Treatment of Diabetes
Lifestyle, Lifestyle, Lifestyle!– Lifestyle changes are vital to manage diabetes, especially type 2 diabetes. Treatment options are similar for both types 1 and type 2 diabetes, with just a few differences. You may find it helpful to work with a dietitian and a diabetes educator, at least when first diagnosed.
Lifestyle treatment, particularly diet and exercise, is more significant in type 2 diabetes because diet and weight loss can reverse the disease. If you are pre-diabetic, diet and exercise changes may delay. Or they could even completely prevent you from developing diabetes. A diabetic or pre-diabetic who has reversed their illness through lifestyle changes will still tend towards diabetes. Nevertheless, lifestyle changes can significantly reduce your chance of developing diabetic complications.
However, it is important to point out that disease reversal is most commonly seen early in the course of the disease. Lifelong diabetics are unlikely to have disease reversal. Your body’s prolonged exposure to high blood sugars can damage the pancreas. While diet and exercise are still pivotal in managing your diabetes, they are no longer able to reverse the condition when it is that far gone. This is why it is important to take diabetes and pre-diabetes seriously from the onset. Even when medications are not needed, the effort you place into diet and exercise changes can yield a big payoff. In type 1 diabetes, since the cause is an auto-immune process, the disorder is not reversible.
Diet. A consultation with a licensed nutritionist, dietician, or diabetes educator will go a long way toward getting you on the right track. Most insurance plans will cover this service, including Medicaid and Medicare. Remember to be patient with yourself. This is a lifelong journey. It will take time for you to learn and develop a plan that suits you.
Principles of a Diabetic Diet
- Minimize consumption of simple carbohydrates. Simple carbs include sugar and processed foods containing white flour such as bread, tortillas, cookies, cakes, and crackers. Your body converts white flour and other simple carbohydrates very quickly and easily to glucose or sugar. White rice and potatoes also are high in simple carbohydrates (carbs).
- Stick to complex carbohydrates. Complex carbs do not create as much of a spike in your blood glucose levels as the simple carbs do. You do not have to be as restrictive of these carbs as you do for the simple carbohydrates. Complex carbohydrates include whole-grain products, such as brown rice, quinoa, oats, whole wheat flour, beans, fruits, and vegetables. While fruits contain sugar, the amount is low enough to allow you to enjoy them in moderation.
- Eat plenty of fiber. Fiber helps control your blood sugar by slowing the absorption of the carbs that you eat. You will find high fiber content in whole grains, beans, fruits, and vegetables.
- Avoid saturated fat. Saturated fats are most often solid at room temperature. This is the “unhealthy” fat, leading to higher cholesterol levels and a higher risk of heart attacks and strokes. Beef/pork and full-fat dairy products such as whole milk, butter, and many kinds of cheese are high in saturated fats. Meats that have less saturated fat include white poultry and many fishes. Most plant-derived fats are free of saturated fat. For example, oils such as olive and canola oils are more “heart-healthy.” The exceptions are coconut and palm oils, which are the only plant fats that are high in saturated fats.
- Control your weight. If you are overweight, decrease the number of calories you take in overall.
Exercise. It is recommended that you obtain at least 150 minutes of moderate exercise weekly. Moderate exercise is the equivalent of a brisk walk. Another way to judge the intensity of exercise is the “talk test.” Moderate exercise means that you can still talk but should not be able to sing while doing the activity. Talk to your doctor before you start an exercise program, especially if you have any heart problems. If you are unable to do moderate exercise, do what you can within your doctor’s guidelines. Even light exercise is beneficial for many aspects of health, compared to being sedentary.
Adjunctive Management of Diabetes
Besides treating your glucose, many other aspects of your health will take on new meaning. These are some important things to treat besides your glucose levels.
- Blood pressure. Your doctor will monitor your blood pressure and treat it accordingly. Having a diabetes diagnosis may cause your doctor to be more aggressive in treating your blood pressure to reduce your risk of heart attacks and strokes.
- Weight. It is essential to keep your weight in a healthy range to maximize the effectiveness of insulin. Body mass index of 18.5-24.9 kg/m2 is considered healthy. If you are overweight and have type 2 diabetes, a weight loss of even 10 pounds can improve your glucose control.
- Tobacco Use. If you have diabetes, it is imperative that you do not smoke. And if you are a non-smoker-good, don’t start. Finally, if you do smoke, quit. Smoking dramatically increases your risk of diabetic complications, including heart attacks, strokes, kidney failure, and amputations due to damages to your body’s blood vessels caused by smoking.
