Treatment Of Diabetes
Treatment Of Diabetes
There's no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms, to prevent health problems developing later in life.
If you've been diagnosed with diabetes, your GP will be able to explain your condition in detail and help you to understand your treatment.
They will also closely monitor your condition to identify any health problems that may occur. If there are any problems, you may be referred to a hospital-based diabetes care team.
This may seem daunting, but your diabetes care team will be able to give you support and advice about all aspects of your treatment.
After being diagnosed with type 2 diabetes, or if you're at risk of developing the condition, the first step is to look at your diet and lifestyle, and make any necessary changes.
Three major areas that you'll need to look closely at are your:
Losing 5-10% of your overall body weight over the course of a year is a realistic initial target. You should aim to continue to lose weight until you've achieved and maintained a BMI within the healthy range, which is:
To help you achieve changes in your behaviour, you may be referred to a dietitician or a similar healthcare professional for a personal assessment and tailored advice about diet and physical activity.
For adults who are 19-64 years of age, the government recommends a minimum of:
In cases where the above activity levels are unrealistic, even small increases in physical activity will be beneficial to your health and act as a basis for future improvements.
Reduce the amount of time spent watching television or sitting in front of a computer. Going for a daily walk – for example, during your lunch break – is a good way of introducing regular physical activity into your schedule.
If you're overweight or obese (see above), you may need to be more physically active to help you lose weight and maintain weight loss.
Your GP, diabetes care team or dietician can give you more information and advice about losing weight and becoming more physically active.
The Diabetes UK website has more information and advice about getting active and staying active.
There's no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms, to prevent health problems developing later in life.
If you've been diagnosed with diabetes, your GP will be able to explain your condition in detail and help you to understand your treatment.
They will also closely monitor your condition to identify any health problems that may occur. If there are any problems, you may be referred to a hospital-based diabetes care team.
Making lifestyle changes
If you're diagnosed with type 2 diabetes, you'll need to look after your health very carefully for the rest of your life.This may seem daunting, but your diabetes care team will be able to give you support and advice about all aspects of your treatment.
After being diagnosed with type 2 diabetes, or if you're at risk of developing the condition, the first step is to look at your diet and lifestyle, and make any necessary changes.
Three major areas that you'll need to look closely at are your:
- diet
- weight
- level of physical activity
Diet
Increasing the amount of fibre in your diet and reducing your fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it. You should:- increase your consumption of high-fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables
- choose foods that are low in fat – replace butter, ghee and coconut oil with low-fat spreads and vegetable oil
- choose skimmed and semi-skimmed milk, and low-fat yoghurts
- eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers
- grill, bake, poach or steam food instead of frying or roasting it
- avoid high-fat foods, such as mayonnaise, chips, crisps, pasties, poppadums and samosas
- eat fruit, unsalted nuts and low-fat yoghurts as snacks instead of cakes, biscuits, bombay mix or crisps
Weight
If you're overweight or obese (you have a body mass index (BMI) of 30 or over), you should lose weight, by gradually by reducing your calorie intake and becoming more physically active (see below).Losing 5-10% of your overall body weight over the course of a year is a realistic initial target. You should aim to continue to lose weight until you've achieved and maintained a BMI within the healthy range, which is:
- 18.5-24.9kg/m² for the general population
- 18.5-22.9kg/m² for people of south Asian or Chinese origin ('south Asian' means Bangladesh, Bhutan, India, Indian-Caribbean, Maldives, Nepal, Pakistan and Sri Lanka)
To help you achieve changes in your behaviour, you may be referred to a dietitician or a similar healthcare professional for a personal assessment and tailored advice about diet and physical activity.
Physical activity
Being physically active is very important in preventing or managing type 2 diabetes.For adults who are 19-64 years of age, the government recommends a minimum of:
- 150 minutes (2 hours and 30 minutes) of "moderate-intensity" aerobic activity – such as cycling or fast walking – a week, which can be taken in sessions of 10 minutes or more, and
- muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, tummy (abdomen), chest, shoulders and arms)
- 75 minutes of "vigorous-intensity" aerobic activity, such as running or a game of tennis every week, and
- muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms)
In cases where the above activity levels are unrealistic, even small increases in physical activity will be beneficial to your health and act as a basis for future improvements.
