Understanding Diabetes: Part 3 of a Three-Part Series
Thursday, December 19, 2013

Dr. Riedel
In the last two articles for this column, I discussed the development of diabetes and some of the common preventive and screening measures used by physicians to monitor the disease. For the third and final column in this series, I would like to review the most common treatments for Type 2 diabetes.

Any questions you have about your own medication regimen should be addressed with your family physician.

The first. and perhaps most important approach to the treatment of diabetes is diet and lifestyle changes. All the medications in the world will not stop the progression of this illness if the patient does not commit to improving his diet and incorporating exercise into his daily life. A commitment to lifestyle changes can significantly improve or even reverse diabetes completely. Our Western diet -- with its emphasis on high-calorie “convenience” foods -- is one of the main causes of diabetes, and is also to blame for much of this country’s obesity epidemic.

The diabetic patient should aim to consume a diet rich in whole foods, which is plant-based, and is low in fat. Lean meats and dairy products should be consumed in limited quantities, ideally less than four days each week. Processed foods – those items with an ingredient list longer than five items – should be avoided.

In addition to dietary changes, diabetics should incorporate physical activity into their daily lives. Taking the stairs, parking at the far end of the parking lot, and walking on your lunch break all help to burn more calories. Aerobic physical activity increases the body’s sensitivity to insulin, which in turn helps control blood sugar levels. Remember, it is very easy to counteract the benefits of increased physical activity by overeating; it takes an hour on the treadmill to burn off the calories in a 20 oz bottle of non-diet soda! In other words, just because you’re exercising doesn’t mean you should consume more food.

For the patient who chooses not to pursue lifestyle changes, or for patients who are diagnosed at a more advanced stage of their illness, there are many medications a physician may prescribe to help control blood sugar. One of the oldest and most widely used medications is metformin. This is a medication that works in the liver to decrease production of sugar; it also increases the sensitivity of the body’s cells to insulin. Metformin has actually been shown to reduce mortality rates in Type 2 diabetics, as well as reducing progression from pre-diabetes to diabetes.  This medication is usually taken twice daily with meals, and is available in combination with many other anti-diabetic drugs to lower “pill burden.”

There are a number of other commonly prescribed oral medications used to treat diabetes. They typically work at various sites along the gastrointestinal tract to improve the body’s utilization of glucose.  Some newer medications require an injection, but are not insulin; these also work in the gut to increase insulin secretion in response to a meal. Oral medications usually do not require daily blood sugar checks.

If oral medications fail to control blood glucose levels, or if a patient is diagnosed at an advanced stage of diabetes, the physician may choose to begin therapy with insulin. This is a chemical that is naturally produced by the body to help process sugar in the blood. Most guidelines recommend starting with long-acting insulin that is injected once a day at night. These products provide a baseline of blood sugar control over a 24-hour period; the dose can be adjusted every few days to quickly achieve improved blood sugars. If this long-acting insulin fails to control the illness adequately, the provider may add mealtime or bolus insulin. Patients using insulin will need to check their blood sugar one or more times daily.

Dr. Jacqueline Riedel is a Family Medicine physician and a member of the Kennedy Health Alliance. She practices in West Deptford, NJ, and can be reached by calling 856/384-0210.