It starts with a visit to your doctor, the exam, then the confirmed diagnosis. But as a wise lady once wrote, “It takes a village.” In order to secure the very best care now and in the future, your plan of care will include Type 2 Diabetes Treatment from the inside out.
While you take the baby steps of self-care toward managing this condition, your medical team needs to include not only your physician, but several other providers such as Registered Dietitians, Certified Diabetes Educators and, if needed, a mental health professional.
Depending on your individual needs and the progression of Diabetes, treatment may include:
- Nutrition therapy
- Physical activity
- Lifestyle measures to manage stress and other issues
- Specialist care to prevent or treat complications
- Bariatric surgery (only if recommended by your doctor).
But we know that the cornerstone of all diabetes treatment is a healthy lifestyle that includes eating the right foods and some type of regular exercise. Medications and/or insulin alone won’t do the job.
Diabetes is a progressive disease, which means that even if you’re doing well with a particular treatment, it may need adjustments or changes later on.
Type 2 Diabetes Treatment From The Inside Out
Many Type 2 Diabetics start with the oral medication Glucophage (metformin) to help
stabilize their blood sugar levels, with or without insulin. There are currently more than 10 classes of oral medications to treat diabetes, each lowering blood sugar in a different way.
If your current treatment isn’t maintaining your blood sugar levels well enough, your doctor may add an additional drug from a different class.
The following are examples of the most commonly used oral medications available:
➡ Metformin can reduce the excess release of glucose from the liver. It’s considered a first-line therapy for people just starting out with their diabetes treatment and is often continued even when other therapies are added.
➡ Side effects are generally minimal, especially when you start with low doses and increase them slowly, but may include stomach upset and diarrhea at first.
➡ Metformin does not cause hypoglycemia (low blood sugar) or weight gain, unlike some other therapies. It has a long safety record and is relatively inexpensive compared with other therapies.
Sulfonylureas and Meglitinides
Sulfonylurea drugs have been used since the 1950’s. These drugs work by causing the insulin-producing cells of the pancreas to produce insulin almost constantly.
➡ Although this means that they may increase the risk of hypoglycemia (low blood sugar) and weight gain, they’re inexpensive and very effective, with a proven track record.
Examples of the most commonly used Sulfonylurea drug are:
Another group of drugs that stimulate insulin-producing pancreatic cells, or beta cells, are called meglitinides. Prandin and Starlix are examples.
➡ The precaution when taking this type of medication is that it can cause very low blood sugar levels.
➡ Alpha-glucosidase inhibitors, such as Glyset (miglitol) and Precose (acarbose), negatively affect your digestion of carbohydrates and can help prevent spikes in blood sugar following meals.
➡ These medicines are especially useful among people with type 2 diabetes whose blood sugar tends to be most out of control after eating.
➡ Note that these drugs can lead to upset stomach, gas, and diarrhea. Low blood sugar is also a possible side effect.
Another family of type 2 diabetes medication is the thiazolidinediones (TZDs), which improve your body’s ability to use the insulin it still makes.
➡ TZDs do not cause low blood sugar and may even protect pancreatic beta cells.
Actos (pioglitazone) is the only approved TZD in the United States.
➡ Because TZDs can sometimes affect the liver, your liver function will be monitored closely by regular blood tests while on these drugs.
Another group of drugs is known as DPP-4 inhibitors.
➡ DPP-4 inhibitors block the production of an enzyme which causes the body to release more insulin.
Examples of DPP-4 inhibitors currently on the market in the United States include:
➡ This medication is considered an important addition to the management of type 2 diabetes because it doesn’t cause hypoglycemia (low blood sugar) or weight gain.
It may even have a positive effect on your cholesterol levels, possibly lowering your risk for heart disease.
Combination Therapy (a combination of two drugs in one pill)
Many of the above drugs for type 2 diabetes are also available in combination form, including Glucovance (glyburide and metformin), as well as Janumet (sitagliptin and metformin).
