The immediate goal of treatment is to lower high blood glucose levels. The long-term goals of treatment are to prevent diabetes-related complications. The primary treatment for type 2 diabetes is exercise and diet. You should learn basic diabetes management skills. They will help prevent complications and the need for medical care…..

• How to test and record your blood glucose (See: Blood glucose monitoring)
• What to eat and when
• How to take medications, if needed
• How to recognize and treat low and high blood sugar
• How to handle sick days
• Where to buy diabetes supplies and how to store them

It may take several months to learn the basic skills. Always continue to educate yourself about the disease and its complications. Learn how to control and live with diabetes. Over time, stay current on new research and treatment.

SELF-TESTING

Self testing refers to being able to check your blood sugar at home yourself. It is also called self-monitoring of blood glucose (SMBG). Regular self-testing of your blood sugar tells you and your health care provider how well your diet, exercise, and diabetes medications are working.

A device called a glucometer can provide an exact blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet. This gives you a tiny drop of blood. You place the blood on a test strip and put the strip into the device. Results are available in 30 – 45 seconds.

A health care provider or diabetes educator will help set up an at-home testing schedule for you. Your doctor will help you set your blood sugar goals.

• Most people with type 2 diabetes only need to check their blood sugar once or twice a day.
• If your blood sugar levels are under control, you may only need to check them a few times a week.
• Tests may be done when you wake up, before meals, and at bedtime.
• More frequent testing may be needed when you are sick or under stress.

The results of the test can be used to adjust meals, activity, or medications to keep your blood sugar levels in an appropriate range. Testing can identify high and low blood sugar levels before serious problems develop.

Keeping a record for yourself and your health care provider. This will be a big help if you are having trouble managing your diabetes.

DIET AND WEIGHT CONTROL

People with type 2 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low. Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. You should work closely with your doctor, nurse, and registered dietitian to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your daily lifestyle and habits, and should try to include foods that you like.

Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop taking medications after losing weight (although they still have diabetes). See: Diabetes diet

Bariatric (weight loss) surgery may be considered for very overweight patients who are not well managed with diet and medications. See:

• Gastric bypass surgery
• Laparoscopic gastric banding

REGULAR PHYSICAL ACTIVITY

Regular exercise is important for everyone, but especially if you have diabetes. Regular aerobic exercise lowers your blood sugar level without medication and helps burn excess calories and fat so you can manage your weight.

Exercise can help your overall health by improving blood flow and blood pressure. It decreases insulin resistance even without weight loss. Exercise also increases the body’s energy level, lowers tension, and improves your ability to handle stress.

Consider the following when starting an exercise routine:

• Always check with your health care provider before starting an exercise program.
• Ask your health care provider whether you have the right footwear.
• Choose an enjoyable physical activity that is appropriate for your current fitness level.
• Exercise every day, and at the same time of day, if possible.
• Monitor blood glucose levels at home before and after exercise.
• Carry food that contains a fast-acting carbohydrate in case blood glucose levels get too low during or after exercise.
• Wear a diabetes identification bracelet and carry a cell phone in case of emergency.
• Drink extra fluids that do not contain sugar before, during, and after exercise.
• You may need to modify your diet or medication if you exercise longer or more intensely, to keep blood glucose levels in the correct range.

MEDICATIONS TO TREAT DIABETES

If diet and exercise do not help maintain normal or near-normal blood glucose levels, your doctor may prescribe medication. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one. These drugs may also be given along with insulin, if needed.

Some of the most common types of medication are listed below. They are taken by mouth or injection.

• Biguanides (Metformin) tell the liver to produce less glucose and help muscle and fat cells and the liver absorb more glucose from the bloodstream. This lowers blood sugar levels.
• Sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin. They are taken by mouth.
• Thiazolidinediones (such as rosiglitazone) help muscle and fat cells and the liver absorb more blood sugar when insulin is present. Rosiglitazone may increase the risk of heart problems. Talk to your doctor.
• Injectible medications (including exenatide and pramlintide) can lower blood sugar.
• Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to the level of glucose in the blood.
• Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract to lower after-meal glucose levels.

