This topic is for adults
who have had type 2 diabetes for more than a few months. Before reading this
topic, you may want to read Type 2 Diabetes: Recently Diagnosed.
If this topic does not answer your questions, see:
Type 2 Diabetes, if you want to learn about type 2
diabetes but do not have the disease.
Type 2 diabetes is a lifelong
disease that develops when the
pancreas cannot produce enough
insulin or when the body's tissues become
resistant to insulin. Insulin is a hormone that helps
the body's cells use sugar (glucose) for energy. It also helps the body store
extra sugar in muscle, fat, and liver cells.
How can you manage diabetes?
You play a major
role in managing your diabetes. The most important thing is to control your
blood sugar. To do this:
Eat a balanced diet. If you are overweight,
reduce your calorie intake to lose some weight. Losing as little as 10 to 20
pounds can improve your blood sugar levels. There are many ways to manage how
much and when you eat. Your doctor, a diabetes educator, or a dietitian can
help you find a plan that works for you.
Exercise regularly. Try to do
moderate activity at least 2½ hours a week. One way to
do this is to be active 30 minutes a day, at least 5 days a week. Exercise
helps control your blood sugar by using glucose for energy during and after
activity. It also helps you stay at a healthy weight; lower
high cholesterol; raise
HDL, or "good," cholesterol; and lower
high blood pressure.
Take your medicine
or insulin as directed, if prescribed by your doctor.
Check your
blood sugar levels regularly, as advised by your doctor.
The goal is to keep your blood sugar in a target range.
You and your doctor may decide to keep your blood sugar as close to normal as
possible. This is called tight control. It's the best way to reduce your chance
of having more problems from diabetes. These are called complications.
Taking care of your diabetes takes time and energy every day. But it will
help you feel better and may prevent, or at least delay, complications.
How can you deal with high and low blood sugar?
Even when you are careful and do all the right things, you can have
problems with high or low blood sugar. It is important to know what signs to
look for and what to do if this happens.
High blood sugar(hyperglycemia) usually happens over a few days or weeks.
Early symptoms include:
Feeling very thirsty.
Urinating
more often than usual.
Feeling very hungry.
Having
blurred vision.
People with diabetes can get high blood sugar for many
reasons, including not taking their diabetes medicines, eating more than usual
(especially sweets), not exercising, or being sick or under a lot of stress. If
you have high blood sugar, follow your treatment plan for lowering it. This may
mean taking missed doses of insulin or medicine. Call your doctor if you don't
know what to do. Treating high blood sugar is important. If it is left
untreated, it can lead to
hyperosmolar state, a dangerous condition.
You can get low blood sugar (hypoglycemia) if you
take insulin or a sulfonylurea pills for diabetes. It can happen suddenly.
Early symptoms include:
Sweating.
Feeling
weak.
Feeling shaky.
Feeling very hungry.
Symptoms of low blood sugar may vary over time. You may
also have these symptoms if you have a sudden large drop in blood sugar, even
though the level does not drop below the normal or near-normal range. Eat 1
tablespoon of sugar, ½ cup of orange juice, or another carbohydrate. Wait 15
minutes, and then check your blood sugar.
What are the complications of diabetes and their symptoms?
Over time, high blood sugar can cause complications
such as problems with your
eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes
you more likely to get serious illnesses or infections. Complications can lead
to blindness, kidney failure, removal of a limb (amputation),
heart attack,
stroke, and death. This is why it is so important to
keep your blood sugar in your target range.
If you had the disease
several years before you were diagnosed, you may already have a complication
from diabetes. Even if you don't have problems now, the longer you have
diabetes, the more likely you are to get one or more complications.
Be sure to tell your doctor if you notice any new symptoms, such as chest
pain, numbness, or a shooting pain in your hands or feet.
How can you prevent complications?
You may be able
to prevent, or at least delay, problems from diabetes by keeping your blood
sugar level as close to normal as you can. Treatment of high blood pressure or
high cholesterol can also help. If you smoke, quit. Smoking increases your risk
for complications.
If you are age 40 or older, talk to your doctor
about whether to take a low-dose aspirin each day to help prevent heart attack,
stroke, or other large blood vessel disease. People with diabetes are 2 to 4
times more likely than people who don't have diabetes to die from heart and
blood vessel diseases.1
See your doctor
every 3 to 6 months. During these visits, your doctor will review your
treatment and do tests and exams to see if your blood sugar is staying within
your target range and if you have any complications. It's also important to
have regular checkups with your eye doctor and dentist. Diabetes can cause
vision and dental problems.
Will your treatment change over time?
The goal of
treatment is to always keep your blood sugar as close to your target range as
you can. At first, you may be able to treat diabetes with diet and exercise
alone. At some point, you may need to use insulin or take pills to control your
diabetes.