➡ Combination medication can be highly effective and may make it easier to stick to a diabetes treatment plan.
One drawback of combination therapy, however, is that the dose of the individual medication in each cannot be individually adjusted. So, If you experience side effects, it can be tougher to figure out which medication is to blame.
Despite trying treatment with other types of agents, or if you have severely elevated glucose levels, you may need insulin for uncontrolled diabetes.
➡ This is especially true if you are symptomatic or need to lower your glucose levels quickly. Symptomatic treatment is any medical therapy for a disease that only affects its symptoms, not its cause
Some people will need to take one or two doses of long-acting insulin per day, such as Lantus (insulin glargine) or Levemir (insulin detemir), and others will need to take long-acting insulin with rapid-acting insulin, such as Humalog insulin (lispro) or Novolog insulin (Aspart) before meals.
➡ Most patients with Type 2 Diabetes who require insulin start with a single injection of long-acting insulin, given once a day.
➡ Short-acting insulin may be added later on to continue helping get glucose levels under control.
➡ That short-acting insulin is generally given with the largest meal of the day, and coverage of additional meals are added as needed.
If you’ve been diagnosed with Diabetes, you should have an individualized meal plan that not only helps to manage blood sugar levels but also helps to manage your blood cholesterol and blood pressure.
It’s often helpful to work with a Registered Dietitian (RD) or a Certified Diabetes Educator (CDE). These specialists can help you design a diabetes meal plan that meets your goals and accommodates your food likes and dislikes, daily schedule, and usual access to food.
➡ In addition, most diabetics should limit carbohydrates, especially simple carbohydrates like white bread, white pasta, white potatoes, white rice, cereal, and juice.
➡ Instead, they should opt for more fresh vegetables and fruit, or high-fiber, whole-grain options, such as the Mediterranean Diet. It is rich in vegetables, lean meats and fish and monounsaturated fats, and low in saturated fats and simple carbohydrates.
You can monitor your glucose levels for about one to two hours after meals to help determine how the food you’ve eaten affects your blood sugar.
Physical Activity Is a Key Tool for Diabetes Treatment
The ADA recommends regular physical activity for people managing Type 2 Diabetes, that includes 150 minutes per week of moderate-intensity aerobic activity. This is easy to achieve by following the necessary steps as outlined in our ©Fit For Life program found on the right side menu of any page.
The organization also recommends three or more minutes of light activity every 30 minutes. That light activity may include:
- Overhead arm stretches
- Torso twists
- Leg lifts or extensions
➡ Before starting a formal exercise program or increasing your level of physical activity, it’s important to get your doctor’s okay and to discuss which activities you can do safely.
But please, consult your doctor about the type and frequency of activity that is best for you, and find out whether you need additional testing to make sure that exercise is safe.
Also known as weight-loss surgery, bariatric surgery either restricts the amount of food that can be eaten or changes the way in which nutrients are absorbed in the digestive tract. The result is usually significant weight loss.
➡ It’s important to understand that there are several types of bariatric surgery — including gastric bypass and gastric sleeve — and that they can vary in invasiveness and effectiveness for treating Type 2 Diabetes.
➡ The diabetes-reversing effects of bariatric surgery can last for many years, but it’s still important for people who once had type 2 diabetes to be monitored for its recurrence.
It’s important for people with type 2 diabetes to stay up to date on diet and treatment recommendations, by coordinating with professionals who are licensed in this specialty. Examples are a qualified diabetes educator a dietitian, nurse, or pharmacist.
➡ Education should be given at the time of diagnosis and periodically over time, such as after the start of insulin therapy.
As for other healthcare professionals, many diabetes clinics have dietitians, pharmacists, social workers, and mental health specialists on staff, all of whom can contribute to your diabetes management programs.
Understanding your diagnosis, the medications you’re prescribed, their actions and your body’s potential reactions to them, as well as any needed lifestyle changes, will guarantee successful management of Diabetes and prevent unexpected and potentially dangerous complications down the line.