Healthy Eating For Type 2 Diabetes
A dietitian or your doctor will be able to advise you on what to eat to meet your nutritional needs and control your blood sugar. Your doctor should be able to refer you to a registered dietitian for personalised advice.
Eating healthy foods with a low glycaemic index can help to optimise your blood sugar levels. This includes wholegrain breads, minimally processed breakfast cereals like rolled or steel cut oats, legumes, fruit, pasta and dairy products.
Avoid high-carbohydrate, low-nutrient foods such as cakes, lollies and soft drinks, and eat a diet low in saturated fat.
You should eat at regular times of the day and may also need snacks. Try to match the amount of food you eat with the amount of activity you do, so that you dont put on weight.
If you are overweight or obese, losing even 5-10 per cent of your body weight can significantly improve blood sugar control.
Initiation Titration And Follow
The initial dosage of insulin is individualized based on the patient’s insulin sensitivity. Insulin therapy may be started with a set dosage, such as 10 units of glargine daily, or by using weight-based equations. Equations to estimate augmentation, replacement, carbohydrate ratio, and correction therapy are listed in Table 2. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal and 50 percent as bolus, divided up before breakfast, lunch, and dinner. For example, a 120-kg patient requiring basal-bolus and correction insulin would need 36 units of basal insulin 12 units of short-acting insulin before each meal and, for correction, 1 unit of a short-acting insulin for every 25 mg per dL above the set glucose target.
American Diabetes Association Blood Glucose and A1C Goals for Patients with Diabetes Mellitus
90 to 130 mg per dL
60 to 100 mg per dL
Postprandial blood glucose
< 180 mg per dL
100 to 130 mg per dL
< 7.0 percent
< 6.0 percent
note: Recent studies have found no cardiovascular benefit with A1C targets of 6.0 or 6.5 percent compared with targets between 7.0 and 8.0 percent. Some microvascular benefit has been associated with A1C targets of 6.0 or 6.5 percent.
Adapted with permission from American Diabetes Association. Standards of medical care in diabetes2010 . Diabetes Care. 2010 33:S11S61.
American Diabetes Association Blood Glucose and A1C Goals for Patients with Diabetes Mellitus
Monitor Your Blood Glucose Levels
Testing your blood glucose levels at home gives you useful information to monitor the effects of insulin on your blood glucose levels. Every time you measure your blood glucose, record your blood results in a diabetes diary. Some blood glucose meters may record your blood glucose levels automatically. Your diary can also help you keep track of events, such as if you had a hypo or low blood glucose, and help to decide how well you are reaching your treatment goals. When you first start insulin, you need to test your blood glucose at least 3 to 4 times a day, but once you have found the insulin dose that bests suits you, you can test less often. Read more about blood glucose testing.
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The Future Of Insulin
More insulin advances are percolating. There will be new insulins that act even faster. Improvements will be made in the open-loop pumps currently on the market, and efforts continue to develop the so-called artificial pancreas, or closed-loop system that promises, with several different models, to control blood sugar without the person having to do all the thinking.
Work also progresses on alternate ways to take insulin. The second generation of inhaled insulin is on the way with the FDA’s approval of Afrezza in 2014. Investigation is ongoing for delivering insulin buccally — via the tongue, throat, and cheeks — or through a skin patch.
While the progress on new insulin products and delivery systems is encouraging, don’t delay starting insulin if your health care provider and your diabetes health status indicate you need it now. The insulin available today is safe and relatively easy to take, and injections are nearly painless. Plus, starting to take insulin sooner rather than later may improve your health quickly and make your life better for many years to come.
Type 2 Diabetes Insulin & Weight Gain
Weight gain is a predictable side effect of insulin shots for type 2 diabetes. Insulin is so efficient at enhancing glucose entry into the cells that the cells often take up more glucose than is needed for energy. Excess glucose is converted to fat and stored in your body.
This is particularly problematic if you are heavy to begin with, as most people with type 2 diabetes are. Insulin causes even more weight gain, which makes blood sugar control all the harder. Doctors usually respond by increasing the insulin dose, which in turn drives weight and blood sugar higher still. Before long, patients are taking an obscene amount of insulin and dont have a prayer of controlling their ballooning weight.
Patients are often chastised for not staying on their diets or exercising. Yet, their doctors never seem to consider the clear links between increasing weight and insulin use. I had one patient who gained 100 pounds in 10 years after starting insulin, as his dose was gradually increased to 100 units per day. I stopped his insulin immediately and started him on a diet, exercise, weight loss, and supplement program. It took him a few years, but he lost all that weight and never went back on insulin or any other diabetic medication.
