The interventions for type 2 diabetes are:
- Weight management
- Medical therapy and insulin
- Control of blood sugar
- Regular exercise
- Eating healthy
One way of losing weight is to have a nutritious diet and keeping fit. According to research, losing an average of 7% of your original body weight is the target. This means that someone who weighs 200 pounds (91 kilograms) needs to lose about 14 pounds (6 kilograms) to positively affect blood sugar.
However, change starts with what you eat!
There’s really not a single one-dish-fits-all for diabetes. But your take-home points should be focused on:
- Reducing daily calories
- Eat less processed carbs
- Increase the portion of vegetables and fruits
- Avoid saturated fats
- Eat more fiber
Go through your meal plans with a dietician or nutritionist. This way, a healthy diet will be devised based on your preferences and make it easier to control your blood sugar. One recommendation you can get is to reduce carbohydrates.
Exercise not only helps you keep in shape but also helps regulate weight and blood sugar. Once in a while head out for a walk, jogging, biking, ball sports, and swimming. Excessive body fat is one of the reasons why you could be finding it hard to control your sugars.
Your doctor should give you the ‘thumbs up’ for some of your physical activities. Basically, the daily target should be 30 to 60 minutes of fitness routine that covers both aerobic exercises, yoga, weight resistance training to get optimum results. A combination of each is recommended but this will be solely centred on what you wish to achieve.
Remember that your muscles use glucose during exercises. You should check your blood sugar before each activity and take a snack to avoid hypoglycemia (dangerously low glucose levels) is you also use diabetes medicine which lower blood sugar.
Don’t also be a couch potato.
Monitoring your blood sugar
Measuring blood sugar is an integral part of managing diabetes. Since you are on drugs that reduce blood sugar, check your sugars after some interval. Your doctor will tell you the best intervals to do so to make sure your blood sugar remains steady.
Diabetes medications and insulin therapy
Insulin is the main drug used in diabetes. In some cases, multiple drugs are prescribed alongside insulin. However, this doesn’t negate the fact that blood sugar control can be achieved in some people using only exercise and proper nutrition.
The decision of which path is suitable for you will be made after talking with your doctor. Certain issues such as blood sugar level and preexisting medical conditions will influence your therapy.
Some drugs used in treating type 2 diabetes include:
- Metformin (Glucophage, Glumetza, others). This is the first-line drug for type 2 diabetes. It reduces the synthesis of glucose by the liver and increases your body’s insulin sensitivity.
Potentially you may experience some mild nausea or diarrhoea but these will fade as your body adapts to the drug. Preferably take metformin with a meal.
If metformin doesn’t work, other oral or injected drugs will be prescribed.
- These are drugs that stimulate insulin production. Such drugs include glipizide (Glucotrol), glyburide (DiaBeta, Glynase), and glimepiride (Amaryl). Side effects include weight gain.
- Just like sulfonylureas, meglitinides stimulate your pancreas to release more insulin. However, these drugs are eliminated faster by your body and have short-lived effects, and can also lead to weight gain. Examples include repaglinide (Prandin) and nateglinide (Starlix).
- These drugs have the same mode of action as metformin. Because these medications increase the risk of heart failure and anaemia, they are not used often. Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones.
- DDP- inhibitors. These drugs – sitagliptin (Januvia) linagliptin (Tradjenta), and saxagliptin (Onglyza) – control blood sugar although they have a weak effect. The only side effect is joint pain and an increased risk of pancreatitis.
- GLP-1 receptor agonists. By slowing digestion, these drugs reduce blood sugar. However, there’s some accompanying weight loss, nausea, and possible pancreatitis.
Liraglutide (Victoza), exenatide (Byetta, Bydureon), and semaglutide (Ozempic) are types of GLP-1 receptor agonists. According to research, the use of semaglutide and liraglutide is associated with a high risk of stroke and heart attack in diabetic people.
- SGL2 inhibitors. Drugs like dapagliflozin (Farxiga), canagliflozin (Invokana), and empagliflozin (Jardiance) inhibit the reabsorption of glucose by kidneys back into your bloodstream. Excess glucose is eliminated in urine.
These drugs are ideally recommended in people who are diabetic and are at risk of a heart attack and stroke. Possible side effects include urinary tract infections, vaginal yeast infection, low blood pressure, diabetic ketoacidosis, and a higher chance of lower limb amputation (with canagliflozin use).
- Most people with type 2 diabetes will also use insulin. Nowadays, it’s a vital part of glucose management unlike in the past where it was used as a last resort.
Insulin is a protein drug and will be digested if given orally so it must be injected. There are many formulations of insulin and your doctor will prescribe the best possible combination for use during the day for optimum 24-hour blood sugar control.
Depending on your weight and blood sugar, you could have a combination of short-acting insulin with a long-acting insulin injection at night such as insulin detemir (Levemir) or insulin glargine (Lantus). Ask your doctor the benefits and shortcomings of each drug, after which the best regimen will be prescribed for you.
If using any of these drugs, be wary of low blood sugar (hypoglycemia) which could end up catastrophic. Apart from these drugs, cholesterol and blood pressure-lowering drugs and low dose aspirin may be prescribed to avert a possible cardiovascular disease.
Sometimes the greatest benefit is noticed after a special surgery for weight loss (bariatric surgery). Potential candidates for this surgery include a BMI greater than 35 and type 2 diabetes.
The most popular bariatric surgery is a bypass surgery since it has shown better results than any other type of weight loss surgery.
As with any other surgery, there’s a risk of long-term nutritional deficiencies, osteoporosis, as well as acute infections, bleeding, and death. However, success is guaranteed with stringent lifestyle changes.