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 >>
Insulin Therapy For Type 2 Diabetes
A number of landmark randomized clinical trials established that insulin therapy reduces microvascular complications (1,2). In addition, recent follow-up data from the U.K. Prospective Diabetes Study (UKPDS) suggest that early insulin treatment also lowers macrovascular risk in type 2 diabetes (3). Whereas there is consensus on the need for insulin, controversy exists on how to initiate and intensify insulin therapy. The options for the practical implementation of insulin therapy are many. In this presentation, we will give an overview of the evidence on the various insulin regimens commonly used to treat type 2 diabetes. Secondary analyses of the aforementioned landmark trials endeavored to establish a glycemic threshold value below which no complications would occur. The UKPDS found no evidence for such a threshold for A1C, but instead showed that better glycemic control was associated with reduced risks of complications over the whole glycemic range (“the lower the better”) (4). For the management of type 2 diabetes, this resulted in the recommendation to “maintain glycemic levels as close to the nondiabetic range as possible” (5). However, in contrast to the UKPDS, the Kumamoto study observed a threshold, with no exacerbation of microvascular complications in patients with type 2 diabetes whose A1C was <6.5%, suggesting no additional benefit in lowering A1C below this level (2). Moreover, the intensive glycemia treatment arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, targeting A1C <6.0%, was discontinued because of higher mortality in this group compared with the standard therapy group targeting A1C from 7.0 to 7.9% (6). Therefore, the American Diabetes Association (ADA) recommendation of an A1C target <7.0% seems the most balan Continue reading >>
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What Does It Feel Like To Grow Up With Type 1 Diabetes? What Are The Biggest Challenges, And What Sorts Of Things Make It Easier To Live With?
I have had Type 1 diabetes since I was 15 years old. Interestingly my high school years were the easiest years for me in terms of diabetes management/coping with the disease, being an undergraduate and to a lesser extent a graduate student were both much more challenging, for reasons which I will mention later in my answer. Challenge 1: Learning the basic rules for managing diabetes, especially carb counting (figuring out what is in the food you are eating) and how to deal with factors like exercise, sickness, and stress. To manage diabetes successfully you have to imitate your own pancreas, and do so with tools that are inferior to a pancreas. It is easy to learn the very basics, but to achieve a high quality of life and have good control so that you have good health later you need to know how to deal with all the subtleties. The body is incredibly complicated and the blood sugar/insulin/pancreas system is no exception. Challenge 2: Being disciplined and careful after some of the things from challenge 1 have become second nature. Once you learn the basics it is easy to stop learning and just coast. It is also easy to get lazy once you have internalized things. It can be very tough to convince children to pay more attention to these things, especially since the consequences of failure don't seem that important to you. Challenge 3: Being disciplined when you are extremely busy and have lots of stress. This was by far the hardest thing for me, but only became a problem when I was a college student. This is a disease where a single mistake can be fatal and it is much easier to make mistakes when you have a lot of things going on, and I think that this is by far the toughest challenge that diabetes has presented to me (and that I think diabetes can present in terms of manag Continue reading >>
Insulin For Type 2 Diabetes: Who, When, And Why?
