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Type 2 Diabetes Mellitus

Prevention & Treatment

Monday, Aug. 27, 2007; 7:47 PM

Copyright Harvard Health Publications 2007

Prevention

Table of Contents

You can help to prevent type 2 diabetes by maintaining your ideal body weight, especially if you have a strong family history of diabetes. Diet and exercise have been shown to delay the onset of diabetes in people who are in the early stages of insulin resistance, identified by borderline blood sugar levels. The medication metformin (Glucophage) offers some additional protection for people with blood glucose levels that are between 100 and 125 mg/dL, near the diabetes range. People with blood sugar levels in this range sometimes are said to have pre-diabetes.

If you already have type 2 diabetes, you can delay or prevent complications by keeping tight control of your blood sugar. In addition, you can lower your risk of heart-related complications by taking an aspirin daily, and by aggressively managing other risk factors for atherosclerosis, such as high blood pressure, high blood levels of cholesterol and triglycerides, cigarette smoking and obesity. Yearly visits with an eye doctor and a foot specialist (podiatrist) are recommended to reduce eye and foot complications.

Treatment

In most people with type 2 diabetes, treatment begins with weight reduction through diet and exercise. A healthy diet for a person with diabetes is low in cholesterol, low in total calories, and nutritionally balanced with abundant amounts of whole-grain foods, monounsaturated oils, fruits and vegetables. A daily multivitamin is recommended for most people with diabetes.

Type 2 diabetes can be controlled with medications taken by mouth (oral medications) or injected medicine (usually insulin, although insulin is not the only injected medicine that can be used for diabetes). Medicines for type 2 diabetes include:

  • Metformin (Glucophage), which improves insulin resistance in the muscle tissues and liver

  • Sulfonylureas, including glyburide (DiaBeta, Glynase, Micronase), glipizide (Glucotrol), and others, which increase the amount of insulin made and released by the pancreas

  • Repaglinide (Prandin) and nateglinide (Starlix), which cause a burst of insulin release with each meal

  • Thiazolidinediones, including rosiglitazone (Avandia) and pioglitazone (Actos), which decrease the conversion of fat to glucose, and which improve insulin resistance

  • Acarbose (Precose) and miglitol (Glyset), which delay the absorption of sugars from the intestine

  • Exanatide (Byetta) and pramlintide (Symlin), which slow your digestion and reduce your appetite for large meals, making blood sugar more manageable. Exanatide also causes a burst of insulin release from your pancreas with each meal. These medicines are both available by injection only.

  • Insulin, which adds to your own insulin supply. When you have enough insulin, you can adequately process glucose despite having insulin resistance.

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