The mainstay of treatment in type 2 diabetes is lifestyle change – weight loss, a structured exercise programme and a diet low in fat, with plenty of fruit and vegetables.
Any diabetic should consult a dietician early in the disease to work out the correct diet for their lifestyle. It is of utmost importance that individuals attempt to stop smoking, and if it is not possible to stop, reduce the habit to an absolute minimum.
However, recent research has shown that in most people, even the correct diet along with exercise will eventually not be sufficient to control their blood glucose and that drugs have to be used.
The broad range of metabolic defects present often requires treatment with combinations of more than one drug. Furthermore, with time, as the ability of the pancreas to produce sufficient insulin wanes, increasing doses of medications and insulin injections may be required to control the blood sugar. The blood sugar levels should be reviewed by the patients doctor on a regular basis.
The medications used for treating type 2 diabetes have the following aims:
Medications that lower the blood sugar levels
Oral hypoglycaemic agents (OHAs)
There is an increasing array of tablets that are now effective in lowering glucose levels in type2 diabetics. They differ in their modes of action, side effect profile, cost and dosing schedule. The choice of which is most suitable needs to be made on an individual basis after a full medical assessment.
The main groups of OHAs are:
Sulphonylureas (Daonil, Glyben, Diamicron, Glucomed, Minibiab, Amaryl)
Metformin (Glucophage, Rolab-metformin)
Meglitinides (Starlix, Novonorm). These are newer and more expensive treatments that are used in combination with metformin.
Thiazolidinediones (Actos, Avandia). This new class of drug helps overcome insulin resistance and they may have some other beneficial effects on the underlying metabolic defects.
Insulin injections may be necessary in controlling the sugar levels and are usually started when the OHAs become ineffective. Insulin treatment should not be delayed once the sugar levels are not adequately controlled on tablets.
Insulin is usually combined with metformin as this increases the patient's sensitivity to the insulin and often reduces the dose of insulin that is needed.
Medications that help prevent or treat the complications of diabetes
It is imperative that the associated metabolic problems in type 2 diabetes are adequately treated as this has been shown to help prevent the serious cardiovascular and other complications for which the diabetic patient is at risk.
The most important conditions that require treatment are hypertension and the lipid abnormalities, both of which are commonly associated with type 2 diabetes.
Some of the commonly used medications which offer specific benifits in diabetes include:
ACE Inhibitors (ramipril/Tritace or Ramace, perindopril/Coversyl, lisinopril/Zestril, captopril/Capoten). These are antihypertensive medications which may offer additional protection against kidney and cardiovascular complications.
ARBs (losartan/Cozaar, irbesartan/Approvel). These are used to treat hypertension and have also recently been shown to be of benefit in slowing the progression of the kidney complications in type 2 diabetics.
"Statins" (atorvastatin/Lipitor, pravastatin/Prava, simvastatin/Zocor). While a low-fat and low-cholestrol diet is important, it is often insufficient. The "statins" are a powerful group of cholesterol lowering agents that are useful in treating the abnormal lipid profile and helping to achieve the strict targets for cholestrol that need to be attained in order to lessen the risk of cardiovascular disease.
Asprin has been shown to be of benefit in preventing cardiovascular events such as heart attacks and strokes and should be used in type 2 diabetics who are at risk or who have a history of previous cardiovascular events.
Viagra. Erectile dysfunction is a common problem in male diabetics and newer forms of treatment are becoming available. Viagra may be an effective, although expensive, option.
For more information on care and support of diabetes visit Diabetes South Africa or phone them on 086 111 3913.
- (Diabetes SA/Health24, May 2009)
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