Physicians who treat people with type 2 diabetes face difficult choices when selecting the best medical therapy for each patient. The decision process is further complicated by the fact that because type 2 diabetes is a progressive disease, therapeutic agents that were initially successful may fail five or ten years later. As recently as 1994, there were only two options for patients with type 2 diabetes: insulin and the sulfonylureas (such as glyburide and glipizide). The good news is that today, seven totally different classes of medications are available, as well as much better insulins. The bad news is that many physicians are more confused than ever, especially when faced with the option of combining two, three, or even more drugs at one time. In addition, the past several years have seen the advent of six combination drugs (such as Glucovance, Avandamet, and Janumet), with more on the way. Faced with this explosion of therapeutic options, many physicians are reluctant to start insulin therapy even when it is clearly indicated. Insulin Resistance and Deficiency in Type 2 Diabetes Most patients with type 2 diabetes suffer from two major defects: insulin resistance and beta cell “burnout.” Insulin resistance typically precedes outright diabetes by several years, appearing in adults and children who are overweight, sedentary, and have a genetic predisposition to diabetes. Patients with insulin resistance are often diagnosed with the metabolic syndrome, which predisposes them to both type 2 diabetes and cardiovascular disease. When food is ingested, insulin is secreted by the beta cells into the bloodstream. The insulin travels to the liver or muscles, where it attaches to receptors on the surface of the cells like a key in a lock. In non-diabetic people, this proc Continue reading >>
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Insulin Therapy For Type 2 Diabetes: How Doctors Use It And Adjust For Treatment
Insulin therapy requires frequent dosage adjustments to maintain adequate blood glucose levels. Here’s information patients with type 2 diabetes can use. So your doctor told you that you need insulin therapy for your type 2 diabetes. This is a common problem and is likely to grow in the coming years. MORE FROM MICHIGAN: Subscribe to our weekly newsletter About 29 million people in the United States have type 2 diabetes, and 86 million more have prediabetes. About 1 in 4 people with type 2 diabetes is on insulin therapy; an additional 1 in 4 probably needs to be. What does it mean to be on insulin therapy? Could you have prevented this? Will insulin actually work? These are frequent questions people who need insulin therapy ask. As someone who has treated people with diabetes for years and has been working to improve the treatment’s effectiveness, I will do my best to help you answer these questions. I also have been working to develop a better way to personalize dosing for insulin. Insulin therapy for type 2 diabetes Diabetes is a condition in which your pancreas fails to secrete a sufficient amount of insulin to help you maintain normal blood glucose, or sugar in the blood, which is transported to various parts of the body to supply energy. There are many causes of insulin deficiency, but the most common is type 2 diabetes. The main risk factors for type 2 diabetes are family history, weight and age. In fact, most overweight and obese people in the Western world will never develop diabetes. Weight is an important, yet misunderstood, risk factor for diabetes. The foods you eat are usually less relevant than the weight itself. Most people in the world with type 2 diabetes do not fulfill the medical criteria of obesity; rather, their weight exceeds the capacity of the Continue reading >>
The Facts About Insulin For Diabetes
Insulin is a hormone that your pancreas makes to allow cells to use glucose. When your body isn't making or using insulin correctly, you can take man-made insulin to help control your blood sugar. Many types can be used to treat diabetes. They're usually described by how they affect your body. Rapid-acting insulin starts to work within a few minutes and lasts for a couple of hours. Regular- or short-acting insulin takes about 30 minutes to work fully and lasts for 3 to 6 hours. Intermediate-acting insulin takes 2 to 4 hours to work fully. Its effects can last for up to 18 hours. Long-acting insulin can work for an entire day. Your doctor may prescribe more than one type. You might need to take insulin more than once daily, to space your doses throughout the day, and possibly to also take other medicines. How Do I Take It? Many people get insulin into their blood using a needle and syringe, a cartridge system, or pre-filled pen systems. The place on the body where you give yourself the shot may matter. You'll absorb insulin the most consistently when you inject it into your belly. The next best places to inject it are your arms, thighs, and buttocks. Make it a habit to inject insulin at the same general area of your body, but change up the exact injection spot. This helps lessen scarring under the skin. Inhaled insulin, insulin pumps, and a quick-acting insulin device are also available. When Do I Take It? It will depend on the type of insulin you use. You want to time your shot so that the glucose from your food gets into your system at about the same time that the insulin starts to work. This will help your body use the glucose and avoid low blood sugar reactions. For example, if you use a rapid-acting insulin, you'd likely take it 10 minutes before or even with your m Continue reading >>
12 Myths About Insulin And Type 2 Diabetes
Insulin facts vs. fiction When you hear the word “insulin,” do you picture giant needles (ouch!) or pop culture portrayals of insulin users with low blood sugar (like Julia Roberts losing it in Steel Magnolias)? Either way, most people think of insulin as a difficult, painful, or potentially scary medical treatment. The problem is that if you have type 2 diabetes, you need to know the real deal before you can make an informed choice about whether or not this potentially lifesaving therapy is right for you. Here, we take a look at the facts and fiction about insulin when it comes to treating type 2 diabetes. Diabetics always need insulin Not necessarily. People with type 1 diabetes (about 5% to 10% of diabetics) do need insulin. If you have type 2, which includes 90% to 95% of all people with diabetes, you may not need insulin. Of adults with diabetes, only 14% use insulin, 13% use insulin and oral medication, 57% take oral medication only, and 16% control blood sugar with diet and exercise alone, according to the CDC. The point is to get blood sugar—which can be a highly toxic poison in the body—into the safe zone by any means necessary. Taking insulin means you’ve ‘failed’ “This is a big myth,” says Jill Crandall, MD, professor of clinical medicine and director of the diabetes clinical trial unit at the Albert Einstein College of Medicine, in the Bronx, N.Y. “Many people who try very hard to adhere to a diet, exercise, and lose weight will still need insulin.” The fact is that type 2 diabetes is a progressive illness, meaning that over time you may need to change what you do to make sure your blood sugar is in a healthy range. Eating right and exercise will always be important, but medication needs can vary. “A large percentage of people with ty Continue reading >>
