Each person needs individualized treatment. Type-1 diabetes always requires insulin, diet, and exercise. Type-2 diabetics require insulin or oral hypoglycemic agents (medication that helps lower blood sugar), if diet and exercise alone fail to lower blood glucose.
Full Answer
What is the management of type 2 diabetes?
pharmacological agents for T2DM prevention. metformin. orlistat- absorbs fat in the diet. acarbose. lifestyle interventions have more lasting effect than drugs. aims of treatment. to alleviate symptoms and improve quality of life. prevent complications of diabetes. to avoid iatrogenic side effects.
Do you need diabetes medications for type 2 diabetes?
· Dipeptidyl-peptidase 4 (DPP-4) inhibitors. Medications. Saxagliptin (Onglyza) Sitagliptin (Januvia) Linagliptin (Tradjenta) Alogliptin (Nesina) Action. Stimulate the release of insulin when blood glucose is rising. Inhibit the release of glucose from the liver.
What are the treatment options for diabetes?
The current American Diabetes Association (ADA) guidelines for goals of therapy in type 2 diabetes are as follows: A. Preprandial blood glucose 90-150 mg/dL and peak postprandial blood glucose < 180 mg/dL B. Preprandial blood glucose 80-130 mg/dL and peak postprandial blood glucose < 180 mg/dL
When is insulin therapy indicated in the treatment of type 2 diabetes?
Type 2 diabetes is associated with the _____ syndrome (inactive ... review what the different types of type 2 DM treatment do. false (60% will develop diabetes within 15 years of gestation) ... Chronic complications of DM are associated with the following conditions: leading to impairment or loss of vision. neuropathies (mostly peripheral) ...
What is the best treatment for type 2 diabetes?
Metformin is generally the preferred initial medication for treating type 2 diabetes unless there's a specific reason not to use it. Metformin is effective, safe, and inexpensive. It may reduce the risk of cardiovascular events. Metformin also has beneficial effects when it comes to reducing A1C results.
What are the two main treatments for type 2 diabetes?
There's no cure for type 2 diabetes, but losing weight, eating well and exercising can help you manage the disease. If diet and exercise aren't enough to manage your blood sugar, you may also need diabetes medications or insulin therapy.
What is a component of treatment for type 2 diabetes?
Biguanides. This group includes metformin, one of the most commonly used drugs to treat diabetes. It tells your liver to hang on to some of the glucose it makes. Meglitinides and sulfonylureas.
Which of the following are accepted medical treatments for type 2 diabetes?
Most people with type 2 diabetes start medical treatment with metformin link pills. Metformin also comes as a liquid. Metformin lowers the amount of glucose that your liver makes and helps your body use insulin better.
Is insulin the best treatment for type 2 diabetes?
Goals of insulin therapy Sometimes, people with type 2 diabetes or gestational diabetes need insulin therapy if other treatments haven't been able to keep blood glucose levels within the desired range. Insulin therapy helps prevent diabetes complications by keeping your blood sugar within your target range.
What are the treatment options for diabetes?
Treatment of type 2 diabetes primarily involves lifestyle changes, monitoring of your blood sugar, along with diabetes medications, insulin or both....Treatments for type 1 and type 2 diabetesMonitoring your blood sugar. ... Insulin. ... Oral or other medications. ... Transplantation. ... Bariatric surgery.
Do people with type 2 diabetes take insulin?
“Someone with Type 1 diabetes will always require insulin injections, because their body produces little or no insulin, but someone with Type 2 diabetes may require insulin injections as part of their treatment plan as well,” said Eileen Labadie, Henry Ford Health diabetes education specialist.
When do you need insulin for type 2 diabetes?
Timing. Insulin shots are most effective when you take them so that insulin goes to work when glucose from your food starts to enter your blood. For example, regular insulin works best if you take it 30 minutes before you eat.
How can type 2 diabetes be prevented?
You can prevent or delay type 2 diabetes with proven, achievable lifestyle changes—such as losing a small amount of weight and getting more physically active—even if you're at high risk. Read on to find out about CDC's lifestyle change program and how you can join.
What is the safest medication for type 2 diabetes?
Most experts consider metformin to be the safest medicine for type 2 diabetes because it has been used for many decades, is effective, affordable, and safe. Metformin is recommended as a first-line treatment for type 2 diabetes by the American Diabetes Association (ADA).
Is there a better drug for type 2 diabetes than metformin?
