Treatments for Diabetes

 

Why is type 2 diabetes treatment important?

Type 2 diabetes is a disease where the level of glucose (also called blood sugar) in a person’s bloodstream becomes too high (hyperglycemia).1,2 Glucose is the source of the body’s energy, but it is not produced by the body, so people must consume it through foods and drinks. The pancreas, an organ located near the stomach, produces a hormone called insulin and releases it into the bloodstream. Insulin moves glucose from the blood into the body's cells to fuel them with energy.

People with type 2 diabetes can have high glucose for two different reasons. In some people with type 2 diabetes, the pancreas does not naturally make enough insulin to process the amount of glucose they consume. In other people with type 2 diabetes, the pancreas produces insulin that does not work well enough to transfer the glucose from blood into the cells (insulin resistance). Healthcare providers diagnose type 2 diabetes using various blood tests to measure the level of glucose in a person’s blood, as well as asking the person about any symptoms that may be related to the disease.

If type 2 diabetes is not treated, it leads to a buildup of glucose in a person’s bloodstream over time that can cause serious health problems related to the heart, kidneys, eyes, and nervous system. However, the risks of developing these kinds of health problems can be lowered if your type 2 diabetes is managed well. The primary goal of type 2 diabetes management is to keep the level of glucose in your bloodstream to a target set by your physician to help prevent complications.1

How is type 2 diabetes treated?

Lifestyle Management

Some people who have been diagnosed with type 2 diabetes can manage their disease through lifestyle management. This involves maintaining a healthy diet and getting regular physical exercise, which helps to lower blood sugar levels and help the body use insulin more effectively.4

Medication

People who cannot control their type 2 diabetes with lifestyle management alone may need to take one or more diabetes medications as well. Fortunately, there is a wide range of drug treatment options available to manage type 2 diabetes. However, it may take some time for you and your healthcare providers to find the best treatment, or combination of treatments, for controlling your blood sugar and reducing your risk of developing health problems related to type 2 diabetes.

Drugs that Increase the Effects of Insulin - this category of type 2 diabetes drugs increases a person’s insulin sensitivity through various actions, which reduces the amount of insulin needed to transform glucose into energy:5

• Biguanides
• Alpha glucosidase inhibitors
• Thiazolidinediones (TZDs)

Insulin Secretagogues - this category of type 2 diabetes medication directly stimulates release of insulin from the pancreas:

• Sulfonylureas
• Meglitinide derivatives

Incretin-Based Drugs - this category of type 2 diabetes drugs works on various parts of the incretin system to increase the effects of incretin, ultimately reducing blood glucose levels:

• Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors)
• Glucagonlike peptide-1 agonists (GLP-1 agonists)

Drugs that Block Glucose Reuptake - this class of drugs help to lower blood sugar by preventing the kidneys from reabsorbing glucose into the body:

• Selective sodium-glucose transporter 2 (SGLT2) inhibitors

Amylin Analogs - This class of injectable medicines for type 2 diabetes work by making food move more slowly through the stomach and also curb appetite:

• Amylin analogs

Others - less common treatment options that are available as possible treatment options

• Bile acid sequestrant - This category of medication reduces the amount of glucose produced by the liver, which helps to lower blood sugar.
• Dopamine agonist - This medication class lowers blood glucose levels by increasing dopamine receptor activity in the brain:

Combination treatments - This treatment class for type 2 diabetes contain two different types of diabetes medications in a single dose to decrease the number of medications taken and in turn, help improve adherence:

Insulin -To control their blood sugar levels, some people may need to take insulin in addition to other types of diabetes medications and lifestyle management. There are several different types of insulin:6

• Rapid acting insulins
• Short-acting insulins
• Intermediate-acting insulins
• Long-acting insulins
• Ultra long-acting insulins
• Premixed insulin products, which combine different types of insulin in a single injection

A key part of managing your type 2 diabetes is making sure you take all your prescribed medications regularly and on time, so that they can work as effectively as possible. It is important to let your healthcare provider know about any side effects your medications cause, and you should never stop taking a medication without talking with your healthcare provider first.

What are complementary and alternative therapies for type 2 diabetes?

Some people with type 2 diabetes may choose to try complementary and alternative therapies to help with the symptoms of type 2 diabetes and/or the other health problems it can cause. These kinds of therapies should only be used in addition to—not instead of—lifestyle management and any prescribed medicines or treatments. Be cautious about any complementary or alternative therapy that claims to “cure” diabetes, because there is no scientific evidence that any of them can do so. Complementary and alternative medicines have often not been tested for effectiveness and their claims are not regulated by the FDA in the same way that drugs are, so there is not a lot of research about their value in helping manage diabetes. If you have type 2 diabetes and are thinking about trying any kind of complementary or alternative therapy, be sure to consult with your healthcare provider for advice about side effects and how to use them in a way that does not interact with your other medications.

