Treatment steps for type II diabetes
The onset of diabetes is recognized when a patient has too high a blood sugar level. This means that his or her body is not making enough insulin to maintain a healthy amount of sugar in the blood. The cells in the pancreas of a person with diabetes gradually wear out and their ability to make insulin gradually and continuously decreases. Eventually, he or she will not have enough insulin to maintain normal blood sugar levels and the sugar level will begin to rise. Doctors and patients have many resources at their disposal to help people with diabetes maintain healthy sugar levels. The most powerful tool is a combination of diet and exercise. It requires training, motivation and teamwork on the part of the doctor and the patient.
When a person without diabetes exercises and loses weight, his or her body needs less insulin to maintain sugar levels. This also applies to people with diabetes: although they have a reduced ability to produce insulin, they can often use their diet and exercise to reduce their need for it and their sugars will return to normal. By maintaining a healthy lifestyle, they reduce the amount of insulin their bodies need to maintain normal blood sugars. If they can lower their insulin requirements enough, their limited capacity to produce insulin may be enough to maintain normal sugar levels. This is analogous to someone who experiences a pay cut and compensates by cutting back on expenses (e.g. buying less luxuries and taking fewer vacations), yet is able to meet their needs without borrowing money.
Unfortunately, diabetes is a progressive disease. This means that over time, a person with diabetes will be less and less able to produce insulin naturally. Even with adopting a healthy lifestyle, a diabetic’s sugar level is likely to start rising again over time. Just as there is a limit to how much you can cut back on your expenses and still have basic necessities, diet and exercise alone may not work indefinitely for every person with diabetes. If a patient has been eating and exercising properly but is experiencing a rise in sugar, his or her doctor may then offer medications that will reduce his or her body’s insulin requirements. Patients still need to maintain the healthy lifestyle habits they previously established to keep insulin requirements as low as possible.
While a combination of diet, exercise, and medications may work for a long time in many patients, it may not work indefinitely for every person with diabetes. When the patient is doing an excellent job with diet and exercise and taking medications appropriately, but blood sugar levels continue to rise, an insulin regimen will be an appropriate next step. While it may seem like a very logical solution to take insulin because the body can’t produce it naturally, patients and their doctors will resist using it because it requires injections, can lead to hypoglycemia (low sugars), and some people think it causes weight gain. (See my other articles on these topics for more information on the relationship between insulin and hypoglycemia/weight gain.)
Many patients would prefer a higher sugar level than recommended by the American Diabetes Association and the American Association of Clinical Endocrinologists if the elevated levels do not cause obvious symptoms and it means they can avoid self-injection. Mild increases in blood sugar, however, can increase the risk of vision impairment, kidney damage, heart attacks, strokes, and foot complications that can lead to amputations. Individuals with mildly elevated levels are also at much higher risk for sugar spikes during unrelated illness. The patient and physician must work together to weigh the discomfort and risks of using insulin against the threat of these complications, and develop a system that is appropriate for the individual.
Many people with diabetes can follow the diet and exercise prescribed by their doctor; however, others struggle to continue making and maintaining healthy lifestyle habits. Because these patients are unable or unwilling to follow the diet and exercise plan recommended by their physician, they are depriving themselves of the first and most powerful means of managing their diabetes. To help them with the diet portion of their regimen, my daughter Tova Searleman and I have set up a website to provide a free 24/7 resource to help patients acquire proper cooking skills and get practical information about this disease. People with diabetes will be able to use the site to learn basic information about diabetes, be informed about the latest advances in diabetes care and research, learn how to shop for nutritious foods, read nutrition labels, and watch videos where Tova demonstrates step-by-step how to prepare delicious meals suitable for people with diabetes and their families. Visit our site and let us know how we can be of further service to you.
Sybil Kramer, physician
Tova Searleman
MEDICAL ADVICE DISCLAIMER: The information on this site is for educational purposes only. It is not intended or implied as a substitute for professional medical advice. The reader should always consult their healthcare provider to determine if the information is appropriate for their own situation, or if they have questions about a medical condition or treatment plan. Reading the information on this website does not create a doctor-patient relationship.
Treatment steps for diabetes
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