Reduce the amount of time spent watching television or sitting in front of a computer. Going for a daily walk – for example, during your lunch break – is a good way of introducing regular physical activity into your schedule.
If you're overweight or obese (see above), you may need to be more physically active to help you lose weight and maintain weight loss.
Your GP, diabetes care team or dietician can give you more information and advice about losing weight and becoming more physically active.
The Diabetes UK website has more information and advice about getting active and staying active.
Medicines for type 2 diabetes hide
Type
2 diabetes usually gets worse over time. Making lifestyle changes, such
as adjusting your diet and taking more exercise, may help you control
your blood glucose levels at first, but they not be enough in the long
term.
You may eventually need to take medication to help control your blood glucose levels. Initially, this will usually be in the form of tablets, and can sometimes be a combination of more than one type of tablet. It may also include insulin or other medication that you inject.
Metformin is recommended for adults with a high risk of developing type 2 diabetes, whose blood glucose is still progressing towards type 2 diabetes, despite making necessary lifestyle changes.
If you're overweight, it's also likely you'll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldn't cause additional weight gain.
However, it can sometimes cause mild side effects, such as nausea and diarrhoea, and you may not be able to take it if you have kidney damage.
Sulphonylureas can increase the risk of hypoglycaemia (low blood sugar), because they increase the amount of insulin in your body. They can also sometimes cause side effects including weight gain, nausea and diarrhoea.
They're usually used in combination with metformin or sulphonylureas, or both. They may cause weight gain and ankle swelling (oedema). You shouldn't take pioglitazone if you have heart failure or a high risk of bone fracture.
Another thiazolidinedione, rosiglitazone, was withdrawn from use in 2010 due to an increased risk of cardiovascular disorders, including heart attack and heart failure.
By preventing this breakdown, the gliptins (linagliptin, saxagliptin, sitagliptin and vildagliptin) prevent high blood glucose levels, but don't result in episodes of hypoglycaemia.
You may be prescribed a gliptin if you're unable to take sulphonylureas or glitazones, or in combination with them. They're not associated with weight gain.
It's injected twice a day and boosts insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes ("hypos").
It also leads to modest weight loss in many people who take it. It's mainly used in people on metformin plus sulphonylurea, who are obese. A once-weekly product has also been introduced.
Another GLP-1 agonist called liraglutide is a once-daily injection (exenatide is given twice a day). Like exenatide, liraglutide is mainly used for people on metformin plus sulphonylurea, who are obese, and in clinical trials it's been shown to cause modest weight loss.
Acarbose isn't often used to treat type 2 diabetes because it usually causes side effects, such as bloating and diarrhoea. However, it may be prescribed if you can't take other types of medicine for type 2 diabetes.
Nateglinide and repaglinide can cause side effects, such as weight gain and hypoglycaemia (low blood sugar).
Sources >> http://www.nhs.uk/Conditions/Diabetes-type2/Pages/treatment.aspx
You may eventually need to take medication to help control your blood glucose levels. Initially, this will usually be in the form of tablets, and can sometimes be a combination of more than one type of tablet. It may also include insulin or other medication that you inject.
Metformin
Metformin is usually the first medicine that's used to treat type 2 diabetes. It works by reducing the amount of glucose that your liver releases into your bloodstream. It also makes your body's cells more responsive to insulin.Metformin is recommended for adults with a high risk of developing type 2 diabetes, whose blood glucose is still progressing towards type 2 diabetes, despite making necessary lifestyle changes.
If you're overweight, it's also likely you'll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldn't cause additional weight gain.
However, it can sometimes cause mild side effects, such as nausea and diarrhoea, and you may not be able to take it if you have kidney damage.
Sulphonylureas
Sulphonylureas increase the amount of insulin that's produced by your pancreas. Examples of sulphonylureas include:- glibenclamide
- gliclazide
- glimepiride
- glipizide
- gliquidone
Sulphonylureas can increase the risk of hypoglycaemia (low blood sugar), because they increase the amount of insulin in your body. They can also sometimes cause side effects including weight gain, nausea and diarrhoea.
Glitazones (thiazolidinediones, TZDs)
Thiazolidinedione medicines (pioglitazone) make your body’s cells more sensitive to insulin so that more glucose is taken from your blood.They're usually used in combination with metformin or sulphonylureas, or both. They may cause weight gain and ankle swelling (oedema). You shouldn't take pioglitazone if you have heart failure or a high risk of bone fracture.
