Type 2 Diabetes

Diet

• Follow a balanced meal plan, eating consistent and moderate amounts of food at regular times.
• Do not skip meals.
• Eat plenty of fruits, vegetables, and fiber.
• Eat limited amounts of fat.
• Eat moderate amounts of protein and low-fat dairy products.
• Carefully limit foods containing sugar, which may be included as part of a balanced diet plan.
• Eat a bedtime snack with protein and a starchy food.
• Keep a record of your food intake to help a dietitian or doctor advise you based on your nutritional needs.

Weight Loss

If you are overweight, talk to your doctor about a reasonable weight goal and a safe diet program.

Exercise

Physical activity helps the body use blood sugar. It will also help you reach and maintain a healthy weight, and lower the levels of fat in your blood. Follow your doctor's recommendations for activity levels and restrictions. In a recent review of 14 clinical trials, exercise was found to improve blood sugar control in 377 patients with type 2 diabetes. *

Oral Medication

Medications taken by mouth may be used to lower blood sugar. These may include:

• Drugs that prompt the pancreas' beta cells to make more insulin (eg, sulfonyureas [glyburide, tolazamide])
• Insulin sensitizers—a class of drugs that help the body better use insulin (eg, rosiglitazone and pioglitazone)
  • See paragraph below on rosiglitazone.
• Starch blockers—a class of drugs (eg, acarbose and miglitol) that helps decrease the absorption of glucose into the bloodstream (through the intestine), resulting in better blood sugar control (a blunted increase) after a meal
• Drugs that help reduce the production of glucose by the liver (eg, metformin)
• Amylin analogues (eg, pramlintide)
• Dipeptidyl peptidase IV (DDPP-4) inhibitor (eg, sitagliptin)
• Incretin-mimetic (eg, exenatide)

In a recent analysis of 42 clinical trials involving over 27,843 patients with diabetes or prediabetes, subjects who took rosiglitazone were 43% more likely to have a heart attack compared to subjects who did not take this medication. There was also a possible increased risk of cardiovascular death in the rosiglitazone group. However, it is important to note that for every subject on rosiglitazone who had a heart attack, 375 were able to take it without having a heart attack. Speak with your doctor if you are taking rosiglitazone for your diabetes or prediabetes. In light of these findings, he or she may recommend switching to an alternative medication while the results of other studies are pending. *

Insulin

Insulin by injection or inhalation supplement the insulin produced by the body. Insulin therapy is needed when blood sugar levels are not kept low enough with diet, exercise, and oral medications.

Blood Sugar Testing

Checking blood sugar levels during the day helps you track the amount of glucose in your blood. Testing is easy with a blood glucose monitor. Keeping track of blood glucose levels is particularly important if you take insulin. However, many patients with type 2 diabetes can be adequately managed by using another test called glycosylated hemoglobin or hemoglobin A1c (HbA1c), which is performed in a doctor’s office. Unlike blood sugar levels, HbA1c has the advantage of measuring average blood glucose levels over a three-month period, which marks the effectiveness of diabetes management over the long-term. Most diabetics are recommended to keep their HBA1C levels below 7 mg/dl.

In a recent study of 453 moderately well-controlled type 2 diabetics who did not take insulin, researchers investigated whether patients who undertook regular self-monitoring of their blood sugar had better control over their diabetes than patients who did not monitor their blood sugar for an average of three years. They found no significant difference in HbA1c levels between the groups, suggesting that regular blood sugar testing in diabetics whose condition is under reasonably good control without insulin may not be necessary. * However, you should be sure to have a discussion with your physician before discontinuing blood sugar monitoring.

Alternative Therapies

Researchers recently studied vitamin E supplementation in a subgroup of patients—those with type 2 diabetes mellitus (DM) and a certain genotype called Haptoglobin 2-2 (Hp 2-2). This genotype is a determining factor for the occurrence of cardiovascular events in patients with DM.

One thousand four hundred and thirty-four patients (aged 55 and over) with the Hp 2-2 genotype were randomized to receive vitamin E (400 units daily) or placebo. Researchers ended the study after 18 months because they found that vitamin E was associated with a significant decrease in the rates of cardiovascular events (combined outcome of heart attack, stroke, or cardiovascular death). Although the rates of heart attacks were significantly reduced with vitamin E, reductions in the rates of stroke, cardiovascular mortality, or all-cause mortality did not reach statistical significance.*