Managing Type 2 Diabetes

The management of Type 2 diabetic is a lifelong process. It involves a combination of several approaches all requiring the cooperation of the patient and the physician’s dedication. The outcome largely dependent on how well these approaches to management are executed. The goal is to offer symptomatic relief and prevent or slow emergence of complications such as diabetic nephropathy, retinopathy and neuropathy.

The initial step in management involves finding out if an individual is diabetic or not, and if diabetic, whether its Type 1 or Type 2 diabetes. In both forms of the disease patients will present with the classic triad of excessive thirst, increased frequency of passing large amounts of dilute urine and unexplained weight loss. Other symptoms might be present too. In most cases the Type 1 diabetic will be a young lean patient while the Type 2 one will be an older obese patient. A physical exam is then performed. One tailored for diabetes will check for any signs of complications. Such could be visual disturbances, integrity of the circulation in the peripheries, abnormal blood pressures and any other signs that might point towards a complication.

The physician might then do some diagnostic tests on the patients. This is aimed at confirming the clinical diagnosis and determining the severity of disease. An important component of these investigations pertains to estimation of blood sugar levels. Various parameters are used. These are fasting plasma glucose (FPG), 2-hour plasma glucose and a random plasma glucose. The level of glycated hemoglobin is determined too. According to the American Diabetes Association a diagnosis of diabetes requires; glycated hemoglobin at 6.5 per cent or higher, a fasting plasma glucose of 126 mg/dL or higher, a 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher and a random plasma glucose of 200mg/dl.  More tests may be performed in an attempt to individualize patient care.

A multidisciplinary approach is required in caring for diabetic patients . This care involves goal setting, dietary modifications and exercise, regular monitoring for complications, appropriate self-monitoring of blood glucose and regular lab testing. Keeping the blood glucose levels near the normal reference range should form part of the objectives. However, this should not take center stage. Sometimes aggressive measures to lower the blood sugar may be detrimental to the cardiovascular system.

Unlike in the past where exercise and diet modifications was the mainstay of treatment, the use of several medications has become more common nowadays. Metformin is among the popular drugs for use in Type 2 diabetes. This drug can be used as a single agent or in combination with other classes of drugs. It usually reduces the production of glucose from the liver, reduces the absorption of glucose in the gut and is thought to increase tissue sensitivity to insulin. It has been known to cause gastrointestinal distress and lactic acidosis among other side effects. Management of complications as they arise is an important aspect too.

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