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Diabetes Type 2 Management

Type 2 Diabetes

Type 2 Diabetes

Print Diagnosis To diagnose type 2 diabetes, you'll be given a: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood s Continue reading >>

Type 2 Diabetes Mellitus Treatment & Management

Type 2 Diabetes Mellitus Treatment & Management

Approach Considerations The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. New abridged recommendations for primary care providers The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers, highlighting recommendations most relevant to primary care. The abridged version focusses particularly on the following aspects: The recommendations can be accessed at American Diabetes Association DiabetesPro Professional Resources Online, Clinical Practice Recommendations – 2015. [117] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. [2] Management includes the following: Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130 mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie, glycemia, lipids, blood pressure). Aggressive glucose lowering may not be the best strategy in all patients. Individual risk stratification is highly recommended. In patients with advanced type 2 diabetes who are at high risk for cardiovascular disease, lowering Hb Continue reading >>

Managing Type 2

Managing Type 2

In type 2 diabetes, your pancreas is still working but not as effectively as it needs to. This means your body is building insulin resistance and is unable to effectively convert glucose into energy leaving too much glucose in the blood. Type 2 diabetes can sometimes initially be managed through lifestyle modification including a healthy diet, regular exercise and monitoring your blood glucose levels. Eating well helps manage your blood glucose levels and your body weight Exercising helps the insulin work more effectively, lowers your blood pressure and reduces the risk of heart disease. Regular blood glucose monitoring tests whether the treatment being followed is adequately controlling blood glucose levels or whether you need to adjust your treatment. The aim of diabetes management is to keep blood glucose levels as close to the target range between 4 to 6 mmol/L (fasting), this will help prevent both short-term and long-term complications. Your healthcare team including your doctor, specialist, dietician and Credential Diabetes Educator, can help you with blood glucose monitoring, healthy eating and physical activity. However, sometimes healthy eating and exercise is not enough to keep the blood glucose levels down. Type 2 diabetes is a progressive condition. As time progresses, the insulin becomes more resistant and the pancreas is less effective converting glucose into energy. To help the pancreas convert glucose into energy, people with type 2 diabetes are often prescribed tablets to control their blood glucose levels. Eventually it may be necessary to start taking insulin to control blood glucose levels. This is when your body is no longer producing enough insulin of its own. Sometimes tablets may be continued in addition to insulin. If you require medication as Continue reading >>

Type 2 Diabetes Treatment

Type 2 Diabetes Treatment

Although diabetes cannot be cured, it can be treated successfully. If a high blood sugar level is brought down to a normal level, your symptoms will ease. You still have some risk of complications in the long term if your blood glucose level remains even mildly high - even if you have no symptoms in the short term. However, studies have shown that people who have better glucose control have fewer complications (such as heart disease or eye problems) compared with those people who have poorer control of their glucose level. Therefore, the main aims of treatment are: To keep your blood glucose level as near normal as possible. To reduce any other risk factors that may increase your risk of developing complications. In particular, to lower your blood pressure if it is high and to keep your blood lipids (cholesterol) low. To detect any complications as early as possible. Treatment can prevent or delay some complications from becoming worse. Type 2 diabetes is usually initially treated by following a healthy diet, losing weight if you are overweight, and having regular physical activity. If lifestyle advice does not control your blood sugar (glucose) levels then medicines are used to help lower your blood glucose levels. One medicine (usually metformin) is used first but two or even three medicines may be needed. Most of the medicines for type 2 diabetes are given in tablet form. However, some people with type 2 diabetes need insulin injections to help control blood glucose levels. Some people gain a great deal of benefit from insulin injections and these are sometimes used fairly soon after the diagnosis of type 2 diabetes has been made. Insulin injections can be used in combination with other medicines to further improve glucose control. Lifestyle - diet, weight control an Continue reading >>

