Type 2 Diabetes

About 16 million Americans live with type 2 diabetes, and about one-third (5 million) are unaware they have it. Type 2 diabetes can develop slowly. Sometimes symptoms are not recognized and blood glucose levels can be higher than normal for a while before it is diagnosed.

Two important aspects of caring for type 2 diabetes are healthy eating and being physically active. In addition, many people need to take one or more oral diabetes medications and/or insulin. While medication can help you manage diabetes, it is no substitute for a healthful diet and regular physical activity. Type 2 Diabetes

INSULIN RESISTANCE AND TYPE 2 DIABETES

Type 2 diabetes develops when the body becomes resistant to insulin and there is a relative lack of insulin being made in the pancreas. Insulin resistance occurs when the body fails to respond properly to the insulin it already makes. Being overweight increases the risk of insulin resistance. Over time, blood glucose levels gradually increase and type 2 diabetes develops.

COMPLICATIONS

Diabetes can lead to a variety of serious health issues and complications if it is not well controlled. Among the most common complications are heart disease and high blood pressure. In fact, many people with type 2 diabetes have heart disease and high blood pressure before they are diagnosed.

GETTING YOUR DIABETES UNDER CONTROL

The most important advice is to take type 2 diabetes seriously from day one. It is critically important that you get and keep your blood glucose (including your A1C), pressure and blood fats (lipids) in optimal target ranges. Talk with your health care provider about what your targets should be. If your current diabetes plan is not helping you hit these targets, make changes in your diabetes plan with your health care provider. Initially, your health care provider may suggest a healthy eating and activity plan to improve your numbers. If these strategies are not successful, your health care provider likely will prescribe an oral diabetes medication. There are several groups of oral diabetes medications. They can be used alone or in combination with one another. Some oral medications also can be used with insulin. One group of medications that is relatively new is called glitazones. what are glitazones?

Glitazones work to make your muscle and fat cells more sensitive to the insulin your pancreas makes. This insulin helps the glucose in your body enter your cells and lower your blood glucose. Glitazones also are known as insulin sensitizers—they enable your body to better use the insulin that your body still makes to lower your blood glucose. Glitazones are available under two brand names, Avandia and Actos.

COULD I GAIN WEIGHT FROM TAKING GLITAZONES?

Yes. Weight gain can occur with several groups of diabetes medications, including glitazones. As the medications bring your blood glucose into better control, you no longer “spill ” glucose, which comes from the calories you consumed, in your urine. This means that your body is making better use of the calories you eat. That’s good—as long as you remember to reduce the amount of food you eat. If you don’t, you will gain weight. Edema, or swelling, can also occur because the medication, in helping to get your blood glucose under better control, is redistributing weight throughout your body. Improved blood glucose control means that your diabetes medication is working.

TIPS WHEN TAKING A GLITAZONE:

Take medications as prescribed. If you have questions about how to take the medications, ask your health care provider or your Walgreens pharmacist.

If you experience any side effects with glitazones, such as weight gain or fluid retention, call your health care provider.

If you begin to gain weight, ask your health care provider about how many pounds are safe to gain.

If your health care provider prescribes a glitazone, make sure he or she knows if you have a history of fluid retention, swelling or heart failure. If you have not had these conditions, but you start to have fluid retention, swelling or shortness of breath, contact your health care provider immediately.

Be patient. Glitazones can take several weeks to have their full impact on lowering your blood glucose.

Ask your health care provider or Walgreens pharmacist to refer you to a dietitian or a diabetes education program so you can learn more about type 2 diabetes.

NEXT, FOLLOW THESE STEPS TO DEVELOP A HEALTHY EATING PLAN:

• Weigh and measure your food portions at least once a week. This will help you control your portions.
• Eat meals at home as often as possible and keep restaurant meals to a minimum.
• Eat three square meals a day. This may help reduce nibbling. Eat snacks only if you have more than four to five hours between meals or feel you can better control your appetite and food intake with more snacks.
• Keep as many unhealthy foods as possible out of the house.
• Eat at least five servings of fruits and vegetables a day. These are low in calories, provide lots of nutrients and keep you full.
• Weigh yourself once per week, on the same day each week and at the same time of day. This will help you keep track of your weight and catch any weight gain early.

