Treatment Of Type 2 Diabetes

Treatment Of Type 2 Diabetes

The diabetes type 2 treatment aims to stop the blood glucose levels between 80 and 120 mg / dl. Only the consequent reduction in blood sugar can prevent the severe sequelae of type 2 diabetes. HbA1c value is determined to monitor the therapeutic success at regular intervals. The target value is approximately in the range of 6.5 to 7.5 percent. In older people, where appropriate, a target of 8.0 percent is also still tolerable.

Also several co-morbidities such as hypertension, dyslipidemia and obesity must be necessarily treated as well in order to positively influence the course of the disease. In particular, a complete renunciation of nicotine is very important.

Type 2 Diabetes Treatment Scheme

For the type 2 diabetes treatment following level of scheme applies. Each stage is applied for about six months. After this period, the HbA1c is measured again. If it is still above 7.5 percent, the next stage of diabetes type 2 treatment is chosen:

Level 1	Basic treatment: lifestyle modification (weight loss, exercise, diet)
Level 2	Monotherapy with an oral antidiabetic drug (usually metformin)
Level 3	Combination of two oral antidiabetic agents or insulin
Level 4	Intensified insulin therapy may use in combination with oral antidiabetic

 

Adjustment Of Lifestyle

Sufficient Exercise

Physical exercise is one of the most important components in treatment of Type 2 diabetes. This help to lowered insulin resistance. In addition, regular physical activity has a positive effect on cardiovascular disease. Regular physical activities like walking, swimming , cycling etc have lot of contribution in controlling diabetes. Daily 30 minutes of exercise (walking, cycling or climbing stairs) have a positive impact.

Diet Adjustment

Balanced and healthy diet also play important role in controlling diabetes so diet adjustment is very necessary. Especially it is recommended to take little sugar (not more than 50 grams of sugar per day, or ten per cent of total energy intake). The primary goal of the diet should be an energy reduced diet. This not only reduces the elevated blood sugar levels but also promotes weight loss.

With regard to food composition, increased fiber content and a reduced fat content food are recommended. Fiber are largely indigestible food ingredients that are mainly present  in plant foods (vegetables, fruits, grains, legumes, etc.). They slow down the absorption of sugar from the intestine into the blood. Thus they prevent increase in blood sugar levels after eating. They work somewhat like a depot, through which the sugar of food can only be gradually added.

Drugs (Antidiabetics)

Medicines for type 2 diabetes are used in inadequate response by lifestyle changes. After  general measures (diet adjustment and exercise) the HbA1c is measured again. If it is still above 7.5 percent, than medicinal measures are necessary.

Oral Antidiabetic Drugs

The group of oral antidiabetic agents is constantly in flux. New agents are introduced almost every year or taken off the market. Basically it is usually started with a single drug (Monotherapy, usually with metformin). If this is insufficient, a combination with another drug or insulin is possible.

Drug group	Examples of active ingredients	Working principle	Possible side effects
Biguanide	Metformin	Increases the effectiveness of insulin up to 20 percent. Also lowers blood fats and cholesterol. Curb your appetite and therefore contributes to weight reduction.	Rare but dangerous side effect: lactic acidosis
Sulfonylureas	GlibenclamidGliquidon glimepiride, etc.	Increases insulin release from the pancreas.	Can lead to weight gain. Risk of hypoglycaemia
Glinides (“Sulfonylharnstoffanaloga”)	Repaglinide, nateglinide	Increases insulin release from the pancreas.	Can lead to weight gain. Risk of hypoglycaemia
Glitazones (“insulin Sensitiz he”)	Pioglitazone	Cells are more sensitive to insulin	Weight gain possible
Alpha-glucosidase inhibitors	Acarbose miglitol	Hemmen sugar-cleaving enzymes in the intestinal mucosa. This sugar are not included but are excreted undigested.	Frequently poor compatibility
Gliptine (DPP-IV) inhibitors	Sitagliptin, vildagliptin, etc.	Increases insulin release from the pancreas.	Low weight gain
Incretin mimetics	Exenatide liraglutide, etc.	Increases insulin release from the pancreas.	Must be injected under the skin.
SGLT-2 inhibitors (Sodium Glucose Transporter Dependant)	Dapagliflozin	Increased excretion of glucose in the urine	More frequent urinary tract infections

 

Insulin Therapy

Insulin therapy in type 2 diabetes, is necessary when dietary measures, a change of lifestyle and oral antidiabetic drugs could not result in a sufficient reduction in blood sugar. The insulin is injected by the patients themselves constantly in the subcutaneous fatty tissue (subcutaneous). There are numerous different insulins, which differ mainly in how quickly they act after eating (injection-meal interval) and how long (duration). The daily insulin requirement of a normal weight person is about 40 IU, overweight and obese people need more insulin.

As a rule, the patients initially inject either a so-called regular insulin or a very fast-acting insulin (insulin analogue) directly before the meal. Despite this measure, still too high fasting blood glucose values ​​is measured in morning . usually lead to the next therapeutic step, the conventional insulin therapy or intensified insulin therapy is used, as it is also used in patients with type 1 diabetes.

Conventional Insulin Therapy

Conventional insulin therapy is mainly useful for diabetic type 2 patients who have a fixed daily nutrition flow (for example in nursing homes). As a rule, a mixed insulin is administered twice daily with respective blood glucose determination. This relatively rigid scheme does not allow significant variations in diet and levels of physical activity. Patients should always carry glucose tablets or a snack with him to encounter quickly any hypoglycemia (<60mg / dl).

Intensified Insulin Therapy (Basal-Bolus Principle)

In intensified insulin therapy patient requires more effort but also offering more space and can effectively lower blood sugar by consequential preventing diabetes.

After the so-called basal-bolus principle as a rule a long-acting insulin is injected once or twice a day. Thus about 50 percent of daily inulin needs are covered (basal). Before eating a meal blood glucose is measured and depending on the measured blood glucose level, a “normal insulin” or short-acting insulin should injected (bolus). Its amount should be calculated based on the carbohydrate content of the meal and the time of day. This form of therapy of type 2 diabetes requires a particularly good training and patient compliance.

The basal-bolus principle provides a lot of freedom in everyday design: The patient can eat whatever and whenever they want and can get active with adequate adjustment. However, extreme physical exertion, lead to increased adrenaline secretion due to derailment of sugar metabolism.