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Type 2 Diabetes Treatment overview There is no cure for diabetes. But when a treatment plan results in blood glucose levels that are normal or nearly so, a person's risk of developing complications is much lower. There are certain things that all people with diabetes need to do to be healthy: have a meal plan and engage in regular physical activity (which can help the body use insulin so it can better convert glucose into energy for cells). Some people also need to take insulin or "oral agents," pills that help the body produce insulin and/or use insulin more effectively. Many people with type 2 diabetes can manage the disease with meal planning and physical activity alone. If type 2 diabetes is diagnosed early, when the body is still producing and using insulin fairly effectively, changing eating habits and being more active may be sufficient to control blood glucose. On the other hand, many individuals have high blood glucose levels for years before they are diagnosed, and the disease may have progressed to the point where medication is also necessary. In both cases, the goal is to take whatever actions are needed to keep blood glucose levels as close to normal as possible in order to avoid complications. It's vital for people with diabetes to monitor their blood glucose closely; regular checking will help determine how well the meal plan, activity plan, and medications are working together to keep blood glucose levels in a normal range. See our section on home blood glucose monitoring. This section has more information on:
Meal planning Your body changes much of the food you eat into glucose. The amount of blood glucose that comes from your diet is important, because the amount of medicine or insulin you take will be calibrated to match the amount of food that you eat every day. If you eat more food than usual without an adjustment in your medication, you may have high blood glucose (hyperglycemia). If you eat less food than usual, you may have low blood glucose (hypoglycemia). When you eat is also important. Your meals and medication work together so that your body can use the sugar from the food for energy or store it for a later time. A dietitian can help you formulate a meal plan. This section has more information on:
Carbohydrate counting One way people with diabetes can manage their food intake to keep their blood glucose as close to normal as possible is by calculating how many grams of carbohydrate they eat. Carbohydrate tends to have the greatest effect on blood glucose. The balance between the amount of carbohydrate you eat and the available insulin determines how much your blood glucose level goes up after meals or snacks. To help control your blood glucose, you need to know what foods contain carbohydrate, the size of a "serving" of different foods, and how many carbohydrate servings to eat each day. There's no magic number of daily servings that's right for everyone; instead, it is important to work with a dietitian to determine what will work for you. By checking your blood glucose, you can see whether changes are needed. If your levels are too high, for example, you may need to eat fewer carbohydrate servings, be more physically active, or work with your diabetes team to adjust your medications. Foods that contain carbohydrate include grains, pasta, and rice; breads, crackers, and cereals; starchy vegetables such as potatoes, corn, peas, and winter squash; legumes such as beans, peas, and lentils; fruits and fruit juices; milk and yogurt; and sweets and desserts. Nonstarchy vegetables such as broccoli, salad greens, and green beans are very low in carbohydrate. Carbohydrate counting can be used by anyone with diabetes, not just people taking insulin. This method can ensure that the right amount of carbohydrate is eaten at each meal and snack. Likewise, insulin and medications may be adjusted based on what the person wants to eat. For example, if you want to eat a much larger meal, this approach can help you determine how much extra insulin to take. Portion control The amount of food you eat is closely related to blood glucose control. If you eat more food than is recommended on your meal plan, your blood glucose goes up. Although foods containing carbohydrate have the most impact on blood glucose, most foods have some effect. The only way you can tell if you are eating the right amount is to measure your foods carefully:
Alcohol consumption The use of alcohol should be discussed with your physician and healthcare team. As a general guideline, people using insulin can have two alcoholic beverages in addition to their regular meals, but no food should be omitted in exchange for an alcoholic drink. For persons who are not on insulin and are watching their weight, alcohol is best substituted for fat choices and, in some cases, bread or other starch choices. Some alcoholic beverages are high in sugar and carbohydrate: sweet wines, sweet vermouth, and wine coolers, for example. Use these sparingly. When making the decision about whether to use alcohol, you should understand what the potential effects of alcohol are on your health. Although alcohol has little effect on blood glucose control, it may worsen other medical problems. Make sure you discuss the use of alcohol with your doctor. Here are some general guidelines:
Oral agents Until fairly recently, there was only one type of diabetes medication available for treating type 2 diabetes.These medications, called sulfonylureas, stimulate the pancreas to produce more insulin. Examples of sulfonylureas include DiaBeta (glyburide), Micronase (glyburide), Glynase PresTab (micronized glyburide), Glucotro1 (glipizide,; Glucotrol XL (glipizide extended release), and Amaryl (glimepiride). In the past five years or so, several other types of diabetes pills have come on the market. They work in a variety of other ways on the multiple factors that are believed to contribute to high blood glucose. These medications include:
Frequently, physicians will prescribe one type of oral medication and discover it isn't helping to control blood glucose effectively. In the past, the patient would most likely have been put on insulin. Now, physicians can try another type of medication--or one of three combination drugs. Glucovance combines glyburide and metformin to both stimulate insulin production and decrease the amount of glucose produced in the liver. Metaglip, a combination of glipizide and metformin, works similarly. Avandamet is a combination of rosiglitazone and metformin. It helps your muscles use insulin more effectively and decreases the amount of glucose released by the liver. Insulin There are several types of insulin, classified by how soon and how long they act. It is helpful to know when the insulin you take starts to work, its peak (when the insulin is working its hardest), and the duration (how long the insulin works). Premixed combinations of slower- and fast-acting insulins are also available.
This section has information on:
Inhaled insulin People who are currently using insulin or who have been told that they may eventually need to begin using it may want to talk to their physicians about Exubera, a new rapid-acting insulin in powder form that is inhaled into the lungs through a patient's mouth using a specially designed inhaler about the size of an eyeglasses case. It is important to note that Exubera does not replace intermediate-acting or long-acting insulin, however, so anyone using those forms will still need to take them by injection. Generally, inhaled insulin is taken before meals, though timing and dosage will be guided by your healthcare provider. Inhaled insulin is not approved for anyone younger than 18 and shouldn't be used by people who smoke or who have given up cigarettes within the past six months--though it's considered safe for people who live with smokers. It's not recommended for patients with asthma, bronchitis, emphysema, or any form of active lung disease. Baseline tests for lung function are recommended before starting treatment, after the first six months of treatment, and every year thereafter, even if no pulmonary symptoms such as lung or breathing problems exist. According to the Food and Drug Administration, which recently approved Exubera, it has been extensively studied for safety. The manufacturer, Pfizer, has said it will continue to study the product over the long term to confirm that it is safe and effective. Several other companies are developing inhaled insulin, too. Using an insulin pump An insulin pump is a small, computerized device that delivers insulin continuously throughout the day. It attempts to mimic the pancreas's normal release of insulin, but you must tell the pump how much insulin to inject. It delivers insulin in two ways: a basal rate, which is a continuous small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to "cover" the food you plan to eat. Effective, safe use of the pump requires a commitment to checking blood glucose at least four times a day, counting carbohydrates, and adjusting your insulin doses based on blood glucose levels, carbohydrate intake, and physical activity. The main advantages of pump therapy are:
The main disadvantages of pump therapy are:
Hints for handling and storing insulin To make sure your insulin is safe and effective:
Weight gain Taking insulin is often associated with weight gain, which can prompt people to cut back on their insulin intake. Reasons for the weight gain include:
Some people cut back on their insulin once they discover they can lose a few pounds quickly by doing so. But when they go back to using the right amount of insulin, they discover that they gain the weight back--and perhaps more--in equally rapid fashion. Manipulating insulin to lose weight is an unhealthy habit to get into. Letting your blood glucose run high can lead to long-term complications. Better to make careful adjustments in how much you eat. |
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