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Throwing Away Your Needles And Lancets
Sharps bins and needle clippers are the safest way of disposing of your insulin needles and your lancets. A needle clipper removes the needle from your insulin pen, and is useful when youre out and about. How you get rid of your sharps bin depends on where you live. Your healthcare team should have information to help you get rid of your bin.
Does Type 1 Diabetes Affect Your Driving Licence
If you have more than one severe hypo while awake in 12 months you must stop driving and tell the DVLA. Your licence will be revoked but you can apply again after three months. See your healthcare team to get their advice on your diabetes treatment and management to cut down the risk of this happening again.
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Understanding Type 2 Diabetes
Symptoms, treatment, and complications from type 2 diabetes may vary from person to person. The following information will help you learn more about this disease and provide you with helpful tools, assessments and resources.
If left untreated or improperly managed, diabetes can lead to a variety of life-threatening complications.
Insulin And Type 1 Diabetes
In type 1 diabetes, the body produces insufficient insulin to regulate blood glucose levels.
Without the presence of insulin, many of the bodys cells cannot take glucose from the blood and therefore the body uses other sources of energy.
Ketones are produced by the liver as an alternative source of energy, however, high levels of the ketones can lead to a dangerous condition called ketoacidosis.
People with type 1 diabetes will need to inject insulin to compensate for their bodys lack of insulin.
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Ways To Lower Your Odds For Needing Insulin
Before people start on insulin therapy, you may be asked to engage in changing your lifestyle. Intensive lifestyle interventions can prevent those with pre-diabetes from developing full blown type 2 diabetes by 58%, according to a clinical trial of over 5,000 people published in Diabetes Care. Lifestyle interventions include eating healthier, exercising, losing weight, getting emotional support, and sleeping well. But its a very hard thing for many to commit to exercise and diet in a very strict way, Dr. Levy says.
Whether youre taking oral medications or insulin, lifestyle modifications can help manage your blood sugar levels, Dr. Levy says. Heres what works:
Medication changes arent always possible for someone with mental health issues, such as schizophrenia. We have many, many options to treat blood sugars. But it could be that they finally found the right drug for their psychiatric disorder. So, we will work around it, Dr. Levy says.
Even after making serious lifestyle changes, your body can still need insulin to function properly. That doesnt mean youve failed or that youre not trying hard enough.
Diabetes is a progressive disease. We know that insulin-producing beta cells fail over time. Even for people who eat perfectly, take their medicine, and whove lost weight. They may still need insulin injections. It doesnt mean theyve done anything wrong. Its just the nature of diabetes, Hinnen says.
Growing Evidence For Insulin Therapy
As noted above, a commonly accepted view is that type 2 diabetes develops when insulin secretion can no longer compensate for the underlying metabolic disturbance. As secretory capacity progressively declines with time , it is understood that most people with type 2 diabetes will eventually require insulin therapy. Increasing use of therapies to protect against cardiovascular disease is extending the life of people with diabetes , and consequently more people will come to need insulin therapy. Diagnosis at a younger age will also extend the time of active treatment of diabetes. The effect of use of insulin in type 2 diabetes from the time of diagnosis has been evaluated in clinical trials, notably the UK Prospective Diabetes Study and Outcome Reduction With Initial Glargine Intervention . UKPDS showed that early and continued glucose control can reduce microvascular complications and, in the long-term, improve cardiovascular prognosis . The beneficial effect of insulin therapy is further supported by studies in type 1 diabetes where it is apparent that if insulin therapy is used effectively to induce early glycemic control, both micro- and macrovascular protection is achieved . Although it is acknowledged that achieving HbA1c< 53 mmol/mol is a difficult task, improvement of glycemic control with insulin is associated with improved patient well-being even if the HbA1c target is not achieved .
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Insulin Is A Treatment Of Last Resort
Although some people exhaust all possible diabetes treatments before resorting to insulin, this may not be the best strategy. By the time a person with type 2 starts insulin therapy, they likely already have diabetes-related complication because of poor blood sugar control, Dr. Crandall says. Because high blood sugar is so toxic and can up the risk of heart attack, stroke, and other problems, you shouldnt waste too much time undergoing treatments that arent getting your blood sugar under control.In fact, starting insulin sooner may avoid complications, cause oral medications to work better , or allow you to use a less-complicated insulin regimen for a longer period of time.
Checking Your Blood Sugar Levels
Checking your blood sugar levels is an important part of managing your diabetes, so well take you through how to check them and what your readings mean.
And weve also got more information about what happens your blood sugar levels get too low, called a hypo, or too high, called a hyper, so that youre aware of the signs and symptoms to look out for.
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How To Choose The Right Method For Injecting Insulin
Both syringes and insulin pens use a small needle to inject insulin into your body. There are pros and cons to each, and which one you ultimately end up with will depend on your lifestyle and your doctors advice.
