Precautions For Managing Diabetes

Diabetes and Your Diet

slide01-manage-bloodsugarIt’s no secret that diet is essential to managingtype 2 diabetes symptoms. While there is no cure-all diet that is perfect for everyone, dietary choices are important in keeping your blood sugar level in the safe range.

Click through this slideshow to learn about how nuts, fruits, vegetables, carbohydrates, starches, proteins, sugars, fats, and other nutrients and foods can help or hurt high blood sugar(hyperglycemia).

The Basics of Blood Sugar Control

Type 2 diabetes is a condition in which the body doesn’t make enough insulin. This can cause high blood sugar and symptoms such as:

  • fatigue
  • blurred vision
  • increased appetite
  •  thirst
  • urination

The normal blood sugar range for diabetics, as determined by the American Diabetes Association, is between 70 and 130 mg/dL before meals and less than 180 mg/dL a few hours after you began eating. You can use a blood sugar monitor to check your blood glucose levels and adjust your diet or medication accordingly.


Low-Fat Diet

Foods that are high in sodium, saturated fats, cholesterol, and trans fat can elevate your risk for heart disease and stroke. However, that doesn’t mean that you have to avoid all fats. Foods rich in good fats—monounsaturated and polyunsaturated fat—can help lower cholesterol levels, according to the Harvard School of Public Health.

Try replacing the meat on your plate with omega-3 fatty acid-rich cold-water fish such as salmon, mackerel, and herring. Olive oil, avocado, and nuts are also good sources of this nutrient.

Foods to Avoid:

  • red meat
  • bacon
  • processed foods

high-fat dairy products like cheese

Fruits and Vegetables


Balancing carbohydrates, fats, and sugars is integral to a diabetes-friendly diet. While processed and refined carbs are bad for you, whole grains and dietary fiber (good carbs) are beneficial in many ways. Whole grains are rich in fiber and beneficial vitamins and minerals. Dietary fiber helps with digestive health, and helps you feel more satisfied after eating.


Foods to Eat:

  • leafy green vegetables
  • nuts
  • whole grains
  • low-fat dairy products
  • beans and peas
  •  fresh low-sugar fruits (blueberries, raspberries, blackberries, cranberries, pears, cantaloupes, grapefruit, and cherries)

Foods to Avoid: high-sugar fruits like watermelon, pineapple, raisins, apricots, grapes, and oranges.


Starches are another type of food your body converts into blood glucose. They not only provide a source of energy but also vitamins, minerals, and fiber. Whole grain starches are the healthiest because they maximize nutrition and break down into the bloodstream slowly. The National Diabetes Information Clearinghouse recommends at least one serving of starch at every meal.

Foods to Eat: whole grain versions of bread, pasta, cereal, rice, crackers, and tortillas

Foods to Avoid:

  • potato chips
  • packaged snacks
  • candy bars

When to Eat

If you have diabetes, you should eat smaller meals throughout the day to avoid unnecessary spikes in your blood glucose level. However, your body requires more sugars and carbohydrates during exercise, so eat before and after a workout.

Your age, weight, height, level of exercise, and other factors also affect your diet. Monitor and record your blood glucose level in response to food and create your own personal diabetes diet with the help of your doctor or dietitian.


Losing Weight

Losing a few extra pounds will not only help your self-esteem, but also lower blood sugar and cholesterol levels and improve blood pressure.

Regular exercise combined with a diet rich in whole grains, fruits, vegetables, and low-fat dairy products can help you lose. Talk to your doctor about an exercise plan that is safe for you and any other steps you can take to improve your health.


More Diabetes Information

At times, living with type 2 diabetes can seem like a challenge, but sticking to a routine and finding a proper diet are the basics of managing your diabetes. Carefully inspecting the sodium, sugar, and carbohydrate levels in packaged food is also important.

Your doctor, a nutritionist, and a dietitian are all vital members of your diabetes management team. It’s important to track your blood glucose levels in relation to what you eat and your insulin treatment regimen (if you have one).

In time, you’ll get to know how your body responds to different foods at different times of the day.


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Diabetes Without Drugs

If you have type 2 diabetes, you can manage it well without any drugs — without any oral medications and without insulin. If you have type 1 diabetes, you will always have to take insulin injections, but you can likely use less than you do now.

To manage diabetes well means keeping your blood sugar level down in the same range as that of people who don’t have diabetes. The way we check this level is the A1C (sometimes called glycated hemoglobin, hemoglobin A1c, or HbA1c). This test tells you what your average blood sugar level was during the previous two or three months by using a drop of blood about as small as that you use on your regular fingerstick tests that tells you what your level is right then.

When you manage your diabetes well, it is well controlled. It is normal. We know that the normal A1C level is 6.0 or below. See “The Normal A1C Level.”

An A1C level of 6.0 or below means that your diabetes is in remission. It does not mean that you have cured it. If you relax your vigilance, your A1C level will go above 6.0 again, and you will again put yourself at risk of the terrible complications of uncontrolled diabetes.

You can use drugs to bring your A1C level down to normal. That’s a good thing. But this strategy does have its costs, and those costs aren’t just money out of your pocket or your checkbook. The worst of those costs are the potential side effects of the drugs.

imagesAll drugs can have side effects. The systems and the organs of our bodies are so interconnected that no drug can target just one part of it without having some effect elsewhere. Sometimes we find that the side effects are helpful, but we can also find that they are harmful. Sometimes they are subtle and affect only a few people, but sometimes they are serious.

All of the drugs that we take to manage our diabetes are known to or are suspected of having some serious side effects in some people. That’s the price most of us are willing to pay.

