There is no cure for diabetes.
The immediate goals of treatment are to stabilize
the blood sugar and to eliminate the symptoms
of high blood sugar. The long-term goals of
treatment are to prolong life, improve the quality
of life, relieve symptoms, and prevent long-term
complications such as heart disease and kidney
failure.
The American Diabetes Association recommends
that pre-meal blood sugars fall in the range
of 80 to 120 milligrams per deciliter, bedtime
blood sugars fall in the range of 100 to 140
milligrams per deciliter, and HbA1c levels are
at or below 7 percent. Education, diet, exercise,
weight control, medication, blood glucose self-testing,
and foot care are vital for good control of
diabetes and prevention of its complications.
EDUCATION:
Diabetes education is an important part of
a treatment plan. People can learn many skills,
including:
- How to recognize and treat low and high
blood sugar
- How to select the right foods and when to
eat them
- How to take insulin or oral medication
- How to test and record blood glucose
- Urine ketone testing (for type I diabetes
only)
- How to adjust insulin and/or food intake
when changing exercise and eating habits
- How to handle sick days
- Where to buy diabetes supplies and how to
store them
After patients learn the basics of diabetes
care, many go on to learn how their diabetes
started and how it can cause long-term health
problems. People with diabetes need to review
and update their knowledge, because new research
and improved ways to treat diabetes are constantly
being developed.
DIET:
The American Diabetes Association (ADA) currently
recommends that 50-60% of a person’s diet should
come from carbohydrates (starches and sugars),
10-20% from protein, and less than 30% from
fats. The ADA no longer recommends a specific
number of calories per day.
Specific meal plans are based on an individual’s
usual food intake. People with Type 1 diabetes
should eat at about the same times each day
and try to be consistent with the types of food
they choose. This helps to prevent blood sugars
from becoming extremely high or low. Type 2
diabetics should eat diets that are well-balanced
and low fat. A registered dietician can be very
helpful in planning a diabetic’s dietary needs.
EXERCISE:
Regular exercise is especially important for
the person with diabetes. It helps with blood
sugar control, weight loss, and high blood pressure.
The Nurses Health Study has shown that diabetics
who exercise are less likely to experience a
heart attack or stroke than diabetics who do
not exercise regularly. A diabetic should be
evaluated by his or her physician before starting
an exercise program.
Here are some exercise considerations:
- Choose an enjoyable physical activity that
is appropriate for the current fitness level.
- Exercise every day and at the same time
of day if possible.
- Monitor blood glucose levels by home testing
before and after exercise.
- Carry food that contains sugar in case blood
glucose levels get too low during or after
exercise.
- Carry a diabetes identification card and
change for a phone call in case of an emergency.
- Drink extra fluids that do not contain sugar
during and after exercise.
- Changes in exercise intensity or duration
may require changes in diet or medication
dose to keep blood sugar levels from going
too high or low.
MEDICATION:
Medications to treat diabetes include insulin
and glucose-lowering pills. People with Type
1 diabetes cannot make their own insulin, so
they must take insulin injections every day
to survive. People with Type 2 diabetes make
insulin, but they do not use it effectively.
They can survive without insulin injections,
but many take insulin shots to achieve control
of their blood sugar levels. Insulin must be
injected under the skin using a needle and syringe,
or in some cases, an insulin pump. Insulin is
not available in oral form.
There are several types of insulin preparations.
They differ in how fast they start to work and
how long they work. Insulin injections may be
required only once a day or several times a
day. Sometimes different types of insulin are
mixed together in a single injection. The types
of insulin to use, insulin doses, and number
of daily injections are chosen by a healthcare
professional trained to provide diabetes care.
People needing insulin are taught to give themselves
their injections by their healthcare providers
or diabetes educators.
Unlike Type 1 diabetes, Type 2 diabetes may
respond to treatment with exercise, diet, or
oral medications. There are several oral medications
that lower blood glucose in Type 2 diabetes.
They fall into one of three groups:
- Medications that increase insulin production
by the pancreas. These include Amaryl, Glucotrol
and Glucotrol XL, Micronase, Diabeta, Glynase,
Prandin, and Starlix.
