Diabetes
management
Diabetes mellitus is a chronic
disease, for which there is no known cure except in very specific situations.
Management concentrates on keeping blood sugar levels as close to normal,
without causing low blood sugar. This can usually be accomplished with a
healthy diet, exercise, weight loss, and use of appropriate medications
(insulin in the case of type 1 diabetes; oral medications, as well as possibly
insulin, in type 2 diabetes).
disease, for which there is no known cure except in very specific situations.
Management concentrates on keeping blood sugar levels as close to normal,
without causing low blood sugar. This can usually be accomplished with a
healthy diet, exercise, weight loss, and use of appropriate medications
(insulin in the case of type 1 diabetes; oral medications, as well as possibly
insulin, in type 2 diabetes).
Learning about the disease and
actively participating in the treatment is important, since complications are
far less common and less severe in people who have well-managed blood sugar
levels.The goal of treatment is an HbA1C level of 6.5%, but should not be lower
than that, and may be set higher.
Attention is also paid to other health problems that may accelerate the
negative effects of diabetes. These include smoking, elevated cholesterol
levels, obesity, high blood pressure, and lack of regular exercise. Specialized
footwear is widely used to reduce the risk of ulceration, or re-ulceration, in
at-risk diabetic feet. Evidence for the efficacy of this remains equivocal,
however.
actively participating in the treatment is important, since complications are
far less common and less severe in people who have well-managed blood sugar
levels.The goal of treatment is an HbA1C level of 6.5%, but should not be lower
than that, and may be set higher.
Attention is also paid to other health problems that may accelerate the
negative effects of diabetes. These include smoking, elevated cholesterol
levels, obesity, high blood pressure, and lack of regular exercise. Specialized
footwear is widely used to reduce the risk of ulceration, or re-ulceration, in
at-risk diabetic feet. Evidence for the efficacy of this remains equivocal,
however.
Diabetic
diet
diet
People with diabetes can benefit
from education about the disease and treatment, good nutrition to achieve a
normal body weight, and exercise, with the goal of keeping both short-term and
long-term blood glucose levels within acceptable bounds. In addition, given the
associated higher risks of cardiovascular disease, lifestyle modifications are
recommended to control blood pressure
from education about the disease and treatment, good nutrition to achieve a
normal body weight, and exercise, with the goal of keeping both short-term and
long-term blood glucose levels within acceptable bounds. In addition, given the
associated higher risks of cardiovascular disease, lifestyle modifications are
recommended to control blood pressure
Anti-diabetic
medication
medication
Medications used to treat
diabetes do so by lowering blood sugar levels. There are a number of different
classes of anti-diabetic medications. Some are available by mouth, such as
metformin, while others are only available by injection such as GLP-1 agonists.
Type 1 diabetes can only be treated with insulin, typically with a combination
of regular and NPH insulin, or synthetic insulin analogs.
diabetes do so by lowering blood sugar levels. There are a number of different
classes of anti-diabetic medications. Some are available by mouth, such as
metformin, while others are only available by injection such as GLP-1 agonists.
Type 1 diabetes can only be treated with insulin, typically with a combination
of regular and NPH insulin, or synthetic insulin analogs.
Metformin is generally
recommended as a first line treatment for type 2 diabetes, as there is good
evidence that it decreases mortality. It works by decreasing the liver's
production of glucose. Several other groups of drugs, mostly given by mouth,
may also decrease blood sugar in type II DM. These include agents that increase
insulin release, agents that decrease absorption of sugar from the intestines,
and agents that make the body more sensitive to insulin. When insulin is used
in type 2 diabetes, a long-acting formulation is usually added initially, while
continuing oral medications. Doses of insulin are then increased to effect.
recommended as a first line treatment for type 2 diabetes, as there is good
evidence that it decreases mortality. It works by decreasing the liver's
production of glucose. Several other groups of drugs, mostly given by mouth,
may also decrease blood sugar in type II DM. These include agents that increase
insulin release, agents that decrease absorption of sugar from the intestines,
and agents that make the body more sensitive to insulin. When insulin is used
in type 2 diabetes, a long-acting formulation is usually added initially, while
continuing oral medications. Doses of insulin are then increased to effect.
Since cardiovascular disease is a
serious complication associated with diabetes, some have recommended blood
pressure levels below 130/80 mmHg. However, evidence supports less than or
equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional
benefit found for blood pressure targets beneath this range was an isolated
decrease in stroke risk, and this was accompanied by an increased risk of other
serious adverse events. A 2016 review found potential harm to treating lower
than 140 mmHg. Among medications that lower blood pressure, angiotensin
converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while
the similar medications angiotensin receptor blockers (ARBs) do not. Aspirin is
also recommended for people with cardiovascular problems, however routine use
of aspirin has not been found to improve outcomes in uncomplicated diabetes.
serious complication associated with diabetes, some have recommended blood
pressure levels below 130/80 mmHg. However, evidence supports less than or
equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional
benefit found for blood pressure targets beneath this range was an isolated
decrease in stroke risk, and this was accompanied by an increased risk of other
serious adverse events. A 2016 review found potential harm to treating lower
than 140 mmHg. Among medications that lower blood pressure, angiotensin
converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while
the similar medications angiotensin receptor blockers (ARBs) do not. Aspirin is
also recommended for people with cardiovascular problems, however routine use
of aspirin has not been found to improve outcomes in uncomplicated diabetes.
Surgery
A pancreas transplant is
occasionally considered for people with type 1 diabetes who have severe
complications of their disease, including end stage kidney disease requiring
kidney transplantation.
occasionally considered for people with type 1 diabetes who have severe
complications of their disease, including end stage kidney disease requiring
kidney transplantation.
Weight loss surgery in those with
obesity and type two diabetes is often an effective measure. Many are able to
maintain normal blood sugar levels with little or no medications following
surgery and long-term mortality is decreased. There however is some short-term
mortality risk of less than 1% from the surgery.The body mass index cutoffs for
when surgery is appropriate are not yet clear. It is recommended that this
option be considered in those who are unable to get both their weight and blood
sugar under control.
obesity and type two diabetes is often an effective measure. Many are able to
maintain normal blood sugar levels with little or no medications following
surgery and long-term mortality is decreased. There however is some short-term
mortality risk of less than 1% from the surgery.The body mass index cutoffs for
when surgery is appropriate are not yet clear. It is recommended that this
option be considered in those who are unable to get both their weight and blood
sugar under control.
Support
In countries using a general
practitioner system, such as the United Kingdom, care may take place mainly
outside hospitals, with hospital-based specialist care used only in case of
complications, difficult blood sugar control, or research projects. In other
circumstances, general practitioners and specialists share care in a team
approach. Home telehealth support can be an effective management technique.
practitioner system, such as the United Kingdom, care may take place mainly
outside hospitals, with hospital-based specialist care used only in case of
complications, difficult blood sugar control, or research projects. In other
circumstances, general practitioners and specialists share care in a team
approach. Home telehealth support can be an effective management technique.
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