You always need to:
Eat a balanced diet with enough calories to
help you stay at a healthy weight. If you are overweight, reduce your calorie
intake to lose some weight.
Get regular exercise.
Check your blood sugar
regularly during the day, as advised by your doctor.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.
Decision Points focus on key medical care decisions that are important to many health problems.
Even with careful
treatment for
type 2 diabetes, you may experience periods of high
and low blood sugar.
High blood sugar may
develop if you:
Skip a dose of your oral medicine for diabetes
or skip a required dose of
insulin.
Eat too much.
Are
feeling a lot of emotional stress or are ill (such as with a severe case of the
flu) or have an infection, especially if you are not eating or drinking
enough.
If you take insulin, you may have some mornings when your
blood sugar level is very high. This could happen because of the
Somogyi effect. Talk with your health professional if
this occurs.
Low blood sugar is not likely
to develop unless you take insulin or some
oral medicines for type 2 diabetes. Low blood sugar
may develop if you:
Take too many doses of your oral medicine in a
day, take the doses too close together, or take your full dose of medicine when
you are not going to eat your usual amount of food.
Exercise too
much without eating enough food.
Skip a meal.
Drink too
much alcohol, especially on an empty stomach.
Because you have
type 2 diabetes, you should learn to recognize and
treat
symptoms of high blood sugar, which include increased
thirst, frequent urination, and blurred vision. High blood sugar usually
develops slowly over hours or days, so you can treat your symptoms before they
become severe and require medical attention.
Low blood sugar
If you take
insulin or
oral diabetes medicines, such as glipizide
(Glucotrol), glimepiride (Amaryl), or glyburide (DiaBeta, Glynase, or
Micronase) you may experience low blood sugar (hypoglycemia). Glyburide stays
in the body longer, so it is more likely than other medicines to cause low
blood sugar.
Learn to recognize
symptoms of low blood sugar, which include sweating,
weakness, and hunger. Treating low blood sugar promptly will help avoid loss of
consciousness, which can occur with severe low blood sugar.
Symptoms of complications
Symptoms of diabetic
complications include:
Chest pain; shortness of breath with exercise
or other exertion;
heart attack;
stroke; or tight or squeezing pain in the calf, foot,
thigh, or buttock that occurs during exercise and causes changes in skin color,
decreased sensation, and leg cramps. These are symptoms of large blood vessel
complications, or
macrovascular disease.
Burning pain,
numbness, or swelling in your feet or hands, which may indicate nerve damage
(diabetic neuropathy). When only one nerve is involved
(focal neuropathy), you may have symptoms in one part of your body. An example
is double vision, which can happen when diabetes affects the nerves that
control your eye muscles.
A wound that won't heal or that looks infected, which may
indicate damage to the blood vessels that supply that area.
Blurred
or distorted vision; seeing
floaters or
flashes of light, large floating red or black spots,
or large areas that look like floating hair, cotton fibers, or spiderwebs; or
pain in your eyes. These may indicate
diabetic retinopathy.
Frequent bloating,
belching, constipation, nausea and vomiting, diarrhea, and abdominal pain,
which may indicate
gastroparesis related to diabetic autonomic
neuropathy.
Profuse sweating or reduced sweating, feeling dizzy or
weak when you sit or stand up suddenly, difficulty sensing when your bladder is
full or difficulty emptying your bladder completely, erection problems or
vaginal dryness, or
hypoglycemia unawareness. These also may indicate
diabetic neuropathy.
You will not have any symptoms of kidney damage (diabetic nephropathy) until the condition is severe.
Then you may notice swelling in your feet, legs, and throughout your body.
Having regular tests for protein in the urine is the only way to detect
diabetic nephropathy before symptoms develop.
What Happens
Although your experience with
type 2 diabetes may be different from that of others
with the disease, everyone with diabetes has to pay attention to eating a
healthy, balanced diet and exercising regularly. Eating too much carbohydrate
can cause your blood sugar levels to rise quickly. A
plate format is a simple way to plan a balanced diet.
For information, see:
It is important to have a healthy eating
lifestyle-including eating whole grains, lean meats, fish, and vegetables-and
to reduce calorie intake if you need to lose weight. You may be able to keep
your blood sugar levels within your
target range with only these measures for a while, but
you will likely need to take oral diabetes medicines as time goes on.
As diabetes progresses, your
pancreas may produce less and less
insulin. If your blood sugar level is persistently
high, it also may cause your pancreas to produce less insulin. This is called
glucose toxicity. When your pancreas produces too little or no insulin, you
will have to give yourself shots of insulin.
Because it is
difficult to achieve the perfect balance of insulin and blood sugar level that
your body would have if you didn't have diabetes, you will experience high
blood sugar levels from time to time. If you take insulin or certain
oral diabetes medicines, you also may experience low
blood sugar. Early treatment of high or low blood sugar can prevent a medical
emergency.