Side Effects Of Taking Insulin When You Don't Need It
Insulin-dependent diabetics take insulin injections because their pancreas no longer produces insulin. Insulin helps cells absorb glucose, the body’s main energy source, from the blood. All Type 1 diabetics, formerly called juvenile diabetics, and some Type 2 diabetics, formerly called adult-onset diabetics, need insulin because their bodies no longer produce enough of the hormone. Without insulin to remove glucose from the blood, blood glucose levels rise, a condition called hyperglycemia. Taking too much insulin or taking insulin when your body already makes enough removes too much glucose from the blood, a condition called hypoglycemia, or low blood sugar. Video of the Day All cells require glucose to function. When you eat, carbohydrates in the food break down in the intestines into glucose. The blood absorbs the glucose. When this happens, your blood glucose levels rise. In response to the increase in blood sugar, the pancreas releases insulin. Insulin facilitates a cell’s ability to remove glucose from the blood and utilize it for energy. If your body has already released enough insulin and you take more, too much glucose is removed from your blood and you become hypoglycemic. Taking an overdose of short-acting or intermediate-acting insulin is more dangerous than taking too much long-acting insulin, eMedTV explains. Taking insulin when you don’t need it causes symptoms such as sweating, shaking, headache, irritability, nervousness, anxiety, weakness, dizziness, hunger, tremors, nausea, and difficulty concentrating or thinking. For diabetics, the treatment for hypoglycemia is to eat something containing quickly absorbed glucose, such as candy or special glucose tablets. If you have a hypoglycemic reaction and take glucose, follow up with a snack containing b Continue reading >>
Insulin And Type 2 Diabetes: What You Should Know
Insulin and Type 2 Diabetes If your health care provider offered you a medication to help you feel better and get your blood sugar under control, would you try it? If so, you might be ready to start taking insulin. Does insulin immediately make you think of type 1 diabetes? Think again. Between 30 and 40 percent of people with type 2 diabetes take insulin. In fact, there are more people with type 2 diabetes who take insulin than type 1 because of the much larger number of people with type 2. Experts believe even more people with type 2 should be taking insulin to control blood sugar -- and the earlier, the better. With an increase in people developing type 2 at a younger age and living longer, more and more people with type 2 will likely be taking insulin. "If you live long enough with type 2 diabetes, odds are good you'll eventually need insulin," says William Polonsky, Ph.D., CDE, associate clinical professor of psychiatry at the University of California, San Diego; founder and president of the Behavioral Diabetes Institute; and author of Diabetes Burnout: What to Do When You Can't Take It Anymore (American Diabetes Association, 1999). Producing Less Insulin Naturally Over Time Research has shown that type 2 diabetes progresses as the ability of the body’s pancreatic beta cells to produce insulin dwindles over time. Your beta cells -- the cells in the pancreas that produce insulin -- slowly lose function. Experts believe that by the time you're diagnosed with type 2 diabetes, you've already lost 50-80 percent of your beta cell function and perhaps the number of beta cells you had. And the loss continues over the years. "About six years after being diagnosed, most people have about a quarter of their beta cell function left," says Anthony McCall, M.D., Ph.D., endocri Continue reading >>
Diabetes Mellitus - Insulin Treatment In Dogs
By Ernest Ward, DVM & Robin Downing, DVM, DAAPM, DACVSMR, CVPP Emergency Situations, Medical Conditions This handout provides detailed information on insulin administration. For more information about diabetes mellitus, see the fact sheets "Diabetes Mellitus - General Information", and "Diabetes Mellitus - Principles of Treatment". What is diabetes mellitus? In dogs, diabetes mellitus is caused by the failure of the pancreas to produce enough insulin to regulate blood sugar. This is Insulin Dependent Diabetes Mellitus (also called Type 1 Diabetes). This type of diabetes usually results from destruction of most or all of the beta-cells that produce insulin in the pancreas. As the name implies, dogs with this type of diabetes require insulin injections to stabilize blood sugar levels. What do I need to know about insulin treatment for diabetes mellitus? In diabetic dogs, the main treatment for regulating blood glucose is giving insulin by injection. Dogs with diabetes mellitus typically require two daily insulin injections as well as a dietary change. Although the dog can go a day or so without insulin and not have a crisis, this should not be a regular occurrence; treatment should be looked upon as part of the dog's daily routine. This means that you, as the dog's owner, must make both a financial commitment and a personal commitment to treat your dog. If are out of town or go on vacation, your dog must receive proper treatment in your absence. Initially, your dog may be hospitalized for a few days to deal with any immediate crisis and to begin the insulin regulation process. For instance, if your dog is so sick that he has quit eating and drinking for several days, he may be experiencing “diabetic ketoacidosis,” which may require a several days of intensive care. On Continue reading >>
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Managing Diabetes Without Insulin – Is It Possible?
