Treatment Of Type 2 Diabetes In Youth
Type 2 diabetes is becoming more common among youth, in parallel with the increasing prevalence of obesity in pediatrics. Despite this, therapeutic modalities remain extremely limited, with scanty data regarding appropriate treatment, desired glycemic targets, and management of associated comorbidities and complications. Management of type 2 diabetes in youth, both acute and long term, should occur in specialty tertiary care pediatric centers. Health care providers should address the pathophysiological components of insulin resistance and decline in β-cell function, aiming to preserve the latter while improving the former. Addressing comorbidities, namely hypertension and dyslipidemia, which are currently inadequately addressed, should be properly assessed and tracked. Further research is critical to establish treatment goals and develop effective diabetes management strategies that will not only enhance adherence to treatment recommendations, but also effectively manage comorbidities and prevent micro- and macrovascular complications. With the escalating rates of obesity, type 2 diabetes is increasing (1,2), not only in adults but also in youth. In the SEARCH for Diabetes in Youth study, it is estimated that the number of adolescents per year diagnosed with type 2 diabetes is ~3,700 and increasing (2,3). Despite this, there is a dearth of approved therapeutic options. The UK Prospective Diabetes Study showed that intensive glucose therapy for adults with newly diagnosed type 2 diabetes was associated with a decreased risk of microvascular complications and, among individuals who were >120% above their ideal body weight, with a decreased risk of myocardial infarction and death from any cause (4). In patients diagnosed with type 2 diabetes at a younger age, there may be Continue reading >>
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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 >>
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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 >>
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 >>
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Management Of Type 2 Diabetes: Evolving Strategies For The Treatment Of Patients With Type 2 Diabetes
Go to: 1. Introduction Type 2 diabetes mellitus (T2DM) is a heterogeneous disorder, characterized by defects in insulin secretion and insulin sensitivity [1,2]. Insulin resistance by itself will not result in T2DM unless β-cell secretion of insulin is decreased. Based on the Centers for Disease Control and Prevention National Diabetes Fact Sheet in 2007 [3], there were 23.6 million Americans with diabetes, of whom 90% to 95% have T2DM; 17.9 million of type 2 diabetic patients are diagnosed while 5.7 million are undiagnosed. Diabetes statistics suggest the prevalence rate of prediabetes is 25.9% (impaired fasting glucose and impaired glucose tolerance [IGT]) with 57 million people being affected. The total direct and indirect cost of diabetes in 2007 was 174 billion dollars [3]. The prevalence of obesity and diabetes appears to run parallel to each other, as indicated by the fact that epidemics of obesity and diabetes are parallel in various regions of the United States. For example, the prevalence of obesity has increased from 10% to 14% in 1991 to 20% to 24% in 2001. Similarly, the prevalence of T2DM has increased from 4% to 6% in 1991 to 8% to 10% in 2001 [4]. The nonmodifiable causes of diabetes include age, ethnicity, and genetics, whereas the modifiable causes include weight/body mass index, central adiposity, and sedentary lifestyle. The impact of diabetes on US mortality is significant—72 507 deaths in 2006, the seventh leading cause of death, and an additional 233 269 deaths linked to diabetes [3]. Diabetes mellitus is the leading cause of new blindness and chronic renal disease, leading to dialysis and nontraumatic amputation. The severity of carbohydrate intolerance correlates with cardiovascular disease and mortality. Mortality rate in persons with normal Continue reading >>
Treatment
Treatment for diabetes aims to keep your blood glucose levels as normal as possible and control your symptoms to prevent health problems developing later in life. If you've been diagnosed with type 2 diabetes, your GP will be able to explain your condition in detail and help you understand your treatment. They'll also closely monitor your condition to identify any health problems that may occur. If there are any problems, you may be referred to a hospital-based diabetes care team. Making lifestyle changes If you're diagnosed with type 2 diabetes, you'll need to look after your health very carefully for the rest of your life. This may seem daunting, but your diabetes care team will be able to give you support and advice about all aspects of your treatment. After being diagnosed with type 2 diabetes, or if you're at risk of developing the condition, the first step is to look at your diet and lifestyle and make any necessary changes. Three major areas that you'll need to look closely at are: You may be able to keep your blood glucose at a safe and healthy level without the need for other types of treatment. Lifestyle changes Diet Increasing the amount of fibre in your diet and reducing your sugar and fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it. You should: increase your consumption of high-fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables choose foods that are low in fat – replace butter, ghee and coconut oil with low-fat spreads and vegetable oil choose skimmed and semi-skimmed milk, and low-fat yoghurts eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers grill, bake, poach or steam food instead of frying Continue reading >>
