Treatment Of Type 2 Diabetes

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[edit] Treatment Of Type 2 Diabetes

Treatment for type 2 diabetes is best approached in a holistic manner. Diabetes pathophysiology was explained under the other diabetes links to prepare you for understanding how important each of the components of therapy is. The most important aspect of the therapy for diabetes is to change to a diabetic diet plan, where refined sugar and starchy foods are limited. This needs to be supervised for several months by a registered dietitian.

Changing eating habits is a challenge, that's why a registered dietitian's input is important. The second aspect, which often is overlooked by the diabetic patient is to change the life style to include a home exercise program, if it has not already been done. By changing to a more active life style where every day there is some speed walking, swimming, square-dancing or similar regular physical activity, the metabolism is being changed. Why is this important?

Because we know that the insulin resistance and sugar toxicity is being controlled this way. To stubbornly attempt to treat diabetes with only pills or only insulin without paying attention to the patient's life style and without paying attention to the direction, in which the hemoglobin A1C is moving, would be a big mistake. Unfortunately the patient would be paying the price with avoidable complications and premature death.

In the mid 1980's the hemoglobin A1C level became available on a large scale.

There were large trials showing in type 2 diabetes patients that pills were not as good as insulin injections in controlling hemoglobin A1C levels optimally. But we knew from studies in type 1 diabetics that there was less mortality in patients that were treated with 3 or 4 insulin injections per day.

However, the "dogma"(or the prevailing teaching) of the time was that type 1 diabetes should be treated with insulin and type 2 diabetes should be treated with pills. On the positive note diabetologists (diabetes specialists) have been able to study the syndrome of insulin resistance in more detail.

They have found that type 2 diabetics may need both oral hypoglycemic tablets to control the insulin resistance as well as insulin injections to control the hyperglycemia. Now it is common knowledge that patients with type 2 diabetes often need both hypoglycemic medication and insulin needles for optimal control and long-term survival without complications. The physician is guided by how well the blood sugar is controlled using a one touch glucometer
by the patient. The physician will also order hemoglobin A1C measurements every 3 months to see whether normal blood sugars are present most of the time over the long-term.

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References:

1. M Frevel Aliment Pharmacol Ther 2000 Sep (9): 1151-1157.

2. M Candelli et al. Panminerva Med 2000 Mar 42(1): 55-59.

3. LA Thomas et al. Gastroenterology 2000 Sep 119(3): 806-815.

4. R Tritapepe et al. Panminerva Med 1999 Sep 41(3): 243-246.

5. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapters 20,23, 26.

6. EJ Simchuk et al. Am J Surg 2000 May 179(5):352-355.

7. G Uomo et al. Ann Ital Chir 2000 Jan/Feb 71(1): 17-21.

8. PG Lankisch et al. Int J Pancreatol 1999 Dec 26(3): 131-136.

9. HB Cook et al. J Gastroenterol Hepatol 2000 Sep 15(9): 1032-1036.

10. W Dickey et al. Am J Gastroenterol 2000 March 95(3): 712-714.

11. M Hummel et al. Diabetologia 2000 Aug 43(8): 1005-1011.

12. DG Bowen et al. Dig Dis Sci 2000 Sep 45(9):1810-1813.

13. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999.Chapter 31, page 311.

14. O Punyabati et al. Indian J Gastroenterol 2000 Jul/Sep 19(3):122-125.

15. S Blomhoff et al. Dig Dis Sci 2000 Jun 45(6): 1160-1165.

16. M Camilleri et al. J Am Geriatr Soc 2000 Sep 48(9):1142-1150.

17. MJ Smith et al. J R Coll Physicians Lond 2000 Sep/Oct 34(5): 448-451.

18. YA Saito et al. Am J Gastroenterol 2000 Oct 95(10): 2816-2824.

19. M Camilleri Am J Med 1999 Nov 107(5A): 27S-32S.

20. CM Prather et al. Gastroenterology 2000 Mar 118(3): 463-468.

21. MJ Farthing : Baillieres Best Pract Res Clin Gastroenterol 1999 Oct 13(3): 461-471.

22. D Heresbach et al. Eur Cytokine Netw 1999 Mar 10(1): 7-15.

23. BE Sands et al. Gastroenterology 1999 Jul 117(1):58-64.

24. B Greenwood-Van Meerveld et al.Lab invest 2000 Aug 80(8):1269-1280.

25. GR Hill et al. Blood 2000 May 1;95(9): 2754-2759.

26. RB Stein et al. Drug Saf 2000 Nov 23(5):429-448.

27. JM Wagner et al. JAMA 1996 Nov 20;276 (19): 1589-1594.

28. James Chin, M.D. Control of Communicable Diseases Manual. 17th ed., American Public Health Association, 2000.

29. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157, page1181.

30. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: "Chapter 107 - Acute Abdomen and Common Surgical Abdominal Problems".

31. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:"Abdominal pain".

32. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: "Chapter 4 - Abdominal Pain, Including the Acute Abdomen".

33. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

34. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier