Type 2 Diabetes is a metabolic disorder that causes sugar in the form of glucose to accumulate in the blood, rather than being used as fuel in our body. The goal of Type 2 Diabetes treatment is to safely keep blood sugar within the normal range.
Normal ranges:
- 90 – 130 mg/dL fasting blood glucose
- HbA1c of 6.5 – 7%
- 2 hours post-meal <180mg/dL
Treatment and Management of Type 2 Diabetes: Diet + Exercise + Weight Loss
Improving diet and exercising regularly are important parts of the treatment and management of Type 2 Diabetes. In overweight or obese individual, weight loss can often return glucose levels to normal, if it occurs early. Exercising, on the other hand, decreases the resistance of the cells to the action of insulin, making it easier for glucose to enter the cells from the bloodstream. This benefit of exercise occurs even when there is no apparent weight loss.
Treatment and Management of Type 2 Diabetes: Medications
If a controlled diet, weight loss, and regular exercise habits do not reduce the blood glucose level, then medications will be the next step to control glucose level. There are a variety of oral and injectable medications used to treat Type 2 Diabetes. Most people with Type 2 Diabetes are initially prescribed Metformin. Metformin blocks the production of glucose by the liver. Metformin also decreases the resistance of cells to insulin, making it easier for the cells to take up glucose from the bloodstream. Next in line are usually Sulfonylureas or DPP-IV inhibitors. Like Metformin, Sulfonylureas are inexpensive and effective. They work by increasing the insulin release and production by the pancreas. However, they may cause hypoglycemia. Hypoglycemia occurs when the blood glucose level drops too low. It is important for people with Type 2 Diabetes who are on such medications to recognise the symptoms of hypoglycemia.
Hypoglycemia symptoms:
- Shakiness
- Sweating
- Palpitations
- Weakness
- Confusion
- Fainting
- Loss of consciousness
Incretin hormones (GIP, GLP-1) are important chemicals secreted by the gut in response to meals and have important anti-diabetic effects. They work by slowing the emptying of the stomach and decreasing appetite, so you feel full longer. They also work by increasing insulin secretion, improving insulin sensitivity, and decreasing glucose production. In Diabetes, the incretin levels are reduced. There are two types of medications that work to improve the level of incretins in the body. The oral DPP-IV inhibitors (Linagliptin, Sitagliptin, Saxagliptin etc) and the injectable GLP-1 analogues. The DPP-IV inhibitors prevent the breakdown of incretin hormones to increase their anti-diabetic effects, aside from increasing insulin production and making cells more sensitive to insulin. They have fewer side effects, including a lower risk of developing hypoglycemia. The injectable GLP-1 analogues replace the incretins directly. They also slow down the movement of food through the digestive tract so you feel fuller for a longer time. They improve insulin secretion, promote weight loss, and have a lower risk of hypoglycemia. Thiazolidinediones (TZD) are another class of oral antidiabetic medication. They work by making the cells more sensitive to insulin and decreasing the production of glucose by the liver. They do not cause hypoglycemia, but they may cause weight gain.
Other types of oral antidiabetic agents include:
- SGLT-2 inhibitors: Blocks glucose reabsorption in kidneys
- Alpha-glucosidase inhibitors: Slows release of sugar into the bloodstream
- Bromocriptine
- Colesevelam
Treatment and Management of Type 2 Diabetes: Insulin
Over time, medications become less effective. Rather than switching a medication, your doctor may combine two different ones that have been shown to work well together. If your blood glucose cannot be controlled by oral medications alone, your doctor may start you on insulin. Insulin is the most common injectable medication used to treat diabetes. In general, there are two types of insulin; long-acting or basal insulin, and short-acting or meal-time insulin. An insulin pump can be used in Type 2 Diabetes, to deliver insulin just like the pancreas.
Treatment and Management of Type 2 Diabetes: Lifestyle modification
A healthy diet, exercise and maintaining a healthy body weight are important aspects of diabetes management, even if you are on medications. You should develop a self-management plan with your doctor and other healthcare professionals such as dieticians or certified professionals. Your plan should include eating healthy food and incorporating regular moderate exercise into your lifestyle. Important dietary interventions specific to diabetes include reducing sugars, starches and fatty foods. Strategies to reduce stress at work, getting adequate sleep, and managing depression, if present, are also important.
Summary: Treatment and Management of Type 2 Diabetes
In short, Type 2 Diabetes is treated by a combination of diet, exercise, and medication. A variety of drugs are available to treat diabetes. However, self-management through lifestyle plays the most important role.
REFERENCES
- https://care.diabetesjournals.org/content/43/Supplement_1/S98
- http://mems.my/wp-content/uploads/2021/01/CPG_T2DM_6thEdition_2020.pdf
- https://emedicine.medscape.com/article/117853-treatment