Another thiazolidinedione, rosiglitazone, was withdrawn from use in 2010 due to an increased risk of cardiovascular disorders, including heart attack and heart failure.
Gliptins (DPP-4 inhibitors)
Gliptins work by preventing the breakdown of a naturally occurring hormone called GLP-1. GLP-1 helps the body produce insulin in response to high blood glucose levels, but is rapidly broken down.By preventing this breakdown, the gliptins (linagliptin, saxagliptin, sitagliptin and vildagliptin) prevent high blood glucose levels, but don't result in episodes of hypoglycaemia.
You may be prescribed a gliptin if you're unable to take sulphonylureas or glitazones, or in combination with them. They're not associated with weight gain.
GLP-1 agonists
Exenatide is a GLP-1 agonist, an injectable treatment that acts in a similar way to the natural hormone GLP-1 (see the section on gliptins, above).It's injected twice a day and boosts insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes ("hypos").
It also leads to modest weight loss in many people who take it. It's mainly used in people on metformin plus sulphonylurea, who are obese. A once-weekly product has also been introduced.
Another GLP-1 agonist called liraglutide is a once-daily injection (exenatide is given twice a day). Like exenatide, liraglutide is mainly used for people on metformin plus sulphonylurea, who are obese, and in clinical trials it's been shown to cause modest weight loss.
Acarbose
Acarbose helps prevent your blood glucose level from increasing too much after you eat a meal. It slows down the rate at which your digestive system breaks carbohydrates down into glucose.Acarbose isn't often used to treat type 2 diabetes because it usually causes side effects, such as bloating and diarrhoea. However, it may be prescribed if you can't take other types of medicine for type 2 diabetes.
Nateglinide and repaglinide
Nateglinide and repaglinide stimulate the release of insulin by your pancreas. They're not commonly used, but may be an option if you have meals at irregular times. This is because their effects don't last very long, but they're effective when taken just before you eat.Nateglinide and repaglinide can cause side effects, such as weight gain and hypoglycaemia (low blood sugar).
Sources >> http://www.nhs.uk/Conditions/Diabetes-type2/Pages/treatment.aspx
Diabetes Treatment: It's Not Just Insulin
Insulin usually isn’t the first line of defense for type 2 diabetes treatment. Find out about lifestyle changes and other medication options you can try to help control type 2 diabetes.
If you’re newly diagnosed with type 2 diabetes, your first worry might be that you’ll need to begin insulin injections immediately to get your blood sugar under control.
But unless your blood sugar levels are dangerously high, chances are
that insulin won’t be the first step in your type 2 diabetes treatment
plan.
The most recent type 2 diabetes treatment guidelines, published in the January 2015 issue of the journal Diabetes Care,
suggest that the best place to begin may be with a personalized,
diabetes-friendly diet and increasing physical activity, along with
using the common oral type 2 diabetes medication metformin (or an
alternative, if there’s a reason you can’t take metformin). People who
are very motivated to address type 2 diabetes through lifestyle changes may try diet and exercise alone for three to six months after diagnosis.
The current type 2 diabetes treatment recommendations are:
- Weight loss. Losing at least 5 percent of body weight can improve type 2 diabetes control significantly, according to the guidelines.
- Dietary changes. Work with your doctor to create a diet that has a healthy balance of protein, carbohydrates, fats, and fruits and vegetables, according to the American Diabetes Association. Limiting the simple carbohydrates in your diet, such as crackers and bread, is a cornerstone of diabetes control.
- Physical activity. About 150 minutes of exercise a week, or 30 minutes five or more days a week, is recommended for type 2 diabetes control. In addition, resistance training at least two days a week is also recommended to significantly improve blood sugar control.
Although it’s possible for type 2 diabetes to go
into remission with these lifestyle changes, many doctors prescribe
metformin from the start.
Type 2 Diabetes Treatment: Next Steps
If lifestyle changes and metformin don’t help
you meet your type 2 diabetes treatment goals, your doctor might
recommend an additional drug, often from one of these different classes
of diabetes medications:
- Sulfonylureas. This class of oral medication triggers beta cells to release more insulin.
- Meglitinides. This class of oral medications also triggers beta cells to release more insulin.
- Biguanides. Metformin is in this class of oral drugs, which reduces the amount of blood sugar (blood glucose) made by the liver and helps increase the muscles’ sensitivity to insulin.