Treatment Of Type 2 Diabetes

Treatment Of Type 2 Diabetes

Learn how to manage type 2 diabetes. In this section, you'll learn about: This section focuses on the medical management of type 2 diabetes. And as the term “ medical management” implies, this management is done with the guidance of your medical provider and medical team. The key principles of medical management are: Regular blood sugar (and ketone) self monitoring as a part of daily living Taking diabetes medications such as pills, injected medicines or even insulin Problem solving how and when to make adjustments in your medication doses to prevent high or low blood sugars Understanding complications and how to screen for, prevent and treat them Good management requires all of these elements. All the elements are intertwined. For example, you need to monitor your blood sugar to know if your treatment is successful. You need to problem solve if the self blood sugar monitoring shows your treatment is not successful. The self blood sugar monitoring will indicate if you need to start, adjust the dose or change the type of diabetes medications. Regular screening for diabetes-related complications may pick up a complication that is in the early stages, and early treatment usually gives the best results. In this section, you will find: Self-management solutions: How to analyze what is causing you to have low blood sugars and/or high blood sugars There are different problem solving sections depending upon your type of treatment: Complications: Reviews diabetic complications –both ones that develop rapidly (acutely) or slowly (chronically) – how to recognize them, and what to do if they occur. Continue reading >>

Weight Management In Type 2 Diabetes: Current And Emerging Approaches To Treatment

Weight Management In Type 2 Diabetes: Current And Emerging Approaches To Treatment

Diabetes is a growing global health concern, as is obesity. Diabetes and obesity are intrinsically linked: obesity increases the risk of diabetes and also contributes to disease progression and cardiovascular disease. Although the benefits of weight loss in the prevention of diabetes and as a critical component of managing the condition are well established, weight reduction remains challenging for individuals with type 2 diabetes due to a host of metabolic and psychological factors. For many patients, lifestyle intervention is not enough to achieve weight loss, and alternative options, such as pharmacotherapy, need to be considered. However, many traditional glucose-lowering medications may lead to weight gain. This article focuses on the potential of currently available pharmacological strategies and on emerging approaches in development to support the glycemic and weight-loss goals of individuals with type 2 diabetes. Two pharmacotherapy types are considered: those developed primarily for blood glucose control that have a favorable effect on body weight and those developed primarily to induce weight loss that have a favorable effect on blood glucose control. Finally, the potential of combination therapies for the management of obese patients with type 2 diabetes is discussed. Obesity and diabetes are intimately linked (1). Obesity—in particular abdominal obesity—is a major driver in the development of diabetes and cardiovascular disease (2), with the increasing prevalence of obesity mirrored by the rising prevalence of diabetes (3). In addition, obesity and overweight are associated with multiple comorbidities (4). Weight reduction, therefore, is a key therapeutic goal in both the prevention and management of type 2 diabetes (5). Weight reduction with intensive l Continue reading >>

Management Of Type 2 Diabetes: What Is The Next Step After Metformin?

Management Of Type 2 Diabetes: What Is The Next Step After Metformin?

O.B. is a 67-year-old African-American man who has had type 2 diabetes for 11 years. He was diagnosed incidentally through laboratory testing. Metformin was initiated at diagnosis and eventually titrated to his current dose of 1,000 mg twice daily. Because of his A1C of 7.5%, his primary care provider started him on sitagliptin, 100 mg daily, 4 years ago. Despite dual oral therapy, his blood glucose levels are still not at goal. He is self-referred to the clinic for help with blood glucose management. He checks his blood glucose once daily fasting. His results, by memory, are 175–190 mg/dl in the morning before breakfast. He has seen a dietitian in the past and is trying to maintain a diet that includes carbohydrates in the amounts of 60 g for breakfast, 45 g for lunch, 15 g for a snack, and 60 g for dinner. However, he has restaurant carryout food for dinner about five times per month, consisting of pizza or barbecue items with French fries. His exercise is limited by right-knee osteoarthritis. His medical and surgical history includes hypertension treated with lisinopril, hyperlipidemia treated with pravastatin, right-knee osteoarthritis, a right hip replacement at the age of 61 years, pneumothorax at the age of 35 years, and benign prostatic hypertrophy. He has no complications from his diabetes. On physical exam, his height is 5′9″, weight is 210 lb, and BMI is 31 kg/m2. His blood pressure is 146/77 mmHg, and his heart rate is 83 bpm. He has no acanthosis nigricans or skin tags on the neck. Physical exam is remarkable for limited range of motion in the right knee and a scar on the right lower extremity from previous hip surgery. He has no peripheral neuropathy. In the clinic, his random blood glucose is 254 mg/dl. On laboratory testing, his A1C is 8.1%. His li Continue reading >>

