The successful treatment of type 2 diabetes depends on a variety of treatment modalities, not least of which is good lifestyle choices. These include weight control, regular exercise, regular monitoring, and compliance with an approved diabetic diet. Other measures include the regulation of blood sugar using oral diabetes medications, and less commonly, insulin.
Basic goals for treating type 2 diabetes:
- Maintain a healthy weight.
- Maintain a healthy level of physical activity
- See your doctor about an exercise program
- Maintain the blood glucose level between 70 and 140 mg/dl:
- Fasting blood sugars should be less than 100 mg/dl.
- Glycosylated hemoglobin levels should remain less than 7%. In some cases, your doctor may suggest a level less than 6.5%.
Treatment options for type 2 diabetes include:
- Diabetes diet:
- Balanced diet that limits the risk of obesity
- Medication for type 2 diabetes:
- Oral hypoglycemic medications
- Sometimes diabetes can be controlled with a single medication, but occasionally a combination of medicines is required.
- Exercise program
- Weight loss for those who are overweight
- Blood glucose monitoring:
- Monitoring helps direct changes in diet and medication dose
- Treatment for illnesses that occur more commonly with diabetes:
- Provide adequate calories for maintaining a normal adult weight.
- Provide adequate calories for pregnancy and breastfeeding.
- Maintain normal blood glucose levels:
- Balance food intake with your physical activity level.
- Diet and insulin doses must be adjusted as activity levels change.
- Maintain normal:
Treatment for type 2 diabetes requires one or more oral medications to control blood sugar levels. Those with type 2 diabetes, who do not improve on oral medications, also require treatment with insulin.
Oral medications for type 2 diabetes:
- Alpha-glucosidase inhibitors
- Amylin mimetics
- Incretin mimetics
- Liraglutide (Victoza)
- Self injector pen
- Gliptin and biguanide combination:
- Meglitinide and biguanide combination:
AODM Amylin Mimetics
Amylin mimetics have the same actions as amylin, a protein that is normally produced by the pancreas. Amylin slows down the movement of food through the intestine. This slows down the absorption of glucose from the intestine, which reduces sudden increases in blood glucose.
An example of an amylin mimetic is:
Actions of biguanide medication include:
- Reduce the amount of glucose produced by the liver
- Reduce the amount of glucose absorbed from food through the stomach
- Makes the insulin that the body produces work more efficiently
An example of a biguanide includes:
Metformin is commonly combined with another medication, for those whose blood sugar is not adequately controlled on metformin alone:
Actions of gliptins include:
- Lower blood sugar levels after a meal
- Improve insulin levels produced by the body after a meal.
- Decrease the amount of sugar that is made by the body.
The most common side effects reported from this new class of drugs is sore throat, upper respiratory infection, and diarrhea.
AODM Glucosidase Inhibitors
Alpha-glucosidase inhibitors block the actions of enzymes in the small intestine. These enzymes allow the body to absorb sugars from the intestine. Treatment with an alpha-glucosidase inhibitor prevents the body from absorbing sugar from the intestine.
Examples of alpha-glucosidase inhibitors include:
AODM Incretin Mimetics
Insulin therapy is the primary treatment for type 1 diabetes. It may also be used in type 2 diabetes when blood sugar levels cannot be adequately controlled with oral medications.
Insulin reduces sugar levels in the bloodstream by stimulating the body to utilize glucose for energy. Insulin is given by injection, or through an automatic insulin pump. Both methods require regular blood sugar measurements, in order to monitor therapy.
Insulin pumps are small devices that that deliver insulin through a tiny needle placed in the skin. This provides a constant dose of short-acting insulin at all times. The pump can be adjusted to release extra insulin before a meal.
Insulin injection therapy involves injections of short, intermediate, or long-acting insulin, at different times of the day. Insulin injections may be given 2 to 4 times per day. Insulin doses vary, depending on a person's size, blood sugar level, caloric intake and activity.
A sliding scale is an individualized program that allows short-acting insulin to be given when blood sugar levels become too high. Such a program can be individualized for each person.
Example of Sliding Scale Insulin Dosing
|Glucose Reading||Regular Insulin Dosing|
|140 - 160||2 units, re-check glucose in 2 hrs|
|200 - 240||4 units, re-check glucose in 2 hrs|
|240 - 300||6 units, re-check glucose in 2 hrs|
|300 - 400||8 units, re-check glucose in 2 hrs|
|400 - 500||10 units, re-check glucose in 2 hrs|
|> 500||See doctor now!|
Check with your doctor for specific adjustments in sliding scale doses. Your sliding scale dose will vary with your weight, diet, level of activity, and sensitivity to insulin.
Meglitinides stimulate cells in the pancreas to produce more insulin. In turn, the insulin reduces sugar levels in the bloodstream by stimulating the body to utilize glucose for energy.
Examples of meglitinides include:
Sulfonylureas stimulate cells in the pancreas to produce more insulin. In turn, the insulin reduces sugar levels in the bloodstream by stimulating cells in the body to utilize glucose for energy. Sulfonylureas may also cause cells to be more responsive to the effects of insulin.
Examples of sulfonylureas include:
Insulin reduces sugar levels in the bloodstream by stimulating cells in the body to utilize glucose for energy. Thiazolidinediones cause cells to be more responsive to the effects of insulin.
Examples of thiazolidinediones include:
Exercise, along with good nutrition and medication, helps keep type 2 diabetes under control. Exercise usually lowers blood sugar and helps insulin work more effectively. If you are overweight, exercise can also help you lose weight.
Regular exercise also provides cardiovascular benefits. This is particularly important for the diabetic, who has 2 to 4 times the incidence of heart disease. Benefits of exercise include improved endurance, lower LDL cholesterol and triglycerides, and increased levels of protective HDL cholesterol.
Remember to monitor blood glucose levels before and after exercise. Try to perform exercise the same time of day when possible. Always wear a bracelet, identifying you as diabetic. Develop an exercise program with your doctor.
AODM Questions For Doctor
The following are some important questions to ask before and after the treatment of type 2 diabetes.
Questions to ask before treatment:
- What are my treatment options?
- Do I need to take medication?
- Do I need to take insulin?
- When do I take insulin?
- What are the risks associated with treatment?
- Do I need to stay in the hospital?
- How long will I be in the hospital?
- What are the complications I should watch for?
- How long will I be on medication?
- What are the potential side effects of my medication?
- Does my medication interact with nonprescription medicines or supplements?
- Should I take my medication with food?
Questions to ask after treatment:
- How do I change my diet?
- What is a type 2 diabetes diet?
- Do I need to lose weight?
- Are there any medications or supplements I should avoid?
- When can I resume my normal activities?
- When can I return to work?
- Do I need a special exercise program?
- How often do I need to measure my blood sugar?
- When should measure my blood sugar?
- What else can I do to reduce my risk for complications?
- How often will I need to see my doctor for checkups?
- How often will I need tests to evaluate my diabetes?
- What local support and other resources are available?
AODM Regular Monitoring
Type 2 diabetes monitoring should include:
Continue to AODM Home Care
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- Lebovitz HE. Type 2 diabetes: an overview. Clin Chem. 1999 Aug;45(8 Pt 2):1339-45. 
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- Patja K, Jousilahti P, Hu G, Valle T, Qiao Q, Tuomilehto J. Effects of smoking, obesity and physical activity on the risk of type 2 diabetes in middle-aged Finnish men and women. J Intern Med. 2005 Oct;258(4):356-62. 
- Ratner RE. Type 2 diabetes mellitus: the grand overview. Diabet Med. 1998;15 Suppl 4:S4-7.