But some of us think we have a safer strategy of managing our diabetes without drugs. Back in 2007 I joined this group with the encouragement of a good friend of mine who is a Certified Diabetes Educator. Before that, I had 14 years of experience taking a wide range of diabetes drugs, including two different sulfonylureas (Diaßeta and Amyrl), Glucophage (metformin), and Byetta. For the past six years I haven’t taking any diabetes drugs, and yet I keep my diabetes in control with an A1C level usually about 5.4.

I had to make three big changes in my life when I went off the diabetes drugs, and they are hard at first. But now they are a routine part of my life, and I would never go back to my old ways. The changes that I had to make are those that almost everyone who has diabetes has to make. In order of importance, I had (1) to lose weight, (2) eat fewer carbohydrates, and (3) exercise more.

Any lifestyle changes this fundamental are difficult, first because a body at rest tends to remain at rest, as Sir Isaac Newton proved more than 300 years ago. I wrote here about both the down side and the up side of “Overcoming Exercise Inertia,” but inertia is just as big a factor in losing weight and in eating wisely.

But we have another difficulty at first when we shift our metabolism from getting our energy from carbohydrates to getting it from fats, the only choice we have. A very low-carb diet necessarily means a high-fat diet, and the transition from carb-burning to fat-burning for energy can make us feel weak for a couple of weeks, as I wrote in “It’s Low-Carb Weak.”

Those are hurdles we all have to cross in making the transition to managing our diabetes without drugs. Is it worth the effort?

For me, my answer is an unequivocal yes, and I feel confident that it will be for you, if you are not managing your diabetes well or even if you are managing it well while using a diabetes drug or two or three. The systems of our bodies are so interrelated that when we manage our diabetes well, we get a positive side effect that spills over into our general well-being.

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Diabetes, Type 2 – Treatment

Treating type 2 diabetes

There is no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms to prevent health problems developing later in life.

images (1)


If you have been diagnosed with diabetes, your GP will be able to explain your condition to you in detail and help you to understand your treatment. They will closely monitor your condition to identify any health problems that may occur.

If there are any problems, you may be referred to a hospital-based diabetes care team.

Care standards for diabetes

In treating diabetes, the aim is to help people with the condition control their blood glucose levels and minimise the risk of developing future complications.

The Department of Health has set out national standards for NHS organisations and professionals covering diabetes care and prevention. The diabetes national service framework was developed by diabetes clinical experts and patients with diabetes. Good diabetes care includes:

  • awareness of the risk factors for type 2 diabetes
  • advice and support to help people at risk of type 2 diabetes reduce that risk
  • access to information and appropriate support for people with type 1 and type 2 diabetes, including access to a structured education programme, such as DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) or X-PERT Health.
  • an agreed care plan, helping all people with diabetes to manage their care and lead a healthy lifestyle, including a named contact for their care
  • information, care and support to enable all people with diabetes to optimise their blood glucose level, maintain an acceptable blood pressure and minimise other risk factors for developing complications
  • access to services to identify and treat possible complications, such as screening for diabetic retinopathy and specialised foot care
  • effective care for all people with diabetes admitted to hospital, for whatever reason.

Lifestyle changes

images (2)For many people who are diagnosed with type 2 diabetes, the first approach to treatment is to make lifestyle changes. These include taking regular exercise, eating healthily and losing weight if you are overweight or obese (a body mass index of 30 or over).

This may be enough to keep your blood glucose at a safe and healthy level without the need for other treatment.

Taking medicines

Type 2 diabetes usually gets worse over time. Even if they work at first, diet and exercise may not be enough to control your blood glucose levels.

If you have type 2 diabetes, you may need, or eventually need, medicines that reduce high levels of blood glucose. Initially, this will usually be in the form of tablets, and may sometimes be a combination of more than one type of tablet. It may also include insulin or other medication that you inject.


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Diabetes Sugar Level Chart

chart.news3All diabetics know that maintaining proper blood sugar levels is the lifeline of their disease. Without maintaining this stability, the disease is left to run rampant through the body causing destruction. A diabetes sugar level chart serves as a reference to help keep things in balance.

The chart gives indicators throughout the stages of diabetes, from pre-diabetes to established diagnoses. It serves as a reference for keeping glucose levels in check so that the likelihood of flareups is minimized.

Under normal circumstances, the proper blood sugar level is between 70 and 150 mg/dL. The range takes into effect the difference in individual body composition, the various levels at which glucose is produced, the rate at which sugar is burned, etc. All of these factors make a person’s readingsas individual as they are. Your doctor can determine what range is appropriate for you.

Glucose readings will also fluctuate throughout the day so it is important to maintain readings in intervals. Readings will typically be the lowest in the morning, caused by forced fasting while you sleep. After meals, the levels will begin to rise for several hours as the food is digested. The rate at which it rises, and the level that it reaches, are directly proportionate to the amount of carbs that are ingested.

Checking Blood Sugar Levels

images (1)People with diabetes must maintain a balanced blood sugar level. This can be difficult to do in certain situations, such as traveling. The first step to making sure that your blood sugar levels stay balanced is to talk to your healthcare provider regarding when and how often to check your blood sugar. Most people check anywhere from one to four times each day.

Check at different times of the day

Most health care practitioners will tell you to vary the time that you’re checking your blood sugar so that you have a better idea of what’s going on throughout the day.

When you wake

The first time you check your blood sugar should be in the morning before you eat anything. This is called fasting blood sugar. Make sure that you haven’t had any food for at least eight hours. This will let you know how well your blood sugar is being controlled during the night while you’re asleep.

Before and after meals

You should also check blood sugar levels before and after a meal so that you can see how your body responds to certain foods. Some people will check at 2 AM or 3 AM in the morning to make sure that their insulin dose is adequate.

Before and after exercise

It’s very important to check blood sugar levels before and after exercise because a person’s body can react strongly to physical movement. For instance, people with high blood sugar will often notice a great reduction in their glucose levels following exercise.

