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Treatments and drugs

By Mayo Clinic staff

Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. A pancreas transplant may be an option for select people.

But no matter what type of diabetes you have, maintaining a healthy diet, exercising and keeping a healthy weight are all keys to managing your diabetes.

Treatments for all types of diabetes
An important part of managing all types of diabetes includes maintaining a healthy weight through a healthy diet and exercise plan:

  • Healthy eating. Contrary to popular perception, there's no diabetes diet. You won't be restricted to boring, bland foods. Instead, you'll need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your meal plan.

    Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. Once you've covered the basics, remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.

  • Physical activity. Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by transporting sugar to your cells, where it's used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes or more of aerobic exercise most days of the week. If you haven't been active for a while, start slowly and build up gradually.

Treatments for type 1 and type 2 diabetes
Treatment for type 1 and type 2 diabetes primarily involves monitoring of your blood sugar along with insulin, other diabetes medications or both.

  • Monitoring your blood sugar. Depending on your treatment plan, you may check and record your blood sugar level several times a week to several times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

    Even if you eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to things like food, physical activity, medications, illness, alcohol, stress and — for women — fluctuations in hormone levels.

    In addition to daily blood sugar monitoring, your doctor may recommend regular A1C testing to measure your average blood sugar level for the past two to three months. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan. Your target A1C goal may vary depending on your age and various other factors. However, for most people, the American Diabetes Association recommends an A1C of below 7 percent. Ask your doctor what your A1C target is.

  • Insulin. Anyone who has type 1 diabetes needs insulin therapy to survive. Some people with type 2 diabetes need insulin, as well. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Often, insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.

    An insulin pump also may be an option. The pump is a device about the size of a cell phone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

    Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

  • Oral or other medications. Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells. Still others block the action of stomach enzymes that break down carbohydrates or make your tissues more sensitive to insulin. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease.
  • Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. Other types of transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy. But pancreas transplants aren't always successful — and the procedure poses serious risks. You'd need a lifetime of potent immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection, organ injury and cancer. Because the side effects can be more dangerous than the diabetes, pancreas transplants are usually reserved for people whose diabetes can't be controlled or those who have serious complications.

Treatment for gestational diabetes
Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin.

Your health care provider will also monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin — which can lead to low blood sugar right after birth.

Treatment for prediabetes
If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help.

Sometimes medications — such as the oral diabetes drugs metformin (Glucophage) and acarbose (Precose) — also are an option if you're at high risk of diabetes. This includes if your prediabetes is worsening or you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.

In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease. Healthy lifestyle choices remain key, however.

Lifestyle and home remedies Tests and diagnosis
References
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  2. Collazo-Clavell ML, ed. The Essential Diabetes Guide. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2008.
  3. Diagnosis and management of type 2 diabetes mellitus in adults. Bloomington, Minn.: Institute for Clinical Systems Improvement. http://www.icsi.org/diabetes_mellitus__type_2/management_of_type_2_diabetes_mellitus__9.html. Accessed Jan. 1, 2009.
  4. Gastroparesis: What you should know. American Academy of Family Physicians. www.aafp.org/afp/20080615/1703ph.html. Accessed Jan. 1, 2009.
  5. McCulloch DK. Overview of medical care in adults with diabetes mellitus. http://www.uptodate.com/home/index.html. Accessed Jan. 1, 2009.
  6. Your guide to diabetes: Type 1 and type 2. National Diabetes Information Clearinghouse. http://diabetes.niddk.nih.gov/dm/pubs/type1and2/YourGuide2Diabetes.pdf. Accessed Jan. 1, 2009.
  7. Diabetes in pregnancy. March of Dimes. http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=6&page_id=12648448&query=gestational+diabetes&hiword=DIABETIC+GESTATION+GESTATIONS+diabetes+gestational+. Accessed Jan. 29, 2009.
  8. Gestational diabetes. American Diabetes Association. http://www.diabetes.org/gestational-diabetes.jsp. Accessed Jan. 1, 2009.
  9. Am I at risk for type 2 diabetes? National Diabetes Information Clearinghouse. http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/risk.pdf. Accessed Jan. 1, 2009.
  10. Eisenbarth GS, et al. Type 1 diabetes mellitus. In: Kronenberg HM, et al. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/115481400-2/0/1555/195.html#4-u1.0-B978-1-4160-2911-3..50033-9--p1391. Accessed Jan. 1, 2009.
  11. Diabetes and pregnancy. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp051.cfm. Accessed Jan. 1, 2009.
  12. Managing gestational diabetes. National Institute of Child Health and Human Development. http://www.nichd.nih.gov/publications/pubs/gest_diabetes/. Accessed Jan. 1, 2009.
  13. Am I at risk for gestational diabetes? National Institute of Child Health and Human Development. http://www.nichd.nih.gov/publications/pubs/upload/gest_diabetes_risk_2005.pdf. Accessed Jan. 1, 2009.
  14. Diabetes. In: Williams Obstetrics. 22nd ed. New York, N.Y.: McGraw-Hill; 2005. http://www.accessmedicine.com/content.. aspx?aID=738493. Accessed Jan. 1, 2009.
  15. Pancreas transplantation. American Diabetes Association. http://www.diabetes.org/type-1-diabetes/pancreas-transplants.jsp. Accessed Jan. 1, 2009.
  16. Other diabetes medications. American Diabetes Association. http://www.diabetes.org/type-2-diabetes/oral-medications.jsp. Accessed Jan. 1, 2009.
  17. Tetanus disease in-short (Lockjaw). Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/tetanus/in-short-both.htm. Accessed Jan. 1, 2009.
  18. Smoking. American Diabetes Association. http://www.diabetes.org/type-1-diabetes/smoking.jsp. Accessed Jan. 1, 2009.
  19. Eye complications. American Diabetes Association. http://www.diabetes.org/type-2-diabetes/eye-complications.jsp. Accessed Jan. 6, 2009.
  20. Saller A, et al. Diabetes and osteoporosis. Aging Clinical and Experimental Research. 2008;20:280.
  21. American College of Endocrinology: Task Force on Prediabetes. American College of Endocrinology consensus statement on the diagnosis and management of pre-diabetes in the continuum of hyperglycemia - When do the risks of diabetes begin? http://www.aace.com/meetings/consensus/hyperglycemia/hyperglycemia.pdf. Accessed Jan. 9, 2009.
  22. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1.

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June 13, 2009

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