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Newly Diagnosed Diabetes Type 2 Management

Newly Diagnosed With Type 2

Newly Diagnosed With Type 2

Tweet The diagnosis experience of people with type 2 diabetes can vary quite significantly. Some people are given a good introduction to what type 2 diabetes is and access to well run diabetes education courses. However, we’re aware that some people newly diagnosed with type 2 diabetes have been given a prescription for tablets and been told to get on with it! Our guide here provides important information as to what type 2 diabetes is and how you can get on top of the condition and start controlling it at an early stage. What is type 2 diabetes? Type 2 diabetes is a condition which develops if your body can no longer respond effectively enough to its own insulin to prevent your blood glucose levels from going too high. The good news is that you can fight back against this and get your body to respond better to insulin. Our Low Carb Program shows you how you can achieve this and, since we launched it in 2015, many thousands of people have improved their ability to control their diabetes. Coming to terms with type 2 diabetes Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why people with diabetes are advised to avoid sources of dietary sugar. The good news is for very many people with type 2 diabetes this is all they h Continue reading >>

Initial Management Of Blood Glucose In Adults With Type 2 Diabetes Mellitus

Initial Management Of Blood Glucose In Adults With Type 2 Diabetes Mellitus

INTRODUCTION Treatment of patients with type 2 diabetes mellitus includes education, evaluation for microvascular and macrovascular complications, attempts to achieve near-normal glycemia, minimization of cardiovascular and other long-term risk factors, and avoidance of drugs that can aggravate abnormalities of insulin or lipid metabolism. All of these treatments need to be tempered based on individual factors, such as age, life expectancy, and comorbidities. Although several studies have noted remissions of type 2 diabetes mellitus that may last several years, most patients require continuous treatment in order to maintain normal or near-normal glycemia. Treatments to achieve normoglycemia focus on increasing insulin availability (either through direct insulin administration or through agents that promote insulin secretion), improving sensitivity to insulin, delaying the delivery and absorption of carbohydrate from the gastrointestinal tract, or increasing urinary glucose excretion. Methods used to control blood glucose in patients with newly diagnosed type 2 diabetes are reviewed here. Further management of persistent hyperglycemia and other therapeutic issues, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. (See "Management of persistent hyperglycemia in type 2 diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus".) TREATMENT GOALS Degree of glycemic control — Improved glycemic control improves the risk of microvascular complications in patients with type 2 diabetes (figure 1) [1]. Every 1 percent drop in glycated hemoglobin (A1C) is associated with improved outcomes with no threshold effect. To date, only one randomized clinical trial has demonstrated a ben Continue reading >>

Management Of Blood Glucose In Type 2 Diabetes Mellitus

Management Of Blood Glucose In Type 2 Diabetes Mellitus

Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalization of blood glucose levels (hemoglobin A1C level less than 7 percent). Insulin resistance, decreased insulin secretion, and increased hepatic glucose output are the hallmarks of type 2 diabetes, and each class of medication targets one or more of these defects. Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. Other medications include sulfonylureas and nonsulfonylurea secretagogues, alpha glucosidase inhibitors, and thiazolidinediones. Insulin can be used acutely in patients newly diagnosed with type 2 diabetes to normalize blood glucose, or it can be added to a regimen of oral medication to improve glycemic control. Except in patients taking multiple insulin injections, home monitoring of blood glucose levels has questionable utility, especially in relatively well-controlled patients. Its use should be tailored to the needs of the individual patient. Type 2 diabetes mellitus, the sixth leading cause of death in the United States, is directly responsible for more than 73,000 deaths annually and is a contributing factor in more than 220,000 deaths.1 It is the leading cause of kidney failure and new cases of blindness in a Continue reading >>

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Both the prevalence and incidence of type 2 diabetes are increasing worldwide in conjunction with increased Westernization of the population's lifestyle. Type 2 diabetes is still a leading cause of cardiovascular disease (CVD), amputation, renal failure, and blindness. The risk for microvascular complications is related to overall glycemic burden over time as measured by A1C (1,2). The UK Prospective Diabetes Study (UKPDS) 10-year follow-up demonstrated a possible effect on CVD as well (3). A meta-analysis of cardiovascular outcome in patients with long disease duration including Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) suggested that in these populations the reduction of ~1% in A1C is associated with a 15% relative reduction in nonfatal myocardial infarction (4). Most antihyperglycemic drugs besides insulin reduce A1C values to similar levels (5) but differ in their safety elements and pathophysiological effect. Thus, there is a need for recommending a drug therapy preference. While the positive effects on prevention of microvascular complications were demonstrated with the various antihyperglycemic drugs (1,2,6,7), several questions are left open regarding this therapy in newly diagnosed type 2 diabetes: What is the comparative effectiveness of antihyperglycemic drugs on other long-term outcomes, i.e., β-cell function and cardiovascular morbidity and mortality? What is the comparative safety of these treatments, and do they differ across subgroups of adults with type 2 diabetes? Should we combine antihyperglycemic drugs at the time of diagnosis according to their pathophysiological effect to address the diff Continue reading >>

What Are The Kinds Of Questions Someone Newly Diagnosed With Prediabetes Or Type 2 Diabetes Would Ask?

