Treating Diabetes

Eating well-balanced meals and proper portion sizes is important for everyone. In some patients with type 2 diabetes, making the right dietary changes can keep glucose levels stable without the use of medications. Even in people with more advanced diabetes, eating well is important for maintaining good health and keeping your blood sugar levels under control.

There is no specific “diet” for people with diabetes, but there are some guidelines for healthy eating.

• Choose whole-grain starches, which have more vitamins, minerals and fiber than refined grains such as white bread. Some examples of whole-grain starches include whole-wheat pasta and whole-wheat bread.
• Eat plenty of vegetables and three servings of fruit each day (one with each meal).
• Choose low-fat meats and dairy products.
• Limit the amount of fats and sweets in your diet.
• Pay attention to portion sizes. Even healthy foods make you gain weight if you eat too much of them. One serving of meat is three ounces – about the size of the palm of your hands. A serving of vegetables is one cup – about the size of your fist.

Becoming more physically active has several health benefits and can help you control your diabetes better by reducing the amount of glucose (sugar) in your bloodstream and by making your body more responsive to insulin. There are several different ways that you can become more physically active, and you don’t even need to go to a gym or spend a lot of money on exercise equipment.

Some Examples Include

• Take the stairs up and down instead of the elevator
• Get off the bus or subway one stop early and walk
• Jump rope
• Clean out a closet

Benefits of exercise
You may have heard that being more physically active can improve your health, but you may not realize just how many benefits there are. Research has shown that regular physical activity can help you:

• lower your blood glucose and blood pressure
• improve your body’s ability to use insulin
• lower your “bad” cholesterol (LDL cholesterol) and raise your “good” (HDL) cholesterol
• lower your risk for heart disease and stroke
• keep your bones strong
• keep your joints flexible
• help you lose weight
• help you lose body fat
• increase your energy
• increase your strength

Types of exercise
There are several different ways that you can increase your physical activity to improve your health. The three main categories are aerobic exercise, resistance training and stretching.

Aerobic exercise
Aerobic exercises strengthen your heart and lungs by making them work harder. To get the most benefits from aerobic exercise, you should get a total of 30 minutes a day on most days of the week.

Some examples of aerobic exercise include:

• Taking a brisk walk
• Jogging
• Dancing
• Hiking
• Swimming
• Taking an aerobics class
• Playing tennis, basketball or other sports

Resistance training
Resistance training, also called strength training, makes your muscles stronger and even improves your bone strength. Being stronger can make daily activities such as carrying groceries easier and reduces the risk of falls in older people.

Some examples of resistance training include:

• Doing exercises with free weights
• Using weight machines
• Using resistance bands

Stretching
Stretching helps keep your joints flexible and makes it less likely that you’ll feel sore after a workout. There are specific stretching exercises that target specific parts of the body. Doing yoga can also help you improve your flexibility and decrease stress.

How to get started
You should always talk to your doctor or diabetes educator before starting a new exercise program. Ask whether you should change the amount of medication you take before you exercise. If you have diabetes-related complications such as heart disease, kidney disease, eye problems or foot problems, ask if you should take any special precautions.

Safety tips
Regular physical activity helps keep you healthy, but certain exercises can be harmful in some people with diabetes.

People with diabetic eye problems, for example, should avoid strength training exercises that increase blood pressure in the eyes. People with diabetes-related nerve problems might need to limit their walking or other activities that might create blisters on the feet. Physical activity can also cause low glucose (hypoglycemia) in people who take insulin or certain diabetes medications. If your blood glucose is below 100, having a small snack before or during exercise can prevent hypoglycemia.

Again, being physically active can really improve your health. Just make sure you’ve spoken with your doctor or diabetes educator so that your level and type of physical activity is right for you and your unique needs.

For patients with type 2 diabetes, there are a few different types of medications that are taken in pill form. These pills differ by how often one needs to take them – from one to three times a day, as well as how they act within the body. Some of these pills work by stimulating the pancreas to make more insulin. Others lower glucose production from the liver, slow down absorbtion of glucose from the digestive system, or decrease insulin resistance in muscle and fat cells. Often diabetes medications are taken in combination to meet a patient’s particular needs. As with other medications, diabetes medications can cause side effects. It is important that you thoroughly discuss these with your doctor before any medication is prescribed.