There are six other major classes of blood-sugar lowering drugs used in Type 2 diabetes. Of these, the SGLT2 inhibitors (short for sodium-glucose co-transporter) are emerging as the next best drug after metformin. All of these medications can be combined with metformin to get blood sugar back towards normal levels.
Diabetes Treatment: Lowering Blood Sugar
Several classes of type 2 diabetes medicines exist. Each class of medicine works in different ways to lower blood sugar. A drug may work by: 1. Sti...
Compare Diabetes Medications
Here's an at-a-glance comparison of common diabetes medications. More medications are available depending on your needs and situation. Ask your doc...
How to Choose Your Diabetes Medication
No single diabetes treatment is best for everyone, and what works for one person may not work for another. Your doctor can determine how a specific...
What are the best ways to manage type 2 diabetes?
Healthy lifestyle choices — including diet, exercise and weight control — provide the foundation for managing type 2 diabetes. However, you may need medications to achieve target blood sugar (glucose) levels. Sometimes a single medication is effective. In other cases, a combination of medications works better.
How does diabetes medicine work?
Each class of medicine works in different ways to lower blood sugar. A drug may work by: Stimulating the pancreas to produce and release more insulin. Inhibiting the production and release of glucose from the liver.
Is diabetes a single treatment?
No single diabetes treatment is best for everyone, and what works for one person may not work for another. Your doctor can determine how a specific medication or multiple medications may fit into your overall diabetes treatment plan and help you understand the advantages and disadvantages of specific diabetes drugs. Oct. 24, 2020.
Is it better to take a single medication or a combination?
Sometimes a single medication is effective. In other cases, a combination of medications works better. The list of medications for type 2 diabetes is long and potentially confusing. Learning about these drugs — how they're taken, what they do and what side effects they may cause — will help you discuss treatment options with your doctor.
Does lowering cholesterol help with diabetes?
Lower cholesterol and have a very modest effect in lowering blood glucose when used in combination with other diabetes medications
Can you use glucose tablets for hypoglycemic episodes?
A. Hypoglycemic episodes can only be treated with glucose tablets or gel, or plain table sugar (sucrose).
Can starchy foods reverse hypoglycemia?
Glucose tablets or gel should be used to reverse hypoglycemia. Table sugar is sucrose and should not be used
How many insulin injections per day for diabetic neuropathy?
1. a single anti-diabetes drug. 2. once daily insulin injections. 3. a combination of oral anti-diabetic medications. 4. three or four injections per day of different types of insulin. 4. three or four injections per day of different types of insulin. Diabetic neuropathies are diagnosed using all of the following except:
What is the IGT of diabetes?
the presence of impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) A normal fasting blood glucose in a person who does not have diabetes is less than. 100 mg/dL. In patients with diabetes, pre-meal blood glucose should be between. 70 and 130 mg/dL.
What is the leading cause of blindness among persons age 20-74?
3. diabetes is the leading cause of blindness among persons age 20-74. 4. diabetes is the leading cause of kidney failure. 1. the US prevalence of diabetes is decreasing. The lifetime risk of developing diabetes for a male born in 2000 is: 1. 1 in 5. 2. 1 in 3. 3. 2 in 5. 4. 1 in 2. 2. 1 in 3.
What are the benefits of using an insulin pump?
the benefits of using an insulin pump include all of the following except: 1. by continuously providing insulin they eliminate the need for injections of insulin. 2. they simplify management of blood sugar and often improve A1C. 3. they enable exercise without compensatory carbohydrate consumption.
What are the consequences of untreated diabetes?
Untreated diabetes may result in all of the following except: 1. blindness. 2. cardiovascular disease. 3. kidney disease. 4. tinnitus. 4. tinnitus. prediabetes is associated with all of the following except: 1. increased risk of developing type 2 diabetes. 2. impaired glucose tolerance.
What are the risk factors for diabetes?
The risk factors for type 1 diabetes include all of the following except: 1. diet. 2. genetic. 3. autoimmune. 4. environmental. 4. environmental. Type two diabetes accounts for approximately what percentage of all cases of diabetes in adults? 1. 55-60%. 2. 35-40%.
What are the complications of hyperglycemia?
Untreated hyperglycemia may lead to all of the following complications except. 1. hyperosmolar syndrome. 2. vitiligo. 3. diabetic ketoacidosis. 4. coma. 2. vitiligo. Hyperinsulinemia may be caused by all of the following except: 1. an insulinoma. 2. nesidioblastosis.
What is the cut point for diagnosis of diabetes?
