Management Of Diabetes Mellitus Type 2

Introduction:
Diabetes Mellitus type 2 is condition in which the there is insufficient production of hormone insulin from the pancreas or the body becomes resistant to normal or even high levels of insulin. This leads to high blood sugar (glucose) levels and if not manged properly may cause a number of complications in long term.

Managing Diabetes mellitus:
The goal of the treatment is not only to manage the symptoms but to keep the blood sugar levels in control and prevent related complications.

1. Identifying The Underlying Disease: Early in the course most patients may have no symptoms at all the the disease may go undiagnosed for years. It is important for any family physician to ask patients while taking a general history the risk factors and family history of diabetes and if suspected carry out appropriate test to identify the disease and control it at a early stage before the complications begin to develop.

2. Dietary And Exercise Modifications: Patient should be properly education and encouraged to change their life style and diet modification. Strict adherence to diet and regular exercise should be encouraged by the primary care physician at each visit. Although there is a common perception that there is a specific diabetic diet in reality it is not so. Patients just need to avoid animal fats, refined carbohydrates and sweets, and center on high fiber low fat food like vegetables and whole grains.

Some patients may have good control of their blood sugar only by managing their diet and will not need medicines. Sometimes a nutritionist may help patients educate about the diet that is healthy and protective for them.

Regular physical activity is important for every one and more so for patients with diabetes. Exercise helps to :

• Lower blood sugar levels without the need for medications
• Burns extra calories and fats and helps manage an ideal body weight.
• Improves blood flow and maintains a normal blood pressure
• Increases energy levels
• Improves the body’s ability to handle stress

3. Regular Monitoring of Blood glucose:
The goal of treatment in type 2 Diabetes mellitus is to keep the blood glucose levels at normal or near normal levels. This can be achieved by regular monitoring and adjusting the diet and medicine if needed.
Home blood sugar testing is easy and may be recommended for patients who are on insulin or oral diabetes medicines. A normal fasting blood glucose is usually less than 100 mg/dl.
Measuring HbA1c helps in determining the average blood sugar during the past two to three months. The goal for most patients is Less than 7%.

4. Pharmacological Treatment:
A number of oral medicines are available to treat type 2 diabetes. They are briefly described below:

Metformin: It is the drug of choice for most patients newly diagnosed with type 2 diabetes mellitus. It improves the body response to insulin and helps reducing high blood sugar levels. 

Common side effects are nausea and gas but it can be reduced when taken along with meals. Patients with impaired kidney function should not be given metformin.

Sulfonylureas: Have been used to treat diabetes type 2 for many years. they act by increasing the amount of insulin the body produces. They are generally used as second line if metformin alone fails to maintain adequate blood sugar levels. 

The most common side effect is hypoglycemia.

Thiazolidinediones: Acts similar to metformin by increasing the body’s sensitivity to insulin. May sometimes have serious side effects along with weight gain.

Alpha glucosidase Inhibitors:They reduce the digestion of polysaccarides in the proximal intestine, primarily lowering post prandinal rise in blood sugar levels. 

The side effects are gas and gastrointestinal symptoms.

Meglitinides: include repaglinide and nateglinide. Mode of action is similar to sulphnylureas but they are not used as first line drugs as they are expensive as well as short acting and need to be taken with each meal. These drugs be used in patients who are allergic to sulfa based drugs.

Insulin: Ultimately many patients with diabetes mellitus type 2 may require insulin. Insulin is available only in injectable form. Depending on the patients needs the doctor may prescribe mixtures of different types of insulin and timings to be given. There are many types of insulin, and they each work in a different way. Options include:

• Insulin glulisine (Apidra)
• Insulin lispro (Humalog)
• Insulin aspart (Novolog)
• Insulin glargine (Lantus)
• Insulin detemir (Levemir)
• Insulin isophane (Humulin N, Novolin N) etc