What could happen if your blood sugar level is very high?
Symptoms of high blood sugar (hyperglycemia) usually
develop gradually over a period of hours or days. Early symptoms are increased
thirst, frequent urination, increased hunger, and blurred vision. But you may
not have any early symptoms. If your blood sugar level continues to rise and
you do not drink enough liquids, you can become
dehydrated.
If you do not take your
diabetes medicine (pills or insulin), or if you have a severe infection or
other illness or become severely dehydrated, your blood sugar may rise to a
dangerous level called a
hyperosmolar state. Left untreated, the condition can
lead to coma and death. Hyperosmolar state usually is treated in a hospital and
often in the intensive care unit. There you are closely observed and receive
frequent blood tests for glucose and
electrolytes. You will receive insulin and other
fluids through a vein (intravenous, or IV) to bring your blood sugar down and
correct the dehydration.
Complications
Long-term diabetic complications are
caused by persistently high blood sugar levels continuing over months or years.
You may already have one or more complications, because you may have had the
disease for several years before being diagnosed. There are four types of
complications:
Microvascular disease,
which affects your eyes or kidneys.
Diabetic retinopathy (eye disease) and
diabetic nephropathy (kidney disease) develop without
early noticeable signs. You are also at risk for other eye diseases, such as
cataracts and
glaucoma.
Macrovascular disease, which affects your
heart and the large blood vessels throughout your body. Diabetes damages the
lining of large blood vessels and contributes to developing
atherosclerosis. Atherosclerosis and a greater
tendency toward blood clot formation can lead to
peripheral arterial disease,
heart attack, or
stroke.
Diabetic neuropathy, which affects the nerves in your body.
Diabetic neuropathy can decrease or completely block
the movement of nerve impulses or messages to organs, legs, arms, and other
parts of your body. Nerve damage can affect both the functioning of internal
organs, such as the stomach (gastroparesis), and your ability to
feel pain when injured. When blood vessels and nerves are affected, broken
bones (fractures) and joint deformities can develop within weeks without
noticeable pain, especially in your feet (Charcot foot).
Weakened immune system, which puts you at risk for
difficult-to-treat and persistent infections and delayed healing of wounds,
especially in your feet. Severe infections in your feet may lead to
amputation.
Other health problems
People with diabetes often
already have other health problems, such as high blood pressure and
high cholesterol, or they develop them as diabetes
progresses. These conditions can contribute to the development and worsening of
complications from diabetes.
Can the progression of diabetes be prevented?
From the time you are diagnosed with diabetes, work closely with your health
professional to keep your blood sugar levels within a normal or near-normal
range. If you do so, you may slow the progression of any complication you
already have and prevent or delay the development of others. You also may feel
better and be more in control of your life.
Eat a balanced diet.
If you are overweight, reduce your calorie intake to lose some weight. Losing
as little as 10 to 20 pounds can improve your blood sugar levels. Try to do at
least 2½ hours a week of
moderate activity. One way to do this is to be active
30 minutes a day, at least 5 days a week.2, 3
You are more likely to
develop complications from
type 2 diabetes if you:
Have persistently high blood sugar over time. The higher your blood sugar and the longer it remains
too high, the greater your risk for developing complications.
Have the disease for a long time. The longer you have
diabetes, the more likely you are to develop complications, even if blood sugar
levels are controlled.
Diabetic nephropathy (kidney disease) develops in 20% to 30% of people with type
2 diabetes.4
Diabetic retinopathy (eye disease) develops in more
than 60% of people with type 2 diabetes by 20 years after diagnosis.5
Most people with diabetes develop some
diabetic neuropathy (nerve damage) over the years, but
only about 13% to 15% have noticeable symptoms.6
Already have one complication. Having one complication from diabetes increases your risk
for developing other complications.
Have other risk factors. Smoking, psychiatric disorders (such as
depression),
high blood pressure,
high cholesterol, and a family history of diabetic
complications may increase your risk for developing a complication. Not having
health insurance coverage for supplies and other medical expenses related to
diabetes care can contribute to poorer control of the disease and the
development of complications.
When to Call a Doctor
Call 911 or other emergency services immediately if you or your child is:
Unconscious or becomes very sleepy
unexpectedly. You or your child may have low blood sugar, called
hypoglycemia. While you wait for emergency help,
follow:
Drowsy, confused, breathing fast, and your or
your child's breath smells fruity. You or your child may have high blood sugar,
called hyperglycemia. A life-threatening condition called
diabetic ketoacidosis could be present.
Call a doctor immediately if you or
your child is vomiting and cannot keep down liquids and:
Your blood sugar is 300 mg/dL or
higher.
Your child's blood sugar is 250 mg/dL or higher.
