activities are best for you. A doctor can also help you determine how often to exercise and how to maintain healthy nutrition and normal blood sugar levels when you exercise.
Blood sugar monitoring:
Frequent measurement of your blood glucose levels can help you determine the effects that your lifestyle changes and medications are having on your blood sugar. Several types of glucometers are available but they all work by taking a very small sample of blood and analyzing the glucose content. Results are obtained in less than one minute and can help you determine what foods to avoid (those that cause large or rapid spikes in your blood glucose level) and determine when to eat in relation to exercise. You can also monitor the effects of your medications on your blood sugar and make sure to avoid hypoglycemia (low blood sugar) that can be a side effect of some medications.
While everyone with type 2 diabetes can benefit from changes in diet and exercise, in many cases these alone are not enough to keep blood sugar within normal limits. In those cases, a doctor may prescribe one or more medications. Medications for type 2 diabetes work by helping the body respond better to insulin or by helping keep blood sugar levels down. Several classes of medications are commonly used, either alone or in combination.
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. These drugs are generally taken once or twice a day before meals. Several sulfonylurea drugs are on the market but some examples include glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs can cause hypoglycemia (low blood glucose levels) as a side effect of insulin release.
Meglitinides stimulate the beta cells of the pancreas to make more insulin right after meals to decrease the glucose in the blood. They are usually taken before each meal. Examples of drugs in this class include repaglinide (Prandin) and nateglinide (Starlix). The side effects of meglitinides include weight gain and hypoglycemia (though this is less of a problem than with sulfonylureas).
Biguanides decrease the amount of glucose that is made by the liver, lowering overall blood glucose levels. Metformin (Glucophage), a common biguanide, also makes muscle cells more responsive to insulin. This allows muscle cells to take up and use (or store) glucose from the bloodstream and lowers blood insulin levels. Biguanides are usually taken twice a day. The side effects of biguanides include nausea, diarrhea, and cramping. Also, people with kidney problems (a common complication of type 2 diabetes) cannot take this medication so your doctor may perform additional tests to evaluate the functioning of your kidneys before prescribing this medication.
Alpha-glucosidase inhibitors block the breakdown of sugars and starches in the digestive tract, thus reducing the impact of ingested carbohydrates on blood sugar levels. These drugs do not impact the liver or the glucose that is already in the blood, only the glucose that can potentially enter the body through the digestive tract. Examples of drugs in this class include acarbose (Precose) and meglitol (Glyset). They are normally taken along with the first bite of each meal. Side effects of alpha-glucosidase inhibitors include gas and diarrhea.
Thiazolidinediones reduce glucose production in the liver; they also partially reverse insulin resistance by improving the sensitivity of insulin receptors in muscle, liver, and fat cells. This helps the body use insulin better and so these medications are often called "insulin sensitizers". The two members of this class currently on the market in the U.S. are pioglitazone (ACTOS) and rosiglitazone (Avandia). Both of these drugs may slightly increase the risk for heart failure in some individuals and one recent study showed that rosiglitazone may cause a small increase in the risk of heart attacks. For the first year of thiazolidinedione therapy, your liver enzyme levels are monitored as a precaution because a similar drug that is no longer on the market increased the risk of liver damage. Otherwise, both drugs generally have few side effects.
Some people who have type 2 diabetes may need to take insulin in addition to other treatments. Insulin is a protein hormone so when taken orally, it gets digested in the stomach just as the protein in a steak does. This is why insulin must be taken by injection. There are several varieties of insulin that differ in their longevity in the body, including: insulin lispro (Humalog), insulin aspart (NovoLog) and insulin glargine (Lantus).
While the most important and effective treatment for type 2 diabetes involves a serious and long-lasting commitment to changes in diet and exercise, this is not always enough. When lifestyle changes alone fail, often taking a combination of the drugs mentioned above, in addition to dietary changes and increased activity levels, are an effective way to control type 2 diabetes. This is most effective when it involves combining drugs from the different classes, for example, taking an alpha-glucosidase inhibitor to reduce absorption of sugars from the digestive tract and a thiazolidinedione to reduce insulin resistance and production of glucose in the liver.
Taking care of your feet:
People with diabetes are prone to foot problems. Poor circulation and nerve damage in the feet can lead to serious complications because without the protective pain sensations, you can injure your feet without realizing it. Reduced circulation also impairs the foot's ability to heal and the result can be chronic infection, eventually requiring amputation. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends the following to take care of your feet:
-- Wash your feet in warm water every day
-- Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems
-- If your skin is dry, rub lotion on your feet after you wash and dry them
-- File corns and calluses gently with an emery board or pumice stone
-- Cut your toenails once a week or when needed
-- Always wear slippers or shoes to protect your feet from injuries
-- Always wear socks or stockings to avoid blisters
-- Wear shoes that fit well
-- Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet
-- Tell your doctor right away about any foot problems
If you have type 2 diabetes, you should visit a health care provider regularly and have a physical examination that includes:
-- Glycated hemoglobin (A1C)
-- Blood pressure check
-- Foot and skin examination
-- Ophthalmoscope (eye) examination
-- Neurological examination
-- Random microalbumin (urine test for protein)
-- BUN and serum creatinine blood tests
-- Serum cholesterol, HDL, and triglycerides
-- Dilated retinal exam
Continued on page 7: How can I prevent type 2 diabetes?