It is widely believed that those with Type 2 diabetes may eventually need insulin if they have diabetes for long enough. However, only about 20-30 percent of people with Type 2 diabetes end up needing insulin injections. In this article, we will explore whether it is possible to manage your diabetes without insulin. If so, how can one do so and when they may eventually need insulin if other treatments do not work out? 1 Type 1 Diabetes disclaimer This article is not for people with Type 1 diabetes because it is imperative that people with Type 1 diabetes require insulin every day without question. A person with Type 1 diabetes produces very little, or no insulin. Without insulin, you cannot convert food into usable energy. Simply put, without insulin, a person with Type 1 diabetes cannot survive. 2 When Robert contacted TheDiabetesCouncil, he was concerned that one day he would have to take insulin shots for his Type 2 diabetes. He had heard a few of his friends with diabetes at church talking about how they had to take insulin injections. Robert was “afraid of needles,” and the thought of giving himself a shot scared him. Is Robert going to need to start taking insulin, or is there any way he can avoid it at this point? If he avoids it, what effects would this have on his health? Will he develop long term complications of diabetes if he doesn’t start giving himself shots of insulin? I suggest also reading these: At TheDiabetesCouncil, we decided to take a look at this particular question in depth, for Robert and for others with diabetes who might benefit from reading this information. Insulin isn’t the “bad guy.” Naturally, the fear of giving oneself an injection or “shot,” can increase anxiety and stress. But what if I told you that once you get past t Continue reading >>
Insulin: The Holy Grail Of Diabetes Treatment
Insulin is a hormone made by beta cells in the pancreas. When we eat, insulin is released into the blood stream where it helps to move glucose from the food we have eaten into cells to be used as energy. In people with type 1 diabetes, the body produces little or no insulin as the cells that produce insulin have been destroyed by an autoimmune reaction in the body. Insulin replacement by daily injections is required. In people with type 2 diabetes the body produces insulin but the insulin does not work as well as it should. This is often referred to as insulin resistance. To compensate the body makes more but eventually cannot make enough to keep the balance right. Lifestyle changes can delay the need for tablets and/or insulin to stabilise blood glucose levels. When insulin is required, it is important to understand that this is just the natural progression of the condition. RMIT University have produced a short overview of insulin, a drug that keeps in excess of one million Australians alive. Watch the video to understand why insulin is important and why so many Australians rely on it to stay alive. Copyright © 2015 RMIT University, Prepared by the School of Applied Sciences (Discipline of Chemistry). At this stage, insulin can only be injected. Insulin cannot be given in tablet form as it would be destroyed in the stomach, meaning it would not be available to convert glucose into energy. Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer. You do not inject it into muscle or directly into the blood. Absorption of insulin varies depending on the part of the body into which you inject. The tummy (abdomen) absorbs insulin the fastest and is the site used by most people. The buttocks and thighs are also used by some people. While i Continue reading >>
Diabetes Treatment: How Much Insulin Do You Need?
