Diabetes

05 February 2010

Treatment plan: type 2 diabetes

Take a look at this step-by-step action plan for type 2 diabetics, courtesy of the National Diabetes Advisory Board of SA.

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Take a look at this step-by-step action plan for type 2 diabetics, courtesy of the National Diabetes Advisory Board of SA.

The goal of the treatment/management is to:
1. Achieve optimal blood-glucose-level concentrations
2. Achieve optimal blood-lipid concentrations
3. Provide appropriate energy for reasonable weight, normal growth and development, and pregnancy and breastfeeding

Step 1. Diagnosis

Step 2. Education, leading to lifestyle changes:

Step 3. Has the treatment targets been reached within 1 (thin or ill people) – 6 months (healthy people)?

Yes – Continue with control through diet and exercise.

No – Proceed to Step 4.

Step 4. Add oral therapy
Now it's diet plus oral therapy.

There are two main types of oral medication available that can be prescribed individually or in combination: sulphonylureas and biguanides, depending on your weight/obesity factor:

  • Sulphonylueras are prescribed to non-obese people (depending whether it's short- or long-acting, you need to take 1- 3 doses per day).
  • Biguanides are prescribed to obese people (1 – 3 doses per day).
  • Start with very low doses and increase slowly (4 – weekly)


Newer classes of oral therapy can be used.

 

Step 5a. Has the treatment targets been reached within 1 (thin or ill people) – 6 months?
Yes – Continue with control through diet, exercise and oral therapy. Proceed to Step 5b.
No – Proceed to step 6, but do not skip Step 5b.

Step 5b. Do have severe symptoms, or are you pregnant, or do you have any infections?
No – Relax
Yes – Proceed to Step 8 

Step 6. Combine the two types of oral medication. Add another class of oral medication.

Step 7. Has the treatment targets been reached?
Yes – Continue and monitor
No – Proceed to step 8

Step 8. Consider insulin therapy, permanently or temporary

  • Indicated early on in the course of the disease in thin or ill people who have not achieved adequate control on diet and oral therapy.
  • Indicated in severe infections, major surgery and in pregnant diabetic women.
  • Should be considered at any stage in all people who have not achieved adequate control on diet and oral therapy.

Read more about insulin therapy

For more information on care and support of diabetes visit Diabetes South Africa or phone them on 086 111 3913.

- (Health24, May 2009)

 

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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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