- Family Planning. If you want to have a child, share your plan with your doctor. Your best chance of a good pregnancy outcome will be in place if your blood sugars are under good or excellent control prior to conceiving. Your medication may need to be changed or adjusted. You should start taking folic acid or prenatal vitamins to reduce the risks to your pregnancy. If you do not want to conceive, speak with your doctor about a contraceptive option that is right for you.
- Foot Care. Your doctor will check your feet periodically and recommend checking your own feet for sores, cuts, or calluses to promptly treat these problems and prevent infection.
- Dental Care. You should see your dentist at least annually as gum disease may be more severe if you have type 1 diabetes or if your type 2 diabetes is poorly controlled.
- Eye Exam. It is important that you see an eye doctor (ophthalmologist or optometrist) at least yearly for a dilated eye exam. This is an exam where the eye doctor puts drops in your eyes to dilate your pupils so they can see your retina better. These yearly exams should start 3-5 years after you are first diagnosed with type 1 diabetes, and in the first year of your diagnosis with type 2 diabetes. This is to check for diabetic retinopathy and treat it early before symptoms develop and to prevent vision loss. The ophthalmologist is a physician who is trained in medicine. The ophthalmologist will have either an M.D. or D.O. after their names. The optometrist has an O.D. designation. Optometrists are able to do a comprehensive eye exam and screen for diseases of the eye. Optometrists can also treat some common eye diseases, but if they find that diabetes is affecting your retina, they will need to refer you to an ophthalmologist for specialty and/or surgical care.
Medications for Treatment of Diabetes
Type 1 diabetes is treated with insulin.
Insulin-Research has shown that early, aggressive insulin therapy with tight control of blood sugar levels leads to long term benefit even decades later in life. At this time, there is no cure for type 1 diabetes outside of a pancreas transplant. And those transplants are exceedingly rare because they have such high risks of complications. If you have type 1 diabetes, you will likely either have a regimen of a once or twice daily long-acting insulin injection along with multiple injections of short-acting insulin at mealtime. Blood glucose monitoring is usually needed frequently to monitor and adjust insulin doses to maintain tight blood sugar levels.
Due to the intensity of this therapy, your doctor may recommend an insulin pump and continuous glucose monitoring. These are devices that have small flexible plastic catheters inserted just under your skin. They are kept in place for multiple days by a special adhesive and deliver continuous insulin and transmit continuous glucose levels. An endocrinologist usually manages this type of intensive insulin therapy. An endocrinologist is a physician who is specially trained in hormonal disorders; they are hormone specialists. Occasionally, the pediatricians, internists, or family doctors may manage your type 1 diabetes. This is less common. Unfortunately, there are no pills that you can take for type 1 diabetes.
Type 2 diabetes medication treatment consists of insulin and/or pills. There are pills that many people with type 2 diabetes can take instead of insulin. However, insulin may still be needed. Sometimes even people who are very careful with diet and exercise can still get to the point where they need insulin therapy. The number of medication options for type 2 diabetes has blossomed in the last several years. If your diabetes is mild, and you are highly motivated, your initial treatment will be with diet and exercise only.
If your diabetes is severe, insulin may be needed. Insulin therapy in type 2 diabetics is less intensive than with type 1 diabetes. Fewer injections are required, and pumps are rarely needed. Some people only need one injection a day of long-acting insulin. However, there are many variations in insulin therapy. You and your doctor will decide.
The most common medication for type 2 diabetes is metformin. Metformin helps to lower blood sugar levels by decreasing the amount of glucose your liver produces. And it helps by decreasing the amount of glucose your intestine absorbs. But it also helps by increasing your body’s sensitivity to insulin. Most medical guidelines recommend metformin as the first medication to use for type 2 diabetes. This is because most people taking metformin do not experience any major side effects. It is generally well-tolerated. Metformin also has low-cost options and good outcome data. Good outcome data means that compared to people who do not take it, metformin is associated with a decreased chance of death and fewer diabetic complications.
Many other diabetic medications, including insulin, do not have this type of outcome data. Some, because they are new, have unknown outcome data as studies are still ongoing. Others, like insulin, seem to be neutral, in that they treat diabetes by lowering your blood sugar. Still, they do not decrease the death rate or complication rate. Metformin can also be used in pre-diabetics.
If you are below age 60, have a history of diabetes in pregnancy and are obese, your doctor may recommend treating your pre-diabetes with metformin. Other medications have been shown to help prevent you from progressing from pre-diabetes to type 2 diabetes. Still, metformin has the most robust evidence and best long-term safety data for this purpose.
