How To Treat For type 1 diabetes
- Type 2 diabetes is a multifaceted and individual disease that falls into several subgroups.
- The treatment of type 2 diabetes is mainly carried out by the patient himself. The basis of the treatment is lifestyle treatment, ie weight loss, increasing exercise, and changes in eating habits that promote health and blood sugar control.
- In some individuals, blood sugar levels can be restored to normal with effective lifestyle therapy.
- Blood glucose-lowering medication is started if the treatment goals are not achieved with lifestyle therapy.
- Along with blood sugar, blood pressure and blood fat levels must also be in order
- In addition to promoting everyday well-being, work, and functional capacity, the goal of treatment is the prevention and good treatment of additional diseases related to diabetes.
Treatment objectives for type 2 diabetes
In the management of type 2 diabetes, there are two primary aims.
- Make it possible to lower your blood sugar as ease as normal. This improves well-being and effectively prevents the development of additional diseases of diabetes.
- Reducing the risk of coronary heart disease and cerebrovascular disease, as well as co-morbid conditions such as kidney disease, fundus disease, and foot problems. In diabetes, the risk of these diseases is clearly increased, which is why special attention must be paid to their prevention.
The goals of treatment will be achieved if diabetes is improved through diet, diet, and increased exercise.
Type 2 diabetes is caused by hereditary factors and individually varying environmental and lifestyle factors. In a large proportion of people with type 2 diabetes, the disease is due to or onset of overweight, especially mid-body obesity and associated metabolic syndrome. The primary treatment is to lose enough weight to make it possible for blood sugar levels to recover, ie remission, without medication in about half of the patients.
Weight loss is aimed at permanent weight loss, in which case the need for drug treatment is passed on for years to come. Increasing exercise enhances the effects of dieting. At the same time, the risk of other diseases is reduced.
Type 2 diabetes and weight loss
If a person with type 2 diabetes is heavily overweight (body mass index over 30), you may want to set a fair weight loss goal, over 10 pounds. Fair weight loss usually leads to remission of diabetes, with blood sugar levels being normal or close to normal without medication.
For example, an extensive treatment study in the UK treated well overweight people with diabetes in an effective weight loss program. With a weight loss of 15 kg, the vast majority (86%) got their blood sugar below diabetes levels without medication. One-third of those who lost 5 to 10 kilos lost the same result.
For fair weight loss, it is advisable to apply for guided weight loss at a health center or elsewhere. Special low-calorie nutritional products can be used for weight loss. If antidiabetic drugs are used, they should be reduced during dieting. This requires instructions from your doctor or diabetes nurse.
In milder obesity, the goal may be to reduce by at least 5 pounds. Because dieting reduces fat from the liver and abdomen more than under the skin, losing a few pounds significantly improves blood sugar levels.
Exercise alone also reduces abdominal fat, so it improves blood sugar levels even without losing weight. The best results are achieved when you manage to reduce the number of calories in your diet and increase your exercise.
In overt obesity (body mass index over 30), obesity surgery is a possible form of weight loss. In most very obese people, the 20-40 kg weight loss achieved through surgery completely cures diabetes, meaning that blood sugar is normal without medication.
Type 2 diabetes and eating habits
Treatment for type 2 diabetes always involves changing eating habits so that blood sugar levels return to normal and the risk of vascular disease is reduced.
The main goal of food changes is to reduce the daily amount of energy in food after dieting. The principles of dietary changes in weight management are described in the articles Weight Loss and Weight Management and How to Reduce Calories Without Dieting.
Another critical objective is the prevention and treatment of hypertension and vascular disease. It is important for blood pressure that the amount of salt in the food is not too high. In terms of blood cholesterol, you should limit the amount of hard or saturated fat and switch to using mainly healthy vegetable oils.
Other principles related to food and eating
- Vegetables, fruits, and berries are eaten in abundance, about half a pound, or six handfuls a day, divided into different meals and snacks. They help with weight management, promote a “good” bacterial strain in the gut, and contain “slow carbohydrates,” which are carbohydrates that are slowly absorbed from the gut and only slightly increase blood sugar.