What Are The Kinds Of Questions Someone Newly Diagnosed With Prediabetes Or Type 2 Diabetes Would Ask?

I am male, vegetarian, teetotaler from Chennai, India. When I was diagnosed with high blood sugar ( HbA1C at 11 ) in 2012, I could not believe it. There were lots of questions - Why me ? I was 50 and looking forward to having a good life , eating what I liked and travelling. I assumed it was not going to happen. I wanted to know if I were going to die a horrible death soon. I wanted to know what I could eat without making my condition worse. Lots of questions and serious depression. I was lucky to consult a great diabetologist in my city. He looked at my reports and said - “We are going to set this right WITHOUT meds !”. I could not believe it and refused to trust him. He investigated my condition and found I had hypothyroid and gave me meds to improve my thyroid function. I started eating complex carbs, gave up processed sugars, included more protien and good heathy fats. I watched my Vitamin D levels and found I improved my overall wellbeing whenever D levels improved. I do resistance exercises 4 hours a week, walk everyday for an hour. I gave up stress and learned to forgive. Learned to accept. Learned to breathe deeply. To this date I have not been prescribed meds and my HbA1C is at 6.1. I am looking forward to being it sub 6 by next quarter. I have started weight training. The questions you should be asking are What are the foods that are going to keep my blood sugar low ? What's my Vitamin D level ? How do I become more active and what type of workouts do I do ? What are my target levels for my blood sugar in the next 3 months and how do I work to reducing it further ? I believe that I have reversed my condition and I hope to keep it that way. For a pre diabetic the path to reversal is easier. Wish you a life full of health and happiness ! Continue reading >>

The Patient With Newly Diagnosed Diabetes

The Patient With Newly Diagnosed Diabetes

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 Diabetes (Diabetes Mellitus) article more useful, or one of our other health articles. The initial management of someone who has just been diagnosed as having diabetes mellitus can have a big effect on the course of the illness. It is essential to establish a clear understanding of the disease, the benefits of all aspects of management and to allay unnecessary fears and myths quickly. See also the separate Management of Type 1 Diabetes and Management of Type 2 Diabetes articles. Assessment Indications for hospital referral at initial presentation include: Children and young people presenting with suspected diabetes should always be referred urgently, on the same day, for admission to hospital for initiation of insulin therapy. Adults who are clearly unwell, or who have ketones in their urine, or who have a blood glucose level greater than 25.0 mmol/L, should also be referred urgently for admission to hospital on the same day. Those who present with diabetic ketoacidosis or hyperosmolar hyperglycaemic state will require immediate treatment in hospital. Young adults (aged under 30 years) should also be referred to a specialist diabetes team. Clinical examination and investigations Measure height and weight, and calculate body mass index (BMI). Urinalysis: ketones and proteinuria. Arrange midstream specimen of urine (MSU) if protein is present. Identify any long-term complications of diabetes already present: Cardiovascular assessment, including smoking status, blood pressure, lipids and ECG. Examine feet for diabetic complications, including cardiovascular disease, diabetic neuropathy Continue reading >>

