Foods And Beverages To Limit
If youve been diagnosed with type 2 diabetes, or even if youre trying to avoid diabetes and manage your weight, there are certain foods and beverages that you should limit if possible. These include:
- foods heavy in saturated or trans fats
- refined baked goods
- sugary drinks
While no one food, enjoyed every so often, should knock you off your healthy path, its a good idea to talk with your doctor about dietary restrictions based on your blood sugar levels. Some people may need to monitor their glucose more carefully than others after eating these foods.
What Are The First Symptoms Of Type 2 Diabetes
Many people with type 2 diabetes do not experience any symptoms at first and it may go undiagnosed for years. If they do have symptoms, these may include:
- being very thirsty
- having cuts that heal slowly
Over time, diabetes can lead to complications, which can then cause other symptoms.
Blood glucose testing is important for detecting pre-diabetes and type 2 diabetes before complications arise.
Do I Have Other Treatment Options For My Diabetes
When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an artificial pancreas and pancreatic islet transplantation for some people with type 1 diabetes.
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Are You Sick Or Stressed
Understand what happens when youre sick, stressed, or fatigued.
Any sort of stress will make you less sensitive to insulin. If you are sick or stressed or exceptionally fatigued, you will release more glucose counter-regulatory hormone. As a result, the exercise may have less of a glucose-lowering effect.
How To Titrate Insulin Dosage And Monitor Progress
A major feature of this regimen is that insulin is added to existing treatment. Glycaemic control should therefore improve immediately and for practical purposes, should not deteriorate. This means that the dose of insulin can be increased relatively slowly, minimising the risk of hypoglycaemia. As described originally, the regimen2 increased the insulin dosage by 4 units a day if the fasting blood glucose exceeded 8 mmol/L on three consecutive days and by 2 units a day if it exceeded 6 mmol/L. We tend to do it slightly slower and adjust insulin dosage according to these glucose thresholds every 1-2 weeks. The slower pace helps to gain the patients confidence and reduces the risk of hypoglycaemia. This titration regimen is of course not cast in stone and there are ongoing trials that are exploring the best options.
After 2-3 months, the patient is likely to be on about 30 units of insulin each day and maximum oral drug therapy. Measuring the HbA1c concentration after this interval helps to quantify the new level of glycaemic control and further increases in insulin dosage can be made accordingly. There is generally a reduction in HbA1c of about 2% and an increase in body weight of several kilograms. If these changes are not evident, one should consider the possibility that the patient has not been taking the insulin regularly or someone unfamiliar with the regimen has reduced or stopped one or more of the oral hypoglycaemic drugs.
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Your Treatment Needs Can Change
Over time, your condition and treatment needs can change. If youve found it difficult to manage your blood sugar with lifestyle changes and other medications, your doctor might prescribe insulin. Following their recommended treatment plan can help you manage your condition and lower your risk of complications.
Signs And Symptoms Of Type 2 Diabetes
The symptoms of type 2 diabetes can be so mild that you don’t notice them. About 8 million people who have it don’t know it. Symptoms include:
- Being very thirsty
- Weight loss without trying
- Getting more infections
If you have dark rashes around your neck or armpits, see your doctor. These are called acanthosis nigricans, and they can be signs that your body is becoming resistant to insulin.
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Why You May Need To Take Insulin
What impacts your need for insulin differs from person-to-person, Dr. Levy says. So, its important to understand what places you at-risk for diabetes complications. The higher your risk, the more you may potentially need to include insulin in your treatment plan. These risk factors include:
But if you dont fall into one of these risk groups, there may be ways that you can avoid taking insulin with certain lifestyle modifications.
Initiating Appropriate Insulin Therapy
The American College of Endocrinology and the American Association of Clinical Endocrinologists recommend initiation of insulin therapy in patients with type 2 diabetes and an initial A1C level greater than 9 percent, or if the diabetes is uncontrolled despite optimal oral glycemic therapy. 11 Insulin may be used alone or in combination with oral medications, such as metformin . This recommendation is based on expert opinion, and not on the results of randomized controlled trials comparing different approaches in patients with an initial A1C level greater than 9 percent.
In the U.K. Prospective Diabetes Study, early intensive glucose control starting with a sulfonylurea, then metformin, then insulin was associated with a 25 percent reduction in microvascular complications and a 12 percent risk reduction in any diabetes-related end point, but was not associated with a reduction in all-cause mortality. 5 A subgroup of patients randomized to intensive therapy with metformin alone had a 36 percent reduction in all-cause mortality. 12 This supports current ADA guidelines that recommend using metformin as first-line pharmacologic therapy however, additional therapies need to be added if diabetes is not controlled with metformin alone.