If you have type 2 diabetes and your doctor thinks it might be a good time to start insulin therapy, there are two important factors to consider: How much insulin do you need to take? When do you need to take it? And both are very personal. “You can’t paint everyone with type 2 diabetes with the same brush,” says Mark Feinglos, M.D., division chief of endocrinology, metabolism,\ and nutrition at the Duke University School of Medicine, in Durham, N.C. “You need to tailor the regimen to an individual’s needs.” A person with type 2 diabetes might start off on half a unit of insulin per kilogram of body weight per day, especially if there is not much known about the nature of his or her diabetes. Still, it is not unusual to need more like one unit, says Dr. Feinglos. (One unit per kilogram would be 68 units per day for someone who weighs 150 pounds, which is about 68 kilograms.) A lot depends on your specific health situation. People with type 2 diabetes suffer from insulin resistance, a situation in which the body loses its ability to use the hormone properly. Early in the course of the disease, the insulin-producing cells of the pancreas respond to insulin resistance by churning out even more of the hormone. Overtime, though, insulin production declines. Taking insulin can help you overcome the body’s insulin resistance, though many factors can affect your dosage. If your body is still sensitive to insulin but the pancreas is no longer making much insulin, for example, Dr. Feinglos says that you would require less insulin than someone who is really resistant to insulin. “But the most important issue is not necessarily how much you need to take,” he adds. “Rather, it’s the timing of what you to take. Timing is everything.” One Shot A Day Or More? If Continue reading >>
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Diabetes Treatment: Using Insulin To Manage Blood Sugar
Understanding how insulin affects your blood sugar can help you better manage your condition. Insulin therapy is often an important part of diabetes treatment. Understand the key role insulin plays in managing your blood sugar, and the goals of insulin therapy. What you learn can help you prevent diabetes complications. The role of insulin in the body It may be easier to understand the importance of insulin therapy if you understand how insulin normally works in the body and what happens when you have diabetes. Regulate sugar in your bloodstream. The main job of insulin is to keep the level of glucose in the bloodstream within a normal range. After you eat, carbohydrates break down into glucose, a sugar that serves as a primary source of energy, and enters the bloodstream. Normally, the pancreas responds by producing insulin, which allows glucose to enter the tissues. Storage of excess glucose for energy. After you eat — when insulin levels are high — excess glucose is stored in the liver in the form of glycogen. Between meals — when insulin levels are low — the liver releases glycogen into the bloodstream in the form of glucose. This keeps blood sugar levels within a narrow range. If your pancreas secretes little or no insulin (type 1 diabetes), or your body doesn't produce enough insulin or has become resistant to insulin's action (type 2 diabetes), the level of glucose in your bloodstream increases because it's unable to enter cells. Left untreated, high blood glucose can lead to complications such as blindness, nerve damage (neuropathy) and kidney damage. The goals of insulin therapy If you have type 1 diabetes, insulin therapy replaces the insulin your body is unable to produce. Insulin therapy is sometimes needed for type 2 diabetes and gestational diabete Continue reading >>
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Insulin: Who Needs It And Who Doesn't?
Does getting a diagnosis of diabetes automatically mean you will need to start taking insulin? The answer depends on the type of diabetes and how much your condition has progressed. People with type 1 diabetes require supplemental insulin because their bodies can no longer produce insulin themselves. However, type 2 diabetes is different. Less than one-third of those with type 2 diabetes take insulin. The CDC puts the number at about 28 percent. Some experts have long believed that more patients with type 2 diabetes should be on insulin in order to reach their blood glucose and lipid (cholesterol) targets. When you are diagnosed with type 2 diabetes you will probably wonder if, or when, you will need insulin. You may fear injections or you may believe that needing insulin represents a personal failure. So, you resist taking the drug, even when you need it. Whether or not a person with type 2 diabetes needs insulin is based on individual circumstances. The first step? Knowing the facts. Does Everyone With Diabetes Need Insulin? Type 1 and type 2 diabetes are conditions in which you don't have enough insulin or don't react to it well enough to remove glucose from the blood. This creates two problems: High blood glucose levels A lack of stored glucose, the body’s major fuel source The difference between type 1 and type 2 diabetes lies in the cause of this condition. Beta cells, found in the pancreas, produce the body’s insulin. In type 1 diabetes, most of those beta cells have been destroyed, limiting the supply of insulin. As a result, individuals with type 1 diabetes must take insulin to control their blood glucose levels. In type 2 diabetes, the pancreas may still produce insulin, but it either produces insufficient amounts or the body resists the insulin itself. Di Continue reading >>