There are several different types of diabetes medications that your doctor may prescribe to help you control your glucose levels. The main types are:

• Sulfonylureas (SUL-fah-nil-YOO-ree-ahs) lower blood sugar by stimulating your pancreas to make more insulin.
• Biguanides (by-GWAN-ides) decrease the amount of glucose your liver makes.
• Alpha-glucosidase inhibitors (AL-fa gloo-KOS-ih-dayss in-HIB-it-ers) slow the rate at which your intestines absorb starches.
• Thiazolidinediones (THIGH-ah-ZO-li-deen-DYE-owns) lower your blood sugar by making your body more sensitive to insulin.
• Meglitinides (meh-GLIT-in-ides) lower your blood sugar by stimulating your pancreas to make more insulin.
• Combination oral medicines are two or more of the above drugs in the same pill.
• DPP-4 Inhibitors enhance the body’s own ability to control blood sugar levels.
• GLP-1 Agonist lowers both glucagon and glucose levels
• SGL2 Inhibitors causes glucose to be excreted in the urine

Insulin Injections

People with type 1 diabetes (as well as some people with Type 2 ) must inject insulin regularly to control their glucose levels. The reason insulin can’t be taken in pill form is because, if it were swallowed, the stomach would break it down before it would have a chance to work. For a long time, insulin injections have been done using a needle and syringe, where the patient measured the proper dose. Many people still use needles and syringes, but today patients have several other options to choose from as well. These include:

• Injection pens with pre-measured dosages
• Jet injection devices that use high-pressure air to shoot insulin under the skin
• External pumps that deliver small doses of insulin at regular intervals.
• Your doctor and/or diabetes educator can tell you more about these different methods and help you choose the one that’s right for you.

There are many different types of insulin. They differ by how quickly they start working and how long they continue working. Often, doctors will combine two different types of insulin to achieve the best possible glucose control. Choosing the right insulin regimen is complicated, but your doctor will work with you to find the best combination for you.

These are some types of insulin:

Type of Insulin & Brand Names	Onset	Peak	Duration	Role in Blood Sugar Management
Rapid-Acting
Lispro (Humalog)	15-30 min.	30-90 min	3-5 hours	Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with longer-acting insulin.
Aspart (Novolog)	10-20 min.	40-50 min.	3-5 hours
Glulisine (Apidra)	20-30 min.	30-90 min.	1-2½ hours
Short-Acting
Regular (R) humulin or novolin	30 min. -1 hour	2-5 hours	5-8 hours	Short-acting insulin covers insulin needs for meals eaten within 30-60 minutes.
Velosulin (for use in the insulin pump)	30 min.-1 hour	1-2 hours	2-3 hours
Intermediate-Acting
NPH (N)	1-2 hours	4-12 hours	18-24 hours	Intermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with a rapid- or short-acting type.
Long-Acting
Insulin glargine (Basaglar, Lantus, Toujeo)	1-1½ hour	No peak time. Insulin is delivered at a steady level.	20-24 hours	Long-acting insulin covers insulin needs for about one full day. This type is often combined, when needed, with rapid- or short-acting insulin.
Insulin detemir (Levemir)	1-2 hours	6-8 hours	Up to 24 hours
Ultra-Long-Acting
Insulin degludec (Tresiba) 30-90 min.		No Peak onset.	42 hours	Ultra-Long-Acting insulin provides steady insulin levels for over 24 hours. Injected once daily to provide base insulin levels. May be combined with short-acting insulin to cover meals.
Pre-Mixed*
Humulin 70/30	30 min.	2-4 hours	14-24 hours	These products are generally taken two or three times a day before mealtime.
Novolin 70/30	30 min.	2-12 hours	Up to 24 hours
Novolog 70/30	10-20 min.	1-4 hours	Up to 24 hours
Humulin 50/50	30 min.	2-5 hours	18-24 hours
Humalog mix 75/25	15 min.	30 min.-2½ hours	16-20 hours
*Premixed insulins combine specific amounts of intermediate-acting and short-acting insulin in one bottle or insulin pen. (The numbers following the brand name indicate the percentage of each type of insulin.)