You have been diagnosed with type 2 diabetes. Type II Diabetes contributes in a large way to kidney disease, eye damage, blood vessel damage that leads to high blood pressure, heart disease and stroke; nerve damage that can result in long term pain, as well as other multiple medical problems. If you already smoke, have high blood pressure, heart disease, or previous stroke, you are at increased risk for even more problems if you do not appropriately treat your diabetes.
Many people wonder where they “get” diabetes.
Diabetes can happen because of genetics (you inherited the problem from your family genes), or if the pancreas has been damaged from infection or trauma. Some drugs can cause diabetes, as well. Diabetes can also be caused by or made worse by misuse of the body (poor lifestyle habits such as obesity, alcohol consumption, poor diet). Most type II Diabetics also have obesity, and there is emerging research that says the diabetes causes the obesity, and NOT the other way around as previously thought. Most people develop the disease after the age of 30.
What happens in the body of a diabetic?
In a diabetic, either the body stops making enough of its own insulin, or the body becomes resistant to using its own insulin. Insulin helps glucose get from the blood stream into the cell. When insulin is impaired, glucose levels in the blood stream rise to levels that are too high for the body. These high levels cause damage to nerves and blood vessels in the body, especially areas of the kidney, eyes, arteries , veins, and nerves. The diabetic person may not ever know these problems are happening until it is too late to correct the damage. That is why it is so important to keep the blood sugar at the correct level. Diabetes is a silent disease until it is too late! Once a diabetic’s kidneys have been damaged, it’s too late to reverse the problem!
Treatment of diabetes is aimed at lowering the blood glucose levels to healthy levels.
Below is a list of the medications that are widely used in this practice to treat diabetes. You can see there are many types of medicines and each one has some special considerations.
Drug Special Considerations Dosage Drug Classification Metformin First line drug of Choice for
Most Type II Diabetics
***Free from PUBLIX***
250-1000 mg twice daily Biguanide Glipizide Good for Lean Individuals 2.5-20 mg in divided doses Sulfonylurea Januvia Stop using if using GLP 1 Agonists 100 mg daily DPP-4 Inhibitors Acarbose Mild fasting, postprandial 25-100 mg three times daily Alpha-Glucosidase
Helps Lose Weight- injection 5-10 migrograms twice a day Incretin Mimetic
GLP 1 Agonists
Insulin Used if 2 other drugs together don’t don’t work well enough.
No treatment is complete without an evaluation of the effectiveness of the treatment.
You will be given follow up appointments regularly until your glucose levels are correct. This may be weekly, monthly, or more often, simply based on your response to the medications.
Once you are responding well to the treatment, you will be seen every three months.
You may be asked to keep a blood sugar log on a daily basis. You will be given a separate sheet
about that testing if it is necessary. Most type II diabetics no longer regularly test with finger sticks.
A list of tests that will be regularly performed are:
Test Name Goal How often: Long term glucose control:
<6.5 Every 3 months
This test will tell on you if you haven’t been managing your sugars!
Normal Levels Every 3 months if previously abnormal Finger stick Fasting Glucose <110 When wakening for the day before eating. Finger stick 2 hours after a meal <140 2 hours after a meal.
*When first diagnosed, you will check a few meals a day.
*Once on the right medicine, you may check this less often
Thyroid – TSH and T4 levels Normal Levels Once a year Cholesterol –
Checked initially, then if abnormal, checked after 6 weeks and again every 3 months if on medicines for cholesterol. Urine for albumin:creatinine ratio <30 If elevated, 2 collections in a 3-6 month period Electrocardiogram Normal Once a year or more often depending on risk factors
It is also necessary for you to have an eye exam by an ophthalmologist to test for eye vessel damage. You may be referred to a podiatrist if you can’t care for your feet on your own, or if you develop nerve damage from diabetes.
You will be given the opportunity to attend diabetic teaching either here at DPC or at Brunswick Hospital. If after 3 months, you are unable to achieve your blood sugar goals, you will be offered a dietician’s services.
Many diabetics would like dietary suggestions. The following is an example of a day’s diet. Notice Carbohydrates are 60-70% of the diet and proteins are 15-20%. Fats should be kept to a minimum, and use artificial sweeteners to sweeten your foods if needed.
**Many type II Diabetics can improve their diabetes by eating 250-500 fewer calories than what they were previously eating before being diagnosed. Losing 10% of the body weight can often reverse the disease process for most type II diabetics. We can help you lose weight here at Darien Primary Care, in a special program designed to help people with diabetes. For more a more complete diet, ask to be seen for diabetic weight management.
Examples of how to lower calories:
Meal Time Carbohydrates Protein Fats 08:00 Breakfast 2 Pieces Toast or
1 Cup oatmeal with milk
1 egg Canola Margarine
Coffee with Artificial Sweetener
10:00 a.m. snack 1 Apple or other fruit 1 Cup skim milk 12:00 Lunch 1 C Wheat Pasta
1 serving Chicken Low Fat Italian Dressing 2:30 p.m. snack 3 graham crackers 1T Peanut Butter Unsweet tea with Artificial sweetener 5:00 Dinner 1 Sweet Potato
½ C Brown Rice
1 Pork Chop Canola Margarine, Artificial Sweetener, cinnamon 8:00 p.m. snack 3 Low Salt Crackers Cheese