Type 2 diabetes can lead to severe health complications if you don’t keep it under control. It is important that you take control of your diabetes with healthy eating habits, by being physically active and by taking the diabetes medications that work best for you. Experts agree that the most important goal to ensure your long-term health is to control your blood glucose, pressure and lipids. To reach this goal, you may have to learn to tolerate a small amount of weight gain, but you will benefit from greater overall health.

Message from JDRF

People with diabetes often suffer devastating complications, including nephropathy (kidney failure), retinopathy (vision impairment or blindness), neuropathy (nerve damage) and heart disease. The growing prevalence of diabetes makes for heavy financial burdens. The annual cost is estimated at more than $100 billion in the United States alone, accounting for 25 percent of all Medicare expenditures. The majority of these costs are for managing complications and for treatment.

In addition to its strong focus on moving promising treatments out of the lab and into human clinical trials, the Juvenile Diabetes Research Foundation has investigated ways to ensure that people with diabetes are monitored for complications from the moment they are diagnosed. Early intervention is vital in the effort to delay or prevent diabetes-related complications. For example, diabetic retinopathy can be effectively treated and its progression slowed or halted in its early stages, but many people with diabetes do not have routine eye examinations until retinopathy has silently progressed and caused serious damage. Reducing the impact of complications requires continued breakthroughs both in research and in medical practice. Among the important recent developments in diabetes complications treatment and prevention are:

A drug for preventing complications

A JDRF-funded research team at Albert Einstein College of Medicine in New York reported it has found a drug that may prove effective at combating many complications. Benfotiamine, which is related to vitamin B1, was found to block three major biological “triggers ” that contribute to complications. As the first drug with such multi-blocking capabilities, benfotiamine could have a significant impact in both type 1 and type 2 diabetes. The drug is now being tested in clinical trials with people who have diabetes.

A drug for Preventing Kidney damage

JDRF-funded clinical studies have revealed that a drug called ruboxystaurine may block diabetic nerve, eye and kidney complications. The drug is known as a PKC inhibitor because it hinders an enzyme, PKC, that leads to the kind of blood vessel damage associated with diabetes complications.

FDA-approveD “Intelligent “ insulin pumps Glucose meters and, more recently, insulin pumps have become staples in daily diabetes management. Now, the two can work together. Recently, the Food and Drug Administration approved the first device that integrates a glucose meter and an insulin pump with a dose calculator. The product combines Medtronic MiniMed’s Paradigm insulin pump with a BD glucose monitor and automates data interchange between the two. The patient checks glucose levels by putting blood on a test strip and inserting it into the monitor. The glucose level is sent by signal from the monitor to the pump, which then recommends insulin dosage. Use of the integrated system is the first step toward an “artificial pancreas “ that can sense blood glucose levels and supply the correct insulin dose without input from the user. JDRF is committed to furthering this important technological research.

Study shows injection works equally well before or after children eat meals As the importance of tight blood glucose control in preventing complications has become increasingly clear, demand has grown for insulin preparations that act more like the body’s naturally secreted insulin. Insulin “analogs “ (preparations that mimic naturally secreted insulin) show great promise, but their effectiveness and safety must be established through clinical trials. Some analogs are long-acting to provide stability over lengthy periods, while others are short-acting to counteract the brief but significant rise in blood glucose following a meal. A new study shows that injecting a rapid-acting insulin analog after a meal works just as well at controlling blood sugar in children as injections before a meal. The finding, reported in the journal Diabetes Care, could help children with type 1 diabetes better regulate their blood glucose because their meals are often unpredictable in composition and size.