Conditions in Depth

This page contains the basic information about Type 2 Diabetes Mellitus .

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Type 2 Diabetes Mellitus

Treatment

In most people with type 2 diabetes, treatment begins with weight reduction through diet and exercise. A healthy diet for a person with diabetes is low in cholesterol, low in total calories, and nutritionally balanced with abundant amounts of whole-grain foods, monounsaturated oils, fruits and vegetables. A daily multivitamin is recommended for most people with diabetes.

Type 2 diabetes can be controlled with medications taken by mouth (oral medications) or injected medicine (usually insulin, although insulin is not the only injected medicine that can be used for diabetes). Medicines for type 2 diabetes include:

• Metformin (Glucophage), which improves insulin resistance in the muscle tissues and liver

• Sulfonylureas, including glyburide (DiaBeta, Glynase, Micronase), glipizide (Glucotrol), and others, which increase the amount of insulin made and released by the pancreas

• Repaglinide (Prandin) and nateglinide (Starlix), which cause a burst of insulin release with each meal

• Acarbose (Precose) and miglitol (Glyset), which delay the absorption of sugars from the intestine

• Exanatide (Byetta) and pramlintide (Symlin), which slow your digestion and reduce your appetite for large meals, making blood sugar more manageable — Exanatide also causes a burst of insulin to be released from your pancreas with each meal. These medicines are both available by injection only.

• Insulin, which adds to your own insulin supply — When you have enough insulin, you can adequately process glucose despite having insulin resistance.

• Thiazolidinediones, including rosiglitazone (Avandia) and pioglitazone (Actos), which decrease the conversion of fat to glucose, and which improve insulin resistance. Due to recent concerns linking one medication in this group to heart disease, drugs from this group are not recommended as a first choice in treatment.

About one of three people with type 2 diabetes use injectable insulin regularly. Insulin often is used in small doses before bed to help to prevent the liver from producing and releasing glucose during sleep. In advanced type 2 diabetes, or for people who want to tightly control glucose levels, insulin may be needed more than once per day and in higher doses. Treatment plans that include very long-acting glargine insulin (Lantus) and very short-acting lispro insulin (Humalog) or aspart insulin (Novolog), are frequently the most successful ways for people with type 2 diabetes to control their blood sugar. To accommodate eating patterns that vary, doses of very short-acting insulin can be adjusted depending on the amount of carbohydrates taken in with each meal.

Medications used to treat type 2 diabetes can have side effects. The major side effects of sulfonylureas, repaglinide, nateglinide and insulin are low blood sugar levels (hypoglycemia) and weight gain. The most common side effects of metformin are nausea and diarrhea, but these are less likely to happen if the drug is taken with meals. Metformin should not be used in people with kidney failure because of the risk of a life-threatening buildup of lactic acid in the blood. Rosiglitazone and pioglitazone frequently cause weight gain and can cause leg swelling or worsen heart failure. They also may cause inflammation of the liver, so liver tests should be monitored. Recently concern has been raised about the possibility that rosiglitazone can increase heart attack risk. Acarbose, which is taken before each meal, can cause excessive gas and bloating, as can other medicines that slow digestion.

Medicines are also available to reduce the risk of complications, or the rate at which complications develop. People with diabetes who have early signs of kidney damage benefit from medicines called ACE inhibitors, including lisinopril (Prinivil, Zestril), enalapril (Vasotec), benazepril (Lotensin) and others, or medicines called angiotensin receptor blockers, including losartan (Cozaar), valsartan (Diovan) and others). These medicines slow the worsening of kidney disease.

All diabetics should consider taking medication to lower their cholesterol, particularly those who have low-density lipoprotein (LDL) cholesterol levels above 100 mg/dL. Cholesterol medicines include statin drugs such as atorvastin (Lipitor), simvastin (Zocor), lovastatin (Mevacor) or pravastatin (Pravachol) and other cholesterol treatments such as gemfibrozil (Lopid) or fenofibrate (TriCor).

Diabetics with blood pressure greater than 130/80 mm/Hg should use medication to control blood pressure if blood pressure can't be improved by exercise and a low-salt diet.

Most people with diabetes benefit from a daily aspirin, which helps to protect against heart attacks.