Call a doctor if you or your child:
Is sick for more than 2 days (unless it is a
mild illness, such as a cold), and you or your child:
Has been vomiting or had diarrhea for more
than 6 hours.
Has blood sugar levels that
are often above 300 mg/dL, and
urine tests for ketones show more than 2+ or moderate
or higher ketones.
Has a blood sugar level that stays below the target range after
you or your child eats some
quick-sugar food.
Has a blood sugar level
that stays high after you or your child takes a missed dose of insulin or oral
diabetes medicines or after you or your child takes an extra dose of insulin
(if prescribed by the doctor).
Has frequent problems with high or
low blood sugar levels. The insulin dose or schedule may need to be changed.
Has problems following the meal plan or
getting physical activity, and you want help.
Watchful Waiting
Watchful waiting is a period of
time during which you and your health professional observe your symptoms or
condition without changing your treatment plan. Watchful waiting is not
appropriate if you:
Are having high or low blood sugar levels
frequently.
Begin to notice symptoms of complications from
diabetes. Early treatment of complications can prevent or delay worsening of
the condition.
Who to See
Health professionals who may be
involved in your treatment for type 2 diabetes include:
People with
type 2 diabetes should see a health professional every
3 to 6 months throughout life for tests and exams to monitor the condition and
adjust treatment. You also need yearly screening tests for eye problems (diabetic retinopathy) and kidney problems (diabetic nephropathy).
Tests you need, and how often you need them
Time interval
Exams and tests
Every 3 to 6 months
Visit your health professional for:
A review of your blood sugar levels since
your last checkup. Your health professional may evaluate whether your treatment
needs to be changed.
A blood pressure check. Keep your blood
pressure below 130/80 mm Hg.7 If you have
high blood pressure, ask whether you should monitor
your blood pressure at home.
An examination of your feet for signs
of injury, infection, or other foot problems.
A hemoglobin A1c or
similar test (glycosylated hemoglobin, or
glycohemoglobin). If your blood sugar levels are
stable and your treatment hasn't changed, this test may be done every 6
months.
Every 6 months
Visit your dentist for an exam to check for
gum problems.
Every year
Visit an
ophthalmologist or
optometrist for a dilated eye exam (ophthalmoscopy) to look for signs of
diabetic retinopathy and
glaucoma, which is increasing in people with diabetes.
Some health professionals may recommend less frequent eye exams if you have no
signs of diabetic retinopathy or glaucoma.
Keep your LDL cholesterol level less
than 100 mg/dL, or aim for keeping it at 70 mg/dL, your triglyceride level less
than 150 mg/dL, and if possible, men need to keep their HDL cholesterol level
more than 40 mg/dL and women more than 50 mg/dL. 8
A thorough examination of your feet,
including testing your ability to feel a thin, flexible piece of
plastic.
A urine test for protein, an indicator of kidney damage.
Either of the following tests may be done:4
Microalbuminuria dipstick test, to
estimate the amount of protein in a urine sample
Spot urine test
for microalbuminuria, to measure the exact amount of protein in a urine
sample
If one of these urine tests shows 30 micrograms or
more of protein per milligram (mcg/mg) of
creatinine in your urine, you have some amount of
kidney damage.
Other possible tests
You may also need:
A
blood glucose test. This test may be used to check the
accuracy of your blood sugar meter to see whether your
home blood sugar tests are reliable. It also may be
done if your health professional is adjusting your diabetes medicine.
An
electrocardiogram (ECG or EKG), if you have had a
heart attack or have heart disease or high blood pressure. An EKG may be done
after a diabetes diagnosis even if you have not had a
heart attack, because people with diabetes have a
higher-than-average risk of heart disease. The test also provides a baseline
against which to compare future tests in case of chest pain.
If you become pregnant,
you need to have an
ophthalmoscopy during the first 3 months and close
follow-up throughout pregnancy and for 1 year after delivery, because pregnancy
increases your risk for eye disease.8 If you already
have eye disease and become pregnant, the eye disease can rapidly become
worse.
Your treatment for
type 2 diabetes will change over time to meet your
individual needs. But the focus of your treatment will always be to keep your
blood sugar levels within a
normal or near-normal range to prevent complications
from diabetes, such as eye, kidney, heart, blood vessel, and nerve disease. You
play an important role in managing your condition. By learning about diabetes
and working with your health professional to create a plan for treatment, you
can improve your health and quality of life.
How can you manage your diabetes?
Follow your diet
It is important to follow a
healthy, balanced diet that includes whole grains, lean meat, fish, and
vegetables. To help control your blood sugar and reduce your risk for
complications from diabetes, limit alcohol. And reduce calories if you need to
lose weight.
Of the three major nutrients (carbohydrate, protein,
and fat),
carbohydrate has the greatest effect on blood sugar.
