Type 2 diabetes treatment usually follows a step-wise approach starting with lifestyle modifications and exercise to oral medications and eventually insulin therapy. Goals of treatment are to keep the blood glucose level as close to normal as possible and delay or prevent complications due to high blood glucose. As diabetes is a life-long disease, appropriate treatment for type 2 diabetes needs lifelong commitment to:
- Blood sugar monitoring.
- Lifestyle changes such as healthy eating, regular exercise etc.
- If necessary, diabetes medication or insulin therapy.
Lifestyle changes: These are an important aspect in the treatment of type 2 diabetes. Lifestyle changes recommended for people with type 2 diabetes include:
- Maintain healthy body weight: the patient must have an aim to maintain body weight as healthy as possible (or body mass index of 18.5 -24.9). If you are obese, try to lose weight.
- Eat healthy: Eat a balanced and healthy diet by including a variety of food from each major food group such as fruits, vegetable, whole grains, lean meat, and dairy in your diet. Watch the amount of food you eat and the calorie intake, more calories than required even as proteins impair the blood sugar control. Limit the intake of carbohydrates, sweets, processed food and fatty foods. Limit the intake of sweets, salt and alcoholic beverages.
- Be physically active: Any regular exercises (moderate physical activity for 30 minutes on most days of the week) can help you to maintain blood sugar levels and body weight. Exercise tends to improve insulin sensitivity and utilisation of blood glucose.
If lifestyle modifications fail to maintain your blood sugar levels in the target range, your doctor will prescribe medications. Medications, however, must not be used as a substitute to lifestyle modifications, but along with them; both of these together improve blood sugar control and decrease the dose of medication needed to control blood sugar levels.
Medications to treat type 2 diabetes
Some commonly used medications for the treatment of type 2 diabetes include:
- Sulfonylureas: These drugs are taken orally and they stimulate the pancreas to secrete more insulin.
- Biguanides: These drugs are taken orally and they reduce the amount of glucose produced by the liver.
- Alpha-glycosidase inhibitors: These agents are taken orally and they slow the absorption of carbohydrates from the intestine. This slows down glucose production.
- Thiazolidinediones: Thiazolidinediones (such as rosiglitazone and pioglitazone) increase the sensitivity or responsiveness to insulin.
- Meglitinides: These agents (such as exenatide, mitiglinide, pramlintide, sitagliptin and saxagliptin) are given as injections. They stimulate the pancreas to secrete more insulin.
Insulin for type 2 diabetes
If the blood sugar level is not maintained within the target range through lifestyle modifications and oral medications, your doctor will prescribe insulin. Insulin is given as an injection because oral preparations of insulin are not available.
The different types of injectable insulin are:
- Rapid-acting insulin such as regular insulin, lispro, glulisine and aspart insulin.
- Long-acting insulin such as Ultralente insulin (has large zinc insulin crystals in an acetate buffer) and insulin glargine (a newer type of insulin that has no peak and causes relatively stable blood level lasting for more than 24 hours).
- Intermediate acting insulin such as neutral protamine Hagedorn (NPH) insulin (this has a mixture of regular and protamine zinc insulin) and Lente insulin (a mixture of 30% Semilente insulin and 70% Ultralente insulin in an acetate buffer).
Your doctor will prescribe a mixture of insulin types (short and long acting) to be taken throughout the day and night based on blood sugar levels and control. Insulin injections can be taken as a standard injection or in several different ways such as insulin pen, insulin infuser, jet injectors, insulin auto injector and insulin pump.
In diabetes, following the doctor’s recommendations regarding lifestyle and dietary modifications, medications (oral medications and/or insulin) and regular follow-up are essential to maintain the glucose level as normal as possible. Maintaining the blood sugar in the target range can prevent or delay the onset of complications due to diabetes.
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