Metformin works by:
- decreasing glucose production in the liver
- decreasing amount of glucose absorbed in the intestine
- increasing your body’s ability to use insulin
Metformin’s main potential side effects are gastrointestinal. This includes nausea, vomiting, diarrhea, gassiness, and stomach pain. These side effects are usually avoided or lowered by starting at a low dose and increasing slowly. If you take metformin for a prolonged time, you may be prone to vitamin B12 deficiency and your doctor may monitor you for this with lab work.
Metformin should not be taken if you have moderate to severe kidney disease. Your doctor will monitor your kidney function. Unlike many other diabetic medications, metformin does not lead to weight gain. If you need a medication for type 2 diabetes and cannot take metformin. Or, if metformin does not work for you, your doctor will likely prescribe another class of medication. There are eight other classes of diabetic drugs outside of metformin and insulin. There are no set guidelines on what is the next best medication option. This is due to a lack of adequate studies. Therefore, there is a lot of variation on what is recommended. Consequently, you and your doctor will decide on the best treatment option for you.
Written by: myObMD writing team, June 07, 2020 | Editor: Dayna Smith, MD | Reviewed October 1, 2020 | Copyright: myObMD Media, LLC, 2020
- Autoimmune – Immune disorder-a condition in which your immune system attacks your own body, causing that organ or system to not function properly.
- Chronic – Something that lasts a long time, or something that never goes away.
- Chronic Pain -Pain that persists more than 3 months.
- Diabetic Ketoacidosis – A life-threatening emergency, usually in Type 1 diabetes, where high blood sugar levels and low insulin levels create a dangerous overproduction of acid in the bloodstream
- Endocrinologist – A medical doctor who specializes in disorders of the endocrine, or hormonal system.
- Glucose – AKA blood sugar. Glucose is the main sugar in your body and its main source of energy.
- Glycosylated Hemoglobin (Hb A1C) – simply called an A1C (pronounced A-one-see). The A1C test gives an average measure of your blood sugar over a 2-3-month period.
- Insulin -The hormone that breaks down the sugars you eat so your bodies can use it for energy
- Insulin Pump – Device that have small flexible plastic catheters inserted just under your skin. Kept in place for multiple days by a special adhesive and deliver continuous insulin.
- Internal Organs – The main body parts that are not visible from the outside of your body, such as your kidneys, liver, pancreas, or ovaries.
- Peripheral Neuropathy – A disorder of the nerves of the legs and/or arms, often leading to chronic pain or numbness.
- Retina – The lining of the inside of your eyeball where your vision cells are located.
- Renal Dialysis – Having your blood filtered by a machine that does the job of the kidneys in removing waste and toxins from the body.
- Screening bloodwork – A test that is done to look for a condition before any symptoms are present
- Sedentary lifestyle – Having little to no exercise or other physical activity in your routine
- Sepsis – A severe system-wide reaction to infection that can involve the shutdown of multiple internal organs.
- Vascular Disease – Also known as hardening of the arteries. This causes impaired blood flow to the affected area of your body.
- Steinberg J, Carlson L. Type 2 Diabetes Therapies: A STEPS Approach. Am Fam Physician. 2019 Feb 15;99(4):237-243.
- Pippitt K, Li M, Gurgle H. Diabetes Mellitus: Screening and Diagnosis. Am Fam Physician. 2016 Jan 15;93(2):103-109.
- American Diabetes Association. Standards of Medical Care in Diabetes—2018 Abridged for Primary Care Providers. Clinical Diabetes 2018 Jan; 36(1): 14-37.
- WebMD. What to Eat When you Have Type 1 Diabetes. Reviewed by Ambardekar M 5-11-2019. https://www.webmd.com/diabetes/diet-type-1-diabetes. Accessed 6-2-2020.
- Mayo Foundation for Medical Education and Research. Type 1 diabetes. Available from: https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011. Accessed 5-31-2020.
- Inzucchi SE, Lupsa B. Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults. Mulder, JE, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com. (Accessed on 5-27-2020).
- Wexler D, Initial management of blood glucose in adults with type 2 diabetes mellitus. Mulder, JE, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com. (Accessed on 6-2-2020).
- Levitsky LL, Misra M. Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents . Hoppin AG, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com. (Accessed on 5-27-2020).
- Centers for Disease Control and Prevention. Measuring Physical Activity. https://www.cdc.gov/physicalactivity/basics/measuring/index.html#:~:text=Moderate%20Intensity,%2C%20but%20not%20race%2Dwalking). Accessed 6-2-2020.
- Metformin: Generic. Epocrates Online. https://online.epocrates.com/drugs/787/metformin. Accessed 6-2-2020
- Berger JS, Newman JD. Overview of peripheral artery disease in patients with diabetes mellitus. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com. (Accessed on 9-19-2020).