- Medications that increase sensitivity to
insulin. These include Glucophage, Avandia,
and Actos.
- Medications that delay absorption of glucose
from the gut. These include Precose and Glyset.
Occasionally, people with Type 2 diabetes no
longer need medication if they exercise, restrict
their diet, and lose weight. However, most Type
2 diabetics will require more than one medication
for good blood sugar control within three years
of starting their first medication. Different
groups of oral medications may be combined,
or insulin and oral medications may be used
together.
Presently, oral medications are not used to
treat diabetes occurring in pregnancy. Gestational
diabetes is treated with diet and insulin.
SELF-TESTING:
Blood sugar testing, also called "self-monitoring,"
is done using a special meter called a glucometer
to check the amount of glucose in a drop of
blood. Testing is usually done before meals
and at bedtime, though more frequent testing
may be needed during times of illness or stress.
If it is done on a regular basis, testing informs
the diabetic patient and their healthcare provider
how well diet, exercise, and medication are
working together to control their diabetes.
Blood sugar testing results can be used to
adjust meals, activity, or medications to keep
blood sugar levels within an appropriate range.
They allow healthcare providers to recommend
changes in diabetes treatment. Testing will
identify high blood sugar and low blood sugar
levels before serious problems develop.
Ketone testing is a second test that is used
in Type 1 diabetes. Ketones build up in the
blood when there is not enough insulin in Type
1diabetes and eventually "spill over" into the
urine. The ketone test is done on a urine sample.
High levels of blood ketones may result in a
serious condition called ketoacidosis. Ketone
testing is usually done:
- When the blood sugar is over 240 milligrams
per deciliter
- During acute illness (for example, pneumonia,
heart attack, or stroke)
- When nausea or vomiting occur
- During pregnancy
FOOT CARE:
People with diabetes are at risk for foot injuries
due to numbness caused by nerve damage and low
blood flow to the legs and feet. The most serious
injury is a foot ulcer. Diabetic foot ulcers
are at very high risk of becoming infected,
and sometimes they cannot be healed. Non-healing
foot ulcers are a frequent cause of amputation
in diabetics.
To prevent foot injury, diabetics should adopt
a daily routine of checking and caring for their
feet as follows:
- Check the feet every day, and report sores
or changes and signs of infection
- Wash the feet every day with lukewarm water
and mild soap, and dry them thoroughly
- Soften dry skin with lotion or petroleum
jelly
- Protect the feet with comfortable, well-fitting
shoes
- Exercise daily to promote good circulation
- See a podiatrist for foot problems, or to
have corns or calluses removed
- Remove shoes and socks during every visit
to the healthcare provider to remind them
to examine the feet
- Stop smoking, because it worsens blood flow
to the feet
For many years, it was thought that the long-term
complications of diabetes were inevitable. We
now know that this does not have to be true
for most people.
Diabetes is frequently complicated by heart
disease, stroke, kidney failure, impaired vision
or blindness, diseases of the nervous system,
and foot and leg amputations. Recent studies
show that good blood sugar control can prevent
these complications.
The Diabetes Control and Complications Trial
(DCCT) studied the effects of tight blood sugar
control on complications in Type 1 diabetes.
Patients treated for tight blood glucose control
had an average HbA1c of approximately 7 percent,
while patients treated less aggressively had
an average HbA1c of about 9 percent. At the
end of the study, the tight blood glucose group
had dramatically less kidney disease, eye disease,
and nervous system disease than the less aggressively
treated patients.
The United Kingdom Prospective Diabetes Study
(UKPDS) studied the effects of tight blood glucose
control in patients with Type 2 diabetes. This
study also found dramatically lower rates of
kidney, eye, and nervous system complications
in patients with tight control of blood glucose
(meaning an average HbA1c of 7%). In addition,
there was a significant drop in all diabetes-related
deaths, including lower risks of heart attack
and stroke. Tight control of blood pressure
was also found to lower the risks of heart disease
and stroke.
The results of the DCCT and UKPDS studies confirm
that good blood sugar control reduces the risk
of long-term complications in both Type 1 and
Type 2 diabetics
