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Managing Diabetes

Diet & Lifestyle

When you are first diagnosed with Type 2 diabetes you will be advised on how best to make some lifestyle changes, including what you eat, and these changes will form the basis for your treatment. In other words, to begin with, diabetes can often be controlled by DIET and LIFESTYLE ONLY, and in the long term the target is to reach as close to target weight as possible. It is very important to realise that being 'perfect' isn't necessary and that even small changes in diet, exercise and weight loss can make a big difference in diabetes control and blood pressure, often more than tablets achieve.    

Drugs

People with Type 2 Diabetes are often prescribed many different tablets from their doctors. These include tablets to lower blood sugar, blood pressure, cholesterol and drugs to reduce your risk of heart attacks and strokes. Many find this bewildering and have difficulty remembering whether they have taken their medication on a daily basis.

Recommendations:

  • Carry a list of your medications in your purse or wallet, this is often useful when attending clinics;
  • Take your tablets regularly. If you have many tablets and tend to forget doses, obtain a dosset box from your pharmacist;
  • Find out about the common side effects of your medication and If a tablet disagrees with you let your doctor know;
  • Some treatments require an occasional blood test to check on your kidney or liver function – remind your doctor when these tests are due. Find out what targets you need to aim for. This is especially important for blood pressure, cholesterol and glucose levels.  

Tablets for treating Type 2 Diabetes

  • The sulphonylureas work by stimulating release of insulin from the pancreas. Examples from this group are gliclazide and glipizide.  They may occasionally cause hypoglycaemia and are rarely used by themselves nowadays. 
  • Metformin is usually the first tablet treatment your GP will try. It is the first choice drug in people with diabetes who are overweight. Side effects can include abdominal discomfort and change in bowel habit, but these are usually avoided by starting on a low dose and inreasing gradually, or trying the slow release form.
  • PIOGLITAZONE makes your body more sensitive to insulin. 

The above glucose lowering tablets often need to be given as a combination of two or three types in order to get good control of the blood glucose levels.  

Aspirin – Other than for people who alreadyhave knon coronay artery disease (angina or heat attacks) there is little evidence of benefit for aspirin in helping the circulation in people with diabetes, although theer ae exceptions. Your GP would be able to advise on this. 

Statins – All people with diabetes over the age of 40 years should take simvastatin 40 mg daily, or a similar drug if this isn't tolerated.  Your GP would be able to advise on this. This offers real benefit in reducing the risk of future heart problems and helps regardless of the cholesterol level before treatment.

Insulin

What is Insulin?

Insulin is a hormone which is secreted by a specialised group of cells within the pancreas called Beta cells. It is a protein, and works as a messenger carrying information from the pancreas to the various cells of the body. Cells have receptors on the surface to which insulin attaches rather like a key to a lock. The 'key' opens the door allowing glucose to enter the cell. Insulin is essential to this process as without insulin, glucose cannot get into the cells.

How do I take insulin?

Insulin is a protein. If swallowed in tablet form it would be digested (broken down) by the acid in the stomach and enzymes in the gut. It is therefore given as an injection.

Why are there so many different preparations available?

The right type of insulin for you and the number of injections per day depend on your lifestyle and other factors which will be discussed between you and your diabetic nurse or doctor. You may need to inject once, twice or four times a day.

Short acting – there is only one type of natural human insulin which is identical in composition to Human Actrapid . These preparations are quickly absorbed when injected subcutaneously (under the skin) and tend to last no more than 6-8 hours after injection.

Longer acting- the longer acting insulins such as Human Insulatard are basically the same insulin which is complexed with a binding protein which slows down the absorption from the subcutaneous fat. This makes the duration of action longer and is why these preparations are sometimes prescribed for use at bed time so that the effect lasts until morning.

Insulin mixtures – mixtures of insulin such as Human Mixtard 30 are simply mixtures of the long acting and short acting insulin which are combined in one vial for reasons of convenience. These mixtures take away the need for mixing doses or having two separate injections. They can be prescribed on a twice daily basis and are therefore popular with patients who do not want the inconvenience of several injections.

Insulin Analogues – the new insulin analogues are 'man-made' insulins which do not exist normally in nature. The quicker acting examples of these insulins are Novorapid and Lispro. The longer acting analogues are called Glargine and Detmir.

A list of insulin preparations available in the UK can be obtained at http://www.diabetes.org.uk/products/insulin.htm