Before driving

If your diabetes is not under good control, always check your blood sugar level before you drive a car. This is especially true if you take any medications that can cause low blood sugar. If you feel any symptoms of low blood sugar, you should always check your glucose level.

During illness

Finally, during illness it is very important to check your blood sugar level more often as being sick can cause your glucose levels to rise. Make sure that you always write down your blood sugar results so that you can keep a good track record for your healthcare provider.

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How is Diabetes Managed?

downloadDiabetes is managed by keeping blood sugar under control and as close to normal as possible. For most people with diabetes, a healthy range is between 90 and 130 mg/dl before meals and less than 180 mg/dl at one to two hours after a meal. This is the key to avoiding complications and discomfort. Here are some ways to manage diabetes:

Exercise. Work up to at least 30 minutes a day, most days of the week. Regular physical activity helps to manage diabetes. People with diabetes should talk to their doctor or health care provider before starting any exercise plan. Some good ways to get exercise are to:

  • Take a brisk walk (outside or inside on a treadmill).
  • Go dancing.
  • Take a low-impact aerobics class.
  • Swim or do water aerobic exercises.
  • Ice-skate or roller-skate.
  • Play tennis.
  • Ride a stationary bicycle indoors.

Here are some ideas for being more active everyday:

  • Park the car farther away from your destination.
  • Get on or off the bus several blocks away from your stop.
  • Take the stairs instead of the elevator or escalator.
  • Exercise while watching TV.
  • Walk around while you talk on the phone.
  • Play with the kids.
  • Take the dog for a walk.
  • Take the stairs instead of the elevator or escalator.
  • Get up to change the TV channel instead of using the remote control.
  • Work in the garden or rake leaves.
  • Clean the house.
  • Wash the car.
  • Stretch out your chores. For example, make two trips to take the laundry downstairs instead of one.
  • Park at the far end of the grocery store lot and walk to the store.
  • At work, walk over to see a co-worker instead of calling or emailing.
  • Stretch or walk around instead of taking a coffee break and eating.
  • During your lunch break, walk to the post office or do other errands.

Choose Healthy Food.

images (1)Good nutrition is a very important part of diabetes management. People with diabetes should work with their diabetes healthcare team to develop an eating plan that meets their personal food preferences while keeping blood glucose in a healthy range. By choosing nutritious foods and balancing what and how much you eat with activity level, blood sugar levels can be kept as close to normal as possible. Here are a few tips on making healthy food choices for the entire family.

  • Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to add variety to your meals. Choose more non-starchy vegetables that have lots of vitamins and minerals such as spinach, carrots, broccoli or green beans with meals.
  • Choose whole grain foods instead of processed grain products like white bread, white rice or regular pasta. Try brown rice with your stir-fry or whole wheat spaghetti with your favorite pasta sauce.
  • Include fish in your meals two to three times a week and choose lean meats like chicken and turkey without the skin. To prepare meats and fish with less fat, trim any visible fat and use low-fat cooking methods such as broiling, grilling, roasting, poaching or stir-frying.
  • Include dried beans (like kidney or pinto beans) and lentils in your meals.
  • Choose low fat dairy products such as milk, yogurt and cheese (1 percent fat or less).
  • Choose liquid oils such as canola, olive or peanut oil for cooking, instead of solid fats such as butter, lard and shortening. Remember that all fats are high in calories. If you’re trying to lose weight, cut back on portion sizes of added fats.
  • Choose fruit that is in-season for dessert – you’ll get more flavor and pay less too! Try to cut back on high-calorie dessert and snack foods such as chips, cookies, cakes and ice cream that give you and your family little nutrition.
  • Choose water and calorie-free “diet” drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks.
  • Control your portion sizes. Remember that the amount of food you eat is important in getting to and staying at a healthy weight. Even eating too much healthy food can lead to weight gain.

Take Your Medicine. It is important for people with diabetes to know what medicines they are taking, why they are taking them and how to take them. People with diabetes should tell their doctor or health care provider if they are taking any herbs or other supplements.

Check Blood Sugar. A doctor or health care provider can explain how to test blood sugar and how often it should be checked.

Quit Smoking. The NYS Smoker’s Quitline (1-866-697-8487) provides help to people who want to stop smoking.

A1C Blood Test. This blood test measures the average blood sugar over the last three months. It should be done two to four times a year. An A1C measure of less than 7 percent is the goal.

Blood Pressure. This should be checked at each visit to a doctor or health care provider. A blood pressure reading of less than 130/80 mmHg is the goal.

Cholesterol. A lipid profile blood test should be checked once a year. This includes total cholesterol, triglycerides, LDL and HDL. The total cholesterol should be less than 200 mg/dL, the LDL (known as the bad cholesterol) should be less than 100 mg/dL and the HDL (known as the good cholesterol) should be greater than 40 mg/dL for men and greater than 50 mg/dL for women.

Eye Exam. A dilated eye exam should be done every year by an optometrist or ophthalmologist (an eye doctor who specializes in eye diseases). During a dilated eye exam, eye drops are used to make the pupil (the black part of the eye) bigger. This allows the eye doctor to see the back of the eye. Finding eye problems early and getting treatment right away will help prevent more serious problems later on.

Foot Exam. It is important that people with diabetes take off their shoes and socks at every doctor’s visit and learn how to check their feet daily for cuts, breaks in the skin, or ingrown toenails. The doctor also needs to know if there are any changes in the color or shape of the feet, or if there is any pain or lack of sensation.

Kidney Test. People with diabetes need to have a blood or urine test ordered by their doctor every year to check how well their kidneys are working.

Flu Shot. A flu shot should be given once every year. A doctor or health care provider may also order a pneumonia shot.

Dental Exam. It is important that people with diabetes have their teeth and gums checked every six months.

Coping Skills. People with diabetes may need to talk to their health care team about any feelings, problems or questions they may have. People with diabetes are at higher risk for depression.

