Diabetes Treatment
Medical Author:
Ruchi Mathur, MD
Medical Editor:
William C. Shiel, Jr., MD, FACP, FACR and
Jay W. Marks, MD
How is diabetes treated?
The major goal in treating diabetes is to minimize any elevation of blood
sugar (glucose) without causing abnormally low levels of blood sugar. Type 1
diabetes is treated with insulin, exercise, and a
diabetic diet. Type 2 diabetes
is treated first with weight reduction, a diabetic diet, and exercise. When
these measures fail to control the elevated blood sugars, oral medications are
used. If oral medications are still insufficient, treatment with insulin is
considered.
Adherence to a diabetic diet is an important aspect of controlling elevated
blood sugar in patients with diabetes. The American Diabetes Association (ADA)
has provided guidelines for a diabetic diet. The ADA diet is a balanced,
nutritious diet that is low in fat, cholesterol, and simple sugars. The total
daily calories are evenly divided into three meals. In the past two years, the
ADA has lifted the absolute ban on simple sugars. Small amounts of simple sugars
are allowed when consumed with a complex meal. For more, please read the
Diabetic Diet article.
Weight reduction and exercise are important treatments for diabetes. Weight
reduction and exercise increase the body's sensitivity to insulin, thus helping
to control blood sugar elevations. For more, please read the Weight Loss and
Fitness articles.
Medications for type 2 diabetes
WARNING: All the information below applies to patients who are not pregnant
or breastfeeding. At present the only recommended way of controlling diabetes in
women who are pregnant or breastfeeding is by diet, exercise and insulin
therapy. You should speak with your doctor if you are taking these medications
and are considering becoming pregnant or if you have become pregnant while
taking these medications.
Based on what is known, medications for type 2 diabetes are designed to:
- Increase the insulin output by the pancreas.
- Decrease the amount of glucose released from the liver.
- Increase the sensitivity (response) of cells to insulin.
- Decrease the absorption of carbohydrates from the intestine.
- Slow emptying of the stomach to delay the presentation of carbohydrates
for digestion and absorption in the small intestine.
When selecting therapy for type 2 diabetes, consideration should be given to:
- The magnitude of change in blood sugar control that each medication will
provide.
- Other coexisting medical conditions (high blood pressure, high
cholesterol, etc.)
- Adverse effects of the therapy
- Contraindications to therapy
- Issues that may affect compliance (timing of medication, frequency of
dosing)
- Cost to the patient and the healthcare system
It's important to remember that if a drug can provide more than one benefit
(lower blood sugar and have a beneficial effect on cholesterol, for example), it
should be preferred. It's also important to bear in mind that the cost of drug
therapy is relatively small compared to the cost of managing the long-term
complications associated with poorly controlled diabetes.
Varying combinations of medications also are used to correct abnormally
elevated levels of blood glucose in diabetes. As the list of medications
continues to expand, treatment options for type 2 diabetes can be better
tailored to meet an individuals needs. Not every patient with type 2 diabetes
will benefit from every drug, and not every drug is suitable for each patient.
Patients with type 2 diabetes should work closely with their physicians to
achieve an approach that provides the greatest benefits while minimizing risks.
Patients with diabetes should never forget the importance of diet and
exercise. The control of diabetes starts with a healthy lifestyle regardless of
what medications are being used.
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