- Thiazolidinediones. These oral drugs help muscle and fat tissue use insulin more effectively and also may reduce the blood sugar released by the liver.
- Alpha-glucosidase inhibitors. These oral drugs slow the rise in blood sugar after meals by stopping the breakdown of starches and some types of sugar in the digestive process.
- DPP-4 inhibitors. These oral drugs help your body use its own compound that reduces blood sugar.
- SGLT2 inhibitors. These drugs cause excess glucose to be removed from your body in the urine.
- Pramlintide. This is an injectable form of the hormone amylin, which is made in the pancreas along with insulin. This medication helps keep A1C low. A healthy level of A1C is considered to be 7 percent or lower.
- Exenatide. This is an injectable synthetic hormone that helps lower blood sugar levels when they’re high. When combined with weight loss, exenatide may lead to better glycemic control, according to research published in the February 2015 issue of Cardiovascular Diabetology.
Determining which of these drugs or combination
of drugs to try is based on a variety of factors, including any other
health conditions you have, the side effects you can tolerate (such as
nausea or weight gain), and your insurance coverage. You also may need
other medication, such as a statin, to help reduce heart disease risk,
which is higher in people with type 2 diabetes.
Research is ongoing to find new types of
medications as well as to determine which combinations of the existing
medications are most effective over time for people with type 2
diabetes.
When You Need to Start Insulin
Although insulin is effective, many people with
type 2 diabetes want to avoid it as long as possible, sometimes because
they worry about giving themselves injections, or because the idea of it
brings home the severity of the disease. However, diabetes is a
progressive disease that makes it harder and harder for your body to
make the insulin needed to manage blood sugar levels as time goes on. If
you can’t meet your goals (such as sticking at or below 7 percent A1C)
using non-insulin methods, your doctor will recommend insulin. A
significant number of people with diabetes do take insulin, sometimes
only for a brief period, to help achieve control of blood sugar levels.
“As many as half of people with type 2 diabetes
need insulin because the current A1C of those with diabetes in the
United States is pretty high," says researcher and endocrinologist
Kenneth Cusi, MD, chief of the division of endocrinology, diabetes, and
metabolism at the University of Florida in Gainesville.
Insulin can help you control your blood sugar
levels over a long period. In a study involving 1,262 adults with
diabetes, adding insulin to other diabetes medications enabled about 40
percent of them to reach the A1C goal of 7 percent, according to the study, published in 2013 in the journal Vascular Health Risk Management.
“There are a lot of misconceptions about
diabetes treatment,” Dr. Cusi says. ”Some people may fear that when you
step up to insulin, you’re going to die or go blind.” But Cusi points
out that dire outcomes such as these could, in fact, be more likely to
occur because insulin was started too late in the course of the disease,
and that people who follow their diabetes treatment plan are far less
likely to experience complications.
The most important takeaway about a successful
type 2 diabetes treatment plan is to find and stick with the regimen
that works best for you. If you need medication for type 2 diabetes,
work closely with your doctor to determine the kind that’s best for you.
Sources >http://www.everydayhealth.com/hs/better-type-2-diabetes-control/diabetes-treatment-not-just-insulin/
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Diabetes is a common disease, yet every
individual needs unique care. We encourage people with diabetes and
their families to learn as much as possible about the latest medical
therapies and approaches, as well as healthy lifestyle choices. Good
communication with a team of experts can help you feel in control and
respond to changing needs.
- See more at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/#sthash.5g9DPwVn.dpuf
- See more at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/#sthash.5g9DPwVn.dpuf
Diabetes
is a common disease, yet every individual needs unique care. We
encourage people with diabetes and their families to learn as much as
possible about the latest medical therapies and approaches, as well as
healthy lifestyle choices. Good communication with a team of experts can
help you feel in control and respond to changing needs. - See more at:
http://www.diabetes.org/living-with-diabetes/treatment-and-care/#sthash.5g9DPwVn.dpuf
Diabetes
is a common disease, yet every individual needs unique care. We
encourage people with diabetes and their families to learn as much as
possible about the latest medical therapies and approaches, as well as
healthy lifestyle choices. Good communication with a team of experts can
help you feel in control and respond to changing needs. - See more at:
http://www.diabetes.org/living-with-diabetes/treatment-and-care/#sthash.5g9DPwVn.dpuf
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