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Managing Type 2 Diabetes

Type 2 diabetes can sometimes initially be managed through lifestyle modification including a healthy diet and regular exercise. However, as the disease progresses, people with type 2 diabetes are often prescribed tablets to control their blood glucose levels. These tablets are intended to be used in conjunction with healthy eating and regular physical activity, not as a substitute. Diabetes tablets are not an oral form of insulin and they require insulin to be present in the body to be effective.

Eventually it may be necessary to start taking insulin to control blood glucose levels, when your body is no longer producing enough insulin of its own. Sometimes tablets may be continued in addition to insulin.

The aim of diabetes management is to keep blood glucose levels as close to ‘normal’ as possible, that is between 4 to 6 mmol/L (fasting), as this will help prevent both short-term and long-term complications.

Regular blood glucose monitoring is necessary to see if the treatment being followed is adequately controlling blood glucose levels.

No matter which medication or management plan your doctor prescribes, make sure you follow their instructions. The pattern and frequency will depend on the individual, the tables and your circumstances.

Tablets for Type 2 Diabetes

There are five classes of tablets currently used in Australia for lowering blood glucose levels in type 2 diabetes. These tablets can be taken alone or with a tablet from another group.

Thiazolidinediones (glitazones)
Alpha Glucosidase Inhibitor


This group of insulin tablets helps to lower blood glucose levels by:
  • Reducing the amount of stored glucose released by the liver
  • Slowing the absorption of glucose from the intestine
  • Helping the body to become more sensitive to insulin so that your own insulin works better.


Chemical Name Some Brand Names
Metformin Diabex Diaformin
Diabex XR Formet
Glucohexal Glucomet
Glucophage Genrx metformin

When to take: with meals.

Possible side effects include: nausea, diarrhoea and a metallic taste in the mouth. These can be reduced by taking the tablets with or after a meal. Speak with your doctor if you experience any side effects to find the right solution for you.

Dosage: they should be started at a low dose. Over time, your doctor may need to gradually increase the dose. The dosage may differ for individuals so ONLY take the dosage prescribed by YOUR doctor.

Points to remember:

  • They generally don’t cause weight-gain, and may actually help to lose a few kilos. It is often prescribed as the first diabetes tablet for people with type 2 diabetes.
  • They should not be used by people with severe liver, kidney or heart disease. Metformin may need to be stopped before surgery or procedures that require injecting a radio-opaque dye such as a coronary angiogram. Always check with your doctor.
  • They may need to be combined with the sulphonylurea class of tablets.


This group of insulin tablets stimulates the pancreas to produce more insulin.

Chemical Name Some Brand Names
Gliclazide Diamicron Glyade
Diamicron MR Mellihexal
Nidem Genrx gliclazide
Glibenclamide Daonil Glimel
Glipizide Melizide Minidiab
Glimepiride Amaryl Dimirel

When to take: before with meals.

Possible side effects include: weight gain, skin rashes, gastric upsets, jaundice andhypoglycaemia. Speak with your doctor if you experience any side effects to find the right solution for you.

Dosage: over time, your doctor may need to gradually increase the dose. The dosage may differ for individuals so ONLY take the dosage prescribed by YOUR doctor.

Thiazolidinediones (glitazones)

This group of insulin tablets is also known as glitazones. They help to lower blood glucose levels by increasing the effect of your own insulin, especially on muscle and fat cells i.e. they improve insulin resistance.

Chemical Name Some Brand Names
Rosiglitazone Avandia
Pioglitazone Actos

When to take: they don’t need to be taken with a meal and can be taken once or twice daily at any convenient time.

Possible side effects include: a small weight gain. Fat is moved from areas where it is bad for your health (around the tummy) to other areas such as the top of the thighs, where you still may not want it but it is not as harmful to your health.
Speak with your doctor if you experience any side effects to find the right solution for you.

Dosage: once or twice daily. The dosage may differ for individuals so ONLY take the dosage prescribed by YOUR doctor.


This group of insulin tablets lower blood glucose levels by stimulating the pancreas to release more insulin, although they are not chemically related to the sulphonylureas.

Chemical Name Some Brand Names
Repaglinide Novonorm Prandin

When to take: before a meal

Possible side effects include: low blood glucose level (hypoglycaemia) and possibly gastro upsets and abnormalities of liver function tests. Speak with your doctor if you experience any side effects to find the right solution for you.

Dosage: one to three times daily. The dosage may differ for individuals so ONLY take the dosage prescribed by YOUR doctor.

Not to be taken by: women who are pregnant or breast-feeding.

Points to remember:

  • They are quick acting and don’t last long so a tablet is taken before each meal to stimulate insulin to cope with that meal. They offer flexibility for people with erratic eating patterns, e.g. shift workers.

Alpha Glucosidase Inhibitor

They help to slow down the digestion and absorption of certain dietary carbohydrates in the stomach (intestine). Taken on their own, they don’t cause hypoglycaemia.

Chemical Name Some Brand Names
Acarbose Glucobay Precose

When to take: just before eating.

Possible side effects include: weight loss, flatulence (wind), bloating and diarrhoea. Speak with your doctor if you experience any side effects to find the right solution for you.

Dosage: started at low doses and increased slowly to reduce side effects. The dosage may differ for individuals so ONLY take the dosage prescribed by YOUR doctor.

Not to be taken by: women who are pregnant or breast-feeding

Points to remember:

  • If hypoglycaemia [Link to Hypo page] occurs, due to another diabetes tablet you may be taking, it must be treated with pure glucose such as glucose tablets, gel or Lucozade.


At some stage your doctor may decide to add a second or even a third type of tablet to maintain your blood glucose levels. For example, metformin plus a sulphonylurea is a common combination.