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Diabetes Management
The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes. The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment. Overview[edit] Goals[edit] The treatment goals are related to effective control of blood glucose, blood pressure and lipids, 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 of 6%[1] to 7.0%[2] Preprandial blood Continue reading >>
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
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
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 >>
Patient Education: Diabetes Mellitus Type 2: Treatment (beyond The Basics)
TYPE 2 DIABETES OVERVIEW Type 2 diabetes mellitus occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body becomes resistant to normal or even high levels of insulin. This causes high blood sugar (glucose) levels, which can lead to a number of complications if untreated. People with type 2 diabetes require regular monitoring and ongoing treatment to maintain normal or near-normal blood sugar levels. Treatment includes lifestyle adjustments, self-care measures, and medicines, which can minimize the risk of diabetes and cardiovascular (heart-related) complications. This topic review will discuss the treatment of type 2 diabetes. Topics that discuss other aspects of type 2 diabetes are also available: (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)".) (See "Patient education: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics)".) TYPE 2 DIABETES TREATMENT GOALS Blood sugar control — The goal of treatment in type 2 diabetes is to keep blood sugar levels at normal or near-normal levels. Careful control of blood sugars can help prevent the long-term effects of poorly controlled blood sugar (diabetic complications of the eye, kidney, nervous system, and cardiovascular system). Home blood sugar testing — In people with type 2 diabetes, home blood sugar testing might be recommended, especially in those who take certain oral diabetes medicines or insulin. Home blood sugar testing is not usually necessary for people who are diet controlled. (See "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)".) A normal fasting blood sugar is less than 100 mg/dL (5.6 mmol/L), although some people will have a different goal. Continue reading >>
How To Beat Type 2 Diabetes With Diet And Lifestyle Changes
It's no secret that type 2 diabetes is on the rise in the United States and around the world. But if you've been diagnosed with diabetes, there's a lot you can do to improve your health — and the best place to start is likely by making some changes to your lifestyle. “Basic principles of good health like eating right, exercising regularly, and maintaining a healthy weight can be as effective as medicine in the management of type 2 diabetes for most people,” says Sue McLaughlin, RD, CDE, lead medical nutrition therapist at Nebraska Medicine in Omaha. That's backed up by the Look AHEAD study, a large clinical trial funded by the National Institutes of Health and the Centers for Disease Control and Prevention (CDC). The researchers found that over a four-year period, changes like eating a healthier diet and getting more exercise led to weight loss and improved diabetes control in 5,000 overweight or obese participants with type 2 diabetes. A December 2016 review in Diabetologia similarly found through 28 studies that participants who were able to achieve about 150 minutes per week of moderate activity lowered their risk of type 2 diabetes by 26 percent compared with nonactive participants. If you're ready to make positive changes to help control diabetes, here's how to get started. Improve Your Diet to Help You Treat Type 2 Diabetes Naturally Keeping close tabs on your diet is a major way to help manage type 2 diabetes. A healthy diet for people with type 2 diabetes includes fresh or frozen fruit and vegetables, whole grains, beans, lean meats, and low-fat or fat-free dairy. Focus on eating fruit and non-starchy vegetables, like broccoli, carrots, and lettuce, and having smaller portions of starchy foods, meats, and dairy products. Be especially careful about loading Continue reading >>
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 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 >>
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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 >>
