Treatment for diabetes, type 2
Treatment complications
Hypoglycaemia (which is often called a 'hypo') occurs when the level of glucose becomes too low, usually under 4 mmol/l. People with diabetes who take insulin and/or certain diabetes tablets are at risk of having a hypo. A hypo may occur if you have too much diabetes medication, delayed or missed a meal or snack, or have taken part in unplanned exercise or physical activity. Symptoms of hypoglycaemia include: trembling, sweating, anxiety, blurred vision, tingling lips, paleness, mood change, vagueness or confusion. To treat hypoglycaemia: take a sugary drink or some sweets. Then eat a starchy snack such as a sandwich. Note: hypoglycaemia cannot occur if you are treated with diet alone.
What are the aims of treatment?
If a high blood glucose level is brought down to a normal or near normal level, your symptoms will ease and you are likely to feel well again. However, you still have some risk of complications in the long-term if your blood glucose level remains even mildly high - even if you have no symptoms in the short-term. Therefore, the main aims of treatment are:
- To keep your blood glucose level as near normal as possible.
- To reduce any other 'risk factors' that may increase your risk of developing complications. In particular, to lower your blood pressure if it is high, and to keep your blood lipids (cholesterol) low.
- To detect any complications as early as possible. Treatment can prevent or delay some complications from getting worse.
Treatment aim 1 - keeping your blood glucose level down
How is the blood glucose level monitored?
The blood test that is mainly used to keep a check on your blood glucose level is called the HbA1c test. This test is commonly done every 2-6 months by your doctor or nurse.
The HbA1c test measures a part of the red blood cells. Glucose in the blood attaches to part of the red blood cells. This part can be measured and gives a good indication of your average blood glucose level over the last 2-3 months.
Treatment aims to lower you HbA1c to below a target level which is usually agreed between you and your doctor. The target level is usually somewhere between 6.5% and 7.5%. If your HbA1c is above your target level then you may be advised to 'step up' treatment to keep your blood glucose level down (for example, by increasing the dose of medication, etc).
Some people with diabetes check their actual blood glucose level each day. If you are advised to do this then you doctor or nurse will give you instructions on how to do it.
Lifestyle - diet, weight control and physical activity
You can usually reduce the level of your blood glucose and HbA1c if you:
- Eat a healthy balanced diet. A practice nurse and/or dietician will give details on how to eat a healthy diet. The diet is the same as recommended for everyone. The idea that you need special foods if you have diabetes is a myth. Basically, you should aim to eat a diet low in fat, high in fibre, and with plenty of starchy foods, fruit and vegetables.
- Lose weight if you are overweight. Getting to a 'perfect weight' is unrealistic for many people. However, losing some weight if you are obese or overweight will help to reduce your blood glucose level (and have other health benefits too).
- Do some physical activity regularly. If you are able, a minimum of 30 minutes brisk walking at least five times a week is advised. Anything more vigorous and more often is even better. For example, swimming, cycling, jogging, dancing. Ideally you should do an activity that gets you at least mildly out of breath and mildly sweaty. You can spread the activity over the day. (For example, two fifteen minute spells per day of brisk walking, cycling, dancing, etc.) Regular physical activity also reduces your risk of having a heart attack or stroke.
Many people with Type 2 diabetes can reduce their blood glucose (and HbA1c) to a target level by the above measures. However, if the blood glucose (or HbA1c) level remains too high after a trial of these measures for a few months, then medication is usually advised.
Medication
There are various drugs that can reduce the blood glucose level. Different ones suit different people. Some drugs work by helping insulin to work better on the body's cells. Others work by boosting the amount of insulin made by the pancreas. Another type works by slowing down the absorption of glucose from the gut. Some people need a combination of drugs to control their blood glucose level. Medication is not used instead of a healthy diet, weight control and physical activity - if possible, you should still do these things as well as take medication. See a separate leaflet called 'Treatments for Type 2 Diabetes' for more details.
Insulin injections
Insulin is needed in some cases if the above treatments do not work well enough. You cannot take insulin by mouth as it is destroyed by the digestive juices in the gut.
Treatment aim 2 - to reduce other risk factors
You are less likely to develop complications of diabetes if you reduce any other 'risk factors'. These are briefly mentioned below, but are discussed more fully in another leaflet called Preventing Cardiovascular Disease Everyone should aim to cut out preventable risk factors, but people with diabetes have even more of a reason to do so.
Keep your blood pressure down
Have your blood pressure checked regularly. The combination of high blood pressure and diabetes is a particularly high risk factor. Even mildly raised blood pressure should be treated if you have diabetes. Medication, sometimes with two or even three different drugs, may be needed to keep your blood pressure down. See separate leaflet called 'Diabetes and High Blood Pressure'.
If you smoke - now is the time to stop
Smoking is a high risk factor. See a practice nurse if you have difficulty stopping. If necessary, medication or nicotine replacement therapy (nicotine gum, etc) may help you to stop.
Other medication
You will usually be advised to take a drug to lower your cholesterol level, and to take a daily aspirin. These help to lower the risk of developing some complications such as heart disease, peripheral vascular disease and stroke.
Treatment aim 3 - to detect and treat any complications promptly
Most GP's surgeries and hospitals have special diabetes clinics. Doctors, nurses, dieticians, chiropodists, optometrists, and other health care workers all play a role in giving advice, and checking on progress. Activities in diabetes clinics include:
- Checking levels of blood glucose, HbA1c, cholesterol, and blood pressure.
- Ongoing advice on diet and lifestyle.
- Checking for early signs of complications, for example:
eye checks - to detect problems with the retina (a possible complication of diabetes) which can often be prevented from getting worse. Glaucoma is also more common in people with diabetes, and can usually be treated.
urine tests - which include testing for protein in the urine which may indicate early kidney problems.
foot checks.
other blood tests.
It is important to have regular checks as some complications, particularly if detected early, can be treated or prevented from getting worse.
Immunisation
You should be immunised against 'flu (each autumn), and against the pneumococcus bacteria (just given once). These infections can be particularly unpleasant if you have diabetes.
Diabetes UK
This leaflet gives only a brief account of diabetes. For further information contact Diabetes UK (formerly the British Diabetic Association). There are numerous branches throughout the country. They produce information leaflets on various topics related to diabetes, and their careline answers enquiries on all aspects of diabetes.
Diabetes UK 10 Parkway, London, NW1 7AA Tel (careline): 0845 120 2960 (lo-call rate) Tel (office): 020 7424 1000 Web: www.diabetes.org.uk
© EMIS and PIP 2006 Updated: November 2006 PRODIGY Validated
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sunil kumar, about 1 year
hi just asking for advice my father who is a type 2 diabetic has to go to dialysis three times a week and is having problems with his kidney due to a result in diabetes recently his has been in and out of hospital due to his blood getting to thick hes just blaming his kidney but i have warned him about his diet being asain he eats o lot of fatty foods but he said thats ok to eat would it be his bad diet thats causing his bllod to thicken or would it be his kidneys .
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