A hemoglobin A1clevel of greater than 6.5 % was recommended in June 2009 by the International Expert Committee on the role of hemoglobin A1cassay in the diagnosis of diabetes as the cut-point for the diagnosis of diabetes [7]. The committee cautioned that this value should not be taken as an absolute dividing line between normoglycemia and diabetes but observed that a hemoglobin A1clevel of 6.5% had the requisite sensitivity and specificity to identify subjects at risk for developing diabetic retinopathy, and therefore should be used as a diagnostic cut-point. The expert committee recommended that clinicians should continue to use the previously recommended approaches to diagnose diabetes based on glucose measurements where it is not feasible to use hemoglobin A1c. It is also reasonable to consider a hemoglobin A1crange of 5.7% to 6.4% as identifying individuals with high risk for future diabetes and to whom the term prediabetesmay be applied if desired [6]. As is the case for individuals found to have IFG and IGT, individuals with a hemoglobin A1clevel of 5.7% to 6.4% should be informed of their increased risk for diabetes as well as for cardiovascular disease and counseled about effective strategies to lower their risks. The diagnostic test should be performed using a method that is certified by the National Glycohemoglobin Standardization Program and standardized to the Diabetes Control and Complications Trial (DCCT) assay. Point-of-care hemoglobin A1cassays are not sufficiently accurate at this time to use for diagnostic purposes [6].
What is the normal blood glucose level for a patient with hyperglycemia?
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).
What is T2DM?
Type 2 diabetes mell itus (T2DM) is a heterogeneous disorder, characterized by defects in insulin secretion and insulin sensitivity [1,2]. Insulin resistance by itself will not result in T2DM unless β-cell secretion of insulin is decreased. Based on the Centers for Disease Control and Prevention National Diabetes Fact Sheet in 2007 [3], there were 23.6 million Americans with diabetes, of whom 90% to 95% have T2DM; 17.9 million of type 2 diabetic patients are diagnosed while 5.7 million are undiagnosed. Diabetes statistics suggest the prevalence rate of prediabetes is 25.9% (impaired fasting glucose and impaired glucose tolerance [IGT]) with 57 million people being affected. The total direct and indirect cost of diabetes in 2007 was 174 billion dollars [3]. The prevalence of obesity and diabetes appears to run parallel to each other, as indicated by the fact that epidemics of obesity and diabetes are parallel in various regions of the United States. For example, the prevalence of obesity has increased from 10% to 14% in 1991 to 20% to 24% in 2001. Similarly, the prevalence of T2DM has increased from 4% to 6% in 1991 to 8% to 10% in 2001 [4].
What is the normal glucose level for a diabetic?
Table 1depicts the 2010 American Diabetes Association (ADA) criteria for diagnosis of glucose tolerance, where fasting blood glucose of less than 100 mg/dL and 2-hour postprandial blood glucose of less than 140 mg/dL are considered within normal range [6]. This table also shows that there are 3 ways to diagnose diabetes: (a) fasting blood glucose of 126 mg/dL or greater; (b) 2-hour postprandial of 200 mg/dL or greater; or (c) random blood glucose of 200 mg/dL or greater with complaint of polyuria, polydipsia, and unexplained weight loss. The diagnosis of diabetes should be confirmed with one additional test to rule out laboratory error, unless the diagnosis is clear on clinical grounds, such as in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis. The diagnosis of IGT includes a 2-hour postprandial of 140 to 199 mg/dL after oral glucose tolerance test (OGTT), while impaired fasting consists of a glucose value of 100 to 125 mg/dL. It is clear that for a diagnosis of IGT, an OGTT should be performed, but in general, a fasting blood glucose greater than 100 mg/dL should alert providers to confirm IGT by an OGTT.
What are the causes of diabetes?
The nonmodifiable causes of diabetes include age, ethnicity, and genetics, whereas the modifiable causes include weight/body mass index, central adiposity, and sedentary lifestyle. The impact of diabetes on US mortality is significant—72 507 deaths in 2006, the seventh leading cause of death, and an additional 233 269 deaths linked to diabetes [3]. Diabetes mellitus is the leading cause of new blindness and chronic renal disease, leading to dialysis and nontraumatic amputation. The severity of carbohydrate intolerance correlates with cardiovascular disease and mortality. Mortality rate in persons with normal glucose tolerance is about 1.2 per 1000 patients, whereas in IGT, mortality is about 2.8/1000 patients, and in T2DM, is about 4 times that of normal glucose-tolerant subjects [5].
Is nutrition therapy good for diabetes?
