Dr. I-Net
|
Managing
Your Diabetes
|
Managing Your Diabetes:
Type 1 treatment centers on replacing insulin to offset the body's inability to produce it. Type 2 treatment typically relies on exercise, weight loss, and one or more medications to overcome insulin resistance and compensate for the insulin shortfall. Taking insulin, though, often becomes necessary. Most people with type 2 diabetes also have the added burden of managing one or more other conditions, such as obesity, high blood pressure, or high cholesterol. Your treatment goal, regardless of which type of diabetes you have, is to keep your blood sugar levels as close to normal as possible (see "Optimal blood sugar levels") to prevent damage to your eyes, kidneys, heart, nerves, and blood vessels. Optimal blood sugar levels Before a meal 70–120 mg/dL About two hours after a meal (when blood sugar levels are usually at their peak) Less than 180 mg/dL.
Even lower levels may be desirable in certain situations, such as during Managing type 1 diabetes Insulin is the foundation of therapy for people with type 1 diabetes. Insulin, at least in its present form, cannot be taken orally because digestive enzymes in the gastrointestinal tract destroy it. Your doctor initially determines the insulin regimen, including the pattern and number of doses, by looking at your blood glucose, diet, and activity levels. Higher blood sugar, bigger meals, and low amounts of activity require more insulin, while lower blood sugar, smaller meals, and increased activity require less. Because food, activity, and medications all influence your blood sugar and because they affect each individual differently, it's important to perform frequent checks. By providing a snapshot of blood sugar at a given time, self-monitoring (see "Monitoring your blood sugar levels,") gives you the information you need to tailor your treatment plan.
For example, as your blood sugar fluctuates, you can adjust the doses and timing of insulin throughout the day and better maintain your target blood sugar levels Managing type 2 diabetes Many people with type 2 diabetes may not need to take insulin or monitor their glucose frequently. Diet, exercise, and a variety of oral drugs or insulin, either alone or in combination, are usually the backbone of treatment. Because the vast majority of people with type 2 are overweight and extra pounds can exacerbate or even cause the disease, the first line of treatment is weight loss. For many people, dropping only a modest amount (10 pounds, for example) may be all that's needed to help reduce insulin resistance, restore insulin secretion, and keep blood sugar levels within the normal range, at least initially.
A long-term plan for diet and exercise is also crucial. However, for most people, evidence suggests that over time, diet and exercise fail to do the job. When they no longer suffice, medication is added to the regimen. Several different classes of drugs are available. They help lower blood glucose levels in various ways: by stimulating the release of insulin, providing insulin or other hormones that affect blood sugar, lessening insulin resistance, diminishing the rate of carbohydrate absorption from the small intestine, or decreasing glucose production in the liver. Although insulin is often used as a last resort, after oral medications have failed, there's growing evidence that it may be advantageous to use it earlier in the course of type 2 diabetes. About 30% of people with type 2 diabetes currently use insulin, and twice as many will probably eventually need it in order to maintain tight control. Intensive treatment pays off Just a few decades ago, experts weren't certain whether strictly controlling blood sugar levels offered people with diabetes long-term health benefits.
Doses were adjusted to account for fluctuations caused by eating and exercising so as to maintain blood sugar levels at 70–120 mg/dL before meals and less than 180 mg/dL after meals. The overall goal was to lower the level of glycosylated hemoglobin, or HbA1c (see "Glycosylated hemoglobin test"), so it stayed within the normal range. Participants in this group also received extensive diabetes education. Fewer long-term complications The volunteers were followed, on average, for more than six years and watched for the onset or progression of eye, kidney, or nerve disease. Compared with the control group, the people receiving intensive therapy had average blood sugar levels that were 70–80 mg/dL lower and HbA1c readings that were 2% lower (7% vs. 9%). Intensive therapy reduced the risk of developing diabetic retinopathy, a degenerative condition affecting the retinas of the eyes, by 76%.
For instance, diabetes puts you at risk for eye disease and blindness, so it's important to visit an ophthalmologist regularly. Because the disease can damage the peripheral nerves that provide sensation to your feet, proper foot care is essential. Therefore, you may benefit from seeing a podiatrist periodically. If efforts to prevent the development of kidney or vascular disease fail, you may need to consult with a nephrologist (kidney specialist), cardiologist, or vascular surgeon. Alternative treatments for diabetes The immense growth in alternative therapies during the last 20 years has not bypassed diabetes treatment.
Most people with diabetes who turn to alternative therapies do so to relieve the symptoms of complications, not to control their blood sugar levels. For instance, acupuncture is sometimes used to control neuropathy, the painful nerve damage of diabetes. And biofeedback, which teaches people how to control some seemingly involuntary processes, is sometimes helpful for incontinence, one potential consequence of neuropathy. While some mineral supplements have been studied to see if they can help people with diabetes control their blood sugar levels, so far not enough is known about such approaches to warrant recommending them. The most commonly studied supplements for managing diabetes are: Chromium. Chromium is needed to make glucose tolerance factor, which aids the action of insulin. Several studies report that chromium supplementation may yield better diabetes control in people who are chromium-deficient. However, supplementation has shown no benefit for those who have adequate amounts of the mineral, and few people, including few people with diabetes, have a chromium deficiency. Magnesium. Not having enough magnesium may increase insulin resistance. It may also impair secretion of insulin by the pancreas and contribute to certain complications of diabetes. But scientists still don't fully understand the relationship between magnesium and diabetes. As with chromium, the available evidence doesn't suggest that magnesium deficiency is a significant risk factor for diabetes, and the value of supplements remains speculative. Vanadium. Some early studies of the compound vanadium found that it normalized blood sugar levels in rats with type 1 or type 2 diabetes.