Treatment For Type 2 Diabetes

Treatment For Type 2 Diabetes

Tweet The primary aim of treating type 2 diabetes is to help control blood glucose levels, but another key aim is to help with weight loss or weight management. Keeping blood sugar levels under control is important as high sugar levels have been shown to significantly increase the risk of health problems (complications) developing later in life. Type 2 diabetes can be treated by a number of different methods, ranging from lifestyle adjustments to tablet medication and injections, through to bariatric (weight loss) surgery. Lifestyle changes are advised for everyone with type 2 diabetes; your doctor will recommend treatment alongside these changes if your blood glucose levels are too high. Your GP and health centre Your GP is an important part of your healthcare and will be able to advise you treating your diabetes, refer you to diabetes education and lifestyle courses and medical specialists, where appropriate, and prescribe medication. Your GP will also be responsible for monitoring your health and ensuring you undergo a number of important diabetes health checks each year. These will include your blood glucose control, blood pressure and cholesterol, amongst others. Diet When it comes to diet, weight loss is often a primary goal for those with type 2 diabetes. If you are overweight, losing weight can help to improve insulin sensitivity and make diabetes easier to manage. To achieve weight loss, your diet should be low-calorie, and because type 2 diabetes is a lifetime condition, it is important to have a diet you are happy to commit and stick to. In the modern world, many of us have become accustomed to eating energy-dense foods, such as bread, rice, pasta and potato-based foods. Whilst these high-energy foods are convenient they’re less good for those who aren’t Continue reading >>

The Early Treatment Of Type 2 Diabetes

The Early Treatment Of Type 2 Diabetes

Jump to Section Abstract The growing epidemic of type 2 diabetes is one of the leading causes of premature morbidity and mortality worldwide, mainly due to the micro- and macrovascular complications associated with the disease. A growing body of evidence suggests that although the risk of developing complications is greater with glucose levels beyond the established threshold for diagnosis – increasing in parallel with rising hyperglycemia—individuals with glucose levels in the prediabetic range are already at increased risk. Early intervention, ideally as soon as abnormalities in glucose homeostasis are detected, is of great importance to minimize the burden of the disease. However, as the early stages of the disease are asymptomatic, diagnosing prediabetes and early overt type 2 diabetes is challenging. The aim of this article is to discuss these challenges, the benefits of early intervention—with emphasis on the prevention trials showing that progression to type 2 diabetes can be delayed by addressing prediabetes—and the existing evidence-based guidelines that have been drawn to optimize the standards of care at the prediabetes and overt type 2 diabetes stages. Continue reading >>

Management Of Type 2 Diabetes In 2017getting To Goal

Management Of Type 2 Diabetes In 2017getting To Goal

(B) Epidural or spinal hematomas may occur in patients treated with ELIQUIS who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include: Increased Risk of Thrombotic Events after Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including ELIQUIS, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events. An increased rate of stroke was observed during the transition from ELIQUIS to warfarin in clinical trials in atrial fibrillation patients. If ELIQUIS is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant. Concomitant use of drugs affecting hemostasis increases the risk of bleeding, including aspirin and other antiplatelet agents, other anticoagulants, heparin, thrombolytic agents, SSRIs, SNRIs, and NSAIDs. The risk of these events may be increased by the postoperative use of indwelling epidural catheters or the concomitant use of medicinal products affecting hemostasis. Indwelling epidural or intrathecal catheters should not be removed earlier than 24 hours after the last administration of ELIQUIS. The next dose of ELIQUIS should not be administered earlier than 5 hours after the removal of the catheter. The risk may also be increased by traumatic or repeated epidural or spinal puncture. If traumatic puncture occurs, delay the administration of ELIQUIS for 48 hours. Acute PE in Hemodynamically Unstable Patients or Patients who Require Thrombolysis or Pulmonary Embolectom Continue reading >>

