The Principles for Treatment of Type 2 Diabetes

A routine check-up may lead to the discovery you have diabetes. The diagnosis is pronounced by the doctor. For most people the conclusion of the medical professionals is that you have type 2 diabetes (T2D). After a total and completely thorough physical examination, your doctor will request a flurry of sophisticated tests to confirm the initial diagnosis – including:

  • A fasting lipid (fats) screen
  • A test of a hemoglobin fraction called A1c or HbA1c – this provides an indicator of the average blood sugar level over the last 2-3 months
  • A urine test for blood sugar levels, proteins and other pertinent substances
  • Repetition, if necessary of the above tests for absolute verification of the diagnosis of diabetes
  • A blood test of your kidney function
  • An electrocardiogram (ECG or EKG)

You are then set to visit more specialists, such as an eye doctor and podiatrist, as well as a dietician and maybe even a psychologist. All are interested in one thing – teaching you the principles of treatment for diabetes control and management.

Treatment Begins

Treatment starts immediately following the diagnosis. It begins by necessity with radical changes in lifestyle to prevent disease complications. The initiation of treatment is under the guidance of one of two individuals: your primary care physician or an endocrinologist. If you decide to opt for a specialist in the field of diabetes, talk to your favorite and most trusted primary care doctor and get a reference. The doctor can recommend someone in the field, an individual you can trust.[1] However, in most cases, you primary care doctor can take care of your needs without a referral to specialist. Other medical specialists and knowledgeable people will have input into your treatment also. They include:

  • A nutritionist
  • A diabetes educator
  • Diabetes support groups
  • A podiatrist

Yet, fundamentally, all the responsibility for adhering to the treatment plan and maintaining the right lifestyle is the responsibility of the patient. There must be a willingness to change the way you live.

Medication and Diet

There is no single method for making dietary changes in diet or selecting medications. Each diabetic patient is different. Their body requires different types of medication in different doses. The same applies to lifestyle changes. While it is true almost everyone will need to address such things as exercise, caloric intake and leisure time activities, the specifics are based on the needs and nature of the individual’s diet and lifestyle patterns. As a result, both the diet and medication will be designed to specifically meet the needs of each patient.

Organizations and experts will provide guidance. They are however just that – guidelines. Experts on diabetes can offer many suggestions as to what needs to be done to keep you healthy.  It will be necessary to be wary of advice that will be offered by next door neighbors, family and friends, only because they are not medical personnel. To help avoid any doubts or issues that may arise, make sure you have someone who is on your side and knowledgeable about diabetes – someone whom you can trust to tell you the truth while listening and who will actually help you address your needs.

Setting up a Plan

It is important you create a plan to manage and control your diabetes. Your specific strategies will act as guidelines to help accomplish goals. You will need to assess such specifics as:

  • How much do you need to reduce weight?
  • What is the role of exercise in reaching your goals and targets?
  • What type of support group can you rely on – both physical and emotional?
  • How much can you rely on your family, organizations and support groups?
  • Do you have in place some type of care plan to address any issues that may arise related to your skin, eyes, teeth and feet?[2]

The goals should be designed to keep your diabetes under control while minimizing the chances of developing possible consequences of mismanaged diabetes.

Major Objective

Your major objective in treating your diabetes is to prevent occult micro and macrovascular complications. In other words, you do not want to create the situation where you die from one of several possible complications, usually cardiovascular disease. You also want to keep your eyes, kidneys, and your legs and feet healthy and avoid the severe complications that can arise. At the same time, you also want to keep your diabetes in check on a daily basis to prevent the occurrence or appearance of any overt symptoms related to both your actual condition and treatment.

Goals of control

The types of things that must be controlled on a regular basis include: blood sugar, blood pressure, blood lipids (cholesterol) and body weight. You can do so by means of combining these factors: education, diet, exercise, and medications. This requires you to accept responsibility for turning your life around and act responsibly to achieve these goals. It also means that you are realistic in the changes you make to reach and maintain these goals.

Being realistic involves the realization not only that you have to change but also that it will not happen overnight. There will be relapses, but there will also be successes. Reward yourself for the times you are successful in meeting your goals. Nobody is perfect, but you can work on positively changing your life to meet and even succeed at what you aim to do.[3] If you keep this in mind, you may be able to manage most aspects of diabetes without relying completely to medication.

Targets 

In order to meet your goals and maintain control over your diabetes, you will need to set specific targets. The following list is an example of certain goals a diabetic may need to meet.[4]

  • Blood sugar –

Before meals: 70-130 mg/dl (3.9-7.2 mmol/l)

After meals: less than 180 mg/dl (< 10.0 mmol/l)

A1c: less than 7.0%

  • Blood pressure: less than 130/80 mm mercury (Hg)
  • Blood lipids –

LDL cholesterol should be less than 100 mg/dl (<2.6 mmol/l)

HDL cholesterol should be more than 40 mg/dl (>1.1 mmol/l)

  • Triglycerides should be 150 mg/dl  or <1.7 mmol/l or less

Conclusion

Diabetes requires that you refuse to be a passive observer of your health and diabetes. You need to be an active participant in management and control of the disease. It is not enough to talk to the doctor or medical team of professionals. You must be willing to do what it takes to stay healthy by following the principles of treatment developed in consultation with your doctor.

References 

[1] Stanley, K (2009). 50 Things You Need To Know About Diabetes. Alexandria, VA: ADA.

[2] American Diabetes Association (2009). Type 2 Diabetes. Your Healthy Living Guide. Alexandria, VA: ADA.

[3] Warshaw, HS; and Pape, J (2009). Real-Life Guide To Diabetes. Alexandria, VA: ADA.

[4] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.