As an alternative to taking two separate tablets there is currently one product that is a metformin and a sulphonylurea (glibenclamide) combined into a single tablet:

Chemical Name Some Brand Names
Metformin/glibenclamide Glucovance


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Treatment Of Diabetes Mellitus

Diabetes mellitus – the most common endocrine disorder – affects more than 25 million people in the U.S., which equates to 7 percent of the population.1,2 While this may not sound like a strikingly high number to some, nurses should emphasize to patients that diabetes is a major cause of heart disease – the No. 1 cause of death in the U.S.

Type 2 diabetes is the most common form of diabetes; the other two forms are type 1 and gestational. It’s believed that with type 2 diabetes, cells become resistant to the effects of insulin, leading to a rise in blood glucose levels.

Obese people have a greater risk of developing type 2 diabetes. Thus, along with the increase in childhood obesity, there also has been a rise in individuals under age 20 with diabetes. In 2010, the number grew close to 2 million.2 Weight reduction and exercise are the first-line treatment for obese patients with diabetes.3

Some lay people refer to diabetes as “sugar diabetes.” While this reference may sound sweet, the complications associated with diabetes are not. Individuals with diabetes have a greater risk of going blind, developing renal failure or neuropathy, or needing a lower-limb amputation. Studies have shown that greater control of blood sugar levels could help prevent potential complications related to diabetes.4

Patient education is key to achieving glycemic control and preventing diabetes-related complications. Nurses should have a strong knowledge base regarding treatment strategies for diabetes and associated risks in order to effectively educate patients and improve clinical outcomes.

If HbA1c levels indicate type 2 diabetes has not been controlled with diet and exercise alone, medications may be added to a patient’s treatment regimen. Although pharmacotherapy for diabetes includes various types of insulin, this article will focus on the oral medications used to treat type 2 diabetes.

Currently, there are six classifications of oral anti-diabetic medications used to manage type 2 diabetes: alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 inhibitors, meglitinides, sulfonylureas and thiazolidinediones. These drugs could help normalize blood glucose levels and decrease diabetes-related complications.

However, these drugs may not be safe to use in some individuals and could cause harmful side effects. Nurses should be knowledgeable regarding the risks and benefits associated with anti-diabetic medications and comfortable with sharing this information with patients.

Alpha-Glucosidase Inhibitors

People with type 2 diabetes may observe that after eating their post-prandial blood sugar level rises significantly. That’s because alpha-glucosidase, an intestinal enzyme, breaks down complex carbohydrates into simple sugars such as glucose. Glucose, a monosaccharide, is then readily absorbed into the blood stream. With insulin resistance, glucose levels are able to rise significantly following a meal.

To help lower post-prandial blood sugar levels, some patients are prescribed alpha-glucosidase inhibitors such as acarbose (Precose) or miglitol (Glyset). Patients take these drugs with the first bite of a meal. This class of drugs delays carbohydrate digestion and decreases the amount of glucose absorbed into the blood stream following a meal. Prior to administering this drug, nurses should confirm patients do not have a history of bowel, renal or liver disease. If the patient does, the prescriber should be notified.

Patients taking alpha-glucosidase inhibitors should be instructed on potential adverse effects. Since this medication doesn’t enhance insulin secretion, it shouldn’t cause hypoglycemia alone. However, it may be combined with a medication like a sulfonylurea that does. Therefore, it is imperative nurses inform patients of the risk for hypoglycemia.

In addition, patients should know if they experience hypoglycemia, glucose gel or tablets are needed to quickly raise their blood sugar. Sucrose or table sugar, a disaccharide, may not work as quickly since the mechanism of alpha-glucosidase inhibitors is to slow the breakdown of this type of carbohydrate.

Besides monitoring blood sugar levels, routine monitoring of serum transaminases (alanine transaminase [ALT] and aspartate transaminase [AST]) is indicated as well. That’s because these drugs could potentially affect the liver. When taking this class of medication, patients may complain of side effects such as stomach pain, diarrhea and bloating even if they follow a diabetic diet. If symptoms are distressing, patients may have to temporarily hold or discontinue the medication. Nurses should stress to patients the importance of keeping their follow-up appointments with healthcare providers.


Nurses may observe many people with type 2 diabetes are taking biguanides. That’s because the American Diabetes Association recommends this drug as a first-line agent when diet and exercise fail to control blood sugar levels.3

The only biguanide available in the U.S. is metformin, which comes in a tablet form (Glucophage) or an oral solution (Riomet). It’s believed metformin lowers blood glucose levels by decreasing hepatic gluconeogenesis and increasing insulin uptake by peripheral tissue. Patients may like that this medication also could improve cholesterol levels and help them lose weight.

Like alpha-glucosidase inhibitors, metformin does not increase insulin secretion. Therefore, it shouldn’t cause hypoglycemia alone. However, when combined with medications that increase insulin secretion, the risk of hypoglycemia is heightened.

Prior to administering metformin, nurses should be aware of potential adverse effects and instruct patients of the same. Patients may verbalize common gastrointestinal complaints such as nausea, bloating and diarrhea. However, more serious side effects such as lactic acidosis could occur.5

Metformin is excreted by the kidneys and patients with renal insufficiency could experience drug accumulation. When drug levels rise, hepatic metabolism of lactate may be impaired; this increases the risk of lactic acidosis. Prior to administration, nurses should be aware of the patient’s creatinine level, and should question patients regarding metformin use prior to surgery or procedures requiring contrast agents. Patients who take metformin have an increased risk of lactic acidosis in the setting of impaired tissue perfusion or with the use of intravenous radiologic contrast agents. Metformin should be stopped for 48 hours following the use of iodinated contrast material.5

In addition, patients should be aware of signs of acidosis such as dizziness, tachycardia, palpitations, nausea, vomiting and hyperventilation, and understand they should seek medical attention if these symptoms occur. The use of alcohol should be avoided when taking metformin.