Type 2 Diabetes And Diet: What You Should Know

Type 2 Diabetes And Diet: What You Should Know

Why does my diet matter? It’s no secret that diet is essential to managing type 2 diabetes. Although there isn’t a one-size-fits-all diet for diabetes management, certain dietary choices should act as the foundation for your individual diet plan. Your diet plan should work with your body — not against it — so it’s important that the food you eat won’t spike your blood sugar levels to high. According to the American Diabetes Association, the normal blood sugar range for people with diabetes is between 80 to 130 mg/dL before meals. It should be less than 180 mg/dL about two hours after you begin eating. Your doctor will provide you with personalized target blood sugar values. Keep reading to learn more about how what you eat can affect your blood sugar, as well as which foods you may want to pick up at the grocery store or toss out of your pantry. Check out: Type 1 diabetes diet » When someone with diabetes has low blood sugar (hypoglycemia), a spoonful of sugar or honey can help raise glucose levels. However, sugar is often considered the nemesis of diabetes because of how quickly it can spike blood glucose levels when eaten alone. If you have diabetes, you should closely monitor your consumption of foods with a high glycemic index (GI). The GI measures how quickly a particular food raises blood sugar. Those foods with a high GI can cause unwanted spikes. This is especially true of refined sugar and other forms of simple carbohydrates like white rice, bread, and pasta. Make sure that most of your carb choices are whole-grain, high-fiber options. For example, if you’d like to have a piece of chocolate cake with frosting, eat it immediately after eating a balanced meal with lean protein, healthy fats, vegetables, and high-fiber carb options such as beans. Ea Continue reading >>

Management Of Type 2 Diabetes In Adults: Summary Of Updated Nice Guidance

Management Of Type 2 Diabetes In Adults: Summary Of Updated Nice Guidance

What you need to know Glycaemic control is only one aspect of care of type 2 diabetes Inform adults with type 2 diabetes at their annual review that setting an HbA1c target is their choice Metformin remains the first line drug, unless it is contraindicated or not tolerated Do not routinely offer self monitoring of blood glucose to all New evidence and developments regarding the management of blood glucose levels, antiplatelet therapy, and erectile dysfunction prompted this update of the 2009 guidance. There were safety concerns surrounding some blood glucose lowering medicines, new evidence on new dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, new indications and combinations for licensed drugs, and the potential impact of drugs coming off patent on health and economic issues. New evidence and safety issues relating to the off label use of antiplatelet therapy (aspirin and clopidogrel) in the primary prevention of cardiovascular disease were also considered. Type 2 diabetes affects 6% of the UK population1 and is commonly associated with obesity, physical inactivity, raised blood pressure, and disturbed blood lipid levels. It causes long term microvascular and macrovascular complications, plus reduced quality of life and life expectancy. The management of diabetes is complex and needs to address the prevention of cardiovascular disease and microvascular disease and the detection and management of early vascular complications. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE),2 recently updated due to the availability of new evidence and developments. The article also summarises a selection of recommendations which still stand. The suggested target le Continue reading >>

