Diabetes Focus Area
Treat

People with diabetes should receive medical care from a physician-coordinated team. Such teams may include, but are not limited to physicians, nurse practitioners, physician’s assistants, nurses, dietitians, pharmacists, and mental health professionals with expertise and a special interest in diabetes. It is essential that you assume an active role in your care.

The goal is to keep your glycohemoglobin (HbA1c) under 7.0% to decrease the risk of long-term complications such as heart attacks, strokes, kidney disease and blindness.

Different Treatments for Different Diabetes Types

Depending on if you have type 1 or type 2 diabetes, your treatment will look different. If you have type 1 diabetes, you will need insulin injections, whereas type 2 diabetes can be treated with a combination of lifestyle adjustments (food choices and physical activity) and/or medication.

Self-Monitoring

The key to managing your blood glucose levels is to check your own blood glucose levels daily using a glucometer. Your health care team will provide you guidelines as to the testing frequency and outcome measures. Daily self-monitoring will provide you feedback to determine the appropriate types of foods per meal, how your body responds before and after exercising and trigger foods that increase your blood sugars.

A Healthy Meal Plan

Treating diabetes involves eating a healthy diet as well as avoiding tobacco and getting regular exercise. Nutrients in the foods you eat contain carbohydrate, fat and protein, along with vitamins, minerals and water. Your blood sugar will respond to all type of carbohydrates. Some carbohydrates (sugars and starches) are absorbed very quickly in our bodies and may cause the blood glucose to rise rapidly. To control your blood sugar level, you may have to change the type of and/or amount of carbohydrates that you eat. If you have diabetes, your meal plan should fit your personal needs. You should therefore work with your health care team to find the exact meal plan for you.

There is no such thing as a “diabetic diet.” There is no need for you to purchase and eat specially prepared “diabetic” foods.

Self-Care and Prevention

The most important part of living with diabetes is controlling your blood sugar levels by monitoring your food choices and daily exercise routine. Many times, a 10-pound weight loss can lead to dramatic improvements. You should receive the following tests or screenings throughout the year: flu shot; foot, eye and dental examination; urine protein test; cholesterol test; blood pressure screenings; and HbA1c.

Prescription Medications

Depending on your type of diabetes and how well you manage your blood sugar, you may or may not need to take prescription drugs. However, there is a large variety of medications available to treat diabetes.

Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (brand name Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (brand names Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.

Alcohol and some diabetes pills might not mix well. Chlorpropamide, and other sulfonylureas, can interact with alcohol to cause vomiting, flushing, or sickness..

Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide (brand name Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals.Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood glucose levels).

Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin (brand name Glucophage) is a biguanide. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. Usually taken two times a day, a side effect of metformin may be diarrhea.

Thiazolidinediones- Rosiglitazone (Avandia), troglitazone (Rezulin), and pioglitazone (ACTOS) form a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and reduce glucose production in the liver. Thiazolidinediones are taken once or twice a day with food. Although effective in lowering blood glucose levels, thiazolidinediones can have a rare but serious effect on the liver. For this reason, your doctor will perform blood tests regularly to monitor the health of your liver.

Alpha-glucosidase inhibitors- Acarbose (brand name Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. Taken with the first bite of a meal, these drugs may have side effects, including gas and diarrhea.

Oral combination therapy: Because the drugs listed above act in different ways to lower blood glucose levels, they are sometimes used together. For example, a biguanide and a sulfonylurea may be used together.

Types of Insulin : There are more than 20 types of insulin products available in four basic forms, each with a different time of onset and duration of action. The decision as to which insulin to choose is based on your lifestyle, your physician's preference and experience, and your blood sugar levels. Among the criteria considered in choosing insulin are:

• how soon it starts working (onset)
• when it works the hardest (peak time)
• how long it lasts in the body (duration)

All insulin delivery devices inject insulin through the skin and into the fatty tissue below. Most users inject the insulin with a syringe that delivers insulin just under the skin. Others use insulin pens, jet injectors, or insulin pumps. Several new approaches for taking insulin are under development.

Ace Inhibitors Prevent Kidney Damage

ACE Inhibitors are usually used to lower blood pressure, but are also good at preventing kidney damage from diabetes. Hence, taking an ACE Inhibitor may be important for you if you have kidney problems or high blood pressure. A similar medicine, called an ARB, may be used instead when the ACE Inhibitors causes side effects, such as, a dry cough. ACE Inhibitors include Enalapril and Lisinopril.