DPP-4 inhibitors

Dipeptidyl peptidase-4 inhibitors, commonly referred to as DPP-4 inhibitors, are another class of drugs used to improve glycemic control in patients with type 2 diabetes. Drugs in this category include sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta).

In response to food intake, the body’s concentration of incretin hormones increases. Incretin hormones increase the release of insulin from pancreatic beta-cells, which helps lower blood glucose levels. However, incretin hormones are inactivated by DPP-4 enzymes. DPP-4 inhibitors work by slowing the inactivation of incretin hormones. This results in an increased concentration of incretin, which leads to increased glucose-dependent insulin secretion and a reduction in fasting and postprandial serum glucose levels.

Potential adverse effects associated with DPP-4 inhibitors include acute pancreatitis and hypersensitivity reactions.5 Patients should be assessed for abdominal pain and signs of anaphylactic reactions, and instructed to seek medical attention should these adverse effects occur. Nurses should hold the medication if any adverse effects are suspected.

When used alone, DPP-4 inhibitors may not cause hypoglycemia. However, when combined with a sulfonylurea, patients have a greater risk of developing hypoglycemia.


Meglitinides are a class of medications that also help to lower blood sugar in type 2 diabetes. Repaglinide (Prandin) and nateglinide (Starlix) are the only meglitinides available in the U.S. Following a meal, these drugs promote beta-cell secretion of insulin and increase insulin levels. Thus, these drugs could lower glucose levels and result in hypoglycemia.

While the amount of insulin released when meglitinides is used depends on the patient’s glucose level, nurses should still confirm that those taking these drugs can verbalize the signs. To help reduce the risk of hypoglycemia, patients should be instructed to take these medications within 30 minutes of a meal, and if they skip a meal, they should skip this medication as well.5 Patients should be reminded that drinking alcohol or engaging in strenuous physical exercise also could increase their risk of developing hypoglycemia. In addition, they should be instructed to have glucose readily accessible in case they experience signs of hypoglycemia such as dizziness, palpitations, trembling, diaphoresis, nausea or weakness.


Sulfonylureas have been available longer than all the other drug classes mentioned so far. While the first generation of these medications may not be as widely used as the second generation, nurses may find that this class of drugs is commonly prescribed to achieve glycemic control.

First-generation sulfonylureas consist of chlorpropamide (Diabinese), tolbutamide and tolazamide. Second-generation medications include glimepiride (Amaryl), glipizide (Glucotrol) and glyburide (Micronase, DiaBeta and Glynase).

Sulfonylureas increase the endogenous release of insulin. Therefore, these medications can increase a patient’s risk of hypoglycemia and as a result have been termed oral hypoglycemic agents. Since these drugs increase insulin secretion and insulin is lipogenic, this class of medications may contribute to weight gain. Nurses also should note that over time these medications may fail to maintain adequate glucose levels despite drug compliance because of a decline in beta-cell function. This necessitates the addition of a second anti-diabetic agent.

The dose of sulfonylureas may have to be reduced in patients with liver disease. Patients should be instructed to report abdominal discomfort, dark urine or light-colored stools or rash.5 In addition, although the second generation of sulfonylureas could carry less of a risk for causing disulfiram-like (Antabuse) reactions, certain agents like sulfonamides and salicylates could increase this risk. Patients should be instructed to avoid alcohol and inform their healthcare provider if they experience a disulfiram reaction. Symptoms include flushing, dizziness and tachycardia.


The last class of oral anti-diabetic medications, thiazolidinediones consist of pioglitazone (Actos) and rosiglitazone (Avandia). These drugs, also referred to as TZDs, work by improving insulin sensitivity in peripheral tissues. They increase glucose uptake and decrease glucose production by the liver, which helps improve blood glucose levels.

In the past two years, the Food and Drug Administration has added a “black box warning” to each of these medications. Patients should be informed of the increased risk of bladder cancer associated with using Actos for more than 1 year.6 Actos should not be used in patients being treated for bladder cancer. Avandia has been linked to increased risk of heart attacks and strokes, and is no longer available through retail pharmacies. Patients on Avandia now must be enrolled in a special program.6

Although these medications are associated with serious side effects, nurses may still encounter patients taking one of these drugs and they should be prepared to educate them accordingly.

Thiazolidinediones could cause liver complications and worsen heart failure.5 Before administering this medication, nurses should consider the patient’s ALT and AST levels and assess the person’s liver and heart. Patients should be instructed to seek medical attention if they notice signs of liver impairment such as nausea, vomiting, anorexia, dark-colored urine or stomach pain. Patients with heart failure should report any increase in shortness of breath, edema, cough or fatigue.

Risks & Benefits

Nurses should emphasize that dietary adherence and exercise play an important role in achieving glycemic control. However, when blood sugar levels are less than optimal or HbA1c levels are greater than 7 percent in spite of diet and exercise, patients have a greater risk for developing complications such as retinopathy, nephropathy, neuropathy and heart disease. To help reduce the risk of these life-altering complications, medications are available.

Nurses should be aware that although medications could potentially help patients achieve target blood sugar levels, inherent risks come with these drugs as well. To promote favorable outcomes, nurses should be prepared to assess patients’ level of knowledge regarding drug therapy and educate them accordingly so they can reach their targeted HbA1c level safely.

ARTICLE SOURCE: This factual content has not been modified from the source. This content is syndicated news that can be used for your research, and we hope that it can help your productivity. This content is strictly for educational purposes and is not made for any kind of commercial purposes of this blog.

Basic Skills To Learn About Diabetes Management

images (2)Your doctor will help you learn what you need to do every day to help yourself. If you have type 2 diabetes and are overweight, then weight loss may be a major goal of your diabetes therapy. Even a moderate weight loss can improve your ability to use the insulin your body makes.

