Download Treatment of Diabetes Mellitus Type 2

Treatment of Diabetes Mellitus Type 2
The goals are to normalize the blood sugar level, eliminate symptoms such as
thirst and weakness, and prevent long-term complications such as heart disease
and eye disease caused by diabetes. In treating type 2 diabetes, diet and weight
loss are generally the first approaches to controlling the blood glucose level.
Diet
Diet is the cornerstone of treatment for all people with diabetes. The doctor may
recommend a diet or refer the person being treated to a nutritionist or dietician.
Dieticians offer advice to ensure that the diet is healthful and easily followed.
Careful control of food intake may help a person achieve and maintain a desirable
weight and, in many cases, help control the blood glucose level. Because there is
no known cure for type 2 diabetes, dietary approaches must be followed
throughout a person's lifetime. For a person with type 2 diabetes, diet should help
the person achieve and maintain an ideal weight, maintain a normal blood glucose
level, and limit foods that may increase the already high risk of heart disease.
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Most experts in the field of diabetes recommend that the daily diet consist of 50 to 60 percent of calories
from carbohydrates, 10 to 20 percent of calories from protein, and 30 percent or less of calories from fat.
Calories from saturated fats and cholesterol should be restricted and replaced with unsaturated and
monounsaturated fats to help lower the blood cholesterol level. Lowering the cholesterol level to prevent
heart disease is essential because people with diabetes have a higher risk for heart disease. Eating highfiber foods, including fresh fruits and vegetables, legumes, and whole grains, has been shown to lower the
blood glucose level. Scheduling smaller meals at regular intervals throughout the day also helps to
maintain a normal blood glucose level. A doctor or dietician can offer help with these guidelines and
individualize recommendations to a person's food preferences and lifestyle.
Exchange lists may help an individual with diabetes follow a healthful diet because the lists offer more
choices than rigid diet plans. Exchange lists group together foods with similar nutrient and caloric values
so that a person can plan the number of servings from each exchange to be eaten during the day.
It is known that foods high in carbohydrates, including whole grains, fruits and vegetables, cause the
blood glucose level to rise, but until recently it was unknown whether specific types of food within the
carbohydrate category differed in their effects on the blood glucose level. Current research suggests that it
is the total amount of high carbohydrate foods eaten at one time, rather than the specific type of food
eaten, that affects the blood glucose level most significantly. Cooked foods raise the blood glucose level
more than do raw foods eaten unpeeled.
Exercise
People with type 2 diabetes derive many benefits from physical activity. Regular exercise in combination
with the proper diet can help weight reduction efforts by burning extra calories. It can also improve the
way the body responds to insulin (it decreases insulin resistance) and improve utilization of glucose in the
body. Exercise can also help reduce the risks of heart disease by lowering fat and cholesterol levels,
lowering blood pressure, and increasing production of high-density lipoprotein (HDL), the "good"
cholesterol. Exercise also provides positive psychological effects that may help a person with diabetes
avoid the stress that can cause fluctuations in the blood glucose level.
A doctor's guidance is important in planning the right exercise program for a person with type 2 diabetes.
Factors such as the condition of the person's heart and circulatory system and overall level of fitness must
be taken into account. For example, a person with high blood pressure or diabetic retinopathy (a disorder
that causes bleeding of the blood vessels in the retina of the eye) must avoid exercises that involve
straining such as lifting heavy weights. The goal is to establish an enjoyable exercise routine that suits a
person's everyday life to encourage regular participation. Walking is often recommended. People who have
problems with their feet must select footwear carefully and examine their feet regularly for sores that may
become infected. Swimming or bicycling may be preferable for some people.
Oral Medications
Medications for people with type 2 diabetes do not replace diet and exercise programs but are used in
combination with them when those elements of treatment alone are not sufficient to control the diabetes.
People with type 2 diabetes who still produce some insulin may be treated with sulfonylureas. These
agents are oral hypoglycemics and work by stimulating the pancreas to produce more insulin. They are
most useful for people of normal weight who have never taken insulin or take less than 40 units a day, are
younger than 40 years, and have had diabetes for less than five years. They are not known to be safe for
pregnant women or nursing mothers.