Because you have diabetes, it's important that you include the proper amount of
carbohydrate in your daily diet and that you space carbohydrate evenly
throughout the day. You can use one of the following approaches:
Planning meals to manage diabetes often means looking
at food in a new way. Some people may have trouble accepting the changes they
need to make in their lifestyle. You may find it helpful to read about how
emotions influence what we eat, when we eat, and how much we eat:
If you are age 40 or
older, talk to your health professional about taking a low-dose aspirin daily
to help prevent
heart attack,
stroke, and other large blood vessel disease (macrovascular disease). People with diabetes are 2 to
4 times more likely than people who don't have diabetes to die from heart and
blood vessel diseases.1
Do activities
that raise your
heart rate. Try to do
moderate activity at least 2½ hours a week.2 One way to do this is to be active 30 minutes a day, at least
5 days a week. Also try to include
resistance exercises in your program at least twice a
week.2, 3 These activities can
include things like weight lifting or yard work. See the topic
Fitness for more ideas.
It may help to
keep track of your exercise on an
activity log(What is a PDF document?)
. Work with your doctor to develop a
safe exercise program.
A low-fat diet, exercise, and weight loss can lower your
cholesterol. Your body needs insulin to process fats, as it does with
carbohydrate. If your diabetes is poorly controlled, the fats in your blood
(particularly
triglycerides) can rise significantly. You should
strive for a goal of less than 100
milligrams per deciliter (mg/dL) or aim for keeping it
at 70 mg/dL, for
low-density lipoprotein (LDL), or "bad," cholesterol.
Adults with diabetes need to keep their HDL cholesterol level more than 40
mg/dL for men and more than 50 mg/dL for women. Triglycerides should be less
than 150 mg/dL. You may need to take lipid-lowering medicines, such as statins,
to reach your goals. Statins reduce LDL levels and the risk of heart disease in
people with diabetes.9 They also have been shown to
reduce the risk of heart attack and stroke by one-third in people with
diabetes, even those who do not have high LDL levels or existing heart
disease.10
Grieve the things you feel you have
lost because of diabetes.
Wear identification to let medical
personnel know that you have diabetes so they can give you appropriate care.
You can buy
medical identification in bracelets, necklaces, or other forms of jewelry at
your local drugstore.
Know why foot care is important, and take
care of your feet daily. For information, see:
Limit your alcohol intake to no more than 1
drink a day for women (none if you are pregnant) and 2 drinks a day for
men.
See your health professional regularly. For more information,
see the Exams and Tests section of this topic.
If you take oral diabetes medicine
Take your
medicine as directed. If you take one of the medicines with low blood sugar as
a side effect, learn to deal with low blood sugar. For information, see:
If you become severely
ill, have surgery, become pregnant, or breast-feed, you may need insulin
injections temporarily even though you normally take only oral medicine. You
should be able to return to your usual treatment after the situation is
over.
As type 2 diabetes progresses, your
pancreas may produce less and less insulin. This means
that you have to take
insulin for the rest of your life, usually by giving
yourself a shot several times a day for the rest of your life.
If
you take insulin, learn how to deal with low blood sugar and give yourself an
insulin shot. See:
The
United Kingdom Prospective Diabetes Study (UKPDS)
showed that keeping blood sugar levels within a normal or near-normal range
helps decrease a person's chances of developing complications from diabetes.
Every effort you make to get your blood sugar level closer to a normal or
near-normal range leads to some lowering of your risk for complications.
Prevention
Keeping your blood sugar levels within a
normal or near-normal range is the best way to reduce
your risk of complications from
type 2 diabetes. The higher your blood sugar level,
the greater your risk for developing eye, kidney, heart, blood vessel, and
nerve disease.11
Be sure you have:
An exercise program. Exercise helps control
your blood sugar, because you use glucose for energy during and after activity.
It also helps you stay at a healthy weight; lower
high cholesterol; raise
HDL, or "good," cholesterol; and lower
high blood pressure. Do activities that raise your
heart rate. Try to do
moderate activity at least 2½ hours a week.2 One way to do this is to be active 30 minutes a day, at least
5 days a week. Also include resistance exercises in your program.3 Resistance exercises can include activities like weight
lifting or even yard work. See the topic
Fitness for ideas on to how add daily activity to your
life.
A daily aspirin, if your doctor says it is okay. People with
diabetes are 2 to 4 times more likely than people who don't have diabetes to
die from heart and blood vessel diseases. If you are 40 or older, talk to your
health professional about taking a low-dose aspirin daily to help prevent
heart attack,
stroke, or other large blood vessel disease (macrovascular disease).12
Adequate treatment for
high blood pressure and
high cholesterol. These conditions increase your risk
for developing diabetic complications, especially heart and blood vessel
diseases.13
Yearly screening for protein in
your urine. This is the only way to detect early kidney damage (diabetic nephropathy). If evidence of kidney damage is
found, medicine can help slow, or possibly reverse, the
damage.
