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
- GLP-1 injectable
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)
(glyclazide or glimepiride)
- Alpha-glucosidase inhibitors
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
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)
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.
What is diabetes?
Symptoms of diabetes
by Dr Hilton Kaplan, MB BCH (Rand),
FCP(SA), MMed(UCT), Specialist Endocrinologist and Physician (March