Let's Talk About Diabetes Treatment
There's no cure for diabetes, but don't let that get you down. You have more choices for effective treatments and easier-to-use technologies than ever before to help you manage symptoms of the disease.by Sunny Sea Gold Health Writer
Diabetes management can be time-consuming. Checking your sugar levels, giving yourself insulin shots, staying on top of your medication schedule, planning your meals, and getting regular exercise—there’s always something to do. The good news: Diabetes treatment puts you in the driver’s seat. The choices you make can have a big impact on how you feel. Here’s what to know about the options available.
Our Pro Panel
We went to some of the nation's top experts in diabetes to bring you the most up-to-date information possible.
Nilem Patel, M.D.
Adventist Health White Memorial Hospital
Los Angeles, CA
Laura Cason, R.D.
Certified Diabetes Educator and Spokesperson
Illinois Academy of Nutrition and Dietetics
Peter Goulden, M.D.
Medical Director of the Division of Endocrinology and Metabolism
Mount Sinai St. Luke's
New York, NY
Type 1 diabetes in an incurable autoimmune disease. Type 2 diabetes cannot be cured, but for some people, diet and exercise work so well and keeps blood sugar levels stable enough that doctors might consider the disease to be in “remission,” with few or no noticeable symptoms.
Since diabetes causes high blood sugar levels, one of the most important changes someone with type 2 diabetes can make is to reduce or cut out sugary beverages like soda and juice drinks that may hike up blood sugar. It’s also smart to limit sweets, fried foods, and alcohol.
The first step is a blood test, usually the A1C (or glycated hemoglobin) test. This test measures what percentage of your red blood cells have been coated with glucose over the past two to three months. An A1C result below 5.7 is considered normal; 5.7 to 6.4 is prediabetic; 6.5 or above suggests diabetes.
Diet and exercise are your best bets. Researchers have looked into supplements like cinnamon and apple cider vinegar to see if they help treat diabetes. There isn’t enough evidence yet to show these or other natural supplements have any benefit, according to the National Center for Complementary and Integrative Health.
What Is Diabetes Again?
Let's refresh: There are three main types of diabete: type 1, type 2, and gestational diabetes during pregnancy. All three types cause people to have higher-than-normal levels of sugar—or, glucose—in their blood.
Here’s what happens normally: During digestion, the food you eat is broken down into several substances, including a sugar called glucose that serves as your entire body’s source of energy. As the glucose enters your bloodstream, your pancreas releases insulin in response, a hormone that helps move the glucose from your blood and into your muscle and fat cells so they can use it for energy.
In type 1 diabetes, the pancreas doesn’t make insulin at all so glucose builds up in the blood. In type 2 diabetes and gestational diabetes, the pancreas usually makes plenty of insulin but the body doesn’t use it very well.
Diabetes takes a lot of so-called “self-management”—checking blood sugar, giving yourself injections and/or oral medications regularly, making time for regular exercise, and changing your diet. If you find yourself feeling overwhelmed by all the various aspects of diabetes treatment, don’t hesitate to talk with your doctor about ways to lighten your load.
Burnout is a pretty common occurrence in folks with diabetes, and your doctor will be able to point your in the direction of someone who can help. For instance, many people find working with a certified diabetes educator (CDE) is useful. These healthcare providers are often registered nurses or registered dietitians and know the ins and outs of diabetes treatment. They will help you come up with a system that works for your life.
Whether or not you decide to work with a diabetes educator, it’s important to find a support system of friends, family, and a medical team that can encourage you, let you vent, and help you remember why you’re doing all of this.
Speaking of which, here’s some of what you can expect to be doing during your diabetes treatment:
Checking Blood Sugar
A lot of people with diabetes need to check their glucose every day, or even several times per day, in order to make decisions about insulin dosages and food and exercise choices.
Most people use a home glucose meter. To use it, you poke a fingertip with a specialized lancet “pen” then drop the blood onto a test strip in the meter. The meter analyzes this single drop of blood and tells you what your blood sugar level is.
In some cases—especially if you take insulin and are at risk of too-low blood sugar—it might make more sense to use a continuous glucose monitor. This tiny sensor is inserted under the skin of your abdomen, arms, or thighs, and checks glucose levels in body fluids regularly. If your levels fall too low, the monitor will alert you.
All people with type 1 diabetes need to take insulin daily in order to get energy from their food and avoid serious complications. Sometimes people with type 2 or gestational diabetes need insulin, too.
There are several different ways to take insulin. The most common is by injection with a syringe or “pen,” usually in your belly, upper arm, thigh, or butt. Some people who need multiple injections per day or are high risk of a diabetes complication known as ketoacidosis may prefer a pump that automatically delivers insulin throughout the day. It does this through a tiny catheter that is worn on your body.
There are also several different types of insulin. Many people take more than one type:
Rapid-acting insulin kicks in 15 minutes after injection, peaks in one hour, and keeps working for two to four hours. Afrezza, a type of inhaled rapid-acting insulin, can be taken before every meal, but you may still need longer-acting insulin as well.
Short-acting (also known as regular) insulin starts working in about 30 minutes, peaks in two to three hours, and keeps working for between three and six hours.