Some of the complementary and alternative therapies that are used by patients with type 2 diabetes include:

• Meditation
• Movement therapy
• Massage therapy
• Acupuncture
• Chiropractic therapy

What are natural remedies for type 2 diabetes?

Natural remedies are a type of complementary and alternative therapy that includes herbal, plant-based, or dietary supplements. There is growing evidence to suggest that some natural remedies may be linked to improved blood sugar control and other types of benefits for people with type 2 diabetes,5 but further research is needed to better understand the effects of natural remedies. It is very important to talk with your healthcare provider if you are thinking about using natural remedies, herbs, vitamins, or supplements of any kind. Some natural remedies can interact with your prescribed diabetes medications in ways that can make the medications less effective, and can even cause dangerous side effects and serious health problems.
Some of the natural remedies used by people with type 2 diabetes are:

• Alpha-lipoic acid
• Beta-glucan
• Berberine
• Chromium
• Ginseng
• Gurmar
• Magnesium
• Cinnamon
• Garlic
• Flaxseed
• Calcium and Vitamin D
• Green tea and alma
• Glucomannan
• Guar gum

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Could You Be Misdiagnosed With Type 2 Diabetes?

Many people believe there are only 2 types of diabetes, most notably type 1 diabetes (T1D) and type 2 diabetes (T2D). However, diabetes is actually a spectrum. Other forms of diabetes don't fit into either of the 2 common categories. That means some people are diagnosed with the wrong type of diabetes.

How does a misdiagnosis happen?

We know how each type of diabetes shows up in the body and what it looks like on lab work. This information, along with specific details about a person (body size, medical history, age, etc.), helps medical professionals make a diagnosis.

However, as helpful as all those guidelines are, they aren't exact. Sometimes diabetes doesn't always show up the way we expect it. For example, I've worked with several hospitalized patients with type 2 diabetes in DKA (diabetic ketoacidosis). DKA is something that happens most often in people with type 1 diabetes. 

Sometimes this led to a medical provider misdiagnosing the patients with type 1 diabetes. Some people have problems with their pancreas that causes diabetes to develop. Most of the time, these folks are misdiagnosed with type 2 diabetes when really the correct diagnosis is type 3c diabetes.1

How common are misdiagnoses?

Being wrongly diagnosed happens more than you might think. Studies show that developing type 1 diabetes after age 30 means you're more likely to be misdiagnosed with type 2 diabetes.2  

Another form of diabetes, latent autoimmune diabetes in adulthood (LADA), is considered a slower-developing type 1 diabetes. Because of the slow changes, it may look more like type 2 diabetes to providers. Researchers estimate that up to 15 percent of people with type 2 diabetes actually have LADA. Type 3c is even more challenging, with studies showing many people end up with a type 2 diabetes diagnosis instead.3,4

What are the types of diabetes?

There are many other forms of diabetes. Here are just a few outside of the type 1 diabetes and type 2 diabetes categories:

• Type 3 diabetes
• Type 3c diabetes
• Gestational diabetes
• Latent autoimmune diabetes in adulthood (LADA)
• Maturity-onset diabetes of the young (MODY)

Why does the proper diabetes diagnosis matter?

The wrong diagnosis can lead to delays in medical care and higher risks for diabetes complications.2,4 

In my experience as a CDCES, I've also seen patients experience delays in care because of the stigmas around type 2 diabetes. I observe that people with type 2 diabetes are wrongly considered "non-compliant" by medical professionals, thus further delaying their care.

I believe some of this relates to the incorrect stigma that "type 2 diabetes is your fault." Also, I see some bias against those with type 2 diabetes by health insurance companies. Unfortunately, diabetes technologies such as insulin pumps or continuous glucose monitors can be harder to get covered with a type 2 diabetes diagnosis. Getting the correct diagnosis may give you better access to these helpful tools.

What can you do to ensure you're correctly diagnosed?

Lab work and referrals to medical specialists (like an endocrinologist) can help you explore your type 2 diabetes diagnosis. If you've struggled with your blood sugar levels or needed insulin within 3 years of diagnosis, you may be more likely to have a different form of diabetes. Experiencing chronic pancreatitis or other pancreas issues could point to a different form of diabetes.2,3,4

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We’re Saying the Same Thing, but Using Different Words: Insulin

 Have you ever been to a medical appointment and felt like your healthcare team was speaking a whole different language? If so, you're not alone. There are so many medical terms used to describe everything from diagnoses to medications.

