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An in-depth report on the causes, diagnosis, treatment, and prevention of type 2 diabetes.
Type 2 diabetes; Maturity onset diabetes; Noninsulin-dependent diabetes
A simple heart-healthy diet with weight control and exercise may be sufficient for some people with type 2 diabetes. Some patients may be able to control their blood sugar with lifestyle measures and not need medication. Even for patients who do need to take drugs, lifestyle plays an essential role in controlling diabetes. Lifestyle changes can be difficult to initiate and sustain, however. Patients should surround themselves with a solid network of doctors, dietitians, family, and friends who understand both their condition and their needs.
Although there are many major dietary approaches for protecting health, experts generally agree on the following recommendations for heart protection:
[For detailed information, see In-Depth Report #43: Heart-healthy diet.]
There is no such thing as a single diabetes diet. Patients should meet with a professional dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs.
Healthy eating habits along with good control of blood glucose are the basic goals, and several good dietary methods are available to meet them. General dietary guidelines for diabetes recommend:
[For detailed information, including diabetic exchange lists and carbohydrate counting, see In-Depth Report #42: Diabetes diet.]
Being overweight is the number one risk factor for type 2 diabetes. Even modest weight loss can help prevent type 2 diabetes from developing. It can also help control or even stop progression of type 2 diabetes in people with the condition and reduce risk factors for heart disease. Patients should aim to lose weight if their body mass index (BMI) is 25 – 29 (overweight) or higher (obese).
The American Diabetes Association recommends that patients aim for a small but consistent weight loss of 1 to 2 pounds per week. Most patients should follow a diet that supplies at least 1,000–1,200 kcal/day for women and 1,200–1,600 kcal/day for men.
Unfortunately, not only is weight loss difficult to sustain, but many of the oral medications used in type 2 diabetes cause weight gain as a side effect. For obese patients who cannot control weight using dietary measures alone, weight-loss drugs, such as orlistat (Xenical) or sibutramine (Meridia), may be helpful. Orlistat may have specific benefits for people with diabetes. It may not only help achieve weight but also improve glucose, cholesterol, and lipid levels. A new weight-loss drug called rimonabant (Acomplia) has been approved in Europe and is being considered for approval in the United States. [For detailed information, see In-Depth Report #53: Obesity.]
Sedentary habits, especially TV watching, are associated with significantly higher risks for obesity and type 2 diabetes. Regular exercise, even of moderate intensity (such as brisk walking), improves insulin sensitivity and may play a significant role in preventing type 2 diabetes -- regardless of weight loss. An important study reported a 58% lower risk for type 2 diabetes in adults who performed moderate exercise for as little as 2.5 hours a week.
Aerobic Exercise . Aerobic exercise has significant and particular benefits for people with diabetes. Regular aerobic exercise, even of moderate intensity, improves insulin sensitivity. People with diabetes are at particular risk for heart disease, so the heart-protective effects of aerobic exercise are especially important. Moderate exercise protects the heart in people with type 2 diabetes, even if they have no risk factors for heart disease other than diabetes itself. (In general, patients with diabetes should aim for a heart rate target of 55 - 75% of their maximum heart rate when exercising.)
Strength Training . Strength training, which increases muscle and reduces fat, may also be helpful for people with diabetes.
Exercise Precautions . The following are precautions for all people with diabetes, both type 1 and type 2:
Patients who are taking medications that lower blood glucose, particularly insulin, should take special precautions before embarking on a workout program:
[For more information, see In-Depth Report #29: Exercise.]
According to the American Diabetes Association, people with diabetes should aim for preprandial (before eating) plasma glucose levels of 90 to 130 mg/dL and postprandial (after eating) plasma glucose levels less than 180 mg/dL. Hemoglobin A1C levels should be less than 7%.
Measuring Blood Glucose. In patients being treated with insulin or insulin-producing or sensitizing drugs, it is important to monitor blood glucose levels carefully to avoid hypoglycemia. Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions.
Blood glucose levels are generally more stable in type 2 diabetes than in type 1, so experts usually recommend measuring blood levels only once or twice a day. For patients who have become insulin-dependent, more intensive monitoring is necessary. Usually, a drop of blood obtained by pricking the finger is applied to a chemically treated strip. The glucose level is read on a standard meter or a small, portable digital display device.
Measuring Hemoglobin A1C. Hemoglobin A1c (HbA1c or HA1c), also called glycated hemoglobin, is measured periodically to determine the average blood-sugar level over the life span of the red blood cell, which is about 8 to 10 weeks. Home tests (DRx, Metrika A1c Now) are available for measuring HA1c that may allow even better monitoring of glucose levels. Patients should keep a chart of their HA1c levels to track any changes that may occur over time.
Some research suggests that not getting enough sleep may impair insulin use and increase the risk for obesity. More research is needed, but it is always wise to improve sleep habits.
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