The goal of the treatment/management is to:
1. Achieve optimal blood glucose levels concentrations
2. Achieve optimal blood lipid concentrations
3. Provide appropriate energy for reasonable weight, normal growth and development and pregnancy and breastfeeding, according to the SA National Diabetes Advisory Board

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Step 1. Diagnosis

Step 2. Education, leading to lifestyle changes:

• Diet (read more in Diet and Diabetes),
• Weight control (read more in Obesity and Diabetes) and 
• Exercise (read more in Diabetes and Exercise).
• It is very important to set attainable targets. 

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 2 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 is short- or long-acting, your 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)

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 ot 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 2 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 011 792 9888/7.
 

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