Diabetes type 2 Part II Treatment

Treatment



Diabetes mellitus type 2 is a chronic, progressive disease that has no clearly established cure. There are two main goals of treatment of the disease:


1. Reduction of mortality and concomitant morbidity (from assorted diabetic complications)



2. Preservation of quality of life


The first goal can be achieved through close glycemic control (i.e., blood glucose levels); the reduction effect in diabetic complications has been well demonstrated in several large clinical trials and is well established beyond controversy.


The second goal is often addressed (in developed countries) by support and care from teams of diabetic health workers (physician, PA, nurse, dietitian or a certified diabetic educator). Endocrinologists, family practitioners, and general internists are the types of physicians most likely to treat people with diabetes. Knowledgeable patient participation is vital and so patient education is a crucial aspect of this effort.


Type 2 is initially treated by adjustment in diet and exercise, and by weight loss, especially in obese patients. The amount of weight loss which improves the clinical picture is sometimes modest (2-5 kg or 4.4-11 lb); this is almost certainly due to currently poorly understood aspects of fat tissue activity, for instance chemical signaling (especially in visceral fat tissue in and around abdominal organs). In many cases, such initial efforts can substantially restore insulin sensitivity.


Treatment goals


Treatment goals for diabetic patients are related to effective control of blood glucose ( less than 126 fasting and less than 200 mg/dl after meals ), blood pressure ( less than 130/80 mmHg )and lipids ( LDL score less than 100, for others less than 70 ) to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies.


The targets are:


HbA1c ( Glycosilated Hemoglobin, a compount that let us know about glucose control in the past 3 months ) of 6% to 7.0%. Preprandial blood glucose: 100-120 mg/dl and postprandial blood glucose: 160 - 190 mg/dl.


Dietary Management



Modifying the diet is known to help control glucose (or glucose equivalent, eg starches) intake, and in consequence, blood glucose levels. Additionally, weight loss is often recommended in persons suffering from type 2 diabetes for the reasons discussed above.
Please be aware about a recognized way of dealing with bad carbs or "not that bad" carbs ( if you eat sufficient quantities, no matter how good a carb is, it will lead to too much glucose in your blood ). It is called glycemic index.

Glycemic index (also glycaemic index, GI) is a ranking system for carbohydrates based on their effect on blood glucose levels. It compares available carbohydrates gram for gram in individual foods, providing a numerical, evidence-based index of postprandial (post-meal) glycemia. The concept was invented by Dr. David J. Jenkins and colleagues in 1981 at the University of Toronto.


Carbohydrates that break down rapidly during digestion have the highest glycemic indices. Carbohydrates that break down slowly, releasing glucose gradually into the blood stream, have a low glycemic index. A lower glycemic index suggests slower rates of digestion and absorption of the sugars and starches in the foods and may also indicate greater extraction from the liver and periphery of the products of carbohydrate digestion. A lower glycemic response is often thought to equate to a lower insulin demand, better long-term blood glucose control and a reduction in blood lipids. The insulin index may therefore also be useful as it provides a direct measure of the insulin response to a food.


Some examples of glycemic index



Low GI: 55 or less such as most fruit and vegetables (except potatoes, watermelon and sweet corn), wholegrains, pasta, beans, lentils )Medium GI : 56 - 69 croissant, basmati rice, brown riceHigh GI: 70 or more corn flakes, baked potato, some white rices (e.g. jasmine), white bread, candy bar


Exercise


In September 2007, a joint randomized controlled trial by the University of Calgary and the University of Ottawa found that "Either aerobic or resistance training alone improves glycemic control in type 2 diabetes, but the improvements are greatest with combined aerobic and resistance training than either alone." The combined program reduced the HbA1c by 0.5 percentage point. Other studies have established that the amount of exercise needed is not excessive, but must be consistent and continuing. Examples might include a brisk 45 minute walk every other day.


Video to control Diabetes type 2 through diet



If you go to a doctor there are several medications he can put you on. Bear in mind that some of the medications you might be started on might not even be to control your blood glucose but could be directed to control problems that diabetes is related to.



Antidiabetic therapy with herbs



There are several herbs hat can help you manage your blood glucose:

Chromium 200-1000mg per day improves glucose tolerance

Gymnema sylvestre 400mg daily improves glucose tolerance

Fish Oil: High doses of DHA and EPA: 2000mg at least, support nerve function and decreases inflammation

Alpha lipoic acid: 300mg-1200mg a day, decreases insulin resistance

High dose Vitamin C: 2000mg and up: decreases glycosilation of proteins

Cinnamon extract: 500mg twice daily ( may double for severe cases )

Biotin: 1000 mg

Yacon: a Peruvian herb may help increasing insulin release from the pancreas.

If you are going to be started on a statin for cholesterol, you do need to supplement with Coenzime Q10 at least 200mg.



If you are looking for just one multi pill against diabetes, try Jarrow's Formula: Glucose Optimizer




Antidiabetic therapy with medications



The best research availiable, besides losing weight, diet and excercise is with metformin. This medication works by making sure that the liver stops making even more glucose in response to the cells chemical mediators ( cells need glucose, but with insulin resistance present very little of the glucose that is in the blood goes into the cells... thus the cells starve and ask the liver to make glucose from it's reserves ). Metformin blocks it.



Another kind of antidiabetics are sulfonylureas such as glyburide and glipizide. These are old types of medications that increase the pancreas production of insulin. This helps glucose control in the short run. In the long run, ends up worsening the problem. The patient will gain weight and become more and more insulin resistant.



A similar kind, but shorter acting, of medications are Starlix and Prandin. These increase insulin for meals only, and have small half lives.



Then, you get to the TZD's which are ACTOS and AVANDIA. These help by increasing insulin sensitivity in muscles and fat tissue. They have got bad press lately due to an increase in cardiovascular mortality. They also cause weight gain which certainly in the long run will make you more insulin resistant.



Then other treatments include insulin. I will not get into these treatments. Insulin for ER treatment and other emergencies is good but in the long run, for diabetes type 2, willnot solve any problem.



Newer treatments include Byetta and Januvia, that at last, do not cause weight gain.

Other drugs that "come with" the diagnosis of diabetes include:

1. Ace inhibitors: Will not only work for blood pressure but they also help avoid complications of diabetes such as kidney diease.
2. Statins or cholesterol lowering drugs: Usually diabetes patients will have elevated cholesterol that your doctor might want to treat with statins.
3. Aspirin: Usually 81mg, for cardiovascular health


Some surgeons are advocating treating Diabetes with gastric bypass and band surgeries. And certainly yes, if you get this surgery and lose a lot of pounds you will get rid of diabetes, but a surgery is not without significant risks. Please make sure you will be willing to endure being fed with shakes for prolonged periods of time if you wish to proceed with surgery. It might be a last resource though, against diabetes.



Until next time!