Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
The choice of medications for type 2 diabetes is individualized, taking into account:
the effectiveness and side effect profile of each medication,
the patient’s underlying health status,
Diabetes mellitus is a metabolic disease characterized by high blood sugar (glucose) levels that result from defects in insulin secretion or the body’s ability to use insulin.
Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas. This release of insulin promotes the uptake of glucose into body cells. In patients with diabetes, the absence of insufficient production or lack of response to insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.
Prediabetes is the term used to describe elevated blood sugar (glucose) that has not yet reached the level for a type 2 diabetes diagnosis. It can be treated by lifestyle changes such as consuming a healthy diet, weight loss, and regular exercise
Proper nutrition is essential for all people with diabetes. Control of blood glucose levels is only one goal of a healthy eating plan. A diabetic diet helps achieve and maintain a normal body weight, while preventing the common cardiac and vascular complications of diabetes.
There is no prescribed diet plan for diabetes and no single “diabetes diet”. Eating plans are tailored to fit each individual’s needs, schedules, and eating habits. Each diabetes diet plan must be balanced with the intake of insulin and other diabetes medications. In general, the principles of a healthy diabetes diet are the same for everyone. Consumption of various foods in a healthy diet includes whole grains, fruits, non-fat dairy products, beans, lean meats, vegetarian substitutes, poultry, or fish.
People with diabetes may benefit from eating small meals throughout the day, instead of eating one or two heavy meals. No foods are absolutely forbidden for people with diabetes. Attention to portion control and advance meal planning can help people with diabetes enjoy the same meals as everyone else.
Glycemic index and glycemic load are further considerations in considering a meal plan for people with diabetes. Foods with low glycemic index and load raise blood sugar more slowly than high glycemic index/load foods. Glycemic index refers to a standardized measurement, while glycemic load takes a typical portion size into account.
Meal timing and amount of insulin administration are considerations when planning a diet for people with type 1 diabetes
Metformin is a biguanide drug that increases the sensitivity of the body’s cells to insulin. It also decreases the amount of glucose produced by the liver.. In 1994, the FDA approved the use of the biguanide called metformin (Glucophage) for the treatment of type 2 diabetes. Today, this is still typically the first drug prescribed for type 2 diabetes.
In addition, metformin tends to suppress appetite, which may benefit people who are overweight.
Metformin often does not reduce blood glucose enough on its own and may be given with other medications such as other oral drugs or insulin.
Possible side effects of metformin include nausea and diarrhea. These usually resolve over time.
Medications that increase insulin output by the pancreas belong to the class of drugs called sulfonylureas. Older generations of these drugs include chlorpropamide (Diabinese) and tolbutamide were abandoned due to association with higher risk of cardiovascular events.
The newer sulfonylurea drugs include glyburide (DiaBeta), glipizide (Glucotrol), and glimepiride (Amaryl).
These drugs rapidly lower blood sugar, but can cause abnormally low blood sugar (called hypoglycemia). In addition, sulfonylureas contain sulfa and should be avoided by those who are allergic to sulfa. Weight gain is a possible side effect of the sulfonylurea drugs.
Like the sulfonylureas, meglitinides is a class of drugs that work by promoting insulin secretion from the pancreas. Unlike the sulfonylureas, which last longer in the body, repaglinide (Prandin) and nateglinide (Starlix) are very short acting, with peak effects within one hour. For this reason, they are given up to three times a day just before meals.
Since these drugs increase circulating insulin levels they may cause hypoglycemia. Weight gain is also a possible side effect.