The chemical names for the sulfonylureas currently in use in the United States include glyburide, glipizide,
glimepiride and chlorpropamide. In prescribing a specific medication, a doctor may take into account
several factors such as the degree to which the blood glucose level must be lowered, other medications
the person is taking, and the impact of the possible side effects of a medication. Side effects are unusual
but, in rare instances, may include hypoglycemia (from reducing the sugar level too much), nausea, skin
rashes, headache, sensitivity to sunlight, and either water retention or increased urination. A newer
medication called repaglinide, which also stimulates insulin production, is now available.
Nonsulfonylureas are another group of medications used to treat diabetes. These are the insulinsensitizing agents metformin, rosiglitazone, and pioglitazone. Metformin decreases the release of glucose
stored in the liver and increases the sensitivity of the cells to insulin. Rosiglitazone and pioglitazone
improve insulin action. Some of these medications carry a slight risk of injury to the liver or kidneys, and
their use must be monitored in people with kidney, liver, or cardiac impairment. A doctor can determine
the appropriate medication for a given individual.
Another class of agents, the glucosidase inhibitors, such as acarbose, work by inhibiting the breakdown of
sugars by intestinal enzymes. As a result, they slow digestion and absorption of sugar, making these
medications most useful for people experiencing marked elevations in the blood sugar level after eating.
A person who takes one of the oral hypoglycemic medications must eat regularly and be aware of the
effects of physical activity on lowering the blood glucose level. The symptoms of low blood sugar are
headache, weakness, shakiness and, in severe cases, physical collapse. Oral medications cannot control
the blood sugar level in all people with type 2 diabetes; some may require insulin. In other people, over
time, oral medications lose their effectiveness and insulin may be needed.
Insulin
A synthetic or bioengineered form of injected insulin may be necessary for treating some people with type
2 diabetes, particularly those unable to control the glucose level with diet, exercise and oral medication.
Other considerations taken into account are the person's age, weight and difficulty controlling the blood
sugar level; history of side effects from oral hypoglycemics; or other health concerns that make the oral
medications unsafe to use. Insulin may be used for people with type 2 diabetes who are pregnant or
undergoing surgery. The doctor determines the correct type of insulin to be administered and offers
instructions on its use. Weight control is still important for insulin to be most effective.
Monitoring the Blood Glucose Level
Because controlling the blood sugar level is the single most important factor in preventing the possible
long-term complications of type 2 diabetes, it is essential that a person keep track of his or her glucose
level. The blood sugar level can fluctuate, making it useful for a person with this form of diabetes to learn
self-monitoring techniques. At one time, home urine testing was used extensively. But it is less accurate
than blood testing and reflects the blood sugar level from several hours before the test. Also, certain
medications and vitamins can affect the results.
Blood tests that can be done at home using special kits are more accurate and offer a more immediate
reading. A drop of blood is drawn with a spring-operated device, and the blood is placed on a special strip
that can be examined visually for color changes that indicate blood sugar level or inserted into a meter
that gives a digital readout. A doctor will recommend how often a person should test his or her blood
sugar level. Several tests a day may be necessary. Self-testing offers a good indication of how a person's
glucose level responds to food intake, exercise, stress, medication, and other events or treatments.
The glucose level of a person with diabetes is also regularly tested at visits to a doctor's office. The
glycosylated hemoglobin test (hemoglobin A1c test) measures the amount of sugar that is attached to the
red blood cells. Red blood cells remain in the bloodstream for about 3 months, enabling this laboratory
test to reveal the average blood sugar level for the past 12 weeks. The results of this test are not affected
by short-term fluctuations. The American Diabetes Association recommends that people who are using
insulin treatment have this test every 3 to 4 months. People with diabetes who do not take insulin should
be tested a minimum of twice yearly.
Excerpted from: Complete Medical Encyclopedia, American Medical Association, 2003.
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© Copyright 2003 American Medical Association
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