Medical nutrition therapy , an important component of healthy lifestyle, remains a cornerstone of diabetes prevention and management. Medical nutrition therapy has been shown to accrue sustained reduction in hemoglobin A1cin diabetic patients [13,14] and also improvement in lipid profile and blood pressure in nondiabetic individuals [15,16]. Look AHEAD (Action for Health in Diabetes), an ongoing randomized clinical study investigating the effect of weight loss on cardiovascular end points in people with T2DM, has shown that 1 year of intensive LSM resulted in significant weight loss, as well as improvement in glycemic control and cardiovascular risk factors [17]. The optimum dietary macronutrient composition remains a subject of interest; however, several studies have shown that dietary measures are effective in weight reduction irrespective of the composition (low fat vs low carbohydrate), provided there is adequate energy restriction, reduction in saturated fat to less than 7%, and adequate provision of dietary fiber [18,19]. Although low-fat and low-carbohydrate diets are both effective in producing weight loss, their effect on lipid profile may differ. Low-carbohydrate diet may yield greater reduction in triglyceride with higher improvement in high-density lipoprotein, but with higher low-density lipoprotein levels in comparison to low-fat diet [20]. Lower consumption of total and saturated fat and processed foods, and higher consumption of fibers, whole grains, fruits, and vegetables have been shown to improve glycemic control in patients with diabetes. In clinical trials, nut consumption increases satiety, have a neutral effect on glucose and insulin, and a beneficial effect on lipid profile [21,22] Artificial sweeteners may cause diarrhea; otherwise, they are safe when used according to Food and Drug Administration (FDA) recommendation. Although diabetic subjects may have increased oxidative stress, placebo-controlled trials have not demonstrated any clear benefit attributable to antioxidant supplementation [23].
Is moderate exercise good for T2DM?
Physical activity: Sedentary lifestyle is a powerful but modifiable risk factor for T2DM; therefore, moderate exercise is of utmost benefit in patients with diabetes.
What is the best treatment for diabetes type 2?
The optimal treatment regimen for the patient with type 2 diabetes consists of initial therapy with small doses of 2 insulin sensitizers, metformin and a TZD, with a gradual titration to the maximum or maximally tolerated doses ( Figure 1 ). Because of the possibility of β-cell rejuvenation or preservation with a TZD, this combination of insulin sensitizers may be the only therapy the patient with type 2 diabetes will ever need. However, if β-cell deterioration continues and insulin-sensitizing combination therapy is unable to or no longer able to maintain glycemic control, the addition of a secretagogue is needed. If this triple oral therapy fails to maintain an HbA 1c value of 6.5% or lower, the addition of 1 injection of insulin is needed. With further β-cell decompensation, the addition of ≥1 insulin injection is required. At that time, the patient with type 2 diabetes is approaching the level of insulin depletion characteristic of type 1 diabetes and should be treated accordingly.
Why do diabetics need TZDs?
Despite the ability of TZDs to lower insulin resistance and its associated cardiac risk factors, and despite the antiproliferative and anti-inflammatory properties of TZDs, the most compelling reason to use a TZD in the patient with diabetes is its ability to preserve or improve pancreatic β-cell function.
What insulin is used in triple therapy?
When triple therapy fails, the addition of a subcutaneous insulin injection to the triple therapy regimen is needed to regain glycemic control. A premixed insulin , preferably of rapid-acting insulin with a compatible intermediate-acting insulin (e.g., insulin analogue lispro 75/25 or aspart 70/30 mix), may be administered with the evening meal, or the long-acting insulin glargine may be injected at bedtime. To maximize the potential of these insulins, start with a small dose (0.2 per kg or 10 U) and titrate by 20% increments at intervals of 2 to 3 days until either the fasting plasma glucose value is ≤110 mg/dL or nocturnal or early morning hypoglycemia occurs. This regimen will result in a normal fasting plasma glucose level in the morning, and oral agents will hopefully maintain glycemic control throughout the day.
How do secretagogues release insulin?
All secretagogues cause the release of more insulin at any given plasma glucose level by closing the energy-sensitive potassium channel in the cell membrane of the β-cells. This leads to β-cell depolarization and an influx of calcium, resulting in increased exocytosis and release of insulin. 36, 37 However, the timing of this process varies greatly among secretagogues. At one end of the spectrum, nateglinide binds to and detaches from the sulfonylurea receptor so rapidly that its attachment time cannot be measured. Repaglinide also has a brief attachment period but significant potency. Sulfonylureas such as glimepiride have an attachment time comparable to that of repaglinide. 37 At the other end of the spectrum, first- and second-generation sulfonylureas have a more prolonged attachment to the sulfonylurea receptor, causing a more prolonged release of insulin, and are more likely to be associated with hypoglycemia. 38 In addition, glyburide has been shown to decrease the counterregulatory release of both glucagon from the pancreas and growth hormone from the pituitary gland, which further increases the risk of hypoglycemia. 39
What is the third agent of metformin?