Here are some of the skills you will need to learn:

Healthy Eating

Design a diabetes meal plan to:

  • Choose healthy foods
  • Select the correct serving sizes
  • Plan when to eat so that you can match your food to your activity

Being Active

Develop an exercise plan so that you can:

  • Stay fit
  • Keep your weight under control
  • Keep your blood glucose in your target range

Blood Glucose Monitoring

images (1)Learn how to use a blood glucose monitor and keep a log of the results so you can:

  • Check your readings on your own to see if your treatment plan is working.
  • See if your values are signaling needed adjustments to your treatment.
  • Recognize when you need to call your doctor for help.

Reducing Risk

You will learn about sick day management and possible complications of diabetes so you can:

  • Understand why diabetes control is so important. Poor blood glucose control increases your risks for heart disease and other diabetes complications.
  • Work with your health care team to keep your blood pressure, cholesterol and blood glucose levels under control.
  • Stop smoking if you are still doing so.

Taking Medication

Your doctor will explain:

  • Why you need to take insulin to keep your diabetes in control.
  • Why your insulin regimen may change over time.
  • Your doctor will help you to select the insulin device that works best for you, and teach you proper injection technique. The BD diabetes website also has animated demonstrations on how to draw and inject insulin, as a refresher to the training you receive from your doctor.

Problem Solving

You will learn how to manage instances of high or low blood glucose by:

  • Making adjustments to your treatment plan
  • Learning how to make temporary changes in your diabetes management for special events in your life

Healthy Coping

You will discover why stress management skills are needed so you can:

  • Learn the coping skills you need to live with diabetes
  • Take best advantage of the support and education provided by your diabetes health care team

Diabetes-related tests and exams

Your doctor will give you a schedule of visits to check your blood glucose levels, cholesterol, blood pressure, weight, feet, kidneys, eyes, and teeth.

You can record your results in the BD Getting Started™ Personal Diabetes Care Card.  Be sure to note how often each test is needed, as directed by your doctor.

ARTICLE SOURCE: This factual content has not been modified from the source. This content is syndicated news that can be used for your research, and we hope that it can help your productivity. This content is strictly for educational purposes and is not made for any kind of commercial purposes of this blog.


The three cornerstones in the treatment of diabetes are food, medications, and activity. Of these three, activity is often a first choice for the person who has diabetes. Moving toward a more physically active life is generally inexpensive, convenient, and easy and usually produces great rewards in terms of blood glucose control and a general feeling of well-being.

Whenever you actively use a muscle, you burn both fatty acids and glucose. During and after periods of activity, your falling glucose level is sensed by the beta cells in your pancreas, and they relax their output of insulin.

This gives your beta cells a break from excessive insulin production. In addition, the lower insulin levels signal your liver to empty its glucose reserves (glycogen) into the blood to supply the muscles with needed energy.

As physical activity continues, the liver converts amino acids, lactic acid, and fats into glucose to supply the muscles. If the activity continues long enough, even the body’s fat cells get in the game. They compensate for the reduced fatty acid levels in your blood by converting their stored triglycerides into fatty acids.

When all of these steps are considered, it’s easy to see why using your muscles is the perfect treatment for diabetes. It lowers blood glucose, lowers fatty acid levels in your blood, and reduces the workload of your pancreas. And, unless you are on a medication that can cause hypoglycemia, physical activity won’t cause your blood glucose level to fall below normal the way some other diabetes treatments may.

In this article, you will learn how exercise can be incorporated into a battle plan for managing diabetes. First, though, you must consider some of the risks, which are outlined in the following section.


Becoming more physically active is not completely without risks for people with diabetes. On the other hand, remaining sedentary is no bargain, either; it does nothing to help your glucose control, your weight management, or your overall well-being. To gain the benefits of increased physical activity and minimize potential risks, you need to understand and evaluate those risks up front and take steps to prevent problems before they occur.


For people with diabetes who take medication or insulin, hypoglycemia is a concern. Whenever you are physically active, your muscles burn glucose. First, they gobble up the glucose they have stored as glycogen. As the activity continues, glucose from the blood pours into the muscles to supply their energy needs, lowering blood glucose levels. However, this march of glucose from the blood into the muscles doesn’t end when the activity stops.

The body needs to refill the muscles’ glucose storage tanks in preparation for future movement. As a result, a hypoglycemic reaction can occur not only during periods of activity but up to 24 hours later. Some people with diabetes who have frequently experienced hypoglycemia begin to associate any form of activity with a loss of glucose control.

For such individuals, a lack of glucose testing may keep them in the dark about how their body reacts to activity. As a result, they are unprepared for the low blood glucose level that can occur when they mow the lawn or when they take a brisk walk through the park. When such a low occurs, they may grab a handful of jelly beans to treat the low, only to find their glucose level skyrocketing as a result. So they take extra insulin or medication at dinner to treat the high, but the blood-glucose roller-coaster ride continues with another low before they go to bed.

These fluctuations create great confusion and frustration, leaving these individuals upset and scared. Activity, they may decide, is not worth the seemingly unpredictable swings in glucose. For such individuals, more frequent blood glucose testing can help them better understand their body’s response to exercise and prepare for it by adjusting medication or food intake.

Heart Disease

Before you increase your activity level, you need to consider the possible presence of heart disease. As you’ve already learned, coronary heart disease is very common in people with diabetes, affecting perhaps as many as 50 percent of them. To assess your risk, you and your doctor need to take into account your age, your blood pressure, your blood fats, whether you have protein in your urine, the length of time you have had diabetes, and your family history.

So before you begin increasing your level of activity, consult your doctor and, if appropriate, have an exercise tolerance test. This test is done on a treadmill and reflects your heart’s ability to work under stress. Your chances of having a positive result, indicating heart disease, increase with each risk factor you have. Even if you are at increased risk or have a positive test, you will likely still be able to increase your physical activity; you will just need to work more closely with your diabetes care team to set safe guidelines for activity and, perhaps, to determine if medications to lower your risk of heart trouble are in order.