Intermediate-acting insulin hits the bloodstream in two to four hours, peaks up to 12 hours later, and is effective for up to 18 hours.
Long-acting insulin takes several hours to start working and is effective for up to 24 hours.
Ultra long-acting insulin takes six hours to get into the bloodstream and lasts about 36 hours.
Taking Diabetes Medications
There are several different oral medicines used to treat people with diabetes, particularly type 2 diabetes. These meds are often used in combination with each other, or with insulin, to control blood sugar.
Actos and Avandia (thiazolidinediones): These oral medications help glucose get out of the bloodstream and into your muscles. Possible side effects include fractures, heart problems, and weight gain.
Amaryl, DiaBeta, Glucotrol, Glynase PresTab, and Micronase (sulfonylureas): This class of drugs encourages the pancreas to make more insulin. The increased insulin helps lower blood sugar. Possible side effects include low blood sugar, skin rash, and weight gain.
Bromocriptine and Cyclocet (D-2 dopamine agonist): This drug causes the liver to release less glucose. Possible side effects include fatigue, weakness, and constipation.
Farxiga, Invokana, and Jardiance (sodium-glucose transporter 2 inhibitors): These drugs decrease the reabsorption of glucose from the urine, decreasing the amount of sugar that returns to the blood. Possible side effects include yeast and urinary tract infections.
Glucophage, Glumetza, Fortamet, and Riomet (metformin): These meds slow the breakdown of carbohydrates into sugar and reduce how much glucose your liver produces. Metformin is usually prescribed to people with type 2 diabetes, but it’s sometimes used along with insulin in type 1. Possible side effects include nausea and diarrhea.
Glyset and Orecose (alpha-glucosidase inhibitors): This type of medication slows the digestion and breakdown of starches into glucose and cuts how much glucose is absorbed by the small intestine. Possible side effects include gas, diarrhea, and stomachache.
Januvia and Onglyza (dipeptidyl-peptidase 4 inhibitors): These drugs trigger the pancreas to produce more insulin. Possible side effects include upper respiratory tract infections, headache, and sore throat.
Prandin and Starlix (meglitinide): Like sulfonylureas, these medications trigger the release of additional insulin. Possible side effects include low blood sugar, weight gain, and nausea.
Symlin (pramlintide): This injection, given at mealtimes, slows digestion of food in your stomach, thereby slowing the speed at which glucose enters the blood. It can be prescribed with insulin for people with type 1 diabetes, or with other medications for people with type 2. Possible side effects include low blood sugar, nausea, and vomiting.
Welchol (bile acid sequestrant): This medication lowers blood sugar and cholesterol. Possible side effects include indigestion, constipation, gas.
Other medications: Because diabetes is a risk factor for cardiovascular disease, drugs that treat high cholesterol and high blood pressure are sometimes prescribed for people with diabetes as a way to help lower their risk.
What Is the Best Diet for Diabetes?
A big part of treating type 2 diabetes is through daily food choices.
Although there is no single diet recommended to treat diabetes, experts agree that a Mediterranean diet rich in fruits, vegetables, whole grains, olive oil, and fish is advantageous in reducing type 2 symptoms.
Work with your endocrinologist, registered dietitian, or a certified diabetes educator to create personalized eating guidelines that work for your life. One simple guideline often recommended to newly diagnosed people is the “plate method.” It’s an easy way to get the right amount of vegetables, lean protein, and starch.
To us it, start with a 9-inch dinner plate, then:
Fill half with non-starchy vegetables (think salad, broccoli, cauliflower, carrots, and zucchini).
Fill one quarter with lean protein (chicken, turkey, tofu, eggs, or beans).
Fill the last quarter with starchy food or grain (rice, pasta, and potatoes).
Some people with diabetes may need to count the grams of carbohydrate in their meals and snacks to help make sure blood sugar doesn’t spike after meals, or to figure out the proper dose of mealtime insulin.
Treating Diabetes With Exercise
Moving your body is a key part of managing blood sugar levels, especially in type 2 diabetes and gestational diabetes. That’s because physical activity helps your body use insulin better, reduces insulin resistance, and lowers blood sugar levels. It doesn’t take a huge time commitment or intense effort, either: Even small amounts of physical activity can help. Experts recommend 150 minutes of moderate exercise per week, which breaks down to about 30 minutes five days a week.
Are There Natural Treatments for Diabetes?
Researchers have looked into dozens of different dietary supplements—from cinnamon to apple cider vinegar to chromium—to see if they help treat or prevent diabetes.
So far, there is some weak scientific evidence that chromium may help keep blood sugar even, and that an antioxidant called alpha-lipoic acid might help with diabetes-related nerve issues. There isn’t enough evidence yet to show that other supplements have any benefit, according to the National Center for Complementary and Integrative Health.
The natural remedies with the best evidence are a healthy diet and plenty of exercise. Making those part of your everyday life is key, not just for treating diabetes, but for overall good health.
If you’ve been sedentary for a while, and haven’t been following the healthiest eating habits, making the transition can take a little while. But the payoff—fewer diabetes symptoms, more energy, and possibly less need for medication—makes your efforts well worth it.
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