- There is no need to switch to completely sugar-free products. Exceptions are sugary soft drinks and juices, as well as whole juices (“fresh juices”), which should be avoided because they provide extra calories and raise blood sugar quickly. Other “fast” carbohydrates (white bread, buns, etc.) should also be reduced. Slow carbohydrates, such as wholemeal bread, can be used in regular amounts.
- The goal is to increase the consumption of high-fiber foods. The main sources of fiber are whole grains, bread, porridges, muesli, etc.
- Snacks do not need to be eaten regularly due to type 2 diabetes. Snacks are only used when the intervals between meals are so long that hunger should be quenched from time to time.
- Snacks may be necessary (especially during exercise) if long-acting tablets or insulin therapy are used.
Learn more about the general health-promoting diet
Type 2 diabetes and exercise
Exercise helps treat diabetes in two ways. It promotes weight loss and weight management, which greatly improves sugar metabolism. In addition, exercise increases the sensitivity of cells to insulin, which lowers blood sugar even without losing weight.
Type 2 diabetes does not require any special exercise, but normal healthy exercise works. The most crucial aspect of exercise is consistency.. Very different forms of exercise are possible; the main thing is to move.
Exercise means exercise equivalent to at least half an hour of walking most days of the week. A minimal quantity of exercise should be considered for a diabetic. Anything that comes on top of it increases the effectiveness of the exercise. It is not necessary to move continuously, but half an hour of exercise can be put together in 10-minute sections.
Everyday exercise, i.e. the diligent use of the legs and other muscles in the course of the day’s chores, is also exercise and beneficial in diabetes. The amount of daily exercise can be measured with a pedometer. Studies have found that 10,000 steps a day promotes weight management and is, therefore, a good goal for most.
Learn more about exercise and type 2 diabetes.
In type 2 diabetes, the risk of low blood sugar (hypoglycemia) is lower than in type 1 diabetes. Even during exercise, they do not occur at all if the treatment is diet, nor with most oral medications. The combination of insulin therapy and sulphonylureas and exercise can lead to low blood sugar.
Principles of use of antidiabetic drugs
Medication is usually started when the long-term blood sugar balance, which measures the red blood cell sugar, ie. " Sugar hemoglobin ", despite dieting, diet, and exercise, is above 48-53 mmol/mol (6.5-7.0%), or fasting blood sugar is consistently above 7 mmol / l. In an overweight patient, treatment is usually started with metformin. If its effectiveness alone is not enough, it can usually be combined with other medicines as appropriate. There are several drug options. Insulin therapy can be used as needed, but there are many other antidiabetic drugs available:
DPP-4 inhibitors, or gliptins, which potentiate the effect of your own intestinal hormone on the pancreas, can be used if metformin is not suitable. Their effectiveness in many is quite limited.
More effective are the so-called glucose scavengers, or SGLT2 inhibitors, which increase the passage of sugar into the urine and lower high blood sugar.
Injectable or oral intestinal hormone derivatives, or GLP-1 preparations, are perhaps the most effective hypoglycemic drugs for type 2 diabetes. In addition, they usually reduce weight, which is useful in the treatment of diabetes.
If lifestyle therapy and oral medications do not produce the desired results ("glucose hemoglobin" is consistently greater than 53 mmol/mol [7.0%]), GLP-1 or insulin will be added to the treatment on an individual basis.
Learn more about coordinating diabetes care and diet
Prevention of arterial disease
Because type 2 diabetes is associated with an increased risk of vascular disease, prevention is intimately connected to therapy.
Efforts are being made to effectively treat high blood pressure and to bring 130/80 millimeters of mercury (mmHg) to the level.
The aim is to bring the harmful LDL-cholesterol level in the blood to a level of 2.5 mmol / l or lower; if necessary, statin drugs are used.
If a diabetic patient has been diagnosed with coronary artery disease or other arterial diseases, they will be started on acetylsalicylic acid (“cardiac aspirin”) to prevent blood clots.
Smokers are encouraged and assisted to quit smoking.
Self-monitoring of blood sugar
In type 2 diabetes, self-monitoring of blood sugar is not required as frequently as in type 1 diabetes. Depending on the individual situation and treatment, how often measurements are needed will be agreed upon with the doctor or diabetes nurse.
Continuous monitoring of glucose levels, i.e. glucose-sensing can also be used in treatment planning, especially in problem situations and insulin therapy.
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