Treatment:

The immediate goal of treatment is to lower high blood glucose levels. The long-term goals of treatment are to prevent diabetes-related complications, such as:

• Amputation of limbs
• Blindness
• Heart disease
• Kidney failure

The primary treatment for type 2 diabetes is exercise and diet.

LEARN THESE SKILLS

You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:

• How to test and record your blood glucose (See: blood glucose monitoring)
• What to eat and when
• How to take medications, if needed
• How to recognize and treat low and high blood sugar
• How to handle sick days
• Where to buy diabetes supplies and how to store them

It may take several months to learn the basic skills. Always continue to educate yourself about the disease and its complications. Learn how to control and live with diabetes. Over time, stay current on new research and treatment.

SELF-TESTING

Regular self-testing of your blood sugar tells you how well your combination of diet, exercise, and medication are working. Tests are usually done before meals and at bedtime. More frequent testing may be needed when you are sick or under stress.

A device called a glucometer can provide an exact blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet. This gives you a tiny drop of blood. You place the blood on a test strip and put the strip into the device. Results are available in 30 - 45 seconds.

A health care provider or diabetes educator will help set up an appropriate testing schedule for you. You will also be taught how to respond to different ranges of glucose values when you self-test.

The results of the test can be used to adjust meals, activity, or medications to keep your blood sugar levels in an appropriate range. Testing provides valuable information for the health care provider. It can identify high and low blood sugar levels before serious problems develop.

Keeping accurate records of test results will help you and your health care provide plan how to best control your diabetes.

DIET AND WEIGHT CONTROL

Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. Your specific meal plans need to be tailored to your food habits and preferences.

Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop taking medications after losing weight (although the diabetes is still there). A registered dietitian can help determine your dietary needs. (See diabetes diet)

REGULAR PHYSICAL ACTIVITY

Regular exercise is important for everyone, but especially if you have diabetes. Regular exercise helps control the amount of glucose in the blood. It also helps burn excess calories and fat so you can manage your weight.

Exercise can help your overall health by improving blood flow and blood pressure. It decreases insulin resistance even without weight loss. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress.

Consider the following when starting an exercise routine:

• Always check with your health care provider before starting an exercise program.
• Ask your health care provider whether you have the right footwear.
• Choose an enjoyable physical activity that is appropriate for your current fitness level.
• Exercise every day, and at the same time of day, if possible.
• Monitor blood glucose levels at home before and after exercise.
• Carry food that contains a fast-acting carbohydrate in case blood glucose levels get too low during or after exercise.
• Wear a diabetes identification bracelet and carry a cell phone in case of emergency.
• Drink extra fluids that do not contain sugar before, during, and after exercise.
• You may need to modify your diet or medication if you exercise longer or more intensely, to keep blood glucose levels in the correct range.

MEDICATION

When diet and exercise do not help maintain normal or near-normal blood glucose levels, your doctor may prescribe medication. Most people with type 2 diabetes will eventually need more than one medication to maintain good blood sugar control. Different groups of medications may be combined or used with insulin.

Some of the most common types of medication are listed below. They are taken by mouth or injection.

• Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract to lower after-meal glucose levels.
• Biguanides (Metformin) tell the liver to decrease its production of glucose. This decreases glucose levels in the bloodstream.
• Injectible medications (including exenatide and pramlintide) can lower blood sugar.
• Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to the level of glucose in the blood.
• Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.
• Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. They increase the cell's sensitivity (responsiveness) to insulin. Rosiglitazone may increase the risk of heart problems. Talk to your doctor.

If you continue to have poor blood glucose control despite lifestyle changes and taking medicines by mouth, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to other medicines. Insulin must be injected under the skin using a syringe. It cannot be taken by mouth.

Insulin preparations differ in how fast they start to work and how long they work. Your healthcare provider will determine the appropriate type of insulin to use and will tell you what time of day to use it.

More than one type may be mixed together in an injection to achieve the best blood glucose control. Usually injections are needed one to four times a day. Your doctor or diabetes educator will show you how to give yourself an injection.

Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity. When they reach their ideal weight, their own insulin and a careful diet can control their blood glucose levels.

It is not known whether hypoglycemia medications taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.

FOOT CARE

People with diabetes are more likely to have foot problems. Diabetes can damage nerves, which means you may not feel an injury to the foot until a large sore or infection develops. Diabetes can also damage blood vessels.

In addition, diabetes affects the body's immune system. This decreases the body's ability to fight infection. Small infections can quickly get worse and cause the death of skin and other tissues. Amputation may be needed.

To prevent injury to the feet, check and care for your feet every day.

See also: Diabetes foot care

CONTINUING CARE

A person with type 2 diabetes should visit a diabetes care provider every 3 months. A complete examination includes:

• Blood pressure check
• Foot and skin examination
• Glycosylated hemoglobin (HbA1c)
• Neurological examination
• Ophthalmoscopy examination

The following evaluations should be done at least once a year:

• BUN and serum creatinine
• Dilated retinal exam
• ECG
• Random microalbumin (urine test for protein)
• Serum cholesterol, HDL, and triglycerides

Support Groups:

For additional information, see diabetes resources.

Expectations (prognosis):

The risk of long-term complications from diabetes can be reduced. If you control your blood glucose and blood pressure, you can reduce your risk of death, stroke, heart failure, and other complications. Reduction of HbA1c by even 1% can decrease your risk for complications by 25%.

Complications:

Emergency complications include diabetic coma.

Long-term complications include:

• Atherosclerosis
• Coronary artery disease
• Diabetic nephropathy (kidney disease)
• Diabetic neuropathy (nerve damage)
• Diabetic retinopathy (eye disease)
• Erection problems
• High blood pressure
• High cholesterol
• Infections of the skin, female genital tract, and urinary tract
• Peripheral vascular disease (damage to blood vessels/circulation)
• Stroke

Calling your health care provider:

Call your health care provider immediately if you have:

• Confusion
• Dizziness
• Double vision
• Drowsiness
• Headache
• Lack of coordination
• Trembling
• Weakness

These symptoms can quickly get worse and become emergency conditions (such as convulsions, unconsciousness, or hypoglycemic coma).