Things to know about insulin syringes:
- They come in a few different sizes.
- Your doctor will tell you how much insulin you need per dose.
- You will usually draw the insulin into the syringe when you need it.
- Theyre not as discreet as an insulin pen.
Things to know about insulin pens:
- Some pens use cartridges that are manually inserted into the pen.
- Other pens are prefilled and thrown away after all the insulin is used.
- Needles in pens are often smaller than those in syringes.
- Not all types of insulin can be used with a pen.
- Pens can be more expensive than syringes and are sometimes not covered by insurance.
How Do I Take And Adjust My Insulin Doses
It is important to learn the different methods of taking insulin and what kinds of insulin can be delivered through each method. There are several ways to take insulin syringe, pen, pump, or inhalation though injection with a syringe is currently the most common for people with type 2 diabetes. There are many apps that can help you calculate your insulin doses.
Your insulin regimen should be tailored to fit your needs and lifestyle. Adjusting your basal insulin dosage and timing will require conversations and frequent follow-up with your healthcare team. When initiating insulin therapy, you may be advised to start with a low dose and increase the dose in small amounts once or twice a week, based on your fasting glucose levels. People with diabetes should aim to spend as much time as possible with glucose levels between 70-180 mg/dl. Insulin may be used alone or in combination with oral glucose-lowering medications, such as metformin, SGLT-2 inhibitors, or GLP-1 agonists.
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When Should Insulin Therapy Be Started
Indications for insulin therapy and when to begin it are poorly defined in guidelines and still subject to individual judgment based on a wide range of opinion . Personal beliefs and experience, familiarity with the use of the different insulin preparations and delivery systems, individual preference, patient needle phobia, concern about chronic hyperinsulinemia, risk of hypoglycemia, and difficulties in controlling body weight are some of the many considerations regarding insulin therapy . Each one of these factors can be weighted differently between doctors and between people with diabetes. The expert group proposed that one way to rationalize the approach to insulin treatment could be to consider some clinical scenarios. These could be as follows: 1) the time of diagnosis or early thereafter 2) in the presence of other emerging medical conditions and 3) in the course of routine ambulatory diabetes management.
What Causes Type 2 Diabetes
The exact cause of type 2 diabetes is not known. However, risk factors for developing type 2 diabetes include:
- family history of type 2 diabetes
- being overweight or obese, especially with excess weight around the waist
- a low level of physical activity
- poor diet
- for women having polycystic ovarian syndrome
- for women having had a baby weighing over 4.5kg
Certain groups of people are more likely to get type 2 diabetes, including:
- Aboriginal and Torres Strait Islander people
- people with Pacific Islander, Southern European or Asian backgrounds
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Why Do I Need To Take Insulin
All people who have type 1 diabetes and some people who have type 2 diabetes need to take insulin to help control their blood sugar levels. The goal of taking insulin is to keep your blood sugar level in a normal range as much as possible. Keeping blood sugar in check helps you stay healthy. Insulin cant be taken by mouth. It is usually taken by injection . It can also be taken using an insulin pen or an insulin pump.
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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Managing Diabetes With Insulin
Injections of insulin can help manage both types of diabetes. The injected insulin acts as a replacement for, or a supplement to, your bodys natural insulin.
People living with type 1 diabetes cant make insulin, so they must inject insulin to control their blood glucose levels.
Many people living with type 2 diabetes can manage their blood glucose levels with lifestyle changes and oral medication. However, if these treatments dont help control glucose levels, people living with type 2 diabetes may also need supplemental insulin.
How Can I Keep My Blood Sugar Level From Getting Too High Or Too Low
You need to check your blood sugar level regularly using a blood glucose monitor. Your doctor or his or her office staff can teach you how to use the monitor. Youll need to write down each measurement and show this record to your doctor. He or she will use this information to decide how much insulin is right for you.
Blood sugar measurements can vary depending on your lifestyle. Stress levels, how often you exercise, and how fast your body absorbs food can affect measurements. Hormonal changes related to puberty, menstrual cycles, and pregnancy can, too. Illness, traveling, or a change in your routine may mean that you have to monitor your blood sugar level more often.
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Know The Signs Of Hypoglycaemia
Hypoglycaemia or low blood glucose occurs when your blood glucose level is less than 4 mmol/l, or where symptoms of hypoglycaemia are experienced at a level close to this. Hypoglycaemia can happen quickly so its a good idea for you and your whnau to know what symptoms to look out for, such as:
- blurred vision
- pale, sweaty skin
Its a good idea to carry something sugary with you in case your blood glucose levels start getting low. Jellybeans are a good, quick source of sugar. Read more about hypoglycemia.