Don't smoke. If you don't smoke, you
can slow down the damage to your blood vessels from diabetes14
Keep your immunizations up to date. Diabetes
affects your immune system, increasing your risk for developing a severe
illness, such as influenza or pneumonia. See the topic
Immunizations for the recommended immunization
schedule.
You play a major role in treating
your
type 2 diabetes. Be sure to:
Follow your diet.
Exercise
regularly.
Maintain blood sugar control.
Take an
aspirin if recommended.
Control blood pressure and
cholesterol.
Follow your diet
Carbohydrate affects your blood
sugar more than other nutrients. When you know how much carbohydrate is in your
food, you can spread the amount throughout the day, which helps prevent high
blood sugar after meals. Use one of the following methods for keeping track of
carbohydrate in your daily diet:
Exercise helps control your
blood sugar, because you use glucose for energy during and after activity. It
also helps you stay at a healthy weight; lower
high cholesterol; raise
HDL, or "good," cholesterol; and lower
high blood pressure. These benefits help prevent
cardiovascular disease, the main cause of death in people who have diabetes.
Do activities that raise your
heart rate. Try to do
moderate activity at least 2½ hours a week.2 One way to do this is to be active 30 minutes a day, at least
5 days a week. Also include resistance exercises in your program.3 Resistance exercises can include activities like weight
lifting or even yard work. It may help to keep track of your exercise on an
activity log(What is a PDF document?)
. See the topic
Fitness for ideas on to how add daily activity to your
life.
Walking, running, bike riding, and swimming are good
activities for people with diabetes. But some activities can make complications
more likely. For instance, weight lifting can increase the risk of
retinal
bleeding if you have eye disease (diabetic retinopathy). If you have
diabetic neuropathy, running may lead to foot
problems. Check with your health professional before you begin an exercise
program to find out what activities are best for you. Work with your health
professional to develop a
safe exercise program.
Maintain blood sugar control
Check your blood sugar as often as prescribed
by your doctor.
If you are 40 or older, talk
to your health professional about taking a low-dose aspirin daily to help
prevent
heart attack,
stroke, or other large blood vessel disease (macrovascular disease). People with diabetes are 2 to
4 times more likely than people who don't have diabetes to die from heart and
blood vessel diseases.1
Control blood pressure and cholesterol
It's
important to keep your blood pressure and cholesterol at recommended levels to
reduce your risk of heart and large blood vessel disease. Exercise can help
keep your blood pressure at the recommended level of less than 130/80
millimeters of mercury (mm Hg). In some cases, one or
more medicines may be needed. For more information, see the Treatment Overview
section of this topic.
A low-fat diet, exercise, and weight loss
can lower your cholesterol. The body needs insulin to process fats, as it does
with carbohydrate. If your diabetes is poorly controlled, the fats in your
blood (particularly
triglycerides) can rise significantly. You should
strive for a goal of less than 100
milligrams per deciliter (mg/dL) or aim for keeping it
at 70 mg/dL, for
low-density lipoprotein (LDL), or "bad," cholesterol.
Triglycerides should be less than 150 mg/dL. Adults with diabetes need to keep
their HDL cholesterol level more than 40 mg/dL for men and more than 50 mg/dL
for women. Your health professional may recommend cholesterol-lowering
medicines called statins to cut your risk of heart disease even if you do not
have high LDL levels or existing heart disease.
Several oral medicines are available to
treat
type 2 diabetes. These medicines increase insulin
production, decrease
insulin resistance, or slow intestinal absorption of
carbohydrate.
You may need more than one
medicine to adequately control your diabetes. Together, two or more medicines
may work more effectively than a single medicine to lower blood sugar level.
Taking two medicines together may reduce side effects by allowing lower doses
of each. But in some cases, taking two medicines can increase the risk of side
effects, such as low blood sugar (hypoglycemia).
You may
need to take
insulin temporarily if you have surgery or are
severely ill, pregnant, or breast-feeding. You also may need to take insulin
daily as a shot if lifestyle and pills (oral medicines) are not controlling
your blood sugar, or if your
pancreas stops producing insulin.
Medicines also may be needed to prevent or slow the development of
complications.
Medication Choices
Aspirin may be
recommended to prevent
heart attack,
stroke, or other large blood vessel disease (macrovascular disease).1 If
you are age 40 or older, talk to your health professional about whether you
should take a low-dose aspirin daily.
Medicines that increase
insulin production are:
Sulfonylureas, such as glipizide
(Glucotrol), glyburide (DiaBeta, Glynase, or Micronase), glimepiride (Amaryl),
the combination medicine glyburide and metformin (Glucovance), the combination
of sitagliptin and metformin (Janumet), or the combination of glipizide and
metformin (Metaglip).
