Your treatment

Treating type 2 diabetes

Type 2 diabetes is a progressive disease. Over time, your pancreas will produce less and less insulin. In order to keep good control of blood sugar as your diabetes progresses, treatment needs to keep pace with your need for proper control.


For this reason, the initial strategy your doctor recommends for you will change over time. The usual sequence of steps is described below.

The step-wise approach to treatment


What are the steps?

* In the early stages, you may be able to keep your blood sugar under good control simply by eating and exercising healthily

* Once diet and exercise are no longer enough to maintain good sugar control, your doctor will recommend starting an anti-diabetic drug. This will help maintain good blood sugar levels for a while, but if high blood sugar becomes a problem again, you will need more than one drug

* Eventually, many people need to inject insulin in addition to or instead of their oral medicine.

How long will you spend on each step?

It depends on how long each treatment step is able to control your blood sugar. This varies for each person, so comparing yourself to other people with diabetes is not very helpful.

Your diabetes care team will discuss the options with you when you need to move onto the next step, and will help you make the move to new steps.


The role of diet

Many people find that, over time, diet alone becomes insufficient to maintain really good control. But diet remains hugely important even when you move to the next step in treatment.

Eating healthily throughout your life increases the length of time when each treatment step is able to control your blood sugar. Controlling your weight to stay within a healthy target range also gives your body the best chance of staying on each step for as long as possible.

Learning about a healthy diet

The best way to learn how to eat healthily for your diabetes is to know where to look for help. Your diabetes care team will provide you with plenty of information and support, and you may be referred to a specialist in this field – a dietician – who can help you plan a diet that’s right for you.

Drugs used to treat diabetes

There are many different drugs that can be used to treat type 2 diabetes. They are called by a whole range of names, such as:

* Anti-diabetic agents

* Oral hypoglycaemics

* OHAs (oral hypoglycaemic agents).


Confusing as they may sound, all these terms mean the same thing. Here, we will use the term ‘ADAs’, which is simple and short.

What are the ADAs (Anti-diabetic agents)

There are several different families of ADAs and the names of some of these are complicated, but each describes a drug or group of drugs that act to lower blood glucose in a way unique to that family. The main families of ADA are:
  • The sulphonylureas (SUs)
  • Meglitinide analogues
  • The biguanides
  • The insulin sensitisers (or thiazolidinediones)
  • The alpha-glucosidase inhibitors
  • The prandial glucose regulators
  • The DDP-4 inhibilors
  • The GLP-1 agonists

How do the ADAs work?

The different families of ADAs all work in slightly different ways to one other. The one thing they have in common is that they all compensate in some way for the body’s inability to make and use enough insulin.

  • Some ADAs stimulate the pancreas to make more insulin
  • Some ADAs reduce the amount of glucose produced by the liver
  • Some ADAs increase the sensitivity of the body tissues to insulin
  • Some ADAs slow down absorption of glucose from the gut.
If taken in excess, some of the ADAs can make you hypoglycaemic.

Insulins in Type 2 diabetes – when are they needed?

In cases where ADAs can no longer control blood sugar, it may be necessary to add insulin, or change therapy to insulin alone.

If you are in this situation, your doctor will discuss this decision with you. Your diabetes care team will explain all about using insulin and will help you make the change to your new type of therapy.

During periods when your body is under stress, such as during prolonged illness, an operation or pregnancy, your oral medication may need to be temporarily substituted with insulin. Again, this is not a decision that you need to make on your own. The doctor in charge of your care will discuss it with you, and help you adjust, should the need arise.

Treating type 2 diabetes: A summary

* Type 2 diabetes is a progressive disease

* In the early stages, diet and exercise may be enough to control your diabetes

* When extra help is needed to control blood sugar, anti-diabetic medication can be started

* Anti-diabetic agents (ADAs) all lower blood glucose in different ways

* Many people with type diabetes need to have insulin injections once the anti diabetic agents do not provide the control needed.

 

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  INS/032/0809

Last updated: August 2009