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Analogue Versus Human Insulin
Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing a type of insulin. In general, analogue insulin is similar to human insulin in controlling diabetes, although some trials have found higher mean A1C levels in patients taking analogue insulin compared with human insulin. 17 Analogue insulin usually causes less postprandial hyperglycemia and delayed hypoglycemia. 18,19 In a recent meta-analysis, glycemic control was not improved with analogue insulin compared with human insulin, but nocturnal hypoglycemia was reduced.17
An industry-funded cost-effectiveness analysis found that the increased cost of medication is more than off set by the reduction in hypoglycemic events. 20 However, the analysis assumed a cost differential of 14 percent, which is inconsistent with current pricing . 20,21 Cost-effectiveness analyses have differed regarding the long-term cost savings of using analogue insulin in patients with type 2 diabetes, with industry-sponsored studies finding reduced cost22 and government-sponsored studies finding no cost reduction. 23 Measures of adherence and quality of life have been improved with analogue insulin compared with human insulin. 24,25
What To Do With The Oral Drugs
The patient is asked to remain on all the oral hypoglycaemic drugs that they are currently taking. The only exceptions are:
- if the patient is taking supra-maximal doses of any of the oral drugs, they are reduced to what is recommended in the product information
- if the patient is suffering from the gastrointestinal adverse effects of metformin, it is reduced to a dose which is tolerated
- if the patient is taking three oral hypoglycaemic drugs including acarbose, the acarbose is stopped as its adverse effects usually outweigh its advantage.
Although the oral drugs have ‘failed’ in the situation of ‘secondary failure’, they are still exerting considerable hypoglycaemic effects. Clinical studies have shown that if either the sulfonylurea or metformin are stopped altogether, then each needs to be replaced by an extra 20-30 units of daily insulin. In other words, the insulin dosage would need to exceed about 60 units a day before improvement in glycaemic control could occur. This would require a more aggressive insulin regimen and titration, making the process of starting insulin much more difficult. If a thiazolidinedione has been used, this could be continued initially at least, as it may also contribute an insulin sparing effect.
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When Should I See My Doctor
If you have any of the symptoms above, you should make an appointment with your doctor to discuss them since they might indicate undiagnosed type 2 diabetes.
Your doctor will look at your symptoms, review any risk factors you have for type 2 diabetes and they will recommend you be tested if needed.
Even if you dont have symptoms, all Australians should be screened for type 2 diabetes, every 3 years, starting at 40 years of age. Aboriginal and Torres Strait Islander peoples should start screening at age 18. Your GP should carry out this screening. It may involve reviewing your risk factors only, or you may need a blood test.
Video provided by Diabetes Victoria.
Type 2 diabetes can also affect your mental health and can make you more vulnerable to anxiety or depression. SANE Australia and Diabetes Australia have produced a guide to good mental health for people affected by diabetes.
Who Gets Type 2 Diabetes
What makes people more likely to develop type 2 diabetes? No one knows for sure. But experts have a few ideas about what puts a person at greater risk:
- Most people who have type 2 diabetes are overweight.
- People with family members who have diabetes get diabetes more often.
- People who are older than 10 are more likely to develop type 2 diabetes than younger kids.
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What Happens If You Avoid Taking Your Insulin
If you have type 1 diabetes, taking insulin is essential and you cannot live without it. If you avoid taking it, your blood sugar levels can become too high and you risk developing diabetic ketoacidosis . If left untreated, DKA could be life-threatening. Thats why its important to make sure you take your insulin.
If you have type 2 diabetes and use insulin to treat your condition, you should continue to take it as prescribed. If you avoid taking it, your blood sugar levels could become too high and you may become ill. Please speak to your healthcare professional if you have any questions or concerns about taking your insulin.
Insulin is a treatment that helps manage blood sugars, so this also reduces the risk of serious long-term complications as well a shorter-term consequences. Its still important to keep going to your appointments and manage your condition with healthy lifestyle choices. Staying active and eating a healthy diet will reduce the risk of complications from your diabetes, but insulin is also an important part of your treatment.
How Should Insulin Therapy Be Intensified
The available options for additional insulin injections include a second injection of basal insulin, prandial insulin before one or more meals, or a switch to biphasic insulin. The choice between intensification of basal insulin versus the introduction of prandial or biphasic insulin should be individualized based on patients diurnal blood glucose profiles. When considering the profiles obtained with NPH insulin or long-acting insulin analog once daily, the effect appears to wane during the day, even in patients starting insulin therapy, i.e., with remaining endogenous insulin secretion . These patients could benefit from adding a second injection of basal insulin . However, in the context of declining endogenous insulin secretion, daytime hyperglycemia is usually related to elevated postprandial glucose levels, favoring the initiation of prandial or biphasic insulin.