Meglitinides, such as repaglinide (Prandin),
nateglinide (Starlix), and the medicine that combines repaglinide and metformin
(Prandimet).
Medicines that decrease insulin resistance are:
Biguanides, such as metformin
(Glucophage or Glucophage XR), the combination medicine glyburide and metformin
(Glucovance), the medicine that combines rosiglitazone and metformin
(Avandamet), the medicine that combines metformin and glipizide (Metaglip), and
the medicine that combines repaglinide and metformin
(Prandimet).
Thiazolidinediones, such as
rosiglitazone (Avandia), pioglitazone (Actos), or the combination of
rosiglitazone and metformin (Avandamet).
Medicines that slow intestinal absorption of carbohydrate
are:
New medicines recently approved by the U.S. Food and Drug
Administration (FDA) include:
Incretin mimetics, such as exenatide
(Byetta). Exenatide lowers both fasting blood sugar and blood sugar after you
eat. Your doctor may recommend Byetta if you have not been able to control your
blood sugar with oral medicines such as metformin or a sulfonylurea. Byetta may
be taken by itself or with other oral medicines. It is given as a shot 2 times
a day, before morning and evening meals.
Amylinomimetics, such as pramlintide (Symlin).
Pramlintide lowers blood sugar after you eat. Your doctor may recommend
pramlintide if you already take insulin but still cannot control your blood
sugar. Pramlintide is only used with insulin. You take it as a shot before
meals.
Dipeptidyl peptidase IV (DPP-4) inhibitors, such as
sitagliptin (Januvia). Sitagliptin lowers blood sugar. It does this by allowing
the body to release insulin for longer than usual after blood sugar
rises.
Cholesterol-lowering medicines known as
statins reduce LDL levels and the risk of heart
disease in people with diabetes.9 They also have been
shown to reduce the risk of heart attack and stroke by one-third in people with
diabetes, even those who do not have high LDL levels or existing heart
disease.10
What to Think About
You will need to take ACE
inhibitors or ARBs if you have protein in your urine, a sign of
diabetic nephropathy. Effective control of your blood
sugar also is essential to prevent progression of nephropathy.
The
U.S. Food and Drug Administration (FDA) has announced a possible safety issue
with the drug rosiglitazone (Avandia). A new study shows that people who take
Avandia may raise their chance of having a heart attack. They may also raise
their chance of death from heart disease.
Manufacturers of
rosiglitazone (Avandia), pioglitazone (Actos), rosiglitazone and glimepiride
(Avandaryl), rosiglitazone and metformin (Avandamet), and pioglitazone and
glimepiride (Duetact) have added a warning that these drugs may cause or worsen
heart failure in certain people.
If you take any of these
medicines, do not stop taking them. Call your doctor to talk about which
medicine is best for you.
Studies indicate that
the large weight loss provided by stomach surgery improves blood sugar control
in people who are extremely overweight.15 But this is a
difficult procedure, and it can only be done on people who meet specific
criteria. If you are extremely overweight, talk with your doctor about whether
you would be a good candidate for stomach surgery. For more information, see
the topic
Obesity.
Other Treatment
Avoid products that promise a cure
for
type 2 diabetes. No cure exists. Also avoid products
that are advertised only by testimonials of satisfied customers. These products
or remedies may be harmful and costly. If you have questions about a product
for diabetes, check with your local American Diabetes Association office, your
doctor, or a diabetes educator.
Other types of meal plans
You may hear of people
with diabetes who follow meal plans other than those typically recommended by
diabetes experts. Talk with a
registered dietitian before you choose an alternate
meal planning method for your or your child's diabetes diet.
Complementary therapies
Other types of treatment
for diabetes are provided by therapists or others who do not operate within
mainstream medical practice. Their unconventional approaches may be attractive,
particularly if you are not having much success with conventional medical
treatments. None of these complementary therapies is proven to effectively
treat diabetes. But you may benefit from safe nontraditional therapies that
complement conventional medical treatment for your disease. Complementary
therapies such as acupuncture, massage, or biofeedback, for instance, may help
relieve stress, relieve muscle tension, and improve your overall well-being and
quality of life.
You should not use complementary therapies alone
to treat your diabetes.
Talk with your doctor if you are using the
following or other complementary or alternative therapies:
Herbal medicines and natural substances such as vanadium, magnesium, or
chromium. Studies indicate that soluble fiber, a natural substance, may help
you keep blood sugar levels within a normal or near-normal
range.
This Web site is for children with diabetes and for their families.
It offers a variety of information and resources, from basic facts about
diabetes to legal support, as well as school information for students and their
teachers, diabetes camps throughout the United States, chat rooms for children
and for their parents, and a valuable link-site connection to other
diabetes-related Web sites.