Today, with the paradigm shift away from secretagogues and toward insulin sensitizers as initial therapy for type 2 diabetes, the addition of a third agent is usually a secretagogue and, very rarely, an α-glucosidase inhibitor . α-Glucosidase inhibitors interfere with enzymatic action in the brush border of the small bowel, slowing the breakdown of polysaccharides and disaccharides to glucose and thereby delaying glucose absorption and decreasing postprandial plasma glucose levels. 31 Because α-glucosidase inhibitors lower only postprandial and not fasting plasma glucose levels, the efficacy of these agents is limited to a 0.5% to 1.0% decrease in HbA 1c values. 32, 33 Recently, attention has been focused on the risk associated with postprandial hyperglycemia. The recent Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) trial found that treating patients, who had impaired glucose tolerance, with acarbose was associated with a significant reduction in the risk of cardiovascular disease and hypertension. 34 Postprandial hyperglycemia is associated with an increase in oxidative stress and endothelial dysfunction in healthy individuals, those with impaired glucose tolerance, and patients with diabetes. It has been shown that acarbose, when taken with meals, can blunt this stress. A definite cause-and-effect relation remains to be established. 34 Side effects such as excess flatus due to undigested carbohydrate fermented by bacteria in the large bowel are troublesome to most patients. 31, 32, 33 The small amount of α-glucosidase inhibitors absorbed is completely excreted by the kidneys. However, patients who are renally compromised can attain a 5-times higher peak plasma drug concentration, possibly leading to hepatotoxicity. 34, 35 Therefore, in patients whose serum creatinine concentration is >2.0 mg/dL, α-glucosidase inhibitors should not be used.
Can TZD be used with metformin?
In patients with type 2 diabetes, the most effective way to initiate TZD therapy is in combination with metformin. Even though the United Kingdom Prospective Diabetes Study (UKPDS) showed a decrease in the incidence of cardiac events with metformin use in overweight patients with type 2 diabetes, metformin is a weak insulin sensitizer when compared with a TZD. 1 Furthermore, a comparative study with the TZD troglitazone found that except for a lowering of plasma CRP levels, the improvement in cardiac risk factors seen with metformin use was not statistically significant; conversely, the TZD showed significant improvement in cardiac risk factors, including low plasma HDL-C and high plasma triglyceride levels, hypertension, elevated circulating PAI-1, decreased CRP plasma levels, and endothelial dysfunction. 1
Diagnosis
- Type 2 diabetes is usually diagnosed using the glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. Results are interpreted as follows: 1. Below 5.7% is normal. 2. 5.7% to 6.4% is diagnosed as prediabetes. 3. 6.5% or high…
Clinical Trials
- Explore Mayo Clinic studiestesting new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Lifestyle and Home Remedies
- Careful management of type 2 diabetes can reduce your risk of serious — even life-threatening — complications. Consider these tips: 1. Commit to managing your diabetes.Learn all you can about type 2 diabetes. Make healthy eating and physical activity part of your daily routine. 2. Work with your team.Establish a relationship with a diabetes educator, and ask your diabetes treatment tea…
Alternative Medicine
- Many alternative medicine treatments claim to help people living with diabetes. According to the National Center for Complementary and Integrative Health, studies haven't provided enough evidence to recommend any alternative therapies for blood sugar management. Research has shown the following results about popular supplements for type 2 diabetes: 1. Chromiumsupple…
Coping and Support
- Type 2 diabetes is a serious disease, and following your diabetes treatment plan takes round-the-clock commitment. To meet the demands of diabetes management, you may need a good support network. Anxiety and depression are common in people living with diabetes. Talking to a counselor or therapist may help you cope with the lifestyle changes or stressors that come with …
Preparing For Your Appointment
- Keeping your annual wellness visits enables your health care provider to screen for diabetes and to monitor and treat conditions that increase your risk of diabetes — such as high blood pressure, high cholesterol or a high BMI. If you are seeing your health care provider because of symptoms that may be related to diabetes, you can prepare for your appointment by being ready to answer …