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How Much Insulin And At What Time
For practical purposes, the patient can always be commenced on 10 units of intermediate-acting insulin, given just before bedtime and as late as possible. This timing allows the insulin to exert its maximum action just before dawn rather than at 2-3 a.m. when it is most likely to cause hypoglycaemia. If the patient is very nervous or reluctant and it is imperative to minimise the risk of hypoglycaemia, however small, then a slightly lower dosage can be used to get the process underway and to gain the patient’s confidence. Patients who have symptoms of hyperglycaemia can start at a higher dose of insulin, but this would rarely need to exceed 20-25 units.
The bedtime dose of insulin is best given as isophane insulin. Currently in Australia, there is only one brand of human isophane insulin available. When it becomes generally available, insulin glargine will probably become the basal insulin of choice as its ‘flatter’ and longer action make it more suitable for this purpose.3
What Causes Type 2 Diabetes
Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy. If you have type 2 diabetes, cells dont respond normally to insulin this is called insulin resistance. Your pancreas makes more insulin to try to get cells to respond. Eventually your pancreas cant keep up, and your blood sugar rises, setting the stage for prediabetes and type 2 diabetes. High blood sugar is damaging to the body and can cause other serious health problems, such as heart disease, vision loss, and kidney disease.
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How Is Type 2 Diabetes Managed
Theres no cure for Type 2 diabetes. But you can manage the condition by maintaining a healthy lifestyle and taking medication if needed. Work with your healthcare provider to manage your:
- Blood sugar: A blood glucose meter or continuous glucose monitoring can help you meet your blood sugar target. Your healthcare provider may also recommend regular A1c tests, oral medications , insulin therapy or injectable non-insulin diabetes medications.
- Blood pressure: Lower your blood pressure by not smoking, exercising regularly and eating a healthy diet. Your healthcare provider may recommend blood pressure medication such as beta blockers or ACE inhibitors.
- Cholesterol: Follow a meal plan low in saturated fats, trans fat, salt and sugar. Your healthcare provider may recommend statins, which are a type of drug to lower cholesterol.
Insulin For Type 2 Diabetes
If you have type 2 diabetes and your doctor thinks insulin can help you, it doesnt mean you now have type 1 diabetes. You still have type 2 diabetes, but you’ve changed treatment.
If you have type 2 diabetes, you may not need to use insulin straight away. But some people have very high blood sugar levels when they are first diagnosed. Insulin can be used as a short-term treatment to help quickly bring down your blood sugar levels.
Some people may need to take insulin for a particular reason, like during pregnancy or a severe illness, or after surgery. But you may also need to start it as a treatment if other medications havent helped managed your blood sugar levels or are not appropriate for you.
If you need insulin it isnt your fault and it doesnt mean you havent managed your diabetes well. It’s simply another medication that can help to keep you as healthy as possible. Managing blood sugars effectively is really important in reducing your risk of future diabetes complications and insulin may be the most appropriate treatment choice for you. Many people with type 2 diabetes need to use it as treatment at some point.
Its still important to keep going to your appointments and manage your condition with healthy lifestyle choices. Staying active and eating a healthy diet will reduce the risk of complications from your diabetes.
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Heres How You Can Get Started:
- Work with your doctor to determine what level of physical activity you should engage in
- Figure out how much time per day you can devote to exercise
- Set fitness goalshaving clear goals can help you stay motivated
- Consider where youll start working outthe gym, in your neighborhood, in a park?
- Build different activities into your daily routine
- Start slowly and allow for recovery time
- Keep track of what you do and stay focused on your goals
- Listen to your body
When To Stop Oral Hypoglycaemic Agents
Sometimes patients develop frequent daytime hypoglycaemia on combined treatment. When this happens, the sulfonylurea dosage should be reduced or ceased if necessary. Apart from this and in the absence of contraindications , there is no good evidence that oral hypoglycaemic drugs must be stopped at any stage and our policy is to continue them while glycaemic control remains satisfactory. Most diabetes specialists would support the continuation of metformin indefinitely, because it increases insulin sensitivity. Others advocate stopping the sulfonylurea after insulin treatment is established, an attitude based more on philosophy than real need. Some patients may wish to reduce the number of tablets they take especially when they are already on multiple medications for blood pressure and lipid control. There is nothing wrong with reducing one or more of the oral hypoglycaemic drugs once they are established on insulin therapy, as long as it is recognised that the dose of insulin needs to go up, by an average of 20-30 units per day for each withdrawn drug, to maintain the same degree of glycaemic control.
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Is Your Blood Sugar Unexpectedly High Following Exercise
When the blood sugar is unexpectedly high after exercise, think about why. Generally, exercise will lower your blood sugar. If the post- exercise blood sugar reading is unexpectedly high, you may need to consider if your blood sugar dropped so low during the activity that your body re-regulated itself by releasing counter-regulatory hormones. If so, the subsequent rebound can cause a high blood sugar reading. Other considerations might be overestimating the impact of the exercise, engaging in a stressful kind of exercise and eating too much carbohydrate beforehand.