Organizations
American Association of Diabetes
Educators
100 West Monroe Street
Suite 400
Chicago, IL 60603
Phone:
1-800-338-3633
Fax:
(312) 424-2427
E-mail:
aade@aadenet.org
Web Address:
www.aadenet.org
The American Association of Diabetes Educators is made up of
doctors, nurses, dietitians, and other health professionals with special
interest and training in diabetes care. The Web site can supply the names of
these types of health professionals in your local area.
American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA 22311
Phone:
1-800-DIABETES (1-800-342-2383)
E-mail:
AskADA@diabetes.org
Web Address:
www.diabetes.org
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
National Diabetes Education Program
(NDEP)
1 Diabetes Way
Bethesda, MD 20814-9692
Phone:
1-800-438-5383 to order materials (301) 496-3583
E-mail:
ndep@mail.nih.gov
Web Address:
http://ndep.nih.gov
The National Diabetes Education Program (NDEP) is
sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers
for Disease Control and Prevention (CDC). The program's goal is to improve the
treatment of people who have diabetes, to promote early diagnosis, and to
prevent the development of diabetes. Information about the program can be found
on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC
(www.cdc.gov/team-ndep).
National Diabetes Information Clearinghouse
(NDIC)
1 Information Way
Bethesda, MD 20892-3560
Phone:
1-800-860-8747
Fax:
(703) 738-4929
TDD:
1-866-569-1162 toll-free
E-mail:
ndic@info.niddk.nih.gov
Web Address:
http://diabetes.niddk.nih.gov
This clearinghouse provides information about research
and clinical trials supported by the U.S. National Institutes of Health. This
service is provided by the National Institute of Diabetes and Digestive and
Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).
American Diabetes Association (2004). Aspirin therapy
in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72-S73.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
Sigal RJ, et al. (2006). Physical activity/exercise
and type 2 diabetes: A consensus statement from the American Diabetes
Association. Diabetes Care, 29(6):
1433-1438.
American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79-S83.
American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84-S87.
Zochodne DW (2001). Peripheral nerve disease. In HC
Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care,
pp. 466-487. Hamilton, ON: BC Decker.
American Diabetes Association (2004). Hypertension
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S65-S67.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S3-S110.
American Diabetes Association (2004). Dyslipidemia
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S68-S71.
Collins R, et al. (2003). MRC/BHF heart protection
study of cholesterol-lowering with simvastatin in 5,963 people with diabetes: A
randomised placebo-controlled trial. Heart Protection Study Collaborative
Group. Lancet, 361(9374): 2005-2016.
Gerstein HC (2001). What is diabetes? In HC Gerstein,
RB Haynes, eds., Evidence-Based Diabetes Care, pp.
62-67. Hamilton, ON: BC Decker.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S12-S54.
Sigal R, et al. (2006). Prevention of cardiovascular
events in diabetes. Clinical Evidence (15):
623-645.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
Wing RR (2001). Weight loss in the management of type 2 diabetes. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 252-276. Hamilton, ON: BC Decker.
Other Works Consulted
American Diabetes Association (2004). Influenza and
pneumococcal immunization in diabetes. Position statement. Clinical Practice
Recommendations 2004. Diabetes Care, 27(Suppl 1):
S111-S113.
Riddle MC, Genuth S (2007). Type 2 diabetes mellitus.
In DC Dale, DD Federman, eds., ACP Medicine, section 9,
chap. 2. New York: WebMD.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
American Diabetes Association (2004). Aspirin therapy
in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72-S73.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
Sigal RJ, et al. (2006). Physical activity/exercise
and type 2 diabetes: A consensus statement from the American Diabetes
Association. Diabetes Care, 29(6):
1433-1438.
American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79-S83.
American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84-S87.
Zochodne DW (2001). Peripheral nerve disease. In HC
Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care,
pp. 466-487. Hamilton, ON: BC Decker.
American Diabetes Association (2004). Hypertension
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S65-S67.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S3-S110.
American Diabetes Association (2004). Dyslipidemia
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S68-S71.
Collins R, et al. (2003). MRC/BHF heart protection
study of cholesterol-lowering with simvastatin in 5,963 people with diabetes: A
randomised placebo-controlled trial. Heart Protection Study Collaborative
Group. Lancet, 361(9374): 2005-2016.
Gerstein HC (2001). What is diabetes? In HC Gerstein,
RB Haynes, eds., Evidence-Based Diabetes Care, pp.
62-67. Hamilton, ON: BC Decker.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S12-S54.
Sigal R, et al. (2006). Prevention of cardiovascular
events in diabetes. Clinical Evidence (15):
623-645.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
Wing RR (2001). Weight loss in the management of type 2 diabetes. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 252-276. Hamilton, ON: BC Decker.
