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Saturday, November 21, 2009
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Saturday, November 21, 2009
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Depending on how advanced a case of diabetes may be affects how it is treated. Some diabetics may control their glucose levels with medication where others may control it with insulin injections. Regardless of how glucose is controlled, effectively treating diabetes starts with a dramatic lifestyle change, including the following:
The treatment of diabetes (Types 1 and 2) begins with diet and exercise. It is not about what a diabetic can't eat, but about eating a well-balanced diet to ensure the body is well fueled. It is not about a requirement to go to the gym and exercise, but rather about getting into good physical shape, increasing activity, and setting health goals for weight and nutrition. A well balanced diet combined with exercise works to make the body work as efficiently as possible.
In some cases, changes in diet and exercise patterns are enough to take the extra stress off the pancreas and diabetes can be brought completely under control. In other cases, a good diet and exercise goes great lengths to bring glucose levels under better control and the rest can be supplemented with drug therapies.
Diabetic Diet
The American Diabetes Association recommends diabetics break their diet into the following:
- 50% carbohydrates
- 20% proteins
- Less than 30% fats
A good diabetic diet is really no different than a good diet of a non-diabetic. It is complete with ample amounts of:
- Fruits and veggies
- Whole grains and beans
- Dairy products
- Lean meats, poultry, and fish
Other considerations in developing a diabetic diet include the following:
- Magnesium is a useful vitamin to guard against the progression of Type 2 diabetes
- Unsaturated fats found in oils should be favored over saturated fats in butter, lard, or red meats
- Sugary foods such as baked goods do not need to be avoided entirely, but should be reserved for special occasions and always consumed in moderation
Consistency is key in a diabetic diet. Skipping or delaying meals can have drastic effects on blood glucose levels. Overindulging can have similar effects. Chosen carefully, a diabetic can enjoy the same meals as the rest of his or her family.
Exercise for Diabetics
A reasonable exercise goal is 30 minutes a day of aerobic exercise. Exercise will have wide ranging effects across the body, including an increased ability to control blood glucose levels.
Although exercise is essential for health and well-being, often other activities are put ahead of it on the never-ending "to do" list. Common barriers are time, money, child care or transportation. However, exercise can be incorporated into daily life in the form of small bursts of time and it does not require lots of money to achieve good results. Some easy was to get more exercise include:
- Parking further from the door at school or a shopping center
- Doing a stepper or using free weights while watching TV
- Taking the stairs instead of the elevator
Ideally, maximal benefit occur with intensive, prolonged activity, but more recent studies indicate that smaller increments of less intense activity can lead to health benefits as well.
Be aware of glucose levels. Diabetics must take care when changing exercise patterns as a sudden change can destabilize blood sugar levels. When starting exercise glucose levels need to be monitored more frequently to observe responses to increased activity. Food intake, as well as insulin and oral medications, must be matched with current exercise levels.
There are classes of drugs that help the body to perform specific steps that it naturally uses manage glucose levels. These medications can tell the pancreas to produce more insulin and or the cells to respond better to the insulin, but the problem is much more complex than taking a pill.
Just because insulin production can be increased with drugs, this treatment will only work for a limited amount of time. Eventually, the pancreas will wear out and the body will require insulin injections to function.
Insulin Secretagogues are a class of drugs, also known as sulfonylureas, work by making the pancreas release more insulin. They are taken before meals and must be taken in proportion to the amount of food to be eaten. There is a danger of a hypoglycemic, or low blood sugar reaction, if too much medicine is taken.
Symptoms of low blood sugar include:
If these symptoms occur, blood sugar levels should be tested, and if low, something high in sugar should be eaten to raise the levels before they become dangerously low.
Medicines in this class include glyburide (Diabeta and Micronase), glipizide (Glucotrol), glimepiride (Amaryl), repaglinide (Prandin), and nateglinide (Starlix).
Meglitinides are a similar class of drugs that signal the pancreas to produce more insulin. They act by a slightly different mechanism than sulfonylureas and are much faster acting. They are taken within a half hour of meals, usually three times a day and must always be taken with food.
Insulin Sensitizers are a class of drugs, also know as thiazolidinediones. They act by making the body cells more sensitive to insulin. Drugs included in this class include metformin (Glucophage) and a sub-class called glitazones, containing pioglitazone (Avandia) and rosiglitiazone (Actos).
Metformin can have a dangerous side affect called lactic acidosis brought on by dehydration. Patients prone to dehydration because of a current or chronic condition should not use it. The glitazones can be very expensive, but tend to be very well tolerated by patients. They are not given to patients with congestive heart failure or active liver disease.
Glucose Absorption Inhibitors are also know as alpha-glucosidase inhibitors. They work in the digestive system to slow the digestion and absorption of carbohydrates. This decreases the jump in glucose levels associated with meals. Side effects including gas, bloating, and diarrhea can be minimized by slowly increasing the dosage to reach an effective level.
Biguanides are taken several times a day with meals. These drugs work to decrease the amount of glucose produced in the liver.
The classes of drugs above can be used individually or in combination with one another. When the diabetes reaches a level where treatment with these drugs is not strong enough to control sugar levels, insulin may be added to the treatment regimen.
In Type 1 diabetes and advanced Type 2 diabetes, insulin is required for glucose management. It's important to note that insulin treatment isn't failure. Some Type 2 diabetics may feel as though they've failed by having to use insulin, but this is not the truth. Every case is different and each patient responds in different ways to treatment.
The natural course of diabetes is for a progression to where the pancreas wears out and insulin is required. How fast the pancreas wears out is dependent on a variety of factors, including weight, diet, genetics, and glucose control.
About Insulin
Insulin must be injected. There are various ways to achieve this.
- Syringe – A needle injection, much like any other shot
- Insulin Pen – A device holding one or more pre-measured does of insulin, shaped like a pen and works much like a syringe
- Insulin Pump – A pump similar in size to a cell phone and worn on the body that can be programmed to inject a precise amount of insulin at certain times of day according to the patient's needs
Insulin comes in several varieties and is tailored to the specific needs of the patient.
- Rapid acting insulin has a peak effect in 1-2 hours and lasts for 4-6 hours.
- Short acting insulin has a peak effect from 2-4 hours and lasts for 6-8 hours.
- Intermediate and Lantus insulins have an even longer effective time up to a stable insulin level for 24 hours after injection with lantus insulin.
Millions of Americans have managed to control their diabetes and live very normal lives. Working with a team of healthcare professionals and never being afraid to ask questions or discuss treatment options, one can make the most of the situation. Diabetes isn't just about survivingthe disease. It can be a tremendous opportunity to adopt a healthy lifestyle and thrive.
This article is a NetWellness exclusive. 
Last Reviewed: Sep 08, 2006
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Robert M. Cohen, MD Associate Professor Division of Endocrinology and Metabolism Department of Internal Medicine College of Medicine University of Cincinnati |
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Laurie Sadler, MD Medical Director and Assistant Professor Center for Vascular Health St. Vincent Charity Hospital School of Medicine Case Western Reserve University |
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