Handbook Of Diabetes, 4th Edition, Excerpt #10: Management Of Type 2 Diabetes

Handbook Of Diabetes, 4th Edition, Excerpt #10: Management Of Type 2 Diabetes

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Lifestyle modification The starting points and mainstays of treatment for type 2 diabetes are diet and other modifications of lifestyle, such as increasing exercise and stopping smoking (Figure 11.1). The major aims are to reduce the weight of obese patients and improve glycaemic control, but also to reduce risk factors for cardiovascular disease (CVD), such as hyperlipidaemia and hypertension, which accounts for 70-80% of deaths in type 2 diabetes. Weight loss is achieved by decreasing total energy intake and/or increasing physical activity and thus energy expenditure. Gradual weight loss is preferred – not more than 0.5-1 kg/week. For effective weight loss and improvement in glycaemic control, the amount of energy restriction is more important than dietary composition, though compliance may be greater with high monounsaturated fat diets (Figure 11.2). Weight loss of as little as 4 kg will often ameliorate hyperglycaemia. Reduced-calorie diets result in clinically significant weight loss regardless of which macronutrients they emphasize…. Antiobesity drugs have so far played only a minor part in the management of the obese patient with diabetes. Sibutramine is a centrally acting serotonin and norepinephrine reuptake inhibitor that acts as an appetite suppressant. It has many contraindications, potential drug interactions and stringent requirements for monitoring, and little information on long-term efficacy and safety. Orlistat acts locally in the gastrointestinal tract, where it blocks enzymatic digestion of triglyceride by inhibiting pancreatic lipase. The absorption of up to 30% of ingested fat is thus prevented. Orlistat can result in a greater weight loss in obese patients with type 2 diabetes over t Continue reading >>

Evaluation And Management Of The Newly Diagnosed Patient With Type-2 Diabetes

Evaluation And Management Of The Newly Diagnosed Patient With Type-2 Diabetes

Abstract 1. To learn the diagnostic criteria for type-2 diabetes. 2. To understand the components of the initial evaluation of an individual with type-2 diabetes. 3. To learn how to manage newly diagnosed individuals with type-2 diabetes. 15.Lund SS, Vaag AA. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association: response to Skyler et al. Diabetes Care. 2009;32(7):e90–1; author reply e2–3. 36.Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation. 2010;121(24):2694–701. Continue reading >>

How Do You Cure Type 2 Diabetes Naturally With Diet?

How Do You Cure Type 2 Diabetes Naturally With Diet?

I’m a specialist practitioner in obesity and diabetes. Type 2 diabetes can be reversed through diet. Absolutely. Firstly this is what is a normal insulin reaction looks like: Insulin is manufactured in the pancreas and secreted when your blood sugar levels rise. Blood sugar needs to be not too high and not too low. Insulin’s mechanism to remove sugar from blood is to put it into cells, like your muscles. If there is an excess after blood glucose has gone into cells it is then put in the liver and further excess becomes fat. What happens with type 2 When insulin is secreted the body’s cells have ‘‘receptors’ that accept the insulin’s key that then open the doors to the cell to let the glucose in. Sadly in type 2 the receptors become resistant to the insulin key. Therefore not enough energy gets into the cell. The body has a negative feedback system. Once the cells do not get enough energy a signal is sent back to the pancreas to manufacture even more insulin. This is a vicious cycle. Insulin keeps going up and resistance keeps getting worse. A drug, called metformin works by making cells receptive again but it has limitations and eventually other drugs are needed. This is not ideal; so how can we reverse this? Well quite simply really. The crux of this scenario is that it is the sugar spikes in the blood that are causing the high levels of insulin in the first place. Certain foods cause insulin to enter the system in a fast and high volume way and some foods hardly disturb insulin at all. The insulin index is similar to the GI system and by picking foods that cause little insulin response the type 2 diabetes begins to reverse. This is a snapshot. The lower the number the lower the insulin response Sadly many government guidelines are not beneficial and larg 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 >>

Top 10 Tips For People Newly Diagnosed With Type 2 Diabetes

Top 10 Tips For People Newly Diagnosed With Type 2 Diabetes

twitter summary: Ten tips for newly diagnosed T2 #diabetes: act NOW for long-term benefits, use healthy eating, exercise, meds + structured blood glucose testing short summary: This article offers ten tips for people newly diagnosed with type 2 diabetes: 1) Know that developing type 2 diabetes does not represent a personal failing; 2) Start to take care of your diabetes as soon as you’re diagnosed (and even better, before, if you know you have prediabetes); 3) Recognize that type 2 diabetes is a progressive disease; 4) Keep in mind that food has a major impact on blood glucose; work to optimize your mealtime choices; 5) Exercise is a powerful and underutilized tool which can increase insulin sensitivity and improve health – use it as much as possible; 6) Use blood glucose testing to identify patterns; 7) Don’t forget that needing to take insulin doesn’t mean you failed; 8) Keep learning and find support; 9) Seek out the services of a Diabetes Educator; and 10) Review our Patient's Guide to Individualizing Therapy at www.diaTribe.org/patientguide. Know that developing type 2 diabetes does not represent a personal failing. It develops through a combination of factors that are still being uncovered and better understood. Lifestyle (food, exercise, stress, sleep) certainly plays a major role, but genetics play a significant role as well. Type 2 diabetes is often described in the media as a result of being overweight, but the relationship is not that simple. Many overweight individuals never get type 2, and some people with type 2 were never overweight. At its core, type 2 involves two physiological issues: resistance to the insulin made by the person’s beta cells and too little insulin production relative to the amount one needs. These problems can lead to high bl Continue reading >>