Diabetes Complications

Before you increase your activity level, you need to account for any diabetic complications or related conditions that may be present. Some types of activity may not be wise for people with certain medical conditions. Any activity that includes straining, such as weight lifting, can dramatically increase blood pressure during the actual activity, further aggravating any hypertension that is present.

To lessen any potential problems, you need to have your blood pressure well controlled before you start increasing your activity level and especially before beginning an activity that involves straining. Proliferative retinopathy is also aggravated by straining, which increases the pressure within some of the weakened blood vessels of the eyes. Activities that require straining or that involve jarring or rapid head motions may also cause an acute hemorrhage in already weakened eye vessels.

For this reason, it is important to have your eyes examined for signs of retinopathy before starting an exercise program and have them rechecked annually. If you have significant nerve disease in your feet, you may not be able to feel injuries to your feet, the most common of which are blisters. This does not mean you cannot exercise, but it means that you need to have your feet checked by your doctor first and you must observe good foot care at home, including inspecting your feet for sore spots and minor injuries daily.

You’ll also want to get expert advice on proper footwear for the activity and be sure that the footwear you choose is fitted properly to your feet.

Once you’ve factored in the risks, you can actually build your exercise program. That is the focus of our next section.

The Benefits of Being More Active and Should I Have a Stress Test?

Before starting moderate- to high-intensity activity, you should have an exercise stress test if you:

  • Lower blood glucose
  • Lower blood pressure
  • Lower blood fats
  • Better cardiovascular (heart and lung) fitness
  • Weight loss and/or maintenance
  • Improved sense of well-being
  • are older than 35
  • are older than 25 and have had type 2 diabetes for more than 10 years or type 1 for more than 15 years
  • have protein in your urine
  • have high blood pressure
  • have high blood cholesterol
  • have a family history of heart disease

Talk to your doctor about having a stress test if any of the above applies to you.


The following guidelines can help you increase your activity level safely. Be sure to work with your diabetes care team, too, so they can monitor you and provide specialized advice for your specific situation.


First, be screened by your doctor for any possible problems before you start any type of activity. This exam should include a treadmill test for people with diabetes who fit certain criteria, an eye examination for proliferative retinopathy, a urine examination for protein, and a medical evaluation of your feet.

Whatever you choose, make sure the activities are enjoyable for you and take into account your abilities and condition. The activities don’t even have to be “exercises” in the traditional sense, as long as they get you moving. Square dancing, taking your dog on long walks, riding your bike, gardening, and even walking the golf course all count.

Vary them so you don’t get bored and fall prey to easy excuses. Choose some that can be done with others and some that can be done alone; some that can be done indoors, some that can be done outdoors; some that can be done when your schedule is light, and some that can be fit in when you’re strapped for time.

Type of Activity

Once you’ve received your team’s okay for exercise, you need to choose activities that fit your physical condition, lifestyle, and tastes. Many people with diabetes, especially those who have not been physically active for a while, find that easy, low-impact activities such as walking and swimming are perfect

Time, Intensity, and Duration

Begin each exercise session with a five- to ten-minute period of low-intensity warm-up activity (such as marching in place) and gentle stretching. The warm-up will prepare your heart for increased activity. The stretching will help you avoid tendon and muscle problems, which are common in people whose tendons have become brittle after years of high blood glucose levels.

ARTICLE SOURCE: This factual content has not been modified from the source. This content is syndicated news that can be used for your research, and we hope that it can help your productivity. This content is strictly for educational purposes and is not made for any kind of commercial purposes of this blog.

Essential Diabetes Tips For Management




Whether you are newly diagnosed or due for a re-cap on the basics, these 5 essentials of diabetes management help you take a step back and ask yourself whether the basics are being met.

Read up on diabetes

Knowledge is one of the best ways to beat diabetes. Diabetes is able to affect our whole body so there can be a lot to take in and sometimes when we absorb the information in small occasional chunks, it can leave us quite confused.

Thankfully, there are some great books available which break down what we need to know in a really well structured way.

As well as providing a solid foundation for understanding diabetes, books can be a cost effective way to improve our diabetes management.

A quality book on diabetes will often cost no more than a tub of test strips.

Every one with diabetes should aim to get hold of at least one really good book on the subject.

Test and record your blood sugars

Once you have read up on diabetes, the next stage is to take your understanding forward on a personal level – how diabetes affects you.

Testing will not only let you see how you’re doing on a regular basis, but it should also help you understand your diabetes and inform your decision making.

This could include helping to choose a suitable diet, knowing how activity affects you and how stressful days and illness need to be managed.

Furthermore, the more detail you record, the better prepared you will be for doctor’s appointments.

  • Blood glucose levels
  • Free blood glucose diary

Some people, particularly those with type 2 diabetes, have experienced difficulty with being prescribed blood glucose testing strips.

Pick a good diet for your diabetes

A good diet will help in a myriad of ways. It can help improve:

  • Blood sugar levels
  • Improve blood pressure and cholesterol
  • Reduce tiredness
  • Improve digestion and
  • Can significantly improve clarity of thought

Diet can be one of the most confusing aspects for people with diabetes as so much information is contradictory.

Even with the conflicting information out there, there are some common themes that run through, such as eating foods with plenty of fibre and a low glycaemic index.

Vegetables and unsalted nuts fit the criteria well. Fish is a good pick and good quality lean meats are generally well regarded.

ARTICLE SOURCE: This factual content has not been modified from the source. This content is syndicated news that can be used for your research, and we hope that it can help your productivity. This content is strictly for educational purposes and is not made for any kind of commercial purposes of this blog.