Management Of Type 2 Diabetes

Management Of Type 2 Diabetes

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. Treatment should be aimed at alleviating symptoms and minimising the risk of long-term complications. Diabetes is a major risk factor for cardiovascular disease, which is the most common cause of death in people with diabetes. Optimal control of glucose and other cardiovascular risk factors (eg, smoking, sedentary lifestyle, hypertension, dyslipidaemia and obesity) is essential.[1] Management of type 2 diabetes has to be tailored to the individual needs and circumstances of each patient - eg, the benefits of tight glucose control must be weighed against any potential complications such as recurrent hypoglycaemia.[2, 3] Patient education Structured patient education should be made available to all people with diabetes at the time of initial diagnosis and then as required on an ongoing basis, based on a formal, regular assessment of need. Suitable programmes are the X-PERT Diabetes Programme and the Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) Programme. See separate Diabetes Education and Self-management Programmes article. A study found that a single education and self-management structured programme for people with newly diagnosed type 2 diabetes mellitus did not show any benefit in biomedical or lifestyle outcomes at three years, although there were sustained improvements in some illness beliefs.[4] Discuss diet and give dietary advice, taking into account other factors - eg, obesity, hypertension, and renal impairmen Continue reading >>

6 Ways To Control Type 2 Diabetes

6 Ways To Control Type 2 Diabetes

Last year during a physical, Lauren Crim of Richwood, TX, got a diagnosis she wasn’t expecting: type 2 diabetes. She had no symptoms, so the news threw her for a loop. “I was devastated,” she says. “My grandmother had diabetes, and I saw her go through major health struggles because of it.” After seeking support from loved ones -- and shedding a few tears -- Crim got to work. With help from her health care team, she changed the way she ate and started exercising. Now, a year later, she’s 22 pounds lighter, and her blood sugar is normal. “My advice to anyone else facing type 2 diabetes is to stick to a plan, stay positive, and put your health first,” she says. A diabetes diagnosis might feel overwhelming, but living well with the condition doesn’t have to be. If you’re ready to take control of your blood sugar levels and get on the path to better health, here’s how to start. “It takes a village to manage diabetes,” says Linda Siminerio, RN, PhD, chair of the National Diabetes Education Program. Along with your doctor or nurse practitioner, you can get help from: Diabetes educators Dietitians or nutritionists Pharmacists Endocrinologists Podiatrists Dentists Psychologists or Therapists Their services are often covered by insurance. Having a health care team is key, but you're the most important member of it. “We want you to be informed and empowered,” Siminerio says. Take an active role in your care. Ask questions. Learn what your medications do and how to take them properly. Practice any other healthy habits your doctor recommends. And know what your A1c levels are and what they mean. “Being overweight is one of the major drivers of the epidemic of diabetes,” says Vivian Fonseca, MD, a professor of medicine and pharmacology at Tulane Uni Continue reading >>

Understanding Type 2 Diabetes

Understanding Type 2 Diabetes

Diabetes is a chronic medical condition in which sugar, or glucose, levels build up in your bloodstream. The hormone insulin helps move the sugar from your blood into your cells, which are where the sugar is used for energy. In type 2 diabetes, your body’s cells aren’t able to respond to insulin as well as they should. In later stages of the disease your body may also not produce enough insulin. Uncontrolled type 2 diabetes can lead to chronically high blood sugar levels, causing several symptoms and potentially leading to serious complications. In type 2 diabetes your body isn’t able to effectively use insulin to bring glucose into your cells. This causes your body to rely on alternative energy sources in your tissues, muscles, and organs. This is a chain reaction that can cause a variety of symptoms. Type 2 diabetes can develop slowly. The symptoms may be mild and easy to dismiss at first. The early symptoms may include: constant hunger a lack of energy fatigue weight loss excessive thirst frequent urination dry mouth itchy skin blurry vision As the disease progresses, the symptoms become more severe and potentially dangerous. If your blood sugar levels have been high for a long time, the symptoms can include: yeast infections slow-healing cuts or sores dark patches on your skin foot pain feelings of numbness in your extremities, or neuropathy If you have two or more of these symptoms, you should see your doctor. Without treatment, diabetes can become life-threatening. Diabetes has a powerful effect on your heart. Women with diabetes are twice as likely to have another heart attack after the first one. They’re at quadruple the risk of heart failure when compared to women without diabetes. Diabetes can also lead to complications during pregnancy. Diet is an imp Continue reading >>

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