Diabetes

Updated 20 February 2017

Treating type 2 diabetes

Type 2 diabetes is treated using medication and lifestyle changes with the aim of effectively managing blood glucose to avoid complications such as cardiovascular, kidney and renal disease.

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Type 2 diabetes is treated using medication and lifestyle changes with the aim of effectively managing blood glucose to avoid complications such as cardiovascular, kidney, nerve and eye disease.

The mainstay of treatment in type 2 diabetes is lifestyle change: weight loss, a structured exercise programme and a diet avoiding sugar, and low in fat, with a reduced carbohydrate content, and with sufficient legumes, nuts, vegetables and some fruit.

All diabetics should consult a dietitian early on in the disease to work out the correct diet for their lifestyle. It is of utmost importance that individuals attempt to stop smoking. Most diabetics even on the correct diet and taking regular exercise will need to control their blood glucose with medication.

The broad range of metabolic defects present often requires treatment with combinations of more than one drug. Increasing doses of medications and insulin injections may be required to control the blood sugar. The blood sugar levels should be reviewed by the patient’s doctor on a regular basis.

1. Medication to regulate blood sugar levels

- Oral agents

- Insulin

- GLP-1 injectable

1.1 Non-insulin medication options

Most of these medications are available in tablet format (known as oral hypoglycaemic agents [OHAs], which literally means glucose-lowering medication taken by mouth).

However, one of the newer generation anti-diabetic medications is only available as an injection. There is an increasing array of tablets that are effective in lowering glucose levels in type 2 diabetics.

They differ in their modes of action, side-effects, cost and dosing schedule. The choice of the most suitable one needs to be made on an individual basis after a full medical assessment. The main groups of oral blood glucose-lowering tablets are:

- Biguanides (e.g. metformin)

- Sulphonylureas (glyclazide or glimepiride)

- DPP-4-inhibitors

- Thiazolidinediones

- Alpha-glucosidase inhibitors

1.2 Insulin

Most type 2 diabetics in order to adequately control blood sugar levels will need insulin at some stage of their condition.

Insulin treatment should not be delayed if the sugar levels are not adequately controlled with tablets.

Insulin is often combined with metformin or a sulfonylurea drug (or one of the newer non-insulin diabetic medication) as this increases the patient’s sensitivity to insulin and often reduces the dose of insulin that is needed.

For years, doctors only prescribed insulin therapy for diabetics when all else has failed. However, things have changed.

Now, experts advocate earlier introduction of insulin in the treatment of type 2 diabetes both because it actually protects the remaining insulin-producing cells in the pancreas and also not to delay obtaining good control of the blood sugar as long-standing poorer control will inevitably lead to diabetic complications.

1. 3 Incretin mimetics (GLP-1 agonists)

 Medications that help prevent or treat the complications of diabetes. It’s imperative that the associated risk factors for developing complications be carefully assessed and treated.

This is imperative to avoid developing serious eye, nerve, kidney and cardiovascular complications. The most important conditions that require treatment are hypertension and lipid abnormalities, both of which are commonly associated with type 2 diabetes.

Read more: 

What is diabetes? 

Symptoms of diabetes 

Diabetes diabetes

Reviewed by Dr Hilton Kaplan, MB BCH (Rand), FCP(SA), MMed(UCT), Specialist Endocrinologist and Physician (March 2016)

 

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Diabetes expert

Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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