If you continue to have poor blood glucose control despite lifestyle changes and taking medicines by mouth, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to other medicines. Insulin must be injected under the skin using a syringe or insulin pen device. It cannot be taken by mouth.

Insulin preparations differ in how fast they start to work and how long they work. Your healthcare provider will determine the appropriate type of insulin to use and will tell you what time of day to use it.

More than one type may be mixed together in an injection to achieve the best blood glucose control. Usually injections are needed one to four times a day. Your doctor or diabetes educator will show you how to give yourself an injection.

Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity. When they reach their ideal weight, their own insulin and a careful diet can control their blood glucose levels.

It is not known whether hypoglycemia medications taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.

MEDICATIONS TO PREVENT COMPLICATIONS

Since those with diabetes have a much higher chance of developing heart disease, kidney disease, and other medical problems, they may need to take certain medicines to treat these problems or prevent them from happening.

An ACE inhibitor (or ARB) is often recommended:

• As the first choice medicine for treating high blood pressure in persons with diabetes
• For those who have signs of early kidney disease

ACE inhibitors include captopril (Capoten), enalapril (Vasotec), quinapril (Accupril), benazepril (Lotensin), ramipril (Altace), perindopril (Aceon), and lisinopril (Prinivil, Zestril).

Statin drugs are usually the first choice to treat an abnormal cholesterol level. Aim for LDL cholesterol level less than 100 mg/dL.

Aspirin to prevent heart disease is most often recommended for persons with diabetes who:

• Are 40 or older
• Have a history of heart problems
• Have a family history of heart disease
• Have high blood pressure or high cholesterol
• Smoke

FOOT CARE

People with diabetes are more likely to have foot problems. Diabetes can damage nerves, which means you may not feel an injury to the foot until a large sore or infection develops. Diabetes can also damage blood vessels.

In addition, diabetes affects the body’s immune system. This decreases the body’s ability to fight infection. Small infections can quickly get worse and cause the death of skin and other tissues. Amputation may be needed. To prevent injury to the feet, check and care for your feet every day.

Children with type 1 diabetes need daily injections of insulin to help their bodies use glucose. The amount and type of insulin required depends on the height, weight, age, food intake, and activity level of the individual diabetic patient. Some patients with type 2 diabetes may also need to use insulin injections if their diabetes cannot be controlled with diet, exercise, and oral medication. Injections are given subcutaneously, that is, just under the skin, using a small needle and syringe, an insulin pen injector, an insulin infusion pump, or a jet injector device. Injection sites can be anywhere on the body where there is a layer of fat available, including the upper arm, abdomen, or upper thigh.

Insulin may be given as an injection of a single dose of one type of insulin once a day, or different types of insulin can be mixed and given in one dose or split into two or more doses during a day. Patients who require multiple injections over the course of a day may be able to use an insulin pump that administers small doses of insulin on demand. The small battery-operated pump is worn outside the body and is connected to a cannula (a thin, flexible plastic tube) that is inserted into the abdomen called an insertion set. Pumps are programmed to infuse a small, steady infusion of insulin (called a basal dose) throughout the day, and larger doses (called boluses) before meals. Because of the basal infusion, pumps can offer many children much tighter control over their blood glucose levels and more flexibility with their diet than insulin shots afford them.

Regular insulin is fast-acting and starts to work within 15 to 30 minutes, with its peak glucose-lowering effect about two hours after it is injected. Its effects last for about four to six hours. NPH (neutral protamine Hagedorn) and Lente insulin are intermediate-acting, starting to work within one to three hours and lasting up to 18 to 26 hours. Ultra-lente is a long-acting form of insulin that starts to work within four to eight hours and lasts 28 to 36 hours. Peakless, or basal-action insulin (insulin glargine, or Lantus) starts working in 15 minutes and has a duration of between 18 and 26 hours.

Tags: Blood, blood glucose, blood sugar, care provider, Diabetes, diet, exercise, glucose, insulin, levels, sugar, type diabetes

This entry was posted on Saturday, July 10th, 2010 at 5:36 pm and is filed under Diabetes. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.