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FOR PATIENTS WITH TYPE 2 DIABETES WHEN DIET & EXERCISE FAIL
In the early stages, Type 2 patients typically achieve normal glucose level through a modification of lifestyle and eating habits. In the event that this is unsuccessful - the following step-by-step process is followed.
TYPE 2 DIABETES TREATMENT FLOW
- Begin monotherapy with an oral agent
- Increase dose of monotherapy until recommended dose is maximised
- If monotherapy does not achieve glycaemic control, a second oral agent is added and the pattern is repeated
- Insulin is added, as a last resort, if glucose control is not achieved with maximum doses of diabetes oral medications
Typically, each of these steps should be tried for four to six weeks before moving to the next one. During this period, elevated blood glucose levels can be harmful and should be monitored and treated. However, for some individuals, non-pharmacologic interventions sufficiently maintain good glycaemic control. In the early stages, patients with Type 2 diabetes may be able to maintain adequate glucose control through diet, exercise, and modest weight loss.
You might also consider putting your patients through nutrition counselling courses, teaching them how to recognise, count, and modify their daily carbohydrate intake. Along with these lessons, you can educate your patients on diet for diabetics: eating low-fat, well-balanced meals that stimulate modest weight loss. Mild to moderate exercise is also encouraged for almost everyone.
USE OF INSULIN IN DIABETES TYPE 2 TREATMENT
Due to the chronic and progressive nature of Type 2 diabetes, some patients eventually require external insulin, which may be prescribed alone or in combination with other diabetes oral medications. Although it is a successful treatment for diabetes Type 2, the use of insulin to achieve sufficient glycaemic control is recommended for patients with difficulties to maintain their blood glucose.
1American Diabetes Association. Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers. Clin Diabetes 2016;34(1):3-21.
2Reznik Y, Cohen O, Aronson R et al. Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomized open‐label controlled trial. Lancet 2014;384:1265–1272.
3Aronson R, Reznik Y, Conget I et al.; OpT2mise Study Group. Sustained efficacy of insulin pump therapy compared with multiple daily injections, in type 2 diabetes: 12-month data from the OpT2mise randomized trial. Diabetes Obes Metab 2016 Feb 8. doi: 10.1111/dom.12642. [Epub ahead of print]
4WHO Fact Sheets #138 and #312: http://www.who.int/mediacentre/factsheets/fs138/en/http://www.who.int/mediacentre/factsheets/fs312/en/.