I thought I'd provide a guide to bring together "layman's" terms and medical jargon into one neat package. Below, you will find medical terms that are most associated with insulin treatment as it related to type 2 diabetes care.1

Complicated words associated with insulin injection

Prandial: The timing that coordinates with meals. Prandial is usually used to describe the timing for blood sugar checks or insulin doses.

Injection rotation*: Changing your insulin injection sites to different areas of your body with each dose. Injection rotation is essential as it helps insulin absorb well and lowers lipodystrophy risk.
Other terms used to describe injection rotation include:

• Site rotation
• Changing sites
• Moving injection sites
• Shot rotation
• Injection pattern

*Some folks can misinterpret what rotation means. Rotation does NOT mean you rotate your needle once it's in your skin.

Lipodystrophy: Skin changes that happen at insulin injection sites. Skin changes can include excess fat tissue building up under the skin or fat tissue shrinking away from under the skin.
Additional terms used to describe lipodystrophy include:

• Scar tissue
• Fat lip
• "Lipo"
• Skin dimple
• Skin divot

Prime: A technique used to fill an insulin pen needle full of insulin before injection. The prime approach also checks that the pen needle is in working order before your injection. Prime can be called need check, fill, or prep.

Terms associated with insulin dosing

Basal/Bolus: A way to describe an insulin dosing pattern that most closely matches your body's natural patterns. This can also be called multiple-daily injections (MDI).

Basal: A way to describe insulin that replaces your body's 24-hour insulin needs. Basal insulin is delivered continuously from an insulin pump, or with 1-2 injections a day.
Other descriptions for basal are:

• Ultra-long-acting insulin
• Long-acting insulin
• Once-a-day insulin
• "Night-time" insulin

Food bolus: A way to describe how insulin is used to replace your body's needs at meals. Bolus insulin is delivered on-demand from an insulin pump or with injections at each of your meals. 
Additional descriptions for food bolus include:

• Rapid-acting insulin or fast-acting insulin
• Meal-time insulin or food insulin
• Prandial insulin
• Regular insulin
• Insulin to carb ratio or carb ratio
• Set dose or base dose

Correction bolus: A way to describe how insulin is used to lower a high blood sugar level. Bolus insulin is delivered on-demand from an insulin pump, or with injections. 
More descriptions for correction bolus are:

• Rapid-acting insulin or fast-acting insulin
• Correction insulin
• Regular insulin
• Extra insulin dose
• Sliding scale
• Correction dose
• Insulin sensitivity factor

Insulin to carb ratio (ICR)*: The number of units of insulin that should be given for a certain amount of carbohydrate. It allows flexibility in meal sizes because insulin dosing is based on how much one eats.  An example is 1:15 or 1 unit of rapid-acting insulin for every 15 grams of carbohydrate. 
Other terms for insulin to carb ratio include:

• Meal-time insulin
• Food insulin
• Carb ratio

*ICRs can be prescribed as 1 unit per gram of carb or 1 unit per carb choice. This can make a big difference in your insulin dose, so make sure you clearly understand your prescription.

Insulin sensitivity factor (ISF): The amount of 1 unit of insulin that is expected to lower your blood sugars to a healthy range. ISF can be calculated based on how much insulin you take daily. The insulin sensitivity factor is also described as a correction factor.

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The Quick-Fix Mediterranean Diet

 The Quick-Fix Mediterranean Diet

By Michael Gollust

Adding international flair to your diet could quickly lead to a healthier heart.

After only 3 months of eating a Mediterranean diet, study participants reduced their risk of cardiovascular disease by approximately 15%. A Mediterranean diet emphasizes whole grains, fruits, vegetables, fish, nuts, low-fat dairy, and olive oil. Planning your meals around these items may be even better for your heart than a low-fat diet.

In a recent study, two groups of participants with moderate risk factors for cardiovascular disease were placed on a Mediterranean diet or a low-fat diet for 3 months. By the end of the study, members of both groups experienced improvements in body mass index (BMI), blood lipids, and other risk factors. While those in the low-fat diet group reduced their risk for cardiovascular disease by an estimated 9%, participants in the Mediterranean-diet group lowered their disease risk by approximately 15%.

The abundant disease-fighting nutrients found in whole grains, fruits, vegetables, olive oil, nuts, and fish make a Mediterranean diet one of the healthiest around. Whole grains are rich in fiber, magnesium, and B-vitamins; fruits and vegetables are filled with heart-healthy antioxidants; and olive oil, fish, and nuts provide artery-friendly mono- and polyunsaturated fats. Make these delicious and healthful foods the foundation of your diet. In a few short months, you'll be on your way to reaping the long-term benefits.

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