Impact Of Education On Weight In Newly Diagnosed Type 2 Diabetes: Every Little Bit Helps

Impact Of Education On Weight In Newly Diagnosed Type 2 Diabetes: Every Little Bit Helps

Abstract Highly structured, intensive behavioral lifestyle interventions have been shown to be efficacious in research settings for type 2 diabetes management and weight loss. We sought to evaluate the benefit of participation in more limited counseling and/or education among individuals with newly diagnosed type 2 diabetes in more modest real-world clinical settings. Electronic Health Records of newly diagnosed type 2 diabetes patients age 35–74 from a large ambulatory group practice were analyzed (n = 1,314). We examined participation in clinic-based lifestyle counseling/education and subsequent weight loss. Results Of the total cohort, 599 (45.6%) patients received counseling/education with (26.2%) and without (19.4%) medication, 298(22.7%) patients received a prescription for medication alone, and 417(31.7%) patients were only monitored. On average, those who participated in counseling/education attended 2.5 sessions (approximately 2–3 hours). The average weight loss of patients who received counseling/education alone during the follow-up period (up to three years post-exposure to participation) was 6.3 lbs. (3.3% of body weight), and, if received with medication prescription, 8.1lbs. (4.0% of body weight) (all at P<0.001). The weight loss associated with medication was only 3.5 lbs. (P<0.001). No significant weight change was observed in the monitoring only group. While efforts to improve both the short-term and long-term effectiveness of behavioral lifestyle interventions in real-world settings are ongoing, it is important for clinicians to continue to utilize less intensive, existing resources. Even relatively small “doses” of health education may help in promoting weight loss and may potentially reduce cardiometabolic risk. Figures Citation: Azar KMJ, Ch Continue reading >>

An Update On Type 2 Diabetes Management In Primary Care

An Update On Type 2 Diabetes Management In Primary Care

Waddell, Jeffrey MSN, ARNP, FNP-C Abstract: Diabetes mellitus is a chronic disease impacting glucose metabolism. Type 2 diabetes mellitus (T2DM) stems from the inability of the body to utilize endogenous insulin properly. Approximately 90% to 95% of newly diagnosed cases of diabetes are T2DM. This article focuses on the initial treatment of T2DM based on the 2017 American Association of Clinical Endocrinologists and the American College of Endocrinology clinical practice guidelines. The 2017 update includes changes and additions regarding psychosocial management, physical activity, surgery, and hypoglycemia. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. 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 >>

Type 2 Diabetes Glucose Management Goals

Type 2 Diabetes Glucose Management Goals

Optimal management of type 2 diabetes requires treatment of the “ABCs” of diabetes: A1C, blood pressure, and cholesterol (ie, dyslipidemia). This web page provides the rationale and targets for glucose management; AACE guidelines for blood pressure and lipid control are summarized in Management of Common Comorbidities of Diabetes. Glucose Targets Glucose goals should be established on an individual basis for each patient, based on consideration of both clinical characteristics and the patient's psycho-socioeconomic circumstances.1-3 Accordingly, AACE recommends individualized glucose targets (Table 1) that take into account the following factors1,2: Life expectancy Duration of diabetes Presence or absence of microvascular and macrovascular complications Comorbid conditions including CVD risk factors Risk for development of or consequences from severe hypoglycemia Patient's social, psychological, and economic status Table 1. AACE-Recommended Glycemic Targets for Nonpregnant Adults1,2 Parameter Treatment Goal Hemoglobin A1C Individualize on the basis of age, comorbidities, and duration of disease ≤6.5 for most Closer to normal for healthy Less stringent for “less healthy” Fasting plasma glucose (FPG) <110 mg/dL 2-hour postprandial glucose (PPG) <140 mg/dL The American Diabetes Association (ADA) also recommends individualizing glycemic targets (Table 2) based on patient-specific characteristics3: Patient attitude and expected treatment efforts Risks potentially associated with hypoglycemia as well as other adverse events Disease duration Life expectancy Important comorbidities Established vascular complications Resources and support system Table 2. ADA-Recommended Glycemic Targets for Nonpregnant Adults3 Parameter Treatment Goal Hemoglobin A1C <6.5% for patients Continue reading >>

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